EAR NOSE & THROAT Abstracts

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?

2011-09-30T16:54:00.000+03:00

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?

Influence of lipoproteins and fibrinogen on pathogenesis of sudden sensorineural hearing loss

2011-04-28T18:47:00.000+03:00

T he Journal of Laryngology & Otology (2011), 125: 258-261
Copyright © JLO (1984) Limited 2010
Z Oreskovic^a1, D Shejbal^a2, G Bicanic^a3 ^c1 and B Kekic^a4

^a1Department of Anesthesiology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia

^a2Department of Otorhinolaryngology, City Hospital Pakrac, Zagreb, Croatia

^a3University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia

^a4University Clinic for Otorhinolaryngology, Sestre Milosrdnice Clinical Hospital, Zagreb, Croatia

Abstract

Aim: To evaluate the relationship between lipoproteins, fibrinogen and sudden sensorineural hearing loss in a Croatian population. Since pathological derangement of lipoproteins and fibrinogen could be one of the causes of sudden sensorineural hearing loss, we hypothesised that patients with sudden sensorineural hearing loss would have more abnormal fibrinogen and lipoprotein concentrations, compared with subjects with normal hearing.

Methods: Plasma concentrations of cholesterol, fibrinogen and triglycerides in patients with sudden sensorineural hearing loss were compared with those in a control group (i.e. subjects with normal hearing function).

Results: Patients with sudden sensorineural hearing loss had significantly higher plasma concentrations of cholesterol and low density lipoprotein cholesterol, compared with controls.

Conclusion: Higher cholesterol and low density lipoprotein cholesterol concentrations were found in patients with sudden sensorineural hearing loss, within a Croatian population. Cholesterol and low density lipoprotein cholesterol concentrations may be important factors in the pathogenesis of sudden sensorineural hearing loss, and should be assessed during the investigation of patients with this condition.

(Accepted June 15 2010)

(Online publication November 05 2010)

Correspondence:

^c1 Address for correspondence: Dr Goran Bicanic, University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Salata 6-7, 10000 Zagreb, Croatia Fax: +385 1 4818810 E-mail: gbic@mef.hr

Footnotes

Dr G Bicanic takes responsibility for the integrity of the content of the paper

Competing interests: None declared

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

2011-04-27T21:01:00.000+03:00

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

Omalizumab: Anti-IgE Therapy in Allergy

2011-01-21T10:25:00.000+03:00

Current Allergy and Asthma Reports (Jan 2011)

Kopp MV

Omalizumab is a humanized, monoclonal anti-IgE antibody that binds specifically to circulating IgE molecules, thus interrupting the allergic cascade. Omalizumab has been shown to be highly effective in treating children and adults with moderate to severe allergic asthma. Beyond this indication, the mode of action itself suggests that omalizumab is not only an antiasthmatic drug but also a promising therapeutic option for various allergic conditions, including allergic rhinitis, food allergy, urticaria, allergic bronchopulmonary aspergillosis, insect hypersensitivity, and atopic dermatitis. However, data from double-blind, placebo-controlled clinical trials are only available for allergic rhinitis and moderate to severe bronchial asthma. The aim of this review is to discuss the current clinical data as well as possible further indications of omalizumab treatment

Vocal cord dysfunction: what do we know?

2011-01-21T07:07:00.000+03:00

European Respiratory Journal 37 (1), 194-200 (Jan 2011)

Kenn K, Balkissoon R

Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial. The essential pathophysiology is that of a hyperfunctional laryngeal reflex to protect the lower airway as a result of any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux and/or psychological conditions. Laryngoscopic demonstration of the paradoxical motion while wheezing or stridorous is considered the diagnostic gold standard. Speech therapy, including the use of special relaxed-throat breathing patterns is effective for VCD that is purely of the functional nature. Knowledge of the clinical features of VCD and identifying factors that may be contributing to the development of VCD can provide adequate clues to the correct diagnosis and management.

Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults

2011-01-14T08:39:00.000+03:00

Journal of Allergy and Clinical Immunology (JACI) 127 (1), 72-80.e2 (Jan 2011)

Nelson HS, Nolte H, Creticos P, Maloney J, Wu J, Bernstein DI

BACKGROUND Immunotherapy for allergic rhinoconjunctivitis (ARC) in North America is generally administered subcutaneously, but alternative formulations might be safer and more convenient. Trials of sublingual formulations in North America are needed to confirm European efficacy and safety data.

OBJECTIVEWe sought to investigate the efficacy and safety of timothy grass allergy immunotherapy tablet (AIT) treatment in North American subjects with ARC.

METHODS Four hundred thirty-nine adults with grass pollen-induced ARC with or without asthma were randomized to once-daily 2,800 bioequivalent allergen units of standardized grass AIT (oral lyophilisate, Phleum pratense, 75,000 standardized quality tablet, containing approximately 15 μg of Phl p 5) or placebo approximately 16 weeks before the 2009 grass pollen season (GPS). The primary end point was the average total combined score of the daily symptom score and the daily medication score during the GPS. Rhinoconjunctivitis Quality of Life Questionnaire with standardized activities (RQLQ[S]) scores, Phl p 5-specific IgG4 levels, and IgE-blocking factor levels were additional end points. Adverse events (AEs) were monitored for safety.

RESULTS Relative to placebo, grass AIT treatment improved total combined scores by 20% (P = .005), daily symptom scores by 18% (P = .02), and RQLQ(S) scores by 17% (P = .02). Daily medication scores were improved by 26% and trended toward significance (P = .08). Phl p 5-specific IgG4 and IgE-blocking factor levels were higher after grass AIT treatment compared with those after placebo at the end of the GPS (P <.001). Grass AIT treatment was safe and well tolerated. The majority of AEs were transient mild local reactions with no investigator-diagnosed grass AIT-related serious AEs or reports of anaphylactic shock/respiratory compromise. In the grass AIT group, 1 subject received epinephrine after experiencing a possible grade 1 systemic reaction (local site reactions, chest discomfort, and rash).

CONCLUSIONS Timothy grass AIT treatment (cross-reactive with related Pooideae grasses) was demonstrated to be effective, generally safe, and well tolerated in North American adults with grass pollen-induced ARC.

Effectiveness criteria for the topical application of glucocorticosteroids to the treatment of exudative otitis media associated with allergic rhinitis

2011-01-07T11:19:00.000+03:00

Vestnik Otorinolaringologii (5), 32-34 (2010)

Poliakova SD, Popova EA

We undertook comparative analysis of ciliotoxic effect of glucocorticosteroids frequently used for catheterization of the eustachian tube in patients presenting with exudative otitis media and concomitant allergic rhinitis. It was shown that the recovery of transport function of ciliary epithelium and appreciable clinical effect of the treatment were achieved by the application of mometasone furoate. Dexamethasone was next to mometasone in terms of efficiency whereas hydrocortisone produced much lower beneficial effect. It is concluded that, taking into account high bioavailability of dexametasone and hydrocortisone (>80%) and contraindications to their intranasal administration, the preference should be given to medications with lower bioavailability.

Neuromonics Tinnitus Treatment: Third Clinical Trial

2010-12-31T17:02:00.000+03:00

Ear & Hearing: April 2007 - Volume 28 - Issue 2 - pp 242-259
doi: 10.1097/AUD.0b013e3180312619

Davis, Paul B.; Paki, Bardia; Hanley, Peter J.

Objectives: The Neuromonics Tinnitus Treatment combines the use of a novel approach to acoustic stimulation with a structured program of counseling and support by a clinician specifically trained in tinnitus rehabilitation. The distinctive acoustic component has been designed to provide stimulation to auditory pathways deprived by hearing loss, engage positively with the limbic system, and allow intermittent, momentary tinnitus perception within a pleasant and relaxing stimulus, thereby facilitating desensitization to the tinnitus signal. The purposes of this study were (1) to demonstrate the efficacy of the treatment, when enhanced with various modifications since previously reported trials and (2) to test the relative clinical effectiveness of two variations of the approach. In the first, intermittent tinnitus perception was facilitated throughout treatment through the use of a stimulus in which intensity peaks allowed the patients' tinnitus perception to be completely covered up, whereas in the intensity troughs their tinnitus was briefly discernible. In the second, subjects experienced little tinnitus perception while listening to the treatment for the first 2 mo, then experienced intermittent perception.

Design: Thirty-five subjects with a predominantly moderate to severe level of tinnitus-related distress before treatment were randomly allocated into one of two treatment groups, corresponding to the two stage-based variations of the Neuromonics Tinnitus Treatment. Participants were provided with a high-fidelity personal sound player with earphones and an acoustic stimulus that had been spectrally modified according to their individual audiometric profile. They were instructed to use the acoustic stimulus for at least 2 hr per day, particularly at those times when their tinnitus was usually disturbing. Each group had equal amounts of clinician time for education, monitoring, and support.

Results: At 2, 4, 6, and 12 mo after commencing treatment, both groups displayed clinically and statistically significant improvements in tinnitus distress, awareness, and minimum masking levels as well as loudness discomfort levels. Improvements increased with time over the first 6 mo of therapy, at which time 91% of all subjects across the two groups reported an improvement in tinnitus disturbance (as measured by the Tinnitus Reaction Questionnaire) of at least 40%, with a mean improvement of 65%. Also, 80% of subjects at 6 mo reported a level of tinnitus disturbance that was no longer clinically significant. There was some indication of a more consistent benefit over 12 mo for the group that was provided initially with a high level of tinnitus interaction; however, inter-group differences were not statistically significant. A relation between reported treatment usage (hours per day) and clinical outcomes was observed, suggesting that a dosage effect may apply with the stimulus provided.

Conclusions: This study found that the Neuromonics Tinnitus Treatment provides rapid and profound improvements to the severity of tinnitus symptoms and their effect on the subject's quality of life. This was a consistent effect, provided by a treatment that subjects reported as being pleasant to use. Both of the stage-based variations of the treatment that were tested in this study were shown to be successful in achieving these outcomes

Chronic cough and irritable larynx

2010-12-31T10:19:00.000+03:00

Journal of Allergy and Clinical Immunology (JACI) (Dec 2010)

Bucca CB, Bugiani M, Culla B, Guida G, Heffler E, Mietta S, Moretto A, Rolla G, Brussino L

BACKGROUND: Perennial rhinitis (PR), chronic rhinosinusitis (CRS), or both, asthma, and gastroesophageal reflux disease (GERD) are the most frequent triggers of chronic cough (CC). Extrathoracic airway receptors might be involved in all 3 conditions because asthma is often associated with PR/CRS and gastroesophageal refluxate might reach the upper airway. We previously found that most patients with rhinosinusitis, postnasal drip, and pharyngolaryngitis show laryngeal hyperresponsiveness (LHR; ie, vocal cord adduction on histamine challenge) that is consistent with an irritable larynx.

OBJECTIVE: We sought to evaluate the role of LHR in patients with CC.

METHODS: LHR and bronchial hyperresponsiveness (BHR) to histamine were assessed in 372 patients with CC and in 52 asthmatic control subjects without cough (asthma/CC-). In 172 patients the challenge was repeated after treatment for the underlying cause of cough. RESULTS: The primary trigger of CC was PR/CRS in 208 (56%) patients, asthma in 41 (11%) patients (asthma/CC+), GERD in 62 (17%) patients, and unexplained chronic cough (UNEX) in 61 (16%) patients. LHR prevalence was 76% in patients with PR/CRS, 77% in patients with GERD, 66% in patients with UNEX, 93% in asthma/CC+ patients, and 11% in asthma/CC- patients. Upper airway disease was found in most (95%) asthma/CC+ patients and in 6% of asthma/CC- patients. BHR discriminated asthmatic patients and atopy discriminated patients with PR/CRS from patients with GERD and UNEX. Absence of LHR discriminated asthmatic patients without cough. After treatment, LHR resolved in 63% of the patients and improved in 11%, and BHR resolved in 57% and improved in 18%.

CONCLUSIONS: An irritable larynx is common in patients with CC and indicates upper airway involvement, whether from rhinitis/sinusitis, gastric reflux, or idiopathic sensory neuropathy.

The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway

2010-12-18T21:25:00.000+03:00

The Laryngoscope

Volume 120, Issue 11, pages 2325–2330, November 2010

Ehab Zeyyan MD¹,
Münir Demir Bajin MD^2,*,
Kudret Aytemir MD²,
Taner Yılmaz MD¹

Article first published online: 22 OCT 2010

DOI: 10.1002/lary.21064

Abstract

Objective:

To evaluate the effects on cardiac functions and blood arterial gases of totally occluding nasal packs and nasal packs with airway.

Study Design:

Prospective, randomized trial.

Methods:

Thirty-nine adults without any comorbidities underwent septoplasty or septorhinoplasty and had nasal packs placed postoperatively; 19 nasal packs with airways and 20 totally occluding nasal packs. Twenty-four-hour Holter monitorization was done pre- and postoperatively. Arterial blood gas analysis was performed both before the operation and after application of nasal packs.

Results:

Application of packs with airway did not cause any significant changes in blood gas parameters. Packing with totally occluding nasal packs caused a significant decrease in HCO₃ and pCO₂, and insignificant changes in pO₂, O₂ saturation, and pH. No serious arrhythmias were observed in any patient. In both groups, nasal packing resulted in a significant increase in minimum heart rates, a significant decrease in maximum heart rates, and insignificant changes in the mean heart rates. Heart rate variability obtained from 24-hour Holter electrocardiography was analyzed by power spectral analysis. An increase in the high-frequency (HF) domain, a decrease in the low-frequency (LF) domain, and a decrease in the LF/HF ratio were observed after packing in both groups.

Conclusions:

Nasal pack-induced cardiac complications may occur due to increased vagal stimuli secondary to nasal mucosa compression rather than obstruction-related hypoxia. The use of nasal packs in the elderly patients with cardiopulmonary disease warrants close observation. Nasals packs with airways should be preferred in patients susceptible to hypoxia. Laryngoscope, 2010

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study

2010-12-03T10:16:00.000+03:00

European Archives of Oto-Rhino-Laryngology (Nov 2010)

Kutluhan A, Salviz M, Bozdemir K, Kanbak O, Ulu M, Yalçiner G, Bilgen AS

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis.

Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups.

The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels.

The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.

Bacterial communication encourages chronic, resistant ear infections

2010-11-30T14:40:00.000+03:00

Bacterial communication encourages chronic, resistant ear infections

Complications of adenotonsillectomy

2010-11-26T13:56:00.000+03:00

Current Opinion in Otolaryngology & Head & Neck Surgery:
December 2010 - Volume 18 - Issue 6 - p 539–543
doi: 10.1097/MOO.0b013e3283404dcc
Pediatric otolaryngology: Edited by Lisa Buckmiller

Statham, Melissa M
Abstract

Purpose of review: Tonsillectomy and adenoidectomy are two of the most commonly performed pediatric surgical procedures. As with all surgical intervention, tonsillectomy and adenoidectomy are associated with a host of potential complications. Fortunately, for most children undergoing adenotonsillectomy (T&A), complications are rare. This review is intended to summarize recent reports, which may lead to prevention and treatment of T&A complications.

Recent findings: The presented reports of complications and risk factors for complications in children undergoing T&A highlight perioperative medical management as a means to decrease perioperative complications. Certain tonsillectomy techniques, such as microdebrider intracapsular tonsillectomy, may lead to decreased posttonsillectomy hemorrhage and dehydration. Despite published recommendations, preoperative assessments for bleeding diatheses vary among practitioners. Conversely, guidelines for evaluation of posttonsillectomy hemorrhage are lacking. Some pediatric populations, such as children with coagulopathy, neurologic disease, and obesity, have increased risk of perioperative complications, and recent reports regarding their care are presented.

Summary: We present recent data pertinent to the contemporary management of medical and surgical complications of T&A, with particular focus on specific at-risk pediatric populations. In the patient groups illustrated in this review, anticipation of complications may decrease complications or lead to improved management of complications when they occur.

Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults

2010-11-26T12:12:00.000+03:00

The Journal of Laryngology & Otology

25 Nov 2010

M Isakson^a1 and S Hugosson^a1 ^c1

^a1Department of Otolaryngology, Örebro University Hospital, Sweden

Abstract

Objectives: We studied the incidence and bacterial epidemiology of acute epiglottitis presenting in the first 16 years following the introduction of general childhood vaccination against Haemophilus influenzae type b. Our main objectives were to analyse (1) the incidence of Streptococcus pneumoniae epiglottitis in adults and (2) the distribution of pneumococcal serotypes involved.

Materials and methods: The medical records of patients with acute epiglottitis (International Classification of Disease code J05.1) were investigated. Streptococcus pneumoniae serotyping was performed using gel precipitation.

Results: The overall incidence of acute epiglottitis was 0.98 cases/100 000/year, compared with 4.5 cases/100 000/year before the vaccination programme. The incidence was reduced both in children and adults, compared with pre-vaccination values. However, the incidence of Streptococcus pneumoniae epiglottitis in adults increased from 0.1 to 0.28 cases/100 000/year over the same time period. The causative agent was Streptococcus pneumoniae in 10 adults. Nine of 10 pneumococcal strains could be serotyped. All but one serotype is represented in the 23-valent pneumococcal polysaccharide vaccine (PPV23) used in adults.

Conclusion: In acute epiglottitis, now a disease of adults, the most important bacterial aetiology is Streptococcus pneumoniae. The serotype distribution found in this study indicates that the infection is preventable by PPV-23 vaccination with the 23-valent polysaccharide vaccine.

(Accepted July 07 2010)

Key words

Correspondence:

^c1 Address for correspondence: Dr Svante Hugosson, Dept of Otolaryngology, Örebro University Hospital, SE-701 85 Örebro, Sweden Fax: +46 19 10 33 01 E-mail: svante.hugosson@orebroll.se

Footnotes

Dr S Hugosson takes responsibility for the integrity of the content of the paper

Competing interests: None declared

Postoperative bleeding in paediatric ENT surgery. First results of the German ESPED trial

2010-11-26T12:06:00.000+03:00

Hämostaseologie 30 (41), S108-11 (Nov 2010)

Bidlingmaier C, Olivieri M, Stelter K, Eberl W, von Kries R, Kurnik K;

Bleeding after ear-nose-and throat surgery in children is a serious complication. With the help of the German Surveillance Unit for Rare Paediatric Disorders (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland; ESPED) a two year survey was performed to record the incidence, severity, reasons and treatment of haemorrhages. During the study period, 1069 bleeds were reported from 720 paediatric hospitals and departments of otorhinolaryngology after adenoidectomy and tonsillectomy. 713 reports could be analyzed. Two deaths occurred after adenoidectomy.

Although laboratory screening was performed in more than 70% of all cases, bleeding complications were neither foreseeable nor preventable. Inherited coagulopathies were rare and in most cases not detected, neither by laboratory screening nor by taking a history.

Since preoperative measures cannot help much to improve the situation, all efforts have to be taken to improve the postoperative period, especially since more than 20% of the hemorrhages occurred during weekends. Guidelines on postoperative care and behaviour should therefore be implemented and parents and patients must be informed on bleeding risks and on what to do in case of emergency. If bleeding occurs, extensive coagulation testing is mandatory.

Safety of intranasal Bevacizumab (avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis

2010-11-19T11:15:00.000+03:00

The Laryngoscope (Nov 2010)

Chen S, Karnezis T, Davidson TM;

OBJECTIVES/HYPOTHESIS:: Assess for complications of intranasal Bevacizumab application in patients with hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis.

STUDY DESIGN:: Retrospective chart review.

METHODS:: In 58 patients presenting with recurrent HHT epistaxis, Bevacizumab was applied intranasally either as a submucosal injection or as a topical spray between October 2006 and June 2010. In many of the injected patients, the potassium titanyl phosphate (KTP) laser was used adjunctively for vessel photocoagulation. A phone interview was performed in July 2010 to assess for treatment complications.

RESULTS:: Of the 58 treated patients 52 were contacted. Patient surveys were performed 1.5 to 46 months following their initial Bevacizumab treatment. Within the treatment population, five patients had sustained a septal perforation. Notably, these patients were treated early in the study period at which time the cartilaginous septum was often both injected and lasered. Subsequently, the treatment protocol was changed and the cartilaginous septum was neither lasered nor injected. After these changes were made no additional septal perforations were identified. No other adverse events were associated with intranasal Bevacizumab treatment.

CONCLUSIONS:: Bevacizumab applied as either a submucosal injection or as a topical nasal spray, with or without application of the KTP laser, is a safe treatment regimen. Still, when Bevacizumab injections are performed, the cartilaginous nasal septum should be avoided as patients may develop septal perforations. Laryngoscope, 2010.

ENT morbidity at high altitude

2010-11-18T16:56:00.001+03:00

The Journal of Laryngology & Otology
FirstView Article
doi: 10.1017/S0022215110002331 (About doi)
Published online by Cambridge University Press 17 Nov 2010

B K Prasad

Department of ENT and Head and Neck Surgery, Command Hospital (Eastern Command (EC)), Kolkata, West Bengal, India

Abstract

Background: People suffer unique health problems in high altitude areas, due to such factors as elevation, aircraft ascent and descent, extreme cold, hypoxia, hypobaria, and low relative humidity. This study was conducted to evaluate ENT morbidity at high altitude.

Methods: Serving soldiers introduced to a high altitude environment who presented with various ENT symptoms were examined to identify ENT disease. In addition, patients undergoing hyperbaric chamber therapy, tracheostomy and treatment of cold injuries were also examined for ENT problems.

Results: The following were detected: 13 cases of otic barotrauma, 11 cases of sinus barotrauma, three cases of vertigo, six cases of pinna frostbite, three cases of barotrauma caused by hyperbaric chamber therapy, an unusually high incidence of epistaxis, and innumerable patients with high altitude pharyngitis.

Conclusion: Diseases of the ear, nose and throat contribute significantly to high altitude morbidity. In a military context, health education of troops is necessary to avoid such problems.

(Accepted June 28 2010)

Correspondence:

^c1 Address for correspondence: Lt Col (Dr) B K Prasad, Department of ENT and Head and Neck Surgery, Command Hospital (EC), Alipore Road, Kolkata 700027, West Bengal, India Email: bipin_rupa@rediffmail.com

Footnotes

Presented at the 62nd Annual Conference of the Association of Otolaryngologists of India, 8 January 2010, Mumbai, India

Daily Short-Term Intratympanic Dexamethasone Treatment Alone as an Initial or Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

2010-10-28T20:51:00.000+03:00

Audiol Neurotol 2011;16:191-197

Seiji Kakehata, Akira Sasaki, Kazunori Futai, Rei Kitani, Hideichi Shinkawa
Department of Otorhinolaryngology, Hirosaki University School of Medicine, Hirosaki, Japan

Objective: Intratympanic (IT) steroid therapy has been proposed as an alternative treatment option for patients with idiopathic sudden sensorineural hearing loss (ISSNHL). However, the number and frequency of IT treatments and drug delivery methods remain to be determined. The purpose of this study was to evaluate the efficacy of daily short-term IT dexamethasone (DEX) treatment alone in ISSNHL patients using laser-assisted myringotomy (LAM) for the drug delivery route as an initial and/or salvage treatment.

Study Design: Retrospective study.

Setting: University hospital. Patients: Seventy-six ISSNHL patients receiving IT DEX. Patients with low-tone hearing loss, unilateral or bilateral fluctuating hearing loss or contralateral hearing loss were excluded.

Intervention: DEX (4 mg/ml) was injected through a perforation made by LAM. IT DEX administration was performed on 8 sequential days.

Main Outcome Measures: Pre- and postprocedure hearing levels. The average hearing level was determined by 5 frequencies (250, 500, 1000, 2000 and 4000 Hz).

Results:Nineteen out of 76 patients fit the criteria for initial treatment in the study (group I), while 24 patients, who had failed systemic therapy, received salvage treatment (group S). The mean age of the patients in groups I and S was 56.2 years with a range from 31 to 73 years of age and 46.0 years with a range from 11 to 76 years of age, respectively. The mean number of days from onset of symptoms to IT therapy in groups I and S was 4.8 days with a range of 1–23 days and 15.3 days with a range of 6–28 days, respectively. In group I, 18 of the 19 patients (95%) showed improvement of more than 10 dB in the pure-tone audiogram, with a mean improvement of 40 dB. Twelve patients (63%) recovered completely and 16 patients (84%) demonstrated successful results with an improvement of more than 30 dB. In group S, 14 of the 24 patients (58%) showed improvement of more than 10 dB with a mean improvement of 16 dB. Two (8%) of the 7 patients (29%) with successful results recovered completely.

Conclusions: Daily short-term IT DEX administration using LAM for ISSNHL patients without concurrent therapy showed a high response rate and high cure rate and proved to be an alternative therapeutic option to high-dose systemic steroids as a first- and/or second-line treatment.

A Novel Dominant and a De Novo Mutation in the GJB2 Gene (Connexin-26) Cause Keratitis-Ichthyosis-Deafness Syndrome: Implication for Cochlear Implantation

2010-10-28T20:42:00.000+03:00

Otology & Neurotology:

Arndt, Susan; Aschendorff, Antje; Schild, Christian; Beck, Rainer; Maier, Wolfgang; Laszig, Roland; Birkenhäger, RalfFebruary 2010 - Volume 31 - Issue 2 - pp 210-215

doi: 10.1097/MAO.0b013e3181cc09cd

Objective: Keratitis-ichthyosis-deafness (KID) syndrome is a rare congenital disorder, characterized by hyperkeratosis and erythrokeratoderma associated with profound sensorineural hearing loss. Additional concomitant phenomena of the KID syndrome are dystrophic nails, dental abnormalities, scarring alopecia, and vascularizing keratitis. The disorder is caused by mutation in the GJB2 gene (connexin-26), a gap junction protein. The aim of this study was to explore the feasibility and procedure of cochlear implantation in patients with KID syndrome and to assess the genetic causes.

Study Design: Retrospective case review.

Setting: Tertiary referral center. Cochlear implant program.

Patients: We report on 2 cases of KID syndrome with congenital profound hearing loss. A 50-year-old woman with skin necrosis and implant extrusion 5 years after cochlear implantation and a 10-month-old infant girl with bilateral deafness, alopecia, bright light sensitivity, and congenital dermatosis.

Intervention: Genetic analysis. Cochlear implantation.

Main Outcome Measures: Mutation analysis, surgical suitability, and hearing rehabilitation.

Results: We detected a novel heterozygous missense mutation (Ile30Asn) in Patient 1 and a de novo mutation (Asp50Asn) in theGJB2 gene (connexin-26) in Patient 2. To decrease the risk of skin flap necrosis, we describe alternative surgical cochlear implantation techniques with a novel very thin receiver/stimulator (Nucleus CI 513; Cochlear Corp.). The postoperative course of both patients has been without any problems until now.

Conclusion: The combination of the cutaneous lesions with visual and auditory impairment demands to diagnose impaired hearing as early as possible. It would be helpful to search for KID syndrome in dealing with patients with deafness, skin lesions of unknown cause, and wound healing problems to choose the right method of surgical treatment and subsequent aftercare.

Ontogeny of Odor Liking during Childhood and Its Relation to Language Development

2010-10-28T20:32:00.000+03:00

Chem. Senses

(2010)doi: 10.1093/chemse/bjq101

Abstract

One important aspect of odor hedonics is its plasticity during human development.

The present study set out to probe the modulators of such olfactory change during that period by testing the hypothesis that language and semantic representations of objects are strong organizers of odor liking. To this end, 15 three-year-old children were tested in a longitudinal study. Participants were exposed to exactly the same 12 odorants once a year over a 3-year period. At each experimental session, they were asked to answer 2 questions: 1) “Do you like or dislike this odor?” and 2) “Can you tell me what it is?” The level of language production was assessed on a standardized test. The 3-year-old children were found to categorize the same number of odorants as liked and as disliked. The follow-up study, in contrast, showed that at 5 years of age they categorized more of these odors as liked and that the shift was significant only in the children with higher language production skills. Taken as a whole, these findings suggest that the 3- to 5-year age range, when children begin to master language, is a turning point in the construction of olfactory hedonic categories during childhood.

Posttonsillectomy hemorrhage: Blame on surgeons or genes?

2010-10-17T22:31:00.000+03:00

The Laryngoscope
Volume 120, Issue 9, pages 1784–1787, September 201

Diana Arweiler-Harbeck MD,
Ender Öztürk MD,
Agnes Bankfalvi MD, PhD,
Stephan Lang MD, PhD,
Winfried Siffert MD, PhD,
Kurt Werner Schmid MD, PhD,
Jürgen Peters MD, PhD,
Michael Adamzik MD, PhD

Abstract

Objective:

To investigate whether the insertion/deletion polymorphism (−94ins/delATTG) in the promoter of NFκB1 is associated with the risk of bleeding after tonsillectomy.

Design and Setting:

Retrospective study with genotyping performed from tonsillar tissue or blood.

Patients:

One hundred forty-eight patients having undergone tonsillectomy due to chronic tonsillitis, with or without posttonsillectomy hemorrhage.

Measurements and Results:

DNA-extraction from paraffin-embedded tonsillectomy tissue or blood was followed by genotyping for the insertion/deletion (−94ins/delATTG) promoter NFκB1 polymorphism. Genotypes differed significantly between patients with (n = 56) and without (n = 92) posttonsillectomy hemorrhage, with the frequency of the homozygous deletion genotype carriers (DD) significantly increased in those with posttonsillectomy bleeding with an odds ratio (OR) for bleeding of 3.78 (95% confidence interval [CI] 1.2–11.7, P = .023) but not in homozygous (II) insertion and heterozygous (ID) genotype carriers (II/ID). Genotype distribution in patients was compatible with the Hardy Weinberg equilibrium. In contrast, there were no statistically significant differences between patients with or without posttonsillectomy hemorrhage with regard to demographic characteristics, different surgeons, postoperative medications like analgesics, antibiotics, anticoagulation therapy, or values of variables of pre- and postoperative coagulation studies. Likewise, these variables revealed no differences between genotypes.

Conclusions:

Carriers of the homozygous deletion allele were at an almost fourfold risk to develop posttonsillectomy hemorrhage compared to homozygous and heterozygous insertion allele carriers, independent of other risk factors. Laryngoscope, 2010

Xylitol as a prophylaxis for acute otitis media: systematic review

2010-10-15T06:59:00.000+03:00

International Journal of Audiology 49 (10), 754-61 (Oct 2010)

Danhauer JL, Johnson CE, Corbin NE, Bruccheri KG

A systematic review was conducted to evaluate evidence regarding xylitol, a sugar alcohol, as a prophylaxis for acute otitis media (AOM) in children. The authors searched PubMed and other databases to identify evidence. Criteria for included studies were: appear in English-language, peer-reviewed journals; at least quasi-experimental designs; use xylitol; and present outcome data. The authors completed evaluation forms for the included studies at all phases of the review.

The authors reviewed 1479 titles and excluded 1435. Abstracts and full texts were reviewed for the remaining 44; four randomized controlled trials met inclusion criteria. Xylitol was a generally well accepted prophylaxis for AOM with few side effects when administered via chewing gum or syrup at 10 g/day given five times daily. Meta-analysis revealed significant treatment effects (Risk ratio = 0.68; 95% confidence interval = 0.57 to 0.83).

Xylitol can be a prophylaxis for AOM, but warrants further study, especially of vehicles other than chewing gum for young children, and information is needed regarding cost, duration of administration required, and expected long-term effects.

Hypothyroid-associated sensorineuronal deafness

2010-10-15T06:55:00.000+03:00

Irish Journal of Medical Science (Sep 2010)

Comer DM, McConnell EM;

A case of panhypopituitarism with hypothyroid-induced deafness in a man improving with hormone replacement is reported.

A review of the medical literature reveals conflicting evidence regarding the underlying mechanism and prognosis of the defect in this context, but the association with hypothyroidism is more than spurious.

Sensorineuronal hearing loss was initially evident, resolving both subjectively and on formal audiological evaluation after administering thyroxine. Central pathology affecting the eighth cranial nerve, as opposed to a conductive or mixed component is the likely culprit.

Alpha-1-Blockers Are Useful in the Symptomatic Management of Obstructive Salivary Gland Diseases

2010-10-15T06:47:00.000+03:00

Presented at AAO-HNSF

By Cheryl Lathrop

BOSTON -- October 3, 2010 -- Alfuzosin was well tolerated and improved symptoms
related to stenosis or lithiasis of the parotid and submandibular glands in a
majority of patients, according to results of a study presented here on
September 27 at the American Academy of Otolaryngology-Head and Neck Surgery
Foundation (AAO-HNSF) Annual Meeting 2010.

Philippe Katz, MD, Institut d’Explorations Fonctionnelles des Glandes
Salivaires, Paris, France, and colleagues retrospectively analysed the files of
patients treated with alfuzosin between January 2005 to January 2008 for
submandibular or parotid ductal stenosis, allergic pseudo-parotitis, or remnant
sialolithiasis after extracorporeal lithotripsy to the parotid or submandibular
glands.

At the first 3-month follow-up visit, an ultrasound was performed and a
subjective evaluation of salivary symptoms was obtained by questionnaire.
Patients then had an ultrasound every 3 months. If treatment was well
tolerated, it was continued for 2 years. Treatment was discontinued if side
effects occurred (patients were questioned about side effects at every 3-month
visit) or if salivary symptoms completely resolved.

Of the 352 patients (282 male, 70 female) 69 had ductal stenosis, 89 had
allergic pseudo-parotitis, 112 had residual parotid lithiasis, and 82 had
residual submandibular lithiasis.

At the first 3-month visit, 80% of the patients with stenosis, 79% of the
patients with allergic pseudo-parotitis, and 67% of the patients with residual
parotid lithiasis reported “very much improved” or “completely resolved.”
However, only 42% of the patients with residual submandibular lithiasis
reported a large improvement (significantly lower than for the other 3
diseases), which the researchers found surprising.

The average follow-up was 33 months. No male/female difference was noted for
safety or efficacy.

Alfuzosin was well tolerated with only 12 (3.4%) patients reporting adverse
effects. Ten patients discontinued the treatment within the first 3 months. The
low complication rate and high efficacy rate imply that alpha-blockers may be
useful in the symptomatic management of obstructive salivary gland diseases.

“A randomised controlled study is warranted to confirm the efficacy of this
approach as compared to conventional treatments,” the researchers noted.

[Presentation title: Alpha-1-Blockers for Obstructive Salivary Gland
Diseases. Abstract 194]

Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment

2010-10-08T12:32:00.000+03:00

Current Opinion in Otolaryngology & Head and Neck Surgery (Aug 2010)

Dubach P, Mantokoudis G, Caversaccio M;

PURPOSE OF REVIEW: We present an update on clinical evaluation, staging, classification and treatment of canal cholesteatoma, including a meta-analysis of clinical data of the last 30 years.

RECENT FINDINGS: Ear canal cholesteatoma is frequently associated secondarily to other canal pathologies. The cause for the rare idiopathic form of the disease remains enigmatic. Epidemiologic and experimental studies of its pathogenesis have increased; however, the main explanatory theory of a deficient migratory capacity of the canal epithelium affected has been falsified only recently. Therefore, the debate on the pathogenesis has gained additional impetus and more data is needed.

SUMMARY: Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease. It presents typically with otorrhea, focal erosion and keratin accumulation in the osseous ear canal and has to be distinguished from keratosis obturans, which leads to otalgia and bilateral conductive hearing loss by ceruminal plugs, with circumferential distention of the ear canal. Treatment by canaloplasty is curative and highly successful. Alternative conservative treatment is feasible, however, requiring long-term follow up, with often painful cleaning of the lesion.

Bilateral symptomatic petrous apex effusion

2010-10-01T17:38:00.000+03:00

INDIAN JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
Volume 62, Number 2, 186-188, DOI: 10.1007/s12070-010-0034-4

Muzeyyen Yildirim, Senem Senturk, Ebru Guzel, Aslan Guzel and Ismail Topcu

Abstract

Petrous apex effusions can present with aural fullness, hearing loss and dizziness. Although they can be followed-up when asymptomatic, clinical management of symptomatic patients is controversial. In this study, we present clinical and radiological findings of a 24-year-old patient with bilateral petrous apex effusion. She had been complaining of bilateral aural fullness and dizziness for 2 years. Radiological examinations revealed bilateral petrous apex effusion. After medical treatment, her symptoms gradually disappeared. In all previous published studies, unilateral petrous apex effusions were reported. To our best knowledge, this is the first patient with trapped fluid in bilateral petrous apex.

Acute otitis media: to follow-up or treat?;

2010-07-16T14:29:00.000+03:00

International Journal of Pediatric Otolaryngology 74 (8), 930-3 (Aug 2010)
Stevanovic T, Komazec Z, Lemajic-Komazec S, Jovic R; .

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and "wait-and-see" approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin. The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.

The role of neuropeptides in pathophysiology of rhinitis

2010-07-15T14:27:00.000+03:00

Post Dermatol Alergol 2010; XXVII, 3: 162–165 07/07/2010 (Not English)

(Advances in Dermatology and Allergology,
Gawlik R –

Neuropeptides and neuropeptide–containing nerves are proven to exist in the human nasal mucosa. The presence and distribution of NPY, CGRP, neurokinin A and SP nerve fibres and neuroendocrine cells have been confirmed. Released neuropeptides and kinins are involved in vasodilatation, increased vascular permeability, irritation of neural endings and inflammatory cell migration, causing symptoms of allergic rhinitis. Different studies have demonstrated that neuropeptides have a great potential biological role in inflammatory mechanisms in the nasal mucosa. The role of neuropeptides and kinins in nasal pathophysiology is discussed.

Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study

2010-07-15T14:22:00.001+03:00

American Journal of Otolaryngology Received 1 November 2009 published online 31 May 2010.
Giancarlo Ottaviano, MDa, Gino Marioni, MDa, Claudia Staffieri, MDb, Luciano Giacomelli, BDc, Rosario Marchese-Ragona, MDa, Andy Bertolin, MDa, Alberto Staffieri, MDa

Abstract

Objectives

Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]).

Methods

In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month.

Results

An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month.
Conclusions

Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations.

a Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Padova, Italy
b Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Treviso, Italy
c Anatomic Pathology Section, Department of Medical/Diagnostic Sciences and Special Therapies, University of Padova, Padova, Italy
Corresponding author. Otolaryngology Section, Department of Medical and Surgical Specialties, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 0 49 8212010; fax: +39 0 49 8213113.

Bacterial communication encourages chronic, resistant ear infections

2010-07-12T07:37:00.000+03:00

Bacterial communication encourages chronic, resistant ear infections

Bacteria in the nose and throat: Most comprehensive comparative analysis

2010-07-12T07:28:00.000+03:00

Bacteria in the nose and throat: Most comprehensive comparative analysis

Oral bacteria may offer probiotic potential against upper respiratory infections

2010-07-12T07:21:00.000+03:00

Oral bacteria may offer probiotic potential against upper respiratory infections

Imaging characteristics of children with auditory neuropathy spectrum disorder

2010-07-09T15:01:00.000+03:00

Otology & Neurotology 31 (5), 780-8 (Jul 2010)

Roche JP, Huang BY, Castillo M, Bassim MK, Adunka OF, Buchman CA;

OBJECTIVE: To identify and define the imaging characteristics of children with auditory neuropathy spectrum disorder (ANSD). DESIGN: Retrospective medical records review and analysis of both temporal bone computed tomographic (CT) and magnetic resonance images (MRI) in children with a diagnosis of ANSD.

SETTING: Tertiary referral center. Patients: One hundred eighteen children with the electrophysiologic characteristics of ANSD with available imaging studies for review.

INTERVENTIONS: Two neuroradiologists and a neurotologist reviewed each study, and consensus descriptions were established.

MAIN OUTCOME MEASURES: The type and number of imaging findings were tabulated. Results: Sixty-eight (64%) MRIs revealed at least 1 imaging abnormality, whereas selective use of CT identified 23 (55%) with anomalies. The most prevalent MRI findings included cochlear nerve deficiency (n = 51; 28% of 183 nerves), brain abnormalities (n = 42; 40% of 106 brains), and prominent temporal horns (n = 33, 16% of 212 temporal lobes). The most prevalent CT finding from selective use of CT was cochlear dysplasia (n = 13; 31%).

CONCLUSION: Magnetic resonance imaging will identify many abnormalities in children with ANSD that are not readily discernable on CT. Specifically, both developmental and acquired abnormalities of the brain, posterior cranial fossa, and cochlear nerves are not uncommonly seen in this patient population. Inner ear anomalies are well delineated using either imaging modality. Because many of the central nervous system findings identified in this study using MRI can alter the treatment and prognosis for these children, we think that MRI should be the initial imaging study of choice for children with ANSD.

Treatment of allergic rhinitis

2010-06-18T08:40:00.000+03:00

American Family Physician 81 (12), 1440-6 (Jun 2010)
Sur DK, Scandale S;

Allergic rhinitis is a common chronic respiratory illness that affects quality of life, productivity, and other comorbid conditions, including asthma. Treatment should be based on the patient's age and severity of symptoms. Patients should be advised to avoid known allergens and be educated about their condition.

Intranasal corticosteroids are the most effective treatment and should be first-line therapy for mild to moderate disease.

Moderate to severe disease not responsive to intranasal corticosteroids should be treated with second-line therapies, including antihistamines, decongestants, cromolyn, leukotriene receptor antagonists, and nonpharmacologic therapies (e.g., nasal irrigation). With the exception of cetirizine, second-generation antihistamines are less likely to cause sedation and impair performance. Immunotherapy should be considered in patients with a less than adequate response to usual treatments. Evidence does not support the use of mite-proof impermeable covers, air filtration systems, or delayed exposure to solid foods in infancy.

Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature

2010-06-18T08:26:00.000+03:00

Academic Emergency Medicine 17 (5), 476-83 (May 2010)
Wing A, Villa-Roel C, Yeh B, Eskin B, Buckingham J, Rowe BH

Objectives: The objective was to examine the effectiveness of corticosteroid treatment for the relief of pain associated with acute pharyngitis potentially caused by group A beta-hemolytic Streptococcus (GABHS).

Methods: This was a systematic review of the literature. Data sources used were electronic databases (Cochrane Library, MEDLINE, EMBASE, Biosis Previews, Scopus, and Web of Science), controlled trial registration websites, conference proceedings, study references, experts in the field, and correspondence with authors. Selection criteria consisted of randomized controlled trials (RCTs) in which corticosteroids, alone or in combination with antibiotics, were compared to placebo or any other standard therapy for treatment of acute pharyngitis in adult patients, pediatric patients, or both. Two reviewers independently assessed for relevance, inclusion, and study quality. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs).

Results: From 272 potentially relevant citations, 10 studies met the inclusion criteria. When compared to placebo, corticosteroids reduced the time to clinically meaningful pain relief (WMD = -4.54 hours; 95% CI = -7.19 to -1.89); however, they provided only a small reduction in pain scores at 24 hours (WMD = -0.90 on a 0-10 visual analog scale; 95% CI = -1.5 to -0.3). Heterogeneity among pooled studies was identified for both outcomes (I(2) = 81 and 74%, respectively); however, the GABHS-positive subgroup receiving corticosteroid treatment did have a significant mean reduction in time to clinically meaningful pain relief of 5.22 hours (95% CI = -7.02 to -3.42; I(2) = 0%). Short-term side effect profiles between corticosteroids and placebo groups were similar.

Conclusions: Corticosteroid administration for acute pharyngitis was associated with a relatively small effect in time to clinically meaningful pain relief (4.5-hour reduction) and in pain relief at 24 hours (0.9-point reduction), with significant heterogeneity in the pooled results. Decision-making should be individualized to determine the risks and benefits; however, corticosteroids should not be used as routine treatment for acute pharyngitis.

ACADEMIC EMERGENCY MEDICINE 2010; 17:476-483 (c) 2010 by the Society for Academic Emergency Medicine.

Oral steroids and doxycycline: two different approaches to treat nasal polyps

2010-05-14T17:39:00.000+03:00

Journal of Allergy and Clinical Immunology (JACI) 125 (5), 1069-1076.e4 (May 2010)

Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, Hens G, Hellings P, Ebbens FA, Fokkens W, Van Cauwenberge P, Bachert C;

BACKGROUND: There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps.
OBJECTIVE: We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps.
METHODS: In a double-blind, placebo-controlled, multicenter trial, we randomly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses (32-8 mg once daily), doxycycline (200 mg on the first day, followed by 100 mg once daily), or placebo for 20 days. Participants were followed for 12 weeks. Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy. Markers of inflammation such as eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE were measured in nasal secretions. Concentrations of eosinophils, ECP, and soluble IL-5 receptor alpha were measured in peripheral blood samples.
RESULTS: Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks. Methylprednisolone significantly reduced levels of ECP, IL-5, and IgE in nasal secretions, whereas doxycycline significantly reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions.
CONCLUSION: This is the first double-blind, placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps, nasal symptoms, and mucosal and systemic markers of inflammation.

A useful procedure for observing the cervical esophagus via the hypopharynx

2010-05-14T17:32:00.000+03:00

Auris Nasus Larynx (Apr 2010)

Nagano H, Yoshifuku K, Kurono Y;

Tags:

OBJECTIVE: The aim of the study was to evaluate upper gastrointestinal endoscopy with movable over tube (i.e., the movable over tube method) for observing the hypopharynx to cervical esophagus, for use in treatment, and to determine its safety.

METHODS: The study population consisted of 28 patients (23 men, 5 women; a mean age of 66.6 years old; age range of 50-80 years old). The patients consisted of nine cases of globus sensation, eight cases of hypopharyngeal cancer (post-chemoradiotherapy), three cases of hypopharyngeal cancer (untreated), two cases of hoarseness, two cases of unknown primary carcinoma, two cases of foreign body, one case of esophageal cancer, and one case of dysphagia. We used upper gastrointestinal endoscopy with movable over tube to examine the hypopharynx to the cervical esophagus in subjects.

RESULTS: With the movable over tube method, which was performed under pharyngeal surface anesthesia and an infusion of diazepam (5-10mg/kg body weight), one could observe from the hypopharynx to cervical esophagus without any blind spots. There were no complications after the examination.

CONCLUSIONS: The results suggest that the movable over tube method is an easy, useful, and safe method to observe the region from the hypopharynx to the cervical esophagus.

Early exposure to paracetamol or to antibiotics and eczema at school age: Modification by asthma and rhinoconjunctivitis

2010-05-14T17:21:00.000+03:00

Pediatric Allergy and Immunology (Apr 2010)

Garcia-Marcos L, González-Díaz C, Garvajal-Urueña I, Pac-Sa MR, Busquets-Monge RM, Suárez-Varela MM, Batlles-Garrido J, Blanco-Quirós A, Varela AL, García-Hernández G, Aguinaga-Ontoso I

The association between early exposure to paracetamol or to antibiotics and eczema is conflicting. This study aims to know whether the early exposure to those drugs is associated with eczema at school age, and whether the strength of the association is modified by the presence of asthma or rhinoconjunctivitis.

Children aged 6-7 (n = 13908) from the International Study of Asthma and Allergies in Childhood in Spain provided data about current asthma, rhinoconjunctivitis and eczema. Parent-reported information was also obtained on paracetamol and antibiotic consumption during the first year of life. Logistic regression analysis with eczema as outcome and including exposure to paracetamol or to antibiotics, together with possible confounders, was carried out in the whole sample of children and in five different strata: no respiratory symptom and any respiratory symptom further subdivided into: asthma with rhinoconjunctivitis, asthma without rhinoconjunctivitis and rhinoconjunctivitis without asthma. In the whole sample, exposure to paracetamol was associated with eczema (aOR 1.56 [1.36-1.80]) as was antibiotic consumption (aOR 1.66 [1.43-1.92]). These associations did not substantially change after additionally adjusting for the other drug. A similar pattern was found among children without respiratory symptoms.
In children with symptoms, adjusting for the other drug modified the association with paracetamol (aOR from 1.32 [1.03-1.71] to 1.09 [0.83-1.43]) but did not change that with antibiotics (aOR from 1.80 [1.38-2.35] to 1.81 [1.37-2.39]). Early exposure to paracetamol or to antibiotics is associated with an increased prevalence of eczema at school age. Asthma and/or rhinoconjunctivitis substantially modifies this association.

Ear-acupressure for allergic rhinitis: a systematic review

2010-05-14T17:19:00.000+03:00

Clinical Otolaryngology 35 (1), 6-12 (Feb 2010)

Zhang CS, Yang AW, Zhang AL, Fu WB, Thien FU, Lewith G, Xue CC

BACKGROUND: Allergic rhinitis affects 10-40% of the population globally with a substantial health and economic impact on the community.
OBJECTIVE OF REVIEW: To assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials.
TYPE OF REVIEW: This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. SEARCH STRATEGY: A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms. EVALUATION METHOD: The methodological quality was assessed using Jadad's scale. The effect size analysis was performed to explore the difference between interventional groups. RESULTS: Ninety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect.
CONCLUSIONS: The benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies

Mometasone furoate nasal spray reduces the ocular symptoms of seasonal allergic rhinitis

2010-05-08T18:38:00.000+03:00

Journal of Allergy and Clinical Immunology (JACI) (Apr 2010)

Prenner BM, Lanier BQ, Bernstein DI, Shekar T, Teper A

BACKGROUND: Mometasone furoate nasal spray (MFNS), a potent intranasal corticosteroid with proved efficacy in relieving nasal allergic rhinitis symptoms, has demonstrated effectiveness in improving ocular symptoms associated with seasonal allergic rhinitis (SAR) in retrospective analyses.

OBJECTIVE: We sought to evaluate prospectively the efficacy of MFNS in reducing total ocular symptom scores (TOSSs) and individual ocular symptoms in subjects with SAR.

METHODS: Subjects 12 years or older (n = 429) with moderate-to-severe baseline symptoms were randomized to MFNS, 200 mug once daily, or placebo in this 15-day, double-blind, parallel-group study. Subjects evaluated morning instantaneous TOSSs and daily reflective TOSSs, total nasal symptom scores (TNSSs; both instantaneous TNSSs and reflective TNSSs, respectively), and individual ocular and nasal symptoms. Mean changes from baseline averaged over days 2 to 15 (instantaneous) and days 1 to 15 (reflective) were calculated. Quality of life was assessed by using the Rhinoconjunctivitis Quality of Life Questionnaire.

RESULTS: MFNS treatment yielded significant reductions from baseline versus placebo in instantaneous TOSSs (-0.34, P = .026, coprimary end point), instantaneous TNSSs (-0.88, P<.001, coprimary end point), reflective TOSSs (-0.44, P = .005), and reflective TNSSs (-1.06, P<.001). Significant decreases in all individual reflective ocular symptoms and instantaneous eye itching/burning and eye watering/tearing were observed for MFNS versus placebo (P<.05). Numeric improvements in instantaneous eye redness were seen but did not reach statistical significance. Improvements in Rhinoconjunctivitis Quality of Life Questionnaire total scores and individual symptom domains were achieved with MFNS treatment versus placebo (P<.001). MFNS was well tolerated.

CONCLUSION: This prospective study demonstrates that MFNS significantly reduces ocular symptoms in subjects with SAR.

Is there a role for leukotriene antagonists in the prevention of recurrent nasal polyps?

2010-05-08T18:36:00.000+03:00

Current Opinion in Allergy and Clinical Immunology 10 (3), 200-5 (Jun 2010)

Rasp G

PURPOSE OF REVIEW: The aim of this review is to provide the current available data for leukotriene receptor antagonists in the treatment of nasal polyps, the use in the postoperative therapy single or as an add-on to standard treatments.

RECENT FINDINGS: Surgical treatment of nasal polyps was refined in the last 30 years by the introduction of functional endoscopic sinus surgery and nasal endoscopy for monitoring nasal polyp patients. As the relapse is the main challenge and as nasal steroids only delay it, a more efficient treatment is needed. Leukotriene antagonists have effects on asthma and allergic rhinitis; preliminary data show some benefits in nasal polyps.

SUMMARY: In the surgery of nasal polyps, recurrence is the main problem. Steroids are the current standard therapy, but the limitations are obvious. The role of leukotrienes in the disorder of nasal polyps is well established now, and with the antagonists available, interest rose in treating nasal polyps. A total of 356 patients took part in several studies involving leukotriene antagonists in the nasal polyp population. Some studies have minor levels of evidence; the data show positive effects for patients in preoperative and postoperative studies and medical treatments. There were benefits as an add-on to steroids and data from allergic rhinitis studies also show possible synergism with antihistamines. There are hints for a positive effect on eosinophil inflammation, clinical symptom scores, nasal airflow, sneezing and postnasal drip. Although some effects are shown, more controlled studies are necessary for reliable data.

Congestion and sleep impairment in allergic rhinitis

2010-05-08T18:32:00.000+03:00

Current Allergy and Asthma Reports 10 (2), 113-21 (Mar 2010)

Craig TJ, Sherkat A, Safaee S;

Allergic rhinitis is a prevalent disease in developed nations, and its prevalence has been increasing throughout the world. Nasal congestion is the most common and bothersome symptoms of rhinitis.

Congestion is associated with sleep-disordered breathing and is thought to be a key cause of sleep impairment in individuals with rhinitis. The end result is a decrease in quality of life and productivity and an increase in daytime sleepiness. Treatment with intranasal corticosteroids has been shown to reduce nasal congestion.

Data on sleep-related end points from clinical trials of intranasal corticosteroids indicate that this reduction is associated with improved sleep, reduced daytime fatigue, and improved quality of life. Other therapies, such as montelukast, also have a positive influence on congestion and sleep.

This review examines nasal congestion and the associated sleep impairment of allergic rhinitis patients. It explores the adverse effects of disturbed sleep on quality of life and how these conditions can be reduced by therapies that decrease congestion.

Rhinosinusitis and Comorbidities

2010-05-08T18:28:00.000+03:00

Current Allergy and Asthma

Ryan MW, Brooks EG;

A variety of systemic conditions impact the incidence, severity, prognosis, and treatment approach in patients with chronic rhinosinusitis (CRS). The controversy surrounding the impact of allergic rhinitis on CRS continues, but it is reasonable to consider and treat allergic sources of inflammation in any patient with CRS.
CRS is more severe in patients with aspirin sensitivity but improves-at least temporarily-to the same degree as in non-aspirin-sensitive patients, given appropriate therapy.
Polypoid rhinosinusitis in cystic fibrosis patients is characterized by compromised mucociliary clearance and infection with staphylococcal and pseudomonal organisms. Affected individuals require frequent antibiotic treatment, saline lavage, and repeated surgeries.
Rhinosinusitis is among the most common infectious complications of humoral immunodeficiency, which is not uncommon in patients with refractory CRS. The treatment approach in immunodeficiency includes aggressive antibiotic treatment and intravenous immunoglobulin. Specific diagnosis of comorbid systemic conditions with CRS will facilitate appropriate management.

Usefulness of computed tomography Hounsfield unit density in preoperative detection of cholesteatoma in mastoid ad antrum

2010-05-08T18:23:00.000+03:00

American Journal of Otolaryngology (Apr 2010)

Park MH, Rah YC, Kim YH, Kim JH;

PURPOSE: This study was performed to evaluate the usefulness of Hounsfield unit (HU) to better distinguish cholesteatoma from other inflammatory conditions in the mastoid ad antrum before primary mastoid surgery.

MATERIALS AND METHODS: We enrolled 82 patients who underwent tympanomastoidectomy for treatment of chronic otitis. Forty-one patients were pathologically diagnosed with cholesteatoma, whereas the others were diagnosed with inflammatory granulation. These lesions were confirmed, and HU was measured in preoperative computed tomography. The difference in HU between cholesteatoma and non-cholesteatoma tissues was analyzed, and the improvement in the diagnosis of cholesteatoma after inclusion of HU data was calculated.

RESULTS: The HU was calculated as 42.68 +/- 24.42 in the cholesteatoma group and 86.07 +/- 26.50 in the non-cholesteatoma group. The differences between the 2 groups were statistically different (Student t test, P<.01). By applying the HU, the sensitivity (51.2%-80.5%), specificity (80.5%-87.8%), positive predictive value (72.4%-86.8%), and negative predictive value (62.3%-81.8%) to diagnose cholesteatoma improved.

CONCLUSIONS: The HU density was found to be statistically different between cholesteatoma and inflammatory granulation tissue in mastoid antrum. An improved diagnosis of cholesteatoma was achieved after adjusting for the HU.

Medical treatment of adenoid hypertrophy with "fluticasone propionate nasal drops"

2010-05-08T18:19:00.000+03:00

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B

BACKGROUND: Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented.

STUDY DESIGN: The prospective, randomized, placebo-controlled study.

SETTING: Tertiary referral center.

PATIENTS AND METHODS: Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400mug/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks.

RESULTS: At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed.

CONCLUSIONS: In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.

Stuttering and the basal ganglia circuits: a critical review of possible relations

2010-05-02T17:40:00.000+03:00

Journal of communication disorders ISSN 0021-9924 CODEN JCDIAI

2004, vol. 37, n^o4, pp. 325-369 [45 page(s) (article)] (7 p.3/4)
ALM Per A.^{(1 2)} ;

⁽¹⁾Department of Clinical Neuroscience, Lund University, Lund, SUEDE
⁽²⁾Department of Clinical Psychology, Lund University, Box 213, 22100, Lund, SUEDE

Résumé / Abstract

The possible relation between stuttering and the basal ganglia is discussed. Important clues to the pathophysiology of stuttering are given by conditions known to alleviate dysfluency, like the rhythm effect, chorus speech, and singing. Information regarding pharmacologic trials, lesion studies, brain imaging, genetics, and developmental changes of the nervous system is reviewed. The symptoms of stuttering are compared with basal ganglia motor disorders like Parkinson's disease and dystonia. It is proposed that the basal ganglia-thalamocortical motor circuits through the putamen are likely to play a key role in stuttering. The core dysfunction in stuttering is suggested to be impaired ability of the basal ganglia to produce timing cues for the initiation of the next motor segment in speech. Similarities between stuttering and dystonia are indicated, and possible relations to the dopamine system are discussed, as well as the interaction between the cerebral cortex and the basal ganglia. Behavioral and pharmacologic information suggests the existence of subtypes of stuttering. Learning outcomes: As a result of this activity, the reader will (1) become familiar with the research regarding the basal ganglia system relating to speech motor control; (2) become familiar with the research on stuttering with indications of basal ganglia involvement; and (3) be able to discuss basal ganglia mechanisms with relevance for theory of stuttering.

The effects of natural pollen exposure on inflammatory cytokines and their relationship with nonspecific bronchial hyperresponsiveness in seasonal allergic rhinitis

2010-04-21T20:52:00.000+03:00

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 126-131(6)

Authors: Kurt, Emel¹; Aktas, Ayse; Gulbas, Zafer; Erginel, Sinan; Arslan, Sertac

Publisher: OceanSide Publications, Inc

Abstract:
The exact mechanism of bronchial hyperresponsiveness (BHR) is not clear in allergic rhinitis (AR); an increase of BHR in pollen season suggests that natural pollen exposure causes airway inflammation in seasonal AR (SAR).

This study was designed to investigate the effects of natural pollen exposure on inflammatory cytokines and their relationship with BHR.

Sixty-six SAR patients with grass pollen sensitivity and 26 nonallergic rhinitis (NAR) patients were included. Peripheral blood samples for cytokine levels were taken and a nonspecific bronchial provocation test was performed during pollen season between May and August. The same measurements were repeated off-season between November and February. These measurements were done in NAR patients once. During the pollen season, SAR patients had significantly more increased levels of IL-13 than NAR patients (11.45 ± 12.54 versus 5.19 ± 4.02; p = 0.005). Blood eosinophil numbers were higher in those patients with BHR during pollen season than those without BHR (399.0 ± 255.8 versus 278.9 ± 193.2 mm⁻³; p = 0.046). Blood eosinophil numbers during off-season were not different in those with and without BHR (respectively, 261.4 ± 202.3 mm⁻³ versus 205.9 ± 116.9 mm⁻³; p = 0.53). IL-10 levels were higher in the patients without BHR (n = 28) than those patients with BHR (n = 22) during off-season (8.12 ± 13.1 versus 3.28 ± 0.37; p = 0.04). Having higher levels of IL-10 than threshold value was more frequent in SAR patients without BHR than those patients with BHR during off-season (7/28 versus 1/22; χ² = 4.34; p = 0.04). IL-10 has a role in the continuation of BHR during off-season in SAR patients.

Document Type: Research article
DOI: 10.2500/aap.2010.31.3325
Affiliations: 1: Department of Allergy, Faculty of Medicine, Eskisehir Osmangazi University, Turkey. dremelkurt@yahoo.com

Comprehensive review of olopatadine: The molecule and its clinical entities

2010-04-21T20:43:00.000+03:00

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 112-119(8) Kaliner, Michael A.¹; Oppenheimer, John; Farrar, Judith R.

Abstract:
Olopatadine is a tricyclic compound with antihistaminic, mast cell-stabilizing, and anti-inflammatory properties.

In the United States olopatadine is approved as a b.i.d. ophthalmic solution, Patanol (Alcon Laboratories, Inc., Fort Worth, TX) to treat all signs and symptoms of allergic conjunctivitis and as a q.d. formulation, Pataday (Alcon Laboratories, Inc.), to treat itching associated with allergic conjunctivitis. A nasal spray, Patanase (Alcon Laboratories, Inc.), was approved in 2008 for treatment of the symptoms of seasonal allergic rhinitis.

The available data on olopatadine was assessed with regard to future uses through a comprehensive literature review and a Roundtable Discussion held at the 2009 meeting of the American Academy of Allergy Asthma and Immunology.

The unique mechanisms of action of olopatadine still under study include mast cell stabilization, potent H₁-anthistaminic activity, and anti-inflammatory effects.

Data support consideration of nasal olopatadine for as-needed use for episodic symptoms of allergic rhinitis, for treatment of nonallergic rhinitis, and for use in combination with topical steroids for patients with moderate-to-severe allergy symptoms.

Document Type: Research article
DOI: 10.2500/aap.2010.31.3317
Affiliations: 1: Institute for Asthma and Allergy, Chevy Chase, Maryland, USA. makaliner@aol.com

Effects of type II thyroplasty on adductor spasmodic dysphonia.

2010-04-17T11:32:00.000+03:00

Otolaryngol Head Neck Surg. 2010 Apr;142(4):540-6.

Sanuki T, Yumoto E, Minoda R, Kodama N.

Graduate School of Medicine, Kumamoto University, Department of Otolaryngology Head & Neck Surgery, Kumamoto, Japan. otostl0319@fc.kuh.kumamoto-u.ac.jp

Abstract

OBJECTIVES: Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD.

STUDY DESIGN: Case series.

SETTING: University hospital.

SUBJECTS AND METHODS: Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/.

RESULTS: Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery.

CONCLUSIONS: Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD.

Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

PMID: 20304275 [PubMed - indexed for MEDLINE]

Sutureless tympanoplasty using acellular dermis.

2010-04-17T11:24:00.000+03:00

Am J Otolaryngol. 2010 Apr 12.

Raj A, Sayal A, Rathore PK, Meher R.

Department of Otolaryngology and Head, Neck Surgery, MAM College and Assoc. LN Hospital, New Delhi, India.

Abstract

OBJECTIVE: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome.

STUDY DESIGN: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing.

RESULTS: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups.

CONCLUSION: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain. Copyright © 2010 Elsevier Inc. All rights reserved.

Impact on hearing of routine ear suctioning at the tympanic membrane.

2010-04-17T11:22:00.000+03:00

Am J Otolaryngol. 2010 Apr 12. [Epub ahead of print]

Nelson JJ, Giraud A, Walsh R, Mortelliti AJ.

Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.

Abstract

OBJECTIVE: Patient and equipment safety has become increasingly scrutinized in today's medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects.

PATIENTS AND METHODS: Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts.

RESULTS: Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities.

CONCLUSIONS: Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.

Copyright © 2010 Elsevier Inc. All rights reserved.

Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza

2010-04-16T18:08:00.000+03:00

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

Winther B, Block SL, Reisinger K, Dutkowski R

OBJECTIVE: Acute otitis media (AOM) is the most common complication of pediatric influenza, and imposes a substantial health care burden. We examined the influence of oseltamivir treatment on the incidence and course of AOM in children with influenza.

METHODS: In the original study, 695 children 1-12 years who presented within 48h of the onset of influenza-like symptoms were randomized to oseltamivir (2mg/kg) or placebo given twice daily for 5 days. AOM was assessed at enrollment and days 3, 6 (+/-1), 10 (+/-2) and 28 (+/-7). AOM was clinically diagnosed by the participating primary care provider, supported by tympanometry when possible. We performed a retrospective analysis of those participants with laboratory-confirmed influenza (LCI). Assessments included the incidence and clinical course of new AOM cases.

RESULTS: In all, 452 children had LCI; 217 received oseltamivir and 235 placebo. AOM was diagnosed on or after study day 3 at a significantly lower frequency in the oseltamivir versus placebo group (12.4% versus 21.7%; relative risk [RR]: 0.57 [95% CI: 0.37, 0.88], respectively). Treatment effects were greatest for children 1-2 years (RR=0.42 [95% CI: 0.20, 0.89]) and 3-5 years (RR=0.45 [95% CI: 0.19, 1.04]), in whom the incidence of AOM was highest.

CONCLUSIONS: Oseltamivir treatment significantly reduces the emergence of new AOM infections in children with LCI; effects are most pronounced in those<5 years. Clinical trial number: WV15758.

Mucocutaneous leishmaniasis masquerading as Wegener granulomatosis

2010-04-16T17:55:00.000+03:00

JCR: Journal of Clinical Rheumatology 16 (3), 125-8 (Apr 2010)

Brahn E, Pegues DA, Yao Q, Craft N;

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles.

The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony.

Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.

Routine clotting screen has no role in the management of epistaxis: reiterating the point

2010-04-16T17:52:00.000+03:00

European Archives of Oto-Rhino-Laryngology (Apr 2010)

Shakeel M, Iddamalgoda T, Supriya M, Ah-See KW, Trinidade A;

Objective of the study is to investigate the role of clotting screen in adult patients presenting with epistaxis. The study is a prospective case series done in a teaching hospital in the Northeast of Scotland. Prospective data was collected for 100 consecutive patients with epistaxis admitted to the Department of Otolaryngology over 1 year (2006-2007 August). The demographics, co-morbidities, long-term medications and blood test results were noted for these patients.

A retrospective audit of all patients attending the Emergency Department (ED) with epistaxis during the same study period was also performed. The following were measured: frequency of clotting screen performed in patients with epistaxis; the treatment modifying effect of clotting screen results. Of the 100 admitted patients, 45 were male and 55 were female.

The majority of them had more than two co-morbidities such as hypertension, ischaemic heart disease and atrial fibrillation. Forty-seven patients were on aspirin, 19 on warfarin and 12 patients on clopidogrel. A clotting screen was done for 80 patients but only 2 patients (2.5%) had an abnormal INR. A total of 356 patients presented to the ED with epistaxis. Of 356 patients, 138 (39%) had their clotting screen checked. Of 138 patients, 42 (30%) were on warfarin. Only 7 patients (7/138 = 5%) had an abnormal result. Our data suggests that routine clotting screen check does not alter the epistaxis management in patients with no risk factors or with stable warfarin dosage.

Therefore, routine clotting screen in patients with epistaxis without relevant risk factors is not an evidence-based practice.

Propranolol treatment for infantile hemangiomas.

2010-04-03T18:14:00.002+03:00

Curr Opin Otolaryngol Head Neck Surg. 2009 Dec;17(6):458-9.
Buckmiller LM.

PURPOSE OF REVIEW: Infantile hemangiomas are the most common benign tumors of infancy and the majority of them occur in the head and neck. Recent literature has described propranolol for the treatment of these vascular tumors.

RECENT FINDINGS: Propranolol was serendipitously found to induce early involution in hemangiomas even during the proliferative phase of the hemangioma cycle. First reported in June 2008, and presented at the International Society for the Study of Vascular Anomalies meeting in Boston that same month, propranolol has stirred much interest in the physicians who treat these types of lesions. Early case report data are now appearing in the literature, and are verifying the findings of the initial studies as an effective treatment for hemangiomas. Our institution has the privilege of maintaining a high volume vascular center and we have begun treating patients with problematic hemangiomas with propranolol as well. The present article will briefly review the literature and give some of our preliminary experience with the drug.

SUMMARY: Research regarding propranolol is in its infancy but, should the initial results and safety record be borne out, it is likely to revolutionize how we manage infantile hemangiomas.

Fungal infection of the ear: A common problem in the north eastern part of Haryana.

2010-04-03T11:41:00.000+03:00

Int J Pediatr Otorhinolaryngol. 2010 Mar 25. [Epub ahead of print]
Aneja KR, Sharma C, Joshi R.

Department of Microbiology, Kurukshetra University, Kurukshetra 136 119, Haryana, India.

OBJECTIVE: The aim of this study was to determine the prevalence of fungal agents, sex distribution and predisposing factors involved in otomycosis. METHODS: Samples from the 118 clinically suspected patients of otomycosis were collected between January 2008 and February 2009, with an age group of 6 and 75 years. Mycological examination of all the samples was done to isolate the fungal agents involved in otomycosis.

RESULTS: Mycological examination has revealed the confirmation of fungal otomycosis in 78% of the suspected patients. Pruritus has been found as the most common symptom. The major predisposing factors responsible for the otomycosis have been found as the wearing of traditional customary clothes followed by itching on other body parts and swimming. It has been found to be more prevalent in females than males in the age group of 31-40 years, higher incidence occurring in the rainy season. The fungi involved in otomycosis belonged to Aspergillus niger, A. flavus, A. fumigatus, A. luchuensis, A. terreus, Candida albicans and Penicillium sp. Of these, A. niger followed by A. flavus were the dominant fungi. Aspergillus luchuensis as the cause of otomycosis has been reported for the first time.

CONCLUSION: Finally we can say higher incidence of otomycosis may be due to high degree of humidity, warm and dusty environment. So, keeping in view the high prevalence of otomycosis in India, critical diagnosis of the causative agent by employing aseptic and proper culture techniques and susceptibility testing for proper treatment of this disease is the need of the hour. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Neurodevelopmental disorders in children with severe to profound sensorineural hearing loss: a clinical study

2010-04-02T10:47:00.000+03:00

Developmental Medicine & Child Neurology (Mar 2010)
Chilosi AM, Comparini A, Scusa MF, Berrettini S, Forli F, Battini R, Cipriani P, Cioni G;

Aim: The effects of sensorineural hearing loss (SNHL) are often complicated by additional disabilities, but the epidemiology of associated disorders is not clearly defined. The aim of this study was to evaluate the frequency and type of additional neurodevelopmental disabilities in a sample of children with SNHL and to investigate the relation between these additional disabilities and the aetiology of deafness.

Method One hundred children with severe/profound SNHL (60 males, 40 females; mean age 5y 7mo, SD 3y 6mo, range 8mo-16y) were investigated using a diagnostic protocol including neurodevelopmental, genetic, neurometabolic, and brain magnetic resonance imaging (MRI) assessment.

Results Forty-eight per cent of the sample exhibited one or more additional disabilities, with cognitive, behavioural-emotional, and motor disorders being the most frequent. The risk of additional disabilities varied according to the type of aetiology. Thirty-seven out of 80 individuals with available MRIs showed signal abnormalities, in particular brain malformations (46%) and white matter abnormalities (54%). Frequency and type of disability were associated with aetiology (p=0.015) and MRI data (p<0.001).

Interpretation A multidimensional evaluation, including aetiological, neurodevelopmental, and MRI investigation, is needed for planning therapeutic intervention, such as cochlear implantation in children with severe to profound hearing impairment. The aetiology of deafness is a relevant risk indicator for the presence of an associated disorder.

Potentially malignant disorders of the oral and oropharyngeal mucosa; present concepts of management

2010-04-02T10:44:00.000+03:00

Oral Oncology (Mar 2010)
van der Waal I

In spite of tremendous progress in the field of molecular biology there is yet no single marker that reliably predicts malignant transformation of a potentially malignant disorder of the oral mucosa. Therefore, it is recommended to excise or laser any oral of oropharyngeal leukoplakia/erythroplakia, if feasible, irrespective of the presence or absence of dysplasia. However, it is actually unknown whether such removal truly prevents the possible development of a squamous cell carcinoma. Therefore, lifelong follow-up is recommended at intervals of no more than 6months. At present, oral lichen planus is more or less accepted as being a potentially malignant disorder. There are no means to prevent such event. The efficacy of follow-up of oral lichen planus is questionable.

Cricothyroid Joint Abnormalities in Patients With Rheumatoid Arthritis

2010-04-02T10:41:00.000+03:00

Journal of Voice (Mar 2010)
Berjawi G, Uthman I, Mahfoud L, Husseini ST, Nassar J, Kotobi A, Hamdan AL

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects-11 patients with advanced RA and eight normal controls-were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Is sensorineural hearing loss with chronic otitis media due to infection or aging in older patients?

2010-04-02T10:35:00.000+03:00

Auris Nasus Larynx 37 (3), 402-6 (Jun 2010)
Yoshida H, Miyamoto I, Takahashi H

OBJECTIVE: To clarify true incidence of sensorineural hearing loss in ears with chronic otitis media (COM).

METHODS: Bone conduction (BC) hearing thresholds of 180 preoperative patients (207 ears) with COM and 226 normal individuals (289 ears)were measured by audiometry, and the percentage of ears with BC thresholds being higher than normal range was evaluated in the COM group. In the COM group, the size of the perforation on the eardrum (n = 196) and the cross-sectional area of the mastoid air cells based on the axial CT image (n = 103) were also measured and correlated with the results of BC threshold.

RESULTS: The percentage of ears with BC thresholds being higher than normal range calculated from comparison to the control group tended to increase with age, ranging from 4.5% in the 20s to 34.1% in the 60s with an average of 26.6%. The increase in the BC thresholds did not correlate with the size of eardrum perforation, but correlated well with the size of the mastoid air cells.

CONCLUSION: These results may suggest that all measures for early cure, including surgery, should be considered as early as possible for patients with COM.

Unified Hands Technique for Mandibular Dislocation

2010-03-29T16:48:00.001+03:00

The Journal of Emergency Medicine
Volume 38, Issue 3, Pages 366-367 (April 2010)
David Cheng, MD, 470 Schooleys Mountain Road, Hackettstown, NJ 07840

Received 6 May 2008; received in revised form 4 December 2008; accepted 17 December 2008. published online 23 March 2009.
Abstract

Background: The conventional approach to mandibular dislocation involves intraoral bilateral inferior-posterior downward force on the patient's molar occlusal surfaces.
Discussion/Technique: The unified hands technique is a new method for reducing a mandibular dislocation. The technique involves intraoral unilateral application of both hands on the side of the dislocated mandible. This maneuver was successful in reducing a mandibular dislocation refractory to the traditional method of intraoral bilateral inferior-posterior downward force on the patient's molar occlusal surface.
Conclusion: The technique described may be useful for the emergent reduction of mandibular dislocations when traditional methods fail.

Multicenter Study of Repeat Epinephrine Treatments for Food-Related Anaphylaxis

2010-03-26T11:26:00.000+03:00

PEDIATRICS (doi:10.1542/peds.2009-2832)

Susan A. Rudders, MDa,b, Aleena Banerji, MDc, Blanka Corel, MDb, Sunday Clark, MPH, ScDd, Carlos A. Camargo, Jr, MD, DrPHb,c
aDivision of Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts;
bDepartment of Emergency Medicine and
cDivision of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
dDepartment of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Objective We sought to establish the frequency of receiving >1 dose of epinephrine in children who present to the emergency department (ED) with food-related anaphylaxis.

Patients and Methods We performed a medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1, 2001, and December 31, 2006. We focused on causative foods, clinical presentations, and emergency treatments.

Results Through random sampling and appropriate weighting, the 605 reviewed cases represented a study cohort of 1255 patients. These patients had a median age of 5.8 years (95% confidence interval [CI]: 5.3–6.3), and the cohort was 62% male. A variety of foods provoked the allergic reactions, including peanuts (23%), tree nuts (18%), and milk (15%). Approximately half (52% [95% CI: 48–57]) of the children met diagnostic criteria for food-related anaphylaxis. Among those with anaphylaxis, 31% received 1 dose and 3% received >1 dose of epinephrine before their arrival to the ED. In the ED, patients with anaphylaxis received antihistamines (59%), corticosteroids (57%), epinephrine (20%). Over the course of their reaction, 44% of patients with food-related anaphylaxis received epinephrine, and among this subset of patients, 12% (95% CI: 9–14) received >1 dose. Risk factors for repeat epinephrine use included older age and transfer from an outside hospital. Most patients (88%) were discharged from the hospital. On ED discharge, 43% were prescribed self-injectable epinephrine, and only 22% were referred to an allergist.

Conclusions Among children with food-related anaphylaxis who received epinephrine, 12% received a second dose. Results of this study support the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine.
Abbreviations: CI = confidence interval

Successful treatment of cutaneous hemangioma of infancy with topical imiquimod 5%: A report of 3 cases

2010-03-26T11:11:00.000+03:00

Ear, Nose and Throat Journal (ENT) 89 (3), E21-5 (Mar 2010)

Dann M, Cable B, Bessinger G, Senchak AJ;
Hemangioma of infancy is the most common benign tumor of childhood. Most of these tumors spontaneously regress over several years. However, many parents seek treatment for children with cutaneous hemangiomas because of the potential for disfigurement and the attendant psychosocial effects. We report our use of the nightly application of topical imiquimod 5% cream as an alternative to traditional management in 3 infants who presented with rapidly growing facial hemangiomas. After approximately 3 to 5 months of treatment, all 3 patients had experienced a near-complete resolution of their lesions without significant side effects. Based on our experience, we believe that topical imiquimod may be an important tool for the otolaryngologist who treats cutaneous hemangiomas.

Induced atelectasis of the middle ear and its clinical behavior

2010-03-24T18:38:00.000+03:00

European Archives of Oto-Rhino-Laryngology Volume 248, Number 5 / July 1991
M. Luntz1, S. Eisman1 and J. Sade1 (1) Department of Otolaryngology, Sackler School of Medicine, The Bioengineering Program, Tel-Aviv University, Ramat Aviv, Israel
(2) 14 Hagefen Street, 47254 Ramat Hasharon, Israel

Received: 10 September 1990 Accepted: 10 October 1990
Summary Atelectatic ears are often treated with ventilating tubes for long periods of time. However, a certain percentage of atelectatic ears and retraction pockets resolve spontaneously over time. In order to determine whether self-aeration had been achieved in atelectatic ears previously fitted with ventilating tubes, the tubes were sealed and the ears were then closely followed. Out of 37 such tests, atelectasis did not recur in 4 ears, allowing their ventilating tubes to be removed. In 33 tests atelectasis redeveloped within 1–2 h after the ventilating tube was sealed, with ears reverting to the same degree and shape as the original atelectatic condition. The seals were then removed, resulting in resolution of atelectasis. These observations were enforced by previous observations of similar changes and suggest that the partial pressures of the blood gases may be an important factor in controlling the level and possibly also the pathogenesis of atelectasis. The method of testing described also can be used in selected cases to determine whether or not a given atelectatic ear still requires a ventilating tube.

Drug-induced rhinitis

2010-03-19T07:51:00.000+03:00

Clinical and Experimental Allergy 40 (3), 381-4 (Mar 2010)
Varghese M, Glaum MC, Lockey RF

Background: Rhinitis is characterized by inflammation of the mucous membranes lining the nose and can be divided into two categories, allergic and non-allergic. Drug-induced is a type of non-allergic rhinitis.

Objective A review of the literature was conducted. Very little is known about this topic and there are no publications to date solely devoted to drug-induced rhinitis.

Methods A PubMed and Medline search was conducted using a combination of the keywords; drug, medication, rhinitis, congestion, rhinorrhea, sneezing, pruritus, vasomotor, reflex, neurogenic, allergic and non-allergic. Medications that were found in the search were then cross-referenced with the physicians desk reference and Epocrates. The final literature search was conducted in August 2009.

Results Three categories of drug-induced rhinitis exist based on the mechanism of action. These include local inflammatory, neurogenic and idiopathic types. Rhinitis medicamentosa, a form of drug-induced rhinitis, has unique characteristics.

Conclusion When possible, the offending medication should be discontinued or substituted. Although there are no established treatment recommendations for drug-induced rhinitis other than avoidance, clinical experience suggests that it would be reasonable to initiate use of an intranasal corticosteroid spray to treat symptomatically. The addition of an intranasal antihistamine in combination with use of an intranasal corticosteroid may be considered as step-up therapy if the intranasal corticosteroid alone is not effective.

Non-invasive evaluation of vertebral artery blood flow in cervical spondylosis with and without vertigo and association with degenerative changes

2010-03-17T17:47:00.000+03:00

Clinical Rheumatology 0770-3198 (Print) 1434-9949 (Online), Published online: 16 February 2010 Remzi Cevik1 , Aslan Bilici2, Kemal Nas1, Zeynep Demircan1 and Rojbin Ceylan Tekin2(1) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010

Abstract Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process.
The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis.
A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo.
The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis.

The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.

Rhinitis and sinusitis

2010-03-12T10:35:00.000+03:00

Journal of Allergy and Clinical Immunology (JACI) 125 (2 Suppl 2), S103-15 (Feb 2010)
Dykewicz MS, Hamilos DL

Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning.
Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms.
An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days.

Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis.

Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required

Fluticasone Reverses Oxymetazoline Induced Tachyphylaxis of Response and Rebound Congestion

2010-03-12T10:24:00.000+03:00

American Journal of Respiratory and Critical Care Medicine (Mar 2010)
Clearie K, Khan F, Lipworth B, Vaidyanathan S, Williamson P

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RATIONALE: Chronic use of intranasal decongestants like oxymetazoline leads to tachyphylaxis of response and rebound congestion, due to alpha-adrenoceptor mediated down-regulation and desensitization of response OBJECTIVES: We evaluated if tachyphylaxis can be reversed by intranasal fluticasone propionate, as well as the relative alpha1-/alpha2-adrenoceptor components of tachyphylaxis using the alpha1-antagonist prazosin. METHODS: In a randomized, double-blind, placebo-controlled, crossover design, 19 healthy subjects received intranasal oxymetazoline 200Amicrog tid for 14 days, followed by addition of fluticasone 200Amicrog bid for a further 3 days. At day 1, 14 and 17, participants received a single dose of oral prazosin 1mg or placebo with measurements made before and 2 hours later.
MEASUREMENTS AND MAIN RESULTS: Outcomes evaluated were peak nasal inspiratory flow, nasal resistance, blood flow and oxymetazoline dose-response curve (DRC). On day 14 vs. day 1, inspiratory flow decreased (mean difference, 95% CI) (â 47.9 L.min(-1);, â63.9 to â31.9, P<.001), the DRC shifted downward (24.8 L.min-1, 20.3 to 29.3, P<.001). On day 17 vs. day 14, after fluticasone, inspiratory flow increased (45.0 L.min(-1), 30.0 to 61.0, P<.001), the DRC shifted upward (26.2 L.min(-1), 21.7 to 30.7, P<.001). On day 1, prazosin reduced inspiratory flow (â52.6 L.min(-1), â19.2 to â86.0) compared to baseline. This effect was abolished on day 14 (7.9 L.min-1, â41.3 to 25.5).
CONCLUSIONS: Oxymetazoline induced tachyphylaxis and rebound congestion is reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trials registration information available at www.clinicaltrials.gov, i.d. #NCT00487032.

Overexpression of glucocorticoid receptor-beta in severe allergic rhinitis

2010-03-10T18:04:00.000+03:00

Auris Nasus Larynx (Feb 2010)
Ishida A, Ohta N, Koike S, Aoyagi M, Yamakawa M;

OBJECTIVE: To clarify the role of glucocorticoid receptor-beta in resistance to glucocorticoid therapy for allergic rhinitis, we studied 37 tissue samples from 20 patients with severe allergic rhinitis, and samples from age-matched controls.
METHODS: Patients were treated with intranasal fluticasone for 6 months and inferior turbinectomy was performed for patients with poor response to glucocorticoid treatment. The expression of glucocorticoid receptor-alpha (GR-alpha), glucocorticoid receptor-beta (GR-beta), and nuclear factor-kappaB (NF-kappaB) in nasal mucosa was studied immunohistochemically.
RESULTS: GR-alpha and NF-kappaB were expressed to a similar extent in patients and controls, but GR-beta was expressed significantly more in patients, resulting in an increased GR-beta/GR-alpha ratio.
CONCLUSION: Our findings suggest that GR-beta plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis

Autoimmune sialadenitis

2010-03-10T17:56:00.001+03:00

Hals-Nasen-Ohrenheilkunde (HNO) (Mar 2010)

Guntinas-Lichius O, Vissink A, Ihrler S

Using the European-American classification criteria the diagnosis of autoimmune sialadenitis in Sjögren's syndrome can generally be easily established or excluded. In addition, sonography performed by the ENT physician is helpful in diagnosing and especially in follow-up screening for MALT lymphomas, which 5%-10% of patients develop. Therapy of sicca symptoms is primarily symptomatic using substitution with fluids and stimulation with oral cholinergic drugs. Corticosteroids and/or antibiotics may play a role in patients with severe inflammatory episodes of autoimmune sialadenitis. Systemic therapy with immunomodulatory drugs such as azathioprine or cyclophosphamide is reserved for patients with extraglandular manifestations. However, the efficacy of this therapy is not proven by clinical studies. Rituximab, a new monoclonal CD20 antibody, seems to offer the first possibility of a causal therapy, under which the lymphoepithelial lesions in the salivary glands can disappear and saliva production improves. However, larger clinical studies are needed to evaluate the efficacy of this new therapy.

Optimal treatment of autoimmune sialadenitis requires interdisciplinary collaboration between ENT physician, oral and maxillofacial surgeon, rheumatologist, ophthalmologist, dentist, and pathologist.

Cavitating Otosclerosis: Clinical, Radiologic, and Histopathologic Correlations

2010-03-10T17:52:00.003+03:00

Otology & Neurotology Feb 2010
Makarem AO, Hoang TA, Lo WW, Linthicum FH, Fayad JN

BACKGROUND:: Despite the high prevalence of otosclerosis and its having long been a subject of scrutiny, cavitary changes in otosclerosis are rare and not well known. Here, we describe and introduce into the literature the unusual histologic and radiologic findings of cavitation and its possible clinical relevance in patients with advanced cochlear otosclerosis.
METHODS:: Cases with clinical otosclerosis and presence of cavitation were selected from our temporal bone collection and correlated with premortem imaging and clinical manifestations.
RESULTS:: Two cases of cochlear otosclerosis presented with a clinical syndrome possibly attributed to the existence of a cavity within the otosclerotic foci.
CONCLUSION:: Cavitating otosclerosis is a not well-known occurrence in patients with advanced cochlear otosclerosis, and it is a possible cause of a "third window" syndrome and surgical complications.

Rhinogenic Laryngitis, Cough, and the Unified Airway

2010-02-22T15:35:00.000+03:00

Otolaryngologic Clinics of North America
Volume 43, Issue 1, Pages 111-121 (February 2010)
John H. Krouse, MD, PhDa, Kenneth W. Altman, MD, PhDb

Over the past 10 years, there has been increasing recognition of the interaction between the upper and lower airways in patients with a variety of infectious and inflammatory illnesses, including allergic rhinitis, rhinosinusitis, and asthma. Epidemiologic and mechanistic links have been proposed to demonstrate these relationships and to offer possible etiologic explanations to account for these observations. Among patients with upper respiratory illnesses, cough can be seen as a common symptom, both from the direct influences of upper airway inflammation, which incite reflex changes and bronchospasm, and from the exacerbation of associated pulmonary processes, such as asthma. Despite this increasing awareness of interaction between the upper and lower airways, the influence of both upstream and downstream respiratory inflammatory processes on laryngeal pathophysiology has not been extensively studied. Research suggests, however, that both direct stimulatory effects on the larynx and secondary effects of mucus production and mucus trafficking can create a range of laryngeal symptoms, including cough.

This review discusses the interaction of the upper and lower airway in respiratory disease, and focuses on the effect of these respiratory processes on laryngeal inflammation, function, and symptoms.

Mastoid pneumocele with secondary pneumatocele causing external auditory canal obstruction and the influence of forced nose blowing.

2010-02-20T17:38:00.002+03:00

Ear Nose Throat J. 2010 Jan;89(1):E3-5.Delabie G, Gordts F, Clement PA.

Department of Otorhinolaryngology, Head and Neck Surgery, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.

We present a case involving a 36-year-old man who had a feeling that his right ear was obstructed and who had associated conductive hearing loss that was exacerbated by nose blowing. On otoscopy, a soft-tissue swelling was seen in the posterosuperior aspect of the right external auditory canal. Computed tomography revealed the presence of hyperaerated mastoid air cells and an air-containing cavity connected with the enlarged mastoid air cells, narrowing the external auditory canal. A radiographic diagnosis of a mastoid pneumocele with secondary pneumatocele was made. A novel hypothesis is presented, that high nasal pressures play an important role in the progressive formation of a pneumocele/pneumatocele as a result of air invasion via the eustachian tube. Symptoms disappeared after a myringotomy tube was placed. Computed tomography performed 6 months later showed an impressive remodeling of the temporal bone.

PMID: 20155688 [PubMed - in process]

Nitric oxide formation in the oropharyngeal tract: possible influence of cigarette smoking

2010-02-20T17:04:00.002+03:00

Nitric Oxide Volume 11, Issue 3, November 2004, Pages 247-255
H. Marteusa, A. Mavropoulosd, J.P. Palma, A.-K. Ulfgrenc, J. Bergströmb and K. Alvinga, ,
aDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
bDepartment of Odontology, Karolinska Institutet, Stockholm, Sweden
cRheumatology Research, Karolinska Hospital, Stockholm, Sweden
dDepartment of Odontology, Oslo University, Oslo, Norway
Received 17 February 2004; revised 31 August 2004. Available online 16 November 2004.
Abstract
Cigarette smoking reduces the level of nitric oxide (NO) in exhaled air by an unknown mechanism. The view that part of the effect of cigarette smoking on NO production should occur in the oropharyngeal tract is supported by several studies. We have therefore compared smokers and non-smokers regarding non-enzymatic formation of NO from nitrite in the oral cavity since this is a primary candidate target for cigarette smoke. We have also looked at NO synthase-dependent NO formation in the mucosa of the oropharyngeal tract as an alternative target for the inhibitory effect induced by cigarette smoke. Smokers exhaled 67% lower levels of NO than controls (p < 0.01, n = 15 each group). We could not detect any significant difference in salivary nitrite, nitrate or ascorbate between smokers and non-smokers. Mouthwash with the antibacterial agent chlorhexidine reduced salivary nitrite (−65%) and exhaled NO levels (−10%) similarly in the two groups. Immunohistochemical techniques revealed dense expression of inducible (but not endothelial or neuronal) NO synthase in the squamous epithelium of non-inflamed tonsillar and gingival tissue biopsies. In the same biopsies, significant Ca2+-independent citrulline-forming activity was detected. We found no difference between smoking and non-smoking subjects regarding NO-synthase expression and in vitro activity. In another group of non-smoking subjects (n = 10), spraying the oropharyngeal tract with the NO-synthase inhibitor NG-monomethyl-L-arginine (250 mg) significantly reduced exhaled NO levels for at least 30 min (−18%, p < 0.01). Our data suggest that cigarette smoking does not affect non-enzymatic NO formation from nitrite in saliva. However, NO is also formed by inducible NO synthase in the squamous epithelium of the normal oropharyngeal tract. We suggest that cigarette smoking may down-regulate enzymatic NO formation in the oropharyngeal compartment as well as in the bronchial compartment.

Adverse Effects of Long-Term Proton Pump Inhibitor Use: A Review for the Otolaryngologist

2010-02-19T10:53:00.000+03:00

Journal of Voice (Feb 2010) Chapman DB, Rees CJ, Lippert D, Sataloff RT, Wright SC;

OBJECTIVE: Proton pump inhibitors (PPIs) are the mainstay of current medical management for laryngopharyngeal reflux, and treatment often involves long-term use of this class of medications. The long-term adverse effects of PPI use have not been studied extensively, but several analyses have demonstrated epidemiological links between PPI use and adverse outcomes. These include altered mineral and vitamin absorption, orthopedic injury, acute coronary syndromes (ACS), and infectious risks.

STUDY DESIGN: A PubMed search was performed for subject headings, including PPIs and adverse outcomes. Relevant studies were included in this review. Studies were compiled, reviewed, and compared in a narrative form.

RESULTS: Several epidemiological links between PPI use and metabolic, infectious, cardiac, and orthopedic adverse outcomes were found. No definite causal effects were identified.

CONCLUSION: Given these epidemiological patterns, we recommend that the clinician be aware of these possible unintended consequences. In addition, we recommend consideration of dual-energy X-ray absorptiometry (DEXA) bone density scans in at-risk patients who have not been previously tested. We recommend consideration of vitamin B(12) and iron levels in selected patients who are at high risk. We also recommend close communication with our cardiology colleagues, as we attempt to ascertain the relationship between clopidogrel and PPI use. We recommend caution in the use of omeprazole in patients undergoing active treatment for ACS. Finally, we recommend consideration of Helicobacter pylori or serum gastrin level testing in patients with known risk factors for gastric carcinoma.

Subdural empyema complicating a concha bullosa pyocele

2010-02-18T22:51:00.001+03:00

International Journal of Paediatric Otorhinolaryngology Volume 65, Issue 3, Pages 249-252 (24 September 2002)
Rémi Marianowskiab, Marcello Farragia, Michel Zerahc, Francis Brunelled, Yves Manacha
a Department of Pediatric Otorhinolaryngology, Hôpital Necker Enfants Malades, Paris, France
b Department of Otorhinolaryngology, Hôpital Morvan, 5 Avenue Foch, 29200 Brest, France
c Department of Pediatric Neurosurgery, Hôpital Necker Enfants Malades, Paris, France
d Department of Pediatric Radiology, Hôpital Necker Enfants Malades, Paris, France
Received 15 February 2002; received in revised form 22 May 2002; accepted 27 May 2002.

Abstract
Concha bullosa is the most common anatomic variant of the middle turbinate and remains usually asymptomatic. We report a case of concha bullosa pyocele with a subdural empyema in a 11-year-old girl presenting with a subcutaneous tumefaction without neurologic deficit. Computed tomography and magnetic resonance imaging confirmed a subdural empyema communicating with subcutaneous effusion and the presence of a concha bullosa pyocele being responsible for the obstruction of ostiomeatal complex leading to frontal sinusitis. Resection of the middle turbinate with a middle meatotomy and a frontal skin incision combined with an adequate antibiotic treatment allowed this child to recover within 6 weeks.

Rhinitis medicamentosa: electron microscopic changes of human nasal mucosa

2010-02-12T10:08:00.000+03:00

Otolaryngol Head Neck Surg. 2007 Jan;136(1):57-61.

Knipping S, Holzhausen HJ, Goetze G, Riederer A, Bloching MB.

Department of Otorhinolaryngology-Head and Neck Surgery, The Martin Luther University Halle Wittenberg, Germany. stephan.knipping@medizin.uni-halle.de

OBJECTIVE: Prolonged application of nasal vasoconstrictors causes rhinitis medicamentosa (RM). Nasal obstruction is induced by rebound swelling when the decongestive effect has disappeared. The aim of this study was to demonstrate ultrastructural changes in RM.

STUDY DESIGN AND SETTING: Tissue samples of inferior turbinates from 22 patients with RM and 10 patients without rhinitis were taken during nasal surgery. Ultrathin sections were investigated by using a transmission electron microscope (TEM).

RESULTS: The TEM findings revealed severe epithelial damages such as loss of ciliated cells. In the subepithelial region, the vascular endothelium showed gaps and ruptures of basal lamina.

CONCLUSION: RM is a drug-induced damage of human nasal mucosa. Loss and destruction of ciliated epithelial cells are the morphologic correlation of the disturbed mucociliary clearance. In addition, vascular endothelium revealed ultrastructural changes. This could be caused by an increased vascular permeability with consecutive interstitial edema.

SIGNIFICANCE: This study demonstrated new morphological aspects of rhinitis medicamentosa.

PMID: 17210334 [PubMed - indexed for MEDLINE]

Rhinitis: a complication to asthma

2010-02-12T09:25:00.000+03:00

Allergy (Jan 2010)

Hansen JW, Nolte H, Backer V, Thomsen SF

Abstract
Background: Asthma and rhinitis often co-occur, and this potentially increases the disease severity and impacts negatively on the quality of life. We studied disease severity, airway responsiveness, atopy, quality of life and treatment in subjects with both asthma and rhinitis compared to patients with asthma or rhinitis alone.

Methods: We examined 878 patients: 182 with asthma, 362 with rhinitis and 334 with both asthma and rhinitis. All had a clinical interview concerning severity of symptoms, treatment, and quality of life, a skin prick test, a lung function test and a bronchial provocation with methacholine.

Results: Patients with both asthma and rhinitis had less severe asthma based on the frequency of respiratory symptoms compared to patients with asthma alone (55%vs 66%P = 0.01). On the contrary, they were more airway responsive (P<0.05) and had more perennial allergy (P<0.001). Asthmatics had poor perception of the general health, independent of rhinitis (P<0.001). No differences were found in asthma-specific quality of life, whereas rhinitis-specific quality of life was worse in those with both asthma and rhinitis compared to those with rhinitis alone (P<0.01). Subjects with both diseases were undertreated in 85% of the cases.

Conclusion: We encourage that these observations be used in the evaluation and treatment of patients with asthma and rhinitis and that they contribute to the understanding of asthma and rhinitis as a uniform airways disease.

An assessment of sinonasal anatomic variants potentially associated with recurrent acute rhinosinusitis

2010-02-12T09:18:00.000+03:00

The Laryngoscope (Feb 2010)
Alkire BC, Bhattacharyya N;

OBJECTIVES/HYPOTHESIS:: To examine sinonasal anatomic variants that may predispose toward recurrent acute rhinosinusitis (RARS).

STUDY DESIGN:: Retrospective case-control.

METHODS:: Sinus computed tomography (CT) scans from a consecutive series of adult patients meeting strict diagnostic criteria for RARS were retrospectively reviewed. A control group was assembled from patients who underwent pituitary or temporal bone CT for a nonrhinosinusitis indication. CT scans were scored for the presence of Haller cells, concha bullosa, and impinging septal spurs. Maximal septal deviation (degrees), infundibular widths, and Lund staging were also assessed. The prevalence of these anatomic variants was statistically compared between the RARS and control groups.

RESULTS:: Thirty-six patients met diagnostic criteria for RARS (mean age, 47.2 years; 2:1 female preponderance); 42 control patients were identified. The mean Lund score for patients with RARS was 2.25 versus 1.27 for the control group (P<.001). Although RARS patients were more likely to manifest concha bullosa (41.7% vs. 28.6%) or impinging septal spurs (27.8% vs. 19.0%), these differences were not statistically significant (P = .165 and P = .260, respectively). However, patients with RARS were significantly more likely to radiographically demonstrate Haller cells (39.9% vs. 11.9%, respectively, P = .006). Finally, patients with RARS had significantly smaller mean infundibular widths when compared with control patients (0.591 mm vs. 0.823 mm, respectively, P<.001).

CONCLUSIONS:: The presence of Haller cells and smaller infundibular widths were statistically associated with RARS when compared to control patients. Our data suggest that anatomy could play a role in the pathogenesis of RARS. Further prospective study is warranted. Laryngoscope, 2010.

EAR NOSE & THROAT Abstracts

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?

Influence of lipoproteins and fibrinogen on pathogenesis of sudden sensorineural hearing loss

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

Omalizumab: Anti-IgE Therapy in Allergy

Current Allergy and Asthma Reports (Jan 2011)

Kopp MV

Vocal cord dysfunction: what do we know?

European Respiratory Journal 37 (1), 194-200 (Jan 2011)

European Respiratory Journal 37 (1), 194-200 (Jan 2011)

Kenn K, Balkissoon R

Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults

Journal of Allergy and Clinical Immunology (JACI) 127 (1), 72-80.e2 (Jan 2011)

Journal of Allergy and Clinical Immunology (JACI) 127 (1), 72-80.e2 (Jan 2011)

Nelson HS, Nolte H, Creticos P, Maloney J, Wu J, Bernstein DI

Effectiveness criteria for the topical application of glucocorticosteroids to the treatment of exudative otitis media associated with allergic rhinitis

Vestnik Otorinolaringologii (5), 32-34 (2010)

Vestnik Otorinolaringologii (5), 32-34 (2010)

Poliakova SD, Popova EA

Neuromonics Tinnitus Treatment: Third Clinical Trial

Ear & Hearing: April 2007 - Volume 28 - Issue 2 - pp 242-259doi: 10.1097/AUD.0b013e3180312619

Davis, Paul B.; Paki, Bardia; Hanley, Peter J.

Chronic cough and irritable larynx

Journal of Allergy and Clinical Immunology (JACI) (Dec 2010)

Bucca CB, Bugiani M, Culla B, Guida G, Heffler E, Mietta S, Moretto A, Rolla G, Brussino L

The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway

The Laryngoscope

Abstract

Objective:

Study Design:

Methods:

Results:

Conclusions:

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study

European Archives of Oto-Rhino-Laryngology (Nov 2010)

European Archives of Oto-Rhino-Laryngology (Nov 2010)

Kutluhan A, Salviz M, Bozdemir K, Kanbak O, Ulu M, Yalçiner G, Bilgen AS

Bacterial communication encourages chronic, resistant ear infections

Complications of adenotonsillectomy

Current Opinion in Otolaryngology & Head & Neck Surgery:December 2010 - Volume 18 - Issue 6 - p 539–543doi: 10.1097/MOO.0b013e3283404dccPediatric otolaryngology: Edited by Lisa BuckmillerStatham, Melissa MAbstract

Statham, Melissa M

Abstract

Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults

The Journal of Laryngology & Otology

25 Nov 2010

M Isaksona1 and S Hugossona1 c1

Postoperative bleeding in paediatric ENT surgery. First results of the German ESPED trial

Hämostaseologie 30 (41), S108-11 (Nov 2010)

Hämostaseologie 30 (41), S108-11 (Nov 2010)

Bidlingmaier C, Olivieri M, Stelter K, Eberl W, von Kries R, Kurnik K;

Safety of intranasal Bevacizumab (avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis

The Laryngoscope (Nov 2010)

The Laryngoscope (Nov 2010)

Chen S, Karnezis T, Davidson TM;

ENT morbidity at high altitude

The Journal of Laryngology & OtologyFirstView Articledoi: 10.1017/S0022215110002331 (About doi)Published online by Cambridge University Press 17 Nov 2010

The Journal of Laryngology & Otology

B K Prasad

Daily Short-Term Intratympanic Dexamethasone Treatment Alone as an Initial or Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

A Novel Dominant and a De Novo Mutation in the GJB2 Gene (Connexin-26) Cause Keratitis-Ichthyosis-Deafness Syndrome: Implication for Cochlear Implantation

Arndt, Susan; Aschendorff, Antje; Schild, Christian; Beck, Rainer; Maier, Wolfgang; Laszig, Roland; Birkenhäger, RalfFebruary 2010 - Volume 31 - Issue 2 - pp 210-215

Ontogeny of Odor Liking during Childhood and Its Relation to Language Development

Posttonsillectomy hemorrhage: Blame on surgeons or genes?

The Laryngoscope

Objective:

Design and Setting:

Patients:

Measurements and Results:

Conclusions:

Xylitol as a prophylaxis for acute otitis media: systematic review

Hypothyroid-associated sensorineuronal deafness

Alpha-1-Blockers Are Useful in the Symptomatic Management of Obstructive Salivary Gland Diseases

Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment

Current Opinion in Otolaryngology & Head and Neck Surgery (Aug 2010)

Dubach P, Mantokoudis G, Caversaccio M;

Bilateral symptomatic petrous apex effusion

INDIAN JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERYVolume 62, Number 2, 186-188, DOI: 10.1007/s12070-010-0034-4

Muzeyyen Yildirim, Senem Senturk, Ebru Guzel, Aslan Guzel and Ismail Topcu

Abstract

Acute otitis media: to follow-up or treat?;

Ear & Hearing: April 2007 - Volume 28 - Issue 2 - pp 242-259
doi: 10.1097/AUD.0b013e3180312619

Current Opinion in Otolaryngology & Head & Neck Surgery:
December 2010 - Volume 18 - Issue 6 - p 539–543
doi: 10.1097/MOO.0b013e3283404dcc
Pediatric otolaryngology: Edited by Lisa Buckmiller

Statham, Melissa M
Abstract

M Isakson^a1 and S Hugosson^a1 ^c1

The Journal of Laryngology & Otology
FirstView Article
doi: 10.1017/S0022215110002331 (About doi)
Published online by Cambridge University Press 17 Nov 2010

INDIAN JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
Volume 62, Number 2, 186-188, DOI: 10.1007/s12070-010-0034-4