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Table of Contents
Year : 2002  |  Volume : 4  |  Issue : 2  |  Page : 55-69

Selected abstracts

Date of Web Publication7-Feb-2022

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.337367

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How to cite this article:
. Selected abstracts. Saudi J Otorhinolaryngol Head Neck Surg 2002;4:55-69

How to cite this URL:
. Selected abstracts. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2002 [cited 2023 Mar 27];4:55-69. Available from: https://www.sjohns.org/text.asp?2002/4/2/55/337367

  Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission Top

pp. 11-14(4) January 2002, vol. 29, no. 1, Auris Nasus Larynx,

Topcu I.; Cureoglu S.[1]; Yaramis A.; Tekin M.; Oktay F.; Osma U.; Meric F.; Katar S.

[l]Department of Otorhinolaryngology, Faculty of Medicine, Dicle University, Kulak Burun Bogaz Anabilim Dai, 21280 , Diyarbakir, Turkey


Objective: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission.

Methods: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected).

Results: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s.

Conclusion: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.

Keywords: Tuberculous meningitis; Hearing loss; Brainstem; Auditory evoked response audiometry; Children

  Contemporary trends in microbiology and antibiotic resistance in otolaryngology Top

pp. 59-63(5) January 2002, vol. 29, no. 1, Auris Nasus Larynx,

Bhattacharyya N.[l]; Shapiro J.

[l]Division of Otolaryngology, Brigham and Women’s Hospital, Harvard Medical School, 333 Longwood Avenue, 02115, Boston, MA, USA


Objective: to determine current microbiologic yields and characterize antibiotic resistance patterns for organisms cultured from head and neck infections.

Methods: results of out-patient cultures submitted from an academic otolaryngology practice over the period 1994-1998 were reviewed. A database was constructed, and culture results were analyzed for sites of infection, organism recovery rate, infecting microbiological agent, antibiotic resistance patterns, and 5-year trends. X2 analysis was used to determine associations between site of infection, infecting agent and antibiotic resistance over the years of the study.

Results: a total of 986 aerobic cultures were reviewed. The most common sites cultured were the nose/paranasal sinuses (469), throat (377), and ear (23). In 465 (47.2%) cultures, normal flora or no growth occurred. Of the throat culture subset, 69.7% were negative, whereas 69.1% of sinonasal cultures recovered organisms. Gram positive cocci were the most commonly recovered organism type (30.9%), followed by Gram negative rods (GNR, 17.2%). These rates remained relatively constant over the years of the study. GNR were found in 39.1 and 25.2% of ear and sinus cultures, respectively. Antibiotic sensitivities were conducted on 257 specimens (49.3% of positive cultures). The average number of antibiotic resistances per bacteria remained stable at approximately 1.59 over the years (P=0.086, analysis of variance (ANOVA)). Antibiotic resistance rates increased for clindamycin, cefazolin, and erythromycin over the years of the study (P<0.05, X2). Ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole resistance rates did not increase over the years of the study. Vancomycin resistance did not occur.

Conclusions: as a significant proportion of head and neck cultures will be negative, their utility should be re-examined. GNR infections are more common in the head and neck than earlier thought. There is a trend towards increasing antibiotic resistance in head and neck infections, urging careful andappropriate use of antibiotics.

Keywords: Otolaryngology; Antibiotic resistance; Microbiology

  Bone involvement in chronic rhinosinusitis assessed by 99mTc-MDP bone SPECT Top

pp. 156-161(0) June 2002, vol. 27, no. 3, Clinical Otolaryngology & Allied Sciences,

Jangy.J.; Koo T.W.; Chung S.Y.; Park S.G.


To investigate the clinical significance of bone involvement in chronic rhinosinusitis, 99mTc- MDP bone single photon emission computed tomography (SPECT) was studied in 43 patients diagnosed as having chronic rhinosinusitis. Quantitative isotope uptake indices calculated on SPECT were compared between the patient and a control group, and between patients with a good postoperative outcome and those with a poor outcome. The patient group showed a significantly higher isotope uptake than the control group. The uptake of isotope in the ethmoid sinus areas in patients who had a poor postoperative outcome was significantly higher than those who had a good outcome. Our study suggests that patients with chronic rhinosinusitis have apparent bony involvement, and patients with more severe bone involvement may have a poorer treatment outcome.

Keywords: rhinosinusitis; bone involvement; single photon emission computed tomography (SPECT)

  Sound localization in patients with cochlear implant-preliminary results Top

pp. 1-7(7) 31 May 2002, vol. 64, no. 1, International Journal of Pediatric Otorhinolaryngology,

Luntz M.[l]; Brodsky A.; Hafner H.; Shpak T.; Feiglin H.; Pratt H.

[1]Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine Technology, Bnai Zion Medical Center, PO Box 4940, 7 Colomb Street, 31048 , Haifa, Israel


Objectives: To evaluate sound localization ability in patients with unilateral cochlear implant, who do not wear a hearing aid on the contralateral ear, and to try to improve this ability by training. Setting: Tertiary academic referral center.

Methods: In the initial test, patients were exposed to sound stimuli from different directions and were asked to localize them. Following a training period the patients were re-evaluated by the same test. For each test, the percentage of correct answers and the final test score were calculated.

Results: In the initial test, the mean score of the study group of four cochlear implant users was 42.8 (out of a maximal score of 100), the mean rate of correct responses was 27.5%. Following a training period (6.5 sessions on the average), on the final test the mean score of the group was 74.3, white the mean rate of correct responses was 66.5%.

Conclusions: The results demonstrated that patients with unilateral cochlear implant have some ability to localize sound, and that this ability may be improved by regular training.

Keywords: Sound lateralization; Speech discrimination; Central auditory system

  Cochlear implantation in the obliterated cochlea Top

pp. 147-152(0) June 2002, vol. 27, no. 3, Clinical Otolaryngology & Allied Sciences,

Raut V; Toner J.G.


We present three cases of acquired deafness, associated with obliterated cochleas, in which the apparently radiologically more favourable side was chosen for implantation. In the first case, because of unexpected obliteration, only a partial insertion was possible. Deteriorating performance and non- auditory stimulation of the facial nerve led to removal of the implant and a contralateral implantation with full insertion under the same anaesthetic gave a good postoperative result. In the second case, CT scanning indicated minimal obliteration, but extensive obliteration was encountered at surgery, which required double-array insertion with a delayed but satisfactory outcome. In the third case, extensive unexpected obliteration was noted at surgery and, in light of the experience gained with the first two cases, it was decided not to proceed but to explore the contralateral side. At surgery on the contralateral side, a patent cochlea was noted with full electrode insertion and an excellent outcome. These cases demonstrate a learning curve for this department and our philosophy now is to explore the contralateral ear rather than accept a partial insertion.

Keywords: cochlear implant; cochlea; obliteration; scala tympani

  The quality of life impact of dysphonia Top

pp. 179-182(0) June 2002, vol. 27, no. 3, Clinical Otolaryngology & Allied Sciences,

Wilson J.A.; Deary I.J.; Millar A.; Mackenziek.


Dvsphonia can affect social life and employment, but formal studies of its general health impact are lacking. The aims of this study were (i) to compare self-rated general health status as measured by the SF-36 in a large cohort of dysphonic patients with those from normative groups; and (ii) to examine the differential impact of dysphonia on the various health status domains. The 163 dysphonic voice clinic attendees (38 men, 125 women) were drawn from recruits to a prospective trial of speech therapy efficacy. The Short-Form 36 (SF-36) scores were compared with published data on 744 age- matched healthy controls. Patients with dysphonia had significantly poorer self-reported health than the controls on all eight SF-36 subscales (limitation of physical activity P < 0.05; other seven, all P < 0.001, Student’s t-test). We thus conclude that dysphonia in patients without obvious laryngeal disease hasan adverse impact on all health status subscales as measured by the SF-36. The study provides further evidence for the inclusion quality of life measures in otolaryngology baseline and outcome assessments.

Keywords: dysphonia; voice disorders; quality of life; SF-36; general health; psychological distress

  Usefulness of Virtual Endoscopic Three-dimensional Reconstructions of the Middle Ear Top

pp. 382-385(4) 1 June 2002, vol. 122, no. 4, Acta Oto-Laryngologica,

Morra A.; Tirelli G.; Rimondini A.; Cioffi V; Russolo M.; Giacomarra V; Pozzi-Mucelli R.


This work uses a new programme for producing 3D radiological images acquired by means of CT which enables the internal surfaces of the examined structures to be visualized. This new method, which is able to navigate inside organs in a similar way to fibreoptic endoscopy, is known as virtual endoscopy. CT examinations of the temporal bone were carried out using spiral equipment and endoscopic 3D processing was carried out on a separate workstation equipped with a volume-rendering programme. Once the technical parameters necessary for obtaining a representation of the internal surfaces had been defined, a simulation of a virtual otoscopy was conducted by moving the virtual endoscope from the external auditory canal through the annulus to the tympanic cavity. Thesimulation can be obtained either by moving the endoscope by hand, using the mouse, or by defining a path along which the software automatically creates an endoscopic 3D reconstruction. The images thus obtained are projected sequentially to give a ““movie”“ effect, i.e. a continuous progression of the endoscope. The average time required to conduct the procedure ranges from 20 to 30 min. A virtual endoscopic visualization of the middle ear was obtained which, in particular, generated images of the tympanic cavity with the ossicular chain. In our experience, virtual otoscopy shows the anatomy of the structures of the tympanic cavity in excellent detail and may be considered complementary to CT, providing useful images enabling better visual representation and understanding of this complex structure. Although clinical applications of the technique remain to be defined it may have a role to play in presurgical diagnostic evaluation of the ossicular chain, epitympanum and retrotympanum.

Keywords: C.T; middle ear; virtual endoscopy.

  Genes in the ear: what have we learned over the last years? Top

pp. 44-53(10) 1 April 2001, vol. 30, no. 2, Scandinavian Audiology,

Van Laer L. [1]; Van Camp G. [1]

[1] Department of Medical Genetics, University of Antwerp, Antwerp, Belgium


In developed countries 50% of childhood hearing impairment is attributable to genetic causes. In a limited number of cases, the hearing impairment is part of a syndrome, and several genes for syndromic deafness have been identified over the last 10 years. In the majority of cases, the hearing impairment occurs without additional clinical abnormalities (non-syndromic). Progressive hearing loss is very frequent in adults. By the age of 80 approximately 50% of the population is affected by age-related hearing loss, which is due partly to genetic factors. Before 1994, little was known about the genes responsible for non-syndromic hearing impairment, although epidemiological studies have suggested that more than 100 genes might be involved. Over the last 6 years, extremely rapid progress was realized in the field of the molecular genetics of hearing and deafness. More than 70 genes for non-syndromic hearing impairment have been localized to the human genome, and 18 of these have been identified.

Keywords: Genetic; Hearing Impairment; Nonsyndromic; Syndromic.

  Posterior Canal Wall Reconstruction Tympanoplasty for Operated Ears with Open Mastoid Top

pp. 249-254(6)1 April 2002, vol. 122, no. 3, f Acta Oto-Laryngologica,

Sasaki Y.; lino Y.; Suzuki J-I.


We investigated the postoperative conditions of ears and the hearing acuity of patients who underwent posterior canal wall reconstruction tympanoplasty for operated ears with open mastoid. The study included 118 ears of 105 patients (57 males, 48 females; age range 5-75 years) and the patients were followed for >1 year after the final operation. Although 114 ears (97%) were dry after the final operation, retraction pockets and eardrums in a lateral position were observed in 5 ears and in 1 ear, respectively. Ossicular reconstruction was performed in 83 ears and in these the mean air conduction hearing levels were significantly improved after the final operation in those that were subjected to type III and IV tympanoplasty. These results indicate that posterior canal wall reconstruction tympanoplasty can be considered to be an effective procedure.

Keywords: Haring improvement; operated ears with open mastoid; posterior canal wall reconstruction.

  Effects of the Electromagnetic Field of Mobile Telephones on Hearing Top

pp. 289-293(5) 1 April 2002, vol. 122, no. 3, f Acta Oto-Laryngologica,

Ozturan O.; Erdem T.; Miman M.C.; Kalcioglu M.T.; Oncel S.


The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Anatomically, the ear is in close proximity to the mobile telephone during use. Hearing loss due to mobile telephone use has not been described in the medical literature; however, if there is a subtle cochlear involvement, it might be detected by means of changes in evoked otoacoustic emissions (OAEs). Thirty volunteers with normal hearing were exposed to mobile telephone EMFs for 10 min and evoked OAEs were measured before and after exposure. No measurable change in evoked OAEs was detected and none of the subjects reported a deterioration in hearing level. To the best of our knowledge, this is the first study on the effects of EMFs emitted by mobile telephones on hearing. It was concluded that a 10-min exposure to the EMF emitted from a mobile telephone had no effect on hearing, at least at outer ear, middle ear and cochlear levels.

Keywords: Adverse effect; cochlea; mobile telephone; otoacoustic emissions.

  Bacterial Interference Between Pathogens in Otitis Media and Alpha-Haemolytic Streptococci Analysed in an In Vitro Model Top

pp. 78-85(8) 1 January 2002, vol. 122, no. 1, Acta Oto-Laryngologica,

Tano K.; Hakansson E.G.; Holm S. E.; Hellstrum S.


Bacterial interference studied by means of agar methods has shown a decreased number of inhibitory alpha-haemolytic Streptococci among otitis-prone children. Additional information was gained regarding the interplay between alpha- haemolytic Streptococci (AHS) and otitis media (OM) pathogens by comparing the bacterial interference in broth with the interference activity studied using agar overlay methods. We found that non- typeable Haemophilus influenzae (NTH I) and Moraxella catarrhalis are readily inhibited by AHS in broth. Streptococcus pneumoniae was more bac- teriostatically inhibited. If two OM pathogens were inoculated simultaneously, an isolate of AHS with poor inhibitory activity was not able to inhibit the growth, in contrast to an isolate of AHS with good inhibitory activity. The initial amount of AHS inoculated with M. catarrhalis seemed to play a decisive role with respect to the inhibitory activity. M. catarrhalis developed reduced susceptibility against AHS both in vivo and in vitro. In vivo studies showed that children with secretory otitis media had fewer isolates of AHS in their nasopharynx with the ability to inhibit all the test pathogens than healthy children (p < 0.001). Although the factor(s) responsible for the inhibitory activity have thus far not been defined we could exclude low pH and nutrition depletion as the inhibitory mechanism of AHS with good inhibitory activity.

Keywords: Alpha; haemolytic; streptococci; moraxella; catarrhalis; typeable; haemophilus; influenzae; otitis; media; stereptococcus; pneumoniae.

  An observational study of the management of traumatic tympanic membrane perforations Top

pp. 181-184(4) 1 March 2002, vol. 116, no. 3, Journal of Laryngology & Otology,

Amadasun J. E. 0.[1]

[1] Westend Hospital and Diagnostic Centre, Warri, Nigeria


Controversies of how best to treat fresh tympanic membrane perforations have always existed. While some otolaryngologists prefer the paper patcli method, others prefer modified myringoplasty. A prospective study is needed to investigate the most effective and least expensive management of this common ear trauma. This study examined prospectively, in three sections, a group of patients with a cellophane patch (n = 6), another group with a gen- tamicin ointment seal (n = 15) and a control group (n = 9) with a gentamicin plug placed at the distal end of the external auditory cavity. Successful healing of the traumatic tympanic membrane perforations was achieved in 50 per cent of the cellophane seal group, 86.7 per cent of the gentamicin ointment seal group and 77.8 per cent of the control group. This study shows that the management of a fresh tympanic membrane perforation should be limited to cleaning the traumatized ear and preventing infection.

Keywords: Tympanic; membrane; perforation.

  Clinical characteristics of so called eosinophilic otitis media Top

pp. 19-28(10) January 2002, vol. 29, no. 1, | Auris Nasus Larynx,

Nagamine H.; IinoY.[l]; Kojima C.; MiyazawaT.; lida T.

[l]Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, 173-8605, Tokyo, Japan


Objective: Although ‘eosinophilic otitis media’ is not as uncommon a condition as was previously believed, its cause and pathogenesis are not yet fully understood. The purpose of this study was to describe the clinical characteristics in patients with ‘eosinophilic otitis media’ to clarify its pathogenesis.

Methods: Seven adult patients with persistent and intractable otitis media with viscous middle ear effusion containing many eosinophils, who were also under treatment for bronchial asthma, were studied. The following examinations were conducted: nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test, temporal bone CT scan, blood analysis, bactcrial and fungal culture of middle ear effusion, histological study of the middle car and nasal specimens, and measurement of eosinophilic cationic protein (ECP) in middle car effusion.

Results: Some patients had persistent perforation with papillomatous granulation tissue arising from the mesotympanic mucosa, and all the patients had nasal polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all the patients, and the hearing level deteriorated progressively during the course in some patients. The eustachian tube function was not always poor but was patulous in some cases. The most severely diseased areas were in the eustachian tube and mesotympanum by temporal bone CT images. All the seven patients had the high levels of total serum IgE, but the RAST scores were negative in three patients and low grade in three patients. The accumulation of eosinophils was observed in middle ear effusion, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranula- tion. High level of ECP was also recovered from middle ear effusion.

Conclusions: Active eosinophilic inflammation occurs in the entire respiratory tract, including the middle ear in these patients. From our present investigation, we propose the criteria and clinical characteristics of ‘eosinophilic otitis media’. Keywords: Otitis media with effusion; Asthma; Allergy; Eosinophils

  Vinegar treatment in the management of granular myringitis Top

pp. 176-180(5) 1 March 2002, vol. 116, no. 3, Journal of Laryngology & Otology,

Jung H.H. [1]; Cho S.D. [1]; Yoo C.K. [1]; Lim H.H. [1]; Chae S.W. [1]

[1] Department of Otolaryngology - Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea


To compare the therapeutic efficacy in the management of granular myringitis, 15 patients with chronic granular myringitis were treated with antibiotic car drops that were used twice to four times a day, and another 15 patients were treated with daily irrigation of the external canal with dilute vinegar solution. All patients treated with dilute vinegar solution had resolution of their original otorrhoea within three weeks, whereas two- thirds of patients recovered within three weeks when treated with antibiolic ear drops. The disadvantages of dilute vinegar therapy were canal irritation with pain and dizziness. When the therapeutic efficacy was compared statistically, a dry car was attained in the dilute vinegar-treated group at six weeks and six months in the antibiotic ear drop treated group (p<0.01). These results suggest that very low pH therapy using dilute vinegar solution is definitely effective in the management of granular myringitis.

Keywords: Polyps; external; treatment; outcome.

  Laryngeal Manifestations of Gastroesophageal Reflux Disease in Children Top

pp. 306-310(5) 1 April 2002, vol. 122, no. 3, Acta Oto-Laryngologica,

Zalesska-Krecicka M.; Krecicki T.; Iwanczak B.; Blitek A.; Horobiowska M.


Although the association between gastroesophageal reflux disease (GERD) and laryngeal disorders in adults is well established there is still a lack of information concerning the true extent of the laryngeal complications of GERD in children. The aim of this study was to determine the laryngeal status of children with diagnosed GERD. We sought to identify the initial appearance of their larynges and then to determine the clinical response to antireflux therapy. GERD was recognized in 90/100 children examined. Using 24-h pH monitoring we found that most of the patients experienced episodes of gastroesophageal reflux during the daytime when they were in an upright position. The hallmark of GERD affecting the larynx in our group was posterior laryngitis, which is characterized by erythema of the mucous membrane overlying the arytenoid cartilages and the posterior mucosal wall of the glottis. The findings regarding the effectiveness of therapy were that, in children with severe laryngeal alterations, voice quality improved significantly after 12 weeks of antireflux treatment (p < 0.001) and laryngeal status was significantly better after 6 weeks of treatment (p < 0.001). This study provides evidence that gastroesophageal reflux in children is the underlying cause of inflammatory and morphological lesions, and that antireflux treatment is effective in reducing or eliminating these lesions.

Keywords: Children; gerd; laryngeal lesions.

  Waiting times during the management of head and neck tumours Top

pp. 275-279(5) 1 April 2002, vol. 116, no. 4, Journal of Laryngology & Otology,

Jones T. M.[l]; Hargrove 0.[2]; Lancaster J.[2J; Fenton J.[l]; Shenoy A.[3]; Roland N. J.[l]

[1] Department of Otolaryngology, the University of Liverpool, UK [2] Department of Otolaryngology, University Hospital Aintree, Liverpool, UK [3] Clatterbridge Center for Oncology, Wirral, UK


The waiting times incurred during the management of 75 consecutive head and neck oncology patients attending for post-treatment follow-up were reviewed. Data were gleaned from general practitioner (GP) referral letters, patient case-notes as well as radiology and histology reports. The mean time for GP referral to ENT was 5.1 weeks. From ENT to endoscopy was 3.1 weeks, to histology 3.5 weeks, to computed tomography (CT) scan 5.6 weeks, to magnetic resonance scan (MR) 4.1 weeks, to primary radiotherapy 10.3 weeks and to surgery 5.5 weeks. The mean symptom duration prior to referral was 4.9 months. Our results compare unfavourably with the standards recommended by the BAO-HNS. Local modifiations may improve matters, but significant increases in funding, manpower and equipment are required to achieve the stipulated standards. Moreover, criteria for referral have to be re-emphasized and patient education has to be addressed as these appear to contribute the longest delay in the diagnosis of head and neck tumours.

Keywords: Waiting list; head and Neck neoplasms; oncology service; hospital; GreatBritain.

  Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis Top

pp. 261-263(3) 1 April 2002, vol. 116, no. 4, t Journal of Laryngology & Otology,

Ricchetti A. [1]; Landis B. N.[l]; Maffioli A. [I]; Giger R. [1]; Zeng C. [1]; Lacroix J-S. [1]

[1] Rhinology Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Switzerland.


Recent studies have suggested that allergic fungal rhino-sinusitis could be involved in the development of nasal polyposis. The aim of this study was to evaluate the response of anti-fungal nasal lavages. Patients performed nasal lavage with 20 ml of a one per one thousand amphotericin B suspension in each nostril, twice a day, for four weeks In addition, all patients continued their saline nasal lavage and their conventional topical corticosteroid spray. This study included 74 patients, with a mean age of 46 years (range from 19 to 73). Before antifungal treatment, the distribution of nasal polyposis according to Malm, was: 13 patients in stage I (17.5 per cent), 48 patients in stage II (65 per cent) and 13 patients in stage III (17.5 per cent). After anti-fungal nasal lavages, the total disappearance of nasal polyposis was observed in 29 patients (39 per cent). Eight patients were stage I, 21 stage II, and none stage III. In patients who have had previous endoscopic polypectomy and functional endoscopic sinus surgery, total disappearance of nasal polyposis was seen in 24 patients (47 per cent). Hyperreactivity to fungal organisms could be one of the mechanisms underlying the development of nasal polyposis. A direct effect of amphotericin B suspension on the integrity of the cell membrane of the polyps’ epithelium could not be excluded.

Keywords: Nasal polyps; Amphotericinb; hypersenstivity; rhintis; siusitis; fungi.

  Pitfalls in preoperative management of acquired laryngeal stenosis. The problem of the hidden obstruction in the airway Top

pp. 29-33(5) 31 May 2002, vol. 64, no. 1, International Journal of Pediatric Otorhinolaryngology,

Hoeve LJ.H.[1]; van der Eerden P.A.

[l]Department of Otorhinolaryngology, Sophia Children’s Hospital, Erasmus MC, PO. Box 2060, 3000 CB , Rotterdam, The Netherlands


Most acquired laryngeal stenoses in infants and children can be treated surgically with successful outcome. We describe two patient cases in which removal of such a stenosis did not result in decanu- lation because another, hidden obstruction was present This demonstrates the importance of preoperative assessment to indicate factors that influence the outcome of surgery, especially in infants with a syndrome. Guidelines for preoperative management and an extensive list of syndromes in which a hidden obstruction can be suspected, are presented.

Keywords: Laryngotracheoplasty; Larynx; Stenosis; Infant; Preoperative management; Syndromes with airway obstruction

  Abnormalities of molecular regulators of proliferation and apoptosis in carcinoma of the oral cavity and oropharynx Top

pp. 165-174(10) 1 April 2002, vol. 29, no. 2, Auris Nasus Larynx,

Kuropkat C.[l]; Venkatesan T.K.; Caldarelli D.D.; Panje W.R.; Hutchinson J.; Preisler H.D.; Coon J.S.; Werner J.A.

[l]Department of Otolaryngology, Head and Neck Surgery, Philipps University, Deutschhausstr. 3, 35037 , Marburg, Germany


Objective: Abnormalities in genes regulating cell proliferation and death may affect disease outcome in squamous cell carcinoma (SCC) of the head and neck. Methods’. Proliferative activity (Histone H3 in-situ-hybridization (HISH) labeling index (LI)) and the genes and/or gene products of Cyclin D-l, c-erbB-2, Bcl-2, p21, and p53, were investigated in 35 patients with SCC of the oral cavity and oropharynx, previously studied for p27 expression. Results: Overexpression or very low expression of Cyclin D-l was associated with unfavorable disease outcome and shorter time-to-recurrence. High c-erbB-2 expression was significantly associated with shorter overall survival and was synergistic with low p27 expression. Bcl-2, HISH LI, p21 expression, and p53 mutation and protein analysis were not significantly predictive, but there were trends suggesting shorter disease-free/overall survival for patients with undetectable Bcl-2, high HISH, and mutant p53. Conclusions: Several cell proliferation and death regulators appeared to predict disease outcome. Limited evidence of cooper- ativeness among regulators was also seen.

Keywords: Oral cancer; Proliferation; Apoptosis; Molecular regulators

  A preventive measure for otitis media in children with upper respiratory tract infections Top

pp. 111-118(8) 25 April 2002, vol. 63, no. 2, International Journal of Pediatric Otorhinolaryngology,

Mora R.[l]; Barbieri M.; Passali G.C.; Sovatzis A.; Mora E; Cordone M.P.

[l]Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa,, Genoa, Italy


Recurrent upper respiratory tract infections (URTI) are very common in patients of all ages. Rhinitis, bronchitis, chronic sinusitis and otitis appear to be the prevalent forms of recurrent respiratory infections in the pediatric population. The aim of treatment is so the solution of the respiratory pathology and the also the prevention of their complications. Antibacterial therapy is still die classical treatment approach in patients both with respiratory tract infections and with otitis media, despite the fact that antibacterial have several well known drawbacks, especially when used to treat recurrent infections. Eighty-four paediatric patients of both sexes (range: 4-14 years) with otitis were enrolled in the study. Patients were included if they had a >2 years’ history of recurrent or chronic respiratory infections, and/or had experienced at least three episodes requiring medical consultations and/or treatment during the winter prior to the study. The young patients were randomised to receive Immucytal (group A) or placebo (group B) treatment according to the following protocol: (1) starting therapy (1 month): one tablet daily in the morning 4 days per week for 3 consecutive weeks; (2) maintenance period (5 months): one tablet daily in the morning 4 days per week for 1 week every month. Placebo and Immucytal tablets were identical in shape and size, in order to maintain double- blind conditions. Patients of group A with recurrent URTI had a significantly decreased incidence of ENT infections, fever and shorter duration of illness, decreased requirement for ancillary medications and fewer work-days lost. The reduction in the incidence of infectious episodes became significant vs. placebo. A significantly improved outcome vs. placebo was also observed on the incidence of fever, frequency and duration of infectious episodes, ancillary therapies. Immucytal treatment was associated with significant changes in both immunological and auditory function parameters. Serum concentrations of immunoglobulins were significantly increased in Immucytal. For both evaluations, a significant difference between treatment groups was found (P>0.001). Preventive strategies, such as ribosomal immunotherapy, may represent a valid alternative approach.

Keywords: Upper respiratory tract infections (URTI); Otitis media; OME; Ribosomal immunotherapy

  Parotid neoplasms: diagnosis, treatment, and intraparotid facial nerve anatomy Top

pp. 359-362(4) 1 May 2002, vol. 116, no. 5, Journal of Laryngology & Otology,

Tsai S.C-S. [1]; Hsu H-T. [1]

[1] Department of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, R.O.C.


The demographics of parotid neoplasms in different populations have been reported by various centres. In this investigation, we reviewed retrospectively all the in-patient and out-patient charts and records of 108 patients who were diagnosed with parotid neoplasms and received parotidectomies in our department from 1 January 1993 to 15 April 2000. Patient age, gender, tumour pathology, fine- needle aspiration cytology results, and the intraparotid anatomy of the facial nerve were noted. We showed that despite the difference between our Taiwanese and previously studied patient populations, both populations had a similar distribution, diagnosis and treatment of parotid neoplasms, although the incidence of parotid tuberculosis was higher in our patient group. In addition, the facial nerve anatomy within the parotid gland had three main branching patterns in the upper and lower division.

Keywords: Parotid nepplasms; Diagnosis; Treatment outcome; facial nerve anayomy.

  Neoglottic formation from posterior pharyngeal wall conserved in surgery for hypopharyngeal cancer Top

pp. 153-157(5) 1 April 2002, vol. 29, no. 2, Auris Nasus Larynx,

Iwai H.[l]; Tsuji H.; Tachikawa T.; Inoue T.; Izumikawa M.; Yamamichi K.; Yamashita T.

[l]Department of Otorhinolaryngology, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, 570-8506, Osaka, Japan


Objective: To describe a new treatment modality of hypopharyngeal cancer consisting of total laryngectomy plus partial pharyngectomy (TLPP) conserving the posterior wall of the pharynx vertically for voice restoration.

Methods: Review of hospital charts, TLPP was undertaken in 15 of 54 patients. Surgical modalities of reconstruction subsequent to TLPP were indicated on the basis of the width of posterior pharyngeal wall conserved during surgery. Posterior pharyngeal walls of width 3 cm or larger were sutured in primary closure. If the width of posterior wall was less than 3 cm, a free forearm flap or free jejunal flap was patched to the wall. Tracheo-esophageal shunt with a voice prosthesis was performed 3 weeks after surgery.

Results: The Kaplan-Meier method indicated no difference in survival rate between patients with TLPP (46.4%) and the remaining patients (47.4%). Nine of 15 patients with TLI’P (two patients with primary closure, three with free forearm flap, and four with free jejunal flap) were examined for voice restoration and fluoroscopy of the ncopharynx. Eight of the nine patients, in whom more than 2 cm of the posterior pharyngeal wall had been eon- served demonstrated a good speech rating, maximum phonation time and neoglottic formation by the posterior pharyngeal wall.

Conclusion: The combination of conservation of the posterior pharyngeal wall, patch graft and a voice prosthesis is a useful method that o(Tcrs sufficient quality of phonation without deterioration of survival rale for patients with hypopharyngcal cancer.

Keywords: Hypopharyngcal cancer; Total laryngectomy plus partial pharyngectomy; Neoglottis; Voice prosthesis; Free flap

  The feasibility of hospital-based universal newborn hearing screening in the United Kingdom Top

pp. 22-28(7) 1 April 2001, vol. 30, no. 2, Scandinavian Audiology,

Albuquerque W. [1]; Kemp D. T[l]

[1] St Helier & Epsom NHS Trust, and the Institute of Laryngology & Otology, United Kingdom


Current hearing screening programmes in the United Kingdom arc performing unacceptably poorly. Davies et al. (1997) suggested that universal newborn hearing screening (UNHS) would be more effective and cheaper to run. However, there is concern that hospital-based UNHS would not be feasible because of early postnatal discharge, and thus babies not staying in hospital long enough to be screened. Two studies were designed to determine the viability of hospital-based UNHS in a district general hospital in the United Kingdom. Study 1 retrospectively determined the discharge age and time of discharge of all 3021 well babies bom at St Helier hospital, Carshalton, and the number of babies born at home in the area, from 19 October 1997-18 October 1998. Most well babies were found to pass through hospital at a convenient time for prcdischarge hearing screening, and the optimal protocol was screening from 9 am-2 pm, 7 days a week. The predicted maximal screening coverage was 92.68%. Study 2 tested the calculated optimal protocol over 1 week. It was found that UNHS with otoacoustic emissions on the maternity ward from 9 am-2 pm, 7 clays a week, achieved a coverage of 89.06%, with an acceptable false positive rate of 6.2%. It is likely that a similar protocol with slight modifications could be implemented successfully in other hospitals in the United Kingdom.

Keywords: Universal; newborn; Hearing; Screening; Neonatal; Screening; Congenital; Hearing; Impairment.

  Universal newborn screening: a dream realized or a nightmare in the making? Top

pp. 15-21(7) 1 April 2001, vol. 30, no. 2, Scandinavian Audiology,

Mencher G. T.[l]; Devoe S. J.[2]

[1] Dalhousie University. Nova Scotia, Canada [2] Leridan Associates, Halifax, Nova Scotia, Canada


There is a very strong movement to develop universal newborn hearing screening. This effort is the end product of a long international research effort to determine the most effective means to screen newborns. Now that OAE and ABR together offer a superior mechanism to achieve universal screening, problems related to middle car effusion, non-high- risk children and adequate resources for all aspects of identification, diagnosis and treatment have come to the fore. Further, what to do in the developing world is also a major problem as audiology embarks on this exciting new frontier. This paper discusses some of the issues, raises some concerns and offers a few small solutions.

Keywords: Unith; Neonates; Hearing; Screening: Infant; Hearing.

  Newborn hearing screening: selected experience in the United States Top

pp. 29-32(4) 1 April 2001, vol. 30, no. 2. Scandinavian Audiology,

Hayes D. [1]

[1] The Childrenis Hospitalñ Denver, University of Colorado, USA


Universal newborn hearing screening (UNHS) is rapidly becoming estandard of card in the United States. More than two dozen states now require, through legislative mandate, that the state establishes a system for early hearing detection and intervention (EDHI), beginning with mandated UNHS. In states with long-standing EDHI programs. the average age of identification and intervention has decreased significantly. In those states, infants arc identified and intervention initiated typically before age 6 months, meeting the Joint Committee on Infant Hearingis (JCIH) rccommen- elation for newborn hearing screening, diagnosis and intervention. Language outcome data suggest that earlier intervention results in better language outcomes for deaf and hard-of-hearing children. This article reviews the current status of UNHS in the United States, summarizes the Colorado statewide program and describes the JCIH Year 2000 position statement for developing comprehensive EDHI programs.

Keywords: Universal; newborn; Screening; UNHS; Early; Hearing; Detection; and Intervention; Edlii; Joint; Committee; on; Infant; Hearing; jcih.

  Speaker clustering for speech recognition using vocal tract parameters Top

pp. 305-315(1 1) March 2002, vol. 36, no. 3, Speech Communication,

Naito M.[l]; Deng L.; Sagisaka Y.

[1]ATR Interpreting Telecommunications Research Laboratory, 2-2 Hikaridai, Scika-cho, Soraku-gun, 619-0288, Kyoto, Japan


We propose speaker clustering methods for speech recognition based on vocal tract (VT) size related articulatory parameters associated with individual speakers. Two parameters characterizing gross VT dimensions are first derived from the formant frequencies of two vowels and are then used to cluster speakers. The resulting speaker clusters are significantly different from speaker clusters obtained by conventional acoustic criteria. Then phoneme recognition experiments are carried out by using speaker-clustered IlMMs (SC-HMMs) trained for each cluster. The proposed method requires a small amount of speech data for speaker clustering and for selecting the most suitable SC-HMM for a target speaker, but gives higher recognition rates than conventional speaker clustering methods based on acoustic criteria.

Keywords: Vocal tract parameters; Speaker-clustering; Speech recognition

  Effect of background noise on perception of English speech for Japanese listeners Top

pp. 121-125(5) 1 April 2002, vol. 29, no. 2, Auris Nasus Larynx,

Shimizu T.[l]; Makishima K.; Yoshida M.; Yamagishi H.

[]]Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, lseigaoka 1-1, Yahatanishi-ku, 807- 8555, Kitakyushu, Japan


Objectives: To avoid the accidents induced by confusions of non-native speech perception in the presence of noise at work, this study examined the effcct of background noise on the discrimination of English specch for Japanese listeners.

Methods: Normal hearing Japanese subjects, who have English learning experience to the level of college graduates, were tested with the CID W-22 word list in quiet settings and in the presence of white, low-frequency weighted (pink noise), or aircraft noise.

Results: The discrimination scores were reduced as S/N ratio decreased, and more adversely affected by background white noise than pink or aircraft noise. The individual variability of English word discrimination scores for Japanese listeners was much larger as the S/N ratio decreased. The typical confusions among phoneme were /m/, /n/, and Is/.

Conclusions: The results of this study suggested that ineffective use of speech cues and difference in composition of English phonemes from Japanese could be responsible for degraded speech discrimination of non-native speech in noise. Moreover, it was expected that Japanese workers with age related hearing loss at higher frequencies might have great difficulty in perceiving English speech sounds in the presence of noise.

Keywords: Speech perception; Noise; Non-native; Japanese; English

  Speaking in Time Top

pp. 5-13(9) January 2002, vol. 36, no. 1, Speech Communication,

Clark H.H.


Most spoken disfluencies, it is argued, are not problems in speaking, but the solutions to problems in speaking. Speakers design most forms of disfluencies as signals, communicative acts, for coordinating with their addressees on certain of their speech actions. At the lowest level, speakers try to synchronize their vocalizations with their addressees’ attention. At (he next level up, they try to synchronize, or pace, the presentation of each expression with their addressees’ analysis of those expressions. Speakers have a variety of strategies for achieving synchronization, and many of these lead to the common forms of disfluencies.

Keywords: Disfluencies; Spontaneous speech; Timing; Pauses; Production

  Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay Top

pp. 129-136(8) 25 April 2002, vol. 63, no. 2, t International Journal of Pediatric Otorhinolaryngology,

Goorhuis-Brouwer S.M.[1]; Knijff W.A.

[l]Departmcnt of Otorhinolaryngology, University Hospital Groningen, P.O. Box 30.001, 9700 RB , Groningen, The Netherlands


Objective: this article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders.

Design: retrospective study-a follow-up after a mean of 2 years.

Materials and methods: verbal and non-verbal functioning before and after therapy were examined in 31 language-impaired children with normal hearing and good health. In 16 children the language functioning was substantial behind their non-verbal functioning. They were categorised as children with specific language impairment (SLI). In 15 children the language problem was in comorbidity with cognitive delay, and these were categorised as children with non-SLl. At the first examination the children were at the age of l;5-5;4 years and at the second examination they were at the age of 3;4-6;l 1 years. The children were examined for language comprehension (Standardised Dutch version of the Reynell Developmental Comprehension Scale), spontaneous language production (Groningen Diagnostic Speech norms) and non-verbal functioning (Snijders-Oomen non-verbal intelligence scale for children between 212 and 7 years).

Results: in both groups, a significant improvement was found in language functioning as well as in non-verbal functioning. Language comprehension and non-verbal IQ-scorcs in both groups improved by about the same amount. Language production made significantly more progress in the SLI group than in the non-SLI group. The improvements in the SLI group were mainly reached by speech therapy, whereas in the non-SLI group this was less the case.

Conclusions: verbal and non-verbal development can improve in young children with developmental language delay. This underlines the idea that language and cognitive development arc interacting and influencing each other in a positive way. Children with SLI seem to benefit more from speech therapy, whereas children with cognitive delay seem to benefit more from special education.

Keywords: Language impairment; Speech therapy; Special education; Verbal development; Non-verbal development

  Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle Top

pp. 175-178(0) June 2002, vol. 27, no. 3, Clinical Otolaryngology & Allied Sciences,

Maini S.; Waine E.; Evans K.


The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage! Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Keywords: audlt; haemorrhage; tonsillectomy; disposable instruments

  Tonsillectomy for biopsy in children with unilateral tonsillar enlargement Top

pp. 15-17(3) 15 March 2002, vol. 63, no. 1,International Journal of Pediatric Otorhinolaryngology,

Spinou E.[l]; Kubba H.; Konstantinidis I.; Johnston A.

[l]Department of Otolaryngology Head and Neck Surgery, Monklands General Hospital, , Scotland ML6 ORD, Airdrie, UK


Objective: Unilateral tonsillar enlargement (UTE) may be a sign of underlying malignancy and tonsillectomy is often recommended for histology. The limited evidence available suggests that the incidence of malignancy in children with UTE is very low, and that in many cases, the apparent enlargement is due to asymmetry of the mucosa of the tonsillar pillars. The purpose of this study was to evaluate the necessity of tonsillectomy as a routine practice for every case of UTE.

Methods: We attempted to identify every child (age<16 years) undergoing tonsillectomy in our unit from January 1991 to January 2000 where the indication for surgery was UTE. Patients were excluded if the primary indication for surgery was anything other than UTE. The case notes and pathology records were reviewed.

Results: Exactly 47 children were identified, aged between 4 and 15 years of age (mean 9.5 years), of whom 29 (62%) were girls. In all cases, the tonsillar asymmetry was noted by the otolaryngologist, but had not been noted by the patient or parents, or commented on by the referring General Practitioner. Eighteen of the children (38%) had no history of sore throats. No malignancies were encountered. When the tonsils were measured by the pathologist after excision, the actual degree of asymmetry in size ranged from 0 to 25 mm. In seven cases (15%), the clinically larger tonsil was actually the smaller of the two when examined by the pathologist. In 17 cases (36%) there was no difference in size at all.

Conclusions: We conclude that apparent UTE is often spurious, and that many unnecessary tonsillectomies are performed when UTE is taken as an indication for surgery in the absence of any other suspicious features. Tonsillectomy carries risks and clinical observation may be prudent where clinical suspicion is low.

Keywords: Tonsillectomy; Tonsillar malignancy; Tonsillar pathology; Lymphoma; Children

  Sudden sensorineural hearing loss: does application of glucocorticoids make sense? Top

Alexiou, C., Arnold, W., Fauser, C., Schratzenstaller, B., Gloddek, B., Fuhrmann, S., Lamm, K. Klinikum rechts der Isar, Hals-Nasen- Ohren Klinik und Poliklinik, Ismaningerstr.22, 81675 Muenchen, Germany. C.A [email protected]. Archives of Otolaryngology - Head and Neck Surgery (2001) March, Vol. 127 (3), pp. 253-8.

Background: Treatment of sudden sensorineural hearing loss (SSNHL) consists of administration of blood flow-promoting drugs with or without the addition of glucocorticoids. General guidelines based on scientific data do not currently exist.

Objective: To investigate the effect of glucocorticoids on the treatment of SSNHL.

Setting: Academic medical center.

Patients and Mehtods: We retrospectively analysed the audiograms of 603 patients with SSNHL: 301 patients (cared for between January 1, 1986, and December 31, 1991) received intravenous blood flow-promoting drugs without glucocorticoids and 302 patients (cared for between January 1, 1992, and December 31, 1998) received intravenous ± oral application). The age distribution of patients with SSNHL in lower, middle, and higher frequencies was similar in both groups.

Results: Patients with SSNHL in lower and middle frequencies (250-2000 Hz), who received glucocorticoids (prednisolone-21-hydrogen-succinate) showed significantly better recovery of hearing levels compared with those who did not receive glucocorticoids (P=0.05). There was no significant difference at higher frequencies between the two groups. Ptients with SSNHL throughout all frequencies (pancochlear hearing loss) who received glucocorticoids also had significantly better recovery of hearing levels compared with those who received blood flow-promoting drugs alone (P=0.05). Also, patients with elevated blood sedimentation rates had better improvement of their hearing levels after receiving glucocorticoids.

Conclusions: Administration of glucocorticoids should be recommended for treatment of patients with SSNHL. In particular, patients with SSNHL in the lower and middle frequency range and pancochlear hearing loss have significantly better recovery of hearing levels.

  Cricotracheal resection in children. Top

Rutter, M. J., Hartley, B. E., Cotton, R. T. Department of Otolaryngology, Childrens Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA, [email protected] Archives of Otolaryngology- Head and Neck Surgery (2001) March, Vol. 127 (3), pp. 289-92.

Objective: To review our experience with cricotra- cheal resection in a pediatric population. DESIGN: Prospective case review of a cohort of patients undergoing cricotrachcal resection.

Setting: Tetiary care pediatric hospital.

Patients: Forty-four consecutive patients undergoing cricotrachcal resection between January 1, 1993, and December 31, 1998.

Main Outcome Measures: Decannulation rates.

Results: Thirty-eight (86 per cent) of the 44 children are decannulated. The ultimate decannulation rate was independent. Twenty-one children had salvage cricotracheal resection, and 19 (90 per ccnt) are decannulated. Nine children had an extended cricotracheal resection, of whom five (56 per cent) are decannulated. A primary cricotracheal resection was performed on a child on whom no previous open airway procedure had been performed. A salvage cricotracheal resection was performed on a child on whom previous open airway reconstruction had not resulted in an adequate airway. An extended cricotracheal resection was performed on a child on whom the cricotracheal resection was combined with a second procedure, either additional expansion cartilage grafting or an open arytenoid procedure. Most of these chlidren had complex airway pathologic conditions.

Conclusions: Cricotracheal resection complements standard laryngotracheal reconstruction techniques in a pediatric population.

  Long-term therapy for spasmodic dysphonia: acoustic and aerodynamic outcomes. Top

Mehta, R. P., Goldman, S. N., Orloff, L. A. Division of Otolaryngology, University of California, San Diego School of Medicine, 200 W Arbor Dr, San Diego, CA 92103-8891, USA. Archives of Otolaryngology - Head and Neck Surgery (2001) April, Vol. 127 (4), pp. 393-9.

Objective: To evaluate the long-term aerodynamic, acoustic, and electromyographic effects of serial botuiinum toxin (BT) injections in patients with adductor spasmodic dysphonia. DESIGN: Two- year, nonrandomized, controlled, before-after study.

Setting: Ambulatory care clinic at a single academic medical center.

Patients: A convenience sample of 91 patients with adductor spasmodic dysphonia evaluated and treated during two years and 64 age- and sex-matched controls.

Interventions: Injections of BT into the thyroarytenoid muscles in conjunction with electromyographic evaluation and acoustic and aerodynamic evaluation before and after serial BT injections.

Main Outcome Measures: Translaryngeal airflow, jitter, shimmer, signal-to-noise ratio, fundamental frequency, standard deviation of fundamental frequency, maximum phonation time, and inappropriate muscle activity by electromyography.

Results: Translaryngeal airflow, jitter, and shimmer improved significantly after serial BT treatments and showed sustained improvement over time. Fundamental frequency, standard deviation of fundamental frequency, and signal-lo-noise ratio did not change significantly after BT treatment, Electromyographic data suggested decreased inappropriate muscle activity with repeated BT injections.

Conclusions: Treatment with BT provides ongoing relief of voice perturbations in patients with adductor spasmodic dysphonia who undergo long-term comulative therapy.

  Secondary otalgia in an adult population. Top

Kuttila, S. J., Kuttila, M. H., Niemi, P. M., Le Bell, Y. B., Alanen, P. J., Suonpaeae, J. T. Otonhammas Oy, PO Box 612, FIN 40101 Jyvaeskylae, Finaland, Archives of Otolaryngology - Head and Neck Surgery (2001) April, Vol. 127 (4), pp. 401-5.

Objective: To analyse the associations of secondary otalgia with general health, stress, insomnia, bruxism, and recurrent head and neck region pains.

Design: A population-based survey. SETTING: General community. SUBJECTS: A total of 391 randomly selected subjects (186 men, 205 women) aged 25, 35, 45, 55 or 65 years. METHODS: Standardized interview and selfreport questionnaires of general health and stress.

Results: Otalgia was statistically significantly associated with all the studied factors . However, in the whole study group, independent predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and bruxism. When analysed in women, the predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and age. When analysed in men, recurrent neck pain was a predictor of otalgia.

Conclusions: We suggest that after ruling out otorhinolaryngologic infectious diseases and temporomandibular disorder in patients with secondary otalgia, the next step is to explore the frequency of stress symptoms, bruxism, and recurrent neck pain. Furthermore, women and men may need a different approach in diagnostics of secondary otalgia. By diagnosing and treating these predictors of otalgia, it may be possible to reach a more successful outcome.

  Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. Top

Drew, S.. Davies, E. Pharmacology Department, Division of Neuroscience, University of Birmingham, Brimingham B15 2 TT, UK. [email protected] British Medical Journal (2001) January 13, Vol. 322 (7278). pp. 73.

Objective: To determine whether Ginkgo biloba is effective treating tinnitus.

Design: Double blind, placebo controlled trial using postal questionnaires. Particiipants: 1121 healthy people aged between 18 and 70 years with tinnitus that was comparatively stable; 978 participants were matched (489 pairs). Intervention: 12 weeks’ treatment with either 50 mg Ginkgo biloba extract LI 1370 three times daily or placebo.

Main outcome Measures: Participants’ assessment of tinnitus before, during and after treatment. Questionnaires included items assessing perception of how loud and how troublesome tinnitus was. Changes in loudness were rated on a six point scale. Changes in how troublesome were rated on a five point scale.

Results: There were no significant differences in primary or secondary outcome measures between the groups. Thirty-four of 360 participants receiving active treatment reported that their tinnitus was less troublesome after 12 weeks of treatment compared with 35 of 360 participants who took placebo.

Conclusions: 50 mg Ginkgo biloba extract LI 1370 given three times daily for 12 weeks is no more effective than placebo in treating tinnitus.

  Complications of percutaneous tracheostomy. Top

Briche, T., Le Mannch, Y., Pats, B. Department of Ear, Nose, Throat, Head and Neck Surgery, Hopital d’lnslruction des Armees Percy, Clamart Ccdex, France, [email protected] Chest (2001) April, Vol. 119 (4), pp. 1282-3.

Percutaneous tracheostomy is a technique that, reputedly, is simple to perfom and causes few complications. It is routinely simple to perform and causes few complications. It is routinely used in intensive care. We present two patients with tracheal stenosis. In one patient, we had to perform and anastomotic resection to cure the patient; in the other patient, we had to place and endoluminal con- former. To our knowledge, this complication has not been reported in association with the use of this technique.

  Recurrent nasopharyngeal carcinoma presenting as diffuse dermal lymphatic infiltration in the neck: three case reports. Top

Leong, S. S„ Tan, E. H., Klioo - Tan, H. S., Yang, T. L„ Wee, J., Tan, S. H„ Poh, W. T., Tan, N. G. Department of Medical Oncology, National Cancer Centre, Singapore, [email protected] Head and Neck (2001) February, Vol. 23 (2), pp. 160-5.

Background: Any malignancy has the propensity to metastasize to skin. The frequency of skin metastases vary in different tumours and occur in about 0.7 to 10 per cent of all patients diagnosed with cancer. It is rare in nasopharyngeal carcinoma.

Method: Three cases of relapsed nasopharyngeal carcinoma with diffuse dermal involvement were described. Their clinical presentation, results of investigations, and response to treatment were reviewed. Literature review of similar forms of presentation was done by means of a MEDLINE search.

Results: At the time of dermal relapse, all three patients had a uniform clinical picture of facial, periorbital, and lip swelling associated with stridor and dysphagia. Histologic findings showed dermal infiltrates or malignant cells, and CT scan showed diffuse infiltration of the subcutaneous tissue. Despite chemotherapy, the clinical course was relentless.

Conclusion: This report describes a presentation of disease that is underdiagnosed and heightens awareness of oncologists to this form of recurrence in nasopharyngeal carcinoma.

  A biochemical model of peripheral tinnitus. Top

Sahley, T. L., Nodar, R. H. Departments of Speech and Hearing, Cleveland State University, Main Classroom Building, Room 431, 1899 East 22nd Street, Cleveland. OH 44115, USA. [email protected] Hearing Research (2001) February, Vol. 152 (1-2), pp. 43-54.

Subjective tinnitus may be defined as the pcceptu- al correlate of altered spontaneous neural activity occurring in the absence of an externally evoking auditory stimulus. Tinnitus can be caused or exacerbated by one or more of five forms of stress. We propose and provide evidence supporting a model that explains, but is not limited to, peripheral (cochlear) tinnitus. In this model, naturally occurring opioid dynorphins are released from lateral efferent axons into the synaptic region beneath the cochlear inner hair cells during stressful episodes. In the presence od dynorphins, the excitatory neurotransmitter glutamate, released by inner hair cells in response to stimuli or (spontaneously) in silence, is enhanced at cochlear (N-methyl-D-asparate (NMDA) receptors. This results in altered neural excitability and / or an altered discharge spectrum in (modiolar-oriented) type I neurons normally characterized by low rates of spontaneous discharge and relatively poor thresholds. It is also possible that chronic exposure to dynorphins leads to auditory neural excitotoxicity via the same receptor mechanism. Finally, the proposed excitatory interactions of dynorphins and glutamate at NMDA receptors need not be restricted to the auditory periphery.

  Detection and localization of interleukin-6 in the rat middle ear during experimental acute otitis media, using mRNA in situ hybridization and immunohistochemistry. Top

Forseni, M., Melhus, A., Ryan, A. F., Bagger- Sjoebaeck, D., Hultcrantz, M. Department of Otorhinolaryngology, Karolinska Hospital, Karolinska Institute, 171 76 Stockholm, Sweden. [email protected] International Journal of Pediatric Otorhinolaryngology (2001) February, Vol. 57 (2), pp. 115-21.

Objective: Otitis media is one of the must common diseases among children. A well-known sequela of acute, chronic, and secretory otitis media is tympanosclerosis. With the exception of surgery, there is no causal treatment availalbe for this condition, which may cause hearing disabilities. This study aimed to describle the localization of interleuking (IL)-6 mRAN and its gene product in the rat middle ear during pneumococcal otitis media. 11-6 is known to be involved in inflammatory and bone remodelling processes.

Methods: Using an experimental model of pneumococcal acute otitis media, the expression of interleuking 1L-6, was analysed. Sprague-Dawley rats were sacrificed at different time points varying from one hour to six days intervals after inoculation The middle ears wer analysed by messenger RNA in situ hybridization, and by immunohistochemistry with cell-type specific antibodies directed against IL-6.

Results: Transcripts of IL-6 were observed only on day one post-inoculation, whereas the final gene product was observed at all intervals after inoculation. IL-6 was localized in the bony part of the bulla nearest to the mucosa, around mucosal vessels, and in the ciliae of the mucosal epithelium. Theresults demonstrated that IL-6 was synthesized locally as early as one hour after bacterial middle ear challenge, and that although transcription could not be detected after 24 h, the cytokine product persisted for at least five days after the infection was introduced.

Conclusions: IL-6 was shown to be produced early in the inflammatory process during induced pneumococcal otitis media in the rat. No production was seen after 24 h although the protein remained in the tissue for at least five days. IL-6 could initiate a differentiation of macrophages to osteoclasts and thereby participate in a bone remodelling process leading to tympanosclerosis development.

  Laryngeal chondrosarcoma : a 24-year experience at the Royal National Throat, Nose and Ear Hospital. Top

Rinaldo, A., Howard, D. J., Ferlito, A. Department of Otolaryngology - Head and Neck Surgery, University of Udine, Italy. Acta Oto Laryngologica (2000) Spetember, Vol. 120 (6), pp. 680-8.

This paper presents a review of the experience of 12 patients with chondrosarcoma of the larynx treated at the Royal National Throat, Nose and Ear Hospital, London over the last 24 years. This represents the largest european series and the third largest in the world. Chondrosarcoma is the most frequent non-epithelial malignant tumour of the larynx, with 83.3 per cent of cases arising from the cricoid cartilage in our series. We have shown that deep wedge biopsy with a C02 laser, aided by computerized tomography scanning, gives the most reliable diagnosis. Laryngeal chondrosarcoma is characterized by indolent growth, a potential for local recurrence and, infrequently, by meteastases. 1 he treatment details of our patienst are discussed. Adequate partial resection is often successful and use of C02 laser as the iitial treatment in five of these cases is presented.


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