Suprameatal approach for cochlear implantation in 45 Chinese children

OBJECTIVE: To investigate the feasibility of applying the suprameatal approach (SMA) for cochlear implantation in Chinese children with profound sensory hearing loss, and to demonstrate a technical modification incorporated in the procedure due to an observed racial difference. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Forty-five Chinese children (total 47 ears) with profound sensory hearing loss were surgically treated from May 2005 to May 2006. The patients were followed anywhere from 1 month to 20 months post-surgery, with 30 patients being followed for more than 6 months. INTERVENTIONS: All patients received cochlear implantation through the suprameatal approach. In this procedure, the cochleostomy was performed in one stage after the suprameatal tunnel was finished, rather than the two-stage approach described by Kronenberg (who firstly introduced the suprameatal approach). Three patients with low-lying dura (which is considered to be the contraindication for cochlear implantation with SMA) were treated with a further modified surgical approach. RESULTS: Among the 47 ears, full electrode pairs were completely inserted in 45 ears without surgical difficulties, but 1 ear was only fitted with 9 pairs of electrodes because of an ossified cochlea, and another with just 8 pairs of electrodes due to serious cochlear dysplasia. An intraoperative "gusher" occurred in the dysplasia case, and a small piece of temporalis muscle was used, along with biology glue, to seal the cochleostomy and prevent further leakage. In 1 case, the electrode was inserted into the cochlea through the tunnel lateral to the chorda tympani because adhesion had occurred between the incus and chorda tympani. There were no postoperative complications in any case. Thirty cases exhibited better hearing or speech development from cochlear implantation after more than 6 months of follow-up. CONCLUSIONS: The SMA was found to be a simple and safe technique for cochlear implantation in Chinese children. It enables wide exposure of the middle ear, and is especially suitable for cases with a narrow facial recess, an anteriorly located facial nerve, or an ossified cochlea. It is almost impossible to injure the facial nerve or the chorda tympani nerve. The cochleostomy can be performed in one stage in those patients with a normal cochlea. With some modifications, a low-lying dura will not be the absolute contraindication of SMA.     

Sphenoid sinus symmetry and differences between sexes

OBJECTIVES: To evaluate the anatomic variations of neurovascular structures adjacent to the sphenoid sinus and their agreement between right and left sides as well as differences between sexes. METHODS: Forty-five cadavers were dissected (24 men, and differences between sexes and agreement of anatomic variations of the sphenoid sinus between sides were analyzed. RESULTS: The mean distance from the sphenoid sinus ostium to the anterior nasal spine was greater in males than in females by an average of 3.0 mm (p = 0.001) while the mean difference of distances between the right and left side was -1.1 +/- 3.1 mm. Female cadavers had a greater frequency of optic-carotid recess (p = 0.04) and dehiscence over the maxillary nerve (p = 0.02), as well as greater relative risk of optic nerve protrusion (p < 0.001), and dehiscence over the internal carotid artery (ICA) (p = 0.002). In male cadavers the intersinus septum was inserted on the course of the ICA 3.5 times more often than in female (p = 0.02). Agreement of anatomic variations between sides ranged from moderate to almost perfect depending on the structures evaluated. CONCLUSIONS: There are anatomic differences of the sphenoid sinus between sexes and between right and left sides, and these differences should be taken into consideration during surgery.     

Surgery of the lateral nasal wall and ethmoid: effects on sinonasal growth: an experimental study in rabbits

OBJECTIVE: To assess the impact of lateral nasal wall surgery on sinonasal growth METHODS: Twenty young New Zealand White rabbits, 6 weeks of age, were included in this experimental study. Surgery was performed on two groups of ten animals each (series I and II). Entrance to the left nasal cavity is achieved through the nasal dorsum via mobilization and rotation of the left nasal bone. Series I: partial resection of the lateral nasal wall (including the ostium to the maxillary sinus) on the left side. Series II: partial resection of the lateral nasal wall and anterior ethmoid. Follow-up period was 20 weeks. Twenty rabbits served as controls. RESULTS: In series I, all skulls have grown normally. In series II the nasal dorsum has also developed symmetrically. Snout length and growth of upper jaw are normal; there is no malocclusion. Three skulls show a slight deviation of the nasal dorsum (two to the left, one to the right). Morphometric measurements of 20 points on the skulls show no significant difference between the control group and the experimental series I and II. CONCLUSION: This experimental study demonstrates that visually controlled partial resection of the bony sinonasal wall, with or without resection of the anterior ethmoid does not affect later development of nose and upper jaw on condition that eventually underlying cartilage is preserved. Contradictory results from other experimental studies, previously published and concerning negative effects of sinus surgery, might be attributed to surgical traumatization of intranasal cartilage structures, in particular, the upper lateral cartilages.     

The order of testing effect in otoacoustic emissions and its consequences for sex and ear differences in neonates

The amplitude values of transient-evoked otoacoustic emissions, recorded from a large sample of neonates, were used to examine the asymmetry between ears tested and the differences due to the sex of the subject. Whilst the sex difference, with females having larger responses than males, has been a consistent finding in previous reports, the right/left ear difference, with the right ear giving a larger response than the left, has produced variable results that differed between laboratories. In this study, the sex difference was confirmed with females giving a 1.2 dB greater response than males. It was not affected by the age of the neonate. A significant effect of test order was found. The measured right/left difference was enhanced when the right ear was tested first but was diminished when the left ear was tested first. If the left ear is tested first then the measured right/left difference would be about 0.5 dB whereas, if the right ear is tested first, the measured right/left difference would be about 1.5 dB. When male/female comparisons were made for right and left ears separately and for the same ear tested first, the sex differences were the same for all four conditions. The sex and right/left differences have been confirmed as statistically significant effects and the order effect could explain the discrepancies and variability of the right/left differences reported in the literature.     

The various shapes of the paries jugularis and the frequency of additional ducts in the fossa jugularis as further factors influencing the spread of pathological processes

We investigated 100 skulls and found in 8 cases a dehiscence of the paries jugularis. In 7 cases this was on the left side and in 1 case on the right. Thickness of the paries jugularis was estimated by means of a diaphanoscopic technique. We classified data according to four degrees of diaphaneity: 0 (hardly translucent), 1 (translucent), 2 (brightly translucent) and 3 (nearly transparent). The frequencies of these degrees were: 0, 38 cases (19%); 1, 122 cases (61%); 2, 35 cases (17.5%); and 3, 5 cases (2.5%). In investigating the frequency of additional ducts in the paries jugularis, we distinguished between three types of solum tympani: type 1, no additional canals (18 cases); type II, 1–10 additional canals (172 cases); and type III, more than 10 additional canals (10 cases).     

Asymmetry of the ethmoid roof: analysis using coronal computed tomography.

OBJECTIVES/HYPOTHESIS: To determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof. STUDY DESIGN: Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans. METHODS: Retrospective review of 200 consecutive direct coronal sinus CT scans done at New York University Medical Center from July 25, 2000 to October 11, 2000. The height and contour of the fovea ethmoidalis were examined for symmetry between the right and left sides. When an asymmetry in the height of the fovea ethmoidalis existed, this difference was quantified. RESULTS: In 19 scans (9.5%), there was an asymmetry between the height of the fovea ethmoidalis on the right and left sides. Of these 19, 12 (63.2%) were lower on the right side, whereas 7 (36.8%) were lower on the left. Ninety-six patients (48.0%) demonstrated a contour asymmetry with "flattening" of the ethmoid roof on one side, 46 on the right and 50 on the left. One patient demonstrated both height and contour asymmetry. The fovea ethmoidalis on the remaining 86 scans (43.0%) was symmetric. CONCLUSIONS: In a patient population with sinus and nasal symptoms, the height and contour of the right and left fovea ethmoidalis were symmetric in less than 50% of individuals. The asymmetry was most often the result of a difference in contour with flattening of the fovea on one side. This underscores the importance of careful preoperative and intraoperative review of paranasal sinus CT scans in patients undergoing endoscopic sinus surgery.     

Vocal fold paralysis after anterior cervical diskectomy and fusion

OBJECTIVE: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis. STUDY DESIGN: Retrospective. METHODS: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed. RESULTS: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right-sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms. CONCLUSIONS: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow-up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.     

Depressive disorders in relation to neurootological complaints

Depression is a state of depressed mood characterized by feelings of sadness, despair, and discouragement. Depression ranges from normal feelings of "the blues" through dysthymia to major depression. Endogenous depression has been identified with a specific symptom complex: psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment. Reactive depression is precipitated by a stressful life event. In the field of depression, we found an overlapping activity between psychiatry and neurootology. Our sample comprises 134 patients (53 [39.55%] male, 81 [60.45%] female) who were classified either by psychiatrists or by neurologists as suffering from depression. By evaluating our neurootological history data bank (Neurootological Data Evaluation-Claussen [NODEC]) as regards 6 important vertigo symptoms, we found that patients presented with a frequency of 2.10 signs per patient. When we extended the list to 11 vertigo and nausea signs, we found 2.93 signs per patients. All patients underwent an objective and quantitative neurootometric analysis. The following rates of abnormal findings were observed: butterfly calorigram of polygraphic electronystagmography, 69.40%; stepping craniocorpograms, 69.40%; and bone-conduction pure-tone audiometry of the right ear, 28.36%, and of the left ear, 36.57%.     

前庭水管HRCT图像标准化处理、径线测量及其临床应用

目的重组前庭水管标准化图像,探讨径线测量对诊断大前庭水管综合征（large vestibular aqueduct syndrome,LVAS）的价值。方法标准化处理100例（200耳）正常人的颞骨HRCT图像获得前庭水管标准化图像,测量前庭水管中段宽度值,建立99％医学参考值范围;对37例（74耳）LVAS患者前庭水管宽度进行测量,并与正常值进行统计学分析。结果前庭水管中段宽度值无男女组、左右侧之间的统计学差异。前庭水管中段宽度值：右侧（0．92&#177;0．21）mm,左侧（0．93&#177;0．26）mm;99％医学参考值范围：右侧O．27～1．15mm,左侧0．27-1．24mm。LVAS患者前庭水管中段宽度最大值为3．2mm,最小值为1．4mm,与正常组比较有显著统计学差异（P〈0．05）。结论在前庭水管标准化图像上,前庭水管中段宽度值大于1．3mm可诊断为前庭水管扩大。临床有相应的症状、体征．相关基因检测异常时．可诊断为大前庭水管综合征。     

In search of correlation between hand preference and laterality of hearing impairment in patients with otosclerosis

The aim of this study was to investigate a possible correlation between handedness and laterality of hearing impairment due to otosclerosis. All patients operated for otosclerosis between August 2008 and February 2014 were queried about their handedness. The study group consisted of 218 right-handed and 21 left-handed (8.9 %) patients [139 female (58.2 %) and 100 male] with an age range of 18–75 years (mean 46.1 years). One-hundred and fifty-seven patients had a bilateral otosclerosis (BO) and 82 (34.3 %) had a unilateral otosclerosis (UO). There were 11 left-handed male and 10 left-handed female (11 % vs. 7.2 %, p = 0.305). In patients with UO, the left ear (LE) was affected in 6/11 (58.3 %) left handed ones, and the right ear (RE) in 41/71 (57.7 %) right handed ones (p = 0.842). In patients with BO, the LE was more affected in the left-handed ones, and the RE in the right-handed ones (7/10, 70 % and 87/147, 59.2 %, respectively, p = 0.5). Overall, 13/21 (61.9 %) left-handed patients presented with only/mostly left-sided otosclerosis, while 128/218 (58.7 %) right-handed patients presented with only/mostly right-sided otosclerosis (p = 0.584). Clinical relevance of presented findings is unclear yet nevertheless current study may contribute one more element in the multifactorial process of otosclerosis-related hearing loss.     

Inmovilidad glótica: estudio retrospectivo de 229 casos

Aretrospective study of the unilateral and bilateral vocal fold immobility cases diagnosed at our hospital between 1985 and 1998 was carried out. Of the 229 cases studied, vocal fold immobility was bilateral in 58 patients (25%), unilateral right in 60 (26%), and unilateral left 111 (49%). The most frequent etiologies in the bilateral cases were thyroid surgery (38%) and prolonged intubation (31%); idiopathic cases (32%) and thyroid surgery (23%) in the unilateral right cases; and idiopathic cases (28%) and extralaryngeal tumors (22%) in the unilateral left cases. Clinical compensation was achieved in more than 85% of cases of unilateral immobility when the etiology was idiopathic or due to surgical damage to the recurrent or vagus nerves, 70% when it was a prolonged intubation, 56% in neurological patients and 38% in extralaryngeal tumors. In patients with bilateral vocal fold immobility, 14% did not require any treatment, 34% had a permanent tracheostomy, and 52% recovered adequate naso-oral ventilation after surgery (tracheostomy only in 12 patients and arytenoidectomy in 18 patients).     

Ⅰ型单纯疱疹病毒致小鼠面神经麻痹的实验性研究

【摘要】目的建立Ⅰ型疱疹病毒感染致小鼠面神经麻痹的动物模型，并探讨单纯疱疹病毒1型（herpes simplex virus type1，HSV-1）在小鼠面神经麻痹发生过程中的致病机制及作用部位。方法选择53只16-18g、4周龄雌性Balb／e小鼠，用26G针头在49只实验组小鼠右耳廓背面近耳根部皮肤连续搔刮后，将25μL HSV-1病毒液滴在创面上。同样方法搔刮左耳廓，滴25μL PBS作为对照。另4只动物不作处理，作为空白对照。PCR法检测接种病毒后不同时问段的实验动物相关部位的HSV-1DNA表达。结果49只接种动物中，37只（75、5l％）出现不同程度的面神经麻痹。其中，右侧14只（14／37，37．84％），左侧3只（8、11％），双侧20只（54．05％）。20只双侧面神经麻痹动物中，13只（65％）先出现右侧面神经麻痹，2只（10％）先出现左侧面神经麻痹，另外5只直接发生双侧面神经麻痹。37只面神经麻痹动物中，6只（16．22％）面神经麻痹自行恢复，平均恢复时间为7．83d。结论HSV-1存在于脑干和大脑皮层面神经运动核放射区与面神经麻痹的出现关系密切。     

人工耳蜗植入术相关的面神经隐窝及后鼓室应用解剖研究

目的:通过对人工耳蜗植入术相关的面神经隐窝及后鼓室解剖结构进行观察测量,为人工耳蜗植入术中避免面神经、鼓索神经等损伤及准确定位鼓阶开窗口提供理论参考。方法:对20侧成人颞骨标本进行解剖,模拟经面神经隐窝入路人工耳蜗植入术,在手术显微镜下观察、测量与人工耳蜗植入手术相关的解剖数据。结果:外耳道后上棘至砧骨短脚之间的距离为(12.44±0.51)mm;鼓索神经发出点至茎乳孔之间的距离为(2.67±0.51)mm;砧骨短脚至鼓索神经发出点之间的距离为(15.22±0.83)mm;面神经隐窝最宽处至砧骨短脚之间距离为(6.28±0.41)mm;面神经隐窝最宽处至鼓索神经发出点之间距离为(9.81±0.71)mm;面神经隐窝最大宽度为(2.73±0.20)mm;镫骨头水平面神经隐窝宽度为(2.48±0.20)mm;圆窗水平的面神经隐窝宽度为(2.24±0.18)mm;锥隆起至圆窗膜前缘之间的距离为(2.22±0.21)mm;镫骨头至圆窗膜下缘之间的距离为(2.16±0.14)mm。结论:利用面神经垂直段并非一条直线垂直下行,而是向后有一拱形的弧度,因此面神经垂直段弧度最大位置是打开并充分开放面神经隐窝起始位置;术中切开耳蜗底回的位置位于锥隆起前下方约2.22mm。     

Certain Anatomical Relations and the Precise Morphometry of the Infraorbital Foramen–Canal and Groove: An Anatomical and Cephalometric Study

Objectives To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures. Study Design This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed. Methods Thirty‐five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram. Results Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 ± 1.39 mm, 33.94 ± 3.15, and 17.23 ± 2.64 mm, respectively. In cephalometric analysis, when S‐N (the distance between the center of the sella turcica and the nasion) and N‐ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant. Conclusion While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.     

Vibratory onset and offset times in children: A laryngeal imaging study

ObjectivesThe aim of the study was to evaluate the differences in vibratory onset and offset times across age (adult males, adult females, and children) and waveform types (total glottal area waveform, left glottal area waveform, and right glottal area waveform) using high-speed videoendoscopy.MethodsIn this prospective study, vibratory onset and offset times were evaluated in a total of 86 participants. Forty-three children (23 girls, 18 boys) between 5 and 11 years and 43 gender matched vocally normal young adults (23 females and 18 males) in the age range (21–45 years) were recruited. Vibratory onset and offset times were calculated in milliseconds from the total, left, and right Glottal Area Waveform (GAW). A two-factor analysis of variance was used to compare the means among the subject groups (children, adult male, and adult female) and waveform type (total GAW, left GAW, right GAW) for onset and offset variables. Post hoc analyses were performed using the Fishers Least Significant Different test with Bonferroni correction for multiple comparisons.ResultsChildren exhibited significantly shorter vibratory onset and offset times compared to adult males and females. Differences in vibratory onset and offset times were not statistically significant between adult males and females. Across all waveform types (i.e. total GAW, left GAW, and right GAW), no statistical significance was observed among the subject groups.ConclusionThis is the first study reporting vibratory onset and offset times in the pediatric population. The study findings lay the foundation for the development of a large age- and gender-based database of the pediatric population to aid the study of the effects of maturation of vocal fold vibration in adulthood. The findings from this study may also provide the basis for evaluating the impact of numerous lesions on tissue pliability, and thereby has potential utility for the clinical differentiation of various lesions.     

Assessment of facial analysis measurements by golden proportion

IntroductionThe face is the most important factor affecting the physical appearance of a person. In facial aesthetics, there is a specific mathematical proportion, which is called golden proportion, used to measure and analyse facial aesthetic qualities in population.ObjectivesThe aim of this study was to measure the facial soft tissue proportions which would help to constitute a standard for facial beauty and diagnose facial differences and anomalies and to compare these proportions to the golden proportion.MethodsOne hundred and thirty-three (133) Turkish patients 18–40 years of age (61 females, 72 males) were involved in the study. Analysis of the photographs was performed by the same physician, and a software programme was used (NIH Image, version 1.62). Facial proportions were measured and differences from the golden proportions were recorded and grouped as normal (1.6–1.699), short (<1.6) and long (>1.699).ResultsAccording to the facial analysis results, the trichion–gnathion/right zygoma–left zygoma was assessed: 33.1% of the patients were in normal facial morphology, 36.8% were in long facial morphology and 30.1% were in short facial morphology, according to this proportion. The trichion–gnathion/right zygoma–left zygoma proportion was significantly higher in males than females (p < 0.001). Statistically significant difference was noted in gender groups, according to the trichion–gnathion/right zygoma–left zygoma and the right lateral canthus–left lateral canthus/right cheilion–left cheilion proportions (p = 0.001, p = 0.028).ConclusionFacial proportion assessments in relation to the golden proportion showed that a statistically significant difference was observed between gender groups. Long facial morphology was observed more in males (51.4%); normal (41%) and short (39.3%) facial morphology were more common in females. The measurements and proportions for facial balance in our study population showed that the facial width and height proportions deviated from the golden proportion.     

Vestibular neuritis: is there any evidence of an asymmetric distribution?

Statistics in the literature showed that neuro-otological diseases (i.e. sudden hearing loss or tinnitus) occur predominantly in the left ear. In a seven-study meta-analysis of patients suffering from vestibular neuritis, Rei? found no clear dominance of one side (50.8% on the right side, 48.4% on the left side and 0.8% on both sides). The purpose of this study is to investigate the laterality of vestibular neuritis in a distinct population of patients. Lateralization of vestibular neuritis was studied in 160 patients treated at Elblandklinikum Radebeul from January 2004 to December 2009. There was a statistically non-significant dominance of the right side in the total sample, specifically in female patients (57% right vs. 40% left), but not in male patients. The study confirms the results of the meta-analysis: that there is no relevant side dominance in patients suffering from vestibular neuritis. In addition to the caloric test, the head impulse test was performed in 157 patients. In 92% of these patients, the disturbance of vestibular function could be confirmed with the head impulse test. This test is altogether a clinically useful instrument especially for follow-up, but also for diagnosis.     

耳道上径路耳蜗植入术

目的 探讨中国聋儿采用耳道上径路耳蜗植入的手术方法 .方法 2005年5月至2007年1月为50例(53侧)极重度感音性聋患儿采用耳道上径路行耳蜗植入.电极通过上鼓室的隧道于砧骨体与鼓索神经之间植入耳蜗鼓阶.结果 53侧手术电极全部植入者51侧;1例患儿(1侧)因耳蜗骨化只植入9对电极(Med-E1 C40+);另1例患儿(1侧)因耳蜗重度发育不良仅植入8对电极(Med-E1 C40+),该患儿术中发生井喷,植入电极时取出了砧骨并切断鼓索神经.1例患儿因鼓索神经与砧骨不易分离,电极经上鼓室隧道沿鼓索神经外侧植入鼓阶.所有病例术后无严重并发症发生.所有患儿耳蜗植入术后声场测听(听力级)均在30～40 dB;50例患儿随访均达6个月以上,其中26例具开放环境下的言语辨别力,己可进行交流;18例患儿可以讲短句,交流不太清楚;6例患儿只会讲单词.结论 耳道上径路耳蜗植入术是一种简单、安全的技术,中耳腔暴露好,不需要行乳突、面隐窝切开,无误伤面神经、鼓索神经的危险,尤其适用于面隐窝狭窄或面神经前移的患儿.     

Barcelona Smell Test - 24 (BAST-24): validation and smell characteristics in the healthy Spanish population

OBJECTIVES: Smell tests for clinical use have been developed in different countries, but no single test has gained general acceptance. The objectives of the study were to evaluate the smell outcomes in a Spanish population. METHODS: A prospective study on healthy volunteers (n = 120) without olfactory disturbances was performed. The volunteers were differentiated by gender, age, and smoking habit groups. We used a new olfactory test, the Barcelona Smell Test 24 (BAST-24) that consists of 24 odours scoring smell detection, identification, and forced choice. RESULTS: Volunteers showed the highest scores on smell detection for both 1st (99%) and 5th cranial nerve (98%) odours. Spontaneous smell identification (54.7% and 59.3%) and forced choice (72.2% and 42.6%) scores were lower than those of smell detection, for both 1st and 5th cranial nerves respectively. On smell identification, volunteers scored higher in the left than in the right nostril. Females had better smell identification for both 1st and 5th cranial nerves (62.8%, 66.7%) than males (50.3%, 58.8%). Non-smokers had higher scores (65%) than smokers (59%) on smell identification for the 5th CN. CONCLUSIONS: For smell identification, females, non-smokers, and left nostril had higher scores than males, smokers, and right nostril respectively. BAST-24 is a good and reliable method to test the olfactory function in the clinical practice.     

Evoked otoacoustic emissions and auditory brainstem responses: concordance in hearing screening among high-risk children

OBJECTIVE: Evoked otoacoustic emissions (OAEs) and diagnostic auditory brainstem responses (ABRs) were determined in 379 high-risk children referred for hearing screening. MATERIAL AND METHODS: This was a retrospective, cross-sectional study. The records of 379 children referred for hearing screening between January 2002 and March 2003 at the Ear Unit of the Philippine General Hospital were evaluated. RESULTS: Of the 379 children, 53.6% were male and 46.4% were female and the mean age was 41+/-47 months. The age distribution was as follows: < or = 12 months, 32.2%; 12-24 months, 52.2%; and > 24 months, 11%. Out of 229 right and 232 left ears, 111 (48.5%) and 112 (48.3%) had "pass" responses and 113 (49.3%) and 116 (50.5%) had "refer" responses, respectively. Five right and four left ears had "noise" responses. Out of 266 right and 209 left ears, the ABR results showed 72 (27.1%) and 30 (14.4%) with normal auditory pathways and 194 (72.9%) and 179 (85.6%) with abnormal auditory pathways, respectively. Of the 131 children whose parents gave their consent for concomitant OAE and ABR testing, agreements were observed between the two tests in terms of classifying the results as normal or abnormal of 78.9% (kappa = 0.51; p = 0.00) in right and 78.6% (kappa = 0.51; p = 0.00) in left ears. When the children were classified as either "with hearing loss-bilateral abnormal ABRs" or "at least one normal ABR", there was an observed agreement of 81% (kappa = 0.6; p = 0.00). OAEs had a sensitivity of 76.9% (95% CI 66.7-84.8%) and a specificity of 90% (95% CI 75.4-96.7%). CONCLUSION: There is good concordance between OAE and ABR results among high-risk children referred for hearing screening.