Equivalence and test–retest reproducibility of conventional and extended-high-frequency audiometric thresholds obtained using pure-tone and narrow-band-noise stimuli

Objectives: Extended high-frequency (EHF) audiometry is useful for evaluating ototoxic exposures and may relate to speech recognition, localisation and hearing aid benefit. There is a need to determine whether common clinical practice for EHF audiometry using tone and noise stimuli is reliable. We evaluated equivalence and compared test-retest (TRT) reproducibility for audiometric thresholds obtained using pure tones and narrowband noise (NBN) from 0.25 to 16?kHz. Design: Thresholds and test-retest reproducibility for stimuli in the conventional (0.25–6?kHz) and EHF (8–16?kHz) frequency ranges were compared in a repeated-measures design. Study sample: A total of 70 ears of adults with normal hearing. Results: Thresholds obtained using NBN were significantly lower than thresholds obtained using pure tones from 0.5 to 16?kHz, but not 0.25?kHz. Good TRT reproducibility (within 2?dB) was observed for both stimuli at all frequencies. Responses at the lower limit of the presentation range for NBN centred at 14 and 16?kHz suggest unreliability for NBN as a threshold stimulus at these frequencies. Conclusion: Thresholds in the conventional and EHF ranges showed good test-retest reproducibility, but differed between stimulus types. Care should be taken when comparing pure-tone thresholds with NBN thresholds especially at these frequencies.     

Age and gender differences in children and adolescents’ attitudes toward noise

Objective: Most school-aged children experience exposure to hazardous sound levels via high-risk noise activities (e.g. loud music/concerts, firearms). Little information exists regarding factors influencing pediatric engagement in these activities and use of hearing protection devices. This study explores effects of age, gender, and attitudes toward noise on participation in acoustic risk-taking behaviors and hearing conservation practices in children and adolescents. Design: Cross-sectional. Study sample: Children and adolescents (10–19 years) with normal hearing. Results: Most children and adolescents (86.5%) participate in at least one potentially high-risk noise behavior. The most frequently cited activities include sporting events, concerts, and playing a musical instrument. Use of hearing protection devices varies by activity, with consistent wear while using firearms but inconsistent application during all other activities. Gender, but not age, influences acoustic risk-taking behaviors: Boys engage in significantly more high-risk noise activities than girls. Participants expressed a neutral attitude toward noise that persisted across age and gender, but a trend shifting toward a pro-noise attitude emerges in later adolescence. Conclusions: The proliferation of acoustic risk-taking behaviors and lack of hearing conservation practices in children and adolescents requires attention at an early age to prevent future noise-induced hearing loss and subsequent quality of life effects.     

Do diet and activity restrictions influence recovery after adenoidectomy and partial tonsillectomy?

Objective

To determine if restrictions of postoperative diet concerning hard food and hot drinks as well as excessive physical exertion influence recovery during 14 days after T&A surgery.

Methods

800 patients aged 3-13 years (median 6) underwent curette adenoidectomy with or without scissors tonsillotomy. 413 adenoidectomies and 387 adenotonsillotomies were performed. Caregivers of the children completed a questionnaire reporting their child's postoperative activity, diet, pain level, peak and duration, episodes of nausea and fever, medication and caregivers’ satisfaction scores. The children were enrolled to food and effort restricted (FER), food non-restricted (FnR), effort non-restricted (EnR), and food and effort non-restricted (FEnR) groups at the end of follow-up.

Results

Two hemorrhages requiring repeat surgery under general anesthesia in FER group and 42 mild episodes of spontaneously subsiding bleeding from nose or mouth occurred. More than one episodes of hemorrhage were observed in other 8 individuals (total incidence of hemorrhages 9.7%). No hemorrhages were noted in the FEnR and FnR groups. There were 23 (4.4%) participants with episodes of bleeding, among them 21 mild hemorrhages, in the FER group and 21 (12.0%) in the EnR group (p < 0.001). Peak pain level was lowest in FEnR group (p < 0.001) and indications for antibiotics most frequent in FnR group (p < 0.001). Parental satisfaction level was highest in FnR and FEnR groups (p < 0.001).

Conclusions

The majority of caregivers reported care of children after T&A surgery according to the instructions. Most frequently disobeyed instructions were those concerning physical exertion. Diet and activity restrictions seem to influence postoperative recovery. Parental satisfaction scores were highest in non-restricted groups.     

D_3 and calcium supplementa

ed into two groups:(1) patients received salmon calcitonin,1α-hydroxyvitamin D_3,and calcium supplementation for 1year.(2) patients were not given salmon calcitonin,1αhydroxyvitamin D_3 and calcium supplementation.Blood Ca,ALP,BGP,PTH,urinary HOP and urinary Cr were measured before and after treatment.Results Over a 1-year follow-up interval,the levels of blood ALP,BGP and urinary HOP/Cr decreased significantly(P<0.001)in cases. No significient changes were found in the levels of blood Ca and PTH incases(P>0.05).Over a 1-year follow-up interval,The level of blood ALP,BGP,Ca,P     

Do anxiety and depression confound symptom reporting and diagnostic accuracy in chronic rhinosinusitis?

OBJECTIVES: We sought to determine the impact of psychiatric comorbidity on symptom reporting and diagnostic accuracy in chronic rhinosinusitis (CRS). METHODS: A prospective cohort of patients presenting for evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed with respect to paranasal sinus computed tomography (CT) Lund score. The degree of correlation between sinonasal symptoms and CT scan stage adjusting for anxiety and depression was determined. The relationships between symptoms, psychiatric comorbidity, and the presence of radiographic CRS were determined with multivariate logistic regression. RESULTS: There were 230 patients (mean age, 43.4 years) enrolled. High levels of anxiety and depression were noted in 23.5% and 13.0%, respectively. According to CT criteria, 61.3% to 71.3% of patients had true CRS. Even adjusting for anxiety and depression, only the nasal symptom domain severity had a statistically significant correlation with Lund score (r = 0.240; p = .001); facial, oropharyngeal, systemic, and total symptoms did not correlate with CT score. Similarly, multivariate analysis revealed that even with adjustment for anxiety and depression, sinus symptom domains failed to predict radiographic positivity. Individually, only dysosmia, dental pain, and fatigue were predictive for CRS (odds ratios, 1.29 [p = .032], 1.69 [p = .001], and 0.70 [p = .023], respectively). CONCLUSIONS: Although anxiety and depression are prevalent in patients with CRS, they do not influence the correlation between nasal symptoms and CT findings. Markers of psychiatric comorbidity do not correlate with CRS symptoms. The presence of anxiety or depression does not cloud symptom reporting in CRS and should not bias clinical decision-making.     

Glucose and insulin profiles and their correlations in Ménière's disease

Changes in carbohydrate metabolism, admittedly one of the most prevalent etiologies of Méière's syndrome, can be diagnosed early by 5-hour glucose and insulin curves with a 100-g glucose load, a test more sensitive than those traditionally used in investigating impaired glucose tolerance or diabetes mellitus. This study investigated carbohydrate metabolism characteristics in 64 patients with typical Ménière's disease. We demonstrated that 72% of them had some variable degree of hyperinsulinemia as shown by their plasma insulin curves, whereas alterations on the glucose curve (reactive hypoglycemia or hyperglycemia) were found for only 21%. More advanced hyperinsulinemic conditions (i.e., glucose intolerance or diabetes mellitus) were usually associated with changes in lipid profiles and with a central pattern of fat distribution and systemic hypertension. We found a very strong correlation between insulin concentrations measured by chemoluminescence and by radioimmunoassay; the latter, however, showed values 1.3 times higher than those measured by chemoluminescence. These findings confirm the need to include 5-hour glucose and insulin curves in the diagnostic routine when investigating Ménière's disease. In that way, an early diagnosis of hyperinsulinemia, the metabolic change most often involved in the pathogenesis of cochleovestibular disorders, can be made.     

Conformal radiotherapy in head and neck tumors: increased tumor control and decreased morbidity?

Conformal radiotherapy in head and neck tumors is only at its premise. Its offers attractive prospect to decrease late morbidity and increase loco-regional control probability not only in patients with primary treatment but also in patients with recurrent disease previously fully irradiated. Such modality however, requires complex infrastructure and qualified staff. Comprehensive evaluation are thus needed to determine the patient population that will benefit the most from this new promising technique before its use can be generalized.     

Atypical mycobacterial tuberculosis--a diagnostic and therapeutic dilemma? Case reports and review of the literature

In immunocompetent preschool children cervical lymphadenitis is a common clinical presentation of atypical mycobacteria. Its rapid diagnosis and treatment is still a challenge, because accurate diagnostic procedures for atypical mycobacteria are still not yet available in routine practice. Two children suffered from craniojugular (16 months old girl) and infraauricular (2.5 years old boy) located neck masses which showed resistance to the medical treatment. In the first case an abscess splitting took place initially, followed by an anti-tubercular drug treatment and necessary surgical reintervention. In the second case surgical removal of all involved lymph nodes, infiltrated surrounding soft tissue and involved skin areas were followed by medical treatment. In both cases presumed infection with mycobacterium tuberculosis was not confirmed, but atypical mycobacteria could be isolated both. In the first case atypical mycobacterium could be specified as mycobacterium avium complex and in the second case as mycobacterium malmoense. Both bacilli showed sensitivity towards medical treatment with clarithromycin, whereby in one case only the surgical reintervention led to a complete removal of clinical symptomatic. In cases of presumed tuberculous neck lymph node infections differential diagnosis of an atypical mycobacterial lymphadenitis should always be supposed, because medical and surgical treatment differ fundamentally.     

Lymphangioma and lymphangiomyomatosis--the same lesion?

The authors present a very rare case observed in a 32 year old female with a huge tumor on the left side of the neck in which extensive changes characteristic for cystic lymphangioma in the lower part and for lymphangiomyomatosis in the upper part of the tumor were observed intraoperatively. On the basis of the discussed case the suggestion is put forward that these two rarely occurring diseases may have similar etiological grounds.     

Role and mechanism of the expression of matrix metalloproteinase 9 and tumor necrosis factor α in upper and lower respiratory tract inflammation in rats

Objective To investigate the role and mechanism of matrix metalloproteinase 9(MMP-9) and tumor necrosis factor α (TNF-α) in the pathogenesis of allergic rhinitis (AR) and asthma (AS). Methods The rat models of AR and AS were made by injecting ovalbumin. The infiltration of eosinophils and mast cells were detected by hematoxylin-eosin (HE) staining and toluidine blue staining respectively, and the expression of MMP-9 and TNF-α in nasal mucosa and lung tissue were examined by immunohistochemical staining ( SP method). The relationship of their expression with upper and lower respiratory tract inflammation was analyzed. SPSS 13.0 software was used to analyze the data. Results The numbers of MMP-9 positive inflammatory cells in nasal mucosa and lung tissue of AR were ( 154.8±12.0)and (124. 0 ±8.2), (43. 2 ±7.6) and (34. 5 ±5.0) in the control groups, the difference was significant (t value were 24. 260, 29. 525 respectively, all P＜0.05). The numbers of MMP-9 positive inflammatory cells in nasal mucosa and lung tissue of AS were (149.9±11.7)and(120.1±7.3), (48.6 ± 7. 6) and (39.1±5.2)in control groups, the difference was significant (t value were 22. 929 and 28. 530respectively, all P＜0.05).The numbers of TNF-α positive inflammatory cells in nasal mucosa and lung tissue of AR were (188.8±17.0), and (134.8±7.9), (57.6±23.3)and(40. 3 ± 8. 2 ) in control groups, the difference was significant (t value were 13. 836 and 26. 220, all P ＜0.05). The numbers of TNF-α positive inflammatory cells in nasal mucosa and lung tissue of AS were (179. 2 ± 15.4 ) and ( 153. 5 ± 10. 1 ), (70. 5 ±33. 1 ) and ( 33.8 ± 14. 0) in control groups, the difference was significant ( t value were 9. 412 and 21. 858, all P ＜0. 05). There was a correlation between the expression of MMP-9 and TNF-α in nasal mucosa and lung tissue of AR ( r values were 0. 893 and 0. 700 respectively, P values were 0. 001 and 0. 024, respectively ) and AS ( r values were 0. 692 and 0. 644 respectively, P values were 0. 027and 0. 044 respectively) groups. Conclusions The inflammation is similar between AR and AS. The MMP9 and TNF-α may play an important role in the pathogenesis of upper and lower respiratory tract inflammation.     

Does cochlear implantation and electrical stimulation affect residual hair cells and spiral ganglion neurons?

Increasing numbers of cochlear implant subjects have some level of residual hearing at the time of implantation. The present study examined whether (i) hair cells that have survived one pathological insult (aminoglycoside deafening), can survive and function following long-term cochlear implantation and electrical stimulation (ES); and (ii) chronic ES in these cochleae results in greater trophic support of spiral ganglion neurons (SGNs) compared with cochleae devoid of hair cells. Eight cats, with either partial (n=4) or severe (n=4) sensorineural hearing loss, were bilaterally implanted with scala tympani electrode arrays 2 months after deafening, and received unilateral ES using charge balanced biphasic current pulses for periods of up to 235 days. Frequency-specific compound action potentials and click-evoked auditory brainstem responses (ABRs) were recorded periodically to monitor the residual acoustic hearing. Electrically evoked ABRs (EABRs) were recorded to confirm the stimulus levels were 3-6 dB above the EABR threshold. On completion of the ES program the cochleae were examined histologically. Partially deafened animals showed no significant increase in acoustic thresholds over the implantation period. Moreover, chronic ES of an electrode array located in the base of the cochlea did not adversely affect hair cells in the middle or apical turns. There was evidence of a small but statistically significant rescue of SGNs in the middle and apical turns of stimulated cochleae in animals with partial hearing. Chronic ES did not, however, prevent a reduction in SGN density for the severely deaf cohort, although SGNs adjacent to the stimulating electrodes did exhibit a significant increase in soma area (p<0.01). In sum, chronic ES in partial hearing animals does not adversely affect functioning residual hair cells apical to the electrode array. Moreover, while there is an increase in the soma area of SGNs close to the stimulating electrodes in severely deaf cochleae, this trophic effect does not result in increased SGN survival.     

Complications associated with Dermabond® during head and neck surgery: MAUDE and literature review

IntroductionDermabond® is a liquid surgical sealant containing 2-octyl-cyanoacrylate that has been widely used during head and neck surgeries. This study aims to provide a summary of adverse events related to Dermabond® in head and neck procedures as reported in the MAUDE database, and to report a complete overview of all documented adverse events related to Dermabond® use in current literature.MethodsThe US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of adverse events related to Dermabond® use from January 1, 2010, to February 1, 2020. Data were extracted from reports pertaining to head and neck procedures. In addition, literature review was performed from January 1970 to January 2021. Various adverse events related to Dermabond® were included in the study.ResultsWe identified 32 adverse events, from which 29 (90.6%) were patient-related events and 3 (9.4%) were operator-related events. Of the patient-related events, contact dermatitis (CD) (20 [69.0%]) was the most common, followed by wound dehiscence (4 [13.8%]). All of the operator-related events were from inadvertent cut injury (3 [100%]). Following the literature review, adverse events of Dermabond® were categorized into CD, wound dehiscence, infection, and cut injury.ConclusionDermabond® demonstrated utility in various surgical procedures including head and neck surgeries but are associated with risks. This study identified adverse events associated with Dermabond®. Further studies are needed to establish the causation of contact dermatitis in certain populations.     

Assessing Penetration and Aspiration: How Do Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing Compare?

OBJECTIVES/HYPOTHESIS: We aimed to investigate whether the type of dysphagia examination (fiberoptic endoscopic evaluation of swallowing [FEES] or videofluoroscopy) influences the scoring of penetration and aspiration. STUDY DESIGN: Prospective, single-blind study. METHODS: Fifteen dysphagic participants were recruited and underwent one FEES and one videofluoroscopy examination, performed and recorded simultaneously. Fifteen independent raters from 12 centers scored penetration and aspiration from recordings using the Penetration Aspiration Scale. Raters were blind to participant details, the pairing of the FEES and videofluoroscopy recordings, and the other raters' scores. Interrater and intrarater reliability were analyzed using weighted kappa. RESULTS: The Penetration Aspiration Scale scores were significantly higher for the FEES recordings than for the videofluoroscopy recordings (ANOVA P < .001). The mean difference between the FEES and videofluoroscopy penetration aspiration scores for the same swallows was 1.15 points. Interrater and intrarater reliability ranged from 0.64 to 0.79 (weighted kappa). CONCLUSIONS: Penetration aspiration is perceived to be greater (more severe) from FEES than videofluoroscopy images. The clinical implications are discussed.