Do patients with chronic rhinosinusitis benefit from consultation with an ENT-doctor?

Conclusion: By consulting an ENT-doctor, patients with chronic rhinosinusitis (CRS), in the general population, receive disease information and adjustment of treatment which can improve disease-specific Quality-of-Life and may improve objective measurements. Objectives: This study aims to follow persons with clinical diagnosed CRS from the general population, to evaluate their benefit from consultation with an ENT-doctor in terms of severity of symptoms and Quality-of-Life. Methods: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Based on the European Position Paper on Rhinosinusitis and Nasal Polyps, persons were diagnosed with CRS and followed for 2 years. Quality-of-Life was measured using the Sino Nasal Outcome Test 22 and European Quality-of-Life – 5 Dimensions. Clinical examination included rhinoscopy, acoustic rhinometry, peak nasal inspiratory flow, smell test, and skin prick test. Results: Out of 91 persons with CRS, only 42% had previously consulted an ENT-doctor, and 51% were in current treatment for CRS. Most patients were advised medical treatment and 20% underwent surgery. Disease-specific Quality-of-Life, peak nasal inspiratory flow, olfactory function, and the nasal volume significantly increased over the 2-year period.     

Psychological characteristics of patients with Ménière's disease compared with patients with vertigo, tinnitus, or hearing loss

An association between Ménière 's disease and psychological distress is frequently reported. Patients who do not have Ménière's disease but who have similar symptoms also experience various kinds of psychological disturbances. We conducted a study to investigate the relationship between Ménière's disease and personality traits, illness behavior, depression, and anxiety. We compared these factors in 77 patients who had Ménière's disease and 133 controls who did not have the disease but had one of its symptoms--either vertigo, tinnitus, or hearing loss. The mental status of study participants was assessed with standard tests. Patients in both groups had higher than normal levels of anxiety and neuroticism. The only significant difference between the two groups was a higher rate of extroversion in the Ménière's disease group. Minor differences emerged when Ménière's patients with tinnitus or vertigo were compared with similar controls. Relationships between psychological observations and otologic symptomatology or an otologic diagnosis were not specific, which illustrates the need to consider the role of illness behavior and personality as targets for psychological support or therapy associated with ENT treatment.     

Do psychological factors change in patients with spasmodic dysphonia after injections with botulinum-toxin?

OBJECTIVE: A pre-/posttherapeutic comparative study was carried out to investigate possible associations of voice symptoms, selected psychological factors and their changing. SAMPLE: A total of 11 patients with spasmodic dysphonia (adductor-type) subjected to botulinum-toxin-therapy. Patients had received treatment without any complications for at least 2 years. During that period of time, they received a minimum of 3 and a maximum of 9 injections (mean: 6). METHODS: Psychosocial data were measured before and after treatment using standardized psychological methods. The time span between measurements ranged from 1;8 to 4;6 years, with an average of 2;1 years. RESULTS: On average, no somatic disorder, no clinically meaningful states of anxiety or pathological manifestations of personality traits could be detected, neither pre- nor posttherapeutically. The average stress load caused by life-changing-events was unobtrusive. Before treatment, 5 of 11 patients had an affective disorder in terms of a depressed mood. This caused a higher than average mean depressivity score for the group as a whole. It was no longer found posttherapeutically. CONCLUSION: The depression is interpreted as a psychic reaction. An association between spasmodic voice symptoms and psychosocial genesis could not be proved.     

management of otitis media with effusion

Otitis media with effusion is one of the most common diseases in children. Its treatment remains controversial. Clinical practice guidelines of OME allow watchful waiting for 3 months before treatment if the child with OME is not at risk for speech/language/or learning problems. Tympanostomy tube insertion is the preferred initial procedure when a child becomes a surgical candidate. Complementary or alternative medicine is not recommended as a treatment for OME. This paper provides a systematic review of management of OME, which we hope will be helpful for clinicians.     

Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir—a prospective study

Recurrent respiratory papillomatosis (RRP) is an uncommon disease that may cause symptoms ranging from hoarseness to severe obstruction of the airway. Several treatment modalities have been tried, all with varying success. The goal of this study is to assess the benefit of the intralesional injection of cidofovir as an adjunct to microsurgical excision in treatment of laryngeal papillomatosis. All patients with RRP who presented between 1999 and 2004 at the University Medical Center Groningen were prospectively analyzed, regardless of the patients age at presentation or duration of the disease. Not all patients were treated with cidofovir. To be included, all patients required a history of repeated microsurgery because of severe recurrence of RRP or because of severe technical difficulties in excising or vaporizing the lesion. Local microsurgery was performed, and then cidofovir, 2.5 mg/ml, was injected intralesionally. Treatment was repeated after 6, 12, 18, 24 and 30 weeks. Six male and three female patients were treated with cidofovir. Localization was the glottis in seven and the technically inaccessible dorsum epiglottidis and subglottis in one case each. The seven patients with glottic localization were cured. The two other patients showed recurrences, but at a lower rate than previously. Several times, however, more than six procedures were necessary. Cumulative doses of cidofovir ranged from 10.5 to 128 mg per patient. Cidofovir is a promising and powerful therapeutic approach for the treatment of RRP. Currently, the combination of microsurgery with intralesional cidofovir seems to be the treatment of choice for RRP.     

Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?

Objective

Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation.

Methods

Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities.

Results

Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery.

Conclusion

Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required.     

External validation of the LittlEARS® Auditory Questionnaire with English-speaking families of Canadian children with normal hearing

Objective

To examine the external validity of the United Kingdom English version of the LittlEARS^® Auditory Questionnaire with English-speaking families of Canadian children with normal hearing.

Methods

The United Kingdom English version of the LittlEARS was administered to English-speaking families of 130 children with normal hearing in Ontario, Canada. Total scores for these children were compared to German-derived normative values.

Results

There was no significant difference between Canadian and German norms when using the United Kingdom English version of the LittlEARS Auditory Questionnaire.

Conclusions

The United Kingdom English version of the LittlEARS Auditory Questionnaire is appropriate for use with English-speaking families of normal hearing Canadian children.     

Mitochondrial DNA Mutations Associated with Aminoglycoside Ototoxicity

The mitochondrial 12S rRNA has been shown to be the hot spot for mutations associated with both aminoglycoside-induced and non-syndromic hearing loss. Of all the mutations, the homoplasmic A1555G and C1494T mutations at a highly conserved decoding region in the 12S rRNA have been associated with aminoglycoside-induced and non-syndromic hearing loss in many families worldwide. The A1555G or C1494T mutation is expected to form novel 1494C-G1555 or 1494U-A1555 base-pair at the highly conserved A-site of 12S rRNA. These transitions make the secondary structure of this RNA more closely resemble the corresponding region of bacterial 16S rRNA. Thus, the new U-A or G-C pair in 12S rRNA created by the C1494T or A1555G transition facilitates the binding of aminoglycosides, thereby accounting for the fact that the exposure to aminoglycosides can induce or worsen hearing loss in individuals carrying these mutations. Furthermore, the growth defect and impairment of mitochondrial translation were observed in cell lines carrying the A1555G or C1494T mutation in the presence of high concentration of aminoglycosides. In addition, nuclear modifier genes and mitochondrial haplotypes modulate the phenotypic manifestation of the A1555G and C1494T mutations. These observations provide the direct genetic and biochemical evidences that the A1555G or C1494T mutation is a pathogenic mtDNA mutation associated with aminoglycoside-induced and nonsyndromic hearing loss. Therefore, these data have been providing valuable information and technology to predict which individuals are at risk for ototoxicity, to improve the safety of aminoglycoside antibiotic therapy, and eventually to decrease the incidence of deafness.     

Driving ability with vestibulär lesions

Bedingt durch die immer noch zunehmende Motorisierung der Bev?lkerung stellt sich in der Praxis des niedergelassenen HNO-Arztes vermehrt die Frage nach der Fahrtüchtigkeit eines Patienten, der einen Ausfall eines Vestibularapparates oder eine andere vestibul?re St?rung erlitten hat. Besonders problematisch ist es,wenn der Patient selbst subjektiv beschwerdefrei ist, eine L?sion aber noch nachweisbar ist, oder der Patient noch über Beschwerden klagt, obwohl eine vestibul?re St?rung nicht mehr objektivierbar ist. Im Folgenden wird der Versuch unternommen,einer L?sung dieser Probleme unter Berücksichtigung bekannter Mechanismen der Erholungsvorg?nge im vestibul?ren System und durch Darstellung der notwendigen Untersuchungsmethoden sowie exakter Definitionen der einzelnen Krankheitsbilder und ihrer Verl?ufe nahezukommen. Prof.Dr.Dr. K.-F.Hamann Universit?ts-HNO-Klinik der TU München, Ismaninger Stra?e 22,81675 München     

Long-term disability of class A patients with Ménière's disease after treatment with intratympanic gentamicin

OBJECTIVE: The main objective of this study was to characterize the residual vestibular symptoms and disability in patients with Ménière's disease who had achieved complete control of vertigo through intratympanic gentamicin treatment. Furthermore, we assessed whether the Functional Level Score prior to treatment reflected the posttreatment symptoms and disability. STUDY DESIGN: Prospective. SETTING: Tertiary medical center. PATIENTS: This study involved 103 patients with Ménière's disease treated with intratympanic gentamicin who, after a long-term follow up, have not suffered new vertigo spells and were not subject to any major modification in their treatment. METHODS: At inclusion and at the last follow-up visit after a minimum of 3 years of ending the treatment, the clinical status (number of vertigo spells), the unsteadiness as well as the disability produced by the disease, symptoms of anxiety, and compensation were asked using specific questionnaires. The results before and after treatment were analyzed using nonparametric tests. RESULTS: After a 5-year follow-up, complete control of vertigo was obtained in 81% of the patients with Ménière's disease who were treated with intratympanic gentamicin. Of them, 15.5% still complained of unsteadiness. A functional level of 6 or unsteadiness after treatment are related with a nonreduction in disability after long-term control of vertigo spells. CONCLUSIONS: The efficacy of gentamicin administered intratympanically is high after long-term follow-up as shown by the disappearance of vertigo spells and by the reduction in disability, increase in perception of quality of life, and reduction in anxiety related to vestibular symptoms. Unsteadiness, although an infrequent complaint, determines a level of almost similar severity in those issues. Special care must be taken with patients with a Functional Level Scale score of 6 at the time of beginning treatment.     

Clear speech for adults with a hearing loss: does intervention with communication partners make a difference?

Spouses of persons with hearing loss served as talkers to examine the benefits of clear speech intervention. One talker received intervention on clear speech. A second talker was simply instructed to speak clearly. Each talker was recorded reading sentences in three conditions: conversational speech, clear speech one week postintervention, and clear speech one month postintervention. Speech acoustic measures were obtained. Then the sentences were presented to subjects with normal hearing and subjects with hearing loss to measure speech recognition. Results showed that simply asking a talker to speak clearly was effective in eliciting clear speech; however, providing intervention yielded changes in more speech parameters, more stable changes, and better speech recognition. When listening to the talker who received intervention, subjects with hearing loss achieved the same performance as subjects with normal hearing. However, they performed worse than subjects with normal hearing when listening to the talker who received clear speech instructions only. Individuals with hearing loss would receive speech recognition benefits if their partners were provided with clear speech intervention.     

Neurovascular compression syndrome with Meniere's disease—a report of the treatment of a patient with microvascular decompression

Neurovascular compression syndrome(NVCS) is currently regarded as one of the causes of disabling positional vertigo (DPV). A 59-year-old man visited our hospital on December 15, 1993. The neuro-otological examination suggested that the patient had Meniere's disease and he was treated with conservative medication. However, the patient continued to suffer definite vertigo attacks, as well as a fluctuation in his hearing. A consultation and discussion lead us to believe the patient was also suffering from NVCS. We planned the microvascular decompression surgery. After surgery, the patient stopped suffering from vertigo attacks but his audiogram showed severe fluctuation in sensorineural hearing levels. It was concluded that the present patient had been suffering from NVCS combined with Meniere’s disease.