Fiberoptic Endoscopic Evaluation of Swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings

Objective

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used as an adjunct to assess swallowing function in children with complex feeding disorders. We report the feeding outcomes of patients who underwent FEES to determine whether associations exist between clinical diagnoses or FEES findings and feeding outcomes.

Methods

Retrospective review of children who underwent FEES for dysphagia or aspiration from 2003 to 2009. The clinical diagnoses and initial FEES findings were compared to follow up feeding status for associations.

Results

79 patients were included (44 males and 35 females). The change from initial to final status: total oral feeding (42-67%), NPO ± minimal tastes (39-21%) and oral feeding with tube feeding (19-12%). Of the clinical diagnoses, tonsillar hypertrophy was associated with ultimately obtaining total oral feeding status (p = 0.046) while the inability to obtain total oral feeding status was associated with neurologic (p < 0.001). The initial FEES findings showed no significant associations with long-term feeding status.

Conclusion

Many children overcome their dysphagia but those with neurologic disorders are less likely to achieve total oral feeding status. In children with dysphagia evaluated by FEES, the long-term feeding status is not significantly associated with the initial FEES findings.     

Food choking hazards in children

Objectives

To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods.

Methods

A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July–September 2010 with publication dates ranging from 1966 to 2010. Study selection: Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series). Data extraction: For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A “majority” of patients for each study was predetermined arbitrarily to be 2/3 of the studied population.

Results

The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies).

Conclusion

Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.     

Supraglottoplasty outcomes in relation to age and comorbid conditions

Objective

To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.

Design

Retrospective study.

Setting

Urban tertiary-care children's hospital.

Patients

Children undergoing supraglottoplasty for severe laryngomalacia between February 2004 and July 2008. 56 patients were identified.

Outcome measures

Persistence of upper airway obstruction, revision surgery (supraglottoplasty), and additional surgery (tracheostomy).

Results

33/56 (58.9%) patients had no comorbid conditions and 23/56 (41.1%) patients had comorbid conditions. In noncomorbid patients, 36.4% of those less than 2 months of age at the time of surgery required revision supraglottoplasty, compared to 5.3% of patients between 2 and 10 months (p < 0.05). Compared to the 2-10-month age group, there was a significantly higher percentage of patients with comorbid conditions in the >10-month group (32.1% vs. 79%, p < 0.01). Patients with comorbid conditions were diagnosed at a significantly later age than those without (6 mo vs. 2 mo, respectively), and had significantly higher rates of revision supraglottoplasty (47.8% vs. 18.2%) and tracheostomy (39.1% vs. 0.0%). 70% of children with neurological conditions required revision surgery, with 60% requiring tracheostomy. The revision surgery and tracheostomy rates were significantly higher compared to the noncomorbid group (p < 0.01 and p < 0.0001). Children with cardiac conditions had a higher rate of tracheostomy than noncomorbid children (30% vs. 0%, p < 0.01). 16.7% of children with genetic conditions required supraglottoplasty, and none required tracheostomy.

Conclusions

In noncomorbid patients, those undergoing supraglottoplasty less than 2 months of age had a significantly higher rate of revision supraglottoplasty. Patients with neurologic and cardiac comorbidities require tracheostomy at a significantly higher rate than noncomorbid patients.     

Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas

Objective

To compare the efficiency of diffusion-weighted MR imaging (MRI) vs. high resolution CT in predicting recurrent or residual cholesteatoma in children who underwent prior middle ear surgery.

Design

Prospective study.

Setting

Tertiary care university hospital.

Patients

Seventeen patients (4 with 2 recurrences) aged 5-17 years (mean 11.4) previously surgically treated for a cholesteatoma of the middle ear, were included for follow-up with systematic CT scan and MRI, between 2005 and 2007.

Methodology

CT scan was performed on a Siemens Somaton 64 (0.5/0.2 mm slices reformatted in 0.5/0.3 mm images), parallel and perpendicular to the lateral semi-circular canal for each ear (100 mm × 100 mm FOV). MRI was undertaken on a Siemens Avanto 1.5 T unit, with an adapted protocol for young children. Diagnosis of recurrent cholesteatoma was based on the evidence of a hyperintense image at B1000 on diffusion-weighted images. Results of CT scan and MRI were compared with operative diagnosis.

Results

Nine patients had a positive MRI, among which 8 had cholesteatoma confirmed during revision surgery. In the 12 negative MRI cases, 5 were positive on revision surgery. None of these lesions was over 3 mm. Two of them were diagnosed on the CT scan. CT scan alone had a positive predictive value of 75%, and a negative predictive value of 58%.

Conclusion

Diffusion-weighted MRI is associated with a high positive predictive value for the detection of recurrent cholesteatoma. CT scan remains the first choice imaging technique. In case of doubtful CT scan, diffusion-weighted MRI could confirm a recurrence or, when negative, avoid second-look surgery.     

Effect of piperacillin-tazobactam coated β-tricalcium phosphate for mastoid obliteration in otitis media

Background and objective

β-Tricalcium phosphate (TCP) has good biodegradability and osteoconductivity as a scaffold material for bone tissue engineering. Both block and granular forms are available; however, it has been associated with risk of infection and exposure. To this end, the study evaluated the effect of piperacillin-tazobactam coated β-TCPs for mastoid obliteration in otitis media.

Materials and methods

Ten guinea pigs were divided into the experimental (piperacillin-tazobactam coated β-TCP granules, n = 5) and control groups (uncoated β-TCP granules, n = 5). After mastoid obliteration, transtympanic injection with a saline suspension of lipopolysaccharide established inflammation. The animals were sacrificed 5 weeks later. Tissue sections were stained with hematoxylin and eosin and examined.

Results

Encapsulation and formation of fibrous capsule by foreign material in the bulla were not evident. The histological evaluation did not reveal inflammatory cells and fibrosis in the piperacillin-tazobactam coated β-TCP group. In contrast, the control group showed numerous inflammatory cells around the implanted uncoated β-TCP granules and incomplete new bone formation.

Conclusion

β-TCP is an effective carrier material for piperacillin-tazobactam. The use of piperacillin-tazobactam coated β-TCP may be optimal for mastoid obliteration.     

Prolonged recovery after out-patient pediatric adenotonsillectomy

Objective

To determine variables predictive of recovery room times in pediatric outpatient adenotonsillectomy.

Study design

Retrospective case-control.

Methods

One-hundred ninety consecutive patients undergoing outpatient adenotonsillectomy at an ambulatory surgery center of a tertiary-care free standing pediatric hospital were grouped into upper and lower deciles of recovery room times. Twenty-one variables were analyzed to determine which variables are predictive of prolonged recovery time. Univariate and multivariate analyses were performed.

Results

Of the 190 patients, mean recovery room time was 103 min (SD 53.1), 22 patients were in the lower decile (mean recovery room time of 63 ± 6 min) and 17 patients were in the upper decile (155 ± 40 min, P < 0.0001). Of the 21 variables analyzed, post-anesthesia care unit (PACU) nursing staff was the only significant predictor of prolonged recovery room time. Compared with one PACU nurse, other nurses (N = 5) predicted a longer recovery time (OR = 10.8, 95% CI 2.0-59.5, P = 0.0017). This association remained significant when controlling for anesthesiologist and surgeon (OR = 8.8, 95% CI 1.5-50.9, P = 0.0072). There were no complications in any patients.

Conclusions

Recovery room times after outpatient adenotonsillectomy vary significantly (mean 103 min (SD 53.1), range 50-241 min). Of potential predictors, only the human factor (PACU nursing staff) was associated with prolonged recovery room times, independent of surgeon and anesthesiologist. Development of standardized protocols for nurses to use for discharge has the potential to increase throughput for adenotonsillectomy patients in an outpatient surgery center setting.     

TLR-9, NOD-1, NOD-2, RIG-I and immunoglobulins in recurrent otitis media with effusion

Objectives

Pattern recognition receptors (PRRs) induce appropriate immune responses after recognizing certain molecular characteristics of pathogens. It is not known, however, whether PRRs are expressed in middle ear infections and whether the expression of PRRs and immunoglobulins is correlated in recurrent otitis media with effusion (OME). We therefore investigated the expression of PRRs and immunoglobulins in children with OME.

Materials and methods

The study population consisted of 66 children with OME, of whom 27 had more than 4 episodes in 12 months or more than 3 episodes in 6 months (otitis-prone group), and 39 had fewer than 4 episodes in 12 months or 3 episodes in 6 months (non-otitis-prone group). The expression in middle ear effusion of Toll-like receptor (TLR)-9, nucleotide-binding oligomerization domain (NOD)-1, NOD-2, and retinoic acid-inducible gene (RIG)-I mRNA, as determined by real-time PCR, and the concentrations of IgG, IgA, and IgM, as determined by ELISA, were compared between the two groups.

Results

The levels of TLR-9, NOD-1 and RIG I mRNAs were significantly lower in the otitis-prone than in the non-otitis-prone group (p < 0.05 each). The concentrations of IgG, IgA and IgM in effusion fluid did not differ significantly between the two groups (p > 0.05), and there were no correlations between immunoglobulin concentration and the expression of PRPs (p > 0.05).

Conclusions

Decreased expression of PRRs may be associated with increased susceptibility to OME.     

Prenatal risk factors and occurrence of allergic rhinitis among elementary school children in an urban city

Objectives

To investigate the incidence and prenatal risk factors for allergic rhinitis among elementary school children in an urban city.

Study design

Risk factor data were collected by questionnaire and direct physical examination. Multiple logistic regression analysis was used to calculate the odds ratios of developing allergic rhinitis among children 6-13 years of age.

Methods

From January 2006 to December 2006, we enrolled 1368 elementary school children in the study. Sampling was done by a multi-stage clustered-stratified random method to determine the study subject. All the children studied attended 12 elementary schools located in the six districts in Taipei, with two schools in each district. Odds ratios were adjusted for the confounding effects of gender, parity, maternal age at childbirth, maternal education, gestational complications, tobacco smokers in the residence, pets, carpets, molds, and air pollution.

Results

The incidence of allergic rhinitis in the study was 50.1% (685/1368). Factors like gender (p < .001), parity (p < .05), carpets (p < .025), and air pollution (p < .001) increased risk, while the other factors did not (p > .05 for all).

Conclusion

Gender, parity, carpets, and air pollution increased the risk of developing allergic rhinitis among elementary school children. Other potential factors such as low birth weight, maternal age at childbirth, parental education, gestational complications, presence of tobacco smokers, and exposure to pets and molds did not significantly increase risk of developing allergic rhinitis.     

Nasality evaluation of Turkish phonemes in vowel-consonant combinations

Objectives

The purpose of this study is to find average nasalance values of Turkish syllables with the nasometer.

Methods

This study is done at Hacettepe University Department of Otolaryngology Audiology and Speech Pathology Unit with 50 participating children.

Results

The normative nasalance values of Turkish phonemes are determined. It is found that nasalance scores of syllables that is combined with/i/phoneme is statistically have higher nasalance scores than/a/and/e/phonemes (p < 0.05). There is no difference find statistically between age and nasalance value (p > 0.05). Statistical difference between age and nasalance score is found in “iki, ?e, e?e, i?i, aç, eç, çi, içi, iç, al, yi, iy, iyi, yiy, ana, ne” syllables (p < 0.05). These phonemes have positive relation with the age. There is no statistical difference between sex and nasalance scores (p < 0.05). Statistical difference is only found in “tat- te- li- lil- aya” syllables (p < 0.05). On these phonemes it is found that girls have higher nasalance score than boys.

Conclusion

As a result, it is thought that gathered nasalance values of Turkish phonemes will be useful for resonance disorder diagnosis and follow ups on treatment.     

Does auditory tube angle really affect childhood otitis media and size of the mastoid?

Objective

To assess the cross-sectional area of mastoid air cells and auditory tube angles (ATA), which were defined as the angles between the longitudinal line bisecting the transverse length of the external auditory canal and the longitudinal axis of the auditory tube (AT), both in healthy ears and diseased ears in patients with unilateral chronic otitis media (COM).

Methods

25 patients who had unilateral COM were included in the study. Assessment was performed using a quantitative digital image processing computer tomography (CT) program.

Study design

Prospective study with institutional review board approval including adult patients who had otological symptoms since their childhood period.

Results

Mastoid areas were greater on the healthy side than on the diseased side (p < 0.05). ATA were not significantly different among groups (p > 0.05). When we compared ATA with mastoid area in each group; there were no significant correlations in both healthy group and COM group (p > 0.05). Mastoid size in COM group was smaller than in the healthy group.

Conclusion

We suggest that middle ear inflammations in childhood may affect mastoid size but, the anatomic relationships of the auditory tube, mastoid and middle ear that form a functional unit may not be significantly important in chronic ear disease.     

Laryngovideostroboscopy in children--diagnostic possibilities and constraints

Objective

The aim of this study was to report our experience with laryngovideostroboscopy (LVS) in consecutively examined children patients.

Methods

The study included 150 children (2.5-14 years of age) diagnosed with dysphonia. Patients were divided into three age groups: group I - from 2.5 to 6 years of age (n = 31), group II - from 6 to 10 years of age (n = 73), and group III - from 10 to 14 years of age (n = 46). LVS was performed during the second visit. 3.5 mg of dormicum were administered orally 30 min prior to LVS in all children from group I and in some patients belonging to group II. Local anesthesia of the pharyngeal mucosa was not needed in any case.

Results

In nine out of 150 children, it was not possible to perform LVS during the first attempt. In eight of these children, the examination was performed successfully during another visit with satisfactory LVS images obtained. LVS revealed soft vocal fold nodules in 85 patients along with other organic changes found in five children: congenital laryngeal web (n = 1), vocal fold cysts (n = 3), and vocal fold paralysis (n = 1). Hyper-functional dysphonia was diagnosed in the remaining 60 subjects.

Conclusions

In order to perform successful LVS in children patient, the purpose and methodology of this examination should be explained to parents on the first visit whereas an attempt to perform LVS should be undertaken during the second visit. Oral administration of dormicum 30 min prior to the examination is advisable, particularly in younger children, and allows us to avoid the use of local anesthetics.     

Cochlear involvement in Familial Mediterranean Fever: a new feature of an old disease

Objectives

In this study we first aimed to assess the cochlear functions in children with Familial Mediterranean Fever. The second aim was to investigate the correlation between the hearing levels and some clinical features of Familial Mediterranean Fever including the duration of the disease, age at onset, genetic analysis and colchicine use.

Methods

Thirty-four children with Familial Mediterranean Fever and 27 age matched children were included in the study. Following otologic examination, all children underwent audiometric evaluation, including Pure Tone Average measurements and Distortion Product Otoaoustic Emission testing. Audiological results of the two groups were compared and correlation between the audiologic status and clinical parameters of the disease like the duration of disease, age at onset, mutations and colchicine treatment were studied.

Results

Pure tone audiometry hearing levels were within normal levels in both groups. Hearing thresholds of Familial Mediterranean Fever patients were found to be increased at frequencies 8000, 10,000, 12,500 and 16,000 (p < 0.05). In otoacoustic emission evaluation, distortion products and signal-noise ratio of FMF children were lower in the tested frequencies, from 1400 Hz to 4000 Hz (p < 0.05). Interaction of the disease duration and age of disease onset was found to predict hearing levels, distortion products and signal-noise ratios of children with Familial Mediterranean Fever (F value = 2.034; p = 0.033).

Conclusions

To our knowledge this is the first study demonstrating cochlear involvement in children with Familial Mediterranean Fever which showed increased hearing thresholds at higher frequencies in audiometry together with decreased distortion products and signal-noise ratios demonstrated by distortion product otoacoustic emission testing. Similar studies must be carried out on adult patients to see if a clinical hearing impairment develops. The possible mechanisms that cause cochlear involvement and the effect of colchicine treatment on cochlear functions must be enlightened.     

Characteristics of hearing impairment in Yemeni children with chronic suppurative otitis media: A case-control study

Background

Chronic suppurative otitis media (CSOM) is a serious disorder particularly in low resource settings. It can lead to disabling hearing impairment and sometimes life-threatening infective complications.

Objective

The aim of the present study was to describe the characteristics of hearing impairment associated with CSOM in Yemeni children.

Methods

A case-control study of 75 children with CSOM and 74 healthy controls. Hearing was assessed by behavioural testing and audiometry.

Results

Cases had lower academic performance than controls (OR 15.31, 95% CI 1.99-322.14, p < 0.001). Disabling hearing impairment >30 dB was present in 51.5% (right ear) and 66.7% (left ear) of children with CSOM.

Conclusion

Disabling hearing impairment was identified as a major health problem in these Yemeni children with CSOM. There is a need for investment to reduce the burden of CSOM and its complications in these communities. Greater attention to the chronic disabling effects of CSOM in children is required in poor communities and low resource settings.     

Ghrelin levels in children with adenoid or chronic tonsil hypertrophies before and after surgery

Objective

We aimed to evaluate the ghrelin levels in the children with adenoid or tonsil hyperthrophies.

Methods

The study included 27 children (17 boys and 10 girls). Mean age was 6.9 ± 3.5 years, ranging from 3 to 16. Ghrelin levels in the patients and their weight and height measurements were evaluated before surgery and after 3 months later of the operation.

Results

While 18 (67%) children were operated for adenoid hypertrophy, 9 (33%) children were operated for adenoid and tonsil hypertrophy. It was found that postoperative ghrelin levels were significantly decreased whereas weight and BMI scores were significantly increased (p < 0.01). A weak correlation was observed between preoperative ghrelin and weight (r = −0.29). This negative correlation became more profound at the postoperative 3rd month examination (r = 0.85) (p < 0.01).

Conclusions

The present study showed that the surgical treatment provides positive contributions on the growing of children with adenoid and tonsil hypertrophies. The ghrelin levels were significantly decreased at the postoperative period in the children, and a negative relationship was observed between the ghrelin levels and the weight. These findings suggest that blood ghrelin levels may be useful as a parameter for following the development of the children.     

Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis

Objectives

To analyze the outcome of a new endoscopic approach for the treatment of pediatric subglottic stenosis.

Study design

Case series.

Setting

Tertiary care center.

Material and methods

Eighteen pediatric cases of grade II to IV subglottic stenosis (8 congenital and 10 acquired) consecutively treated at our institutions by Endoscopic Anterior Cricoid Split (EACS) and balloon dilation between 2006 and 2010. Treatment protocol encompassed systematic postoperative laryngeal stenting (7 days of intubation or 1 month of Montgomery T-tube in previously tracheotomized patients) and endoscopic controls with possible additional balloon dilation every 15 days for at least 2 months.

Results

Patients’ ages ranged from 1 to 101 months. Postoperative follow-up ranged from 4 to 45 months (median value ± SD: 15.3 ± 11.9). The mean duration of the endoscopic procedure was 35.2 ± 13.2 min. The number of days spent in PICU during the perioperative period varied between 2 and 15. Four patients (22.2%) needed one and 14 patients (77.7%) required several (from 4 to 7) additional balloon dilations during the postoperative endoscopic controls. No incident was observed during or immediately after EACS. Treatment was efficient in 83% of cases (n = 15), with no residual respiratory symptoms and grade 0 to 1 SGS at the end of follow-up.

Conclusion

EACS is a safe and efficient technique to treat pediatric subglottic stenosis, regardless of their grade and length, provided to associate it with postoperative laryngeal stenting and regular endoscopic follow-up with possible additional balloon dilations. In our teams, it has become the first line treatment for most grades II to IV SGS. Its indications can be extended to congenital stenosis with cartilaginous involvement and to long-lasting acquired stenosis with firm fibrosis.     

Post-operative bleeding is less after partial intracapsular tonsillectomy than bipolar total procedure

Objective

To compare bleeding after partial intracapsular tonsillectomy (PIT) and bipolar diathermy tonsillectomy (BDT).

Design

Retrospective chart review.

Setting

Stollery Children's Hospital, tertiary pediatric referral centre.

Patients

All children (≤17 years of age) who had tonsillectomy. Patients who had incomplete information or less than 2-weeks follow-up were excluded.

Main outcome measure

(1) Post-tonsillectomy bleeding, (2) other data collected included demographics, length of follow-up, indication(s) for surgery, other procedures performed, and co-morbidities.

Results

Over a 4.5-year period 677 patients (333 BDT, 344 PIT) were identified in our search, and 77 (38 BDT, 39 PIT) were excluded. The mean age was 7.7 ± 3.8 years in the BDT group and 6.5 ± 3.2 years in the PIT group. Sex distribution was similar in the 2 groups (chi square p = 0.61). Twenty (6.8%) BDT patients experienced post-tonsillectomy bleeding, compared to three (0.98%) of PIT patients (p = 0.0001, 95% CI 1.52-2.18, OR = 7.32). Over 3 times as many PIT patients (153) had co-morbid conditions than BDT patients (44); this was statistically significant (chi square p < 0.00001, 95% CI 1.78-2.38).

Conclusion

PIT results in significantly less post-tonsillectomy bleeding than BDT. These findings favor partial over total techniques with respect to reducing this important complication.     

Hearing results of stapedotomy and malleo-vestibulopexy in congenital hearing loss

Aims

To analyze hearing results of surgical treatment of hearing loss associated with the congenital stapes ankylosis with or without malformations of ossicular chain.

Study design

Retrospective chart review.

Methods

The charts of 1369 stapedotomies performed by senior author (JH) from 1991 to 2006 were reviewed. In 40 cases operative findings were consistent with isolated congenital stapes fixation or associated with middle ear malformations. The modified stapedotomy technique was employed in 33 cases and malleo-vestibulopexy was used in 7 cases. Operative findings were standardized according to Cremers’ classification. The outcomes of 40 surgeries were analyzed according to the 1995 AAO-HNS Committee on Hearing and Equilibrium guidelines. High frequency hearing results on 4, 8 and 12 kHz were reported in addition to standard frequencies. Results of stapedotomies and malleo-vestibulopexies were calculated separately. Surgical complications were described.

Results

The mean post-operative air conduction (AC) was 33 dB, bone conduction (BC) 22 dB and speech reception thresholds (SRT) 31 dB. Closure of the air-bone gap (ABG) to within 10 dB was achieved in 24/40 (60%) of cases. Lack of improvement was observed in 3/40 (8%) patients. In 26/32 (81%) of cases with potential for bilaterally serviceable hearing it was achieved. In 24/40 (60%) of cases symmetrical hearing with interaural difference of less than 10 dB was demonstrated.

Conclusion

Significant hearing gain in patients with congenital stapes ankylosis makes surgical treatment a valuable adjunct or an alternative to hearing aids in selected cases.     

Eustachian tube function in patients with Meniere's disease

Objective

The aim of the present study was to clarify the relationship between Eustachian tube function and inner ear function, especially with respect to the hearing ability of patients with Meniere's disease.

Methods

Patients with Meniere's disease underwent nystagmic examinations and audiometric measurements, including hearing tests, tympanometry, and Eustachian tube function tests (sonotubometry). We compared the audiometric examination results of normal subjects to those of patients with Meniere's disease.

Results

Twenty-five percent of patients with Meniere's disease exhibited Eustachian tube dysfunction, but 92% displayed normal tympanometry findings. Their sonotubometry durations and amplitudes were not significantly different from those of normal subjects. However, the patients’ hearing level was significantly correlated to sonotubometry duration and amplitude. Our patients were classified according to the four stages of Meniere's disease: stage 1 (n = 9); stage 2 (n = 5); stage 3 (n = 8); and stage 4 (n = 2). The incidence of Eustachian tube dysfunction in these four groups of patients were 0% (0/9); 40% (2/5); 38% (3/8); and 50% (1/2), respectively.

Conclusion

Our study provides evidence demonstrating that treatment of Eustachian tube dysfunction may be useful in preventing the hearing of Meniere's patients from becoming worse.     

Ototoxicity caused by topical administration of gentamicin versus tobramycin in rabbits

Aim

To investigate the possible differences in cochleotoxic effects in rabbits between twice-daily administration of topical gentamicin and tobramycin throughout the perforated tympanic membrane with the use of distortion-product otoacoustic emissions (DPOAEs).

Materials and methods

Twenty female rabbits were studied prospectively daily for 21 days. The rabbits’ ears were divided into two groups: right and left ear groups. Twice-daily for 21 days after paracentesis, 0.3% gentamicin was administered topically in the left ears, and 0.3% tobramycin was administered topically in the right ears. For 21 days, the cochlear activity of the right and left ears of all rabbits was examined every 7 days using DPOAEs. The numerical values of the distortion product (DP) intensity recorded on days 7, 14 and 21 of drug administration were compared between the two groups.

Results

Cochlear activity was reduced earlier in the gentamicin group in the 2-4 kHz frequencies compared to the tobramycin group in the second DPOAE measurement (day 7 of the experiment). In two rabbits in the gentamicin group, the third DPOAE measurement showed that cochlear activity was reduced in all frequencies. In six rabbits in the tobramycin group, the third DPOAE measurement showed that cochlear activity was reduced in all frequencies. There was no statistical significance between the two groups except day 7 in the 2 and 3 kHz frequencies (p < 0.05).

Conclusion

We concluded that low frequencies (2 and 3 kHz) are more sensitive to the administration of topical gentamicin than to topical tobramycin. Early cessation of tobramycin drops may be minimally cochlear toxic compared to gentamicin within the first 7 days when these drugs are misused in treating chronic otitis media.