Clinical evaluation and symptoms of chemosensory impairment: one thousand consecutive cases from the Nasal Dysfunction Clinic in San Diego

BACKGROUND: The aim of this study was to measure olfactory impairment in patients with various etiologies using symptom ratings and psychophysical measures of olfactory function. METHODS: We performed a cross-sectional, population-based study at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. One thousand consecutive patients presented to the UCSD Nasal Dysfunction Clinic for evaluation of chemosensory dysfunction. Olfactory impairment was assessed by odor threshold and odor identification and symptom scores were assessed by self-report. RESULTS: The degree of olfactory impairment was driven by diagnostic category, age, and gender. Postviral disturbance was more prevalent in women and among elderly people. Elderly people and patients under 20 years of age showed the highest incidence of head trauma. Overall, older patients had poorer thresholds. Men showed higher prevalence of olfactory loss secondary to inflammation and toxin exposure. Patients with inflammation scored better than patients with other diagnoses (i.e., congenital, head trauma, postviral, toxin exposure, and miscellaneous causes). Patients with congenital etiologies and head trauma had the poorest scores. Symptom ratings were significantly different depending on diagnostic category, age, and gender. Patients with inflammation rated the majority of symptoms as most bothersome. Patients with postviral diagnoses were most likely to report parosmias. Patients with head trauma rated taste and smell loss as significantly more severe than other patients. CONCLUSION: Evaluation of 1000 patients at the UCSD Nasal Dysfunction Clinic in San Diego revealed differential olfactory impairment and differential symptom complaints based on diagnostic category, age, and gender.     

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.     

Appropriate hearing screening in the pediatric patient with head trauma

Purpose

To develop an algorithm for the appropriate audiologic screening of in children with head trauma.

Methods

Participants were the first consecutive 50 children admitted to a children's hospital trauma service after October 1, 2005, whose injuries resulted in a Glasgow Coma Scale (GCS) score ≤13 and/or loss of consciousness (LOC) but no history of hearing loss. Screening tympanometry, otoacoustic emissions testing, and/or routine audiometric evaluation were performed as soon as possible after admission. Age, GCS score, Pediatric Trauma Score, Injury Severity Score, presence of head and neck soft tissue injury, temporal bone fracture, skull fracture not involving the temporal bone, midface/mandible fractures, intracranial abnormality on computed tomography, and cervical fracture were analyzed as risk factors for hearing loss.

Results

Seventeen (34%) of the 50 children had abnormal hearing test results. Fischer's exact test showed abnormal test results were most strongly related to temporal bone fracture (p = 0.0041), non-temporal bone skull fracture (p = 0.0211) and younger age (p = 0.0638).

Conclusions

Any child with head trauma and clinical or radiologic evidence of temporal bone fracture should have early hearing evaluation. Using the proposed algorithm to test children with head trauma and GCS ≤13 and/or LOC and age <3 years or any type of skull fracture may help identify children with hearing loss in a more cost effective manner.     

Classification and therapy of craniocerebral injury (CCI)

In spite of great success in research severe traumatic brain injury (TBI) remains the most frequent cause for morbidity and mortality in the age < 45 years. The primary lesion emerges at the moment of trauma. Due to several pathophysiological mechanisms secondary lesions occur that enlarge size of contusions significantly. As a consequence of intracranial bleedings and brain edema intracranial pressure (ICP) increases and threaten the patient. Extent of severity (declared in Glasgow Coma Scale Score [GCS]), expansion and type of bleedings (acute and chronic subdural hemorrhage, epidural bleeding, contusion bleedings and intracerebral hemorrhage) determinate operative and conservative therapy as well as intensive care medicine. A specific feature represents frontobasal lesions that, apart of penetrating injuries, are treated interdisciplinary not before ICP is stable, brain edema declining and coagulation sufficient several days after trauma. A persisting rhinoliquorrhoe cause meningitis up to 85 % within 10 years. Patient with GCS < 8 have to be intubated and controlled ventilated. Basic monitoring does not differ from those of other patients treated at the intensive care ward (sufficient breathing [pO (2), pCO (2)], arterial blood pressure, CBC and coagulation parameters, fluid monitoring and nutrition). Additionally, ICP have to be measured and be treated corresponding to the algorithm of ICP treatment. Complementary, oxygen saturation of brain tissue (ptiO (2)), local cerebral blood flow (r-CBF) and cerebral metabolism (micro dialysis) can be measured. Just the combination of the single monitoring parameters gives evidence of the functional condition of the injured brain and relieved planning and performing of the appropriate therapy.     

Imaging and surgical approach of nasal dermoids.

OBJECTIVE: Determine the most accurate and cost effective radiographic evaluation for nasal dermoids. Determine the best surgical approach for excision of nasal dermoids. DESIGN: Retrospective chart review. SETTING: Division of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California. PARTICIPANTS: All patients with nasal dermoids evaluated and treated from 1990 to 2000. INTERVENTION: Preoperative radiographic evaluation and surgical excision. OUTCOME MEASURES: Accuracy of CT and MRI correlated with surgical findings and results. RESULTS: Ten patients were identified with the diagnosis of nasal dermoid. The age at diagnosis ranged from 0 to 24 months, with a mean of 3 months. Six children presented with masses located at the glabella, three patients presented with masses located at the nasal dorsum and one presented with a mass at the nasal tip. Six children underwent a computed tomogram with contrast of the head. Seven children underwent a MRI study of the head. Three children underwent an initial CT followed by MRI. Twenty percent of children were found to have intracranial extension. CT scan accurately diagnosed intracranial extension in one case, was indeterminate in a second case and falsely positive in a third case. MRI correctly diagnosed intracranial extension in two cases and had no false positive or false negative results. No children were found to have associated intracranial anomalies. In the early years of the review, a simple excision was made over the mass with blunt and sharp dissection for removal. (An external rhinoplasty incision is now used with better exposure and improved cosmetic results.) In cases with intracranial communication, a combined approach of external rhinoplasty and craniotomy was used. CONCLUSIONS: MRI alone is the most cost effective and accurate means of evaluating nasal dermoids and is essential for preoperative planning. The surgical approach of choice is external rhinoplasty for both cosmetic reasons and exposure of nasal dermoids with and without intracranial extension.     

Traumatic perilymphatic fistulas in children: etiology, diagnosis and management

Post-traumatic perilymphatic fistulas have been described following ear and temporal bone injury, particularly in the setting of temporal bone fractures. However, indications for exploratory surgery in cases of trauma without temporal bone fracture are vague and not well described. We describe three children who presented with symptoms suggestive of perilymphatic fistula (PLF) without an associated temporal bone fracture: two with penetrating tympanic membrane injuries and one with blunt temporal bone trauma. All had symptoms of hearing loss and vestibular disturbance. Two of the children cooperated with ear-specific audiologic assessment, which demonstrated sensorineural hearing loss (SNHL) on the traumatized side. The third child showed audiometric evidence of a SNHL on the injured side, but due to his age, the degree of severity of the SNHL was unable to be appropriately addressed prior to the patient being surgically managed. All three children underwent exploratory surgery and were found to have bony defects in the region of the oval window. All were repaired with fascial grafts to the oval and round windows with complete resolution of vestibular symptoms. However, two of the three patients with documented post-operative audiograms suffered from persistent SNHL on the injured side. We conclude that exploratory middle ear surgery is indicated in patients suffering from blunt or penetrating temporal bone or middle ear trauma who demonstrate persistent vestibular symptoms, sensorineural hearing loss or radiographic evidence of oval window pathology. As this is a limited number of patients, a larger series may be warranted to study the actual incidence of post-traumatic PLF in the child with persistent hearing loss and vertigo after head or ear trauma.     

Peripheral hearing loss following head trauma in children

The purpose of this prospective study was to determine the incidence and type of hearing loss occurring in children who suffered head injuries. Fifty children admitted to the neurosurgical service after sustaining head trauma were studied. Neurologic, otologic, and audiologic evaluations were performed. Diagnostic studies included skull roentgenograms and computerized tomography scans. A 32% incidence of conductive hearing loss and a 16% incidence of high-frequency sensorineural hearing loss was found in this group. All patients with temporal bone fractures had conductive hearing losses, but the presence of a skull vault fracture did not correlate with the presence, type, or degree of hearing loss. In addition, there was no correlation between either cause of injury, loss of consciousness, or Glasgow Coma Scale scores and the presence, type, or degree of hearing loss. There was a significant incidence of both sensorineural and conductive hearing loss in this series of patients, which indicates that close audiologic and otologic follow-up is necessary for all head injury patients.     

The age dependent relationship between facial fractures and skull fractures

OBJECTIVE: To provide clinical evidence to support the age dependent relationship between facial fractures and skull fractures. DESIGN: Retrospective chart review of all children and adults admitted with combined facial fractures and skull fractures and skull fractures alone between January 1991 and November 1997. SETTING: The Albany Medical Center Hospital, a tertiary level-one trauma center. PATIENTS: Two hundred and one children, ages 1 month to 17 years, with skull fractures (frontal, parietal, or temporal), and 41 children with concurrent facial fractures were included in this study. One hundred and thirty-nine adults, ages 18-90 years, with skull fractures, and 70 adults with concurrent facial fractures were also studied. OUTCOME MEASURES: The gender, age, skull fracture, facial fracture, Glasgow coma score (GCS), mechanism of injury, and outcome of all patients admitted with frontal, parietal, or temporal fractures with or without facial fractures. RESULTS: There are a significantly greater (P < 0.001) number of facial fractures associated with skull fractures among adults as compared to children. Moreover, there is an exponential rise in facial fractures associated with skull fractures between infancy and adolescence. The GCS of children with combined facial and skull fractures is significantly lower than in those with skull fractures only (P < 0.001). CONCLUSION: The spectrum of craniofacial injuries is related to the specific developmental stage of the craniofacial skeleton. This is demonstrated by the variable pattern of combined facial and skull fractures observed clinically in children and adults.     

Value of imaging studies in vertiginous children

OBJECTIVE: Imaging of the head is expensive and can be stressful for children, some of whom need anesthesia for the procedure. The aim of this study was to determine which vertiginous children benefit most from head imaging. METHODS: We conducted a retrospective chart review of all children aged under 18 years who were referred to the Helsinki University Children's Hospital Radiology Department (tertiary referral center) for head computerized tomography (CT) or magnetic resonance imaging (MRI) over a 1-year period. We analyzed and reviewed the medical records of 87 children who had undergone imaging of the head due to vertigo. RESULTS: Altogether 978 children underwent imaging of the head for various indications. Of these, 87 aged 0-16 years (mean age 8 years) were imaged because of vertigo. Abnormalities were seen in the images of 37 children; 23 were new findings and 14 showed no change in comparison to earlier deviant images. The most common abnormalities in head imaging were brain tumors, infections, multiple sclerosis lesions, and other lesions in T2-weighted images. Of the 23 vertiginous children with a new finding, 19 also had neurological deficits. While four children had no neurological symptoms, three had intense headaches. CONCLUSIONS: Head imaging is necessary for vertiginous children with neurological deficits or persistent headaches or who have sustained a head trauma. If vertigo is the only symptom without trauma, imaging studies will not aid diagnostic work-up.     

Local injection of dexamethasone acetate suspension into the nasal mucosa in cases of olfactory disturbance

Local injections of suspended steroid solution into the nasal mucosa were performed for 102 patients with olfactory disturbances. Dexamethasone acetate suspension in a concentration of 4 mg/0.5 ml was injected into the mucosa of the nasal septum on each side every 2 weeks for a total of 8 times. Mecobalamin and ATP were also administrated in a daily dose of 750 micrograms and 300 mg, respectively. Of the 102 olfactory disturbance patients, 32 patients had chronic sinusitis, 24 patients had common cold, 14 patients had allergic rhinitis, 9 patients had head trauma and the remaining 23 patients the reason for the disturbance was unknown. Using a visual analogue scale, improvements were found in 63.7%. We assessed the effect of this therapy on the threshold of olfactory sensation and perception using a T & T olfactogram. The overall mean values of olfactory sensation and perception were significantly improved; from 4.75 +/- 1.44 (SD) to 3.01 +/- 2.13 (SD) and from 5.30 +/- 0.88 (SD) to 4.19 +/- 1.60 (SD), respectively. All but the cases of head trauma showed significant improvement. Overall, 44 (43.1%) of the 102 patients were defined as having had a positive olfactory response to this treatment (an improvement in the average perception olfactory score of > = 1.0). In cases of chronic sinusitis, 15 (46.9%) of the 32 patients were positive. 12 (50.0%) of the common cold 24 patients, 7 (50.0%) of the 14 allergic rhinitis patients, 2 (22.2%) of the 9 head trauma patients and 11 (47.8%) of the 23 unknown etiology patients were positive for this treatment. Patients with severe olfactory dysfunction and anosmia showed a lower response than the patients who were mildly to moderately affected. Patients showing no response in the Alinamin intravenous test showed also lower improvement rates than those showing a normal response. Interestingly, 8 (27.6%) of 29 patients with a normal appearance of the olfactory clefts and no response for the Alinamin test responded positively to this treatment. This meant that the olfactory disturbance might be due to the existence of edema surrounding the olfactory nerve, not of the olfactory cleft. The improvement rate of patients treated within one year from the onset of these olfactory disturbance was better than the rate of those over one year. The present new therapeutic modality is very useful as a treatment which showed only be performed by otolaryngologists.     

Screening of olfactory function using the Biolfa olfactory test: investigations in patients with dysosmia

OBJECTIVE: To present a statistical evaluation of a new olfactory test, Biolfa. MATERIAL AND METHODS: The olfactory test was carried out in individuals with normal olfactory function (n=67; 31 males; mean age 27.4 years) and in patients with mild, moderate or severe hyposmia (n=155; 61 males; mean age 54.6 years). The main diagnoses of the hyposmic patients were upper respiratory tract infection (32%), nasal polyposis (24%), head trauma (8%), idiopathic (8%), old age (5%) and chronic rhinitis (5%). In the first part of the test, olfactory thresholds were measured for three different substances (eugenol, aldehyde C14 and phenyl ethyl alcohol). The second part comprised an odor identification test for determining olfactory function for a large panel of common odors of Southern European countries. RESULTS: Mean olfactory thresholds were determined for subjects with normal olfaction and hyposmic patients; there was a statistically significant relationship between olfactory thresholds and degree of olfaction (mild to moderate hyposmia versus severe hyposmia). For the odor identification test, a global score was determined to allow the differentiation of normosmic subjects from patients with mild, moderate or severe hyposmia. The principles of decision theory (i.e. analysis of the receiver operating characteristic curve) were applied to the problem of evaluating the ability of Biolfa to distinguish subnormal subjects from hyposmic subjects. CONCLUSION: This study provides a basis for the routine clinical use of Biolfa.     

Angiography of the carotid artery in centro-lateral skull base fractures?

BACKGROUND: In latero-basal, central or spheno-fronto-orbital skull base fractures the internal carotid artery is more frequently involved in severe lesions than expected. PATIENTS AND METHODS: Between 1996 and 2003 we examined 684 patients with Glasgow Coma Scales (GCS) between 2 and 15, median 7.2, using computed tomography (CT). In suspicion of a latero-basal, central or spheno-fronto-orbital fractur they got an additional high resolution skull base CT. If the bony canal of the internal carotid artery (ICA) was involved the patient underwent digital subtraction angiography (DSA). The ICA lesion was treated either interventional neuroradiologically, by surgery or only conservatively. RESULTS: Of the 684 patients 33 (4.8 %) had fractures of the ICA bony canal and therefore underwent DSA. Among them were 25 men and 8 women (mean age 35.3 years). Lesions of the ICA were seen in 1.9 % of the patients. A traumatic cavernous-carotid fistula was found in 7 patients (1 %) and in 6 patients (0.9 %) a dissection and/or an aneurysm of the ICA was diagnosed. Six of the patients had clinical symptoms. The lesions were treated primarily interventional neuroradiologically (n = 5) as well as surgically in two cases by clipping the aneurysm and closing the sphenoid sinus, respectively. CONCLUSIONS: Vessel lesions of the ICA in skull base fractures and involvement of the bony carotid canal are more frequent than mentioned in current literature. A solid diagnosis can only be achieved by DSA. Early diagnosis and treatment is important for improving the prognosis of these often multiply injured patients.     

Vestibular disorders following head injury in children

One hundred and ninety-nine child patients with blunt head injury were examined. Spontaneous and/or positional nystagmus (greater than or equal to 7 degrees/s) was observed immediately after trauma in 46% of cases, 6-12 months (average 10.2 months) later in 20%, and 2-8 years (average 4.7 years) later in 18%. Central ENG disturbances were found immediately after trauma in 43% of cases, 6-12 months later in 24%, and 2-8 years later in 12%. Only 1.5% of the child patients suffered from vertigo more than 6 months after trauma. The results of the study led to the conclusion that head injuries cause about as many similar objective vestibular lesions in children as in adults but fewer subjective symptoms.     

Post-traumatic olfactory dysfunction

OBJECTIVES: This study demonstrates histopathologic and immunocytochemical changes in the olfactory bulb of a patient with post-traumatic olfactory dysfunction. These results are analyzed in light of current understanding of the pathophysiology of anosmia and dysosmia following head trauma. Emphasis is placed on potential mechanisms of human regeneration and recovery. STUDY DESIGN: The current study documents the history of a patient with the initial complaint of complete anosmia following minor head trauma. Two months after the injury the patient developed persistent, severe dysosmia with debilitating weight loss. Neurosurgical treatment, including removal of the olfactory bulbs and tracts, resulted in permanent resolution of dysosmia. METHODS: Histopathologic and immunocytochemical analysis of the olfactory bulbs was undertaken and compared with age-matched control tissue. RESULTS: Pathological analysis of the olfactory bulb revealed a marked reduction in the number of nerve processes with few intact olfactory glomeruli compared with an age-matched control. Specific immunohistochemical staining for the olfactory neuron-specific protein OMP, however, demonstrated the presence of intact axonal projections between the olfactory mucosa and the bulb. CONCLUSIONS: These results support the hypothesis that post-traumatic anosmia involves, at least in part, damage to peripheral olfactory nerve fibers with histological changes in the olfactory bulb. Potential mechanisms for the development of post-traumatic dysosmia are also discussed.     

Clinical characteristics of nosocomial sinusitis

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.     

Pediatric all-terrain vehicle related temporal bone fractures

Objectives

To determine the prevalence of helmet use in children involved in all-terrain vehicles (ATV) accidents.

Study design

Retrospective chart review.

Setting

Tertiary Academic Medical Center.

Subjects and methods

Retrospective review was performed using the trauma registry of an academic tertiary medical center identifying ATV injured patients under 13 years of age between 2003-2008. Data regarding age, gender, ethnicity, driver/passenger status, helmet status, length of hospital stay, Glascow Coma Scale, Injury Severity Score, Abbreviated Injury Score, and presence of temporal bone fracture were analyzed.

Results

Seventy-four ATV injured pediatric subjects were identified. Average age was 8.6 years, 62% male, 38 were drivers, 32 were passengers. Helmet use data were available on 47 (64%) subjects, of these 9 (19%) wore helmets, and 38 (81%) were not wearing helmets. There was no observed statistical difference between helmeted and unhelmeted riders when comparing age, gender, ethnicity, driver/passenger status, length of hospital stay, Glascow Coma Scale (GCS), Injury Severity Score, Abbreviated Injury Score, or presence of temporal bone fracture.

Conclusions

This review found that documented helmet use in pediatric ATV injuries to be profoundly low (19%). Within our cohort no protective benefit from helmet use was identified, suggesting the inherent and potentially unalterable dangers of pediatric ATV recreation.     

Pediatric oropharyngeal trauma: what is the role of CT scan?

OBJECTIVES/HYPOTHESIS: Pediatric oropharyngeal trauma (OPT) is a common injury in children with rare, but at times severe complications including carotid injury and dissection of air/micro-organisms into the deep tissues of the neck or chest. Cervical CT scan with contrast (CT angiography (CTA)) is nearly universally available and may enhance the evaluation of OPT patients by screening for these potentially devastating complications. STUDY DESIGN: Retrospective record review, systematic review of the literature. METHODS: Twenty-three patients diagnosed with OPT from 1997 to 2003 at Boston Children's Hospital were identified by database review. Records were reviewed for site and mechanism of injury, use of diagnostic studies, management, and outcomes. Results were compared to previously published reports. The current literature was reviewed to assess the level of evidence pertaining to the evaluation of OPT patients with CT scan. An extrapolation was made to the general trauma literature to further evaluate the ability of CT angiography to detect carotid injury. RESULTS: Demographics and mechanism of injury in the current series were unchanged from previous reports. CT demonstrated superior detection and localization of free air. Systematic review of OPT literature revealed data on the use of CT scan as evaluation tool were lacking. Extrapolations to the trauma literature strongly indicate helical CTA has high sensitivity and specificity in detecting carotid injury. CONCLUSIONS: Pediatric oropharyngeal trauma is a common injury with rare, but severe complications. The routine use of CT scan with contrast may assist in the evaluation of these patients to detect injuries that could lead to severe complications. Collection of prospective data on the ability of CT scan to detect carotid injuries is needed but may not be feasible.     

Diverse etiologies of facial paralysis in children

Facial paralysis (FP) in children is most often idiopathic, however, many diverse and identifiable etiologies exist. Twenty-five cases of children admitted consecutively to the Children's National Medical Center over 8.5 years for the evaluation of FP were reviewed retrospectively. In 21 (84%) of the patients the FP was discovered to be secondary to a specific etiology or associated with a recognizable syndrome. In 7 cases, the FP was an initial manifestation of a serious underlying disorder. Causes of the FP in this series include: otitis media, mastoiditis, temporal lobe abscess, osteopetrosis, both blunt and penetrating trauma, iatrogenic surgical injury, facial burns, cerebellar astrocytoma, leukemia rhabdomyosarcoma, intracerebral arteriovenous malformation, Goldenhar syndrome, and Melkersson-Rosenthal syndrome. Four (16%) patients were diagnosed as having Bell's palsy. Methods of management, including the use of electrodiagnostic testing are described.     

碱性成纤维细胞生长因子促进兔耳廓皮肤复合伤创面修复的观察

OBJECTIVE: To study the role of basic fibroblast growth factor (bFGF) in the repair of irradiation- and surgery-induced auricle trauma. METHODS: The bilateral auricles of New Zealand white rabbits were received surgical trauma and beta-active irradiation(90Sr-90Y), bFGF was then applied to the wound. The efficacy of bFGF on wound healing was compared with the control group. RESULTS: On the 10th day after the trauma, the mean epithelalized area was (34.17 +/- 0.37) mm2 and the mean number of microvessels/high power field was (10.25 +/- 2.34) in the treated group, whereas both were (26.25 +/- 0.20) mm2 and (4.38 +/- 0.92) respectivety in the control group. There was a significant difference between the two groups (P < 0.05). On the 7th and 14th days after the trauma, the mean epithelialized area in the treated group was significantly different from that of the control group. The measurement by the image cytometry showed that the treated group had a mean nuclear peak area value of (38.28 +/- 7.23) micron 2 and the mean S-stage cell value of (31.28 +/- 10.35)%, and those of the control group were (28.02 +/- 8.13) micron 2 and (20.14 +/- 9.46)% respectively. There were significant differences (P < 0.05) between them. CONCLUSION: Application of bFGF can, to a certain extent, accelerate the repair of irradiated and surgically injured soft tissue.     

Peripheral auditory assessment in minor head injury: a prospective study in tertiary hospital

Hearing loss is a common problem encountered in ENT practice. Hearing loss following head injury is a major medical problem in both adults and children, which may go unnoticed when it does not affect speech frequencies. Sensorineural hearing loss at high frequencies is a common finding in minor head injury. Patients with history suggestive of mild head injury (MHI) according to Glasgow coma scale score were evaluated. The most common cause of MHI was road traffic accidents involving two wheeler riders without helmets. Higher the frequencies affected, and severe the hearing loss, poorer was the prognosis. Distortion product oto-acoustic emissions assessment at 3000 and 4000?Hz were found to be significant and has a higher predictive value in assessing outer hair cell damage.