Is severe epistaxis associated with acetylsalicylic acid intake?

Objectives/Hypothesis:

Epistaxis represents a very common emergency in any ear, nose, and throat (ENT) department around the world. Despite other risk factors, acetylsalicylic acid (ASA) contributes to nosebleeds by its intrinsic ability to impair thrombocyte aggregation. The aim of this study was to investigate the influence of ASA on the severity of epistaxis and to compare it with other potential risk factors.

Study Design:

A prospective cohort study was performed at the ENT department of University Hospital Zurich.

Methods:

A total of 591 events were evaluated concerning surgical interventions and the length of in‐hospital stay. Further analyses regarding recurrences and number of treatments and a specially designed severity score, as well as other outcome parameters, were performed.

Results:

Ninety‐nine patients needed to stay in‐hospital for at least 1 day. Nearly 30% of all patients had ASA intake, and only 18% were on vitamin K antagonist therapy. Patients on ASA showed significantly more surgical interventions, a higher recurrence rate, and a larger number of required treatments as well as an increased severity score. Duration of in‐hospital stay and the complication rate, however, were not associated with drug intake.

Conclusions:

We not only identified ASA to be one of the major risk factors in epistaxis, but also quantified its impact on the severity of nose bleeding. We emphasize the importance of a well‐indicated antiaggregational therapy, and strongly discourage using ASA as a life‐style drug for the elderly. ASA therapy needs to be discontinued whenever possible and reasonable. Laryngoscope, 2010     

Is human papillomavirus and p16 expression associated with survival outcomes in nasopharyngeal cancer?: A systematic review and meta-analysis

Introduction

Human papillomavirus (HPV) is a known prognostic indicator in oropharyngeal cancer. Not much is known about the prognostic role of HPV in Nasopharyngeal cancer (NPC). Here, we performed a systematic review and meta-analysis of the literature to investigate if HPV status was a prognostic factor for NPC.

Is discordance in TEOAE and AABR outcomes predictable in newborns?

Objective

To determine the perinatal predictors of discordant screening outcomes based on a two-stage screening protocol with transient-evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR).

Methods

A cross-sectional study of infants tested with TEOAE and AABR under a hospital-based universal newborn hearing screening program in Lagos, Nigeria. Maternal and infant factors associated with discordant TEOAE and AABR outcomes were determined with multivariable logistic regression analyses adjusting for potential confounding factors.

Results

Of the 4718 infants enrolled under the program 1745 (36.9%) completed both TEOAE and AABR. Of this group, 1060 (60.7%) passed both TEOAE and AABR (“true-negatives”); 92 (5.3%) failed both TEOAE and AABR (“true-positive”); 571 (32.7%) failed TEOAE but passed AABR (“false-positives”) while 22 (1.3%) passed TEOAE but failed AABR (“false-negatives”). Infants with false-positives were likely to be admitted into well-baby nursery (p = 0.001), belong to mothers who attended antenatal care (p = 0.010) or who delivered vaginally (p < 0.001) compared to infants with true-negatives while infants with true-positives were also more likely to be delivered vaginally (p = 0.002) or admitted into well-baby nursery (p = 0.035) compared to infants with false-negatives. Infants with true-positives were significantly more likely to be delivered vaginally (p < 0.001) and have severe hyperbilirubinemia (p = 0.045) compared with infants with true-negatives. No association was observed between false-negatives and true-negatives. Antenatal care status, mode of delivery and nursery type were useful predictors of discordant outcomes among all infants undergoing screening (c-statistic = 0.73).

Conclusions

Given the available screening technologies, discordant TEOAE and AABR may be inevitable for some categories of hearing loss among apparently healthy newborns whose mothers received prenatal care. The potential limitations of perinatal morbidities as basis of targeted screening for such cases therefore merit further consideration.     

Is familial adenomatous polyposis associated with sensorineural hearing loss?

Abstract

The mutation causing familial adenomatous polyposis (FAP) affects the adenomatous polyposis coli (Apc) gene, which has a role in the cytoskeleton and has been shown to be important in the structure of supporting cells in the cochlea. One previous study suggested that FAP sufferers may have sensorineural hearing loss. In order to demonstrate whether this is the case we invited patients known to suffer from familial adenomatous polyposis to take part in our study. Audiograms were performed and compared to normal values for that patient's age and gender calculated using ISO standard data. Thirteen patients were included in the study analysis. No conductive hearing losses were identified. A statistically significant greater hearing loss was identified at 500 Hz (2.8 dBHL, P = 0.03) and 1000 Hz (2.5 dBHL, P = 0.05). No audiometric difference could be identified between the patients with FAP and attenuated FAP. A power calculation demonstrated that the study was of adequate size. This study did not demonstrate a clinically significant difference in hearing loss between the FAP group and the calculated normal values.

Sumario

La mutación que causa la poliposis adenomatosa familiar (FAP) afecta el gene polipomatosis adenomatosa coli (Apc), que tiene un papel cuya importancia en el citoesqueleto y en la estructura de las células de sostén de la cóclea se ha demostrado. Un estudio previo sugirió que quienes sufren la FAP pueden tener una pérdida auditiva sensorineural. Con objeto de demostrar si esto es así, invitamos a pacientes que (sabíamos) sufrían la enfermedad para tomar parte en este estudio. Los audiogramas que se practicaron fueron comparados con los valores normales de acuerdo con la edad y el género de los pacientes, usando los datos ISO estándar. Se incluyeron trece pacientes para el análisis del estudio. No se identificaron pérdidas auditivas conductivas. Si hubo una pérdida auditiva mayor, estadísticamente significativa en 500 Hz (2.8 dBHL, P = 0.03) y en 1000 Hz (2.5 dBHL, P = 0.05). No se pudo identificar una diferencia audiométrica entre los pacientes con FAP o con FAP atenuada. Un cálculo especial demostró que el estudio fue de un tamaño adecuado. Este estudio no mostró una diferencia clínicamente significativa de la pérdida auditiva entre el grupo con FAP y los valores calculados como normales.     

Is antenatal corticosteroids exposure associated with hearing loss in preterm infants? A systematic review and meta-analysis

PurposeTo perform a systematic review and meta-analysis of clinical studies exploring the association between antenatal corticosteroids exposure and hearing loss in preterm infants.MethodPubMed, Cochrane library, and EMBASE databases from the inception dates to December 22, 2020 without language restriction. Key search terms included hearing loss, cortisol steroid, and antenatal. Included studies were case control or cohort studies examining preterm (<37 weeks' gestation) or very low-birth-weight (<1500 g) infants and reporting primary data that could be used to explore the association between antenatal corticosteroids exposure and the development of hearing outcomes. This meta-analysis follows the reporting guidelines (MOOSE) for observational studies. Data were independently extracted by 2 researchers. A fixed effects model was used to calculate odds ratios (OR) and 95 % CI. Subgroup analysis was conducted according to different types of antenatal steroids exposure (dexamethasone vs betamethasone) and subgroup analyses based on betamethasone and betamethasone combined with magnesium sulfate (betamethasone vs betamethasone combined with magnesium sulfate).ResultsA total of 110 potentially relevant studies were found, of which 7 met the inclusion criteria (A total of 8130 preterm infants were included. 5337 preterm infants were exposed to antenatal corticosteroids, and 2793 preterm infants were not exposed to antenatal corticosteroids.). Meta-analysis showed that antenatal corticosteroids exposure was significantly associated with hearing loss in preterm infants. (OR, 0.64; 95 % CI, 0.48–0.87; P = 0.004) In addition, significant differences were found between antenatal betamethasone exposure and antenatal dexamethasone exposure. (OR, 0.27; 95 % CI, 0.10–0.77; P = 0.01) Betamethasone and betamethasone combined with magnesium sulfate showed that the difference was no statistically significant. (OR, 1.34; 95 % CI, 0.74–2.43; P = 0.33).ConclusionThe results of this study confirm that among preterm infants, exposure to antenatal corticosteroids exposure is associated with a lower risk of developing hearing impairment.Systematic review registration numberPROSPERO 2021 CRD42021255665.     

Eustachian tube diameter: Is it associated with chronic otitis media development?

Objective

To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis.

Is epistaxis associated with arterial hypertension? A systematic review of the literature

Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.