Why is the endoscope stuck in the baby's nose?

Ingested or inhaled foreign bodies are common in young children. We describe such a case but with a unique course of events. Upon initial examination of an 8-month old baby presenting with respiratory distress a flexible endoscope was inserted through the nose and a foreign body was not seen. Several attempts to extract the endoscope were unsuccessful. The baby was taken to the operating room and under general anesthesia the endoscope was pushed further into the nose and a door-key with the endoscope edge in its hole appeared from the nasopharynx behind the soft palate and both were removed.     

Is Hypozincemia Related to Tinnitus?: A Population Study Using Data From the Korea National Health and Nutrition Examination Survey

Objectives

The aim of present study was to determine the relationship between serum zinc level and tinnitus using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

The present study examined the relationship between serum zinc level and tinnitus using data from the KNHANES. A total of 2,225 KNHANES participants responded to the tinnitus questionnaire and provided blood samples to measure serum zinc concentration. Based on questionnaire responses, participants were categorized into control, mild tinnitus, moderate tinnitus, and severe tinnitus subgroups.

Results

There were no significant differences between groups in serum zinc level after adjustment for sex, age, and hearing loss.

Conclusion

It was concluded that hypozincemia is not related to tinnitus in a large population.     

Are titanium implants superior to gold implants in the tympanic cavity?

BACKGROUND: Gold implants in reconstructive surgery of the middle ear have proved to work sufficiently: That applies to tympanic cavity conditions without signs of chronic inflammation as also to the bacterially infected middle ear. For some years titanium implants are also in the use and established as well. The biocompatibility of titanium, the clinical and the audiological results are satisfactory. When using gold-prostheses in stapes surgery however, the still unsolved problem of occasional deafness has to be considered. PATIENTS: The clinical and functional results of middle ear surgery were examined retrospectively. There was no preselection of patients. 53 patients underwent middle ear surgery with titanium prostheses, 42 patients with gold prostheses. RESULTS: Due to their material properties and due to their delicate shape titanium prostheses (PORP, TORP) can be inserted into the tympanic cavity more simply and with better fit. The audiological results of gold and titanium prostheses are comparable. The extruding rate of the gold prostheses is substantial, whereas the extruding rate of titanium is negligible. CONCLUSION: The functional results of both materials are comparable. Due to the high extruding rates of gold prostheses titanium is clearly superior.     

Over-injection of autologus fat in the vocal fold: how to remove the excess?

Chordal injection of autologous fat is useful in treating incomplete closure of the glottis on phonation, because it is simple, uses an intraoral approach and is mostly effective. However, when excess fat is injected, the removal of the excess is generally much more difficult than the injection. A 48-year-old man underwent intrachordal injections of autologous fat twice bilaterally for vocal fold atrophy. He came to our hospital because his hoarseness became worse after every operation. Three-dimensional computed tomography revealed that a large amount of fat was injected in the bilateral subglottal and glottic regions. These findings indicated that his dysphonia was due mainly to the excessive injected fat, and removal of the fat was planned. Under local anesthesia, we partially removed the excess fat through a window made in the thyroid cartilage, without touching the vocal folds. The voice and laryngeal findings were monitored during the surgery according to fiber-stroboscopic findings. Postoperatively, a significant improvement was seen in the voice and vibration of the vocal folds, although the results were not completely satisfactory.     

Does Hyaluronic Acid Distribution in the Larynx Relate to the Newborn's Capacity for Crying?

Objectives/Hypothesis: The newborn is heavily dependent on voice communication and therefore has relatively higher vocal demands and expenditures than the adult, the loudness output per mass performance exceeds that of the adult, and the newborn larynx exhibits significant histological and biochemical differences. The neonatal larynx is capable of sustaining relatively greater pitch and loudness than the adult over longer periods of time. This ability may be related to a more compact arrangement of collagen within the lamina propria, less interstitial space, and a uniform distribution of hyaluronic acid (HA). As HA is the primary determinant of vocal fold viscosity and water content, the distribution of HA in the superficial portion of the neonatal vocal fold is hypothesized to be related to newborn crying endurance. Our objective was to examine the histological structure and the quantity and arrangement of HA within the lamina propria of the pediatric larynx and review the relevant physiology of hyaluronic acid and its impact on voice production. Study Design: Histological and digital subtraction analysis. Methods: Intact, neonatal larynges were sourced from fresh cadaveric specimens. Trichrome stain was used to assess the collagen content and location in the tissues. HA was stained using a colloidal iron staining technique with and without incubation with bovine testicular hyaluronidase. Average optical density was calculated in tissue before and after treatment with hyaluronidase, and the stain intensity ratio was calculated. Results: A total of 14 larynges were suitable for examination, eight males and six females. Histological examination revealed a uniform appearance of the vocalfold without evidence of a distinct vocal ligament or layered structure. Colloidal iron staining revealed an even distribution of HA throughout the vocal fold with no significant difference between quadrants. Images of the colloidal iron-stained tissue had a mean pixel intensity of 82 of 255. Slides of vocal fold tissue treated with hyaluronidase revealed a pixel intensity of 106 of 255 for a 22% mean difference in stain intensity (P < .01). Conclusions: The identification of the layered structure of the adult lamina propria has raised a number of questions as to the development and purpose of the human larynx. Based on histological observations from the current study, possible explanations for the physiological differences include differences in the distribution and tissue concentration of HA and consequently dynamic viscosity, oncotic affinity for water, and less intercellular space in the superficial lamina propria.     

Do the Blind Hear Better? Investigations on Auditory Processing in Congenital or Early Acquired Blindness II. Central Functions

The same 18 normally hearing students and 18 matched normal-sighted students, as in part I of this study, were compared in regard to pure-tone integration, speech discrimination ability and late cortical-evoked potentials. The blind subjects showed increased disinhibition (‘cleaning’) with broad-band noise and a decreased inhibition with the same stimulus at the contralateral ear, better speech discrimination, especially with regard to sentence tests without and with competing environment-simulating noise, and, by electric response audiometry (ERA), a shortened N, latency. Thus, the hypothesis of a better utilization of auditory information after the loss of the visual information channel could be confirmed, and may be ascribed to the plasticity of the central nervous system.

Dans cette 2e partie de notre étude, nous avons examiné la fonction auditive centrale des měmes sujets que précédemment à l'aide des tests suivants: intégration binaurale du son pur; intelligibilité vocale monaurale à l'aide de chiffres binaires et de substantifs monosylla-biques et binaurale, d'une part et, d'autre part, à l'aide de phrases prononcées en présence ou en l'absence d'un bruit ambiant de 50 dB (A); latence et amplitude de N₁/P₂ des potentiels évoqués tardifs corticaux. Le groupe des aveugles présente: une plus faible inhibition de δl par un son de měme fréquence à l'oreille controlatérale; une meilleure activation de δI par un bruit à bande large, mais les résultats restent à la limite de la signification statistique; une bien meilleure discrimination de la parole à tous les niveaux, et surtout en présence de bruit en audition binaurale et, en ERA, une diminution significative de la latence de N₁, sans modification de l'amplitude de N₁/P₂. Une conclusion définitive ne peut pas ětre formulée pour le moment, toutefois, ces résultats semblent confirmer l'hypothèse de l'existence, à la suite d'une cécité prolongée, d'une meilleure utilisation de l'information auditive graˇce à la plasticité du système nerveux central.     

Do the Blind Hear Better? Investigations on Auditory Processing in Congenital or Early Acquired Blindness I. Peripheral Functions

18 normally hearing blind students and 18 matched normal-sighted students were compared with regard to differential auditory sensitivity and acoustic reflex thresholds. Evaluation of interaural time differences for directional hearing and acoustic reflex thresholds showed no differences between the groups. The difference limen for intensity when interpreted by the SISI test, and the difference limen for frequency revealed a slightly optimizing trend in the blind group. However, differences missed statistical significance as to difference limen for intensity and, in the 3-σ range, also as to difference limen for frequency. Any superior hearing of the blind was not mirrored by a corresponding superiority in peripheral supraliminal performance.

On suppose depuis longtemps que les aveugles entendent mieux que les voyants. Nous pensions que cette meilleure performance pouvait ětre due à une meilleure capacité d'analyse périphérique de l'information auditive. Pour vérifier cette hypothèse, nous avons comparé chez 18 jeunes aveugles et 18 jeunes voyants, tous normo-entendants, les paramètres suivants: la différence de temps interaurale nécessaire à la localisation droite-gauche; le seuil différentiel d'intensité par le test SISI, le seuil différentiel de fréquence et le seuil du réflexe stapédien controlatéral. Nos résultats montrent que l'aveugle ne présente ni un seuil différentiel affiné en ce qui concerne la durée, l'intensité ou la fréquence, ni une sensibilité plus grande pour les intensités sonores supraliminaires.     

Simultaneous Grouping in Cochlear Implant Listeners: Can Abrupt Changes in Level Be Used to Segregate Components from a Complex Tone?

A sudden increase in the amplitude of a component often causes its segregation from a complex tone, and shorter rise times enhance this effect. We explored whether this also occurs in implant listeners (n = 8). Condition 1 used a 3.5-s “complex tone” comprising concurrent stimulation on five electrodes distributed across the array of the Nucleus CI24 implant. For each listener, the baseline stimulus level on each electrode was set at 50% of the dynamic range (DR). Two 1-s increments of 12.5%, 25%, or 50% DR were introduced in succession on adjacent electrodes within the “inner” three of those activated. Both increments had rise and fall times of 30 and 970 ms or vice versa. Listeners reported which increment was higher in pitch. Some listeners performed above chance for all increment sizes, but only for 50% increments did all listeners perform above chance. No significant effect of rise time was found. Condition 2 replaced amplitude increments with decrements. Only three listeners performed above chance even for 50% decrements. One exceptional listener performed well for 50% decrements with fall and rise times of 970 and 30 ms but around chance for fall and rise times of 30 and 970 ms, indicating successful discrimination based on a sudden rise back to baseline stimulation. Overall, the results suggest that implant listeners can use amplitude changes against a constant background to pick out components from a complex, but generally these must be large compared with those required in normal hearing. For increments, performance depended mainly on above-baseline stimulation of the target electrodes, not rise time. With one exception, performance for decrements was typically very poor.     

Is hearing loss due to mutations in the Connexin 26 gene progressive?

Serial audiograms were analysed for seven subjects, who were homozygous for the 35delG GJB2 mutation. The criterion for determining progression of hearing loss was at least a 1-dB loss in air conduction pure-tone average-3 (ACPTA-3) or ACPTA-4 per year for 2 to 10 years, with a minimum change of 10 dB ACPTA 3 or 4. Bilateral progression of hearing loss was found in 43% (3/7) of the subjects. A meta-analysis of seven studies with non-overlapping data sets and similar ascertainment criteria indicated that 19% of DFNB1 subjects with GJB2 mutations have progressive hearing loss. These data suggest that it may be incorrect to assume that congenital hearing loss due to this mutation is stable. We recommend rigorous audiologic surveillance for individuals with DFNB1.     

Does xanthine oxidase contribute to the hydroxyl radical generation in ischemia and reperfusion of the cochlea?

We investigated the effect of a hydroxyl radical scavenger, 1,3-dimethyl-2-thiourea (dimethylthiourea), and two xanthine oxidase inhibitors, oxypurinol and allopurinol, on the threshold shift of the compound action potential (CAP) after transient ischemia of the cochlea. Transient ischemia of 30 min duration was induced in albino guinea pigs via a skull base approach. The animals were treated with perilymphatic perfusion of dimethylthiourea, oxypurinol or allopurinol from 10 min before the onset of ischemia to 4 h after the termination of ischemia. Dimethylthiourea ameliorated the CAP threshold shifts at 4 h after the onset of reperfusion in a dose-dependent manner. However, oxypurinol and allopurinol did not affect the post-ischemic cochlear dysfunction. These results imply that the hydroxyl radical plays an important role in generation of cochlear dysfunction induced by ischemia-reperfusion and that xanthine oxidase may not be the primary source of this radical.     

What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room

Introduction

Airway fires are a well-described and potentially devastating complication of oropharyngeal surgery. However, the actual factors required to ignite the fire have never been well-delineated in the medical literature. In this study, we used a mechanical model to assess the oxygen parameters necessary to cause an oropharyngeal fire.

Methods

An electrosurgical unit (Bovie) was grounded to a whole raw chicken and a 6.0 endotracheal tube (ETT) was inserted into the cranial end of the degutted central cavity. Oxygen (O₂) was then titrated through the ETT tube at varying concentrations, with flow rates varying from 10 to 15 L/min. Electrocautery (at a setting of 15 W) was performed on tissue in the central cavity of the chicken near the ETT. All trials were repeated twice to ensure accuracy. Positive test results were quantified by the time required to obtain ignition of any part of the mechanical setup and time required to produce a sustained flame. A test was considered negative if no ignition could be obtained after four minutes of direct electrocautery.

Results

At an O₂ concentration of 100% and a flow rate of 15 L/min, ignition with a sustained flame was obtained between 15 and 30 s after initiation of electrocautery. At 100% O₂ at 10 L/min, ignition was obtained at 70 s with immediate sustained flame. At an O₂ concentration of 60%, ignition occurred at 25 s and sustained fire after 60 s. At an O₂ concentration of 50% ignition with a sustained flame occurred between 128 and 184 s. At an O₂ concentration of 45%, neither ignition nor sustained flames could be obtained in any trial.

Conclusions

Operating room fires remain a genuine danger when performing oropharyngeal surgery where electrocautery is performed in an oxygen-enriched environment. In our study, higher O₂ flow rates with higher FiO₂ correlated with quicker ignition in the chicken cavity. A fire was easily obtained when using 100% O₂; as the O₂ concentration decreases, longer exposure to electrocautery is required for ignition. Below 50% O₂ we were unable to obtain ignition. Our study is the first to examine the relative risk of ignition and sustained fire in a mechanical model of oropharyngeal surgery. Decreasing the fraction of inspired O₂ (FiO₂) to less than 50% may substantially decrease the risk of airway fire during oropharyngeal surgery.