Organised haematoma of the maxillary sinus in patients with chronic renal failure

Objective: Organised haematoma of the maxillary sinus may be present in chronic renal failure patients, because these patients are at high risk of haemorrhage. Case reports: We present two cases of organised haematoma of the maxillary sinus in patients with chronic renal failure. Conclusion: A diagnosis of organised haematoma of the maxillary sinus should be considered when a patient with a history of chronic renal failure develops unilateral, recurrent epistaxis and nasal obstruction.     

High frequency audiometry and chronic renal failure

High frequency audiometry with pure tones from 9 to 18 kHz was performed in 37 patients with chronic renal failure undergoing conservative medical treatment and in a control group of 96 patients (age range 30 59 years for both groups). It was noted that the high frequency thresholds were significantly higher for the patients with chronic renal disease, and further deterioration of hearing function was observed at the examination performed after 1 year of follow-up. It was concluded that high frequency audiometry is a sensitive method for detecting hearing changes in patients with chronic renal failure and can be used to monitor these patients.     

High Frequency Audiometry and Chronic Renal Failure

High frequency audiometry with pure tones from 9 to 18 kHz was performed in 37 patients with chronic renal failure undergoing conservative medical treatment and in a control group of 96 patients (age range 30-59 years for both groups). It was noted that the high frequency thresholds were significantly higher for the patients with chronic renal disease, and further deterioration of hearing function was observed at the examination performed after 1 year of follow-up. It was concluded that high frequency audiometry is a sensitive method for detecting hearing changes in patients with chronic renal failure and can be used to monitor these patients.     

Hearing status in patients with pronounced chronic kidney insufficiency

Hearing function was assessed in 63 patients with pronounced chronic renal failure (40 males, 23 females aged 20-52 years). Chronic renal failure resulted from chronic glomerulonephritis in 34 patients (16, 10 and 8 cases of nephrotic, hypertensive and mixed form, respectively), chronic pyelonephritis in 29 patients. The acoustic function was evaluated using acumetric methods, tonal threshold and suprathreshold audiometry, ultrasound sensitivity test, speech audiometry. Hearing disorders detected in patients with chronic renal failure were moderate and were characterized as neurosensory hypoacusis. The defects concerned high frequency perception. Hearing thresholds were high in all the examinees.     

Terminale Niereninsuffizienz und Innenohrschwerhörigkeit

Summary Conflicting reports have been presented with respect to inner ear function of renal patients. Therefore, a detailed analysis of inner ear function was performed in patients of the Heidelberg Dialysis and Transplantation Program.From 1976 to 1980, 125 patients with terminal renal failure were examined; in 45 patients hearing defects were observed. In eight patients causes unrelated to renal disease were found. In 37 patients a recruitment positive hearing loss was observed with an average decrease of 20–30 dB at higher frequencies. Twenty-six patients had a history of administration of aminoglycosides or biopsy proven hereditary glomerulonephritis (Alport's syndrom). Eleven patients had not been given aminoglycosides in this university but had been treated outside with no records available. There was no relation between hearing loss and serum creatinine, urea or electrolyte concentrations. Hearing loss was also unrelated to duration of uremia and number of dialyses. None of the patients showed improvement of hearing function after succesful transplantation. — It is concluded that hearing loss possibly unrelated to aminoglycosides, diuretics or hereditary nephritis is found in less than 10% of all patients in terminal renal failure. In none of the patients was hearing loss improved by reversal of uremia. Therefore it is unlikely that the degree of uremie intoxication observed with current modalities of treatment adversely affects inner ear function.     

Electrophysiological examinations (ABR and DPOAE) of hearing organ in hemodialysed patients suffering from chronic renal failure

Deterioration of function of hearing organ is one of the most important clinical problem in uremic patients with chronic renal failure. The present study aimed to assess the function of hearing organ using the brainstem auditory evoked responses (ABR), impedance audiometry and distortion product otoacoustic emission cochlear function (DPOAE) in 31 haemodialysed patients with chronic renal failure (16 females and 15 males, mean age 43.0 years). The control group consisted of 15 healthy subjects. The latency of the waves I, III, V and I-V interpeak in evoked response audiometry were significantly longer in the patients with CRF (chronic renal failure) compared to the control group. Measurement of DPOAE showed decrease of DPOAE level in patients suffering from CRF. A influence of single hemodialysis and treatment of hemodialysis by 6 months on ABR latencies and DPOAE values were not observed.     

Otologic symptoms in chronic renal failure. The possible role of aminoglycoside-furosemide interaction

Summary In the light of a number of reports about otologic symptoms in chronic renal failure, hemodialysis and kidney transplantation we report the findings in a greater material. The material comprises in total 281 patients, 19 in regular, longtime hemodialysis and 262 with one or more kidney transplantations. The frequency of otologic symptoms was 10%, corresponding to 26 patients, of which 3 had Alport's syndrome and not investigated further. The group with otologic symptoms had significantly more hemodialysis, and marginally larger amounts of ototoxic medication. Otherwise the groups do not diverge.When disregarding 6 patients, where other explanation of the patients symptoms is more likely (hemodynamic conditions in connection with operation, congenital hearing loss and one case of Menière's disease), we find that ototoxic medication probably is the main cause of the otologic symptoms. In particular attention is paid to a possible interaction between aminoglycosides (especially Gentamycin) and diuretics (Furosemide).We find, however, that the majority of the patients do not develop otologic symptoms, and these symptoms are not the direct result of renal failure itself but are due to a complex blend of exogenous and endogenous factors.The material includes only one patient who obtained normal hearing after successful transplantation, and where uremic intoxication migh have been releasing.In the light of several reports about frequent occurrence of acoustic-vestibular symptoms in patients with chronic renal failure, treated with peritoneal dialysis, hemodialysis and/or kidney transplantation, we report our findings concerning the symptoms in a number of patients from the nephrological unit, Rigshospitalet.     

Hearing loss in pediatric renal patients

Modern techniques of prolonging life and useful function for endstage renal patients have been accompanied by a variety of new clinical and pathological manifestations, among which are inner ear problems. Of 151 pediatric renal patients followed prospectively 47% had hearing loss, which closely approximates that found in renal patients of all ages. However, only 5.3% of pediatric-age patients, as compared with 15% of all age groups, have hearing loss of unknown etiology. Certain types of hearing loss, for example, those due to acoustic trauma and Ménière's, were not found in the pediatric-age group, while ototoxic, congenital and genetic hearing losses were more common in young persons than in the overall group. Management includes assessment of hearing and vestibular function prior to and at intervals during the administration of ototoxics, monitoring of blood levels, careful attention to otological symptoms and observing the principles of hearing conservation.     

慢性肾功能不全血液透析患者的高频纯音听阈检测

目的:探讨慢性肾功能不全血液透析患者的高频听阈的变化特点。方法:将慢性肾功能不全行血液 透析的患者(透析组)与正常人(对照组)的高频听阈的变化特点进行比较。结果:透析组与对照组高频听阈的平 均阈值均随年龄的增加而增加,然高频阈值的检出率则随年龄和测听频率的增加而下降;但透析组阈值增加的程 度明显高于对照组。结论:透析组患者的听力损害以高频下降为主,其高频阈值亦较对照组高,差异有统计学意 义。     

Assessment of hearing organ ability in high-frequency auditory in patients suffering from chronic renal failure treated by haemodialysis and human recombinant erythropoietin (rhPEO)

The problem of hearing loss occurrence in the course of chronic renal failure (CRF) was investigated in numerous research studies, attempting to explain both the etiological factors and treatment possibilities. According to various authors, the percentage of hearing loss occurrence in patients suffering from CRF differs between 20% and 80%. The idea of this paper is based on an observation that if peripheral blood parameters such; haemoglobin, amount of red blood cells improve when influenced by rhEPO, then tissue oxidation improvement connected with it causes also better metabolism of cilliar's cells, what helps to improve hearing. The purpose of this study has been to assess the influence of treatment with human recombinant erythropoietin obtained through genetic recombination and by haemodialysis upon the condition of the hearing organ in patients with CRF (as a result of both a single procedure and long-term treatment). 65 haemodialysed patients with chronic renal failure were enrolled in this study. 31 of them (with haematocrit value below 28%) were treated with rhEPO for 4 months (3 times a week, 4000 units). The remaining 34 patients (with haematocrit values of above 28%) were not treated with rhEPO. Impairment of hearing was found in 87.1% of the CRF patients examined, while the hearing loss in high frequency range (9-18 kHz) was significantly more pronounced than those observed in the conventional range. In 70% of the patients the hearing loss was the cochlear type. Thus, combining haemodialysis with recombinant human erythropoietin in treatment of CRF patients results in significant improvement of hearing, correlated with positive results in fighting anaemia. The improved hearing found is, most surely, related to better oxygen supply of ciliated cells of internal ear, resulting from improved oxygen supply in peripheral blood and tissues of the body, and may also be related to the centric activity of erythropoietin, as the presence of receptors for EPO was found in the central nervous system (CNS) neurocytes, and it was also proven that EPO is produced in CNS, probably in astrocytes.     

Multiple brown tumours in a patient with tertiary hyperparathyroidism

We describe the case of a 49-year-old female with chronic renal failure and secondary hyperparathyroidism that not dissapeared after kidney transplant and turned into an autonomous form (tertiary hyperparathyroidism). The xRays and CT showed the presence of multiple brown tumors in iliac bones and tibia. We performed a parathyroidectomy removing a lower left adenoma confirmed in the histological exam the renal. After the surgery the osteoarticular manifestations improved and lithiasis dissapeared. There were not any postoperative complications such as hypocalcemia or recurrential palsy although Nephrology Department had to control her renal function.     

Subtotal parathyroidectomy: a possible treatment for calciphylaxis

Calciphylaxis is a rare disorder in patients with chronic renal failure that is characterized by ischemic necrotic skin lesions. The prognosis is grave and mortality is high (80%). The precise mechanism of calciphylaxis is still unknown, but in addition to chronic renal failure, elevated parathyroid hormone levels appear to play a role. The role of parathyroidectomy in treating affected patients is questionable. In this article, we describe the case of a patient with chronic renal failure who developed rapidly progressive subcutaneous calcifications and ulcerations in the lower extremities. These lesions regressed following subtotal parathyroidectomy. We also review the literature on calciphylaxis, with a focus on treatment options.     

Infiltration of epinephrine in tonsillectomy: a randomized, prospective, double-blind study

A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.     

Contemporary management of rhinosinusitis and cystic fibrosis

Historically, cystic fibrosis has been a devastating disease, with patients rarely living beyond childhood. Recent advances during the last two decades, however, have led to an improved understanding of the disease on a molecular level. Such understanding has in turn led to new treatments, longer life expectancy, as well as new challenges in the management of both pulmonary and extrapulmonary manifestations of cystic fibrosis. The otolaryngologist caring for patients with cystic fibrosis is thus challenged with the medical and surgical management of chronic sinusitis and sinonasal polyposis in these challenging circumstances.     

Auditory brain stem response and otoacoustic emission results in children with end-stage renal disease

Background

Abnormalities in auditory system are frequent in patients with end stage renal disease (ESRD). There is not yet any consensus for the effect of renal failure and hemodialysis on auditory complications. The aim of this study was to evaluate the auditory abnormalities in pediatric ESRD patients undergoing long term hemodialysis and compare the results with those of nondialytic chronic renal failure (CRF) children and controls.

Methods

Children aged 1-16 years were evaluated in three groups: 25 ESRD patients undergoing hemodialysis, 25 nondialytic patients with CRF, and 25 age and sex-matched normal counterparts. Patients with history of otological diseases, ear trauma, diabetes mellitus, receiving ototoxic drugs and syndromes with hearing abnormalities were excluded. The auditory brainstem response (ABR) and otoacoustic emission (OAE) were tested in all subjects. Frequency of cases with abnormal findings was compared between the groups.

Results

The ABR testing was abnormal in 11 (44%) dialytic patients with normal results in all nondialytic CRF cases and controls (p < 0.001). The OAE testing was abnormal in all dialytic patients with abnormal ABR testing results (44%), in 1 (4%) nondialytic CRF patient and in no controls (p < 0.001). There ware no significant differences with regard to age, gender, height, weight, blood pressure, serum levels of blood urea nitrogen (BUN), creatinine, sodium, and potassium, glomerular filtration rate (GFR), duration of dialysis and dialysis adequacy between dialytic patients with and without abnormal results of ABR/OAE testing.

Conclusion

Sensorineural hearing loss is rare among nondialytic pediatric patients with CRF but very common in ESRD children undergoing long term dialysis.     

Hearing impairment associated with chronic renal failure

The auditory sensitivity of 67 patients with chronic end-stage renal failure was assessed. In order to determine the incidence of hearing loss and to describe the impairment and possible contributing factors, one group of 39 patients was assessed prior to treatment by hemodialysis. Twelve of these subjects were then followed for 1 year as they are treated by hemodialysis. The reMayning 27 patients, not treated by hemodialysis, were also retested in one year. A second group of 28 patients who had been receiving hemodialysis over periods of 1 1/2, 3, and 6 years was also evaluated. A high incidence of high-frequency impairment was obtained which could not be attributed to age, noise exposure, ototoxicity, or hereditary. An association between this high-frequency impairment and both the renal disease and its treatment was suggested. Clinically significant sensorineural hearing loss did not appear associated with non-genetic kidney disease.     

Endoscopic management of failed frontal sinus obliteration

BACKGROUND: Frontal sinus obliteration (FSO) traditionally has represented the final stage in the algorithm for difficult to manage frontal sinus disease. In addition, FSO has been used in selected cases of frontal sinus trauma. However, this procedure has been associated with failure in 5-10% of cases. Advances in surgical instrumentation and image-guided surgical navigation have permitted endoscopic management of these failures. METHODS: Eleven patients presenting with failure of a previously performed FSO were managed endoscopically with the assistance of image-guided surgical navigation. RESULTS: Initial frontal sinus pathology included chronic inflammatory disease in six patients and frontal sinus trauma in two patients. Two patients underwent obliteration after neurosurgical frontal craniotomy and one patient underwent obliteration after curettage of a frontal sinus ossifying fibroma. Frontal sinuses were obliterated with fat in eight cases, bone chips in two cases, and bone cement in one case. The mean time interval to FSO failure was 11.1 years (range, 4 months-35 years). The etiology of failure included mucocele in eight patients, chronic frontal sinusitis in two patients, and Pott's puffy tumor in one patient. All 11 patients were managed endoscopically, of which 3 patients underwent a trans-septal frontal sinusotomy. Two patients required revision endoscopic surgery, but all were patent at last follow-up (mean, 14.8 months). CONCLUSION: Endoscopic management of failed FSO may be performed safely. These approaches are viable alternatives to open revision procedures in the management of failed FSO.     

Ischemic optic neuropathy after endoscopic sinus surgery: a case report

For the past 2 decades, endoscopic sinus surgery (ESS) has proven effective for treating paranasal sinus disease. Orbital complications of varying degrees, from mild orbital hematoma to catastrophic blindness, have been widely reported. However, defects of the visual field resulting from post-ESS ischemic optic neuropathy (ION) has not to our knowledge been reported in the literature. We were presented with a 51-year-old male patient suffering from loss of sight following an otherwise uneventful ESS. ION is a rare condition, characterized by acute or subacute postoperative loss of sight. The major risks for developing ION include intraoperative anemia, hypotension and systemic illnesses such as hypertension, diabetes or renal failure. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure, and patients should be given prompt opthalmological consultation when loss of sight is diagnosed postoperatively. Early aggressive and rapid correction of blood pressure and blood transfusions may be helpful in the treatment of patients who develop ION after surgery.     

Vestibular evoked myogenic potentials of haemodialysed patients with end stage renal disease

End stage renal disease (ESRD) can cause malfunction of multiple organs, including auditory and vestibular systems. During recent years, a significant amount of research has demonstrated the direct involvement of the otolith organs in stabilizing body and gaze which led to the development of specific functional tests. Stable gaze and body are more important in patients with ESRD, as they have an increased risk of bone fracture. The aim of this study was to investigate saccule and related neural pathways in haemodialysed patients with chronic renal failure. Twenty patients (40 ears) with ESRD were tested for vestibular evoked myogenic potentials (VEMP). Results were compared with those of 16 healthy controls (32 ears). VEMP response was significantly different between subjects and patients with ESRD. There was a significant difference between the presence and absence of VEMP waves in ESRD patient when compared with creatinine levels.     

Effects of experimental renal insufficiency on the osmotic pressure and the biochemical composition of perilymph

The biochemical effects of experimental renal insufficiency produced by bilateral nephrectomy on perilymph were studied. Rats were used for the experiments; measurements were carried out at various intervals after nephrectomy. Statistically significant changes in perilymph (osmolality, Na, K, Cl, and urea), and serum (osmolality, urea and creatinine) were found. These findings represent a marked labyrinth alteration, and may partly explain the pathophysiology of labyrinthine disturbances in chronic renal disease.