Measuring the density of the fissula antefenestram and the section of the basal turn of the cochlea: Are they useful in the radiological diagnosis of otosclerosis?

IntroductionThe role of objective parameters in terms of improvement of the accuracy of high-resolution computed tomography (HRCT) of the temporal bone in the diagnosis of otosclerosis remains unclear.ObjectivesTo investigate the relationship between the density of the fissula antefenestram (FAF) and of the width of the transversal section of the basal turn of the cochlea (BTC), and the diagnosis of otosclerosis.MethodsThis is a retrospective study in which preoperative HRCT data from ears of patients submitted to stapedotomy due to otosclerosis (case group) were evaluated. For the control group, normal hearing ears having undergone HRCT for other purposes were included. Case and control HRCT images were objectively assessed by an experienced blinded radiologist. During this evaluation, measurements of the relative radiological density of the FAF and of the transversal section of the BTC were obtained. The results were compared between the groups. Also, a receiver operating characteristic curve was created and the area under the curve (AUC) was calculated for each variable. Significance level was set at .05.Results40 ears were included in each group. Case ears presented reduced values for the relative radiological density on the FAF (p-value<0.0001). Moreover, ears with otosclerosis (p-value: 0.022) presented lower transversal section of the BTC. The AUC for these variables reached 0.929 and 0.646, respectively.ConclusionsOtosclerotic ears present reduced radiological density on the FAF and narrower BTC. The relative density of the FAF also shows a great diagnostic power in the context of this disease.     

Screening for Menière's disease in the general population - the needle in the haystack

CONCLUSION: Based on clinical history alone, 98.4% of the population with vestibular vertigo do not qualify for a diagnosis of Menière's disease (MD). Although frequent in dizziness clinics, MD is rare in the general population. OBJECTIVE: To narrow down the prevalence of MD in the general population. SUBJECTS AND METHODS: A representative sample adult population sample (n=4869) was screened for moderate or severe dizziness/vertigo. Subsequently, 1003 participants completed a validated neurotologic telephone interview on vestibular vertigo (VV). Prevalence of MD was determined by stepwise application of clinical criteria according to the AAO (1995): (1) at least two vertigo attacks of > or =20 min duration, (2) unilateral hearing loss, and (3) accompanying cochlear symptoms. RESULTS: Lifetime prevalence of VV was 7.4%. Of 243 participants with VV, 51 (21%) had recurrent vertigo lasting > or =20 min. Of these, nine reported unilateral hearing loss, and four had accompanying cochlear symptoms (1.6% of VV patients, population prevalence 0.12%).     

What is the right size of the adenoid curette?

The use of an adenoid curette of appropriate size is recommended in operative textbooks for adequate adenoid removal and avoidance of potential injury to the eustachian tubes. The aim of this study is to calculate the right size of adenoid curettes to be used for children of different ages. The inter-tubal space (ITS) between the torus tubarius on both sides is the narrowest passage for adenoid curettage, and is identified in this study as the nasopharyngeal dimension to be considered in selecting the size of the adenoid curette. This prospective study is carried out on a series of 72 adenoidectomy cases aged from three to nine years at the Hearing and Speech Institute in Cairo, Egypt. The inter-tubal dimension (ITD) is measured for each child at the end of adenoidectomy and the results are recorded against the patient's age. The ITD ranged from 17-21 mm in our series with no significant difference between males and females. There is an increase in ITD with age with a sharp increase at ages five and seven years. Accordingly, the patients are divided into three age groups and recommendations for appropriate adenoid curette sizes ranging from 18 to 21 mm are given for each group.     

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.     

Myringoplasty: does the size of the perforation matter?

Does the size of a tympanic membrane defect influence the success rate in myringoplasty? Many studies which have suggested that size does not affect results have included only small numbers of patients. After a power analysis to identify the size of groups needed to detect a clinically significant difference between the success rate of small and large perforations, a retrospective study was carried out to answer the question. A retrospective study of 423 myringoplasty-only operations showed that size does influence success; the success rate for small perforations was 74.1% compared with 56.0% for large perforations (P = 0.0003). Size also influences the change in four-frequency air conduction thresholds (small perforations +7.2 dB, large perforations +10.2 dB; t = 2.08, P = 0.039) in successful myringoplasties, a positive value indicating an improvement in hearing. This change is unlikely to be clinically significant. Patients should be made aware of these facts when informed consent is being obtained.     

Does the Kyphotic Change Decrease the Risk of Fall?

Objectives

Falls are a major problem in the elderly. Age-related degeneration of the human balance system increases the risk of falls. Kyphosis is a common condition of curvature of the upper spine in the elderly and its development occurs through degenerative change. However, relatively little is known about the effect of kyphotic changes on balance in the elderly. The aim of this study is to investigate the influence of kyphosis on the balance strategy through use of the motor control test (MCT) in computerized dynamic posturography.

Methods

Fifty healthy subjects who were not affected by other medical disorders that could affect gait or balance were enrolled in the study. By simulation of kyphotic condition through change of the angles of the line connecting the shoulder to the hip and the ankle axis by approximately 30°, the latency and amplitude of the MCT were measured in upright and kyphotic condition.

Results

In the kyphotic condition, latency was shortened in backward movement. In forward movement, latency was shortened only in large stimulation. The amplitude in forward movement was decreased in kyphotic condition. However, the change of amplitude was not significant in large intensity backward movement in the same condition.

Conclusion

Kyphotic condition decreases the latency of MCT, especially in backward movement. These findings imply that kyphotic condition may serve as a protective factor against falls.     

Searching for the cheese: does ethmoid pneumatization affect the location of the anterior ethmoid artery?

Endoscopic sinus surgery is a widely used technique in otolaryngologic practice. To avoid complications, the locations of important anatomical structures, such as the anterior ethmoid artery (AEA), should be determined preoperatively. We want to evaluate the effect of ethmoid cavity pneumatization on the location of the AEA and to determine consistent landmark(s) for locating the AEA. 524 consecutive patients undergoing sinus CT scans between February and October 2012 were reviewed retrospectively. After the exclusion criteria were applied, 150 CT scans (300 sides) were selected for the study. A statistically significant positive correlation was found between ethmoid pneumatization and the distance of the AEA to the attachment of the inferior turbinate to the lateral nasal wall (Spearman’s rho = 0.305; p < 0.001). Likewise, a statistically significant positive correlation was found between ethmoid pneumatization and the distance between the AEA and the frontonasal junction (Spearman’s rho = 0.219; p < 0.001). We found that the artery was located mostly between the second and third lamellae [n 211 (71 %) cases]. There was no statistically significant correlation between ethmoid pneumatization and AEA location in terms of the lamellae. Increased ethmoid volume increases the distance of the AEA from the frontonasal junction and the lateral attachment of the inferior turbinate. However, increased pneumatization of the ethmoid cavity did not affect AEA localization in terms of the lamellae. Based on our findings, we suggest that using the lamellae to locate the AEA is reliable.     

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease?

IntroductionPapillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial.ObjectiveTo evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis.MethodsCross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study.ResultsA total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging.ConclusionsA high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes.