Silent sinus syndrome, a case presentation

"Silent Sinus Syndrome" is a quite rare condition of otherwise asymptomatic maxillary sinusitis that presents with enophthalmos. Despite the fact that the "Silent Sinus Syndrome" presents with enophthalmos, these patients are finally treated by the otorhinolaryngologist, who should be familiar with this condition, in order to facilitate prompt diagnosis and treatment. We present the case of a 33 year old man with enophthalmos and no other associated symptom that was caused by chronic rhinosinusitis. Functional endoscopic sinus surgery was the treatment of choice. No reconstruction of the orbital floor was performed. One year follow up, following surgical treatment revealed an excellent result.     

Transient otoacoustic emissions in the detection of olivocochlear bundle maturation

OBJECTIVE: The medial olivocochlear bundle, forms a neural pathway connecting the superior olivary complex to the outer hair cells of mainly the contralateral cochlea. Although the biological significance of the bundle remains ambiguous, it is clear that activation of medial olivocochlear fibers alters cochlear output and this can be experimentally evident through a series of changes on otoacoustic emissions, called otoacoustic emission suppression. The aim of this study is to observe the maturation of the medial olivocochlear bundle by measuring the suppression effects on transient otoacoustic emissions. METHODS: The study population consisted of 27 premature babies (53 ears) from the P&A Kyriakou Neonatal Intensive Care Unit (conceptional age: 31-36 weeks) and 43 fullterm babies (61 ears) (conceptional age: 37-42 weeks) from the same unit. The ILO-92 system is used to deliver both the linear clicks to the ear examined (producing the emissions) and the white noise to the contralateral ear. The mode used is based on the alternating on and off presence of the white noise in the contralateral ear. RESULTS: 12/53 (22%) ears of preterm babies presented suppression > or =1 dB. 32/61 (52.4%) ears of fullterm babies presented suppression > or =1 dB. The mean suppression for the ears of premature infants was 0.52 dB, (+/-0.1 S.E.M.). The mean suppression for the ears of fullterm infants was 0.90 dB, (+/-0.09 S.E.M.). At the second half of the time window, suppression of fullterms rises above 1 dB (a pattern similar to that of adults), whereas it remains below 1 dB for preterms. CONCLUSIONS: Suppression of otoacoustic emissions helps us to study the function of the medial olivocochlear bundle in different populations. It appears in premature babies but becomes stronger as the postconceptional age advances.     

Prospective study of a panel of tumor markers as prognostic factors in patients with squamous cell carcinoma of head and neck

OBJECTIVE: The identification of a reliable circulating tumor marker in squamous cell carcinoma of the head and neck (SCCHN) could assist in diagnosis and monitoring response to therapy. AIM: The aim of this study was to investigate the effectiveness of the serum tumor markers CYFRA 21-1, TPA-M, SCCA, and CEA. STUDY DESIGN: Serum levels of CYFRA 21-1, TPA-M, SCCA, and CEA were measured in 136 patients with a histologically proven SCCHN before and after treatment and in 125 healthy subjects, as controls. We evaluated the sensitivity and specificity of these tumor markers and to correlate their levels with tumor staging, grading, or performance status. RESULTS: The study showed that none of the above markers presented satisfactory specificity and sensitivity in early diagnosis. In comparison with the other markers, TPA-M was the most effective of all markers and indicated a positive correlation with the grade of differentiation and nodal status. A remarkable correlation between high levels of TPA-M and CYFRA 21-1 in advanced stages (III, IV) of cancer has been shown. CONCLUSIONS: All the tumor markers that were studied have significant limitations in the early diagnosis of cancer, but TPA-M and CYFRA 21-1 may have a role in monitoring the success of therapy and follow up of patients with SCCHN.     

Die Richtungsänderung der Druckveränderung und die Tympanometrie-Kurven

Summary The effect of the change of the pressure direction (negative to positive and vise versa) on the compliance curve (impedance bridge) and on the susceptance and conductance curves (Oto-admittance meter) is described.The results are discussed in relation to the literature and the clinical value of them.     

Prognostic value of multiple-frequency tympanometry in acute otitis media.

Multiple-frequency tympanometry (MFT) and conventional 226-Hz tympanometry were performed in 86 ears of children affected by acute otitis media (AOM) after therapy. In a 3-month follow-up period, the recurrence rate of AOM and persistence of middle-ear effusion in these children were evaluated in comparison with the early results of the two methods, as well as the relation of MFT findings to the possibility of development of AOM sequelae. It seems that abnormal resonant frequency values and recordings by MFT right after an episode of AOM indicate persistence of changes in the mass and stiffness balance of the middle ear, not demonstrated by conventional tympanometry, that could be responsible for a higher probability of AOM sequelae.     

Differences in the suppression of distortion product otoacoustic emissions by contralateral white noise between patients with acute or chronic tinnitus

Objective: The mechanisms underlying the shift from acute tinnitus to chronic remain obscure. An association between tinnitus and medial olivocochlear bundle (MOCB) reflex dysfunction has been hypothesised by several studies. The differences between participants with acute and chronic tinnitus have not yet been investigated. Design: Participants were examined with distortion product otoacoustic emissions (DPOAEs) suppression elicited by contralateral white noise. They were compared in terms of frequency regions with non-recordable DPOAEs, suppression amplitudes and the presence of DPOAE enhancement. Study sample: Eighteen participants with acute tinnitus, 40 age-matched adults with chronic tinnitus and 17 controls were included. All participants (aged 34.7?±?9.6years; mean?±?Standard deviation) had normal hearing. Tinnitus was bilateral in 22 participants and unilateral in 36. Results: Ears with chronic tinnitus presented significantly lower DPOAE suppression amplitudes than ears with acute tinnitus (p?p?p?=?0.0002, respectively). Non-recordable DPOAEs were significantly more frequent in the chronic than in the acute tinnitus and control groups (p?Conclusions: The differences between study groups indicate that when tinnitus becomes chronic, DPOAEs suppression presents changes that might reveal corresponding steps in tinnitus pathophysiology. Treatment implications are discussed.     

Success rate of newborn and follow-up screening of hearing using otoacoustic emissions

OBJECTIVE: During the last 6 years, and after a long period of pilot study, a universal newborn hearing screening program based on otoacoustic emissions is implemented in Iaso Maternity Hospital. Our purpose is to present the success rate of otoacoustic emission testing on discharge from the hospital and 1 month later. METHODS: All full-term newborns who were screened during a period of 2 years and failed testing after one or more sessions of transiently evoked otoacoustic emissions, on discharge from the hospital, were included in the study. These newborns were retested approximately 1 month after discharge. RESULTS: Twenty-five thousand and thirty-two newborns were examined in total. We found 534 (2.1%) 'refer' cases. Only 223 of them (41.8%) returned to retest in follow-up after 1 month. From the rescreening, 59 (2.3 per thousand) newborns failed in the test again and were referred for diagnostic audiological evaluation. CONCLUSIONS: The rate of referrals was small, but efforts should be made to decrease it further. The final number of 'failures' found, approaches the expected rate of definitely diagnosed deafness reported from other settings. The main problem we have still to confront is the high missed to-follow-up rate.     

Maturation of the auditory system: 1. Transient otoacoustic emissions as an index of inner ear maturation

The transiently evoked otoacoustic emission amplitude of 42 preterm babies (84 ears; post-conceptional age [PCA] 30-36 weeks) was compared with the TEOAE amplitude of 39 full-term babies (78 ears; PCA 37-45 weeks) in order to trace the inner ear maturation characteristics. An ILO-92 otoacoustic emission recording system was used with linear clicks of 70 dB peak equivalent SPL. The results obtained indicated: (1) There was no statistically significant difference between preterm and full-term ears; (2) There was no significant difference between males and females; (3) There was a significant difference between left and right ear TEOAE amplitude; (4) The interaction of ear with age in relation to TEOAE amplitude was statistically significant; (5) Noise and stimulus parameters did not reveal any significant differences between right and left ears; (6) A positive correlation existed between birthweight and TEOAE amplitude; and (7) A negative correlation existed between aminoglycoside treatment and TEOAE amplitude. The results indicate subtle changes in TEOAE amplitude over time, showing a natural development of the inner ear function during the process of maturation.