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Israelsson K.-E.,ENT clinic | Bogo R.,Karolinska Institutet | Berninger E.,Karolinska University Hospital
Journal of the American Academy of Audiology | Year: 2015

Background and Purpose: The rapidly evolving field of hearing aid fitting in infants requires rapid, objective, and highly reliable methods for diagnosing hearing impairment. The aim was to determine test-retest reliability in hearing thresholds predicted by multiple auditory steady-state response (ASSRthr) among normal-hearing (NH) and hearing-impaired (HI) adults, and to study differences between ASSRthr and pure-tone threshold (PTT) as a function of frequency in each participant. ASSR amplitude versus stimulus level was analyzed to study ASSR growth rate in NH and HI participants, especially at ASSRthr. Research Design and Study Sample: Mixed multiple ASSR (100% AM, 20% FM), using long-time averaging at a wide range of stimulus levels, and PTT were recorded in 10 NH and 14 HI adults. ASSRthr was obtained in 10 dB steps simultaneously in both ears using a test-retest protocol (center frequencies 5 500, 1000, 2000, and 4000 Hz; modulation frequencies 5 80-96 Hz). The growth rate at ASSRthr was calculated as the slope (nV/dB) of the ASSR amplitudes obtained at, and 10 dB above, ASSRthr. PTT was obtained in both ears in 1 dB steps using a fixed-frequency Békésy technique. All of the NH participants showed PTTs better than 20 dB HL (125-8000 Hz), and mean pure-tone average (PTA; 500-4000 Hz) was 1.8 dB HL. The HI participants exhibited quite symmetrical sensorineural hearing losses, as revealed by a mean interaural PTA difference of 6.5 dB. Their mean PTA in the better ear was 38.7 dB HL. Results: High ASSRthr reproducibility (independent of PTT) was found in both NH and HI participants (test-retest interquartile range 5 10 dB). The prediction error was numerically higher in NH participants (f ≥1000 Hz), although only a significant difference existed at 1000 Hz. The median difference between ASSRthr (dB HL) and PTT (dB HL) was approximately 10 dB in the HI group at frequencies of 1000 Hz or greater, and 20 dB at 500 Hz. In general, the prediction error decreased (p < 0.001) with increasing hearing threshold, although large intersubject variability existed. Regression analysis (PTT versus ASSRthr) in HI participants revealed correlation coefficients between 0.72-0.88 (500-4000 Hz) and slopes at approximately 1.0. Large variability in ASSRthr-PTT versus frequency was demonstrated across HI participants (interquartile range approximately 20 dB). The maximum across-frequency difference (ASSRthr-PTT) in an individual participant was 50 dB. HI participants showed overall significantly higher amplitudes and slopes at ASSRthr than did NH participants (p < 0.02). The amplitude-intensity function revealed monotonically increasing ASSRs in NH participants (slope 2 nV/dB), whereas HI participants exhibited heterogeneous and mostly nonmonotonically increasing ASSRs. Conclusions: Long-time averaging of ASSR revealed high ASSRthr reproducibility and systematic decrease in prediction error with increasing hearing threshold, albeit large intersubject variability in prediction error existed. A plausible explanation for the systematic difference in ASSRthr between NH and HI adults might be significantly higher ASSR amplitudes and higher overall growth rates at ASSRthr among HI participants. Across-frequency comparison of PTT and ASSRthr in an individual HI participant demonstrated large variation; thus, ASSR may not be optimal for, e.g., reliable threshold prediction in infants and subsequent fine-tuning of hearing aids. © 2015, American Academy of Audiology. All rights reserved.

Messina A.,University of Palermo | Casani A.P.,University of Pisa | Manfrin M.,ENT Clinic | Guidetti G.,Vertigo Center
Acta Otorhinolaryngologica Italica | Year: 2017

Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often relapses after the first episode, with a recurrence rate between 15% and 50%. To date both the aetiopathogenetic processes that lead to otoconia detachment and the factors that make BPPV a relapsing disease are still unclear, but recent epidemiological studies have shown a possible association with cardiovascular risk factors. The aim of the present study (Sesto Senso Survey) was to evaluate in the Italian population through an observational survey, the main demographic and clinical characteristics of patients with BPPV (first episode or recurrent) with particular focus on the potential cardiovascular risk factors. The survey was conducted in 158 vestibology centres across Italy on 2,682 patients (mean age 59.3 ± 15.0 years; 39.1% males and 60.9% females) suffering from BPPV, from January 2013 to December 2014. The results showed a high prevalence of cardiovascular risk factors such as high blood pressure (55.8%), hypercholesterolaemia (38.6%) and diabetes (17.7%), as well as a family history of cardiovascular disease (49.4%). A high percentage of patients also had hearing loss (42.9%), tinnitus (41.2%), or both (26.8%). The presence of hypertension, dyslipidaemia and pre-existing cardiovascular comorbidities were significantly related to recurrent BPPV episodes (OR range between 1.84 and 2.31). In addition, the association with diabetes and thyroid/autoimmune disease (OR range between 1.73 and 1.89) was relevant. The survey results confirm the significant association between cardiovascular comorbidities and recurrent BPPV and identify them as a potential important risk factor for recurrence of BPPV in the Italian population, paving the way for the evaluation of new therapeutic strategies in the treatment of this disease. © 2017, Pacini Editore S.p.A. All rights reserved.

Suarez C.,Instituto Universitario Of Oncologia Del Principado Of Asturias | Suarez C.,Hospital Universitario Central Of Asturias | Rodrigo J.P.,Instituto Universitario Of Oncologia Del Principado Of Asturias | Rodrigo J.P.,Hospital Universitario Central Of Asturias | And 4 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2010

Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation. © 2010 The Author(s).

Bougea A.M.,National and Kapodistrian University of Athens | Spandideas N.,ENT Clinic | Alexopoulos E.C.,National and Kapodistrian University of Athens | Thomaides T.,Red Cross | And 2 more authors.
Explore: The Journal of Science and Healing | Year: 2013

Objective: To evaluate the short-term effects of the emotional freedom technique (EFT) on tension-type headache (TTH) sufferers. Design: We used a parallel-group design, with participants randomly assigned to the emotional freedom intervention (n = 19) or a control arm (standard care n = 16). Setting: The study was conducted at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens. Participants: Thirty-five patients meeting criteria for frequent TTH according to International Headache Society guidelines were enrolled. Intervention: Participants were instructed to use the EFT method twice a day for two months. Outcome Measures: Study measures included the Perceived Stress Scale, the Multidimensional Health Locus of Control Scale, and the Short-Form questionnaire-36. Salivary cortisol levels and the frequency and intensity of headache episodes were also assessed. Results: Within the treatment arm, perceived stress, scores for all Short-Form questionnaire-36 subscales, and the frequency and intensity of the headache episodes were all significantly reduced. No differences in cortisol levels were found in any group before and after the intervention. Conclusions: EFT was reported to benefit patients with TTH. This randomized controlled trial shows promising results for not only the frequency and severity of headaches but also other lifestyle parameters. © 2013 Elsevier Inc. All rights reserved.

Dispenza F.,U.O. Otorinolaringoiatria Azienda Sanitaria Provinciale Agrigento Ospedale San Giovanni di Dio | Dispenza C.,University of Palermo | Marchese D.,University of Palermo | Kulamarva G.,ENT Clinic | Saraniti C.,University of Palermo
American Journal of Otolaryngology - Head and Neck Medicine and Surgery | Year: 2012

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space. © 2012 Elsevier Inc. All rights reserved.

Dellmann A.,Institute For Pathologie | Schroeder H.-G.,ENT Clinic | Donhuijsen K.,Institute For Pathologie
European Archives of Oto-Rhino-Laryngology | Year: 2010

Osteoblastoma of the larynx is an extremely rare type of locally progressive and destructive tumour which is mimicking osteosarcoma radiologically and histologically. Since prognostic and therapeutic strategies for benign osteoblastoma differ from the more common osteosarcoma of the larynx, a meticulous pre-operative histological diagnosis is required to avoid over-therapy. We report about two patients with osteoblastoma of the larynx with organ-saving resection and long-period follow-up without tumour recurrence. A review of the literature detected five further osteoblastomas of the larynx, all in elderly men, like our observations. This situation is quite different from the usual osteoblastomas of bone, which occur in young adults of both sexes equally. © 2009 Springer-Verlag.

Heslop A.,Aarhus University Hospital | Lildholdt T.,ENT Clinic | Gammelgaard N.,ENT Clinic | Ovesen T.,Aarhus University Hospital
Laryngoscope | Year: 2010

Objectives/Hypothesis: To compare the clinical failure rates among children with otorrhea through tympanostomy tubes treated with topical or systemic antibiotics versus topical saline. Study Design: Randomized, double-blind, controlled patient study. Methods: A three-armed randomized clinical trial using topical ciprofloxacin or oral amoxicillin or topical saline. The primary outcome was treatment failure defined as presence of otorrhea in at least one ear after 7 days of treatment. Results: The treatment failure rates were 23% and 70% in the group treated with topical ciprofloxacin and oral amoxicillin, respectively. Treatment failures were seen in 58% of children treated with topical saline. Thus, topical ciprofloxacin significantly reduced treatment failures compared to both oral amoxicillin and topical saline. The most frequent bacteria isolated from treatment failures in general were streptococci and Moraxella catarrhalis. Conclusions: The significant effect of topical ciprofloxacin is probably related to a higher local concentration of antibiotics in the middle ear rather than the result of mechanical rinsing and dissolution of the bacterial load. © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.

Iyer N.G.,Sloan Kettering Cancer Center | Shaha A.R.,Sloan Kettering Cancer Center | Silver C.E.,Yeshiva University | Devaney K.O.,Allegiance Health | And 3 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2010

Incidental lesions of the thyroid gland are an increasing problem facing clinicians. While asymptomatic palpable lesions are detected in only 4-7% of the population, currently available imaging modalities are sensitive enough to detect lesions in 20-30% of the population. Guidelines for managing these incidentalomas are limited, largely due to lack of well-powered prospective studies. This review will address the currently available data on thyroid incidentalomas, detected through clinical examination, cross-sectional imaging, ultrasound, and PET scans. We will focus on the modalities of detection and risk of malignancy, further investigation and management options and the deficiencies therein. We propose a pragmatic algorithm when faced with this clinical dilemma under differing circumstances. © Springer-Verlag 2010.

Zehnder J.,ENT Clinic | Tschopp K.P.,ENT Clinic
ORL | Year: 2013

Objectives: The aim of this study was to investigate the long-term compliance of the Velumount® palatal device. Methods: This was a cohort study: 46 patients who received a Velumount device three years previously were enrolled. A questionnaire was sent to all patients. The data of 43 patients (93%) could be evaluated. Results: Seventeen (40%) patients used the Velumount device regularly (>5 nights per week). However, 24 (56%) abandoned its use, 1 (2%) used it only occasionally (1-2 nights/week) and 1 (2%) used it only on special occasions. The main reasons for discontinuing Velumount were gag reflex (36%) and foreign body sensation (20%). Conclusions: The long-term compliance of the Velumount is 40%. Those patients who tolerate Velumount well use it regularly at least 5 nights per week. The Velumount palatal device is a valuable treatment option in counseling for patients with primary snoring or mild obstructive sleep apnea. © 2013 S. Karger AG, Basel.

Ashoor A.A.J.,ENT Clinic
Bahrain Medical Bulletin | Year: 2010

Background: Benign Paroxysmal Positional Vertigo (BPPV) is a very common vestibular disorder. It is characterized by short lasting positional vertigo. Different etiology may be responsible for it. The diagnosis is based on history and on the nystagmus findings. Treatment of choice is the repositioning maneuver after Epley and/or Semont. Objective: To assess the efficacy of the Repositioning Maneuver (RM) in the management of Benign Paroxysmal Positional Vertigo (BPPV). Setting: ENT Clinics, Al-Khobar, Saudi Arabia. Design: Prospective study. Method: Fourteen patients complaining of vertigo from May 2007 to May 2009 were included in the study. All patients were seen, examined and treated by the author. After a detailed history, audiological and vestibular tests were performed. The patients either been subjected to Epley and/or the Semont maneuver. Result: Fourteen patients aged 30-64 years (mean 49 years), 8 males and 6 females were included in the study. All were complaining of acute short lived positional vertigo. Examination of patients showed positive Dix-Hallpike test (DHT), some canal paresis, abnormal gait test and sensorineural hearing loss. Thirteen patients were free of symptoms after the maneuvers. One showed no improvement. Patients with dizziness have to be rehabilitated. Mean follow up was 3 months. Conclusion: Epley and Semont maneuvers are very effective procedures to treat benign paroxysmal positional vertigo. In this study, eleven out of fourteen patients were relieved of their symptoms. The recommended time for follow up is 3 months and for reassessment one month.

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