ENT News
Magnetic resonance imaging screening in acoustic neuroma
Magnetic resonance imaging (MRI) is the definitive investigation for detection of an acoustic neuroma. It is however an expensive resource, and pick-up rate of a tumor can be as low as 1% of all patients scanned. This study aims to examine referral patterns for MRI screening for patients presenting with asymmetrical sensorineural hearing loss (ASHL). A second aim was to suggest appropriate screening criteria. Overall two acoustic neuromas were picked up out of 132 scans performed. Of the scans performed for ASHL, a third did not fit with any of the published criteria. Of the 30 positive scans for a tumor, the patients/audiograms revealed that 10% did not fit the published criteria despite the patients having no other audiovestibular symptoms. There appears to be no universally accepted guidelines on screening in ASHL with clinical acumen being used by most ENT consultants in this region. Applying protocols may reduce the amount of scans performed, but up to 10% of tumors may be missed by this approach.
Prevalence and Characteristics of Tinnitus among US Adults
Tinnitus is common; however, few risk factors for tinnitus are known. This article examined cross-sectional relations between several potential risk factors and self-reported tinnitus in 14,178 participants in the 1999-2004 National Health and Nutrition Examination Surveys, a nationally representative database. Approximately 50 million US adults reported having any tinnitus, and 16 million US adults reported having frequent tinnitus in the past year. The prevalence of frequent tinnitus increased with increasing age, peaking at 14.3% between 60 and 69 years of age. Non-Hispanic whites had higher odds of frequent tinnitus compared with other racial/ethnic groups. Hypertension and former smoking were associated with an increase in odds of frequent tinnitus. Loud leisure-time, firearm, and occupational noise exposure also were associated with increased odds of frequent tinnitus. Among participants who had an audiogram, frequent tinnitus was associated with low-mid frequency and high frequency hearing impairment. Among participants who were tested for mental health conditions, frequent tinnitus was associated with generalized anxiety disorder.
Acute otitis media: To follow-up or treat?
Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin.
The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.
Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use
IntroductionPhosphodiesterase-5 inhibitors have become an increasingly popular class of medications for the treatment of erectile dysfunction. These medications dilate the penile blood vessels and cause prolonged erections. While these agents are effective in treating impotence, a number of side effects have been reported as a result of their use and misuse. Among these complications are epistaxis, esophageal variceal hemorrhage, intracranial hemorrhage, and hemorrhoidal bleeding.1-5 We report a case of a vocal fold hemorrhage associated with the casual use of vardenafil in a 31-year-old man
Use of Botulinum Toxin Type A for Chronic Cough
An article in the Archives of Otolaryngology reviewed the experience and outcomes of a novel use of botulinum toxin type A (BtxA) in the treatment of chronic cough. In the study all patients had significant relief of cough after BtxA injection, with complete resolution after a median of 7 injections (range, 4-16), using a mean dose of 4.0 U (range, 1.0-10.0 U) per treatment session for a mean duration of 25.7 months. According to this article, this is the first reported series in the literature of the use of BtxA in the treatment of chronic cough in adults. Further research and long-term follow-up are warranted, but BtxA is effective in directly decreasing laryngeal hypertonicity and possibly reducing neurogenic inflammation and neuropeptide-mediated cough. Botulinum toxin type A can be considered for the treatment of chronic cough refractory to other medical therapies.
High-resolution ultrasound in the evaluation and prognosis of Bell's palsy
Bell's palsy is a commonly encountered paralysis of the facial nerve occurring worldwide. Prognosis for Bell's palsy is good, but the proportion of patients with poor outcomes may reach 30%. Ultrasound (US) may provide a novel approach for evaluating and prognosticating Bell's palsy, in comparison with known electrophysiological techniques. A study out of the European Journal of Neurology measured the diameter of the distal facial (VII) nerve using US in patients with Bell's palsy treated with prednisolone, in comparison with healthy controls. Overall it was found that the diameter of the distal VII nerve is a good predictor of favorable (positive predictive value: 100%) and bad outcomes (negative predictive value: 77%) in Bell's palsy at 3 months after clinical presentation. US was also found to be superior to VII nerve conduction and blink reflex studies in outcome prediction.
Do Either Corticosteroids or Antiviral Agents Reduce the Risk of Long-Term Facial Paresis in Patients with New-Onset Bell's Palsy?
The cause of Bell's palsy remains uncertain, although accumulating evidence suggests a viral etiology. To date, treatment to minimize long-term deficits from this disorder typically includes anti-inflammatory or antiviral medication. Three multicenter, randomized, controlled trials enrolled over 1500 adult patients with paroxysmal, unilateral paresis of cranial nerve VII and treated them with varying regimens and combinations of prednisolone, antiviral agents, and placebo, and evaluated complete recovery up to 12 months later. Current evidence suggests that prednisolone, an inexpensive and readily available medication, is effective for this common condition, but there was no statistically significant difference observed with acyclovir. Valacyclovir provides minimal added benefit to prednisolone alone.
Antimicrobial Resistance to Ampicillin seen in pediatric chronic rhinosinusitis
Few studies in the past decade have focused on antimicrobial resistance of bacteria in pediatric rhinosinusitis. A study in the American Journal of Otolaryngology aimed to characterize organisms cultured from pediatric chronic rhinosinusitis, as well as current resistance patterns of pathogens.
The most common isolates were
α-hemolytic
Streptococcus (20.8%),
Haemophilus influenzae (19.5%),
Streptococcus pneumoniae (14.0%), coagulase-negative
Staphylococcus (13.0%), and
Staphylococcus aureus (9.3%). Anaerobes accounted for 8.0% of all isolates.
Susceptibility rates of
H influenzae for ampicillin were 44.7% in the first 3 years of the study and 25% in the next 3 years, suggesting the
resistance rate of
H influenzae for ampicillin appears to be a growing problem in pediatric rhinosinusitis.
Secondhand Smoke as a Potential Cause of Chronic Rhinosinusitis
An article in this months Archives of Otolaryngology- Head & Neck Surgery assessed the role of secondhand smoke (SHS) in the etiology of chronic rhinosinusitis (CRS). Of controls and case patients, respectively, 28 (9.1%) and 41 (13.4%) had SHS exposure at home, 21 (6.9%) and 57 (18.6%) at work, 258 (84.3%) and 276 (90.2%) in public places, and 85 (27.8%) and 157 (51.3%) at private social functions. Results suggested that approximately 40.0% of CRS appeared to be attributable to SHS.
Effects of exposure to smoking on the microbial flora of children and their parents
The effects of exposure to direct and indirect smoking on the colonization with pathogenic bacteria and organisms that interfere with their growth were examined in an article in this months International Journal of Pediatric Otolaryngology. It found parents that smoked were more often colonized by potential pathogens than parents that did not smoke. The flora of healthy children of Smoking parents contained high number of potential pathogens similar to the one found in their parents and Otitis Media Prone children. Since Smoking parents harbor more potential pathogens and less interfering organisms they may serve as a source of pathogens that can colonize and/or infect their children. These studies illustrate the adverse effects of direct and indirect exposure to smoking on colonization with potential pathogens.
New Bell's Palsy Treatment Video
New Therapies Fight Phantom Noises of Tinnitus
Although there is no cure, researchers say they have never had a better understanding of the cascade of physiological and psychological mechanisms responsible for tinnitus. As a result, new treatments under investigation — some of them already on the market — show promise in helping patients manage the ringing, pinging and hissing that otherwise drives them to distraction.
Plasma Osteopontin Levels in Patients With Head and Neck Cancer Undergoing Chemoradiotherapy
Archives of Otolaryngology Head and Neck Surgery Abstract
To explore the prognostic role of plasma levels of osteopontin (OPN), a phosphoglycoprotein with adhesive properties, in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concomitant chemoradiotherapy. Previous studies have proposed OPN level as a prognostic factor in several cancers. In patients with HNSCC undergoing chemoradiotherapy, a low pretreatment plasma OPN level is associated with treatment response and better survival. Modulation of OPN levels by chemoradiotherapy may also be associated with outcome. Further studies with serial measurement of OPN levels are warranted in these patients.
Sleep Benefits From Tonsillectomy Peak at 6 Months
Children who had their tonsils and adenoids removed slept better after having the procedure, but the benefit began to decline six months post-surgery, a new study has found.
Corticosteroids vs Corticosteroids Plus Antiviral Agents in the Treatment of Bell Palsy
Archives of Otolaryngology
The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.
Potential adverse effect of
using the high dose of amoxicillin in the treatment of acute
otitis media in children
Archives of Otolaryngology Head Neck Surgery
Of 50 children diagnosed as having acute otitis media, 25 received a low dose of amoxicillin (45 mg/kg/d) (group 1) and 25 received a high dose of amoxicillin (90 mg/kg/d) (group 2) for 10 days. The number of penicillin-susceptible isolates was equally reduced after both therapies. However, an increase was noted in the recovery of S aureus only in group 2. A greater eradication rate of interfering organisms following therapy was noted in group 2 than in group 1. These changes may contribute to the greater recovery rate of patients infected with S aureus who received a high dose of amoxicillin.
