International Journal of Otolaryngology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Radiological Assessment of the Indian Children with Congenital Sensorineural Hearing Loss Mon, 14 Jul 2014 12:03:54 +0000 Introduction. Congenital sensorineural hearing loss is one of the most common birth defects with incidence of approximately 1 : 1000 live births. Imaging of cases of congenital sensorineural hearing loss is frequently performed in an attempt to determine the underlying pathology. There is a paucity of literature from India and for this reason we decided to conduct this study in Indian context to evaluate the various cochleovestibular bony and nerve anomalies by HRCT scan of temporal bone and MRI with 3D scan of inner ear in a tertiary care centre. Material and Methods. A total of 280 children with congenital deafness (158 males and 122 females), between January 2002 to June 2013 were included in the study and they were assessed radiologically by HRCT scan of temporal bone and MRI with 3D scan of inner ear. Results. In the present study we found various congenital anomalies of bony labyrinth and vestibulocochlear nerve. Out of 560 inner ears we found 78 anomalous inner ears. Out of these 78 inner ears 57 (73%) had cochlear anomaly, 68 (87.1%) had anomalous vestibule, 44 (56.4%) had abnormal vestibular aqueduct, 24 (30.7%) had anomalous IAC, and 23 (29.4%) had abnormal cochleovestibular nerves. Conclusion. In present study, we found lower incidences of congenital anomalies comparative to existing literature. Sangeet Kumar Agarwal, Satinder Singh, Samarjit Singh Ghuman, Shalabh Sharma, and Asish Kr. Lahiri Copyright © 2014 Sangeet Kumar Agarwal et al. All rights reserved. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine Wed, 25 Jun 2014 06:09:35 +0000 A multicenter clinical trial was performed to compare the efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine at recommended doses in patients with vertigo. One hundred and sixty patients (mean age 58 years) were randomly assigned to double-blind treatment with EGb 761 (240 mg per day) or betahistine (32 mg per day) for 12 weeks. An 11-point numeric analogue scale, the Vertigo Symptom Scale—short form, the Clinical Global Impression Scales and the Sheehan Disability Scale were used as outcome measures. Both treatment groups were comparable at baseline and improved in all outcome measures during the course of treatment. There was no significant intergroup difference with regard to changes in any outcome measure. Numerically, improvements of patients receiving EGb 761 were slightly more pronounced on all scales. Clinical global impression was rated “very much improved” or “much improved” in 79% of patients treated with EGb 761 and in 70% receiving betahistine. With 27 adverse events in 19 patients, EGb 761 showed better tolerability than betahistine with 39 adverse events in 31 patients. In conclusion, the two drugs were similarly effective in the treatment of vertigo, but EGb 761 was better tolerated. This trial is registered with ISRCTN02262139. Larysa Sokolova, Robert Hoerr, and Tamara Mishchenko Copyright © 2014 Larysa Sokolova et al. All rights reserved. How Neuroscience Relates to Hearing Aid Amplification Wed, 18 Jun 2014 08:30:01 +0000 Hearing aids are used to improve sound audibility for people with hearing loss, but the ability to make use of the amplified signal, especially in the presence of competing noise, can vary across people. Here we review how neuroscientists, clinicians, and engineers are using various types of physiological information to improve the design and use of hearing aids. K. L. Tremblay and C. W. Miller Copyright © 2014 K. L. Tremblay and C. W. Miller. All rights reserved. The Relationship between the Efficacy of Tonsillectomy and Renal Pathology in the Patients with IgA Nephropathy Mon, 19 May 2014 00:00:00 +0000 Objective. The aim of this study was to evaluate the effects of tonsillectomy as a treatment for IgA nephropathy in relation to renal pathological findings. Methods. This is a retrospective analysis of 13 patients having IgA nephropathy treated by tonsillectomy. Results. UP/UCre levels decreased from 820.8 to 585.4 one month postsurgery and then showed slight worsening to 637.3 at the most recent follow-up. There was no significant difference in the improvement rate between pathological grades I–III and IV. There was positive correlation between Pre-UP/UCre level and the reduction rate of UP/UCre, which was statistically significant (R = 0.667, R2 = 0.445, and ). Conclusions. Reduction of UP/UCre at one month postsurgery is considered to be an overall prognostic factor, and tonsillectomy is considered to be an effective therapy for IgA patients regardless of the grade of renal pathology. Tsutomu Nomura, Yoshimi Makizumi, Tsuyoshi Yoshida, and Tatsuya Yamasoba Copyright © 2014 Tsutomu Nomura et al. All rights reserved. Aerodigestive Foreign Bodies in Adult Ethiopian Patients: A Prospective Study at Tikur Anbessa Hospital, Ethiopia Tue, 15 Apr 2014 00:00:00 +0000 Introduction. Foreign bodies (FBs) in the aerodigestive tract are important causes of morbidity and mortality and pose diagnostic and therapeutic challenges. The best method of removal of an esophageal and tracheobronchial FB is endoscopic guided extraction. Objective. To present our experience of the removal of aerodigestive FBs in adult Ethiopian patients using rigid endoscopes. Methods. A hospital-based prospective study, at Tikur Anbessa Referral and Teaching Hospital, from January 2011 to December 2012 (over two years). Results. A total of 32 patients (18 males and 14 females) with a mean age of years were treated for FB ingestion and aspiration at Tikur Anbessa Hospital. The FBs were impacted at the esophagus in 18 (56.2%) patients, at the pharynx in 7 (21.8%), and at the air way in 7 (21.8%) patients. Pieces of bones were the commonest objects found in the esophagus (17/18 of the cases) and the pharynx (4/7), while fractured tracheostomy tubes and needles were frequently seen in the air way (3/7 cases each). The foreign bodies were visible in plain radiographs of 26 (81.2%) patients. Successful extraction of FBs was achieved by using Mc gill forceps in 11 cases, rigid esophagoscopes in 9 patients, and bronchoscopes in 4 cases. Four cases required open surgery to remove the foreign bodies. Two complications (one pneumothorax and one esophageal perforation) occurred. All patients were discharged cured. Discussion and Recommendations. Aerodigestive FBs are not so rare in the hospital and timely diagnosis and removal of accidentally ingested and aspirated foreign body should be performed so as to avoid the potentially lethal complications associated. Rigid esophagoscopy requires general anesthesia and is associated with its own complications, but our experience and outcome of its use are encouraging. Abebe Bekele Copyright © 2014 Abebe Bekele. All rights reserved. Chronic Maxillary Rhinosinusitis of Dental Origin: A Systematic Review of 674 Patient Cases Tue, 08 Apr 2014 09:31:18 +0000 Objectives. The aim of this systematic review is to study the causes of odontogenic chronic maxillary rhinosinusitis (CMRS), the average age of the patients, the distribution by sex, and the teeth involved. Materials and Methods. We performed an EMBASE-, Cochrane-, and PubMed-based review of all of the described cases of odontogenic CMRS from January 1980 to January 2013. Issues of clinical relevance, such as the primary aetiology and the teeth involved, were evaluated for each case. Results. From the 190 identified publications, 23 were selected for a total of 674 patients following inclusion criteria. According to these data, the main cause of odontogenic CMRS is iatrogenic, accounting for 65.7% of the cases. Apical periodontal pathologies (apical granulomas, odontogenic cysts, and apical periodontitis) follow them and account for 25.1% of the cases. The most commonly involved teeth are the first and second molars. Conclusion. Odontogenic CMRS is a common disease that must be suspected whenever a patient undergoing dental treatment presents unilateral maxillary chronic rhinosinusitis. Jerome R. Lechien, Olivier Filleul, Pedro Costa de Araujo, Julien W. Hsieh, Gilbert Chantrain, and Sven Saussez Copyright © 2014 Jerome R. Lechien et al. All rights reserved. Gastric Decompression Decreases Postoperative Nausea and Vomiting in ENT Surgery Wed, 02 Apr 2014 14:11:42 +0000 There is a passive blood flow to the stomach during oral and nasal surgery. It may cause postoperative nausea and vomiting (PONV). We researched the relationship between gastric decompression (GD) and severity of PONV in ear, nose, and throat (ENT) surgery. 137 patients who have been into ENT surgery were included in the study. In Group I (), patients received GD after surgery before extubation; patients in Group II () did not receive GD. In postoperative 2nd, 4th, 8th, and 12th hours, the number and ratio of patients demonstrating PONV were detected to be significantly more in Group II as compared to Group I. PONV was also significantly more severe in Group II as compared to Group I. In Group I, the PONV ratio in the 2nd hour was significantly more for those whose amounts of stomach content aspired were more than 10 mL as compared to those whose stomach content aspired was less than 10 mL. In the 4th, 8th, and 24th hours, there is no statistically significant difference between the stomach content aspired and PONV ratio. GD reduces the incidence and severity of PONV in ENT surgery. Kerem Erkalp, Nuran Kalekoglu Erkalp, M. Salih Sevdi, A. Yasemin Korkut, Hacer Yeter, Sertuğ Sinan Ege, Aysin Alagol, and Veysel Erden Copyright © 2014 Kerem Erkalp et al. All rights reserved. Mucin Gene Expression in Reflux Laryngeal Mucosa: Histological and In Situ Hybridization Observations Mon, 24 Mar 2014 11:00:24 +0000 Objectives/Hypothesis. To determine if laryngopharyngeal reflux alters mucin gene expression in laryngeal mucosa. Methods. In situ hybridization was employed to study the expression of the 8 well-characterised mucin genes MUC1-4, 5AC, 5B, 6, and 7 in reflux laryngeal mucosa from laryngeal ventricles, posterior commissures, and vocal folds compared to control/normal laryngeal mucosa. Results. MUC1-5 genes are expressed in normal and reflux laryngeal mucosa. MUC1, 3 and 4 are expressed in respiratory and squamous mucosa whereas MUC2 and 5AC are expressed in respiratory mucosa only. MUC3, 4 and 5AC are downregulated in reflux mucosa. MUC5AC expression is significantly reduced in the 3 mucosal sites and when mucosal type was taken into account, this remains significant in combined laryngeal and ventricular mucosa only. Conclusions. MUC3, 4 and 5AC expression is downregulated in laryngopharyngeal reflux. This may be due to laryngeal mucosal metaplasia and/or alteration of mucin gene expression in the preexisting mucosa. Altered mucin gene expression might predispose laryngeal mucosa to the damaging effect of reflux. Mahmoud El-Sayed Ali, David M. Bulmer, Peter W. Dettmar, and Jeffrey P. Pearson Copyright © 2014 Mahmoud El-Sayed Ali et al. All rights reserved. Allergic Sensitization to Perennial Allergens in Adults and Children Sensitized to Japanese Cedar or Japanese Cypress Pollen in Japan Mon, 17 Mar 2014 10:52:55 +0000 In Japan, seasonal allergic rhinitis in the spring due to exposure to Japanese cedar or Japanese cypress pollen is common. However, the allergic profile for perennial allergens in spring pollinosis remains unclear. Therefore, in this study, we investigated the allergic profiles of 652 patients with rhinitis. Total serum IgE, serum-specific IgE, and blood eosinophil counts were measured. Allergic sensitization, determined by the serum allergen-specific IgE level, did not always correspond with the patient’s symptoms. Only 27% of patients with allergic symptoms in response to spring pollens were sensitized to these allergens alone; 31% of patients were also sensitized to perennial allergens, even without symptoms due to perennial allergens. Total serum IgE and eosinophil cell counts were significantly elevated in patients sensitized to perennial allergens and spring pollens, as compared to patients sensitized only to spring pollens. Most children sensitized to spring pollen (84%) were sensitized to perennial allergens, at a higher rate than adults (49%). Patients sensitized to spring pollens are likely to be latently sensitized to perennial allergens. This is especially true for children and should be monitored closely. Improvement in seasonal allergic conditions, including latent perennial allergy, is important to prevent symptoms that could advance to asthma. Masafumi Ohki and Masanobu Shinogami Copyright © 2014 Masafumi Ohki and Masanobu Shinogami. All rights reserved. Branchial Anomalies: Diagnosis and Management Tue, 04 Mar 2014 13:04:24 +0000 Objective. To find out the incidence of involvement of individual arches, anatomical types of lesions, the age and sex incidence, the site and side of predilection, the common clinical features, the common investigations, treatment, and complications of the different anomalies. Setting. Academic Department of Otolaryngology, Head and Neck Surgery. Design. A 10 year retrospective study. Participants. 30 patients with clinically proven branchial anomalies including patients with bilateral disease totaling 34 lesions. Main Outcome Measures. The demographical data, clinical features, type of branchial anomalies, and the management details were recorded and analyzed. Results and Observations. The mean age of presentation was 18.67 years. Male to female sex ratio was 1.27 : 1 with a male preponderance. Of the 34 lesions, maximum incidence was of second arch anomalies (50%) followed by first arch. We had two cases each of third and fourth arch anomalies. Only 1 (3.3%) patients of the 30 presented with lesion at birth. The most common pathological type of lesions was fistula (58.82%) followed by cyst. 41.18% of the lesions occurred on the right side. All the patients underwent surgical excision. None of our patients had involvement of facial nerve in first branchial anomaly. All patients had tracts going superficial to the facial nerve. Conclusion. Confirming the extent of the tract is mandatory before any surgery as these lesions pass in relation to some of the most vital structures of the neck. Surgery should always be the treatment option. injection of dye, microscopic removal and inclusion of surrounding tissue while excising the tract leads to a decreased incidence of recurrence. Sampath Chandra Prasad, Arun Azeez, Nikhil Dinaker Thada, Pallavi Rao, Andrea Bacciu, and Kishore Chandra Prasad Copyright © 2014 Sampath Chandra Prasad et al. All rights reserved. Hearing Benefit in Allograft Tympanoplasty Using Tutoplast Processed Malleus Thu, 13 Feb 2014 00:00:00 +0000 Objectives. Tutoplast processed human cadaveric ossicular allografts are a safe alternative for ossicular reconstruction where there is insufficient material suitable for autograft ossiculoplasty. We present a series of 7 consecutive cases showing excellent air-bone gap closure following canal-wall-down mastoidectomy for cholesteatoma and reconstruction of the middle ear using Tutoplast processed malleus. Patients and Methods. Tympanoplasty with Tutoplast processed malleus was performed in seven patients to reconstruct the middle ear following canal-wall-down mastoidectomy in a tertiary ENT centre. Main Outcome Measures. Hearing improvement and recurrence-free period were assessed. Pre-and postoperative audiograms were performed. Results. The average pre operative hearing loss was 50 ± 13 dB, with an air-bone gap of 33 ± 7 dB. Post operative audiograms at 25 months demonstrated hearing thresholds of 29 ± 10 dB, with an air-bone gap of 14 ± 6 dB. No prosthesis extrusion was observed, which compares favourably to other commercially available prostheses. Conclusions. Tutoplast processed allografts restore conductive hearing loss in patients undergoing mastoidectomy and provide an excellent alternative when there is insufficient material suitable for autograft ossiculoplasty. Anja Lieder and Wolfgang Issing Copyright © 2014 Anja Lieder and Wolfgang Issing. All rights reserved. Demography and Histologic Pattern of Laryngeal Squamous Cell Carcinoma in Kenya Tue, 21 Jan 2014 13:11:15 +0000 Background. Laryngeal squamous cell carcinoma is a common head and neck cancer worldwide. Objective. To determine the demographic characteristics of patients with laryngeal cancer, establish their tumor characteristics and relate it to their smoking and alcohol ingestion habits. Methods. Fifty cases and fifty controls were recruited of matching age, sex, and region of residence. History and pattern of cigarette smoking and alcohol ingestion was taken and analyzed. Results. 33 (66%) of the cases and 3 (6%) among controls were current cigarette smokers. 74% had smoked for more than 30 years, OR 21.3 (95% CI: 2.6–176.1). There was a male predominance (96%) and most cases (62%) were from the ethnic communities in the highland areas of Kenya predominantly in Central and Eastern provinces. Very heavy drinkers had increased risk of OR, 6.0 (95% CI: 1.957–18.398) and those who smoked cigarettes and drank alcohol had poorly differentiated tumors G3, , OR 11.652 (95% CI 2.305–58.895), and G4, OR 7.286 (95% CI 0.726–73.075). They also presented with advanced disease (73.6%). Conclusion. Cigarette smoking and alcohol ingestion are strong risk factors for development of late stage and poorly differentiated laryngeal squamous cell carcinoma in Kenya. Owen Pyeko Menach, Asmeeta Patel, and Herbert Ouma Oburra Copyright © 2014 Owen Pyeko Menach et al. All rights reserved. Contralateral Ear Occlusion for Improving the Reliability of Otoacoustic Emission Screening Tests Sun, 12 Jan 2014 12:09:46 +0000 Newborn hearing screening is an established healthcare standard in many countries and testing is feasible using otoacoustic emission (OAE) recording. It is well documented that OAEs can be suppressed by acoustic stimulation of the ear contralateral to the test ear. In clinical otoacoustic emission testing carried out in a sound attenuating booth, ambient noise levels are low such that the efferent system is not activated. However in newborn hearing screening, OAEs are often recorded in hospital or clinic environments, where ambient noise levels can be 60–70 dB SPL. Thus, results in the test ear can be influenced by ambient noise stimulating the opposite ear. Surprisingly, in hearing screening protocols there are no recommendations for avoiding contralateral suppression, that is, protecting the opposite ear from noise by blocking the ear canal. In the present study we have compared transient evoked and distortion product OAEs measured with and without contralateral ear plugging, in environmental settings with ambient noise levels <25 dB SPL, 45 dB SPL, and 55 dB SPL. We found out that without contralateral ear occlusion, ambient noise levels above 55 dB SPL can significantly attenuate OAE signals. We strongly suggest contralateral ear occlusion in OAE based hearing screening in noisy environments. Emily Papsin, Adrienne L. Harrison, Mattia Carraro, and Robert V. Harrison Copyright © 2014 Emily Papsin et al. All rights reserved. Evidence of Bacterial Biofilms among Infected and Hypertrophied Tonsils in Correlation with the Microbiology, Histopathology, and Clinical Symptoms of Tonsillar Diseases Tue, 24 Dec 2013 09:30:14 +0000 Diseases of the tonsils are becoming more resistant to antibiotics due to the persistence of bacteria through the formation of biofilms. Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. We have isolated the microorganisms, evaluated their antimicrobial susceptibility, and detected the presence of bacterial biofilms in tonsillar specimens in correlation with the clinical manifestations of tonsillar diseases. Therefore, a total of 140 palatine tonsils were collected from 70 patients undergoing tonsillectomy at University Malaya Medical Centre. The most recovered isolate was Staphylococcus aureus (39.65%) followed by Haemophilus influenzae (18.53%). There was high susceptibility against all selected antibiotics except for cotrimoxazole. Bacterial biofilms were detected in 60% of patients and a significant percentage of patients demonstrated infection manifestation rather than obstruction. In addition, an association between clinical symptoms like snore, apnea, nasal obstruction, and tonsillar hypertrophy was found to be related to the microbiology of tonsils particularly to the presence of biofilms. In conclusion, evidence of biofilms in tonsils in correlation with the demonstrated clinical symptoms explains the recalcitrant nature of tonsillar diseases and highlights the importance of biofilm’s early detection and prevention towards better therapeutic management of biofilm-related infections. Saad Musbah Alasil, Rahmat Omar, Salmah Ismail, Mohd Yasim Yusof, Ghulam N. Dhabaan, and Mahmood Ameen Abdulla Copyright © 2013 Saad Musbah Alasil et al. All rights reserved. Aural Foreign Bodies: Descriptive Study of 224 Patients in Al-Fallujah General Hospital, Iraq Tue, 03 Dec 2013 15:17:49 +0000 Foreign bodies (FB) in the external auditory canal are relative medical emergency. The objective of this study was to describe the types of FB and their complications and to highlight on new FB not seen before which was the bluetooth devices that were used for cheating during high school examination in Al-Fallujah city. This was a two-year hospital-based descriptive study performed in the Department of Ear, Nose and Throat (ENT), Al-Fallujah General Hospital, from June 2011 to May 2013; during this period, 224 FB had been extracted from 224 patients. Beads were extracted from 68 patients (30.4%), cotton tips were extracted from 50 patients (22.3%), seeds and garlic were extracted from 31 patients (13.8%), papers were extracted from 27 patients (12.1%), insects were extracted from 24 patients (10.7%), button batteries were extracted from 13 patients (5.8%), and bluetooth devices were extracted from 7 patients (3.1%). Most of the cases did not develop complications (87.5%) during extraction. The main complications were canal abrasion (4.5%). Proper instrumentation allows the uncomplicated removal of many FB. The use of general anesthesia is preferred in very young children. Bluetooth device objects should be considered as new aural FB, especially in our territory. Ahmad Nasrat Al-juboori Copyright © 2013 Ahmad Nasrat Al-juboori. All rights reserved. Comparison of Pediatric and Adult Tonsillectomies Performed by Thermal Welding System Thu, 28 Nov 2013 10:31:55 +0000 Objective. To compare pediatric and adult age groups in terms of postoperative bleeding and pain following tonsillectomy performed by thermal welding system (TWS). Method. The study consisted of 213 patients, of whom 178 were children and 35 were adults. The mean age of the pediatric patients (81 girls and 97 females) was years (range 3–13 years) and the mean age of the adults (20 males and 15 females) was years (range 15–41 years). All of the patients were evaluated in terms of postoperative bleeding and pain following tonsillectomy performed by TWS. Results. Bleeding was detected in the late postoperative period in 11 pediatric and 7 adult patients and of them 2 pediatric and 3 adult patients controlled under general. Postoperative bleeding was significantly less prevalent in the pediatric age group compared to the adult age group (). Likewise, postoperative pain was significantly less prevalent in the pediatric age group as compared to the adult age group (). Conclusion. Both postoperative bleeding and pain following tonsillectomy performed by TWS were more prevalent in the adult age group compared to the pediatric age group. Tolga Ersözlü, Yavuz Selim Yıldırım, and Selman Sarica Copyright © 2013 Tolga Ersözlü et al. All rights reserved. Sinus Fungus Ball in the Japanese Population: Clinical and Imaging Characteristics of 104 Cases Tue, 12 Nov 2013 09:59:19 +0000 Sinus fungus ball is defined as noninvasive chronic fungal rhinosinusitis occurring in immunocompetent patients with regional characteristics. The clinical and imaging characteristics of paranasal sinus fungus ball were retrospectively investigated in 104 Japanese patients. All patients underwent endoscopic sinus surgery. Preoperative computed tomography (CT), magnetic resonance (MR) imaging, age, sex, chief complaint, causative fungus, and clinical outcome were analyzed. Patients were aged from 25 to 79 years (mean 58.8 years). Female predominance was noted (58.7%). Most common symptoms were nasal discharge and facial pain. CT showed high density area in 82.0% of the cases (82/100), whereas T2-weighted MR imaging showed low intensity area in 100% of the cases (32/32). Histological examination showed that most causative agents were Aspergillus species (94.2% (98/104)). Culture test was positive for 16.7% (11/66). Recurrence was found in 3.2% (3/94). Older age and female predominance were consistent with previous reports. MR imaging is recommended to confirm the diagnosis. Kazuhiro Nomura, Daiya Asaka, Tsuguhisa Nakayama, Tetsushi Okushi, Yoshinori Matsuwaki, Tsuyoshi Yoshimura, Mamoru Yoshikawa, Nobuyoshi Otori, Toshimitsu Kobayashi, and Hiroshi Moriyama Copyright © 2013 Kazuhiro Nomura et al. All rights reserved. Long-Term Effect of Enzyme Replacement Therapy with Fabry Disease Tue, 08 Oct 2013 16:06:53 +0000 Objective. To determine the effects of enzyme replacement therapy (ERT) on the hearing acuity in patients with Fabry disease. Materials. The study sample comprised 34 ears of 17 affected patients who underwent pure-tone audiometry before and after ERT. Methods. The patients were studied in relation to factors such as changes in hearing, presence of accompanying symptoms, status of renal and cardiac function, age, and gender. Data of pure-tone audiometry obtained before ERT and at the final examination were compared. Results. At the end of the follow-up period, no significant worsening of hearing acuity was noted at the end of the follow-up period. SSNHL was detected in 10 ears of 6 patients. Steroid therapy successfully cured the disease in 9 of the 10 ears. Conclusions. No significant worsening of hearing acuity was noted from the beginning to the end of ERT. The rate of improvement in SSNHL of Fabry disease was excellent in the treated patients. Hearing loss is a factor that causes marked deterioration of the patients’ quality of life, and it is desirable that the hearing acuity of patients be periodically evaluated and prompt treatment of SSNHL be administered, if available. Manabu Komori, Yuika Sakurai, Hiromi Kojima, Toya Ohashi, and Hiroshi Moriyama Copyright © 2013 Manabu Komori et al. All rights reserved. Clinical Predictors for Successful Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea Thu, 19 Sep 2013 14:34:17 +0000 Objective. To assess the clinical parameters for successful uvulopalatopharyngoplasty in the management of obstructive sleep apnoea syndrome documented with pre- and postoperative polysomnography. Materials and Methods. A study group of 50 patients diagnosed as having OSA by full night polysomnography were assessed clinically and staged on basis of Friedman staging system. BMI and neck circumference were considered, and videoendoscopy with Muller’s maneuver was done in all to document the site of obstruction. The study group divided into surgical and nonsurgical ones. Twenty-two patients out of fifty were then selected for uvulopalatopharyngoplasty. The selection of surgical group was done primarily on basis of clinical parameters like neck circumference, Friedman stage of the patient and site, and/or level of obstruction of patient. Postoperative polysomnography was done six months after surgery to document the change in AHI score. Result. The study group consists of fifty patients with mean age of years. UPPP was done in twenty-two, and the result of the surgery as defined by 50% reduction in preoperative AHI with postoperative AHI < 20/h was seen to be 95.2%. Postoperative change in AHI done after 6-month interval was seen to be statistically significant with P value < 0.001. Conclusion. UPPP is ideal option for management of obstructive sleep apnoea syndrome in properly selected patients on the basis of Friedman stage and site of obstruction detected by videoendoscopy with Muller’s maneuver. Aamir Yousuf, Zafarullah Beigh, Raja Salman Khursheed, Aleena Shafi Jallu, and Rafiq Ahmad Pampoori Copyright © 2013 Aamir Yousuf et al. All rights reserved. Sinonasal Cancer and Occupational Exposure in a Population-Based Registry Wed, 04 Sep 2013 11:38:11 +0000 We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008–2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings. Carolina Mensi, Dario Consonni, Claudia Sieno, Sara De Matteis, Luciano Riboldi, and Pier Alberto Bertazzi Copyright © 2013 Carolina Mensi et al. All rights reserved. Role of Intranasal Steroid in the Prevention of Recurrent Nasal Symptoms after Adenoidectomy Sun, 04 Aug 2013 11:36:18 +0000 Background. Intranasal steroid provides an efficient nonsurgical alternative to adenoidectomy for theimprovement of adenoid nasal obstruction. Objective. To demonstrate the role of intranasal steroid in the prevention of adenoid regrowth after adenoidectomy. Methods. Prospective randomized controlled study. Two hundred children after adenoidectomy were divided into 2 groups. Group I received postoperative intranasal steroid and group II received postoperative intranasal saline spray. Both medications were administered for 12 weeks postoperatively. Patients were followed up for 1 year. Followup was done using the nasopharyngeal lateral X-rays, reporting the degree of the symptoms. Results. Significant difference between both groups after 6 months and after 1 year. The intranasal steroid group had significantly lower score after 6 months and after 1 year as regards nasal obstruction, nasal discharge, and snoring than the intranasal saline group. 2 weeks postoperatively, there was no difference between both groups as regards nasal obstruction, discharge, or snoring. As regards lateral radiographs, there was statistically significant difference between both groups 1 year but not 6 months postoperatively. Conclusion. Factors influencing the outcome of intranasal steroids therapy in the prevention of adenoid regrowth have not been identified. However, this treatment may obtain successful results in children to avoid readenoidectomy. Tamer S. Sobhy Copyright © 2013 Tamer S. Sobhy. All rights reserved. Management of Globus Pharyngeus Thu, 11 Jul 2013 16:00:37 +0000 Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus. S. Kortequee, P. D. Karkos, H. Atkinson, N. Sethi, D. C. Sylvester, R. S. Harar, S. Sood, and W. J. Issing Copyright © 2013 S. Kortequee et al. All rights reserved. A Prevalence Study of Hearing Loss among Primary School Children in the South East of Iran Thu, 27 Jun 2013 10:20:02 +0000 Hearing impairment substantially affects child’s ability to normally acquire the spoken language. Such negative effects create problems for the child not only in terms of communication but also in terms of achievement in school as well as social and emotional growth. The aim of this research is to study the prevalence of hearing disorders and its relationship to age and gender among primary school students of Zahedan, Iran. In this cross-sectional and descriptive analytical study, 1500 students from elementary schools were screened for hearing loss. The selection of samples was performed using multistage sampling method. Primary information was obtained through direct observation, otoscopy, and audiometric and tympanometric screenings. Data was obtained and analyzed via ANOVA test. Statistical analysis showed a significant correlation between the age and the prevalence of middle ear abnormal function. Conductive hearing loss in males and females was 8.8% and 7.1%, respectively. In addition, 1% and 0.7% of male and female students, respectively, suffered from sensorineural hearing loss. Results indicated that 20.2% of students of elementary schools in Zahedan needed medical treatment for their problems. Therefore, it is recommended that the hearing screening of school-age children should be included in annual school health programs in this region. Aqeel Absalan, Ibrahim Pirasteh, Gholam Ali Dashti Khavidaki, Azam Asemi rad, Ali Akbar Nasr Esfahani, and Mohammad Hussein Nilforoush Copyright © 2013 Aqeel Absalan et al. All rights reserved. Goiter and Laryngeal Sensory Neuropathy Wed, 29 May 2013 15:45:49 +0000 Objective. Examining the prevalence of laryngeal sensory neuropathy (LSN) in goiter patients versus a control group. Study Design. Cross-sectional study. Methods. 33 Goiter patients were enrolled versus 25 age-matched controls. TSH levels, size of thyroid gland, and presence or absence of thyroid nodules were reported. Subjects were asked about the presence or absence of any of the following symptoms: cough, globus pharyngeus, and/or throat clearing that persistented for more than 6 weeks. The presence of one or more of these symptoms for at least six weeks in the absence of LPRD, allergy, asthma, ACE inhibitor intake, and psychogenic disorder was defined as LSN. Results. For goitrous patients mean age (years) was () versus () for controls. 82% goitrous patients had known nodules and 27% carried a simultaneous diagnosis of hypothyroidism. Among those with documented size (61%), mean total thyroid volume was  cm3, with a range from 9.430 to 67.022 cm3. The overall prevalence of LSN among goitrous patients was 42% versus 12% among controls (). There was no correlation between LSN, size of thyroid gland, and TSH level. Conclusion. The prevalence of LSN in goitrous patients is significantly higher than that in a nongoitrous population. Abdul Latif Hamdan, Jad Jabour, and Sami T. Azar Copyright © 2013 Abdul Latif Hamdan et al. All rights reserved. Risk Factors for Hearing Loss in Children following Bacterial Meningitis in a Tertiary Referral Hospital Wed, 15 May 2013 17:29:46 +0000 Objective. This study aimed to examine hearing function in children admitted with bacterial meningitis to determine the risk factors for sensorineural hearing loss. Setting. The study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital. Subjects and Methods. The study involved 83 children between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14. On discharge they underwent hearing testing to evaluate for presence and degree of hearing loss. Results. Thirty six of the 83 children (44.4%) were found to have at least a unilateral mild sensorineural hearing loss during initial audiologic testing. Of the children with hearing loss, 22 (26.5%) had mild or moderate sensorineural hearing loss and 14 (16.9%) had severe or profound sensorineural hearing loss. Significant determinants identified for hearing loss included coma score below eight, seizures, cranial nerve neuropathy, positive CSF culture, and fever above 38.7 degrees Celsius. Conclusions. Sensorineural hearing loss was found to be highly prevalent in children treated for bacterial meningitis. There is need to educate healthcare providers on aggressive management of coma, fever, and seizures due to their poor prognostic value on hearing. Benson Wahome Karanja, Herbert Ouma Oburra, Peter Masinde, and Dalton Wamalwa Copyright © 2013 Benson Wahome Karanja et al. All rights reserved. Diagnosis and Management of Extracranial Head and Neck Schwannomas: A Review of 27 Cases Wed, 08 May 2013 15:00:04 +0000 Objectives. Clinical records of 27 patients with extracranial head and neck schwannoma were retrospectively reviewed. Methods. Ultrasonography (US) was performed in all cases. Seven patients underwent CT. Twenty-five patients underwent MRI. Fine needle aspiration cytology (FNAC) was performed for 12 of the 27 patients. Clinical history, surgical data, and postoperative morbidity were analyzed. Results. The images of US showed a well-defined, hypoechoic, primarily homogeneous solid mass. At CT, only one of 7 cases (14%) was able to suggest the diagnosis of schwannoma. At MRI, twenty of 25 cases (80%) suggested the diagnosis of schwannoma. Only three of 12 cases (25%) displayed a specific diagnosis of schwannoma rendered on FNAC. The distribution of 27 nerves of origin was 10 (37%) vagus nerves, 6 (22%) sympathetic trunks, 5 (19%) cervical plexuses, 3 (11%) brachial plexuses, 2 (7%) hypoglossal nerves, and 1 (4%) accessory nerve. Complete tumor resection was performed in 11 patients, and intracapsular enucleation of the tumor was performed in 16 patients. The rate of nerve palsy was 100 (11/11) and 31% (5/16). Conclusions. MRI is sensitive and specific in the diagnosis of schwannoma. Intracapsular enucleation was an effective and feasible method for preserving the neurological functions. Ryuji Yasumatsu, Torahiko Nakashima, Rina Miyazaki, Yuichi Segawa, and Shizuo Komune Copyright © 2013 Ryuji Yasumatsu et al. All rights reserved. Prevalence of K-RAS Codons 12 and 13 Mutations in Locally Advanced Head and Neck Squamous Cell Carcinoma and Impact on Clinical Outcomes Tue, 30 Apr 2013 11:47:40 +0000 Background. RAS gene mutations have an impact on treatment response and overall prognosis for certain types of cancer. Objectives. To determine the prevalence and impact of K-RAS codons 12 and 13 mutations in patients with locally advanced HNSCC treated with primary or adjuvant chemo-radiation. Methods. 428 consecutive patients were treated with chemo-radiation therapy and followed for a median of 37 months. From these, 199 paraffin embedded biopsy or surgical specimens were retrieved. DNA was isolated and analyzed for K-RAS mutational status. Results. DNA extraction was successful in 197 samples. Of the 197 specimens, 3.5% presented K-RAS codon 12 mutations. For mutated cases and non-mutated cases, complete initial response to chemoradiation therapy was 71 and 73% (). LRC was respectively 32 and 83% (), DFS was 27 and 68% (), distant metastasis-free survival was 100 and 81% () and OS was 57 and 65% () at three years. K-Ras codon 13 analysis revealed no mutation. Conclusion. K-RAS codon 12 mutational status, although not associated with a difference in response rate, may influence the failure pattern and the type of therapy offered to patients with HNSCC. Our study did not reveal any mutation of K-RAS codon 13. Eric Bissada, Olivier Abboud, Zahi Abou Chacra, Louis Guertin, Xiaoduan Weng, Phuc Félix Nguyen-Tan, Jean-Claude Tabet, Ève Thibaudeau, Louise Lambert, Marie-Lise Audet, Bernard Fortin, and Denis Soulières Copyright © 2013 Eric Bissada et al. All rights reserved. The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia Sun, 28 Apr 2013 08:01:04 +0000 Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being) is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1) early identification of persons with chronic hearing impairment; (2) appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss. Catherine M. McMahon, Bamini Gopinath, Julie Schneider, Jennifer Reath, Louise Hickson, Stephen R. Leeder, Paul Mitchell, and Robert Cowan Copyright © 2013 Catherine M. McMahon et al. All rights reserved. HPV Prevalence and Prognostic Value in a Prospective Cohort of 255 Patients with Locally Advanced HNSCC: A Single-Centre Experience Wed, 24 Apr 2013 13:47:32 +0000 Background. HPV is a positive prognostic factor in HNSCC. We studied the prevalence and prognostic impact of HPV on survival parameters and treatment toxicity in patients with locally advanced HNSCC treated with concomitant chemoradiation therapy. Methods. Data on efficacy and toxicity were available for 560 patients. HPV was detected by PCR. Analysis was performed using Kaplan-Meier survival curves, Fisher’s test for categorical data, and log-rank statistics for failure times. Results. Median follow-up was 4.7 years. DNA extraction was successful in 255 cases. HPV prevalence was 68.6%, and 53.3% for HPV 16. For HPV+ and HPV−, median LRC was 8.9 and 2.2 years (), median DFS was 8.9 and 2.1 years (), and median OS was 8.9 and 3.1 years (). Survival was different based on HPV genotype, stage, treatment period, and chemotherapy regimen. COX adjusted analysis for T, N, age, and treatment remained significant (). Conclusions. Oropharyngeal cancer is increasingly linked to HPV. This study confirms that HPV status is associated with improved prognosis among H&N cancer patients receiving CRT and should be a stratification factor for clinical trials including H&N cases. Toxicity of CRT is not modified for the HPV population. E. Thibaudeau, B. Fortin, F. Coutlée, P. Nguyen-Tan, X. Weng, M.-L. Audet, O. Abboud, L. Guertin, A. Christopoulos, J. Tabet, and D. Soulières Copyright © 2013 E. Thibaudeau et al. All rights reserved. Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty Thu, 04 Apr 2013 09:05:21 +0000 Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15 mm and 88 mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes. J. C. Bewick, M. A. Buchanan, and A. C. Frosh Copyright © 2013 J. C. Bewick et al. All rights reserved.