Introduction. Otitis media with effusion is a common pediatric disease whose diagnosis is based on pneumatic otoscopy, pure-tone audiometry, and tympanometry. The aim of this study was to evaluate transiently evoked otoacoustic emissions in the diagnosis of otitis media with effusion as compared to tympanometry. Patients and Methods. 38 children with bilateral otitis media with effusion were studied. 40 normal children of similar age and sex were used as controls. All subjects underwent pneumatic otoscopy, standard pure-tone audiometry, tympanometry, and transiently evoked otoacoustic emissions. Results. In the group of children with bilateral otitis media, transiently evoked otoacoustic emissions were absent in 51 ears (67&#37;). In the remaining 25 ears (33&#37;) the mean emission amplitude was reduced, as compared to the mean value of the control group. Conclusions. Transiently evoked otoacoustic emissions should be included in the diagnostic workup of otitis media with effusion because it is a fast, reliable, and objective test. Transiently evoked otoacoustic emissions should always be used in conjunction with tympanometry, because a more meaningful interpretation of transiently evoked otoacoustic emissions measures is possible.

Dimitris G. Balatsouras

George Koukoutsis

Panayotis Ganelis

George S. Korres

Andreas Aspris

Antonis Kaberos

Transiently Evoked Otoacoustic Emissions in Children with Otitis Media with Effusion

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean &#x000b1; SD of AD was &#x02212;6.96% &#x000b1; 12.66% in patients with excellent result, &#x02212;27.67% &#x000b1; 27.70% with good result, and &#x02212;66.05% &#x000b1; 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.

Zhang WenHao

Chen Minjie

Yang Chi

Zhang Weijie

Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate. Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance. Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87&#37;) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48&#37;) and staged tonsillectomy prior to pharyngoplasty in 10 (43&#37;). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population. Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

 L. M. Paulson

C. J. MacArthur

K. B. Beaulieu

J. H. Brockman

H. A. Milczuk

Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

Objective. To know the characteristics of endoscopic laryngeal and pharyngeal abnormalities in Japanese patients with laryngopharyngeal reflux symptoms (LPRS). Methods. A total of 146 endoscopic images of the larynx and pharynx (60 pairs for the rabeprazole group and 13 pairs for the control group) were presented to 15 otolaryngologists blinded to patient information and were scored according to several variables potentially associated with laryngopharyngeal reflux. The median value of the 15 scores for each item from each image was obtained. The mean pretreatment scores of each item and total score were assessed in both rabeprazole and control groups. In the rabeprazole group, the endoscopic findings before and after the 4-week treatment with rabeprazole were compared. Changes between corresponding duration in the control group were also evaluated. Results. The median and mean pretreatment total score was 3 and 3.02, respectively, from the 73 patients with LPRS. No significant differences were observed before and after treatment in either the rabeprazole or control groups for any item or total score. In 24 patients with a high pretreatment score (total score &#x2265; 4) from the rabeprazole group, significant decreases in scores for &#x201c;thick endolaryngeal mucous&#x201d;
 (0.54 to 0.17, <svg style="vertical-align:-0.17555pt;width:63.962502px;" id="M1" height="10.9125" version="1.1" viewBox="0 0 63.962502 10.9125" width="63.962502" xmlns="http://www.w3.org/2000/svg">
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</svg>) and total (4.77 to 3.58, <svg style="vertical-align:-0.17555pt;width:71.775002px;" id="M2" height="10.9125" version="1.1" viewBox="0 0 71.775002 10.9125" width="71.775002" xmlns="http://www.w3.org/2000/svg">
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</svg>) were observed after the 4-week treatment.

Nobuhiko Oridate

Ryoji Tokashiki

Yusuke Watanabe

Aki Taguchi

Osamu Kawamura

Kazuma Fujimoto

Endoscopic Laryngeal Findings in Japanese Patients with Laryngopharyngeal Reflux Symptoms

Management of traumatic facial nerve disorders is challenging. Facial nerve decompression is indicated if 90&#8211;95&#37; loss of function is seen at the very early period on ENoG or if there is axonal degeneration on EMG lately with no sign of recovery. Middle cranial or translabyrinthine approach is selected depending on hearing. The aim of this study is to present retrospective review of 10 patients with sudden onset complete facial paralysis after trauma who underwent total facial nerve decompression. Operation time after injury is ranging between 16 and105 days. Excitation threshold, supramaximal stimulation, and amplitude on the paralytic side were worse than at least &#37;85 of the healthy side. Six of 11 patients had HBG-II, one patient had HBG-I, 3 patients had HBG-III, and one patient had HBG-IV recovery. Stretch, compression injuries with disruption of the endoneurial tubules undetectable at the time of surgery and lack of timely decompression may be associated with suboptimal results in our series.

Sertac Yetiser

Total Facial Nerve Decompression for Severe Traumatic Facial Nerve Paralysis: A Review of 10 Cases

Objectives. To review 
 our experience of conducting auditory brainstem 
 response (ABR) test on children in the operating room 
 and discuss the benefits versus limitations of this 
 practice. Methods. Retrospective 
 review study conducted in a pediatric tertiary care 
 facility. A total of 267 patients identified with 
 usable data, including ABR results, medical and 
 surgical notes, and follow-up evaluation. 
 Results. Hearing status successfully 
 determined in all patients based on the ABR results 
 form the operating room. The degrees and the types of 
 hearing loss also documented in most of the cases. In 
 addition, multiple factors that may affect the 
 outcomes of ABR in the operating room identified. 
 Conclusions. Hearing loss in children 
 with complicated medical issues can be accurately 
 evaluated via ABR testing in the operating room. 
 Efforts should be made to eliminate adverse factors to 
 ABR recording, and caution should be taken when 
 interpreting ABR results from the operating room.

Guangwei Zhou

Briana Dornan

Wheaton Hinchion

Clinical Experience of Auditory Brainstem Response Testing on Pediatric Patients in the Operating Room

Gastroesophageal reflux disease is mediated principally by acid. Today, we recognise reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognising pharyngeal acidification using a miniaturised pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit.

Karna Dev Bardhan

Vicki Strugala

Peter W. Dettmar

Reflux Revisited: Advancing the Role of Pepsin

Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter.

Ameer L. Elaimy

Peter W. Hanson

Wayne T. Lamoreaux

Alexander R. Mackay

John J. Demakas

Robert K. Fairbanks

Barton S. Cooke

Sudheer R. Thumma

Christopher M. Lee

Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia

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International Journal of Otolaryngology&nbsp;publishes original research articles and review articles in all areas of otolaryngology-head and neck surgery.

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International Journal of Otolaryngology - Table of contents 2012

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