Mobile phone usage does not affect sudden sensorineural hearing loss.

OBJECTIVE: Recent studies found that mobile phone users had a significantly greater risk of having elevated thresholds in speech frequencies. This study investigated the correlation between the laterality of sudden sensorineural hearing loss, handedness and the preferred ear for mobile phone use. METHODS: The study included all patients who presented with sudden sensorineural hearing loss to the Department of Otolaryngology - Head and Neck Surgery in our tertiary referral medical centre between 2014 and 2016. Patients were asked to indicate their dominant hand and preferred ear for mobile phone use. RESULTS: The study comprised 160 patients. No correlation was found between the dominant hand or preferred ear for mobile phone use and the side of sudden sensorineural hearing loss. There was no correlation between the side of the sudden sensorineural hearing loss (preferable or non-preferable for mobile phone use) and audiometric characteristics. CONCLUSION: No correlation was found between the laterality of ears used for mobile phone and sudden sensorineural hearing loss.

Predicting the outcome of peritonsillar abscess in children.

OBJECTIVES: peritonsillar abscess (PTA) is the most common deep neck infection in children. The causes of its development and recurrence are not fully understood. The aim of this study was to investigate the predictive factors of PTA outcome such as recurrent tonsillitis, recurrent/residual PTA and interval tonsillectomy in children. METHODOLOGY: retrospective study of surgically confirmed paediatric PTA case series in one medical centre (1997-2007). Anamnestic, clinical and laboratory parameters of primary PTA were compared with recurrent cases. RESULTS: thirteen 13 of the 8 1 enrolled patients (16 %) had had PTA previously. Their incidence of trismus and percentage of neutrophils in peripheral blood were lower than in the primary cases. Past history of PTA, a positive pus culture and type of pathogen did not influence outcome. CONCLUSION: no evaluated factor was found to be definitive for predicting PTA outcome. The clinical presenation of a recurrent PTA may be less severe in appearance than in a primary case.

Mastoid subperiosteal abscess as a first sign of unnoticed cholesteatoma in children.

AIM: To present children who underwent mastoidectomy for congenital cholesteatoma presented as a subperiosteal abscess. RESULTS: All seven children (age range 7-14 years, six boys) presented with retroauricular swelling, erythema and fluctuation in the mastoid area, and one child also had a mastoid-cutaneous fistula. Five children had otorrhoea, while the other two had normal-appearing tympanic membranes. None of the children had a history of middle ear disease. Four children were treated with antibiotics for a recent episode of otitis media prior to admission. The main findings at surgery were pus, granulations and erosion of the mastoid cortex. Pseudomonas aeruginosa and Proteus sp. were isolated from the abscess in two patients, and the other five cultures were negative. All the patients demonstrated some degree of hearing impairment after surgery. CONCLUSION: Surgical eradication of a mastoid SA in older children is essential as it may be the first indication of an underlying CC.

Distortion product otoacoustic emissions following stapedectomy versus stapedotomy.

OBJECTIVES: To evaluate distortion product otoacoustic emissions following stapes surgery in patients with otosclerosis, and to compare in this respect two surgical techniques used in our department. METHOD: This retrospective study included 17 stapedectomy and 23 stapedotomy patients aged 16-68 years who had been followed up for at least 12 months. Distortion product otoacoustic emission results at 2, 3, 4 and 5 kHz (i.e. =f2, with 2f1 - f2 = 0.6f2) were obtained pre-operatively and four weeks post-operatively. The control group included 13 volunteers aged 18-50 years with normal hearing and normal otoscopic findings. RESULTS: Distortion product otoacoustic emissions were detected pre-operatively in 34.8 per cent of stapedotomy patients and 29.4 per cent of stapedectomy patients, and post-operatively in 91.3 per cent of stapedotomy patients and 88.2 per cent of stapedectomy patients. The differences between the stapedotomy and stapedectomy groups were statistically insignificant for each tested frequency, both pre- and post-operatively. The patients' post-operative distortion product otoacoustic emission amplitudes were less than those of normal hearing individuals, even in patients with complete air-bone gap closure and a significant improvement in hearing. CONCLUSION: Distortion product otoacoustic emissions were detected in most of our patients following successful stapes surgery, and appeared to be unaffected by the surgical technique or prosthesis used.

Influence of coexisting myringosclerosis on myringoplasty outcomes in children.

OBJECTIVE: To obtain information on the success rate of tympanoplasty with concomitant myringosclerosis. METHODS: The medical records of 40 children with myringosclerosis (23 girls, 17 boys; age range six to 16 years, mean age 9.85 years) who had undergone primary tympanoplasty were retrospectively studied. Surgical success was defined as the perforation remaining closed 12 months post-operatively. RESULTS: Sclerotic plaques occupied whole remnant eardrums in 17 patients, and were located in various parts of the eardrum in 23. Tympanosclerosis associated with myringosclerosis was present in six patients. The success rate of primary tympanoplasty was 92.5 per cent. All three surgical failures were observed in girls with marginal perforations. These children underwent successful revision procedures for their residual perforations, variously at four, eight and 10 months after the initial surgery. CONCLUSION: Appropriate freshening of the perforation edges, with removal of sclerotic plaques, can result in a high rate of successful closure of perforated tympanic membrane with coexisting myringosclerosis.

Pilomatrixoma of the retroauricular area and arm.

Pilomatrixoma is a benign tumor of hair follicles that usually occurs as a single tumor and appears in the head and neck region, extremities, and trunk. The authors present a case of pilomatrixoma with multifocal localization. Simple excision of lesions is the recommended procedure, and recurrence usually is rare.

Suprameatal approach: new surgical approach for cochlear implantation.

The conventional technique for cochlear implantation is via a mastoidectomy and posterior tympanotomy. An alternative approach for cochlear implantation is hereto described. The middle ear is entered through a suprameatal approach (SMA) bypassing the mastoid cavity. This surgical approach shortens the duration of the procedure to approximately one hour. The introduction of the cochlear implant electrode array involves drilling in the suprameatal region and the osseous portion of the external auditory canal at a safe distance from the anatomical position of the facial nerve. This prevents possible injury by direct trauma or drill overheating of the chorda tympani or facial nerves. We report 15 consecutive patients who were operated on using the SMA technique. No complications were encountered as a result of this surgical technique but further experience may be necessary.

Acute mastoiditis--the antibiotic era: a multicenter study.

OBJECTIVES: To evaluate the clinical course and identify the causative organisms of acute mastoiditis in a community where most of the patients who develop acute otitis media are treated with antibiotics. METHODS: A multicenter retrospective review of a series of 223 consecutive cases of acute mastoiditis. SETTING: Nine secondary or tertiary academic or non-academic referral centers. RESULTS: Prior to the diagnosis of acute mastoiditis, 121 of the patients (54.3%) had been receiving oral antibiotic treatment for acute otitis media for periods ranging from 1 to 21 days (mean 5.3 days). Samples for bacterial culture were obtained from 152 patients. Cultures were negative in 60 patients. The organisms isolated in the 92 positive cultures were: Streptococcus pneumoniae (15 patients), Streptococcus pyogenes (14 patients), Staphylococcus aureus (13 patients), Staphylococcus coagulase negative (three patients), Pseudomonas aeruginosa (eight patients), Haemophilus influenzae (four patients), Proteus mirabilis (two patients), Escherichia coli (two patients), Klebsiella pneumoniae (one patient), Enterobacter (one patient), Acinetobacter (one patient), anaerobic gram-negative bacilli (one patient), and fungi (two patients). Ten patients had mixed flora. Sixteen patients presented with complications (cerebellar abscess, perisinus empyema, subdural abscess or empyema, extradural abscess, cavernous sinus thrombosis, lateral sinus thrombosis, bacterial meningitis, labyrinthitis, petrositis, or facial nerve palsy). CONCLUSIONS: Antibiotic treatment cannot be considered an absolute safeguard against the development of acute mastoiditis. Early myringotomy for acute otitis media seems to decrease the incidence of complications. The distribution of causative organisms in acute mastoiditis differs from that in acute otitis media. Intracranial complications in acute mastoiditis are not rare. Because of the diversity of causative organisms in acute mastoiditis and the growing resistance of bacteria to the various antibiotics, all means to obtain a sample for culture prior to antibiotic treatment, including general anesthesia.