Evaluation of pure-tone audiometric protocols in vestibular schwannoma screening.

The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics. We retrospectively analyzed presenting symptoms, pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols (AAO-HNS, AMCLASS-A/B, Charing Cross, Cueva, DOH, Nashville, Oxford, Rule3000, Schlauch, Seattle, Sunderland) for sensitivity and specificity. Results were pooled with data from five other studies, and analysis of sensitivity, specificity and positive likelihood ratio (LR+) for each protocol was performed. Our results show that protocols with significantly higher sensitivity (AMCLASS-A/B, Nashville) show also significantly lowest specificity, and tend to have low association (positive likelihood ratio, LR+) to the VS. The highest LR+ was found for protocols AAO-HNS, Rule3000 and Seattle. In conclusions, knowing their properties, screening protocols are simple decision-making tools in VS diagnostic. To use the advantage of the highest sensitivity, protocols AMCLASS-A + B or Nashville can be of choice. For more reasonable approach, applying the protocols with high LR+ (AAO-HNS, Rule3000, Seattle) may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.

Symptoms at presentation in children with sleep-related disorders.

OBJECTIVE: To assess the link between sleep-disordered breathing and cognitive function in children. To identify correlations among polysomnography, upper respiratory infections, or cephalometric as well as rhinometric measures. METHODS: This study is based on a questionnaire survey of snoring in a population cohort of 2100 children. Altogether, 44 snorers and 51 non-snorers participated in this community based clinical study. All children underwent polysomnography, cephalometry and rhinometric measurements. In addition, a standardized test of intelligence (WPPSI-R), a neuropsychological test battery (NEPSY) and a parental questionnaire on behavioral symptoms (CBCL) were administered. RESULTS: Frequently snoring children scored lower in Language functions (Comprehension of Instructions, P=0.01; Speeded naming, P=0.007) and had more internalizing problems, P=0.04 than did the non-snoring group. However, the polysomnography parameters of these snoring children revealed no major sleep-related breathing disorder. OAHI, mean lowest SpO(2) and respiratory effort correlated with Auditory Attention (P<0.05), Body Part Naming (P<0.05) and Memory (P<0.05). Tonsillar size correlated with OAHI (P<0.01) and respiratory effort (P=0.01) and respiratory airflow (P<0.01). In cephalometry, the minimal distance from velum to posterior wall was shorter showing the shorter length among snorers than non-snorers, 5.5mm vs. 6.6mm, respectively (P<0.05). Recurrent upper respirataory infections (URIs) were common among the snoring than non-snoring children (P=0.01). Children suffering recurrent URIs have more somatic complaints than children without recurrent URIs (P<0.01). CONCLUSIONS: Snoring children with apparently normal and/or no obstructive apnea, hypopnea, or marked SpO(2) desaturations appear to suffer impairment in neurocognitive and behavioral functions compared to non-snoring children. These snoring children did not reveal any major abnormalities of polysomnographic parameters, such as sleep-related breathing disorder, including partial upper airway obstruction. Polysomnographic parameters also correlated poorly with neurocognitive test results in these snoring children. The correlations between polysomnography and upper respiratory infections, with cephalometric and rhinometric measures, were also poor.

Mood is associated with snoring in preschool-aged children.

OBJECTIVE: To study emotional and behavioral problems and sleep and cognitive performance in snoring and nonsnoring 3- to 6-year-old children. METHODS: As part of an epidemiological study of sleep disordered breathing (SDB) in preschool-aged children, 43 snorers and 46 nonsnorers participated in a clinical study. Their parents completed the Child Behavior Checklist (CBCL). The children were assessed with Wechsler Preschool and Primary Scale of Intelligence, Revised and subtests of the Developmental Neuropsychological Assessment (NEPSY-A) representing aspects of attention, language skills, sensorimotor functions, memory, and learning. RESULTS: On the CBCL snoring children had significantly more parent reported internalizing symptoms (p < .05) than the nonsnoring children, especially symptoms of anxious/depressed mood (p < .01) and emotional reactivity (p < .05). More children from the snoring group than from the nonsnoring group (22 vs 11%) scored in the subclinical or clinical range on the internalizing scale. Interestingly, no significant difference between the groups was found in the amount of externalizing symptoms. The amount of sleep problems other than snoring was higher in the snoring than in the nonsnoring group (p < .01). On tests measuring auditory attention (p < .01) and language skills (verbal IQ, p < .05), the snoring group performed worse than the nonsnoring group. CONCLUSIONS: Our results support the view that SDB should be considered a possible risk factor for mood disorder symptoms and impaired cognitive performance in children.

All snoring is not adenoids in young children.

OBJECTIVE: To determine the prevalence of snoring in young children and to assess age, growth, previous surgery therapy, respiratory problems and sleep-related symptoms in relation to child's snoring, and to evaluate the relationship between child's snoring and parents' snoring and smoking. CHILDREN AND METHODS: A cross-sectional study evaluated 2100 children 1-6 years of age in Helsinki, Finland. Child's frequency of snoring on a five-point scale (never to every night) and age, height, weight and body mass index, previous adenotonsillectomies, tympanostomies, allergic rhinitis and respiratory infections were determined as was frequency of parental snoring and smoking. Sleep problems were determined based on Finnish or Swedish modified version of the sleep disturbance scale for Children. RESULTS: Of the 2100 eligible children, 1471 (71%) returned questionnaires. Children always or often snoring numbered 92 (6.3%), sometimes snoring, 183 (12.4%), and never or occasionally snoring, 1196 (81.3%). No difference in age (p=0.06) or gender (p=0.39) existed between snorers and non-snorers. History of previous adenotonsillectomies (p<0.001), allergic rhinitis (p<0.001), recurrent respiratory infections (p<0.001), and otitis media (p<0.001) were more common among snorers than among occasional or never-snorers. Nocturnal symptoms such as breathing problems, sleep hyperhydrosis, sleep-wake transition disorders, and daytime somnolence were associated with children's snoring. Frequency of children's snoring was also associated with parental snoring (p<0.001) and smoking (p<0.001). CONCLUSIONS: Snoring is common among young children and is associated with previous adenotonsillectomy, allergic rhinitis, respiratory infections, nocturnal symptoms, and parents' snoring and smoking. The high prevalence of snoring among children with adenotonsillectomy raises the question whether adenotonsillectomy alone is adequate treatment for snoring in young children.

Acoustic rhinometry in small children.

OBJECTIVES: To study how acoustic rhinometry succeeds in a sample of small children of one to six years of age and to evaluate reasons for failed recordings. METHODS: Twenty-six healthy children one to six years of age were invited to the Helsinki University Hospital, Department of Otorhinolaryngology for clinical examination and measurements with acoustic rhinometry. RESULTS: Three children of ten refused recordings in the age group of one to two years. The children's nose adaptor was too small for three of seven children in the age group of three to four years. The anatomical nose adaptor and the adult nose tube were suitable for children between five to six years of age. CONCLUSIONS: Acoustic rhinometry is well tolerated and usually well accepted in small children. The recordings succeeded in most children. However, lack of adequate equipment hinders measurements in part of the children.