Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

In vitro and in vivo effects of lutein against cisplatin-induced ototoxicity.

INTRODUCTION: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 µM) and to 25 µM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 µM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.

Hearing threshold levels for an otologically screened population in Spain.

OBJECTIVE: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard. DESIGN: A prospective study in an otologically screened population. STUDY SAMPLE: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination. RESULTS: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000). CONCLUSIONS: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.

Earphones in extended high-frequency audiometry and ISO 389-5.

OBJECTIVE: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. DESIGN: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. STUDY SAMPLE: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination. RESULTS: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. CONCLUSIONS: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.

Extended high-frequency (9-20 kHz) audiometry reference thresholds in 645 healthy subjects.

OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.

Effect of intratympanic dimethyl sulphoxide (DMSO) in an in vivo model of cisplatin-related ototoxicity.

Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.

Bleeding control in endoscopic sinus surgery: a systematic review of the literature.

In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of ß-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.

Medical management of Ménière's disease: a 10-year case series and review of literature.

Ménière's disease is frequent in our area. It is a disabling pathology that affects the patient's quality of life. Its etiology and pathophysiology remain unclear and there are some therapeutic alternatives with controversial results. We present our series and treatment protocol for Ménière's disease and discuss the current evidence regarding its medical treatment. In the last 10 years, 252 patients were diagnosed with Ménière's disease based on their symptoms, and the results of tonal audiometry, videonystagmography and caloric stimulation tests. All cases received medical treatment according to our management protocol. Ménière's disease is more frequent in women (54.76%); 83.73% of cases are unilateral. Among these, vertigo was observed in 93.7%, hearing loss in 88.1%, tinnitus in 86.1% and pathologic caloric stimulation tests in 71% (88.27% with a reduced vestibular response). A 5-year follow-up was performed in 89.6% of the patients. Subjective improvement as reported by patients was achieved in 94.4% of the cases. There is great controversy about the medical treatment of Ménière's disease. We found no evidence for the most adequate medical treatment among the different alternatives described in literature. The patient's acceptance and understanding of the disease is very important.