Perceptions on music and noise in the operating room: a cross-sectional study.

Objectives. Noise in operating rooms (ORs) during surgery may affect OR personnel and pose a threat to patient safety. The sources of noise vary depending on the operation. This study aimed to investigate how OR staff perceived noise, whether music was considered noise and what its perceived effects were. Methods. Surgeons, anaesthesiologists, residents and nurses were interviewed. iPads were placed in the ORs to gather noise-level data. Results. Ninety-one interviews were conducted. Most participants (60.5%) reported the presence of noise and 25% the presence of music in the OR. Noise data from iPads registered levels ranging between 59.52 and 85.60 dB(A). χ2 analyses yielded significant results between participants' role and the perceived effects of noise (p = 0.02). Responses to open-ended questions were thematically categorized. Conclusions. Surgeons generally chose the music played in ORs and were likely positively inclined to its effects, while anaesthesiologists and nurses minded the lack of choice and were more likely to consider it as noise.

Auricular Myoclonus: A Case Report and Literature Review.

Auricular myoclonus is an extremely rare disorder that manifests as involuntary semi-rhythmic movements of the auricle. We report the case of a 15-year-old female who presented to our outpatient clinics with bilateral spontaneous, uncontrolled movements of the auricles (auricular myoclonus) that are only briefly suppressible by some facial movements and completely disappear during sleep. Needle electromyography revealed baseline tonic motor unit activity with bursts of higher motor units amplitude in the posterior and superior auricularis muscles. Her symptoms improved with pregabalin intake, however, with incomplete resolution. This paper will review previously reported cases, as well as the different treatment modalities that have been used.

A Patient With a Protuberant Fibro-Osseous Lesion of the Temporal Bone.

Protuberant fibro-osseous lesion of the temporal bone, otherwise known as "Bullough's lesion", is a rare, benign exophytic fibro-osseous tumor. In this brief report, we present a case of a 61-year-old woman with a history of a right-sided skull mass that had been increasing in size for approximately 6 years before presentation. Clinical, radiological and histological features are examined and discussed. We achieved excellent results with surgical resection, with no evidence of recurrence.

Adaptation of the Arabic Version of the Tinnitus Handicap Inventory.

OBJECTIVE: To translate the Tinnitus Handicap Inventory (THI) into literary Arabic to come up with a unified Arabic version and to determine its validity and reliability in assessing the quality of life of Arabic-speaking patients with tinnitus. STUDY DESIGN: Clinical measurement study. SETTING: Tertiary care center. SUBJECTS AND METHODS: The original English THI was translated into literary Arabic by a forward- and back-translation process according to the published guidelines for cross-cultural adaptation of health-related quality-of-life measures and applied to 100 patients with chronic tinnitus. Internal consistency reliability was then assessed by calculating Cronbach's alpha coefficient. Pearson correlation coefficients were also calculated for the different scales and the different baseline characteristics. RESULTS: Results showed high internal consistency and reliability coefficients (total THI: 0.93, functional subscale: 0.86, emotional subscale: 0.86, catastrophic subscale: 0.66) comparable to those of the original English THI. CONCLUSION: The Arabic version of the THI is a valid and reliable tool for the assessment of the impact of tinnitus on the quality of life of Arabic-speaking patients with the complaint of chronic tinnitus.

Recurrent facial nerve paralysis: an unusual presentation of fibrous dysplasia of the temporal bone.

Facial nerve paralysis (FNP) is a rare occurrence in fibrous dysplasia (FD) of the temporal bone (FDTB). Eight such cases have been described in the literature. In none of these cases was the FNP the presenting symptom, and in all, a direct etiology for the paralysis was identified. We present the first case of recurrent, unilateral FNP as the sole otological manifestation of FDTB. We discuss possible etiological factors for the paralysis favoring a compressive, transient ischemia of the facial nerve. The authors suggest adding FDTB to the differential diagnosis of recurrent FNP.

Nasopharyngeal cancer in the Middle East: experience of the American University of Beirut Medical Center.

PURPOSE: To review the data of nasopharyngeal carcinoma (NPC) treated at the American University of Beirut Medical Center and reflect on the characteristics and treatment outcome of NPC in the Middle East compared with those of Western countries and countries in which NPC is endemic. METHODS AND MATERIALS: Between 1966 and 1998, 151 patients with the diagnosis of NPC received definitive radiotherapy at the American University of Beirut Medical Center. Of the 151 patients, 111 were males (gender ratio, 2.78); the median age was 45 years (range, 11-75 years). Most (95%) patients (n = 144) were Lebanese, 4 were Syrians, and 3 were from the Gulf countries. Most (60%) patients (n = 91) had Stage IV disease, 27% had Stage III, and 13% had Stage I or II disease; nodal disease was present in 117 patients (77%). The pathologic type was predominantly lymphoepithelioma or World Health Organization type III (95 patients, 63%). Treatment consisted of definitive radiotherapy alone for 116 patients (77%). All others received induction chemotherapy, primarily with cisplatin-containing regimens. The median radiation dose was 66 Gy (range, 47-73 Gy) to the primary and 67 Gy (range, 49-85 Gy) to involved neck nodes given at 2 Gy/fraction. The average follow-up was 3.02 years (range, 0.1-24.5 years). RESULTS: The 5-year and 10-year disease-free survival (DFS) rate was 46%. Using univariate analyses, the following factors significantly affected DFS: node size (<3 vs. 3-6 vs. >6 cm; p = 0.01), node level (upper vs. mid vs. lower neck; p = 0.004), and duration of radiotherapy (p = 0.002). However, T stage, age, gender, radiation dose, use of chemotherapy, and histologic features had no statistically significant influence on DFS. The actuarial rate of local control at 5 and 10 years was 81% and 73%. T stage, N stage, and histologic features were statistically significant variables for local control in the univariate analyses. Using a Cox regression model, N stage (N1-N2 vs. N3; relative risk 2.09, p = 0.004) was identified as an independent variable for DFS, and N stage and pathologic features were identified as independent variables for local control. The actuarial rate of distant metastases was 32% at both 5 and 10 years. Distant metastases were only affected by N stage (upper-mid vs. lower neck; p = 0.004). Six patients (4%) were reported to have Grade 4 late complications. CONCLUSION: Our results indicate that the characteristics of NPC patients in Lebanon and their parameters of outcome are comparable to those reported in Western series, particularly for the relative frequency and effect of lymphoepithelial histologic type. Because of potential confounding factors, no definite conclusions about induction chemotherapy could be drawn from this retrospective study.

The oto-palato-digital syndrome: variable clinical expressions.

The oto-palato-digital (OPD) syndrome is a rare but well-defined disorder characterized by a skeletal dysplasia of the hands and feet, hearing loss, and anomalies of the palate. Since it was first described by Taybi in 1962, a little over 30 cases have been reported in the literature. A more lethal variant of the syndrome was described later by Fitch and was termed OPD type II. Several studies were conducted to determine the exact mode of inheritance of this syndrome, whereas others have focused on the characterization of the skeletal anomalies and their variations. Otologists were interested in determining the etiology of the associated hearing loss. We report 4 cases of patients with the spectrum of anomalies that characterize the OPD syndrome. These patients include 3 siblings and 1 unrelated patient who presented to our service complaining of hearing loss. The skeletal anomalies, special features, and audiologic findings are described and compared with those in previously reported cases. A discussion based on a literature review of the mode of inheritance, of variation in the clinical expression, and of the etiology of hearing loss is also included. Finally, we review and discuss the subdivision of this syndrome into the 2 types (I and II).

Rhinolithiasis: a forgotten entity.

OBJECTIVE: To review the clinical presentation of patients with rhinoliths, which are calcareous concretions with an unclear pathogenesis. STUDY DESIGN AND SETTING: Using retrospective chart review we analyzed clinical, radiological, and demographic data as well as our diagnostic work-up and management of 8 patients. RESULTS: Most patients presented with nonspecific nasal complaints; most commonly, purulent rhinorrhea and nasal obstruction. The rhinolith was discovered incidentally in some patients. CONCLUSION: Rhinoliths are rare and can have various clinical presentations. The treatment of choice is surgical removal. SIGNIFICANCE: A high index of suspicion is required for the diagnosis of such a forgotten entity.