The effect of oral guaifenesin on pediatric chronic rhinitis: A pilot study.

OBJECTIVES: To investigate the effectiveness of guaifenesin in the relief of nasal symptoms in children with chronic rhinitis (CR). We hypothesized that guaifenesin use over a 14-day study period would improve subjective nasal complaints in pediatric patients with chronic rhinitis, as measured by the SinoNasal-5 (SN-5) survey. We also hypothesized improvement in nasal volume and cross-sectional area with guaifenesin. STUDY DESIGN: Randomized, placebo-controlled, parallel group, masked clinical trial. METHODS: The study consisted of a 14-day, randomized, placebo-controlled, parallel group, masked clinical trial of oral guaifenesin for CR in children aged 7-18 years. A 2:1 ratio of subjects on active medication to placebo was used. The study was approved by the Western Institutional Review Board. On initial enrollment and at the conclusion of therapy, the SN-5 was completed by parents, acoustic rhinometry measurements performed, and mucus sampling for rheology was obtained. RESULTS: 30 subjects were enrolled in the study, with 20 receiving guaifenesin and 10 placebo. Treatment with guaifenesin for 14 days produced a significant mean change towards clinical improvement in SN-5 scores compared with placebo (p = 0.013). There was no significant difference in quality of life assessment scores between the two groups or in any of the acoustic rhinometry parameters. Many of the study subjects had difficulty producing a mucus sample sufficient for analysis. CONCLUSIONS: Based upon our pilot data, it appears that guaifenesin treatment may produce objective improvements in pediatric patients with CR. Further research with larger samples sizes, inclusion of children younger than 6, and biophysical mucus analyses is warranted. LEVEL OF EVIDENCE: Level 2b.

Tinnitus management with percutaneous osseointegrated auditory implants for unilateral sensorineural hearing loss.

OBJECTIVE: To determine the effects, if any, of percutaneous osseointegrated auditory implants (OAI) on tinnitus in patients with unilateral SNHL. STUDY DESIGN: Prospective cohort series. SETTING: Tertiary academic referral center, single surgeon. PATIENTS: Adult OAI recipients with unilateral severe to profound sensorineural hearing loss (SNHL) in the implanted ear. INTERVENTION: Percutaneous OAI. MAIN OUTCOME MEASURE(S): The Tinnitus Reaction Questionnaire (TRQ) and the Tinnitus Handicap Inventory (THI) were recorded pre-implantation, and at 6 and 12 months following device activation. RESULTS: Ten eligible patients were enrolled. The mean pre-operative TRQ and THI scores for all subjects were 32.80 ± 23.41 and 37.00 ± 22.75, respectively. Both scores decreased 6 months after device activation, with TRQ mean of 19.67 ± 21.73 (p=0.0012) and THI mean of 27.11 ± 23.41 (NS). After 12 months, the downward trend continued with TRQ mean of 17.30 ± 20.67 (p=0.0008) and THI mean of 21.70 ± 23.02 (p=0.0116). Subgroup analysis comparing patients with severe SNHL to those with profound SNHL demonstrated a decrease in TRQ and THI scores at 12 months for both groups, but it was only statistically significant for the severe SNHL group (n=7). CONCLUSIONS: OAI use in SSD is associated with a statistically significant decrease in tinnitus as measured by the TRQ and THI. The reasons for this are likely multifactorial, though possibly due to stimulation of residual cochlear function in the SSD ear. Further study of a larger cohort is ongoing.

Destructive lesion of the temporomandibular joint: A case of tophaceous pseudogout.

Tophaceous pseudogout of the temporomandibular joint is a rare entity that clinically and radiographically mimics neoplastic or infectious conditions. Diagnosis requires histopathologic examination. Given the rarity of this condition, there is a paucity of information pertaining to the surgical approach, reconstructive options, and postoperative outcomes.