Aeroallergens in West Crete, Greece: A five year (2010-2014) aerobiological study.

The objective of the analytic observational study was to present air-pollen counting program results for a 5-year period. Airborne pollens and fungi collection, from both urban and sub-urban areas, were obtained using a special Burkard pollen trap installed on the roof of Chania General Hospital. Aeroallergen concentration measurement was made in a standardized way with fixation of the material collected and then counting using an optical microscope. Annual and total circulating pollen and fungi counts for the study period are presented. In the year 2014, the highest total annual count was recorded, while 2013 was the year with the lowest one. Months with the highest average concentrations were June for the years 2010 and 2011 (1291 and 1114.6 grains/m(3), respectively) and May for the consecutive 3 years 2012-2014 (1120, 890 and 1353.1 g/m(3), respectively). Peak periods for circulating aeroallergens were April-June. Trees pollen accounted for the majority of circulating aeroallergens (615.9 and 677.1 g/m(3) during peak periods in the years 2012 and 2014), while fungi accounted for the majority of circulating aeroallergens (818.5, 729.4, 890.7 spores/m(3)), during the peak periods in the years 2010, 2011 and 2013. Variability in peak airborne allergen periods could be partly explained by the differences in climatic conditions during the study period.

Comparison of acoustic rhinometry and nasal inspiratory peak flow as objective tools for nasal obstruction assessment in patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a disease with increasing incidence, characterized by persistent symptoms and negative impact on patient`s quality of life. Nasal inspiratory peak flow (NIPF) and acoustic rhinometry (AR) were studied and compared as assessment tools for CRS with or without nasal polyps (NP), as well as, in follow up monitoring of conservative medical treatment. OBJECTIVES: Seventy-eight patients were prospectively studied. Objective assessment included NIPF and AR at baseline and at 4 and 8 weeks after onset medical treatment. Measurements were studied in correlation with Sinonasal Outcome Test-22 (SNOT-22) questionnaire, Visual Analogue Scale (VAS) and endoscopic appearance score (EAS). RESULTS: Both NIPF and AR improved significantly, after medical treatment. NIPF score reflected CRS symptoms` improvement according to SNOT-22 total score at the end of treatment protocol, showing moderate to strong correlation with nasal obstruction VAS grading during the treatment period. AR measures were associated with EAS in all sets of examinations and correlated moderately with VAS scoring at 8 weeks. CONCLUSION: NIPF and AR were proven to be promising methods for objective evaluation and monitoring of nasal obstruction based on different aspects of nasal physiology in patients with CRS.

SNOT-22 validation in greek patients.

BACKGROUND: Chronic rhinosinusitis (CRS) with or without nasal polyps is a frequent and significant health problem. The 22-item Sinonasal Outcome Test (SNOT-22) is a valid, disease-specific health status instrument translated into several languages. The translation into Greek has been considered essential for the individual assessment of the patients' symptoms and a reliable tool for quality of life evaluation. METHODS: Our study included 40 patients with CRS without nasal polyps and 40 healthy individuals as control group recruited from the ENT Allergy and Endoscopy Clinic of Chania General Hospital. Assessment included full ENT examination and nasal endoscopy. In the study, we compared the patients' examination and reexamination results with the results of the control group, and thus estimated test-retest reliability, internal consistency (determined by Cronbach's alpha) and validity. RESULTS: The statistical significance level calculated by the paired t test was p < 0.05 for all questions, which proves the questionnaire's consistency. The kappa value was estimated for each symptom, with an average value of 0.94. Cronbach's alpha was 0.934 in the test and 0.856 in the retest. The p value was <0.05 between both the control group and the test group and between the control group and the retest group. CONCLUSION: Our study certifies the existence of a valid, reproducible Greek version of SNOT-22, which overcomes limitations of use, allows to answer the questionnaire in Greek, and thus makes it highly recommended for Greek clinicians.

Clinical application of subjective measurements for OSAS assessment: predictive factors of syndrome severity.

PURPOSE OF THE STUDY: To examine the clinical value of subjective evaluations of obstructive sleep apnea syndrome (OSAS) in correlation with syndrome severity as diagnosed with polysomnography. PROCEDURES: 210 patients with mild to severe OSAS were assessed. Objective evaluation included polysomnography. Subjective assessment included full ENT examination, neck circumference (NC) plus body mass index measurements, Mueller maneuver and Epworth Symptom Scale (ESS). RESULTS: The presence of lateral pharyngeal wall movement, abnormal ESS scoring and male gender can be considered independent risk factors for the prediction of moderate/severe OSAS (p < 0.05). Increased NC can also be considered a clinical risk factor related to male gender and lateral pharyngeal wall movement (p = 0.05). CONCLUSIONS: Subjective OSAS assessment, including evaluation of lateral pharyngeal wall movement, ESS scoring and NC measurement can safely predict, mainly in males, OSAS severity, as diagnosed with polysomnography. MESSAGE OF THE PAPER: Subjective assessment from the ENT point of view should raise high suspicion towards the early diagnosis of moderate/severe OSAS.

Assessing the need for adenotonsillectomy for sleep-disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study.

OBJECTIVE: To assess whether children with sleep-disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. METHODS: Children with snoring and tonsillar hypertrophy (4 to 10-years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3-month follow-up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ-SRBD <0.33 (low-risk for apnea-hypopnea index ≥5/h) if they had score ≥0.33 at baseline. RESULTS: Sixty-eight children were assigned to the AT and 72 to the control group and two-thirds of them had PSQ-SRBD ≥0.33. The AT group experienced significantly larger improvement between follow-up and baseline than controls (between-group difference [95% CI] for PSQ-SRBD: -0.31 [-0.35 to -0.27]; and mESS: -2.76 [-3.63 to -1.90]; P < .001 for both). Children with baseline PSQ-SRBD ≥0.33 in the AT group had an eight-times higher probability of achieving PSQ-SRBD <0.33 at follow-up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92-17.54]; P < .001). CONCLUSION: Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ-SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Use of Oximetry to Determine Need for Adenotonsillectomy for Sleep-Disordered Breathing.

: media-1vid110.1542/5802711151001PEDS-VA_2017-3382Video Abstract OBJECTIVES: We evaluated the efficacy of adenotonsillectomy (T/A) in children with sleep-disordered breathing (SDB) in a controlled study using oximetry. We hypothesized that children with SDB and abnormal nocturnal oximetry in a community setting will have improved hypoxemia indices after T/A. METHODS: Children with snoring and tonsillar hypertrophy (4-10 years old) who were candidates for T/A were randomly assigned to 2 oximetry sequences (baseline and 3-month follow-up): (1) oximetry immediately before T/A and at the 3-month follow-up, which occurred postoperatively (T/A group); or (2) oximetry at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (1) proportion of subjects with McGill oximetry score (MOS) >1 at baseline acquiring MOS of 1 at follow-up and (2) proportion of subjects achieving oxygen desaturation (≥3%) of hemoglobin index (ODI3) <2 episodes per hour at follow-up if they had ODI3 ≥3.5 episodes per hour at baseline. RESULTS: One hundred and forty children had quality oximetry tracings. Twelve of 17 (70.6%) children with MOS >1 in the T/A group and 10 of 21 (47.6%) children with MOS >1 in the control group had MOS of 1 at follow-up (P = .14). More subjects in the T/A than in the control group achieved ODI3 <2 episodes per hour at follow-up (14 of 32 [43.8%] vs 2 of 38 [5.3%]; P < .001). Three children with elevated ODI3 were treated to prevent persistently abnormal ODI3 in 1 child at follow-up. CONCLUSIONS: An ODI3 ≥3.5 episodes per hour in nocturnal oximetry is related to increased resolution rate of nocturnal hypoxemia after T/A for SDB compared with no intervention.

Subjective and Objective Voice Assessments After Recurrent Laryngeal Nerve-Preserved Total Thyroidectomy.

OBJECTIVES: This study aims to investigate early voice changes after total thyroidectomy, to assess the improved parameters in intermediate postoperative intervals, to evaluate the effect of age on voice after thyroidectomy, and to determine the correlation between the objective and the subjective method outcomes. STUDY DESIGN: This is a prospective, nonrandomized study. MATERIALS AND METHODS: One hundred ninety-one participants, divided into two age groups, underwent three full voice assessments (preoperatively and 1 and 8 weeks after thyroidectomy) by means of videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic evaluation, and a self-evaluation questionnaire. Two control groups enrolled in the study: (1) patients with an indication of neck surgery not related to laryngeal nerve injury risk or strap muscle dissection and (2) patients with an indication of a non-neck surgery. RESULTS: No statistically significant difference was found in any voice parameter, between preoperative and 1-week postoperative assessment regarding the control groups. A statistically significant difference was found between preoperative evaluation and 1 week after thyroidectomy for the total study population, as well as for the ≥40 years' age subgroup for all parameters evaluated except for shimmer. The <40 years' age subgroup showed a statistically significant difference in pitch, maximum phonation time, and grade, roughness, breathiness, asthenia, and strain (GRBAS) score between preoperative evaluation and 1 week after thyroidectomy. None of the parameters showed a statistical significant difference in the <40 years' age subgroup at 8 weeks' evaluation. The Voice Handicap Index (VHI) score correlated significantly with the GRBAS score preoperatively and postoperatively at 1 and 8 weeks' evaluations. Furthermore, VHI correlated significantly with pitch a week postoperatively. GRBAS scores showed significant correlation not only with VHI but also with acoustic parameters including pitch, shimmer, and noise-to-harmonic ratio 1 and 8 weeks after thyroidectomy. CONCLUSIONS: Objective voice changes are common in the majority of the thyroidectomized patients in the early postoperative period. Our results revealed that these changes are related to thyroidectomy per se. Older patients (≥40 years of age) show acoustic and aerodynamic changes 8 weeks postoperatively, although they report no voice abnormalities and their perceptual evaluation is similar to the preoperative one.

Alternaria and Cladosporium calendar of Western Thrace: Relationship with allergic rhinitis symptoms.

OBJECTIVES/HYPOTHESIS: Alternaria and Cladosporium are the most important outdoor moulds. The aim of this study was to present fungal spore monitoring data, investigate the relationship of fungal counts with climate conditions, and to explore the clinical significance of Alternaria and Cladosporium species monitoring in allergic rhinitis (AR). STUDY DESIGN: Analytic observational study. METHODS: A 7-day volumetric trap was used to collect circulating Alternaria and Cladosporium fungi. Sixty-nine AR patients were studied and recorded their symptoms by Total 5 Symptoms Score (T5SS). Sensitization prevalence to fungi species was detected by skin prick tests. Monitoring data were correlated to climate conditions and patients symptoms score. RESULTS: Alternaria and Cladosporium were detected throughout the calendar year in ranges of 0 to 217 spores/m(3) and 6.5 to 1,600 spores/m(3) per day, respectively. Highest daily concentrations of both fungi were detected during the summer (73.9 ± 34.4 spores/m(3) for Alternaria and 595.8 ± 288.0 spores/m(3) for Cladosporium) and lowest during the winter (2.4 ± 3.0 spores/m(3) for Alternaria and 24.3 ± 15.7 spores/m(3) for Cladosporium). Both were positively correlated to mean daily temperature and negatively to relative humidity (all P < 0.001). Clinically, a strong significant correlation between T5SS and airborne fungi levels, both for Alternaria (r = 0.822, P = 0.001) and Cladosporium (r = 0.787, P = 0.002) species was observed. CONCLUSIONS: We found Cladosporium to be the most frequently detected airborne mould, whereas Alternaria was the most prevalent with regard to sensitization rate. Patients' symptoms score was significantly correlated to spore concentrations. Both fungi were clearly affected by climate factors, such as temperature and relative humidity. These findings are important in AR management. LEVEL OF EVIDENCE: N/A.

Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires in the Greek language.

OBJECTIVES/HYPOTHESIS: The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions. STUDY DESIGN: Nonrandomized prospective. METHODS: Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed. RESULTS: The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively. CONCLUSION: VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.

Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report.

INTRODUCTION: Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. CASE PRESENTATION: We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%. CONCLUSIONS: Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.