Pre-operative high resolution computed tomography scans for cholesteatoma: has anything changed?

OBJECTIVE: CT temporal bone scans are often performed to aid in surgical planning and management of cholesteatomas. With improvements in the resolution of CT scans today, it is now possible to obtain more information from these scans than before. The aim of this study is to compare findings on high resolution CT (HRCT) temporal bone scans to intra-operative findings, so as to determine how well various middle ear structures are assessed by HRCT scanning. STUDY DESIGN: Retrospective study. SETTING: Otology clinic of a tertiary otolaryngology centre. SUBJECTS AND METHODS: 32 mastoidectomies performed by a single otologist for clinically confirmed cholesteatoma were included. Correlation of CT and intra-operative findings on the status of structures including the ossicles, semicircular canals, facial canal and tegmen was analysed using kappa and AC1 statistics. RESULTS: In all patients, a soft tissue mass with bony erosion in keeping with a cholesteatoma was seen on CT. Radiosurgical agreement was excellent for the presence of semicircular canal erosion (k=0.89, AC1=0.96), facial canal dehiscence (k=0.74, AC1=0.76), tegmen erosion (k=0.76, AC1=0.92) and malleus erosion (k=0.76, AC1=0.85). It was good for incus erosion (k=0.71, AC1=0.92) and stapes erosion (k=0.63, AC1=0.73). CONCLUSION: There was good to excellent radiosurgical agreement in the assessment of the status of various middle ear structures. Improvement in radiosurgical agreement from existing studies in the literature was noted. This was especially true for features such as facial canal dehiscence. With technological advancements, CT temporal bone scans appear even more valuable for evaluation of patients prior to cholesteatoma surgery.

Voice problems amongst primary school teachers in Singapore.

HYPOTHESIS/OBJECTIVES: Teachers are often cited to be at high risk of vocal disturbances. Many studies were performed in the West, but none locoregionally. The aim of this study is to determine the prevalence of voice problems amongst primary school teachers in six schools in Singapore and explore the associated risk factors. METHODS: A cross-sectional study was conducted across six primary schools and 214 full-time teachers were surveyed. Teachers were asked to report if they have voice problems at the day of the interview, during the past 1 year and throughout their careers. Teachers who reported having current voice problems were invited for videolaryngostroboscopy. Multivariate analyses were performed to analyze risk factors associated with voice problems. RESULTS: The point prevalence was 13.1% (95% confidence intervals [CI]: 9.3-18.3%). The past year prevalence and career prevalence were 25.4% (95% CI: 20-31.6%) and 32.1% (95% CI: 26.2-38.6%), respectively. Results showed that reflux symptoms (adjusted odds ratio [adj OR]=6.1, CI: 2.5-14.6) and microphone usage (adj OR=5.6, CI: 1.8-17.6) are risk factors for current voice disorders. Allergic rhinitis symptoms (adj OR=2.1, CI: 1.1-4.3), hypothyroid-like symptoms (adj OR=2.6, CI: 1.3-5.1), and microphone use (adj OR=3.4, CI: 1.1-10.0); allergic rhinitis symptoms (adj OR=2.6, CI: 1.4-5.1), reflux symptoms (adj OR=3.1, CI: 1.5-6.5), and the teaching of arts and theater studies (adj OR=2.8, CI: 1.4-5.9) are risk factors for voice problems in past 1 year and throughout the career, respectively. CONCLUSION: The findings confirm that teaching is a high-risk profession for acquiring voice problems. The risk factors uncovered are statistically and clinically significant and biologically plausible. There is a need for educational authorities and healthcare providers to develop effective and comprehensive prevention programs to arrest vocal attrition and its detrimental effects on the quality of teaching.