Otologic findings in children with gastroesophageal reflux.

BACKGROUND: Nearly 90-95% of children with drool have physiologic gastroesophageal reflux (GER) that usually resolves by 12-15 months of age; however, 5-10% of children with drool have pathologic GER. Of these children, most recover clinically by 18 months of age without therapy, yet 10% develop chronic, recurrent gastroesophageal reflux disease (GERD) with sequelae. The respiratory symptoms associated with GER consist mainly of bronchial asthma and laryngospasm, but often include a persistent cough of unknown aetiology, obstructive apnoea, and an obstructive respiratory syndrome confined to the nasopharynx. Gastric acid reflux, enters the adenoids, causes oedema of the tubal orifices, and later leads to relapsing diseases of the middle ear in children. AIM AND SCOPE: To evaluate the incidence of otologic manifestations in children with GER and the efficacy of treatment, comparing two different groups of children (i.e., treated versus untreated). SUBJECTS AND METHODS: From January 2005 to November 2006, audiologic screening of newborns and suckling children (0-24 months of age) at risk for auditory illnesses was held at the University Department of Otolaryngology in Catania. Seventy-three children (average age, 13 months) were selected after failing acoustic otoemissions for chronic bilateral catarrhal pathology involving the middle ear (tympanometry type B) and were positive for at least one of the different signs of GER at the time of history-taking. The children were randomised and subdivided into two groups: (1) a group of 40 children (27 females and 13 males; average age, 12 months) who received treatment; and (2) a group of 29 children (16 males and 13 females; average age, 14 months) who did not receive treatment. Four children were lost to follow-up after completing the study. All children enrolled in the study underwent a rhinopharynxlaryngeal fibroscopy with flexible optics, a gastric ultrasound scan after clinical observation, and a multi-channel pH-metry for 18-24h. RESULTS: Findings obtained by rhinopharynxlaryngeal fibroscopy showed that 82% of cases had diffuse hyperaemia involving the entire rhinopharyngeal mucosa and 13% of the cases had arytenoidal hyperaemia. Resolution and improvement of the reflux occurred in 52.5 and 40% of the cases in the treated group, respectively, versus complete resolution and an improvement in symptoms of 45 and 30% of cases, respectively, in the control group. CONCLUSIONS: The hypothesis of a correlation between reflux and chronic middle otitis of the serous-mucous type was confirmed in the present study. Adopting a preventive treatment strategy may be useful in reducing the possibility of ear involvement.

Oxidative stress, nitric oxide, endothelial dysfunction and tinnitus.

To assess whether pathogenic endothelial dysfunction is involved in acute idiopathic tinnitus we enrolled 44 patients and 25 healthy volunteers. In blood from the internal jugular vein and brachial vein we determined malonaldehyde, 4-hydroxynonenal, myeloperoxidase, glutathione peroxidase, nitric oxide, L-arginine and L-ornitine, thrombomodulin (TM) and von Willebrand factor (vWF) activity during tinnitus and asymptomatic period. Higher plasma concentrations of oxidative markers and L-arginine, and lower nitric oxide and L-ornitine levels were observed in jugular blood of patients with tinnitus, there being a significant difference between brachial and jugular veins. TM and vWF activity were significantly higher in patients' jugular blood than in brachial blood. Our results suggest oxidant, TM, vWF activity production are increased and nitric oxide production reduced in brain circulation reflux blood of patients with acute tinnitus. These conditions are able to cause a general cerebro-vascular endothelial dysfunction, which in turn induce a dysfunction of microcirculation in the inner ear.

Auditory brain stem response throughout the menstrual cycle.

A prospective study was performed to evaluate the changes in the auditory brain stem response (ABR) that occur in healthy premenopausal women throughout the menstrual cycle. Ninety-four women with ovulatory menstrual cycles underwent ABR testing by auditory evoked potentials for wave I, III, and V latencies and for interpeak I-III, I-V, and III-V intervals during the follicular, periovular, and luteal phases of the menstrual cycle. The wave latencies and the interpeak intervals showed shorter values during the periovular phase than during the luteal phase (p < .05) and shorter values during the follicular phase for wave I (p < .05) and interpeak interval I-V (p < .05). The ABR seems to be influenced by the variations of ovarian steroids that occur during the menstrual cycle.

ADAM-9 expression in intestinal-type adenocarcinoma of the sinonasal tract.

Malignant tumors of the paranasal fossae and sinuses represent 0.2% to 0.8% of all malignant tumors in the body and 3% to 6% of other head and neck tumors. It is possible to distinguish 4 different histologic types of sinonasal malignant tumors: squamous carcinoma, adenocarcinoma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. According to the WHO classification, there are 2 main types of adenocarcinomas: intestinal-type (ITAC) and nonintestinal type. ITACs are generally connected with professional exposure to wood and leather dust. The metalloproteinase 9 (ADAM-9) is a type 1 transmembrane protein that has been associated with cancer development and metastases. Our case of poorly differentiated sinonasal ITAC showed moderate to strong cytoplasmic positivity for ADAM-9 in association with moderate membrane staining for c-erbB-2 oncoprotein. In our opinion, the expression of these proteins could explain the tumoral growth and together they could represent the most interesting targets when designing any tumor treatment scheme.