Exploring the characteristics of children with obstructive adenoid responding to mometasone fuorate monohydrate: preliminary results.

This study aimed at observing the efficacy of mometasone fuorate monohydrate nasal spray on obstructive adenoids in children and identifying the characteristics of responders using a pilot study including children aged 2-11 years, with evidence of more than 50 % obstruction. Allergic rhinitis and nasal obstruction were evaluated on baseline (V0), 6- (V1), and 12-week (V2) visits. Degree of obstruction was evaluated by nasopharyngoscopy at V0 and V2. Subjects received 100 µg mometasone fuorate daily. Results were compared with those of a matching control group. Nineteen children (8 females, 11 males; 2.25-8.50 years old, mean 4.24 years, median 4.00 years) completed treatment and follow-up adequately. There was 58 % reduction in a clinical score assessing the severity of adenoidal obstruction (P < 0.05), 56 % reduction in severity of obstructive symptom (P < 0.05), and 75 % reduction in allergic rhinitis score (P < 0.05) between V0 and V1. No further significant improvement was noticed between V1 and V2. The degree of obstruction dropped from 85 to 61 % as noted on endoscopy (P < 0.05). None in the control group showed spontaneous decrease or resolution of the symptoms. Age of patients, allergic rhinitis score, and severity of the clinical score had no impact on the response parameters. No side effects were observed. Mometasone furoate monohydrate nasal spray appears to be effective in treating children with obstructive adenoids. The effect seems to be independent of the presence of mild intermittent allergic rhinitis, the age of patient, or the severity of symptoms.

Ear-canal reflectance, umbo velocity, and tympanometry in normal-hearing adults.

OBJECTIVE: This study compares measurements of ear-canal reflectance (ECR) to other objective measurements of middle ear function including audiometry, umbo velocity (VU), and tympanometry in a population of strictly defined normal-hearing ears. DESIGN: Data were prospectively gathered from 58 ears of 29 normal-hearing subjects, 16 females and 13 males, aged 22 to 64 yr. Subjects met all of the following criteria to be considered as having normal hearing: (1) no history of significant middle ear disease; (2) no history of otologic surgery; (3) normal tympanic membrane on otoscopy; (4) pure-tone audiometric thresholds of 20 dB HL or better for 0.25 to 8 kHz; (5) air-bone gaps no greater than 15 dB at 0.25 kHz and 10 dB for 0.5 to 4 kHz; (6) normal, type-A peaked tympanograms; and (7) all subjects had two "normal" ears (as defined by these criteria). Measurements included pure-tone audiometry for 0.25 to 8 kHz, standard 226 Hz tympanometry, ECR for 0.2 to 6 kHz at 60 dB SPL using the Mimosa Acoustics HearID system, and umbo velocity (VU) for 0.3 to 6 kHz at 70 to 90 dB SPL using the HLV-1000 laser Doppler vibrometer (Polytec Inc). RESULTS: Mean power reflectance (|ECR|) was near 1.0 at 0.2 to 0.3 kHz, decreased to a broad minimum of 0.3 to 0.4 between 1 and 4 kHz, and then sharply increased to almost 0.8 by 6 kHz. The mean pressure reflectance phase angle (∠ECR) plotted on a linear frequency scale showed a group delay of approximately 0.1 msec for 0.2 to 6 kHz. Small significant differences were observed in |ECR| at the lowest frequencies between right and left ears and between males and females at 4 kHz. |ECR| decreased with age but reached significance only at 1 kHz. Our ECR measurements were generally similar to previous published reports. Highly significant negative correlations were found between |ECR| and VU for frequencies below 1 kHz. Significant correlations were also found between the tympanometrically determined peak total compliance and |ECR| and VU at frequencies below 1 kHz. The results suggest that middle ear compliance contributes significantly to the measured power reflectance and umbo velocity at frequencies below 1 kHz but not at higher frequencies. CONCLUSIONS: This study has established a database of objective measurements of middle ear function (ECR, umbo velocity, tympanometry) in a population of strictly defined normal-hearing ears. These data will promote our understanding of normal middle ear function and will serve as a control for comparison to similar measurements made in pathological ears.

Comparison of ear-canal reflectance and umbo velocity in patients with conductive hearing loss: a preliminary study.

OBJECTIVE: The goal of the present study was to investigate the clinical utility of measurements of ear-canal reflectance (ECR) in a population of patients with conductive hearing loss in the presence of an intact, healthy tympanic membrane and an aerated middle ear. We also sought to compare the diagnostic accuracy of umbo velocity (VU) measurements and measurements of ECR in the same group of patients. DESIGN: This prospective study comprised 31 adult patients with conductive hearing loss, of which 14 had surgically confirmed stapes fixation due to otosclerosis, 6 had surgically confirmed ossicular discontinuity, and 11 had computed tomography and vestibular evoked myogenic potential confirmed superior semicircular canal dehiscence (SCD). Measurements on all 31 ears included pure-tone audiometry for 0.25 to 8 kHz, ECR for 0.2 to 6 kHz using the Mimosa Acoustics HearID system, and VU for 0.3 to 6 kHz using the HLV-1000 laser Doppler vibrometer (Polytec Inc, Waldbronn, Germany). We analyzed power reflectance |ECR| as well as the absorbance level = 10 × log10(1 - |ECR|). All measurements were made before any surgical intervention. The VU and ECR data were plotted against normative data obtained in a companion study of 58 strictly defined normal ears (). RESULTS: Small increases in |ECR| at low-to-mid frequencies (400-1000 Hz) were observed in cases with stapes fixation, while narrowband decreases were seen for both SCD and ossicular discontinuity. The SCD and ossicular discontinuity differed in that the SCD had smaller decreases at mid-frequency (∼1000 Hz), whereas ossicular discontinuity had larger decreases at lower frequencies (500-800 Hz). SCD tended to have less air-bone gap at high frequencies (1-4 kHz) compared with stapes fixation and ossicular discontinuity. The |ECR| measurements, in conjunction with audiometry, could successfully separate 28 of the 31 cases into the three pathologies. By comparison, VU measurements, in conjunction with audiometry, could successfully separate various pathologies in 29 of 31 cases. CONCLUSIONS: The combination of |ECR| with audiometry showed clinical utility in the differential diagnosis of conductive hearing loss in the presence of an intact tympanic membrane and an aerated middle ear and seems to be of similar sensitivity and specificity to measurements of VU plus audiometry. Additional research is needed to expand upon these promising preliminary results.

Cavernous hemagioma of the maxillary sinus: a rare cause of epistaxis.

BACKGROUND: A case of cavernous hemangioma of the maxillary. METHOD: A 25 year old lady presented with history of nasal obstruction, recurrent epistaxis and headache. On exam she had a mass in the left osteomeatal complex that was friable and bled easily on palpation. Computerized tomography of the paranasal sinuses 2mm coronal cuts showed complete opacification of the left maxillary sinus and magnetic resonance imaging revealed a 1.5 x 3 x 2.5 cm lobulated soft tissue mass lesion that enhanced with intravenous gadolinium administration, but no flow-void signals were present. Histologically, the mass was made up of dilated and anastomosing blood vessels. RESULT: The radiologic findings may be attributed to a malignant lesion especially when extensive bone erosion is present. CONCLUSION: Cavernous hemangioma of the maxillary sinus is a very rare benign entity that presents with recurrent epistaxis and nasal obstruction.

Spontaneous sublingual haematoma: a rare entity.

Sublingual haematoma, also known as pseudo-Ludwig phenomenon, is an entity commonly described in patients on anticoagulation therapy. Spontaneous sublingual haematoma is a rare subtype. It is thought to be due to aneurismal changes in the facial or lingual arteries, occurring mostly in the elderly hypertensive population. Two case reports of spontaneous sublingual haematomas have been reported so far in the literature. Both cases were elderly patients and presented with a sublingual mass and elevation of the floor of the mouth. One patient was intubated whereas the other underwent an emergency tracheotomy. The authors present the third case of spontaneous sublingual haematoma that was afebrile and had a sudden onset of sore throat that progressed to dyspnoea and required a life-saving tracheotomy. The patient recovered quickly postoperatively and could be discharged home in a couple of days and was decannulated in 1 week. No recurrence of the haematoma was noticed on follow-up after 1 year.

Vocal changes in patients with polycystic ovary syndrome.

PURPOSE: The purpose of this study is to look at the prevalence of vocal symptoms and acoustic changes in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHOD: A total of 17 patients with PCOS diagnosed on the basis of three criteria: the presence of irregular menstrual cycles, hirsutism, and polycystic ovaries were included in the study. Twenty-one normal females' frequencies matched on age with the cases were used as controls. The following vocal symptoms were investigated: throat clearing, deepening of the voice, loss of voice, lump in the throat, and difficulty being heard. Acoustic analysis and laryngeal videostroboscopy were performed. RESULTS: The age range was between 19 and 38 years with a mean age of 26 years. The most common prevailing symptom was throat clearing present in 76.5% versus 4.8% in the controls, followed by loss of voice (47.6%), lump in the throat (41.2%), and deepening of voice (35.3%). The differences in the prevalence of throat clearing, deepening of voice, lump in the throat, and difficulty being heard were statistically significant compared with controls (P value<0.05). There was no statistically significant difference in the acoustic parameters except for an increase in the relative average perturbation (P value=0.035) and a decrease in maximum phonation time (P value=0.001) in patients with PCOS. In the PCOS group, three patients had evidence of mild vocal fold edema and one patient had vocal fold nodules. In the control group, one subject had vocal fold edema and one subject had vocal fold nodules. CONCLUSION: Patients with PCOS seem to have more vocal symptoms compared with controls. Physicians should be aware of vocal changes in hirsute subjects with PCOS.

Cricothyroid joint abnormalities in patients with rheumatoid arthritis.

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects--11 patients with advanced RA and eight normal controls--were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Effect of pregnancy on the speaking voice.

The study aims to investigate the vocal symptoms and acoustic changes in pregnant women pre- and postpartum in comparison to the controls. A total of 25 pregnant women who presented for delivery were enrolled in this study. Twenty-one nonpregnant women were matched as controls. Vocal symptoms such as hoarseness, vocal fatigue, and aphonia were assessed. Acoustic analysis included fundamental frequency (F(0)), habitual pitch, relative average perturbation (RAP), shimmer, noise-to-harmony ratio (NHR), and maximum phonation time (MPT). There were no significant differences in the incidence of vocal symptoms in pregnant women versus controls. However, vocal fatigue was more prevalent in the pregnant group. With respect to the acoustic parameters, there was a significant decrease in the MPT at term. The rest of the variables were comparable. Postpartum, the MPT significantly increased and there was an increase in F(0) and a significant decrease in the voice turbulence index (VTI). Pregnant women have more vocal fatigue and a reduction in MPT compared to the controls. Immediately after delivery, there is a significant increase in MPT.