Pediatric Barcelona Olfactory Test ̶ 6 (pBOT-6): Validation of a Combined Odor Identification and Threshold Screening Test in Healthy Spanish Children and Adolescents.

BACKGROUND AND OBJECTIVE: Few odor tests have been developed for children. Objectives: The aim of the present study was to develop and validate a simple and quick olfactory test to evaluate odor identification and threshold in a Spanish pediatric population. METHODS: The Pediatric Barcelona Olfactory Test-6 (pBOT-6) consisted of a set of 6 odorants for a forced choice identification test and a 6-dilution phenyl ethyl alcohol geometric series for the threshold test. The pBOT-6 was compared with the Universal Sniff test (a validated international pediatric smell test) in 131 healthy Spanish volunteers aged 6-17 years. A Bland-Altman plot was used to determine the agreement between the 2 tests. Reliability was analyzed in 15 volunteers using the intraclass correlation coefficient. Normative data were obtained, and 8 children diagnosed with subjective loss of smell were tested for validation. RESULTS: The Bland-Altman analysis demonstrated a minimal bias of -1.71% with upper and lower limits of agreement of -31.1% and 27.6%, respectively. The intraclass correlation coefficient was 0.83 (95%CI, 0.6-0.96) for the identification test and 0.73 (95%CI, 0.36-0.9) for the threshold test, with excellent and good consistency between measurements over time. Mean pBOT-6 scores were significantly higher in healthy volunteers than in patients with loss of smell. Discrimination between normosmia and loss of smell was achieved with a sensitivity of 96.9% and a specificity of 100%. CONCLUSIONS: pBOT-6 offers an effective and fast method that is useful in clinical routine to distinguish, with high sensitivity and specificity, between pediatric patients with normosmia and those with loss of smell.

Position paper on nasal obstruction: evaluation and treatment.

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Diffraction by three-dimensional slit-shape curves: decomposition in terms of Airy and Pearcey functions.

We analyze the diffraction field generated by coherent illumination of a three-dimensional transmittance characterized by a slit-shape curve. Generic features are obtained using the Frenet-Serret equations, which allow a decomposition of the optical field. The analysis is performed by describing the influence of the curvature and torsion on osculating, normal, and rectifying planes. We show that the diffracted field has a decomposition in three optical fields propagating along three optical axes that are mutually perpendicular. The decomposition is in terms of the Pearcey and Airy functions, and the generalized Airy function. Experimental results are shown.

Germination of Crotalaria and Lupinus (Fabaceae) seeds submitted to different pre-germination treatments and their effect on enzymatic activity during early germination.

Most of the wild and native legume seeds has a hard and impermeable testa, which causes physical dormancy and prevents them from germinating even when environmental conditions are favorable. The study evaluated the effect of scarification treatments on germination and enzymatic activity of Crotalaria longirostrata (Cl) and Lupinus exaltatus (Le) seeds. After scarification treatments, germination percentage (GP) and rate (GR) were assessed during 30 days after seeding (DAS); and water absorption (WA) and specific enzymatic activity (SEA) during early germination (0, 6, 18, 36, 72, 120 h) in a growing chamber at 25 °C and photoperiod of 12 h. Scarification with 98% H2SO4 15 min increased GP and GR in both species. At 30 DAS, GP and GR of Le seeds were 34% and 0.97 seeds day-1, respectively. In Cl seeds, GP was 64% and GR 0.90 seeds day-1. Scarification with H2O at 80 °C 1 min also promoted germination in Cl (52%). At 120 h after seeding, Le and Cl seeds showed already a high GP with acid scarification (31% and 48%, respectively). In seeds of both species, scarification treatments affected WA and SEA during early germination. During this period, scarification treatments that increased GP also showed a higher α-D-galactosidase activity. The maximum enzyme activity was observed 72 h after hot water scarification in Cl (82.6 U/mg total protein), followed by acid scarification (54.5 U/mg total protein). In Le, the activity peak was 36 h after acid scarification (9.5 U/mg total protein). No relationship was observed between ß-glucosidase activity and GP in both species. In conclusion, during early germination of both species, the increase in GP is accompanied by a rise in α-D-galactosidase activity between 36 and 72 h after seeding; and in Cl seeds, an alternative scarification treatment to increase GP may be the use of hot water.

[Tinnitus retraining therapy in Ménière disease]. / Terapia de reentrenamiento (TRT) en el acúfeno de la enfermedad de Ménière.

OBJECTIVE: To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator). DESIGN: Descriptive prospective study (EBM level 3). PATIENTS: Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol. MAIN OUTCOME MEASURES: Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI). RESULTS: Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change. CONCLUSIONS: TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.

[Assessment of hyperacusis: the self-rating questionnaire on hypersensitivity to sound]. / Evaluación de la hiperacusia: test de hipersensibilidad al sonido.

BACKGROUND: Hyperacusis is a decreased sound tolerance. The audiological examination includes the loudness discomfort level measurement and the handicap evaluation, so we introduce the Spanish validation of the german sound intolerance questionnaire. OBJECTIVES: To update the concept of hyperacusis and to evaluate its handicap through a Spanish validation of the Geräuschüberempfindlichkeit (GUF). PATIENTS: Forty patients referred to our Tinnitus and Hyperacusis Clinic in the University Hospital, between October 2004 and February 2005. OUTCOME MEASURES: The Spanish version of the GUF was performed after transla-tion and retro-translation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the GUF and its subscales (cognitive, somatic behaviour and emotional reaction) showed a high reliability and internal consistency (Cronbach's alfa: 0.9007). Higher GUF scores were statistically demonstrated in hyperacusis patients with hearing loss (p < 0.05) or tinnitus (p < 0.05). CONCLUSIONS: Spanish adaptation of the GUF is valid, reliable and can be used in a clinical setting to quantify the impact of hyperacusis on patient's quality of life.

Germination of Crotalaria and Lupinus (Fabaceae) seeds submitted to different pre-germination treatments and their effect on enzymatic activity during early germination / Germinação de sementes de Crotalaria e Lupinus (Fabaceae) submetidas a diferentes tratamentos pré-germinativos e o efeito da atividade enzimática na fase inicial da germinação

Abstract Most of the wild and native legume seeds has a hard and impermeable testa, which causes physical dormancy and prevents them from germinating even when environmental conditions are favorable. The study evaluated the effect of scarification treatments on germination and enzymatic activity of Crotalaria longirostrata (Cl) and Lupinus exaltatus (Le) seeds. After scarification treatments, germination percentage (GP) and rate (GR) were assessed during 30 days after seeding (DAS); and water absorption (WA) and specific enzymatic activity (SEA) during early germination (0, 6, 18, 36, 72, 120 h) in a growing chamber at 25 °C and photoperiod of 12 h. Scarification with 98% H2SO4 15 min increased GP and GR in both species. At 30 DAS, GP and GR of Le seeds were 34% and 0.97 seeds day-1, respectively. In Cl seeds, GP was 64% and GR 0.90 seeds day-1. Scarification with H2O at 80 °C 1 min also promoted germination in Cl (52%). At 120 h after seeding, Le and Cl seeds showed already a high GP with acid scarification (31% and 48%, respectively). In seeds of both species, scarification treatments affected WA and SEA during early germination. During this period, scarification treatments that increased GP also showed a higher α-D-galactosidase activity. The maximum enzyme activity was observed 72 h after hot water scarification in Cl (82.6 U/mg total protein), followed by acid scarification (54.5 U/mg total protein). In Le, the activity peak was 36 h after acid scarification (9.5 U/mg total protein). No relationship was observed between β-glucosidase activity and GP in both species. In conclusion, during early germination of both species, the increase in GP is accompanied by a rise in α-D-galactosidase activity between 36 and 72 h after seeding; and in Cl seeds, an alternative scarification treatment to increase GP may be the use of hot water.

Resumo A maioria das sementes de leguminosas nativas e selvagens têm um tegumento rígido e impermeável, ​​o que causa dormência física e impede a germinação, mesmo se as condições ambientais forem favoráveis. O estudo avaliou o efeito de tratamentos de escarificação sobre a germinação e a atividade enzimática de sementes de Crotalaria longirostrata (Cl) e Lupinus exaltatus (Le). Após os tratamentos de escarificação, a percentagem (PG) e a velocidade de germinação (VG) foram avaliadas durante 30 dias após a semeadura (DAS); absorção de água (AA) e atividade enzimática específica (AEE) na fase inicial da germinação (0, 6, 18, 36, 72 e 120 h) em uma câmara de crescimento a 25 °C e fotoperíodo de 12 h. A escarificação com 98% de H2SO4, durante 15 min aumentou PG e VG nas duas espécies. Aos 30 DDS, PG e VG de sementes de Le foram de 34% e 0,97 sementes dia -1, respectivamente. Em sementes de Cl, PG foi de 64% e VG 0,90 sementes dias-1. A escarificação com H2O a 80 °C 1 min também promoveu a germinação em Cl (52%). A 120 h após a semeadura, as sementes de Cl e Le já tinha atingido uma alta PG com escarificação ácida (31% e 48%, respectivamente). Nas sementes das duas espécies, os tratamentos de escarificação afetaram a AEE e a AA nafase inicial da germinação. Durante este período, os tratamentos de escarificação que aumentaram PG, também mostraram a atividade mais elevada de α-D-galactosidase. A atividade enzimática máxima foi observada 72 h após o tratamento com água quente em Cl (82,6 U/mg de proteína total), seguido por escarificação ácida (54,5 U/mg de proteína total). Em Le, o pico de atividade foi de 36 h após a aplicação do tratamento ácido (9,5 U/mg de proteína total). Em contraste, não foi observado nenhuma relação entre a actividade β-glicosidase e PG. Em conclusão, durante a germinação precoce das duas espécies, o aumento da GP é acompanhado por um aumento da atividade da α-D-galactosidase entre 36 e 72 h após a semeadura; e em sementes de Cl, um tratamento de escarificação alternativo para aumentar GP pode ser o uso de água quente.

Caring for hemodialysis patients in Saudi Arabia. Past, present and future.

There are currently 5706 patients receiving hemodialysis therapy in the Kingdom of Saudi Arabia - a 15 fold increase when compared to 1983. The annual increase in the number of patients on dialysis for 1999 is 696 (10 fold increase when compared to 1983). Besides the massive increase in the number of patients in the last 20 years, we have noticed a marked increase in the mean age of patients (51.3 years in 1999 as compared to 37.9 years in the early 80s). Diabetes mellitus which was an insignificant contributory etiology (4%) in the early 80s is now a major cause (16-25%). Similarly mortality has increased from 4% annually to 11-14% annually. This is largely due to increasing age and prevalence of diabetes mellitus. Within the expired cohort the mean age was 62.3 years compared to 51.3 years of the total dialysis population, and diabetes mellitus was present in 60.5% in those who expired. Moreover, ischemic heart disease was diagnosed in 50% before death. Tuberculosis and Hepatitis C virus incidences, however, have not improved over the years but the degree of rehabilitation has, largely due to better hemoglobin level and due to the technological advances in dialysis delivery. This article describes these changes, their causes and implications.

[The neck cysts and infectious mononucleosis due to cytomegalovirus]. / Masa cervical y mononucleosis infecciosa por citomegalovirus.

Infectious mononucleosis is usually produced as primoinfection by Epstein-Barr virus, but the second most common cause is cytomegalovirus. Clinical presentation of infectious mononucleosis is a pharyngitis and tonsillitis, associated to neck nodes, fever and general malaise, as well as haematological features such as an absolute lymphomonocytosis. Occasionally it is the neck node that is more severe, even without initial lymphomonocytosis. We report a deep neck abscess within a neck node as subacute presentation of infectious mononucleosis by cytomegalovirus. We review the clinical presentation of infectious mononucleosis, specially due to cytomegalovirus, as well as the importance that this disease could have while dealing with diagnosis and management of neck masses.

[Medullar carcinoma of the thyroid gland: surgical treatment of mediastinal metastases]. / Carcinoma medular de tiroides: tratamiento quirúrgico de metástasis mediastínica.

Metastatic medullary carcinoma is related to very bad prognosis. Surgery, associated or not to radiotherapy, may be effective in controlling metastasis due to local invasion, as in mediastinal extension. We present a case of medullary carcinoma with mediastinal disease that was treated through mediastinal dissection following by complimentary radiotherapy. After three years of follow-up, the patient remains free of recurrence, although calcitonin levels have not become normal yet.

[Cost-efficiency analysis of treatment of otitis media with effusion in children]. / Análisis de coste-efectividad del tratamiento de la otitis media serosa infantil.

Otitis media with effusion is a common disorder in children, associated to hearing loss and recurrent acute otitis media. It has three basic treatments: Spontaneous resolution, oral antibiotics and surgery including adenoidectomy and/or grommets insertion. Through a sensibility analysis on a theoretical group of 1000 patients our aim is to study the cost-effectiveness of the different therapeutic options, evaluating direct and indirect costs, and identifying the most efficient option (cost-effective). We analysed effectiveness and variable costs of each arm of the decision tree, considering initial and rescue treatments. As expected, effectiveness grows up to the most through treatment, including adenoidectomy and grommets insertion, from 92% to 98% of children treated. Nevertheless, unitary cost of each child treated also increases, from 302 to 401 euros; that is, choosing the most cost-effective treatment enables to save approximately 100 euros per child. But, fixed costs, which are much higher (600 euros per child), will not change, limiting our management resources.

[Myringotomy under topical anesthesia with phenol]. / Miringotomía bajo anestesia tópica con fenol.

Myringotomy is a common outpatient surgical procedure. It can be performed under general inhaled anesthesia, but it is usually carried out under local anesthesia by lidocaine infiltration or instillation of different anesthetic agents. We present our experience with myringotomy and tympanic tube placement using topical anesthesia with 88% phenol as an outpatient procedure. We report 55 patients in which we performed 81 treatments. In this series, only two ears (2.47%) did not tolerate the surgical procedure, tube insertion under general anesthesia being necessary in one case. Topical anesthesia with phenol facilitates the outpatient treatment of adult otitis media with effusion.

[Cochlear microphonic potentials with surface electrodes in the diagnosis of sensorineural hearing loss]. / Potenciales microfónicos cocleares con electrodos de superficie en el diagnóstico de hipoacusias neurosensoriales.

Cochlear microphonic potentials have only been used experimentally because of technical difficulties and the need for inserting transtympanic electrodes. We present the results of a study of 70 ears, 40 with sensorineural hearing loss and 30 with normal hearing. Cochlear microphonics were recorded with surface electrodes. The stimulus was a pure, continuous tone. Statistical analysis disclosed a difference in cochlear microphonic threshold between the two groups. The normal threshold was defined as 83.73 dB and the most significant frequency was 4,000 Hz. The present report shows that this new method can be useful in diagnosing sensorineural hearing loss.

[New method for recording human cochlear microphonic potentials]. / Nuevo método de registro de potenciales microfónicos cocleares en seres humanos.

The use of invasive methods to record cochlear microphonic potentials preclude its use in routine clinical diagnosis in humans. We present an instrument and method used to obtain cochlear microphonics recordings using external electrodes in human beings. Biological and technical tests were performed before application. Stimulation with a pure, continuous and defined tone yielded cochlear microphonics that can be interpreted easily. This new method allows human cochlear physiology and pathophysiology to be studied non-invasively.

[Variability of N in Meniere's disease]. / Variabilidad del N en la enfermedad de Ménière.

Intratympanic treatment of incapacitating vertigo in Menière's disease has become a first option treatment for most otolaryngologists nowadays. Reporting their results following adequate minimum follow-up and under the same criteria is as important as to clearly state the indications that have been settled, through adequate handicap psychometric tests. Furthermore, when results are reported, knowing the total number of patients (N) with a diagnosis of Menière's disease is essential to evaluate such results in those treated patients, bearing in mind that most Menière's patients do well with medical treatment as well.

[Usefulness of the new classification for regional extension on CT of head and neck cancer]. / Utilidad de la nueva clasificación de la extensión regional en TC del cáncer de cabeza y cuello.

OBJECTIVE: To present the usefulness of the new classification of neck nodes based in commuted tomography (CT). MATERIAL AND METHODS: We present several illustrative images showing neck nodes in each of the new levels (Ia, Ib, IIa, IIb, III, IV, Va, Vb, and VI) as an adjunct to nodal classifications. RESULTS AND CONCLUSION: An imaging-based classification for the cervical nodes allows to know much better their distribution along the neck, helping to find correlation between clinical, radiological and surgical findings.

[What clinical significance do vascular anomalies of the outer ear canal have?]. / Cuál es el significado clínico de las anomalías vasculares del conducto auditivo interno?

Vascular anomalies of the internal auditory canal (IAC) are relatively common, being found in 20-25% of magnetic resonance imaging (MRI) studies performed in patients with unilateral sensorineural hearing loss. They are usually asymptomatic and their diagnosis is almost always based on MRI, as they are generally undetected by routine clinical examination. Recently, the clinical relevance of these IAC anomalies and the effectiveness of vascular decompression have been debated. We present a series of 7 vascular anomalies of the IAC found in a series of 83 consecutive MRI scans performed in a screening program for IAC and cerebellopontine angle pathology. We reviewed their clinical and radiological presentation to evaluate their clinical relevance. In this series, we found no correlation between the presence of such vascular anomalies and the clinical symptoms that motivated MRI, so we conclude that most of these anomalies were accidental findings.

[Multi-sensory interaction in tinnitus: visual evoked potentials and somatosensory stimulation]. / Interacción multisensorial en el acúfeno: evocación por movimientos oculares y estimulación somatosensorial.

Anomalous cross-modal interactions along the audiovestibular, visual and soma-tosensorial pathways could be the responsible for aberrant signals, clinically expressed as phantom perceptions. This results in tinnitus that can be modified by gaze movements or somatosensorial stimulation through skin, orofacial (jaw) and cervical movements. This phenomenon has also been described in some patients with acute unilateral deafferentation of the auditory peripheral system as a result of surgery to remove a tumour in the posterior fossal. Neuroimaging preliminary studies (PET, f-MRI) describe multisensorial interactions and cortical reorganisation processes in chronic tinnitus. Treatment approaches are still unknown although counselling regarding the benignity of the process and the high percentage of habituation to the symptom is the most effective framework. We present our experience in four cases.

[Maxillary sinus hypoplasia]. / Hipoplasia del seno maxilar.

Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.

[Study of hyperacusis at a tinnitus unit]. / Estudio de la hiperacusia en una unidad de acúfenos.

OBJECTIVES: Description of the epidemiological and clinical characteristics of hyperacusis in a tinnitus clinic unit. STUDY DESIGN: Transversal descriptive. PATIENTS: Two hundred and fifty patients referred to our Tinnitus Unit a Teaching Hospital, between January 1999 and December 2000. OUTCOME MEASURES: Questionnaires to evaluate hyperacusis and tinnitus interference in life quality. Epidemiological and audiological data as well as tinnitus characteristics in hyperacustic patients are reported. RESULTS: Sixty three percent of the patients showed hyperacusis according to sound threshold level. Hearing loss was present in 83%. Discomfort with background noise was referred in 54% of cases and 52% avoided at least one daily activity because of this discomfort. Tinnitus in hyperacusis population showed a disability level of 47% using the Tinnitus Handicap Inventory (THI). CONCLUSIONS: A physiopathological relation between tinnitus and hyperacusis could be explained by the high prevalence of both symptoms in the same population. It is necessary to agree in the criteria to define hyperacusis as well as for the evaluation of its effect in quality of life. The tinnitus retraining therapy (TRT) is the more accepted hyperacusis treatment approach in the literature.