Sex difference in counts of α4 and α7 nicotinic acetylcholine receptors in the nasal polyps of adults with or without exposure to tobacco smoke.

OBJECTIVE: To assess counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults with or without long-term exposure to cigarette tobacco smoke. METHODS: Twenty-two patients with and 22 patients without exposure to cigarette tobacco smoke participated in the study. After endoscopic polypectomy, the fragments of the nasal polyps were analysed by immunohistochemistry. RESULTS: Compared to patients with no exposure, patients with exposure showed higher counts of α4 and α7 nicotinic acetylcholine receptors (t-test, p 0.05). CONCLUSION: Exposure to cigarette tobacco smoke may induce increased counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults, with lower counts in males than females without exposure to tobacco smoke.

Quality of life of young patients with recurrent respiratory papillomatosis.

OBJECTIVE: To assess quality of life of children and teenagers with recurrent respiratory papillomatosis, according to the evidence of infection by human papillomavirus types 6 and 11, compared with healthy volunteers and patients with chronic otitis media. METHOD: Participants and their parents completed the Pediatric Quality of Life Inventory 4.0. RESULTS: Patients with recurrent respiratory papillomatosis and their parents reported lower quality of life than healthy subjects (p < 0.01), but similar quality of life to patients with chronic otitis media. Those with human papillomavirus type 11 showed the lowest scores among all participants (p < 0.05). CONCLUSION: Young Mexican patients with recurrent respiratory papillomatosis and their parents perceive a poor quality of life, and they may experience limitations in interactions with their peers. Infection by human papillomavirus type 11 may increase the impact of the disease on quality of life.

Influence of exposure to tobacco cigarette smoke on the eosinophil count in the nasal mucosa of young patients with perennial allergic rhinitis.

BACKGROUND: To assess the influence of exposure to tobacco cigarette smoke on the eosinophil count and the frequency of apoptosis of eosinophils in the nasal mucosa of teenagers with perennial allergic rhinitis. METHODS: Fifty patients were evaluated (aged 10 to 19 years old): 25 patients with and 25 patients with no recent exposure to tobacco cigarette smoke, by means of The Global Youth Tobacco Survey and cotinine/creatinine ratio. After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of nasal symptoms; then, a nasal sample was processed to identify the eosinophil count and the frequency of apoptosis of eosinophils. RESULTS: Patients with active exposure to tobacco cigarette smoke had higher eosinophil counts than patients with no exposure to the smoke. In the two groups, apoptosis of eosinophils in the nasal mucosa was scarce and no significant correlation was observed between the frequency/severity of the nasal symptoms and the eosinophil count. CONCLUSION: Teenagers with perennial allergic rhinitis and active exposure to tobacco cigarette smoke may show increased eosinophil counts in the nasal mucosa, which might not be related to apoptosis of eosinophils or to the frequency/severity of nasal symptoms.

Rhinomanometry in young patients with perennial allergic rhinitis with/without recent exposure to tobacco smoke.

OBJECTIVE: To assess the influence of environmental exposure to tobacco smoke on the nasal symptoms and nasal resistance of young patients with perennial allergic rhinitis. DESIGN: Cross-sectional study. SETTING: Tertiary referral centre. PARTICIPANTS: Fifty patients were evaluated (aged 10-19 years old): 25 patients with and 25 patients without recent exposure to tobacco smoke (confirmed by cotinine/creatinine ratio). MAIN OUTCOMES MEASURES: After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of the nasal symptoms. Then total nasal airway resistance was recorded by active anterior rhinomanometry. RESULTS: Patients with exposure to tobacco smoke had a larger total resistance than patients without exposure (t-test, P < 0.01). No significant correlation was observed between the total score of the questionnaire of nasal symptoms and the nasal resistance. CONCLUSIONS: In young patients with perennial allergic rhinitis, exposure to tobacco smoke can be related to increased nasal resistance, which may not be recognised by the report of nasal symptoms.

Systemic high blood pressure and inner ear dysfunction: a preliminary study.

OBJECTIVE: To assess the association between inner ear dysfunction and retinal vascular changes related to systemic arterial hypertension. DESIGN: A comparative, cross-sectional and observational study. SETTING: Primary care. MAIN OUTCOMES MEASURES: Hearing and vestibular symptoms evaluated by a standardized questionnaire; cochlear function evaluated by audiometry and distortion product otoacoustic emissions; vestibular function evaluated by oculomotor and bithermal caloric tests and vascular retinal compromise evaluated by ophthalmoscopy (according to the modified Scheie classification). RESULTS: Forty-two subjects participated in the study, 21 with and 21 without arterial hypertension, age and sex matched; with no history of diabetes mellitus and with normal glucose levels and normal blood lipids. Although patients with hypertension reported vertigo more frequently than control subjects, conventional oculomotor and bithermal caloric tests showed no difference between the two groups. Patients with hypertension showed deterioration of hearing thresholds at 8 kHz and, compared with normotensive subjects, a higher frequency of abnormal otoacoustic emissions (P = 0.01). According to Scheie classification, 43% (95% CI: 33-53%) of the patients showed second degree retinal vascular compromise and 24% (95% CI: 15-33%) of them showed first degree compromise. The degree of the vascular retinal compromise was significantly correlated with the hearing thresholds at 8 kHz (Spearman's correlation coefficient 0.45, P = 0.002) and it was also consistent with the absence of otoacoustic emissions at frequencies between 4 and 8 kHz. CONCLUSION: The results of this preliminary study suggest that patients with systemic arterial hypertension may have cochlear dysfunction associated with the vascular disease because of hypertension, which could be silent and without clear evidence of vestibular dysfunction.

[Meningeal herniation associated to chronic otitis media in an otology center in the City of Mexico]. / La hernia de meninges asociada a otitis media crónica en un centro de atención otológica de la ciudad de México.

To assess the frequency and clinical characteristics of meningocele and meningoencephalocele into the middle ear, at an otological referral center of Mexico city. After analyzing 586 recordings of middle ear surgery, we identified that 3 (0.5%) had defects of the tegmen timpani, 2 had brain abscesses (0.34%) and 1 had (0.17%) a facial palsy. Two of the patients with defects of the tegmen timpani had herniation of the intracraneal tissue. Case 1. A 38 year old woman with a history of bilateral chronic otitis media, with 2 surgeries in the left ear. She was seeking medical care because of right hearing loss. However, computed tomography and magnetic resonance showed a defect of the tegmen timpani with temporal lobe herniation in the left ear. Case 2 was a 46 year old woman with no history of ear disease, just high blood pressure. She was seeking medical care because of right hearing loss, vertigo and headache. The clinical evaluation suggested tissue in the middle ear and the computed tomography showed a defect of the tegmen timpani, meningocele was confirmed by surgery. In the 2 patients the clinical characteristics did not suggest herniation of intracraneal tissue as the first diagnosis. This show us the importance of an intended evaluation and image studies to make an early diagnosis.

Cerebral blood flow during supine rest and the first minute of head-up tilt in patients with orthostatic intolerance.

AIM: To assess the cerebral blood flow velocity during the first minute of head-up tilt in patients with postural tachycardia syndrome (POTS) or neurally-mediated reflex syncope compared with patients with dizziness. METHODS: We evaluated 120 patients selected from 470 patients who underwent head-up tilt testing: 40 with POTS, 40 with typical neurally-mediated reflex syncope and 40 who complained of dizziness with no history of loss of consciousness and a negative head-up tilt test (with and without isosorbide). Transcranial Doppler sonography of the middle cerebral artery, heart rate and brachial blood pressure were recorded during a 70 degrees head-up tilt test. RESULTS: During both baseline in supine position and the first minute of upright tilt, patients with postural tachycardia syndrome showed higher heart rate and cerebral blood flow velocity than patients with dizziness and patients with neurally-mediated reflex syncope (P < 0.05, ANOVA), but no significant difference was observed on the Gosling's pulsatility index. CONCLUSION: Patients with POTS have an autonomic dysfunction that is not triggered by upright posture but is accentuated by it.

Comparative study of cerebral blood flow between postural tachycardia and neurocardiogenic syncope, during head-up tilt test.

We assessed the cerebral blood flow velocity response to head-up tilt test in patients with typical neurocardiogenic syncope compared with patients showing postural tachycardia. Fifty patients (21 men) with history of orthostatic intolerance, younger than 50 years (mean 27 +/- 10), participated in the study. Transcranial Doppler sonography of the middle cerebral artery, heart rate and brachial blood pressure were recorded during a head-up tilt test. According to the outcome of the test, patients were categorized in two groups: neurocardiogenic syncope (29 patients) and postural tachycardia (21 patients). The clinical history of the two groups was similar. During baseline in the supine position, no differences in haemodynamic parameters were observed. From the first min of tilt, the heart rate was higher in patients with postural tachycardia than in patients with neurocardiogenic syncope. Although, during tilt, the absolute values of the cerebral blood flow parameters were similar in the two groups, throughout tilt, continuous observation of the Doppler recording in patients with postural tachycardia showed intermittent fluctuation of the blood flow velocity, with an oscillatory pattern, which were not observed in the recordings in patients with neurocardiogenic syncope. Comparison of patients with neurocardiogenic syncope, and those with postural tachycardia also showed larger variations of the pulsatility index (P < 0.05) in the postural tachycardia group. These findings support the possibility that abnormalities within the central nervous system play a pivotal role in the pathogenesis of postural tachycardia.

[Evidence of otospongiosis obtained by computerized tomography. Does it compromise the post-stapedectomy auditory gain?]. / La evidencia de otospongiosis por tomografía computada, compromete la ganancia auditiva post-estapedectomía?

To study the influence of tomographic otospongiosis/otosclerosis on the audiometric gain after stapedectomy, we evaluated 34 patients (mean age 39.9 years, S.D. 9.8) with otosclerosis and mixed hearing loss. We performed Computed Tomography (CT) with densitometry before stapedectomy and audiometry before and 4 weeks after the surgery. CT results were classified as compatible or not for otospongiosis (< 1000 UH) or for otosclerosis (> 2000 UH). According to the affected turns of the cochlea, the studies were classified in 3 groups. In 43% of the patients the CT showed otospongiosis. After stapedectomy, air conduction thresholds of the low (125-500 Hz), middle (500-2000 Hz) and high frequency bands (2000-8000 Hz) and for the air/bone gap were similar for the ears with or without otospongiosis (p > 0.05, ANOVA). However, patients with otospongiosis in all the cochlea showed the lowest audiometric gain for the high frequency band (p < 0.05 ANOVA). Evidence of otospongiosis evaluated just by CT has a low impact on the audiometric outcome after stapedectomy.

[Stability of auditory thresholds during the first 5 weeks after stapedectomy]. / Estabilidad de los umbrales de audición durante las primeras 5 semanas post-estapedectomía.

To assess repeatability of audiological test performed every week during the first month post-stapedectomy, audiometry was performed to 21 patients with otosclerosis (mean age 37.8 years, S.D. 9.29), every week, during the 2 weeks prior to stapedectomy and during the first 5 weeks and at week 12 after stapedectomy. Repeatability of the audiological test was evaluated comparing the difference between the audiological evaluations performed before the surgery and the difference between each consecutive pair of audiological evaluations after the surgery, using Bland & Altman method and ANOVA, allowing for 5% of significance. Before the surgery, audiological thresholds, using head phones, were repeatable for low (125-500 Hz), mid (500-2000 Hz) and high (2000-8000 Hz) frequencies in 95% of the patients. After the surgery, repeatability of air conduction thresholds for the low frequency band was evident from the 2nd week, for the mid frequency band was evident from the 3rd week and for the high frequency band from the 4th week. The gain observed at week 5 after surgery was similar to the gain observed at week 12. In conclusion, in this study, stable air conduction auditory thresholds were obtained during the first month after stapedectomy.

Tilt testing in neurocardiogenic syncope: isosorbide versus isoproterenol.

OBJECTIVE: To compare the diagnostic value of pharmacological stimulation with sublingual isosorbide dinitrate and intravenous isoproterenol during tilt testing in patients with neurocardiogenic syncope and with a negative tilt test without pharmacological provocation. METHODS AND RESULTS: One hundred and twenty patients with a history of neurocardiogenic syncope (aged 15 to 77 years) and 50 healthy volunteers (aged 25 to 70 years) were prospectively submitted to head-up tilt (HUT). Those who did not develop syncope or presyncope during passive HUT for 30 minutes underwent repeated HUT with isoproterenol infusion at 4 microg/min (ISOP HUT), for 10 minutes, and, subsequently, were tilted after sublingual administration of 5 mg of isosorbide dinitrate (ISDN HUT) for another 12 minutes. ISDN HUT was always performed after ISOP HUT. Sensitivity and specificity of passive HUT were 41% (95% C.I. 32.9% to 51.0%) and 100%, respectively. Sensitivity of ISOP HUT was 51.4% (95% C.I. 39.2% to 63.6%) and specificity 70% (95% C.I. 55.4% to 82.1%) and for ISDN HUT were 70% (95% C.I. 57.9% to 80.4%) and 88% (95% C.I. 75.7% to 95.5%), respectively. The accuracy of ISDN HUT was significantly higher than the accuracy of ISOP HUT 77.5% (95% C.I. 68.9% to 84.6%). There were fewer side effects during ISDN HUT. CONCLUSION: Sublingual isosorbide dinitrate is at least as sensitive as isoproterenol to assess patients with suspected neurocardiogenic syncope and with a negative tilt test without provocation. The low rate of side effects and the higher accuracy of ISDN HUT, along with the simplicity of this challenge compared to ISOP HUT, suggest that sublingual isosorbide dinitrate should be preferred as a provocative agent to evaluate neurocardiogenic syncope after a negative passive tilt test.