The use of different intranasal splints Doyle splints versus Reuter bivalve splints versus no splints in primary septal surgeries: A randomised clinical trial looking at morbidity.

OBJECTIVE: The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. DESIGN: Randomised clinical trial SETTING: Single-Center trial at a tertiary care facility PARTICIPANTS: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. MAIN OUTCOME MEASURES: Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. RESULTS: Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post-op visits were scheduled significantly earlier in patients with splints (p < .05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p < .05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p > .05). CONCLUSION: Increased post-operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post-operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints.

Rhinolithiasis: A Misleading Entity.

INTRODUCTION: Rhinolithiasis is a rare entity; it entails a stone located in the nasal cavity. The entity presents with different signs and symptoms that can be easily confused with other more common clinical entities such as chronic rhinosinusitis. However, it can also mimic sinonasal tumors, making its proper diagnosis crucial. MATERIALS AND METHODS: In this article, we present a case series of 15 patients over the past 13 years between 2002 and 2015 who were seen in the clinics at the American University of Beirut Medical Center. We will shed light on the common presenting symptoms, physical examination findings, proper diagnostic modalities, and treatment options. Our data will be compared to the literature. CONCLUSION: Rhinolithiasis could present with a wide spectrum of signs and symptoms and could be overlooked or mistaken for other diagnosis such as sinusitis or malignancy. It could be differentiated from other entities by rigid nasal endoscopy and computed tomography scan. The diagnosis of rhinolithiasis requires a high index of suspicion.

Bilateral superior semicircular canal dehiscence in a child with sensorineural hearing loss and without vestibular symptoms.

To report a rare case of bilateral superior semicircular canal dehiscence (SCCD) in a child. Case report, 11-year-old female patient. Descriptive case report. Audiological findings of bilateral symmetrical low frequency sensorineural hearing loss with ascending curves and bilateral superior semicircular canal dehiscence on a high resolution computed tomography (CAT) scan. The young child presented with bilateral fluctuating hearing loss with no vestibular symptoms. She was found to have bilateral superior semicircular canal dehiscence. We hereby present a rare case of bilateral semicircular canal dehiscence found incidentally on high resolution CAT scan in a young child during work up for bilateral sensorineural hearing loss.

Transient-evoked otoacoustic emissions in a group of professional singers who have normal pure-tone hearing thresholds.

OBJECTIVES: The objective of this study was to determine whether transient-evoked otoacoustic emissions (TEOAEs) measured in a group of normal-hearing professional singers, who were frequently exposed to high-level sound during rehearsals and performances, differed from those measured in age- and gender-matched normal-hearing non-singers, who were at minimal risk of hearing loss resulting from excessive sound exposure or other risk factors. DESIGN: Twenty-three normal-hearing singers (NH-Ss), 23 normal-hearing controls (NH-Cs), and 9 hearing-impaired singers (HI-Ss) were included. Pure-tone audiometry confirmed normal-hearing thresholds (>or=15 dB HL) at 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, and 8.0 kHz in NH-Ss and NH-Cs, and confirmed mild, high frequency, sensorineural hearing loss in HI-Ss (HI-Ss were included only to estimate sensitivity and specificity values for preliminary pass or fail criteria that could be used to help identify NH-Ss at risk for music-induced hearing loss). TEOAEs were measured twice in all ears. TEOAE signal to noise ratio (S/N) and reproducibility were examined for the whole wave response, and for frequency bands centered at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz. RESULTS: Moderate to high correlations were found between test and retest TEOAE responses for the three groups. However, absolute test-retest differences revealed standard deviations that were two to three times larger than those reported previously, with the majority of the variability occurring for the 1.0 kHz band. As such, only the best TEOAE response (B-TEOAE) from the two measurements in each ear was used in further analyses, with data from the 1.0 kHz band excluded. With one exception, within-group comparisons of B-TEOAE S/N and reproducibility across ears and gender revealed no statistically significant differences for either NH-Ss or NH-Cs. The only significant within-group difference was between left and right ears of NH-C females for S/Ns measured in the 2.0 kHz band, where median responses from right ears were found to be higher than left ears. Across-group comparisons of B-TEOAEs revealed lower median S/N and reproducibility values for NH-Ss compared with NH-Cs for the whole wave response and 1.4 kHz band. For the 2.0 kHz band, reproducibility was similar for the normal-hearing groups but median S/N was found to be lower for NH-Ss. No significant differences in S/N or reproducibility were found between normal-hearing groups for the 2.8 and 4.0 kHz bands. Using data from NH-Cs and HI-Ss to establish sensitivity and specificity values for various TEOAE pass or fail criteria, six preliminary criteria were identified as having sensitivity and specificity values >or=90%. When these criteria were applied to NH-Ss, the number of NH-S ears passing ranged from 57% to 76%, depending on the criteria used to judge the NH-S ears, which translates into 24% to 43% of ears failing. CONCLUSIONS: Although TEOAE responses were measurable in all singers with normal audiometric thresholds, responses were less robust than those of NH-Cs. The findings suggest that subtle cochlear dysfunction can be detected with TEOAE measurement in a subset of normal-hearing professional singers. Although preliminary, the study findings highlight the importance of pass or fail criterion choice on the number of ears that will be identified as "at risk" for music-induced hearing loss.

Atypical lipomatous tumors of the face: a controversial issue.

We reviewed the topic of atypical lipomatous tumors including definition, diagnosis and management, with special emphasis on head and neck location and to report on the management of a rare case located in the temporalis muscle. Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLS) are rarely reported in the head and neck. Their behavior dictates a complete resection. Resection with a safety margin is sometimes needed according to the histological characteristics. Tumors located to the masticator space can be accessed through a mucosal approach achieving relative safety to the facial nerve. ALT constitute a group of tumors of a borderline behavior. Their management can be affected by some histological criteria and by their location in the head and neck region where vital structures can be affected.