Individual Responses of Captive Amazon Parrots to Routine Handling Can Reflect Their Temperament.

Individual responses to physical restraint and temperament have been assessed in birds of several species; however, there is a paucity of research which investigates both aspects, especially in captive parrots. This lack of studies raises doubts about which temperament traits, if any, are evidenced during handling and if the intensity of responses to restraint is affected by behavioral training programs, a common practice used in ex situ conservation programs. To understand more about the subject, this study aimed to identify the main temperament dimensions of parrots and investigate their relationship with response to physical restraint for blood collection. A secondary aim was to evaluate whether parrots exhibited higher responsiveness to physical restraint after training to improve flight capacity and increase aversion to humans. The main dimensions identified were activity, neophilia, vigilance, and fearfulness. The more fearful parrots in temperament evaluations were more responsive to physical restraint, showing more vocalizations and struggle attempts than the less fearful ones. After training, the parrots showed higher responsiveness to physical restraint. We suggest that physical restraint for routine handling, such as blood collection, could be a feasible option for centers of rehabilitation to use to obtain data on individual behavioral differences in fear responses.

Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial.

PURPOSE: The purpose of this prospective, randomized, multicenter clinical trial was to compare the therapeutic efficacy of systemic versus intratympanic versus combined administration of steroids in the treatment of idiopathic sudden sensorineural hearing loss. METHODS: 102 patients with an up to 14 days history of idiopathic sudden sensorineural hearing loss were randomized to 1 of 3 arms and followed prospectively. Group A (35 patients) received prednisolone intravenously followed by methylprednisolone orally, whereas Group B (34 patients) were administered intratympanic methylprednisolone. Patients in Group C (33 patients) were administered the combination of the above-mentioned treatment modalities. The patients were followed-up with pure tone audiograms on days 1 (initiation of treatment), 3, 5, 10, 30 and 90. RESULTS: The final mean hearing gain was 29.0 dB HL for Group A, 27.0 dB HL for Group B and 29.8 dB HL for Group C. The differences between the three groups were not statistically significant. When hearing improvement was assessed according to Siegel's criteria, no statistically significant difference was recorded either. Furthermore, patients younger than 60 years old achieved significantly better hearing outcomes. CONCLUSIONS: The results demonstrated that systemic, intratympanic and combined steroid administration have similar results in the primary treatment of idiopathic sudden hearing loss. Younger patients are more likely to achieve better hearing outcomes.

Nasal air-conditioning after partial turbinectomy: myths versus facts.

BACKGROUND: Turbinectomy, although a common procedure, is often accused of having a negative impact in all nasal functions. This study is the first in vivo study that evaluates objectively the effect of partial turbinectomy on nasal air-conditioning capacity. METHODS: In total, 57 patients with prior partial inferior turbinectomy and 28 healthy controls were examined. Intranasal temperature and humidity values were measured at the level of the head of inferior and middle turbinate. Nasal patency was evaluated by means of acoustic rhinometry. The clinical assessment was completed with nasal endoscopy and the Nasal Obstruction Symptom Evaluation questionnaire for subjective evaluation of nasal patency. RESULTS: Significant changes of temperature were found in both detection sites with 13% reduced heating capacity of the air at the level of the inferior and 19% at the level of the middle turbinate, respectively. No similar results were found for humidity measurements. No correlations were found between air-conditioning values and acoustic rhinometry results for both study groups. Nasal endoscopy revealed normal healing in all patients. No major complications were reported by the patients. Their subjective ratings of nasal obstruction were similar to healthy controls. CONCLUSION: Partial turbinectomy seems to have a negative impact on intranasal air heating but not to humidification. This effect has no impact on clinical condition and subjective perception of surgical outcome.

Corticosteroids and vestibular exercises in vestibular neuritis. Single-blind randomized clinical trial.

IMPORTANCE The management of patients with unilateral acute vestibular neuritis (VN) has not been established to date. OBJECTIVE To compare the use of vestibular exercises vs corticosteroid therapy in the recovery of patients with acute VN. DESIGN, SETTING, AND PARTICIPANTS Prospective, single-blind, randomized clinical trial at a primary referral center. Among all patients with acute vertigo, those having VN were eligible for inclusion in the study. INTERVENTIONS Forty patients with acute VN were randomly assigned to perform vestibular exercises or to receive corticosteroid therapy. After a baseline examination, follow-up evaluations were performed at 1, 6, and 12 months. MAIN OUTCOMES AND MEASURES Efficacy outcomes included clinical, canal, and otolith recovery. Scores on the European Evaluation of Vertigo Scale and the Dizziness Handicap Inventory were used for the evaluation of clinical recovery. Findings of caloric irrigation and vestibular evoked myogenic potentials indicated canal and otolith improvement, respectively. RESULTS Comparing the 2 treatment groups, no statistically significant differences were found in clinical, canal, or otolith recovery. At the 6-month examination, the number of patients with complete disease resolution in the corticosteroids group was significantly higher than that in the vestibular exercises group. However, at the end of the follow-up period, 45%(9 of 20) of patients in the vestibular exercises group and 50% (10 of 20) of patients in the corticosteroids group had complete disease resolution (P > .05). CONCLUSIONS AND RELEVANCE Treating patients who have acute VN with vestibular exercises seems equivalently effective as treating them with corticosteroid therapy in clinical, caloric, and otolith recovery. Corticosteroid therapy seems to enhance earlier complete acute VN resolution, with no added benefit in the long-term prognosis.

Bilateral secondary neurolymphomatosis of the internal auditory canal nerves: a case report.

BACKGROUND: Neurolymphomatosis describes the malignant lymphomatous infiltration of nerves. METHODS: We encountered a unique case of a 47-year-old patient with non-Hodgkin's lymphoma presenting with bilateral sensorineural hearing loss, vestibular dysfunction and bilateral facial nerve palsy. RESULTS: Magnetic resonance imaging demonstrated enhancement and thickening of internal auditory canal nerves bilaterally consistent with neurolymphomatosis. Patient was treated with combined intrathecal chemotherapy and total brain irradiation. CONCLUSIONS: One must always remain vigilant for metastatic disease in patients with sensorineural hearing loss and/or vestibular dysfunction and facial nerve palsy in the context of known malignancy.

Hybrid carcinoma of the larynx: a case report (adenoid cystic and adenocarcinoma) and review of the literature.

Introduction. The nonsquamous carcinomas of the larynx are considered rare with the majority of malignant tumors in this area, reaching the rate of 95%, to be squamous cell neoplasms. Case Report. The case refers to a 53-year-old man that presented with symptomatology of motor nerve disease. During the evaluation of the neurologic disease, a subglottic mass of the larynx was revealed accidentally in the imaging examination. Under general anesthesia, we performed direct laryngoscopy and biopsy of the mass. The histopathologic examination revealed a hybrid carcinoma coexistence of two different carcinomas, an adenoid cystic carcinoma and an adenocarcinoma, not otherwise specified with poor differentiation. Regarding the therapeutic plan, the mass was considered inoperable due to its expansion to trachea and the patient received radiotherapy. Conclusions. Both the adenocarcinoma and adenoid cystic carcinoma are extremely rare types of malignant tumors in the larynx. The special interest of the present case is the coexistence of these two rare tumors in the same region of the larynx, being a hybrid tumor of the salivary glands in the larynx, which is the second reported case, based on our systematic literature review.

Sarcoidosis-like granulomatosis of the hypopharynx as a complication of anti-TNF therapy.

INTRODUCTION: Sarcoidosis is a multisystem granulomatous disease of unknown etiology, occasionally presenting with signs and symptoms that occur within the head and neck. Recently, granulomatous reactions and cases of sarcoidosis have been reported in patients treated with anti-TNF agents. METHODS: This report describes a 56-year-old man who developed sarcoidosis in the hypopharynx during adalimumab therapy for psoriatic arthritis. A retrospective review of the literature was performed using the PubMed database. RESULTS: In our patient, a chronic granulomatous reaction consistent with sarcoidosis developed after 2 years of continuous treatment with adalimumab. The diagnosis of sarcoidosis was established by the typical well-formed non caseating granulomas on biopsy, after excluding all other granulomatous conditions. Following withdrawal of anti-TNF agents and a course of steroids, the clinical picture resolved. CONCLUSIONS: The development of sarcoidosis during treatment with TNF-a antagonists represents a rare and paradoxical adverse event. To our knowledge this is the first case of sarcoidosis of the hypopharynx reported in the literature.

Duplication of the external auditory canal: two cases and a review of the literature.

The objective of the present paper is to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of 2 patients with first branchial cleft anomaly. The first case was an 8-year-old girl presented with an elastic lesion located in the left infra-auricular area, in close relation with the lobule, duplicating the external auditory canal. The magnetic resonance imaging revealed a lesion, appearing as a rather well-circumscribed mass within the left parotid gland and duplicating the ear canal. A superficial parotidectomy was subsequently performed, with total excision of the cyst. The second patient was a 15-year-old girl presented with a congenital fistula of the right lateral neck. At superficial parotidectomy, a total excision of the fistula was performed. During the operation the tract was recorded to lay between the branches of the facial nerve, extending with a blind ending canal parallel to the external acoustic meatus. Conclusively, first branchial cleft anomalies are rare malformations with cervical, parotid, or auricular clinical manifestations. Diagnosis of first branchial cleft lesions is achieved mainly through careful physical examination. Complete surgical excision with wide exposure of the lesion is essential in order to achieve permanent cure and avoid recurrence.

Speech perception and production in children with inner ear malformations after cochlear implantation.

OBJECTIVE: The aim of this study was to assess the speech perception and speech intelligibility outcome after cochlear implantation in children with malformed inner ear and to compare them with a group of congenitally deaf children implantees without inner ear malformation. METHODS: Six deaf children (five boys and one girl) with inner ear malformations who were implanted and followed in our clinic were included. These children were matched with six implanted children with normal cochlea for age at implantation and duration of cochlear implant use. All subjects were tested with the internationally used battery tests of listening progress profile (LiP), capacity of auditory performance (CAP), and speech intelligibility rating (SIR). A closed and open set word perception test adapted to the Modern Greek language was also used. In the dysplastic group, two children suffered from CHARGE syndrome, another two from mental retardation, and two children grew up in bilingual homes. RESULTS: At least two years after switch-on, the dysplastic group scored mean LiP 62%, CAP 3.8, SIR 2.1, closed-set 61%, and open-set 49%. The children without inner ear dysplasia achieved significantly better scores, except for CAP which this difference was marginally statistically significant (p=0.009 for LiP, p=0.080 for CAP, p=0.041 for SIR, p=0.011 for closed-set, and p=0.006 for open-set tests). CONCLUSION: All of the implanted children with malformed inner ear showed benefit of auditory perception and speech production. However, the children with inner ear malformation performed less well compared with the children without inner ear dysplasia. This was possibly due to the high proportion of disabilities detected in the dysplastic group, such as CHARGE syndrome and mental retardation. Bilingualism could also be considered as a factor which possibly affects the outcome of implanted children. Therefore, children with malformed inner ear should be preoperatively evaluated for cognitive and developmental delay. In this case, counseling for the parents is mandatory in order to explain the possible impact of the diagnosed disabilities on performance and habilitation.

Autoimmune recurrent facial palsy and bilateral sudden sensorineural hearing loss following Ramsay Hunt-like syndrome.

OBJECTIVE: To describe the first published case of recurrent facial nerve palsy associated with bilateral sudden sensorineural hearing loss of autoimmune origin. CASE REPORT: A 33-year-old male presented with acute facial palsy on the left following a vesicular herpetic eruption in the external ear canal on the same side. Serologic measurements demonstrated an elevation of IgM antibodies against herpes simplex virus but not for varicella-zoster virus, confirming a Ramsay Hunt-like syndrome due to herpes simplex virus. The following four months, the patient exhibited other three episodes of facial palsy, well responded to steroid treatment. During the clinical course, a sudden sensorineural hearing loss was also diagnosed, initially on the left side and then on both sides. The autoimmune markers such as the antinuclear antibody and the anti-gangliosides antibodies (anti-GM1, anti-GQ1b) were found positive. Despite steroid treatment, hearing did not show any improvement, remaining moderate on the right and severe on the left. CONCLUSION: Recurrent facial nerve palsy and bilateral sudden sensorineural hearing loss could be the expression of autoimmune disturbances. The initial triggered factor could be the herpes simplex virus infection, such as a Ramsay Hunt-like syndrome.

Tuberculous retropharyngeal abscess as a cause of oropharyngeal dysphagia.

Tuberculosis is known to affect almost every organ in the body, but its manifestations in the head and neck region are quite rare. A tuberculous retropharyngeal abscess is a very rare condition and can be the cause of oropharyngeal dysphagia. It is usually secondary to tuberculosis of the spine and has the potential of significant morbidity and mortality if not treated appropriately. We present a case of a 74-year-old man with a retropharyngeal abscess with no evidence of spinal tuberculosis.

Conversion of canalolithiasis to cupulolithiasis in the course of a horizontal benign paroxysmal positional vertigo case.

The benign paroxysmal positional vertigo of the horizontal semicircular canal is manifested with either geotropic or apogeotropic horizontal nystagmus. A 61-year-old male patient who experienced repeated episodes of positional vertigo is presented in this study. The vertigo was reported to be more severe while rotating his head to the left and then to the right. The initial examination revealed a geotropic purely horizontal nystagmus at the lateral positions of the head compatible with canalolithiasis of the left horizontal semicircular canal. In this case, the otoconia debris migrates from the vestibule into the horizontal semicircular canal through its nonampullary end, where they float freely (canalolithiasis). Five days later, the geotropic nystagmus transformed to apogeotropic. Thus, it may be assumed that the otoconia debris adhered to the cupula and converted the canalolithiasis to cupulolithiasis of the horizontal semicircular canal on the same side. With rotation of the head to the left while the patient was in the supine position, gravity causes the weighted cupula to deflect ampullofugally, resulting in apogeotropic nystagmus; the opposite was noticed when the head was rotated to the right. The so-called barbecue maneuver was initially effective curing the geotropic form of the condition and consequently the modified Semont maneuver for the apogeotropic form.

Endoscopic closure of an iatrogenic rupture of upper esophagus (Lannier's triangle) with the use of endoclips - case report and review of the literature.

We present a case report regarding a 74-year-old male with iatrogenic esophageal perforation, after an attempt to remove a food bolus impaction at Lannier's triangle (proximal esophagus). The perforation was treated endoscopically (flexible EGD) by clip application in two sessions, with excellent outcome. Esophageal perforations occur rarely, usually following a medical procedure. The clinical manifestations are often insidious with potentially catastrophic complications. Although the majority of cases have been treated conservatively and/or operatively over the years, there is a rising tendency for non-operative endoscopic interventions due to the high morbidity and mortality rates seen even in specialized units. For this reason self-expandable stents, endoclips, tissue sealants and suturing devices have been used. A high degree of clinical suspicion is essential for successful management of esophageal perforations, as is early decision to intervene and respect for basic surgical principles such as prevention and limitation of extraesophageal contamination, prevention of reflux of gastric contents and restoration of gastrointestinal tract integrity. The published reports on the use of endoclips for repairing perforations of the proximal esophagus are rare. To our knowledge, this is the first case report regarding the endoscopic application of endoclips for the successful closure of an iatrogenic perforation at Lannier's triangle.

Psychometric properties of the EORTC head and neck-specific quality of life questionnaire in disease-free Greek patients with cancer of pharynx and larynx.

PURPOSE: The purpose of our study was to formally translate to and determine the psychometric properties of QLQ-H&N35 in a group of Greek patients who had been successfully treated for laryngeal or pharyngeal cancer. METHOD: The Greek translation of the questionnaire was performed according to the instructions of EORTC Quality of Life group as described in the translation manual. The procedure included forward and backward translations followed by a pilot study and was reported and accepted by the EORTC Quality of Life group. In a cross-sectional study, the translated EORTC QLQ-H&N35 in conjunction with the core EORTC QLQC30 questionnaire was given to 116 patients who had been successfully treated for cancer of larynx or pharynx. RESULTS: The compliance was high, and the QLQ-H&H35 demonstrated acceptable reliability (internal consistency) and construct validity. The questionnaire had the ability to distinguish between patients with different performance status, site, treatment modality, and disease stage. CONCLUSION: The Greek version of EORTC H&N35 in conjunction with the EORTC C30 is a valid and informative tool in assessing quality of life in Greek patients with cancer of larynx and pharynx.

Corticosteroids in the treatment of vestibular neuritis: a systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyze the results of all randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis. DATA SOURCES: An electronic search was performed in MEDLINE, EMBASE, Cochrane Library, and CENTRAL databases, and then extensive hand-searching was performed for the identification of relevant studies. No time and language limitations were applied. STUDY SELECTION: Prospective randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis. DATA EXTRACTION: Odds ratios (ORs), weighted mean differences (WMD), 95% confidence intervals (CIs), and tests for heterogeneity were reported. DATA SYNTHESIS: Four studies were eventually identified and systematically reviewed. Meta-analysis was feasible for 3 studies. Regarding the recovery of clinical symptoms, the proportion of patients with clinical recovery at 1 month after the initiation of therapy did not differ significantly between the corticosteroids and placebo groups (OR, 1.45; 95% CI, 0.26-8.01; p = 0.67). The proportion of patients with caloric complete recovery was significantly different between the corticosteroids and placebo groups both at 1 (OR, 12.64; 95% CI, 2.6-61.52; p = 0.002; heterogeneity, p = 0.53; fixed effects model) and 12 months (OR, 3.35; 95% CI, 1.45-7.76; p = 0.005; heterogeneity, p = 0.03; random effects model) after the initiation of therapy. The caloric extent of canal paresis at 12 months after the initiation of therapy seemed to differ significantly between patients who received corticosteroids and those who received placebo (WMD, -12.15; 95% CI, -19.85 to -4.46; p < 0.05; heterogeneity, p < 0.05; random effects model). CONCLUSION: The present systematic review and meta-analysis, based on the currently available evidence, suggests that corticosteroids improve only the caloric extent and recovery of canal paresis of patients with vestibular neuritis. At present, clinical recovery does not seem be better in patients receiving corticosteroids.

Primary laryngeal lymphoma: report of 3 cases and review of the literature.

BACKGROUND: Extranodal lymphomas limited to the larynx are rare, accounting for less than 1% of all laryngeal neoplasms. The aim of this study was to report the experience of our department in the management of these aggressive lesions, as they require special diagnostic and therapeutic attention. METHODS: The case records of 3 patients with the diagnosis of lymphoma involving the larynx were retrospectively reviewed. RESULTS: The histopathological diagnosis revealed 1 case of marginal zone lymphoma mucosa-associated lymphoid tissue type, 1 case of T-lymphoblastic lymphoma, and 1 case of a rare coexistence of in situ squamous cell carcinoma with an isolated intravascular (angioimmunoblastic) lymphoma of peripheral T-cell origin. Details of the presentation, diagnostic procedures, treatment, and outcome of these patients were presented. CONCLUSIONS: Primary laryngeal lymphoma is a rare entity. Early symptoms are subtle and nonspecific, and confirmation of the diagnosis is often difficult. Because of the rarity of this tumor type, the optimal management remains controversial and it seems that should be managed not as a distinct disease entity but as an unusual presentation of non-Hodgkin lymphoma, according to the recent treatment trends.

Extramedullary plasmacytoma of temporal bone: report of 2 cases and review of literature.

OBJECTIVE: The aim of the study was to report 2 cases of extramedullary plasmacytoma (EP) with localization to middle ear that were diagnosed and managed in our department. METHODS: The first patient was a 60-year-old man with progressive hearing loss, tinnitus, recurrent episodes of otalgia, and otorrhea in his right ear during the last 2 years. The second patient was a 66-year-old man who presented with aural fullness in his right ear and a mild pain in the region of right mastoid. Mild hearing loss and episodes of dizziness with sensation of falling for about 6 months were reported in the clinical history. CONCLUSIONS: The prognosis of EP is considered favorable in regard to the solitary bone plasmacytoma and multiple myeloma (MM). The differential diagnosis of EPs from other plasma cell dyscrasias and especially from MM is considered essential. It is a radiosensitive tumor and, especially for EPs of temporal bone, the combined treatment of surgery resection and postoperative radiation seems to provide the best local control and the lower risk of occurrence. The therapeutic strategy includes a close follow-up of the patients because of the risk of occurrence and/or dissemination into MM. The 10-year survival rate reaches 70% with the appropriate therapy.

Influence of the turbinate volumes as measured by magnetic resonance imaging on nasal air conditioning.

BACKGROUND: Changes in nasal airflow caused by varying intranasal volumes and cross-sectional areas affect the contact between air and surrounding mucosa entailing alterations in nasal air conditioning. This study evaluates the correlation between nasal air conditioning and the volumes of the inferior and middle turbinates as measured by magnetic resonance imaging (MRI). METHODS: Fourteen healthy volunteers were enrolled. Each volunteer had been examined by rhinomanometry, acoustic rhinometry, intranasal air temperature, and humidity measurements at defined intranasal sites as well as MRI of the nasal cavity and the paranasal sinuses. The volumetric data of the turbinates was based on the volumetric software Amira. RESULTS: Comparable results were obtained regarding absolute humidity values and temperature values within the nasal valve area and middle turbinate area for both the right and the left side of the nasal cavity. No statistically significant differences were found in the rhinomanometric values and the acoustic rhinometry results of both sides (p > 0.05). No statistical correlations were found between the volumes of the inferior (mean, 6.1 cm3) and middle turbinate (mean, 1.8 cm3) and the corresponding humidity and temperature values. Additionally, the air temperature and humidity values did not correlate with the rhinometrical endonasal volumes (0-20 mm and 20-50 mm from the nasal entrance). CONCLUSION: The normal range of volumes of the inferior and middle turbinate does not seem to have a significant impact on intranasal air conditioning in healthy subjects. The exact limits where alterations of the turbinate volume negatively affect nasal air conditioning are still unknown.

Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature.

OBJECTIVE: Postural restrictions after canalith repositioning maneuvers (CRM) for benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) have no proven value and therefore most physicians regard them as unnecessary. The aim of this study was to assess the short-term efficacy of head and body movement limitations after a single Epley maneuver. A review of the literature was performed to assess the current level of evidence for the efficacy of postural restrictions. MATERIALS AND METHODS: Sixty-four patients, median age 59 years (range 37-82 years), with p-BPPV, were allocated either to instructions for movement restrictions or free movements for 48 h after a single Epley maneuver. The minimization method was used for allocation to treatment. This procedure 'minimizes' the differences in the distribution of pre-specified prognostic factors (e.g. sex and age) between the two groups of treatment. Minimization was preferred over randomization which is not as effective in balancing baseline characteristics when the number of participants is small. Outcome was assessed by physician and patient reported measures (Dix-Hallpike test, subjective vertigo intensity in a 10-point scale, patient's assessment of improvement) within 1 week after treatment by an independent investigator. The level of statistical significance was 0.05. RESULTS: More patients with movement restrictions reported a subjective improvement after treatment (p=0.007). Ninety percent of patients with movement restrictions and 74.2% of patients with free movements had a negative follow up Dix-Hallpike test but the difference was not significant (p=0.108). The mean pre-treatment vertigo intensity was reduced from 6.07 and 5.97 to 1.18 and 2.86, respectively but the difference was not significant (p=0.122). CONCLUSIONS: Postural restrictions do not increase the efficacy of the canal-repositioning maneuver despite the fact that patients report a subjective improvement after post-procedural instructions. In the review of the literature, all studies except one conclude that postural restrictions are unnecessary. However, a number of methodological issues such as inadequate sample size are not addressed and more conclusive evidence is required. Based on current evidence, the use of postural restrictions after the canal-repositioning maneuver is unjustified.