Identification of bacteria isolated from nasal polyps and their ability to produce superantigens and biofilms in Lebanese patients.

Staphylococcus aureus superantigens and bacterial biofilms have been implicated in the development of chronic rhinosinusitis and nasal polyps. We conducted a study of 32 Lebanese patients-21 males and 11 females, aged 15 to 71 years (mean: 39)-to identify bacteria isolated from nasal polyps and to determine if these bacteria produced superantigens and biofilms. Polyps were surgically removed, homogenized, and subjected to bacteriologic studies. The presence or absence of S aureus enterotoxin A, B, C, and D (superantigen) genes was determined in all isolates by polymerase chain reaction. Biofilm production by coagulase-negative staphylococci and Pseudomonas aeruginosa was assessed by tissue culture plate assay. A total of 34 bacterial species/groups were isolated from the nasal polyps. Of these, only 3 (8.8%) were S aureus, and only 1 possessed an enterotoxin-coding gene (enterotoxin B). Moreover, of the 21 coagulase-negative staphylococci isolates that were found, none possessed the investigated genes, and only 1 had a strong biofilm-formation property. Our results could not confirm that S aureus enterotoxins (superantigens) or biofilm-producing bacteria play a role in the development of nasal polyps in the Lebanese group studied.

Quality of life of patients following stages III-IV vestibular schwannoma surgery using the retrosigmoid and translabyrinthine approaches.

OBJECTIVE: Surgery is an unquestionable treatment for stages III and IV vestibular schwannomas. The postoperative quality of life (QOL) remains the main issue of concern. In this study, we have evaluated the postoperative QOL of these patients operated by two surgical approaches, the retrosigmoid approach (RSA) and the translabyrinthine approach (TLA). MATERIALS AND METHODS: This is a retrospective review of 101 stages III and IV vestibular schwannoma cases operated between 2000 and 2006 at our center by the senior author (J.M.). The Short Form SF-36 questionnaire and additional questions were sent to the patients. Comparison was made between the patient group and a control group to evaluate the postoperative QOL. RESULTS: The response rate was 67.3%. There were 44 males and 57 females. The average follow up was 5.9 years. 59 patients were operated using the TLA and 42 using the RSA. Both patient groups had significantly lower scores on the questionnaire when compared to the normal population, and thus a less satisfactory QOL. Pain was the symptom that correlated most with poorer scores on the SF-36 questionnaire, although it was the least frequent symptom reported by the patients. Unsteadiness and facial weakness were the least bothersome complaints. Facial weakness did not correlate with a poorer QOL. CONCLUSION: Operated stages III-IV vestibular schwannoma patients suffer from a certain degree of QOL deterioration compared to normal controls. Hearing deficit was the most prevalent symptom. Pain was the least frequent but the most bothersome and with the highest correlation with a poorer QOL. Interestingly, unsteadiness and facial weakness were the least bothersome complaints. Facial weakness did not correlate with a poorer QOL.

A middle ear implant with a titanium canal wall prosthesis for a case of an open mastoid cavity.

OBJECTIVE: Open mastoid cavity rehabilitation should focus on both anatomical and functional aspects. We hereby report the technique and results of a combined strategy to reconstruct the external ear canal using a titanium wall implant and the middle ear using a fully implantable active middle ear device. METHODS: A fully implantable active middle ear implant was used to rehabilitate the mixed hearing loss of a 63-year-old woman, and a titanium posterior canal wall prosthesis was used to reconstruct the external ear canal during the same procedure. The middle ear implant was placed directly on the footplate. The auditory results were compared to the preoperative unaided thresholds and to the amplification of a conventional hearing aid. RESULTS: Following the procedure, there was an anatomically normal external ear canal with a healed tympanic membrane separating the external from the middle ear spaces. The postoperative auditory gains were on average 31.8 dB on pure-tone audiometry, and 20 dB on speech reception threshold. No complications occurred. CONCLUSION: The rehabilitation of the external ear canal in an open mastoid cavity allows for clinical follow-up of the patient, and the implantation of an active middle ear implant provides appropriate auditory gains both in pure tones and in speech reception thresholds.

Rehabilitation of canal wall down mastoidectomy using a titanium ear canal implant.

OBJECTIVE: To describe the rehabilitation of canal wall down mastoidectomy cavities using a custom-made titanium wall implant and to analyze the benefits and the long-term functional results. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary care center. PATIENTS AND METHODS: We have reviewed the data of 113 consecutive operated ears from 106 patients during a 9-year period (1993-2002). The following preoperative and postoperative criteria were compared: the persistence or resolution of otorrhea, cholesteatoma, and vertigo; external auditory canal healing, position of the titanium prosthesis, and tympanic membrane findings. In addition, the hearing status was evaluated by comparing the preoperative data with the 6-month and last follow-up postoperative data to deduce the air-bone gap (ABG) and the auditory gains. RESULTS: Operated ears (88.5%) were dry after the initial rehabilitation, and 97.3% were dry after a revision surgery for defective canal healing. Most patients (96.5%) were free of vertigo. The external auditory canal wall was in a good position in all cases and allowed for a primary skin healing process in 84% of cases; the remaining patients underwent revision surgery under local anesthesia to complete the healing. The reconstructed drum was stable and anatomic in 73% of the cases (n = 83) after the first surgery. Thirty-six patients (32%) underwent various revision procedures: aeration tube placement for 16 patients with mesotympanic retraction and/or serous effusion, revision surgery for 12 patients with attic retraction or evidence of cholesteatoma, and revision for 5 patients with perforation. At last follow-up, 100% of the ear canals were healed, and 85% of patients had a normal tympanic membrane. No residual cholesteatoma was found at last follow-up. Thirty-six percent of patients had an ABG within 20 dB at last follow-up, and 69% within 30 dB. CONCLUSION: The rehabilitation of canal wall down mastoidectomies improves the quality of life of patients regarding cholesteatoma recurrence, otorrhea, and vertigo in more than 95% of cases and stabilizes the hearing loss to less than 30 dB of ABG for more than two thirds of patients. The main unresolved problem is the persistent dysfunction of the middle ear cavity, with unsatisfactory auditory improvements. Middle ear implants represent in selected cases a new solution to rehabilitate the refractory hearing losses.

Mastoid hyperpneumatization with atlantoaxial fistulization presenting as head rotation-induced aural fullness.

OBJECTIVE: To describe a unique presentation of mastoid hyperpneumatization with atlantoaxial air fistulization. PATIENTS: Case report, 30-year-old male patient. INTERVENTIONS: Descriptive case report. MAIN OUTCOME MEASURES: Subjective aural fullness, with objective tympanogram changes, induced by head rotation. RESULTS: The patient complained of left ear fullness exclusively and repeatedly during neck extension and head rotation to the right side. These head positional changes cause a change of pressure of the atlantoaxial intra-articular emphysematous air, and these fluctuations in pressure are transmitted through the communicating mastoid fistula to the middle ear and tympanic membrane, leading to the sensation of ear fullness. CONCLUSION: We hereby describe the first case of mastoid hyperpneumatization fistulizing into the atlantoaxial joint and presenting with an ipsilateral aural fullness that occurs mainly during contralateral head rotation and extension. This is a characteristic clinical sign that has not been previously described.

Leishmaniasis of the auricle mimicking carcinoma.

Leishmaniasis of the auricle has been rarely reported in our region of the world, where it is labeled as "Old World Leishmaniasis." It may mimic other pathologies, such as malignancies or other infectious processes. We present a case of an auricular Leishmania lesion which was first suspected to be a carcinoma. Four previous auricular Old World Leishmania cases have been reported. The epidemiology, clinical presentation, diagnosis, and treatment of this entity are briefly reviewed.

Vocal changes following radiotherapy to the head and neck for non-laryngeal tumors.

To investigate vocal changes in patients following the neck irradiation for non-laryngeal tumors sparing the glottic region. Fifteen patients were enrolled for the study. Phonatory effort and voice evaluation were reported. Perceptual evaluation and acoustic analysis were performed. Men/women ratio was 6/9. The mean age was 54 years with a range from 24 to 84. The most common primary site of tumor was the nasopharynx and tongue. The mean phonatory effort was significantly greater in the irradiated group versus controls (0.54 vs. 0.08 with a P value 0.01). Fifteen percent reported their voice as being poor and almost 85% as being fair. All the parameters of the GRABS perceptual evaluation were significantly worse in the irradiated group. There were no statistically significant differences between all the acoustic variables in both groups except for an decrease in the Habitual pitch in the irradiated patients. Radiation therapy to head and neck region can affect voice even if the radiation beams spare the vocal folds.

Accidental Removal of a Carotid Endovascular Stent during Oropharyngeal Mass Biopsy.

A 54-year-old male patient, with a history of a right mandibular adenocarcinoma, previously excised, and treated with post operative chemo- and radio-therapy, presented with a right oropharyngeal necrotic mass of several months duration. His history is pertinent for a right internal carotid endovascular stenting 2 years prior to presentation. During biopsy of his oropharyngeal lesion, a specimen of tissue was retrieved, with the carotid stent within. There was no bleeding. To the best of our knowledge, there is no such case reported in the literature. We present this case as a reminder on the importance and risks of radiation-induced necrosis and its distortion of the surrounding anatomy, especially in the presence of foreign bodies or protheses.

Vocal characteristics in children with attention deficit hyperactivity disorder.

The aim of this study was to evaluate vocal changes in patients with attention deficit hyperactivity disorder (ADHD). Nineteen children diagnosed to have ADHD according to the Diagnostic and Statistical Manual of Mental Disorders criteria and 19 controls were enrolled in this study. They underwent vocal perceptual evaluation and acoustic analysis. Hoarseness, breathiness, strain, and loudness were graded on a scale of 0-3. The following acoustic parameters were recorded: Fundamental frequency, Shimmer, Relative average perturbation, Noise-to-Harmony ratio, Voice Turbulence Index, and Habitual pitch. Children with ADHD were perceived to have significantly more hoarseness, breathiness, and straining in their voice. They were also louder compared to controls. There were no significant changes in the acoustic parameters except for the Fundamental frequency, which was lower in the ADHD group. The vocal behavior in children with ADHD is different than controls. Early diagnosis of such behavior in this group of children is important.

Formant frequencies in Middle Eastern singers.

PURPOSE: This work was conducted to describe the formant frequencies in a group of Middle Eastern singers and to look for the presence of the singer's formant described in operatic singers. MATERIAL: A total of 13 Middle Eastern singers were enrolled in this study. There were 5 men and 8 women. METHOD: Descriptive analysis was performed to report the various formants (F1, F2, F3, and F4) in both speaking and singing. The Wilcoxon test was used to compare the means of the formants under both conditions. RESULTS: For both sexes combined, for the /a/ vowel, F1 singing was significantly lower than F1 speaking (P = .05) and F3 singing was significantly higher than F3 speaking (P = .046). For the /u/ vowel, only F2 singing was significantly higher than F2 speaking (P = .012). For the /i/ vowel, both F2 and F3 singing were significantly lower than F2 and F3 speaking, respectively (P = .006 and .012, respectively). There was no clustering of the formants in any of the Middle Eastern sung vowels. CONCLUSION: Formant frequencies for the vowels /a/, /i/, and /u/ differ between Middle Eastern singing vs speaking. There is absence of the singer's formant.

Recurrent facial nerve paralysis: an unusual presentation of fibrous dysplasia of the temporal bone.

Facial nerve paralysis (FNP) is a rare occurrence in fibrous dysplasia (FD) of the temporal bone (FDTB). Eight such cases have been described in the literature. In none of these cases was the FNP the presenting symptom, and in all, a direct etiology for the paralysis was identified. We present the first case of recurrent, unilateral FNP as the sole otological manifestation of FDTB. We discuss possible etiological factors for the paralysis favoring a compressive, transient ischemia of the facial nerve. The authors suggest adding FDTB to the differential diagnosis of recurrent FNP.

Status of the remaining parotid duct and gland following superficial parotidectomy.

The changes in Stensen's duct and remaining parotid tissue following superficial parotidectomy have not been studied previously. The aim of this clinical case control study is to describe these changes using sialography and CT-sialography techniques. Fourteen superficial parotidectomy cases underwent parotid sialography bilaterally. CT sialography was also done. Stensen's duct was patent in 11 cases (79%), and non-patent in three cases (21%). Its angle in relation to our reference line was 20 degrees in operated cases versus 37 degrees for the non-operated cases. Following superficial parotidectomy, the remaining parotid tissues usually remain functional and retain drainage through Stensen's duct. Furthermore, superficial parotidectomy changes the direction of this duct. Parotid sialography and CT sialography can still be used to study the status of remaining parotid tissue following superficial parotidectomy. The post-surgical changes should be reviewed with care before interpreting these studies.

Microdebrider-assisted partial tonsillectomy: short- and long-term outcomes.

Microdebrider-assisted partial tonsillectomy has gained popularity in recent years. However, no prospective long-term follow-up exists in the literature and the risk of increase in tonsillitis is still a concern. We conducted a prospective randomized controlled study to assess the short-term benefits of microdebrider-assisted partial tonsillectomy (group 1) compared to electrocautery-assisted total tonsillectomy (group 2), to monitor the durability of the improvement and watch for any change in the rate of tonsillitis. Patients with symptomatic tonsillar hyperplasia were included and underwent either technique of tonsillar surgery. Duration of operation, amount of intra-operative blood loss, immediate and late complications, postoperative pain, return to normal activity and diet, and relief of obstructive symptoms were measured. Recurrence of symptoms and change in rate of tonsillitis in group 1 were monitored. We studied 143 patients, 77 in group 1 and 66 in group 2. There was no significant difference in the surgical time (P>0.05) or postoperative bleeding (P>0.05) but more blood loss in group 1 (P<0.05) and more dehydration in group 2 (P<0.05) were encountered. All patients had complete relief of symptoms. Group 1 returned earlier to normal activity (2.19 vs. 5.71 days; P<0.05), to normal diet (5.28 vs. 8.16 days; P<0.05) and needed less frequent analgesics (2.14 vs. 6.1 days; P<0.05). More than two-thirds of group 1 and less than one-third of group 2 were pain free after day 3. Most group 1 parents (96.1%) were highly satisfied, at initial follow-up, regarding the decision to perform the surgery in contrast to group 2 parents (19.7%). No recurrence of symptoms and no increase in rate of tonsillitis were noticed among group 1 after 20 months mean follow-up (median 20.6, range 1-36.2 months). Group 1 showed short-term benefits over group 2 and maintained the resultant improvement on the long-term with no infectious drawbacks.