The Importance of Extended High Frequencies in Hearing Evaluation of Pediatric Patients with Type 1 Diabetes

Objective: Type 1 diabetes (T1D), one of the most common childhood diseases worldwide, can cause hearing loss through systemic effects. Diabetes-induced hearing loss is considered a progressive sensorineural hearing loss with a gradual onset, typically occurring at high frequencies (HFs). Extended HF (EHF) hearing sensitivity in children with T1D who did not complain of hearing loss was investigated as an early marker for hearing loss at the standard/conventional frequency range of hearing. Methods: Forty-two children (21 with T1D and 21 healthy controls) were evaluated in a case-control design. Conventional and EHF (14,000, 16,000, and 18,000 Hz) audiometry were performed. The diabetes group underwent routine blood biochemistry and glycated hemoglobin A1c measurements. The data were analyzed by the Student's t-test, Mann-Whitney U test, chi-square test, and logistic regression analysis. Results: The mean hearing thresholds were significantly higher (p<0.05) in the diabetes group than in controls at 500, 2,000, 4,000, and 8,000 Hz [all <15 decibel hearing level (dB HL)]. The number of ears with thresholds >15 dB HL at 14,000-18,000 Hz but ≤15 dB HL at 500-4,000 Hz was significantly higher in the diabetes group than in the control group (p=0.049). Conclusion: Children with diabetes showed normal hearing thresholds within the conventional audiometric frequency range but they had higher hearing thresholds during EHF audiometry when compared with controls. Audiometry in these children should be performed using frequencies above 8,000 Hz combined with the conventional frequency range. EHF audiometry may be an effective method for identifying subclinical hearing loss in children with diabetes. Thus, diabetic children with an EHF mean hearing threshold above 15 dB HL should be monitored more closely in terms of blood glucose regulation to prevent diabetes-related hearing loss at the conventional frequency range.

The impact of preoperative psychological characteristics on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery.

PURPOSE: To investigate the effect of preoperative mental state on postoperative satisfaction and quality of life in patients undergoing septoplasty and inferior turbinate ablation surgery. METHODS: A total of 41 patients who underwent septoplasty and inferior turbinate ablation surgery due to nasal congestion were included in the study. Patients were asked to complete the Mental Symptoms Checklist Revised (SCL-90 R), World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF-TR), and Visual Analogue Scale (VAS) tests before and after their surgery. The surgical procedure for all patients was performed by a single ear-nose-throat physician. The preoperative and postoperative test results were then compared. RESULTS: A significant decrease was noted in the postoperative SCL-90 R somatization (p < 0.001), additional items (p = 0.001), and global severity index (GSI) (p = 0.002) scores; a significant increase was observed in the postoperative WHOQoL-BREF-TR physical health score (p = 0.029); and a significant decrease was seen in the postoperative VAS scores (p < 0.001). The preoperative SCL-90 R GSI showed a negative correlation with the postoperative WHOQoL-BREF-TR total score and a significant positive correlation with the postoperative VAS scores (p < 0.05 for all). There was a significant difference between those with a postoperative VAS score of ≤ 2 and > 2 in terms of GSI and all preoperative SCL-90 R subscale scores, except for the additional items subscale. Increased preoperative psychological symptoms reported by the patients were associated with a lower perception of postoperative quality of life. CONCLUSION: The preoperative mental state of patients undergoing septoplasty and inferior turbinate ablation surgery affects postoperative satisfaction and quality of life. In addition, the recognition of this parameter may contribute to the treatment management of these patients and the legal protection of physicians.

Does Oral Monosodium Glutamate Have a Cochleotoxic Effect? An Experimental Study.

INTRODUCTION: The effect of orally consumed monosodium glutamate (MSG), which is a common additive in the food industry, on the cochlea has not been investigated. The present study aimed to investigate the possible cochleotoxic effects of oral MSG in guinea pigs using electrophysiological, biochemical, and histopathological methods. METHODS: Thirty guinea pigs were equally divided into control and intervention groups (MSG 100 mg/kg/day; MSG 300 mg/kg/day). At 1 month, 5 guinea pigs from each group were sacrificed; the rest were observed for another month. Electrophysiological measurements (distortion product otoacoustic emission [DPOAE] and auditory brainstem response [ABR]), glutamate levels in the perilymph and blood samples, and histopathological examinations were evaluated at 1 and 2 months. RESULTS: Change in signal-to-noise ratio at 2 months was significantly different in the MSG 300 group at 0.75 kHz and 2 kHz (p = 0.013 and p = 0.044, respectively). There was no statistically significant difference in ABR wave latencies of the guinea pigs given MSG compared to the control group after 1 and 2 months; an increase was noted in ABR thresholds, although the difference was not statistically significant. In the MSG groups, moderate-to-severe degeneration and cell loss in outer hair cells, support cells, and spiral ganglia, lateral surface junction irregularities, adhesions in stereocilia, and partial loss of outer hair cell stereocilia were noted. CONCLUSION: MSG, administered in guinea pigs at a commonly utilized quantity and route of administration in humans, may be cochleotoxic.

Prevalence of and factors affecting otitis media with effusion in children in the region from Balkans to Caspian basin; A multicentric cross-sectional study.

OBJECTIVE: The aim of our study was to contribute to the literature about the prevalence of OME by conducting a research in a wide geography examining most of the associating factors together with a questionnaire. Additionally, possible effects of altitudes and latitudes, concordance between the otoscopic examination findings and tympanometric and acoustic reflex test results were evaluated in 4-7 years old children in the same season in different countries. METHODS: In the randomly sampled schools from different regions of different cities where people of different scoioecomonic statuses live, 4-7 year-old children were included in the study. The results of the questionnaire covering the potential factors in OME etiology were evaluated together with the results of the otoscopic examination and tympanometry findings, and also the acoustic reflex findings to direct the interpretation in cases of low amplitude - blunted peak tympanograms which can be interpreted as a "Type B" or "Type As". All the results were gathered in the same season. RESULTS: Ten centers from nine countries participated in the study. A total of 4768 children were evaluated. The frequency of OME diagnosed by otosopic examination was 22.48% (n=1072) and the diagnosis rate when otoscopic examination plus type B tympanometry were taken into account was found as 11.3% (n=539) in general population. Factors increasing the prevalence of OME were found as; mother's educational level (p=0.02), child's age (p=0.006), history of upper respiratory tract infection (p=0.001), smoking father (p=0.01), mother being a housewife or laborer (p=0.01), history of allergy (p=0.001), asthma (p=0.04), or allergy symptoms (p=0.02). No direct relationship was found between altitudes or latitudes and prevalence of OME. CONCLUSION: The important affecting factors found after analyzing all of the potential risk factors in the same model are secondhand smoke exposure, low level of mother's education, mother's occupation, positive history of URTI, and age of the child being less than 7. By paying attention to the factors that increase the prevalence of OME, putting particular emphasis on the preventable ones such as smoking, education, and fighting with allergies could decrease the prevalence of this public health issue.

Frequency of Epstein-Barr virus and human papilloma virus in patients with nasopharyngeal carcinoma.

PURPOSE: Nasopharyngeal cancer is a type of malignancy originating from the epithelial cells lining the nasopharynx. In genetic and environmental factors, infection with Epstein-Barr virus is one of the particular factors held accountable for the etiopathogenesis. Human papillomavirus has been associated with cervical, anogenital, and oropharyngeal cancers. The aim of the present study is to demonstrate the presence and incidence of Epstein-Barr virus and human papillomavirus in patients with nasopharyngeal cancer. METHODS: The information collected for these patients included age at the time of biopsy, gender, alcohol consumption and smoking, and histopathological type of nasopharyngeal cancer. Only patients for whom nasopharyngeal biopsy was performed as punch biopsy were included in the study. In situ hybridization was performed with formalin-fixed, paraffin-embedded tissue sections for Human Papillomavirus and Epstein-Barr virus nucleic acids obtained by means of automated Ventana BenchMark Medical system RESULTS: Utilizing in situ hybridization with samples obtained from 56 patients diagnosed with nasopharyngeal cancer. Epstein-Barr virus was positive in 41 out of the 56 (73.2%) patients, while human papillomavirus was positive in 3 (5.4%), and 1 patient (1.8%) had co-infection. Thirty seven (90.2%) of the 41 patients positive for Epstein-Barr virus were Type-2 according to WHO, while 4 (9.8%) were Type-1. All three patients (100%) with Human Papillomavirus positivity were Type-2 according to WHO. CONCLUSIONS: This study shows the close association between nasopharyngeal cancer and Epstein-Barr virus whereas such an association is not shown for Human Papillomavirus.

The Effect of Mode of Delivery on Newborn Hearing Screening Results.

OBJECTIVE: Congenital hearing loss is one of the most important public health problems with a frequency of about 1-6 per 1000 live births all over the world. Although neonatal hearing screening tests are important for the timely detection and rehabilitation of hearing loss, determining the factors that may affect the screening results will contribute greatly to the development of screening programs. In this study, the effects of the modes of delivery on the results of tests in the screening program was investigated. METHODS: In this study, the results of 10.575 newborns who were screened according to the National Neonatal Hearing Screening Protocol between January 2013 and May 2017 were evaluated. The screening test results of 2.653 newborns were examined retrospectively according to the type of delivery after candidates were excluded according to the exclusion criteria and risk factors for hearing loss. Of these newborns, 1.571 (59.2%) were born by normal delivery and 1.082 (40.8%) by cesarean section. Screening test results were analyzed using Pearson's Chi-square test. RESULTS: No statistically significant difference was observed among the 2.653 neonatal hearing screening test results in terms of mode of delivery (p>0.05). In both delivery modes, the rate of false positive was found to be high (81.9%) in the first hearing screening test of newborns, and this rate decreased in the second screening test (14.5%). CONCLUSION: The mode of delivery has no significant effect on the neonatal hearing screening results; however, the observation that neonates had been more successful in the second screening test in both groups suggests that the test protocol should be re-evaluated in terms of timing.

Does noise exposure during pregnancy affect neonatal hearing screening results?

OBJECTIVE: The aim is to investigate whether noise is effective on hearing screening tests of neonates born to mothers exposed to noise during pregnancy. MATERIAL AND METHOD: Screening results of 2653 infants from the period of January 2013-May 2017 were evaluated. Transient Evoked Otoacoustic Emissions (TEOAE) and Auditory Brainstem Response (ABR) were used. Infants of 65 mothers exposed to noise (LAeq 80-85 dBA/8 hours/day) during pregnancy (Week ± SD; 32.58 ± 2.71) comprised the study group while the control group consisted of infants of 2588 mothers without noise exposure. RESULTS: Among the 65 infants, 23 (35.4%) passed screening at the first emission test (OAE1); 34 (52.3%) at the second emission test (OAE2); 7 (10.8%) at the ABR stage, 1 (1.5%) infant was referred to a tertiary center. In the control group, 458 (17.7%) infants passed at OAE1; 1822 (70.4%) at OAE2; 289 (11.2%) at ABR stages, 19 (0.7%) infants were referred to a tertiary center. The rate of infants that passed screening at OAE1 in the study group was high (P = 0.00001). Sixty-four (98.46%) infants in the study group and 2569 (99.26%) infants in the control group passed the tests. The difference between the two groups was not significant, indicating that exposure to noise during pregnancy had no unfavorable effects on auditory functions (P = 0.392). CONCLUSION: Unfavorable effect of noise exposure during pregnancy was not observed on auditory functions of the infants. The higher rate of infants that passed the screening test at OAE1 stage in the study group raised the question, "Does the exposure of the noise at exposure action levels (80-85 dB A) during pregnancy contribute to auditory maturation of fetus?"

Dyspnea Associated with Henna Stone: A Rare Cause of Pediatric Tracheotomy.

Tracheotomy is one of the oldest surgical procedures, and it is a life-saving procedure to overcome upper airway obstructions. While congenital causes play an important role in pediatric tracheotomy indications, upper airway edema and obstruction due to anaphylaxis rarely require tracheotomy. Allergy can cause life-threatening acute edema by anaphylactic reactions in the respiratory tract. Henna stone is the material for dyeing hair with henna and making a temporary tattoo. It contains high proportions of paraphenylendiamine. In this study, the case of a 3-year-old boy who had accidentally drunk some henna stone solution that was prepared for hair dyeing at home and who had to undergo emergency tracheotomy because of upper airway obstruction is presented. The potential dangerous effects of this material and the importance of emergency tracheotomy as a life-saving procedure are emphasized.

Mechanism of action of allergen immunotherapy.

BACKGROUND: Allergen immunotherapy (AIT) leads to the production of antiallergen immunoglobulin (IgG) or "blocking antibody" in the serum and an increase in antiallergen IgG and IgA in nasal secretions. There is also a decrease in the usual rise in antiallergen IgE that occurs after the pollen season. METHODS: In this paper, mechanisms of action of allergen immunotherapy is reviewed. RESULTS: Regulatory T (Treg) cells and their cytokines, primarily interleukin (IL) 10 and transforming growth factor beta, suppress T-helper type 2 immune responses and control allergic diseases in many ways. AIT induces a shift in the proportion of IL-4-secreting T-helper type 2 cells in favor of IL-10-secreting inducible Treg cells specific for the same allergenic epitope that increases in number and function. Different types of inducible Treg control several facets of allergic inflammation. There are two main types of immunotherapy: subcutaneous immunotherapy and sublingual immunotherapy. Subcutaneous immunotherapy is efficacious and is indicated for the reduction of seasonal symptoms. Sublingual immunotherapy involves the regular self-administration and retention of allergen extract under the tongue for 1-2 minutes before the extract is swallowed. The allergens cross the mucosa in 15-30 minutes and are then captured by tolerogenic dendritic cells and processed as small peptides. Next, via the lymphatic system, a systemic immune response is created to produce an early decrease in mast cell and basophil degranulation. CONCLUSION: AIT is indicated for the treatment of moderate-to-severe intermittent or persistent symptoms of allergic rhinitis. AIT can be administered to those >5 years of age and has been shown to be safe in children as young as 3 years of age. In this article, AIT and other types of immunotherapies were discussed as well as the indications for immunotherapy.