Photodynamic therapy of eyelid basal cell carcinoma.

BACKGROUND: Photodynamic therapy (PDT; i.e. selective destroying of malignant cells by exposing them to red light after photosensitization) has been increasingly used for non-melanoma skin cancers. Due to excellent cosmetic and functional results, especially in difficult-to-treat areas, it may offer a comprehensive alternative to previous treatment modalities. OBJECTIVE: A series of six patient cases was used to evaluate the efficacy of PDT in the treatment of lower eyelid basal cell carcinoma (BCC). Methods Histological confirmation of BCC, a detailed demonstration of the technique with an illustrative series of cases and a review of related literature. RESULTS: Six patients with lower eyelid BCC were treated with two treatment sessions of PDT within a week. Five patients had a nodular type and one patient had a superficial type of BCC. The follow-up after treatment continued for 20-36 (mean 26.5) months. No recurrences were observed during the follow-up. All the patients were satisfied with the good results and tolerated the treatment well without any harm to the eyeball or surrounding skin. CONCLUSION: PDT, although experimental in the eyelid area because of the small amount of data and the lack of a long-term follow-up, may be considered a promising comprehensive alternative when treating BCC in the eyelid area.

Prognosis of hearing impairment in Ménière's disease.

The deterioration of hearing in Ménière's disease is known to be dependent on the individual and to be highly variable. In most cases, however, it leads to moderate hearing impairment. In order to be able to predict deterioration, we used multivariable modelling with a source population of definite cases of Ménière's disease diagnosed according to the latest recommended American Academy of Otolaryngology--Head and Neck Surgery criteria. The records of 205 patients were retrospectively analysed. Their earliest and latest pure-tone air conduction audiograms were used to evaluate the long-term effects of the disease on hearing. The effect of age and the follow-up period were calculated for different frequencies (0.125-8 kHz) and for the pure-tone average over the frequencies 0.5 to 4 kHz (PTA0.5-4 kHz). Deterioration in PTA0.5-4 kHz was approximately 1 dB/year due to the duration of the disease and approximately 0.5 dB/year due to aging. Hearing impairment in Ménière's disease appeared to increase linearly with the duration of the disease for patients < 50 years of age, but in the older subjects the effect of the duration of the disease decreased. Both aging and the duration of the disease affected the hearing level. The duration of the disease did not seem to have any statistically significant effect on the difference between the two ears. The difference that occurred at the onset of the disease remained until presbyacusis in the better ear reached the hearing level of the worse ear. The difference in hearing deterioration between men and women was not significant.

Prevalence of Meniere disease in Finland.

OBJECTIVES: To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommendation. STUDY DESIGN: Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) in seven Finnish hospitals serving a population of 1.5 million people. METHODS: Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re-evaluated. Definite cases according to AAO-HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996. RESULTS: A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P<.001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000). CONCLUSIONS: The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.