Colour vision requirements in visually demanding occupations.

Normal trichromatic colour vision (CV) is often required as a condition for employment in visually demanding occupations. If this requirement could be enforced using current, colour assessment tests, a significant percentage of subjects with anomalous, congenital trichromacy who can perform the suprathreshold, colour-related tasks encountered in many occupations with the same accuracy as normal trichromats would fail. These applicants would therefore be discriminated against unfairly. One solution to this problem is to produce minimum, justifiable CV requirements that are specific to each occupation. This has been done successfully for commercial aviation (i.e. the flight crew) and for Transport for London train drivers. An alternative approach is to make use of new findings and the statistical outcomes of past practices to produce graded, justifiable CV categories that can be enforced. To achieve this aim, we analysed colour assessment outcomes and quantified severity of CV loss in 1363 subjects. The severity of CV loss was measured in each subject and statistical, pass/fail outcomes established for each of the most commonly used, conventional colour assessment tests and protocols. This evidence and new findings that relate severity of loss to the effective use of colour signals in a number of tasks provide the basis for a new colour grading system based on six categories. A single colour assessment test is needed to establish the applicant's CV category which can range from 'supernormal', for the most stringent, colour-demanding tasks, to 'severe colour deficiency', when red/green CV is either absent or extremely weak.

The Macular Assessment Profile test - a new VDU-based technique for measuring the spatial distribution of the macular pigment, lens density and rapid flicker sensitivity.

The measurement of macular pigment optical density (MPOD) in the eye is often carried out using optical techniques based on heterochromatic flicker photometry (HFP). These require the use of two spectrally-narrow beams, one at the wavelength of maximum absorption of the macular pigment (MP) and the other in the long wavelength region of the visible spectrum where MP absorption is negligible. A new technique for the measurement of MPOD spatial profiles has been developed by overcoming the current shortcomings associated with the use of visual displays. The new Macular Assessment Profile (MAP) test makes use of a 'notch' filter and a photometric model to measure and compute the peak MPOD value. Two other useful parameters are also computed from the same measurements. These describe the subject's sensitivity to rapid flicker and the absorption of blue light by the lens. MPOD profiles, lens density, rapid flicker sensitivity, and red/green (RG) and yellow/blue (YB) colour thresholds were measured in 54 normal subjects aged 18-61 years. The results confirm previous findings on ageing effects and demonstrate the complete absence of correlation between MPOD and the subject's YB chromatic thresholds. In contrast, RG chromatic sensitivity improves with higher levels of MPOD.

Loss of chromatic sensitivity in AMD and diabetes: a comparative study.

BACKGROUND: Abnormalities in rod and cone photoreceptor morphology have been reported in normal aging retinas in the absence of known pathology and have been taken as an indicator of susceptibility to retinal disease. Some loss of visual performance may therefore precede retinal structural changes that can be detected reliably using conventional fundus imaging techniques. Red/green (RG) and yellow/blue (YB) colour discrimination thresholds are sensitive measures of normal retinal function and poor YB discrimination is often taken as an indicator of retinal disease, though it is generally acknowledged that RG loss is also present in most cases of acquired deficiency. Although structural changes in age-related macular degeneration (AMD) and diabetes share some similarities, significant differences remain and this may result in different patterns of RG and YB loss. AIM: The aim of this study was to quantify and compare the severity of RG and YB loss of chromatic sensitivity in patients with AMD and diabetes. METHODS: Patients with varying severity of AMD and diabetes and normal subjects of similar age were recruited for the study. RG and YB colour detection thresholds were measured in the two groups of patients and the control group, using the Colour Assessment and Diagnosis (CAD) test. RESULTS: Each AMD subject investigated showed significant, but unequal loss of YB and RG chromatic sensitivity, with YB discrimination showing the greatest loss. Diabetic subjects also exhibited reduced chromatic sensitivity, but with almost equal and highly correlated RG and YB thresholds (R(2) = 0.99). The severity of colour vision loss measured with the CAD test also correlates well with a clinical classification index of disease progression in AMD, and with the level of hyperglycaemic control in diabetes. CONCLUSIONS: These findings suggest that accurate measurements of RG and YB colour thresholds can provide a sensitive measure of functional change in diseases of the retina with patterns of loss that differ significantly in AMD and diabetes.

Sex-related differences in chromatic sensitivity.

Generally women are believed to be more discriminating than men in the use of color names and this is often taken to imply superior color vision. However, if both X-chromosome linked color deficient males (8%) and females (<1%) as well as heterozygote female carriers (15%) are excluded from comparisons, then differences between men and women in red-green (RG) color discrimination have been reported as not being significant (e.g., Pickford, 1944; Hood et al., 2006). We re-examined this question by assessing the performance of 150 males and 150 females on the color assessment and diagnosis (CAD) test (Rodriguez-Carmona et al., 2005). This is a sensitive test that yields small color detection thresholds. The test employs direction-specific, moving, chromatic stimuli embedded in a background of random, dynamic, luminance contrast noise. A four-alternative, forced-choice procedure is employed to measure the subject's thresholds for detection of color signals in 16 directions in color space, while ensuring that the subject cannot make use of any residual luminance contrast signals. In addition, we measured the Rayleigh anomaloscope matches in a subgroup of 111 males and 114 females. All the age-matched males (30.8 +/- 9.7) and females (26.7 +/- 8.8) had normal color vision as diagnosed by a battery of conventional color vision tests. Females with known color deficient relatives were excluded from the study. Comparisons between the male and female groups revealed no significant differences in anomaloscope midpoints (p = 0.709), but a significant difference in matching ranges (p = 0.040); females on average tended to have a larger mean range (4.11) than males (3.75). Females also had significantly higher CAD thresholds than males along the RG (p = 0.0004), but not along the yellow-blue (YB) discrimination axis. The differences between males and females in RG discrimination may be related to the heterozygosity in X-linked cone photo pigment expression common among females.

A study of unusual Rayleigh matches in deutan deficiency.

Rayleigh match data were modeled with the aim of explaining the locations of match midpoints and matching ranges, both in normal trichromats and in subjects with congenital color deficiency. Model parameters included the wavelength of peak sensitivity of cone photopigments, the effective photopigment optical density, and the noise amplitude in the red-green color channel. In order to avoid the suprathreshold, perceptual effects of extreme L:M cone ratios on color vision, selective post-receptoral amplification of cone signals is needed. The associated noise is also amplified and this causes corresponding changes in red-green threshold sensitivity. We propose that the noise amplitude and hence the size of the matching range in normal trichromats relates to the known inter-subject variation in the relative numbers of L and M cones. If this hypothesis can be shown to account for the extremes of the red-green matching range measured in normal trichromats, it is of interest to establish the extent to which it also predicts the unexpected, small matching ranges that are observed in some subjects with red-green color deficiency. A subset of subjects with deutan deficiency that exhibited less common Nagel matches were selected for genetic analysis of their cone pigment genes in order to confirm the type of deficiency, and to predict the corresponding peak wavelength separation (delta lambda(max)) of their two, long-wavelength cone pigments. The Rayleigh match model predicted accurately the midpoint and the range for the spectral differences specified by the genes. The prediction also required plausible selection of effective optical density of the cone pigments and noise. The noise needed varied, but the estimates were confined to lie within the limits established from the matching ranges measured in normal trichromats. The model predicts correctly the small matching ranges measured in some deuteranomalous subjects, principally accounted for by a low estimate of noise level in the red-green channel. The model also predicts the "normal" matches made by some subjects that rely on two hybrid genes and therefore exhibit red-green thresholds outside the normal range, typical of mild deuteranomaly.

Detección precoz de la sordera mediante otoemisiones. Análisis de los resultados en 200 niños consecutivos explorados / Early hearing loss detection by otoemissions. Analysis of the results in 200 consecutive children reviewed

Presentamos un estudio retrospectivo de 200 niños consecutivos explorados en nuestro hospital entre noviembre del 2005 y abril del 2006 del programa o protocolo de Detección Precoz de Soderas establecido desde hace varios años en nuestra Comunidad. Aquellos niños con sospecha de hipoacusia tras la realización de las otoemisiones acústicas son sometidos a potenciales evocados auditivos de tronco cerebral (PEATC) 3 meses después

We present a retrospective study of 200 consecutive children explored in our hospital between november 2005 and april 2006, as a part of the protocole or program of early identification hearing loss stablished several years ago in our Comunity. In case of suspected hypoacusia after performing otoacoustic emissions, children must be sent to PEATC 3 months later

[Zenker's esophageal diverticulum as differential diagnosis of paratracheal cystic lesion]. / Divertículo esofágico de Zenker como diagnóstico diferencial de lesión quística paratraqueal.

We report the case of a 52 years old patient with clinic of food regurgitation and some dysphagia without other added symptoms who was sent to our ENT consulting rooms. It was performed a cervicothoracic CT which informed as a paratracheal cystic lesion with differential diagnosis between esophageal or tracheal diverticulum. The possibility of that last one was discarted by a normal bronchoscopy.

[Sphenoidal sinus polyp-cyst as casual finding in a patient with severe and sudden retrocochlear hearing loss]. / Pólipo-quiste del seno esfenoidal como hallazgo casual en paciente con hipoacusia brusca severa retrococlear.

We present the case of a 56 years old female controlled in our ENT Department because of right sudden hearing loss, tinnitus and vertigo. The endoscopic exam was normal. Audiogram showed a severe neurosensorial hypoacusia and PEATC confirmed the so called hypoacusia suggesting a retrocochlear origin of it. As imaging tests an otic-craneal CT and IRM were asked for, which informed of the presence of a cystic lesion versus polyp in sphenoidal sinus of 15 x 10 mm without other alterations or significant pathology.

[Facial and oropharyngeal angioedema in patient with alimentary fish allergy. Diagnosis and treatment]. / Angioedema facial y orofaríngeo en paciente con alergia alimentaria a pescado. Diagnóstico y tratamiento.

Vegetal or animal food can produce hipersensibility reactions IgE mediated of diverse intensity. We report the case of a 54 years old woman without previous allergic antecedents who after eating frozen fish had to go to Emergencies due to angioedema especially in face and oropharynx. The ENT exploration by fibroscopia descarted laryngeal edema but the patient showed initially respiratory symptoms so she was treated with SC adrenalina and then steroids during her admission. The diagnosis of alimentary alergia would be confirmed after by Allergology with cutaneous test prick type.

[Cholesterol cyst-granuloma on petrous apex. Report of a case and differential diagnosis]. / Quiste-granuloma de colesterol de la punta del peñasco. Presentación de un caso y diagnóstico diferencial.

Cholesterol granulomas and cysts located on the petrous apex can course of a silent way during years. We describe one case assisted in our consulting rooms which was discovered after performing CT and MRI (with and without paramagnetic contrast) in a patient with vertigo associated to conscience loss without other symptoms. In the discussion is exposed which must be the differential diagnosis of this pathology.

Divertículo Esofágico de Zenker como diagnóstico diferencial de lesión quística paratraqueal / Zenker´s esophageal diverticulum as differential diagnosis of paratracheal cystic lesion

Presentamos el caso de un paciente de 52 años con clínica de regurgitación de alimentos y cierta disfagia sin otra sintomatología añadida visto en nuestras consultas externas de ORL. Se le practicó una TC cérvicotorácico que informaba de una lesión quística paratraqueal compatible con divertículo esofágico o traqueal. La posibilidad de este último se descartó mediante broncoscopia que resultó ser normal

We report the case of 52 years old patient with clinica of food regurgitation and some dysphagia without other added symptoms who was sent to our ENT consulting romos. It was performed a cervicothoracic CT which informed as a paratracheal cystic lesion with differential diagnosis between esophageal or tracheal diverticulum. The possibility of that las one was discarded bya a normal bronchoscopy

Pólipo-quiste del seno esfenoidal como hallazgo casual en paciente con hipoacusia brusca severa retrococlear / Sphenoidal sinus-cyst as casual finding in a patient with severe and audden retrocochlear hearing loss

Presentamos el caso de una mujer de 56 años controlada en nuestro servicio de ORL, a causa de acúfenos y vértigo de aparición brusca. La exploración endoscópica fue normal. La audiometría mostraba una hipoacusia neurosensorial severa y los potenciales evocados auditivos (PEATC) confirmaron la citada hipoacusia apuntando un origen retrococlear de la misma. Como pruebas de imagen se solicitarion TC y RMN óticocraneal, en la que se informaba de la presencia de una lesión quística versus pólipo en seno esfenoidal de 15 por 10 mm sin otras alteraciones o patología significativa

We present the case of a 56 years old female controlled in our ENT Department because of right suden hearing loss, tinnitus and vertigo. The endoscopic exam was normal. Audiogram showed a severe neurosensorial hypoacusia and PEATC confirmed the so called hypoacusia suggesting a retrocochlear origin of it. As imaging tests and otic-craneal CT and IRM were asked for, which informed of the presence of a cystic lesion versus polyp in sphenoidal sinus of 15 x 10 mm without other alterations or significant pathology

Angioedema facial orofaríngeo en paciente con alergia alimentaria a pescado / Facial and oropharyngeal angioedema in patient with alimentary fish allergy

Los alimentos tanto de origen vegetal como animal pueden ocasionar reacciones de hipersensibilidad IgE mediadas de diversa intensidad. Presentamos el caso de una mujer de 54 años sin antecedentes alérgicos previos que tras ingesta de pescado congelado tuvo que acudir a Urgencias por angioedema de predominio en cara y orofaringe. La exploración ORL mediante fibroscopia descartó edema laríngeo pero la paciente presentó inicialmente clínica respiratoria por lo que fue tratada con adrenalina SC y posteriormente corticoides durante su ingreso. El diagnóstico de alergia alimentaria se confirmaría después por parte de Alergología mediante pruebas cutáneas tipo prick-test

Vegetal or animal food can produce hipersensibility reactions IgE mediated of diverse intensity. We report the case of a 54 years old woman without previous allergic antecedents who after eating frozen fish had to go to Emergencies due to angioedema especially in face and oropharynx. The ENT exploration by fibroscopia descarted laryngeal edema but the patient showed initially respiratory symptoms so she was treated with SC adrenalina and then steroids during her admission. The diagnosis of alimentary alergia would be confirmed after by Allergology with cutaneous test prick type

Quiste-granuloma de colesterol de la punta del peñasco. Presentación de un caso y diagnóstico diferencial / Colesterol cyst-granuloma on petrous apex. Report of a case and differential diagnosis

Los quistes y granulomas de colesterol localizados en la punta del peñasco pueden cursar de forma silente durante años. Describimos un caso atendido en nuestras consultas que fue descubierto tras realizar TC y RMN óticocraneal (con y sin contraste) en una paciente con vértigo asociado a pérdida de conocimiento sin otra sintomatología. Exponemos en la discusión cuál debe ser el diagnóstico diferencial de esta patología

Cholesterol granulomas and cysts located on the petrous apex can course of a silent way during years. We describe one case assisted in our consulting rooms which was discovered after performing CT and MRI (with and without paramagnetic contrast) in a patient with vertigo associated to conscience loss without other symptoms. In the discussion is exposed which must be the differential diagnosis of this pathology

[Etiopathogenia of the epistaxis admitted by emergencies service. Analysis and considerations in 250 consecutive patients]. / Etiopatogenia de las epístaxis ingresadas vía de urgencias. Análisis y consideraciones en 250 pacientes consecutivos.

Epistaxis represent a relatively common symptom in the hospitalary Emergencies Services. In our casuistry of 250 consecutive patients assisted and admitted because of that cause in 2 different hospitals of the region between 1996 and 2005, we have noticed the presence of one or more base pathologies or risk factors in originate most of them which could the nose bleeding. These causes are analysed beside the location of the epistaxis and the different treatment options that were used until its resolution.

[Maxillary sinus hypoplasia masquerading a chronic sinusitis]. / Hipoplasia del seno maxilar simulando una sinusitis crónica.

Maxillary sinus hypoplasia is a relatively uncommon clinical condition that may be misdiagnosed as chronic sinusitis or neoplasm by otolaryngologist. We report an unilateral clinical case of this entity confirmed by CT and a short literature review is performed at this respect.

[Cervical osteophytosis as cause of dysphagia. Forestier-Rotes Querol's disease]. / Osteofitosis cervical como causa de disfagia. Enfermedad de Forestier-Rotes Querol.

The so called Forestier-Rotes Querol's disease or diffuse idiopathic skeletal hyperostosis can affect the neck caused by osteophytos and ossification-calcification of the vertebral ligaments. The location in that region can produce dysphagia or hoarseness, among other symptoms, so that the patient can assist or be sent to ENT valoration. We are reporting a case of this pathology which was diagnosed in our hospital. Finally a bibliographic review is performed.

Recovery of vision and pupil responses in optic neuritis and multiple sclerosis.

The recovery of visual performance and pupil responses were investigated in patients with demyelinating optic neuritis (ON) and multiple sclerosis (MS). The pupil constriction amplitude and the time delay (latency) of the pupil response were measured in 14 patients with a history of unilateral ON in response to either achromatic (luminance) or chromatic (isoluminant) stimulus modulation. Five of these subjects were diagnosed later with MS. In addition, we measured detection thresholds for achromatic stimuli using standard visual field perimetry and chromatic thresholds using a new colour assessment and diagnosis (CAD) test that isolates the use of colour signals. The results show that, despite significant improvements in visual function following the acute phase (as assessed using visual acuity and fields), significant pupil response deficits remain. The findings also demonstrate that accurate measurements of pupil responses and chromatic thresholds can reveal deficits that remain undetected with more conventional techniques. These preliminary findings suggest that the techniques described here can provide useful information about remitting and relapsing demyelinative phases, often observed during MS and ON.

[Kartagener sindrome (primary ciliary dyskinesia). Report of a case and literature review]. / Síndrome de Kartagener (disquinesia ciliar primaria). Caso clínico y revisión de la literatura.

Kartagener syndrome (a clinical variant of primary ciliary dyskinesia) is a recessive autossomical disease characterized by the triad of chronic sinusitis, bronchiectasis and situs inversus with dextrocardia. We report one case described in a 8 years old boy who besides presented a seromucous otitis and bronchitis of repetition. Finally we performed a short bibliographic review at respect of this uncommon pathology.

[Vogt Koyanagi Harada syndrome. Report of a case with hearing loss, tinnitus, vertigo associated to uveitis]. / Síndrome de Vogt Koyanagi Harada. A propósito de un caso con hipoacusia, acúfenos y vértigo asociados a la uveitis.

Vogt-Koyanagi-Harada sindrome is an autoimmune sistemic disease characterized by granulomatous bilateral uveitis with involvement of the central nervous system which can compromise the VIII craneal pair function producing tinnitus and neurosensorial hypoacusia. We report a case diagnosed in a young woman who also suffered episodes of vertigo. We review the literature of that pathology.