Proposal of a new scoring system for equalization problems during freediving.

OBJECTIVE: Scuba diving and freediving are popular activities around the world, and their growth has increased the frequency of related pathology. A good ability to equalize is of paramount importance for diving. This is especially true for freediving, during which dive time is limited to just one breath. Even though equalization disorders are quite common in divers, a scoring system does not exist to date. In this paper we propose a new scoring system for equalization problems of freedivers: the EP score, shorthand for "equalization problems." METHODS: We administered the EP score assessment to 40 Italian freediving spearfishermen who were divided in two groups: Group A comprised 20 freedivers complaining of equalization problems and multiple barotraumas but totally asymptomatic in their everyday lives. These individuals had already received medical treatment and nasal surgery without improvement and then had undergone Eustachian tube balloon dilation. Group B comprised 20 healthy freedivers without any history of equalization disorders. We performed a statistical analysis to evaluate the reliability of this scoring system and to evaluate its usefulness in diagnosis and follow-up. RESULTS: Our data show substantial statistical differences between healthy freedivers and freedivers complaining of equalization disorders (Z-Score = -5.396 at p ⟨ 0.05); data do not show any statistical difference between healthy freedivers and patients successfully treated by Eustachian tube balloon dilation (U-value = 152.5 and Z-Score= -1.271 at p ⟨ 0.05). CONCLUSION: The EP score assessment seems to be a reliable tool to quantify equalization disorders during freediving and to evaluate how the difficulty varies over time and after treatment. Since equalization disorders could be present in different populations, the EP score assessment could be applicable to a wider group.

Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population.

BACKGROUND AND PURPOSE: To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. PATIENTS AND METHODS: Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. RESULTS: A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). CONCLUSION: This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.

Eustachian tube balloon dilation in treatment of equalization problems of freediving spearfishermen.

BACKGROUND: Eustachian tube balloon dilation is a minimally invasive surgical procedure used to treat Eustachian tube dysfunction which is not responsive to conventional therapies. METHODS: In this cohort intervention series we report the results of balloon dilation in treating refractory equalization problems in 20 freediving spearfishermen; in 19 cases the problem was unilateral and in one case bilateral. All the patients had already received medical and insufflation therapy and four patients had also had nasal surgery. None of these treatments or procedures had achieved improvement. We used a 20 mm x 3 mm disposable balloon catheter inserted through a 70-degree guide catheter and inflated up to 12 ATM three times at three different depths of insertion within the Eustachian tube. Every inflation lasted 120 seconds. RESULTS: Fifteen out of 20 patients improved. Ten patients reported a complete resolution of equalization problems, five showed improvement with persistence of a slight equalization delay on the treated side. Five patients did not report any improvement. Two complications occurred: subcutaneous emphysema of the parotid region in one case; and a mild high frequency (4-8 KHz) sensorineural hearing loss in another patient. CONCLUSION: Balloon dilation of the Eustachian tube is an effective therapy in the treatment of equalization problems with a good success rate.

A systematic review and meta-analysis of the diagnostic accuracy of anti-heat shock protein 70 antibodies for the detection of autoimmune hearing loss.

OBJECTIVE: We reviewed case-control studies concerning the diagnostic accuracy of Heat Shock Protein 70 (Hsp-70) auto antibodies in the detection of immunomediated inner ear disease. MATERIALS AND METHODS: We searched for relevant articles published in English language on PubMed and Scopus up to December 2011. A quality assessment of the retrieved articles was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Pooled data on the accuracy of the test were calculated, where possible. RESULTS: Three articles were deemed eligible. Among them, 2 evaluated the relationship between Hsp-70 and immunomediated inner ear disease by using the Western blot, whereas one report used the enzyme-linked immunosorbent assay method. Pooled sensitivity of Western blot test for Hsp-70 was 0.70 (95% confidence interval [CI], 0.59-0.80), with a large heterogeneity (I = 72.7%), and pooled specificity was 0.98 (95% CI, 0.87-1.00), with an I of 61.0%. Pooled positive likelihood ratios (LR) was 14.7 (95% CI, 2.1-104.1; I = 31.4%), and pooled negative LR was 0.32 (95% CI, 0.10-0.70; I = 78.8%). Sensitivity and specificity of enzyme-linked immunosorbent assay test for Hsp-70 auto antibodies was 0.85 (95% CI, 0.55-0.98) and 0.98 (95% CI, 0.86-1.00). Risk of bias was performed by using QUADAS 2 tool, with high scores obtained for patient selection and index test domains and low for the applicability criterion. DISCUSSION: This review shows that studies on autoimmune hearing loss diagnosis based on the detection of Hsp-70 autoantibodies used different inclusion and methodologic criteria and are affected from potential bias. Additional studies are actually required to identify an accurate laboratory diagnostic method for the autoimmune hearing loss.