A controlled comparison of auditory steady-state responses and pure-tone audiometry in patients with hearing loss.

We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.

Results of endonasal dacryocystorhinostomy in pediatric patients.

We conducted a prospective interventional study to evaluate the role of endoscopic endonasal dacryocystorhinostomy in children. Our study population was made up of 20 patients-18 boys and 2 girls, aged 2 to 12 years (mean: 5.3)-who presented with signs and symptoms suggestive of nasolacrimal duct blockage that was refractory to conventional medical treatment. In all cases, blockage was confirmed by nasolacrimal duct syringing that demonstrated regurgitation from the opposite punctum. The primary outcome measures for success were resolution of symptoms and duct patency on lacrimal irrigation. At 6 months, 17 patients (85%) experienced complete symptomatic relief, 1 (5%) had partial relief, and 2 (10%) reported no relief. Moreover, the nasolacrimal duct was patent in 17 patients, partially patent in 2, and blocked in 1. We conclude that endoscopic endonasal dacryocystorhinostomy is a safe and effective procedure in children with nasolacrimal duct blockage when medical therapy and probing have been unsuccessful.

Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery.

We conducted a prospective, comparative, interventional study to evaluate the role of intranasal septal splints and to compare the results of this type of support with those of conventional nasal packing. Our study population was made up of 60 patients, aged 18 to 50 years, who had undergone septoplasty for the treatment of a symptomatic deviation of the nasal septum at our tertiary care referral hospital. These patients were randomly divided into two groups according to the type of nasal support they would receive: 30 patients (25 men and 5 women, mean age: 23.3 yr) received bilateral intranasal septal splints and the other 30 (26 men and 4 women, mean age: 22.4 yr) underwent anterior nasal packing. Outcomes parameters included postoperative pain and a number of other variables. At 24 and 48 hours postoperatively, the splint group had significantly lower mean pain scores (p < 0.05). At 48 hours, the splint group experienced significantly fewer instances of nasal bleeding (p < 0.01), swelling over the face and nose (p < 0.01), watering of the eyes (p < 0.01), nasal discharge (p = 0.028), nasal obstruction (p < 0.001), and feeding difficulty (p = 0.028). Likewise, mean pain scores during splint or pack removal were significantly lower in the splint group (p < 0.01). At the 6-week follow-up, only 2 patients (6.7%) in the splint group exhibited a residual deformity, compared with 8 patients (26.7%) in the packing group (p = 0.038). Finally, no patient in the splint group had an intranasal adhesion at follow-up, while 4 (13.3%) in the packing group did (p < 0.05). We conclude that intranasal septal splints result in less postoperative pain without increasing postoperative complications, and thus they can be used as an effective alternative to nasal packing after septoplasty.

Child abuse: multiple foreign bodies in gastrointestinal tract.

The incidents of foreign body ingestion in infants and children are usually viewed as accidents, but these events may be a form of child abuse. We are reporting a case of child abuse who presented with multiple foreign bodies in the gastrointestinal tract. Physicians are required to report abuse when they have reason to believe or to suspect that it occurred. The purpose of reporting is not punishment of the perpetrator - it is the protection of the child. It is certainly in the best interest of the child, because child abuse is a recurrent and usually escalating problem that exposes the child to substantial risk.

Clinical experience of removing dentures from aerodigestive tract.

OBJECTIVE: A denture as an aerodigestive tract foreign body continues to present challenges to otolaryngologists. Records of patients who presented with a denture as an aerodigestive tract foreign body were retrospectively reviewed. METHODS: Records of patients treated during the last 8 years were reviewed to gather information on the age, sex, and presenting symptoms of the patient, location of the denture, radiographic findings, and endoscopic procedure required. RESULTS: Our review identified 15 patients, with the mean and median age being 59.6 and 63 years, respectively. One patient presented with a denture in the valleculae, 4 patients with a denture in the airway, and 10 patients with a denture in the hypopharynx/esophagus. Rigid endoscopy was performed to remove the dentures in most patients. An esophagotomy was required in 1 patient. CONCLUSIONS: Fixed partial dentures should be advised by dentists, especially in patients who have predisposing factors such as old age, epilepsy, mental retardation, or alcoholism.

Overlooked foreign body: eighteen years inside the bronchus.

A long-standing undiagnosed foreign body bronchus in an adult is very rare. We report a rare case of an overlooked foreign body in the bronchus. A 38-year-old man presented with the complaints of chronic cough with expectoration and wheezing for the last 18 years. Computed tomography of the chest detected a foreign body in the right lower lobar bronchus. Detailed history revealed that the patient had aspirated a whistle 18 years earlier that was overlooked by the treating clinicians. It remained undiagnosed in chest radiographs. It was extracted using a rigid bronchoscope. We emphasize the need to remain vigilant for endobronchial foreign bodies in patients with persistent cough and wheeze.