Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Τετάρτη 21 Ιουλίου 2021

Vestibular Hypersensitivity in Patients with Chronic Noise Exposure

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Abstract

It has been demonstrated that high-intensity noise exposure adversely affects the human balance function. The Tullio phenomenon (TP) refers to sound-induced imbalance which is resulted from hypersensitivity of vestibular end organs to normal acoustic stimuli. Although different etiologies have been attributed to TP, evidence on the role of excessive noise exposure in the development of this symptom is limited. The present study aims to assess the vestibular functions in patients manifesting TP symptom who were exposed to long-term excessive noise levels. This was an analytic cross-sectional study conducted on 17 males diagnosed with TP with a history of chronic noise-induced hearing loss (TP group) and 17 healthy individuals. All subjects in both groups underwent complete otological, videonystagmography (VNG), and cervical vestibular myogenic potential (cVEMP) assessments. The most common complaint in TP subjects was vertigo and imbalance. During the VNG assessme nt, we found abnormal positional nystagmus and caloric irrigation (vestibular hyperfunction) results in 4 (23.53%) and 9 (52.94%) patients, respectively. Seven (41.17%) patients indicated cVEMP thresholds which were abnormally lower than the normal values ( ≤ 70 dB HL). However, when both VNG and cVEMP results were considered together, the abnormal rate reached 70.58% (12 of 17 cases). Our findings showed that both the semicircular canal as well as otolith stuctures could be affected in TP patients with a history of chronic noise exposure.

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Endotracheal Intubation with Laryngeal Mirror in Simulated Difficult Direct Laryngoscopy: Comparison of Gum Elastic Bougie Versus Styleted Endotracheal Tube

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Abstract

Laryngeal mirror (LM) is an inexpensive, portable, readily available device which can help visualize the vocal cords in difficult airway (DA) situations. We evaluated its use in improving glottic view prior to placing the airway adjuncts in simulated difficult airway.Eighty patients scheduled to undergo elective surgery under general anaesthesia with endotracheal intubation were allocated- Bougie group (Group B) and Stylet group (Group S). Direct laryngoscopy was performed and CL grade III simulated. The glottic view was obtained using laryngeal mirror and Gum Elastic Bougie (GEB)/ Styleted Endotracheal Tube (ETT) inserted under mirror view. Time taken to obtain glottic view in LM and time for successful intubation were noted.Significant improvement in glottic view with LM was observed, with the view improving to Grade I in 76.25% and grade II in 23.75% of patients. Both groups were comparable with respect to number of attempts and success rate (p =  0.55).The success rate was 90% in group B and 95% in group S. Time taken for intubation was less in Group S (52.44 ± 14.23 s vs. 62.805 ± 20.74 s) [p = 0.01]. Hence, overall stylet proved to be a better adjunct with mirror guided intubation.We recommend stylet assisted rather than GEB assisted ET intubation under LM guidance in emergency scenarios. Also, further controlled trials are recommended to know the exact location of the mirror in relation to bulb of the laryngoscope as well as different angles at which it is placed to improve the view and stabilize the assembly.

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Future Solutions for Voice Rehabilitation in Laryngectomees: A Review of Technologies Based on Electrophysiological Signals

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Abstract

Loss of voice is a serious concern for a laryngectomee which should be addressed prior to planning the procedure. Voice rehabilitation options must be educated before the surgery. Even though many devices have been in use, each device has got its limitations. We are searching for probable future technologies for voice rehabilitation in laryngectomees and to familiarise with the ENT fraternity. We performed a bibliographic search using title/abstract searches and Medical Subject Headings (MeSHs) where appropriate, of the Medline, CINAHL, EMBASE, Web of Science and Google scholars for publications from January 1985 to January 2020. The obtained results with scope for the development of a device for speech rehabilitation were included in the review. A total of 1036 articles were identified and screened. After careful scrutining 40 articles have been included in this study. Silent speech interface is one of the topics which is extensively being studied. It is based o n various electrophysiological biosignals like non-audible murmur, electromyography, ultrasound characteristics of vocal folds and optical imaging of lips and tongue, electro articulography and electroencephalography. Electromyographic signals have been studied in laryngectomised patients. Silent speech interface may be the answer for the future of voice rehabilitation in laryngectomees. However, all these technologies are in their primitive stages and are potential in conforming into a speech device.

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Intratympanic Dexamethasone in Sudden Sensorineural Hearing Loss

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Abstract

Sudden sensorineural hearing loss can be a frightening experience for the sufferer and needs immediate treatment. Systemic steroid therapy has been the mainstay of treatment of this condition but concerns about their side effects has led to their use by intratympanic injection. We studied the results of intratympanic dexamethasone (IT-Dexa) both as a primary therapy and as salvage treatment after failure of oral steroids. A total of 39 patients of SSNHL were studied prospectively. Of these 23 were given oral steroids. Ten of these showed no response and were treated with IT-Dexa 4 mg/ml twice a week for two weeks. In addition, 16 patients who reported later than two weeks or had concomitant medical disorders like diabetes and/or hypertension were treated with IT-Dexa. While oral steroids showed hearing improvement (≥ 10 dB) in 56.5% patients, the recovery rate was 62.5% and 80% in those treated primarily with IT-Dexa and as salvage therapy respectiv ely. There was a negative correlation of delay in institution of treatment with hearing recovery. Conclusion: intratympanic dexamethasone is a safe and effective treatment and should be offered to patients as a primary treatment modality and also as salvage therapy after failure of oral steroids. For best results the treatment should be started at the earliest.

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CT Cisternogram Findings in Idiopathic Cerebrospinal Fluid Leaks with Emphasis on Long Term Management

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Abstract

To study the various computed tomography (CT) cisternogram findings in idiopathic cerebrospinal fluid (CSF) leaks and the long term treatment modalities after surgical repair of idiopathic CSF leaks. This was a descriptive study conducted among 25 patients in MCV memorial ENT trust hospital, Pollachi between May 2014 and May 2020 amongst patients who underwent CT cisternogram for unilateral or bilateral spontaneous rhinorrhea with or without associated headache, visual disturbances and papilloedema diagnosed to be idiopathic CSF leak by investigations. These patients then underwent CSF leak repair and postoperatively were managed with weight reduction, low salt diet and diuretic therapy. Post surgery these patients were followed up for a period of 12 months and were evaluated on the basis of presence or absence of headache, rhinorrhea and papilloedema at the end of 1st month, 3rd month, 6th month and 1 year and data was collected. CT cisternogram f indings were evaluated by proportion method and evaluation of long term management was done using proportion and repeated measures ANOVA for all patients. Evidence of the presence of previously mentioned CT cisternogram or contrast MRI findings at the end of 1 year of post-surgical treatment was recorded where patients were willing for the same. CT Cisternography was done for all patients and 72% patients had empty sella appearance while 28% had partially empty sella. Other findings included perioptic filling, optic blunting and arachnoid pits which were found in 11(44%), 8(32%) and 12(48%) of patients respectively. Only 3(12%) out of 25 patients had an encephalocoele. The commonest site of leak in CT cisternography was the cribriform plate (52%) followed by lateral recess of sphenoid (48%). None of the patients had multiple sites of leak in CT cisternography. On follow up post surgery maximum resolution of symptoms was found at the end of 12 months where 23 out of 25 pati ents improved. In our study, out of 25 only 5 patients agreed to undergo post diuretic therapy MRI scan out of which 2 patients had partially empty sella and 3 had normal sella indicating resolution of BIH. CT cisternography is an important investigation which aids in the diagnosis of CSF rhinorrhea due to idiopathic intracranial hypertension (IIH). The medical management of IIH post surgery such as weight reduction, salt restriction and diuretic therapy is also crucial to prevent recurrence of symptoms.

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Cerebrospinal fluid-lymphatic fistula causing spontaneous intracranial hypotension in a child with kaposiform lymphangiomatosis

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Pediatr Radiol. 2021 Jul 20. doi: 10.1007/s00247-021-05132-6. Online ahead of print.

ABSTRACT

Spontaneous intracranial hypotension is an uncommon etiology of secondary headaches in children. We report a unique case of a girl with kaposiform lymphangiomatosis who developed postural headaches and imaging features of spontaneous intracranial hypotension without a spinal extradural collection. The girl underwent dynamic computed tomography myelography which revealed a cerebrospinal fluid (CSF)-lymphatic fistula related to a lymphatic malformation associated with the right T10 nerve. She underwent surgical ligation of the CSF-lymphatic fistula, resulting in resolution of the headaches. Spinal CSF-lymphatic fistulas are rare and have previously been reported in two patients with Gorham-Stout disease. The current report suggests that patients with systemic lymphatic anomalies who develop postural headaches should undergo evaluation for spontaneous i ntracranial hypotension and a CSF-lymphatic fistula. If discovered, surgical ligation is a potential treatment.

PMID:34286352 | DOI:10.1007/s00247-021-05132-6

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Does lead take the lead as the best explanation for Beethoven deafness?

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Eur Arch Otorhinolaryngol. 2021 Jul 21. doi: 10.1007/s00405-021-07006-x. Online ahead of print.

NO ABSTRACT

PMID:34287713 | DOI:10.1007/s00405-021-07006-x

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