Effect of local bupivacaine infiltration on post-tonsillectomy pain

Tonsillectomy is still one of the most common surgeries in the world which is accompanied by severe pain post-operatively. Although analgesic drugs are used orally or parenterally to control post-tonsillectomy pain, it is still one of the complications of this procedure especially in adults. Regarding the controversy in the role of injection of local analgesic drugs in tonsillectomy and the high prevalence of this procedure, the present study was performed to evaluate the effect of local bupivacaine infiltration, as an analgesic drug on pain after tonsillectomy in patients older than 9 years of ages. A double-blind experimental clinical trial was performed during a 3-year-period of time. One hundred and seven patients over 9 years old who were candidates for tonsillectomy because of recurrent tonsillitis [more than 6 times in a year or more than 3 times for at least two consecutive years], were selected. All patients underwent tonsillectomy by dissection/snare technique, and suturing the bleeding sites. The method of anesthesia was similar in all individuals. For each patient, 5 ml of 0.5% bupivacaine was injected into one tonsil, as the case, and 5 ml of normal saline was injected into the other one, as the control. Neither the surgeon nor the patient was aware of the content of these two injectable materials. The type of material was randomly selected for each tonsil. The intensity of post-tonsillectomy pain at each side was measured 4, 8, and 24 hours and one week post-operatively by numeric pain intensity scale [NPS] in 107 patients. Data were analyzed by SPSS software and paired t-test with 95% confidence interval. This study showed that the difference in the mean level of post-tonsillectomy pain was significant between the case and the control groups regardless of age [p < 0.001 for 4, 8 and 24 hours and p < 0.1 for a week postoperatively]. Furthermore, there was a statistically significant difference in the mean level of pain after tonsillectomy among the male patients regardless of age between the two groups 4, 8 and 24 hours, postoperatively [p < 0.001]. This difference was not significant one week after surgery [p < 0.02].In females, the difference in the mean level of post-tonsillectomy pain regardless of age was statistically significant between the two groups in four different times of evaluation[p < 0.02]. To reduce the post-tonsillectomy pain, 5 cc of 0.5% bupivacaine solution can be injected into the tonsillar bed 5 minutes preincisionally

Occupational hearing loss in elementary school teachers

Regarding the noisy environment of schools and teachers' complaint of hearing loss, the present study was performed for the evaluation of occupational hearing loss in different elementary school teachers. Between 1995 and 2000, a case- control prospective analytical study was performed in Tehran city on 2000 elementary school teachers [case group] and 2000 individuals that were not teachers [control group].Both groups had similar age and sex. The age range was 25-55 yrs. The case group was selected from 10 educational districts of Tehran [1, 2, 5, 6, 9, 10, 13, 14, 17 and 18]. The cases had no history of contact with confirmed hearing loss inducing factors. The control group had the same confounding variables as the case group. Evaluations were carried out in both groups by interview, making questionnaires, physical exam, pure-tone and speech audiometries; the results were recorded. This survey showed that hearing sensitivity of the case group was lower than that of the control group [P < 0.001] to different frequencies in both ears in regard to age, occupational history and working in different grades of elementary schools [grades 1 to 5]. However, no significant difference was detected regarding hearing loss among the teaching grades and increased occupational history had no influence on this issue. Hearing loss was more significant in high frequencies [4 and 8 kHz] and was more prevalent in the latter [p < 0.001]. Occupational noise exposure causes high-frequency sensorineural hearing loss. Thus, we recommend to measure intensity of noise in elementary schools and vocational technical schools in particular. In addition, hearing sensitivity level of students and teachers should be measured before the admission and employment, respectively. Annual regular audiometric examinations should also be performed for high-risk individuals and knowledge regarding complications of occupational noise exposure should be increased. As a conclusion, decreasing the number of students in each class, quiet classrooms, decreasing the hours of teaching and using hearing protection devices can prevent noise induced hearing loss

Effect of diabetes mellitus on the hearing ability of diabetic patients

Diabetes mellitus is the most common endocrine disease. Most of the patients suffering from diabetes mellitus complain of hearing loss. Since the previous studies made in this regard were not complete, this study was further conducted in order to evaluate the adverse effects of diabetes mellitus on the hearing ability of the diabetic individuals referring to the clinics of the Medical Universities of Tehran, during 1994-2001 [1373-1380].This investigation was a prospective analytical study carried out on two groups of population in Tehran. The first group consisted of 1500 diabetic patients [case group], and the second group consisting of 1400 normal individuals [control group]. The age of the studied population was between 15-55 years. The "case group" consisted of "Diabetic Mellitus Confirmed" patients who were randomly chosen and were willing to cooperate with this study. Initially all of the patients were interviewed and later underwent complete physical examination, audiometry [pure tone, speech, impedance], and "Auditory Brainstem Evoked Response" [ABR] evaluations. The "control group" consisted of individuals that had visited the clinics due to different reasons and according to the standards of the "International Diabetes Federation" they were considered as "Not having Diabetes". They were also willing to participate in this study. Similar audiometric examinations were performed on this group. Finally the examination results of the two groups were compared. The following results were obtained in this study: 1- The existence of a specific and distinct hearing loss in high frequencies [4-8KHz] between the case and control groups [p<0.05].2- Presence of a significant difference in the hearing level of the NIDDM patients in the high frequencies as compared to the control group [p<0.01].3- There was a distinct hearing loss in the "Complicated Diabetic Patients" in the high frequencies as compared to the normal control group [p=0.01] 4- Patients with short term diabetes mellitus had normal level of hearing, but in patients suffering from long term diabetes mellitus, there was a significant hearing impairment in the high frequencies [4-8 KHz] as compared to the control group [p<0.005]. Due to the prevalence of diabetes mellitus in the community and the presence of sensorineural hearing loss [especially bilateral] in the high frequencies in a significant number of studied patients, it's recommended to carry out a complete diagnostic audiometric evaluation in all the diabetic patients and to repeat the auditory tests regularly every year. With this method, we can not only be informed of the "Hearing status" of the patient but also use the results as a guideline and outlook for a better control of diabetes and its related complications

Parental smoking and risk of otitis media with effusion among children

Serous otitis is due to eustachian tube dysfunction and accumulation of fluid in the middle ear cavity. Otitis media with effusion [OME] is common among children and can cause hearing loss. Smoking is a common predisposing factor of this condition. The present study was conducted with the aim of determining the effects of smoking on the prevalence of OME among children residing in urban area of Tehran between 1996 and 1998. This cross-sectional study performed on 3833 pre-school and school-aged children which their age ranged from 2 to 11 years. Children were examined with pneumatic otoscope and tympanometry was performed; meanwhile, their parents were asked to complete a questionnaire. The incidence of OME was 9.1% and 14.1% in pre-school and school-aged children; respectively, and was higher among children with smoker parents. Parental smoking is a preventable predisposing factor for OME; meanwhile, there are significant statistical differences between healthy and sick children regarding their parents pack-years smoking