Early detection of noise induced hearing loss by extended high frequency audiometery

Surrounding noise, especially in industrial environments, is one of the most common etiologic factors of sensory-neural hearing loss [SNHL], which is not curable, but preventable. By industrialization of communities, the prevalence of the disease and its unfavorable socioeconomic outcome is growing up. Since the preventable defect, early diagnosis has the utmost importance. In recent years, the role of extended high frequency audiometry [EHFA] as a sensitive diagnostic tool for noise induced hearing loss has received much attention. This study deals with the role of EHFA in early diagnosis of this disorder. This was a retrospective cohort study during 2003-4 in Isfahan, Iran. A total number of 30 male labors, aged 20-50 years working in a noisy industrial environment, were compared with an equal number of controls with normal conventional audiometry, and no risk factor for other causes of SNHL according to their history and otoscopic examination. All 60 individuals underwent both types of conventional and extended high-frequency audiometry. Data were analyzed with SPSS software using t-test, paired t-test and correlation tests of Pearson and Spearman. There was no difference between the right and left ears. The exposed subjects had significantly worse hearing than the non exposed group, at all tested frequencies [especially at 16 KHz]. The age effect was notable in both groups. The correlation between high frequency threshold and duration of noise-exposure was significant only at 16, 18 and 20 KHz. The higher mean frequency threshold of the cases was predictable; the normal findings of conventional audiometry, reveal that EHFA can be useful in early diagnosis of acoustic injuries

[ survey of occlusion and oro-jaw-facial cephalogmetric Indices in 6-12 year old children with adenoid enlagement]

Enlargement of Adenoid is one of the most common disorders in childhood affecting different aspects of oral and dental health and quality of life. As a result of frequent respiratory infections, allergy, nasal septum deviation and choronic sinusitis due to adenoid enlargement, facial height, gonial angle, overjet and overbite undergo changes. The purpose of this study was to assess the effect of adenoid enlargement on oro-jaw-facial cephalometric Indices and occlusion. In this cross-sectional analytical study, 96 children [6-12 years old] with adenoid enlargement [case group] and 96 children with normal size adenoid [control group] were randomly selected among patients referring to Khorasgan dental school and ENT clinics and different hospitals in Isfahan. Variables of overjet, overbite, open bite, mouth breathing, lip incompetency, gingivitis, SNA, SNB, ANB, gonial angles and facial height in two groups were evaluated. The data were analysed by chi-square and t-tests using SPSS version 9 software. The differences in anterior facial height, anterior/posterior facial height, gonial angle, SNB, overjet, snoring, mouth breathing, gingivitis and posterior crossbite between case and control groups were significant [P<0.05]. Adenoid enlargement induces some oromaxillofacial changes which inturn affect the region functionally and esthetically. The severity of these changes depends on the level of adenoid enlargement, time length of changes and induced mouth breathing duration versus normal growth and development maintenance mechanisms as well as the practitioner's interventional strategies

survey of the different concentrations of epinephrine on the volume of blood loss in septorhinoplasty under halothane anesthesia

Epinephrine usages in septoplasty and Septorhinoplasty have less hemorrhage during operation and blood loss field rule. But under general anesthesia with halothane usage of solutions, epinephrine will be with some risk. The question is which concentrations of epinephrine will be more efficacious and have less complication. This study was arranged as a clinical trial on 80 patients equally divided in four groups. In group 1 we used solution of epinephrine 1/100000 in group 2, solution of epinephrine 1/100000 with normal saline was used. In group 3 we used solution of epinephrine 1/200000 with Lidocaine 1% at last, solution of epinephrine 1/200000 with normal saline was used in the 4th group. Each of the groups included 20 patients who underwent septoplasty or Septorhinoplasty under general anesthesia with halothane. We monitored changes of systolic and diastolic blood pressures, pulse rates, volume of blood loss and any finding about dangerous dysrrhythmias such as ventricular arrhythmia. The mean percent of changes for systolic blood pressure was measured 8.46 +/- 4.59, this percent for diastolic blood pressure was measured as 10.55 +/- 5.89, and for pulse rates the mean percent of changes evaluated 7.85 +/- 4.61. In all of the groups, the percents were evaluated as less than 15% that were clinically acceptable. The mean volume of blood loss was evaluated as 73.13 +/- 30.02 milliliters. The differences were not statistically significant among the four groups. In the group 1, one case experienced an episode of ventricular tachycardia and in the second group one patient had ventricular tachycardia. Another patient showed an episode of ventricular fibrillation. Despite no statistically significant difference between group using solutions of epinephrine 1/100000 and solutions of epinephrine 1/200000 about mean percents of changes in systolic blood pressures, pulse rates and volume of blood losing, the higher concentrations of epinephrine 1/100000 raised the risk of dangerous ventricular arrhythmias, so this concentration is not recommended

Silent sinus syndrome

Silent sinus syndrome[SSS] is a rare clinical condition. In this report, we are presenting a 58 years old woman with chief complain of right global pain. All ophthalmic examinations were normal. In CT-scan of para nasal sinuses right maxillary sinus volume was decreased but she had no sinonasal symptoms

evaluation of sensory neural hearing loss in thalassaemic patients treated with desferrioxamine and its risk factors

In major thalassaemia patients who need blood transfusion, iron overload is a major therapeutic disadvantage that leads to heart failure which is the major cause of death in such patients. Desferrioxamine [DFO] is the most efficient factor for iron chelation, but it carries adverse effects such sensory-neural hearing loss. The study began in March 2002 and continued untill March 2003, on 160 cases of thalassaemia to determine the incidence of sensory - neural hearing loss and its risk factors in patients who received Desferrioxamine [DFO]. All cases underwent audiometric tests. Retrospectively, other needed information were either obtained through interview or extracted from the medical files. Results were analyzed with ANOVA, t-test and Chi-square tests. Seventy-six patients of the total 156 patients showed impairment in PTA [48.7%] with 24 of them suffering significant involvement [15.4%]. These abnormalities generally affected high frequencies including, 4000 and 8000 Hz. Male gender, increased serum billirubin level and fasting blood sugar were statistically correlated with hearing loss [p.v = 0.038, p.v = 0.38, p.v = 0.002 respectively]. There was no significant correlation between hearing loss and other factors. Mean DFO administration in patients, was 29.69 mg/kg/day and mean therapeutic index of DFO was 0.01 mg/kg/day/mg/lit. Both of them were below the critical level [<40mg/kg/day and <0.025mg/kg/day/mg/lit respectively],however hearing loss had developed. Controlling DFO dosage per se does not seem to be enough for decreasing ototoxicity rate. Periodic audiometric tests are highly recommended to detect hearing loss as soon as possible. There are some other factors such as male gender, increased billirubin and FBS, which contribute to DFO ototoxicity. Looking for these risk factors and controlling them, would help identifying susceptible patients and preventing this complication

Prevalence of dental occlusal patterns and their association with obstructive upper airway diseases in primary school children, Isfahan, Iran

Teeth, apart from their physiologic function, play an important role in general appearance of indivduals. Therefore any disorder in their growth and evolution, will cause psychologic, social and even economic problems for the person. This observational cross- sectional study aimed to investigate relationship between dental occlusal patterns and obstructive nasal-upper airway- diseases. This study was perfromed in schools of No.4 Education at district of Isfahan in educational year 1381-82 between 607 students [277 male, 330 female] aged 9-12 years old. Results of accurate ENT and dentistry physical examination were registered and analyzed using SPSS software and Chi-square and Mantel - Hanzel test. With increasing age, The frequency of abnormal occlusal patterns increases [from 45.5% to 68.2% in males and 25.8% to 48.5% in females, p=0.015]. The increasing in degree of palatal tonsilar hypertrophy was related to higher frequency of abnormal occlusal patterns [36.7% in +1 tonsilar hypertrophy, and 70% in +4 tonsilar hypertrophy, p=0.02]. Also, history of frequent common colds, and history of previous nasal fractures were related with abnormal patterns [58.9% [p=0.032], and 83.4% [p= 0.043%], respectively].Five other parameters including sinusitis, hypertrophy of nasal turbinates, rhinitis, nasal polyposis and nasal septal deviation were not associated with abnormal occlusal patterns [p>0.1]. Some of obstructive upper airwacy diseases are related with abnormal dental occlusal patterns. These parameters can be simply diagnosed, treated or prevented

[ evaluation of distribution of tracheotomy cases according age/sex indications in surgery and complications]

Background: elective tracheotomy is commonly performed in hospitals in association with intensive care units. Otherwise, after failure in attempts for intubation, this surgical procedure is fulfilled when emergency conditions exist. According to the high incidence of this operation and its importance the authors designed study by gathering information about patients including the most common, and postoperative complications, knowledge about these problems, and leads to prevention of complications of intubation and tracheotomy

Methods and Materials: in a retrospective study with randomized sampling files of 249 cases of tracheotomy were studied. 72.65% of cases were male. Ages of patients ranged from 3 months to 85 years. The most common indications for long-term intubation and long airway holding were coma, laryngeal cancer, laryngeal trauma, thyroid cancers, laryngitis and epiglottitis respectively

Results and Conclusion: the time between intubation and tracheotomy was 10 days or less in 20.296, between 11-20 clays in 57.96%, and 21 days or more in 21.6% of cases. The most common complications Post operatively, were ostium infection[8.4%], pneumothorax [1.6%], unilateral atelectasis of lung [1.4%], Hemorrhage of the site of operation [1.2%], Subcutaneous emphysema, [0.8%], tracheomalacia [0.4%], rupture of innominate artery [0.4%], tracheal stricture [0.8%] and at last, large granulation tissue on the anterior wall of trachea [0.4%] respectively, However, 27.48% of cases died because of their basic problem, so evaluation of probable delayed complications was impossible. About 57.15% of cases had no complications