An absence of cilia outer microtubules, an etiology not previously recognized in bilateral mucocele.

Most paranasal sinus mucoceles are unilateral and affect one or at most two contiguous sinuses. We describe the case of a 44-year-old woman with bilateral maxillary sinus mucoceles who presented clinically with left malar pain, right-sided swelling, and proptosis of the right eye. The diagnostic workup included computed tomography and magnetic resonance imaging. In addition, because of the atypical bilateral presentation, we analyzed mucosal sinonasal tissue samples by electron microscopy. Microscopic analysis revealed an absence of one of the microtubule doublets in three of the outer doublets of the axoneme, thereby establishing a diagnosis of isolated ciliary dysfunction. To the best of our knowledge, ciliary dysfunction as a cause of bilateral mucoceles has not been previously reported in the literature. The patient underwent successful surgery for removal of the mucoceles, and she exhibited no evidence of recurrence at the 18-month follow-up. When a diagnosis of bilateral mucocele formation is made, we suggest that ciliary dysfunction be considered in the differential diagnosis and that electron microscopy of the sinonasal mucosa be performed in the workup.

Pruebas de despistaje auditivo en adultos / Hearing loss screening tests for adults

Introducción: La detección temprana de hipoacusia ha sido ampliamente estudiada en recién nacidos gracias a las nuevas tecnologías en pruebas diagnósticas y tratamiento; existen protocolos bien establecidos de despistaje universal en esta población. Sin embargo, en adultos, el despistaje auditivo es un tema que también cobra importancia debido al aumento en la esperanza de vida, al cambio en la pirámide poblacional mexicana, que se estima que en los siguientes 50 años se transformará hacia una forma rectangular (con un aumento en la prevalencia de presbiacusia), y al establecimiento de programas de protección social en salud como el Seguro Popular. No se cuenta con investigaciones mexicanas sobre despistaje auditivo en adultos. El objetivo de este trabajo es evaluar una prueba de emisión tonal y un cuestionario como estrategias de despistaje en adultos. Métodos: Se tomó una muestra de 500 personas sin antecedente de patología otológica en la consulta externa de un hospital general. Se realizó otoscopia, 2 pruebas de despistaje auditivo (emisión tonal y cuestionario) y audiometría a todos los sujetos. Resultados: El cuestionario es una prueba sensible pero poco específica, mientras que la prueba de emisión de tono fue menos sensible pero más específica con tasa mayor de exactitud. La mejor estrategia resultó la combinación de ambas pruebas que alcanzó una exactitud del 90%. Conclusiones: Se propone como la mejor estrategia de despistaje en adultos un cuestionario y una prueba de emisión tonal que garantiza de forma rápida, sin necesidad de entrenamiento especial, una evaluación completa del estado de audición en lo objetivo y subjetivo (AU)

Introduction: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the «Seguro Popular». There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. Methods: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. Results: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. Conclusions: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training (AU)

Hearing loss screening tests for adults.

INTRODUCTION: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the "Seguro Popular". There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. METHODS: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. RESULTS: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. CONCLUSIONS: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training.