Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a 30-decibel (dB) loss in hearing over three contiguous frequencies within 3 days. The cause remains unknown, and there is currently no consensus in the literature as to how it is best treated. Conventional treatment in our unit comprises steroids, pentoxyphiline and dextran, with the potential addition of hyperbaric oxygen therapy (HBOT). METHODS: A prospective randomised trial was performed on all soldiers diagnosed with ISSNHL in our institution from 1 January 2007 to 31 December 2016. Participants were randomly allocated to one of two groups. Group A was treated with conventional treatment plus HBOT. Group B was treated with conventional treatment only. Data collection included age, gender, clinical symptoms, pure-tone audiometry results and treatment outcome. RESULTS: 60 participants were enrolled (53 male, 7 female) with ages ranging from 18 to 65 years (mean age of 30.3). No significant differences were observed in the baseline characteristics between the two groups, including gender, age, site, associated symptoms, duration of symptoms and severity of hearing loss. Hearing recovery using Siegel's criteria on days 8 and 13 showed no significant differences between treatment groups. However, the hearing recovery on day 180 was significantly better in those who received the conventional treatment plus HBOT (P<0.05). Additionally, no significant side effects were observed in either group. CONCLUSIONS: HBOT plus existing conventional treatment was associated with a better outcome than conventional treatment alone. We would recommend the addition of HBOT is recommended as a first-line treatment modality for all soldiers presenting with ISSNHL.

Acute fulminant invasive fungal sinusitis with cavernous sinus syndrome.

Acute fulminant invasive fungal sinusitis is most commonly found in immunocompromised patients with conditions such as diabetes mellitus, malignancies and acquired immune deficiency syndrome. The most common pathogens are Aspergillus and Mucoraceae and the sinus most frequently involved is the maxillary sinus. Fever, rhinorrhea, facial pain, headache, and diplopia are common presenting symptoms. Complications of this infection include intracranial and / or intraorbital spread of the infection; the prognosis is poor. Here, a rare case of acute fulminant invasive fungal sinusitis with cavernous sinus syndrome is reported.

Lobular capillary hemangioma of the nasal cavity: a retrospective study of 15 cases in taiwan.

BACKGROUND: Lobular capillary hemangioma of the nasal cavity is an uncommon benign vascular tumor of unknown etiology. There have been only very few case reports in Taiwan. AIMS: This study aimed to analyze the clinical features, radiological findings, treatment modalities, and outcome of lobular capillary hemangioma treated at a teaching hospital in Taiwan during a period of 10 years. STUDY DESIGN: Descriptive study. METHODS: Retrospective chart reviews were performed on patients who were diagnosed with lobular capillary hemangioma of the nasal cavity at Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, from January 2003 to December 2012. Data retrieved included age, gender, clinical symptoms, computed tomography (CT) findings, treatment modalities, and outcome for further analysis. RESULTS: Of the 15 patients identified, there were five males and ten females ranging from 17 to 86 years of age, with a mean age of 43.8±20.2. Epistaxis was the most common presenting symptom. All patients presented a unilateral nasal lobular capillary hemangioma. The most commonly affected site was the anterior nasal septum, followed by the inferior turbinate, vestibule, middle turbinate, and posterior nasal septum. All lesions presented as soft tissue density without bony erosions under CT examination. Endoscopic excisional surgery (n=12) or classical local excision (n=3) was performed for complete removal of the hemangioma. No evidence of recurrence was observed with 6 to 75 months of follow-up. CONCLUSION: Lobular capillary hemangioma of the nasal cavity was usually found to occur in anterior septum with epistaxis. Complete excision with endoscopic surgery or classical local excision was recommended and recurrence can be prevented.

Influences of patient age on deep neck infection: clinical etiology and treatment outcome.

OBJECTIVES: To analyze the differences in clinical features, etiology, treatment modalities, and microbiology of the deep neck infections between the elderly and the adults. STUDY DESIGN: Cases series. SETTING: Single hospital. SUBJECTS AND METHODS: A retrospective review was performed on patients older than 18 years of age with diagnosis of deep neck infection from January 2008 to December 2012. A total of 148 patients were enrolled in this study, including 32 elderly (older than 65 years of age) and 116 adults who aged between 18 and 65. Data collected included age, gender, clinical presentations, etiology, treatment modalities, and microbiology. RESULTS: Odontogenic and salivary origin were the most common sources of infection for the elderly group, whereas the odontogenic and tonsillar origin were the most common sources of deep neck infections in the adult group. Compared to the adult group, the elderly group had significantly higher ratio with multiple spaces involved (53.1% vs 30.2%, P = .016), complication (15.6% vs 4.3%, P = .024), and surgical interventions (75.0% vs 38.8%, P < .001), in addition to longer hospital stay (11.1 ± 7.2 days vs 8.2 ± 4.5 days, P = .029). CONCLUSION: Compared to the adult group, the elderly patients with deep neck infection had more cases with multiple spaces involvement, complications, surgical interventions, and longer hospital stay. However, the outcome of the elderly group was the same as the adult group. Therefore, the benefits of aggressive management for deep neck infection should not be withheld from patients simply because of the old age.