ABSTRACT
Existe la creencia de que la leche aumenta la producción de moco, incluso que las personas con asma deben evitar los productos lácteos. Sin embargo no existe evidencia que recomiende no ingerirlos de forma general, ni durante los catarros, ni en los sujetos con asma. En sujetos sanos o con catarro, la ingesta de leche o productos lácteos no se asocia con un aumento en la producción de moco, aunque algunos pacientes manifiestan síntomas como mayor espesor del moco y la saliva. En asmáticos la mayoría de los trabajos no encuentran un empeoramiento con su consumo, incluso aparece como un factor protector. La evidencia científica no apoya la asociación entre el consumo de leche o derivados y la producción de moco, ni tampoco con la aparición o exacerbación de asma. Por esta razón no se aconsejan las dietas restrictivas debido al posible déficit de nutrientes que estas pueden ocasionar
There is a belief that milk increases mucus production, it is even thought that people with asthma should dairy products. However, there is no evidence in the recommendation to avoid these products in general, during colds, or in subjects with asthma. Intake of milk or dairy products is not associated with an increase in mucus production in healthy subjects or upper respiratory infection, although some subjects show symptoms such as increased thickness of mucus and saliva. Most studies do not find a worsening with milk consumption in asthmatic subjects. Even a protective factor is found in milk. The scientific evidence does not support the association between consumption of milk or dairy products and mucus production, nor with the onset or exacerbation of asthma. This is why restrictive diets are not advised because of the potential nutrient deficiency that can cause
Subject(s)
Humans , Milk , Asthma , MucusABSTRACT
Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.
Subject(s)
Deglutition Disorders , Eosinophilic Esophagitis , Adolescent , Child , Child, Preschool , Eosinophilic Esophagitis/complications , Eosinophilic Esophagitis/diagnosis , Esophagoscopy , Humans , Infant , Otolaryngologists , Quality of Life , Young AdultABSTRACT
INTRODUCTION: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 µM) and to 25 µM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 µM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.
Subject(s)
Antineoplastic Agents/toxicity , Auditory Threshold/drug effects , Cisplatin/toxicity , Hair Cells, Auditory/drug effects , Lutein/pharmacology , Protective Agents/pharmacology , Animals , Apoptosis/drug effects , Cell Line , Cell Survival/drug effects , Dose-Response Relationship, Drug , Female , Hair Cells, Auditory/pathology , Lutein/toxicity , Mice , Protective Agents/toxicity , Rats, WistarABSTRACT
OBJECTIVE: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard. DESIGN: A prospective study in an otologically screened population. STUDY SAMPLE: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination. RESULTS: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000). CONCLUSIONS: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.
Subject(s)
Audiometry, Pure-Tone/standards , Auditory Threshold , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Audiometry, Pure-Tone/statistics & numerical data , Child , Child, Preschool , Female , Healthy Volunteers , Humans , Male , Middle Aged , Prospective Studies , Reference Standards , Spain , Young AdultABSTRACT
OBJECTIVE: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. DESIGN: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. STUDY SAMPLE: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination. RESULTS: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. CONCLUSIONS: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.
Subject(s)
Acoustic Stimulation/instrumentation , Acoustics/instrumentation , Audiometry, Pure-Tone/instrumentation , Auditory Pathways/physiology , Auditory Threshold , Pitch Perception , Adolescent , Adult , Age Factors , Calibration , Child , Child, Preschool , Equipment Design , Female , Humans , Male , Pressure , Reference Values , Sound , Young AdultABSTRACT
OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.
Subject(s)
Audiometry, Pure-Tone/standards , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Healthy Volunteers , Humans , Male , Middle Aged , Reference Values , Young AdultABSTRACT
Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.
Subject(s)
Cisplatin/toxicity , Cochlea , Dimethyl Sulfoxide/pharmacology , Animals , Antineoplastic Agents/pharmacology , Cochlea/drug effects , Cochlea/pathology , Cytoprotection , Male , Protective Agents/pharmacology , Rats , Rats, WistarABSTRACT
Introducción: el perjuicio estético sigue siendo hoy en día un problema a la hora de la valoración del daño corporal, ya que no se establecen cuáles son los elementos a considerar ni su cuantificación, asumiendo así un componente subjetivo tanto por parte del individuo que lo sufre como del perito encargado de la valoración. Material y métodos: se lleva a cabo una revisión bibliográfica. Se realiza un análisis de los textos y baremos más importantes empleados en la valoración del perjuicio estético, para posteriormente proponer una nueva sistemática de valoración del daño estético, que intente disminuir al máximo la subjetividad y valorar las diferentes partes del perjuicio estético. Resultados: se propone un nuevo baremo para la valoración del daño estético, en el cual se tienen en cuenta tres aspectos principales: alteraciones en la piel (cicatrices y quemaduras), amputaciones y pérdidas de sustancia, y alteraciones dinámicas (marcha, postura, expresión y habla), tomando como referencia el baremo del Real Decreto Legislativo 8/2004. Discusión: la elaboración del presente protocolo se ha basado en el baremo de la Tabla VI recogida en el Real Decreto Legislativo 8/2004, en el que se establece que edad, sexo y profesión no deben tenerse en cuenta, y en el que la valoración del daño estético se hace en un apartado independiente del daño funcional. Un baremo válido debe incluir todos los aspectos que atañen al perjuicio estético, tanto estático como dinámico (AU)
Introduction: Even today the aesthetic impairment remains a problem when assessing corporal damage, as it has not been established which are the elements to be considered and their quantification, thus assuming a subjective component by both the individual as the expert in charge of the assessment. Materials and methods: A literature review and analysis of the texts and major scales found is carried out. An analysis of methods and scales used in the assessment of aesthetic impairment is carried out in order to propose a new systematic assessment of aesthetic damage, minimizing subjectivity and assessing the different parts of the aesthetic damage. Results: A new scale for assessing the aesthetic damage is proposed; taking into account 3 main areas: changes in the skin (scars and burns), amputations and loss of substance, and disturbances of the dynamic (motion, posture, expression, and speech), with reference to the Real Decreto Legislativo 8/2004. Discussion: The preparation of this protocol has been relied on the scale of Table VI contained in the Real Decreto Legislativo 8/2004, which states that age, sex and profession should not be taken into account,and that the assessment of aesthetic impairment is done in a separate section of functional impairment. A valid scale should include all aspects pertaining to the aesthetic impairment, both static and dynamic (AU)
Subject(s)
Humans , Cicatrix , Accidents/legislation & jurisprudence , Wounds and Injuries , Compensation and Redress/legislation & jurisprudence , Body Image , Forensic Medicine/methods , Statistics on Sequelae and DisabilityABSTRACT
In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of ß-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.
Subject(s)
Blood Loss, Surgical/prevention & control , Endoscopy , Hemostasis, Surgical , Paranasal Sinuses/surgery , HumansABSTRACT
Ménière's disease is frequent in our area. It is a disabling pathology that affects the patient's quality of life. Its etiology and pathophysiology remain unclear and there are some therapeutic alternatives with controversial results. We present our series and treatment protocol for Ménière's disease and discuss the current evidence regarding its medical treatment. In the last 10 years, 252 patients were diagnosed with Ménière's disease based on their symptoms, and the results of tonal audiometry, videonystagmography and caloric stimulation tests. All cases received medical treatment according to our management protocol. Ménière's disease is more frequent in women (54.76%); 83.73% of cases are unilateral. Among these, vertigo was observed in 93.7%, hearing loss in 88.1%, tinnitus in 86.1% and pathologic caloric stimulation tests in 71% (88.27% with a reduced vestibular response). A 5-year follow-up was performed in 89.6% of the patients. Subjective improvement as reported by patients was achieved in 94.4% of the cases. There is great controversy about the medical treatment of Ménière's disease. We found no evidence for the most adequate medical treatment among the different alternatives described in literature. The patient's acceptance and understanding of the disease is very important.
