[Intratympanic corticosteroid perfusion in the therapy of Meniere's disease].

INTRODUCTION: Over the last two decades the intratympanic perfusion of corticosteroids has been used as a minimally invasive surgical therapy of Meniere's disease. According to experimental studies the antiinflammatory, immunoprotective, antioxidant and neuroprotective role of the locally perfused corticosteroids was noticed in the inner ear structures. The recovery of action potentials in the cells of the Corti organ was confirmed as well as a decreased expression of aquaporine-1, a glycoprotein responsible for labyrinth hydrops and N and K ions derangement. OBJECTIVE: The study showed results of intratympanic perfusion therapy with dexamethasone in patients with retractable Meniere's disease who are resistant to conservative treatment. METHODS: Single doses of 4 mg/ml dexamethasone were given intratympanically in 19 patients with retractable Meniere's disease. Six single successive doses of dexamethasone were administered in the posteroinferior quadrant of the tympanic membrane. Follow-up of the patients was conducted by using a clinical questionnaire a month after completed perfusion series as well as on every third month up to one year. RESULTS: One month after completed first course of perfusions, in 78% of patients, vertigo problems completely ceased or were markedly reduced. The recovery of hearing function was recorded in 68% and marked tinnitus reduction in 84% of patients. After a year of follow-up, in 63% of patients the reduction of vertigo persisted, while hearing function was satisfactory in 52%. Tinitus reduction was present in 73% of patients. CONCLUSION: Intratympanic perfusion of dexamethasone in patients with Meniere's disease is a minimally invasive therapeutic method that contributes to the reduction of the intensity of vertigo recurrent attacks, decrease of the intensity of tinnitus and improvement of the average hearing threshold. Patients with chronic diseases and Meniere's disease who are contraindicted for systemic administration of cortocosteroids (hypertension, diabetes, glaucoma, peptic ulcer, etc.) have an additional therapeutic option by dexamethasone intratympanic perfusion.

[The impact of hearing loss on the quality of life in adults].

INTRODUCTION: The hearing apparatus is one of the most important factors related to the development of oral communication. Thus, hearing disorders and deafness lead to severe handicap. Hearing impairment in adults cause verbal communication disorders that influence psychical, emotional and social functioning. Nowadays, there is a noticeable world tendency towards improving hard of hearing person's quality of life. OBJECTIVE: Objective was to assess the association between hearing impairment and health-related quality of life. METHODS: A hundred adults with billateral hearing impairment underwent hearing examination and answered the Hering Handicap Inventory for the Elderly-Screening (HHIE-S, Ventry and Weinstein), specific for hearing impairment. RESULTS: Almost half of all participants (44%) had a moderate hearing loss, and 36% had a mild loss. Infrequently, participants had a severe degree of hearing loss (13%) and deafness (7%). Self reported hearing handicap revealed significant emotional, social and situational dysfunctions (chi2 = 40.960; df = 1; p < 0.01). Severity of hearing loss was significantly correlated with hearing handicap (r = 0.212; p < 0.05). More often, participants revealed social and situational than emotional hearing handicap (Chi2 = 131.89; df = 100; p < 0.05). Only 12% of all participants habitually used hearing aids, and they observed a significantly better quality of life scores (chi2 = 6.23; df = 1; p < 0.05). CONCLUSION: Health-related quality of life must be estimated as a factor of great importance. Investigations should involve a more extansive population with hearing loss and a national programme should be started.

[Voice analysis before and after vocal tiredness].

BACKGROUND/AIM: A school teacher's occupation is one of the most vocal demanding professions. Vocal tiredness affects acoustic characteristics of voice, leads to the change in acoustic quality during vocal production. The aim of this study was to examine the influence of vocal tiredness on voice acoustic characteristics of school teachers. METHODS: The study included 36 school teachers (16 male and 20 female) of 27-58 years of age. Vocal tiredness was evaluated by analyzing acoustic parameters of voice, using computerized laboratory "Kay Elemetrics". The voices were recorded before the first class on the beginning of a working week and after the last class at the end of a working week. Signal, noise and tremor parameters were processed. In their analysis the methods of descriptive statistics, as well as the analytical statistics (Student's t-test for paired samples, chi2 test, Mann Whitney U-test and Pearson's correlation coefficient) were applied. RESULTS: The obtained results showed statistically significant differences in average values of parameters as a consequence of the vocal tiredness (p < 0.01), while gender, age and being smoker or not, did not have a significant effect on voice acoustic characteristics in this group of examinees (p > 0.05). CONCLUSION: The results of the study suggest a casual relationship between vocal tiredness and voice quality in vocal professionals.

[Otoacoustic emissions in hearing screening in children].

BACKGROUND/AIM: Prevention of the consequences of hearing loss can be accomplished by early hearing screening of the cochlear function in newborus, but also with continuous hearing screening in the early childhood. The aim of this study was to investigate the reliability and feasibility of otoacoustic emissions (OAE) in hearing screening in children, evaluate the frequency and type of hearing loss and determine etiological factors of these losses. METHODS: In the study, 133 children, aged 2 to 7.5 years, were tested on both ears with transient evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE). Before screening tests all children had undergone otoscopic examination. If children had not passed either or both hearing screening tests and/or abnormal otoscopic findings in at least one ear, audiological evaluation was scheduled to confirm or exclude hearing loss. RESULTS: Eighty-five percent of children passed the hearing and otoscopic screening bilaterally. For additional audiologic tests 15% of children were referred. Agreement between otoscopic examination and screening tests was very good (agreement for TEOAE 95%, for DPOAE 93%). The results showed that normal tympanograms were very likely to be associated with normal screening tests. Sensitivity of TEOAE test was 94.12%, specificity 78.95%, while DPOAE sensitivity was 87.50% and specificity 75%. Hearing loss was found in 6.76% of the cases, conductive in 6.01% and sensorineural in 0.75%. Conductive hearing loss was a consequence of chronic otitis media with effusion in 25% of the cases, and a consequence of adhesive process in the middle ear in 8.33% of cases. Sensorineural hearing loss was a consequence of using ototoxic medications. CONCLUSION: TEOAE and/or DPOAE tests are reliable, noninvasive, and feasible methods for hearing screening in childhood.