Audio-vestibular Abnormalities in Patients With Vitiligo: A Prospective Case-control Study.

INTRODUCTION: Vitiligo is a disease that is characterized by a deficit of functional melanocytes all over the body including the inner ear. OBJECTIVES: To study the effect of the reduction of melanocytes on the audio-vestibular system in patients with vitiligo. SUBJECTS AND METHODOLOGY: Our study included 35 patients with vitiligo (study group) and 35 healthy volunteers (control group). Audiological and vestibular function assessments were performed in all the participants and the results were compared between the two groups. We assessed the auditory function utilizing pure-tone audiometry and the auditory brainstem response, while vestibular function was assessed by the Dizziness Handicap Inventory, the cervical vestibular-evoked myogenic potential (cVEMP), and videonystagmography. RESULTS: Twelve patients with vitiligo showed impairment of the hearing especially in high frequencies in comparison with the control group. Auditory brainstem response wave III and I-III inter-peak latencies were significantly prolonged in the study group relative to the control subjects. On cVEMP testing, waves P13 and N23 were significantly delayed in the study group and the caloric test results showed that five vitiligo patients had unilateral weakness and three patients had bilateral weakness. CONCLUSION: Vitiligo is a systemic disease that can influence the audio-vestibular system. Screening tests for early detection of audio-vestibular changes in patients with vitiligo are important, as they are more susceptible to oxidative damage of ototoxic medications, noise exposure, and age-related hearing loss.

Olfactory dysfunction in essential tremor versus tremor dominant Parkinson disease.

BACKGROUND: Essential tremor (ET) and tremor dominant Parkinson disease (TDPD) variant constitute the main causes of geriatric tremor which differentiation is not always an easy mission. The objective of this work was to study the olfactory performance in ET and PD patients for possible consideration as a differentiating biomarker. METHODS: This study was performed on 36ET, 22 TDPD variant and 24 healthy controls subjects (HCS) submitted to extended n-butanol Sniffin' Sticks test (SST) and olfactory bulbs volumetry (OBV). RESULTS: There were significant decreases in SST threshold, discrimination, identification and TDI variables in TDPD patients compared to ET and HCS. ET patients showed significant decrease in the same variables compared to HCS. Regarding OBV, there were significant decreases in TDPD patients compared to ET and HCS with nonsignificant difference between the 2-latter groups. Our results showed that TDI score of 25 can differentiate between TDPD and ET patients with sensitivity and specificity (94 %, 91 %) respectively. CONCLUSION: Olfactory assessment is a rapid, safe, and easily applicable biomarker that could differentiate TDPD from ET in doubtful cases.

Sandwich grafting technique for endoscopic endonasal repair of cerebrospinal fluid rhinorrhoea.

The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery. The clear anatomical exposure of the roof of the nasal and paranasal sinus cavities by the endoscope offers the surgeon a golden chance to identify the area of CSF leak, and thus enables one to adequately plan the management. The aim of this work is to evaluate the use of facia lata sandwich graft technique for endoscopic endonasal repair of CSF rhinorrhoea. Forty patients with CSF rhinorrhoea were treated endoscopically using 2 layers of facia lata (underlay and onlay) interposed with a layer of septal cartilage or conchal bone in-between (sandwich technique) for repair. Fifty-five percent of cases were regarded as spontaneous CSF leaks with no obvious cause, 30% following head injury and 15% were iatrogenic. The ethmoidal roof was the commonest location of CSF leak (60%) followed in frequency by the cribriform plate and the sphenoid sinus (20% each). Follow-up period was 12-24 months. We have achieved a 95% success rate in managing CSF leaks in our 40 patients in the first attempt repair and 100% success rate after second attempt repair. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high success rate and avoid the morbidity associated with craniotomy. Using the three-layer, sandwich-grafting technique of facia lata further adds more security to the sealing of CSF and augments the results of repair.

Role of adenoid biofilm in chronic otitis media with effusion in children.

To study the extent of surface adenoid biofilm and to evaluate its role in the pathogenesis of chronic otitis media with effusion (COME) in children. The study was carried out on 100 children between 3 and 14 years of age, who were divided into two groups. The first group (50 children) had otitis media with effusion associated with adenoid hypertrophy, whereas the second group (50 children) had adenoid hypertrophy without middle ear effusion. Adenoidectomy with ventilation tube insertion was done for group 1 cases, whereas, only Adenoidectomy was done for group 2 cases. Microbiological study, Scanning electron microscope and multiplex- PCR were done for suspected adenoid biofilms and specimens from middle ear effusion. Adenoids removed from children with COME had higher grade biofilm formation (74 %) than the second group (42 %). No correlation was found between adenoid size and biofilm formation. Culture of adenoid tissue in group 1 patients was positive in 52 % of cases compared to 96 % by PCR, while in group 2 culture of adenoid tissue was positive in 38 % compared to 48 % by PCR. Culture of middle ear fluid was positive in 32 % of cases only compared to 80 % by PCR. A positive correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected and identified by PCR technique. On the other hand, no correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected by culture. The size of the adenoid is not the main determinant factor in OME pathogenesis but the degree of bacterial colonization is much more important. Adenoids in COME may act as a reservoir of chronic infection rather than causing mechanical Eustachian obstruction. Higher grade biofilm formation was found in cases with middle ear effusion than those with adenoid hypertrophy only. These findings support the hypothesis that there would be an association between adenoidal biofilm formation and COME. This study focused on the value of PCR in detecting pathogens in the adenoid and middle ear specimens although the bacterial culture would be negative.