Tinnitus characteristics in patients with hyperacusis and vertigo (including Ménière's disease) vs. hyperacusis alone.

INTRODUCTION AND OBJECTIVES: To compare clinical and psychoacoustic tinnitus characteristics in patients with the comorbidity of hyperacusis, hyperacusis and vertigo, and with Ménière's disease (MD). MATERIALS AND METHODS: Three hundred and twenty-nine tinnitus patients underwent audiological and otoneurological evaluation. Records of 94 individuals younger than 65 years, 40 women and 54 men (mean age 41.8, range 24-64 years), who complained of tinnitus and hyperacusis, were analyzed. One hundred and thirty-one ears with tinnitus were identified: 67 in the group of patients with tinnitus and hyperacusis (group 1; 41 patients); 28 in the group fulfilling criteria of MD diagnosis (group 2; 28); and 36 in the group with tinnitus, hyperacusis and typical symptoms of vertigo (group 3; 25). RESULTS AND CONCLUSIONS: Mean value of interaural difference in canal paresis in group 1 was 6.3%; in group 2: 23.7%; and in group 3: 25.9%; p<.001. Mean tinnitus pitch value was significantly lower in group 3 (1679Hz; SD=1139) and group 2 (2250Hz; SD=1162) compared to group 1 (4538Hz; SD=3123; p=.012). Values of tinnitus intensity and other characteristics did not significantly differ between the groups. Tinnitus and hyperacusis were most frequently preceded by acoustic trauma. Tinnitus coinciding with hyperacusis and vertigo was observed in patients after head trauma. Mean tinnitus pitch was lower in the groups of patients with hyperacusis and peripheral labyrinthine lesion than in tinnitus sufferers with hyperacusis alone. Tinnitus sufferers with low tinnitus pitch should undergo vestibular system evaluation. Hyperacusis and vertigo are likely comorbidities in tinnitus patients after head trauma. Hyperacusis may coincide in tinnitus patients after head trauma.

Tinnitus characteristics in patients with hyperacusis and vertigo (including Ménière's disease) vs. hyperacusis alone

Introduction and objectives: To compare clinical and psychoacoustic tinnitus characteristics in patients with the comorbidity of hyperacusis, hyperacusis and vertigo, and with Ménière's disease (MD).Materials and methodsThree hundred and twenty-nine tinnitus patients underwent audiological and otoneurological evaluation. Records of 94 individuals younger than 65 years, 40 women and 54 men (mean age 41.8, range 24–64 years), who complained of tinnitus and hyperacusis, were analyzed. One hundred and thirty-one ears with tinnitus were identified: 67 in the group of patients with tinnitus and hyperacusis (group 1; 41 patients); 28 in the group fulfilling criteria of MD diagnosis (group 2; 28); and 36 in the group with tinnitus, hyperacusis and typical symptoms of vertigo (group 3; 25).Results and conclusionsMean value of interaural difference in canal paresis in group 1 was 6.3%; in group 2: 23.7%; and in group 3: 25.9%; p<.001. Mean tinnitus pitch value was significantly lower in group 3 (1679Hz; SD=1139) and group 2 (2250Hz; SD=1162) compared to group 1 (4538Hz; SD=3123; p=.012). Values of tinnitus intensity and other characteristics did not significantly differ between the groups. Tinnitus and hyperacusis were most frequently preceded by acoustic trauma. Tinnitus coinciding with hyperacusis and vertigo was observed in patients after head trauma.Mean tinnitus pitch was lower in the groups of patients with hyperacusis and peripheral labyrinthine lesion than in tinnitus sufferers with hyperacusis alone. Tinnitus sufferers with low tinnitus pitch should undergo vestibular system evaluation. Hyperacusis and vertigo are likely comorbidities in tinnitus patients after head trauma. Hyperacusis may coincide in tinnitus patients after head trauma. (AU)

Introducción y objetivos: Comparar las características clínicas y psicoacústicas del tinnitus en pacientes con comorbilidad de hiperacusia, hiperacusia y vértigo, y con enfermedad de Ménière (EM).Materiales y métodosTrescientos veintinueve pacientes con tinnitus se sometieron a evaluación audiológica y otoneurológica. Se analizaron los registros de 94 pacientes menores de 65 años, 40 mujeres y 54 hombres (edad media 41,8, rango 24-64 años), que se quejaron de tinnitus e hiperacusia. Se identificaron 131 oídos con acúfenos: 67 en el grupo de pacientes con acúfenos e hiperacusia (grupo 1; 41 pacientes); 28 en el grupo que cumplía criterios de diagnóstico de enfermedad de Ménière (grupo 2; 28); y 36 en el grupo con acúfenos, hiperacusia y síntomas típicos de vértigo (grupo 3; 25).Resultados y conclusionesEl valor medio de la diferencia interaural en paresia del canal en el grupo 1 fue del 6,3%; en el grupo 2 del 23,7%; y en el grupo 3 del 25,9%; p<0,001. El valor medio del tono del tinnitus fue significativamente menor en el grupo 3 (1679Hz; DE=1139) y el grupo 2 (2250Hz; DE=1162), en comparación con el grupo 1 (4538Hz; DE=3123; p=0,012). Los valores de la intensidad del tinnitus y otras características no difirieron significativamente entre los grupos. El tinnitus y la hiperacusia fueron precedidos con mayor frecuencia por traumatismos acústicos. Se observó tinnitus coincidente con hiperacusia y vértigo en pacientes después de traumatismo craneoencefálico.El tono medio del tinnitus es menor en los grupos de pacientes con hiperacusia y lesión laberíntica periférica que en los que padecen tinnitus con hiperacusia. (AU)

Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia

Introduction and Objectives: Chronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence.Patients and MethodsThe measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia.ResultsIn 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm.ConclusionsRecords of the entering examination must be considered before turbinoplasty under local anaesthesia. (AU)

Introducción y objetivos: Las molestias relacionadas con la rinitis crónica pueden ser resultado de la hipertrofia aislada de los cornetes nasales inferiores. Si los síntomas persisten a pesar del tratamiento conservador, está indicada la turbinoplastia. Sin embargo, la mucosa nasal que recubre los cornetes inferiores parece descongestionarse inmediatamente antes de la cirugía realizada con anestesia local, en comparación con el examen realizado al ingresar los pacientes para cirugía. El estudio tuvo como objetivo confirmar esta observación y formular hipótesis sobre las razones de su ocurrencia.Pacientes y métodosSe realizaron mediciones de las distancias más largas entre el borde medial de la mucosa del cornete nasal inferior y el tabique nasal, así como las distancias más cortas entre el borde inferior del cornete y el suelo de la cavidad nasal en la parte inferior de ambos meatos nasales comunes, en las fotografías tomadas durante los exámenes endoscópicos: las realizadas al ingresar el paciente para turbinoplastia y las realizadas inmediatamente antes del procedimiento. Los resultados en este grupo se compararon con los obtenidos en pacientes operados bajo anestesia general.ResultadosEn 130 pacientes de 18 a 60 años (media = 40,7) años, operados bajo anestesia local, la suma de las distancias medias entre el tabique nasal y el borde medio del cornete inferior en ambas cavidades nasales fue de 3,4 mm durante el primer examen, y 4,5 mm (p = 0,0008) durante el segundo. En el grupo de 42 participantes de 26 a 47 años, promedio = 36,8 años operados bajo anestesia general, los valores fueron: 4,8 mm y 3,6 mm (p = 0,02), respectivamente. Las diferencias fueron significativamente menores en los fumadores (0,3) en comparación con los no fumadores 1,3 mm (p = 0,04).ConclusionesDeben considerarse los registros del examen realizado durante el ingreso previo a la turbinoplastia bajo anestesia local. (AU)

Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia.

INTRODUCTION AND OBJECTIVES: Chronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence. PATIENTS AND METHODS: The measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia. RESULTS: In 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm. CONCLUSIONS: Records of the entering examination must be considered before turbinoplasty under local anaesthesia.

[Results of inferior nasal turbinate reduction in old and very old patients with chronic rhinitis]. / Ergebnisse der Nasenmuschelverkleinerung bei alten und sehr alten Patienten mit chronischer Rhinitis.

BACKGROUND: Symptoms of chronic rhinitis in old and very old populations may result from isolated hyperplasia of nasal inferior turbinates. Turbinoplasty is a possible method of treatment in these individuals. However, preoperative concerns are associated with their poor general condition: tendency to epistaxis, treatment with anticoagulants, hypertension, and less effective healing. OBJECTIVE: The aim of this study was to determine differences in results of turbinoplasty obtained in old and very old individuals with chronic rhinitis, compared to young and otherwise healthy patients. MATERIAL AND METHODS: We analyzed records of 130 patients with hyperplasia of the inferior turbinates, who had undergone bipolar diathermy turbinoplasty: 82 individuals aged 18-59 (mean = 33.8; SD = 10.2), 30 patients aged 60-74 (mean = 66.0; SD = 3.7) and 18 participants aged 75 + years (mean = 85.3; SD = 6.5). The patients were questioned about the intensity of their symptoms before and one month after the surgery, using the SNOT-20 questionnaire. The duration of wound healing and satisfaction scores were also noted. RESULTS: Nasal patency, nasal discharge and post-nasal drip improved in old and very old patients, similarly as in the young ones. Olfactory and taste function improved significantly more in young individuals. Postoperative healing time was significantly longer in very old patients. CONCLUSIONS: Some results of turbinoplasty in old and very old patients were significantly worse than in young ones.

Double tinnitus in a single ear.

OBJECTIVE: To search for distinctive clinical features of patients with double tinnitus in a single ear. Design retrospective: Study sample: Six hundred and fourteen tinnitus patients were interviewed using a detailed questionnaire. They underwent thorough audiological evaluation. Records of seven patients reporting double tinnitus in 10 ears were identified and analysed. There were three women and four men in the group (mean age 40, range 29-49 years). RESULTS: All but two individuals declared sudden onset of the complaints. Three patients had been diagnosed with sudden sensorineural hearing loss. In all the patients, the components of double tinnitus were compared both to a pure tone and to a narrow band noise. The sounds were considered by the patients to be primary (more prominent) or secondary. All but one patient declared hypersensitivity to loud sounds. Vertigo was present in only two of the double tinnitus sufferers. Abnormal DPOAEs frequency values and audiogram notch frequencies were closer to the primary than the secondary tinnitus matches. CONCLUSIONS: In our study, double tinnitus was rare, mostly perceived by patients with a sudden onset of tinnitus. This is the first report presenting audiological findings in patients with double tinnitus in a single ear. Prospective search of cohorts of tinnitus sufferers for such patients and functional neuroimaging of their auditory pathways for determining underlying mechanisms of the complaints is advocated.

Paediatric otitis media with effusion is connected to deficits in music perception.

PURPOSE: This study tested the hypothesis that children with otitis media with effusion (OME) attending a primary school are at risk of impairment of their musical skills. OME is characterized as an inflammation with accumulation of secretion in the tympanic cavity, leading to conductive hearing loss. METHOD: Perception of music in children is assessed using the Montreal Battery of Evaluation of Music Abilities (MBEMA). Listeners are required to judge whether two successive melodies are the same or different on tests of scale, contour, interval and rhythm. They are also queried by a memory test. A total of 92 children (49 girls and 43 boys), aged 6.0-8.0 years (mean 7.3, SD 0.7), attending a music school, were examined using the MBEMA. Twenty-three children were allocated to the OME group, while the remaining 69 to the control group. Age and gender distribution did not differ between children with OME and the controls. All participants had normal bone conduction hearing thresholds. The conductive hearing loss of the children with OME did not exceed 40 dB at any frequency. Their OME was bilateral and had lasted 3-9 months. RESULTS: The obtained scale, rhythm and total MBEMA scores were higher in the control group than in the OME group, with statistically significant differences for scale and rhythm scores. CONCLUSIONS: OME can influence music perception in children at the beginning of their school education. OME correlates with both pitch- and rhythm-related aspects of music perception.

Comparison of characteristics observed in tinnitus patients with unilateral vs bilateral symptoms, with both normal hearing threshold and distortion-product otoacoustic emissions.

CONCLUSION: Tinnitus characteristics in normal-hearing patients differ between the groups with unilateral and bilateral complaints. OBJECTIVES: The study was to determine the differences between tinnitus characteristics observed in patients with unilateral vs bilateral symptoms and normal hearing threshold, as well as normal results of distortion-product otoacoustic emissions (DPOAEs). METHOD: The patients answered questions concerning tinnitus duration, laterality, character, accompanying symptoms, and circumstances of onset. The results of tympanometry, auditory brainstem responses, tinnitus likeness spectrum, minimum masking level (MML), and uncomfortable loudness level were evaluated. Records of 380 tinnitus sufferers were examined. Patients with abnormal audiograms and/or DPOAEs were excluded. The remaining 66 participants were divided into groups with unilateral and bilateral tinnitus. RESULTS: Unilateral tinnitus in normal-hearing patients was diagnosed twice more frequently than bilateral. Tinnitus pitch was higher in the group with bilateral tinnitus (p < .001). MML was lower in unilateral tinnitus (p < .05). Mean age of patients was higher in the unilateral tinnitus group (p < .05). Mean tinnitus duration was longer (p < .05) and hypersensitivity to sound was more frequent (p < .05) in the bilateral tinnitus group. Repeated exposure to excessive noise was the most frequent cause in the bilateral tinnitus group.

Adult tonsillectomy: postoperative pain depends on indications / Tonsilectomia no adulto: a dor pós-operatória depende das indicações

ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.

Resumo Introdução: Dor intensa é uma das queixas mais importantes no pós-operatório de uma tonsilectomia. Com frequência, essa dor é descrita pelos pacientes, como comparável à dor que acompanha a tonsilite aguda. Apesar da tonsilite recorrente ser a indicação mais frequente para cirurgia, muitas tonsilectomias são realizadas por outras indicações, e esses pacientes podem não estar familiarizados com essa dor. Objetivo: Verificar se indivíduos com tonsilite recorrente apresentam diferenças na intensidade dolorosa pós-tonsilectomia vs. pacientes com outras indicações para cirurgia, sem histórico de episódios de tonsilite aguda. Método: Foram realizadas 61 tonsilectomias sob anestesia geral, com o uso de um laser potassium titanyl phosphate (KTP) (para que fosse eliminada uma possível influência de uma dissecção agressiva das tonsilas fibrosadas em pacientes com história de tonsilite recorrente), e hemostasia através de ligaduras de vasos sanguíneos nos leitos tonsilares. Os pacientes foram medicados com 37,5 mg de cloridrato de tramadol + 325 mg de paracetamol (comprimidos) durante 10 dias. As variáveis pós-operatórias foram tempo de internação hospitalar, hemorragia e percentual de readmissão. Os pacientes forneceram informações sobre a intensidade da dor em dias consecutivos, duração da dor, perda de peso corpóreo no dia 10 do pós-operatório, intensidade e duração da dificuldade de deglutição, e necessidade de doses adicionais de analgésicos. A velocidade de cicatrização também foi avaliada. Fibras nervosas capsulares foram examinadas histologicamente nas tonsilas resecadas com o uso de imunocorantes para marcadores de fibras nervosas gerais e de sensibilidade. Resultados: As indicações para a cirurgia foram: tonsilite aguda recorrente (34 pacientes), ausência de história de tonsilite recorrente - Tonsilite focal (20) e halitose (7). A intensidade da dor nos dias 3-4 do pós-operatório e a incidência de reinternações em decorrência de desidratação foram significativamente mais altas no grupo sem história de tonsilite recorrente. Não foram observadas diferenças significantes nas densidades relativas de fibras nervosas imunorreativas para protein gene product (PGP) 9.5 e calcitonin gene-related peptide (CGRP). Conclusão: Os pacientes com tonsilite recorrente e qualificados para tonsilectomia informaram menor intensidade da dor em relação aos pacientes sem histórico se tonsilite recorrente, e os escores para dor não apresentaram relação com a densidade das fibras nervosas.

Adult tonsillectomy: postoperative pain depends on indications.

INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5mg Tramadoli hydrochloridum+325mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.

Effectiveness of Polyvalent Bacterial Lysate and Autovaccines Against Upper Respiratory Tract Bacterial Colonization by Potential Pathogens: A Randomized Study.

BACKGROUND: Polyvalent bacterial lysate (PBL) is an oral immunostimulating vaccine consisting of bacterial standardized lysates obtained by lysis of different strains of bacteria. Autovaccines are individually prepared based on the results of smears obtained from the patient. Both types of vaccine can be used to treat an ongoing chronic infection. This study sought to determine which method is more effective against nasal colonization by potential respiratory tract pathogens. MATERIAL AND METHODS: We enrolled 150 patients with aerobic Gram stain culture and count results indicating bacterial colonization of the nose and/or throat by potential pathogens. The participants were randomly assigned to each of the following groups: 1. administration of PBL, 2. administration of autovaccine, and 3. no intervention (controls). RESULTS: Reduction of the bacterial count in Streptococcus pneumoniae-colonized participants was significant after the autovaccine (p<0.001) and PBL (p<0.01). Reduction of the bacterial count of other ß-hemolytic streptococcal strains after treatment with the autovaccine was significant (p<0.01) and was non-significant after PBL. In Haemophilus influenzae colonization, significant reduction in the bacterial count was noted in the PBL group (p<0.01). Methicillin-resistant Staphylococcus aureus colonization did not respond to either treatment. CONCLUSIONS: The autovaccine is more effective than PBL for reducing bacterial count of Streptococcus pneumoniae and ß-hemolytic streptococci, while PBL was more effective against Haemophilus influenzae colonization.

Adult tonsillectomy: anatomical differences affect postoperative transient hypernasality.

OBJECTIVE: Our purpose was to determine how anatomical conditions of the throat influence the degree and duration of posttonsillectomy transient hypernasality. PATIENTS AND METHODS: A total of 82 tonsillectomies were performed. The participants were divided into groups: 1 ­ small tonsils, high soft palate position; 4 ­ large tonsils, low soft palate position, and 2 and 3 ­ intermediate tonsil dimensions and soft palate positions. Variables studied included the diameter of vapor (DV) on the mirror positioned under the patient's nose while articulating nasal sentences before and after surgery, the distance from the uvular tip to the posterior pharyngeal wall, healing grading as well as the degree and duration of hypernasality. RESULTS: The mean hypernasality after tonsillectomy was greatest in group 4 and lowest in group 2. Before tonsillectomy, the mean DV was largest in group 2 and smallest in group 4. After tonsillectomy, the mean DV was largest in group 4 and smallest in group 3. Overall, the mean DV was significantly greater after tonsillectomy compared to the value before surgery. CONCLUSION: The degree of hypernasality after tonsillectomy depends on the soft palate position in relation to the tongue base and the size of the tonsils. Hypernasality is greatest in patients with large tonsils and a low soft palate position in relation to the tongue base.

How do pediatric adenoidectomy and adenotonsillotomy influence maternal psychological status?

We conducted a study to determine the impact that pediatric adenoidectomy or adenotonsillotomy (adenoidectomy with a partial tonsillectomy) had on the short-term psychological status of the children's mothers. Mothers of 100 treated children were examined with the 14-item Hospital Anxiety and Depression Scale (HADS) questionnaire immediately before the operation and 3 days afterward; to establish a baseline for control purposes, they completed another questionnaire 10 days postoperatively. We also compiled data for the mothers' demographic information and the children's physical status. In the preoperative period, we found that (1) the anxiety scores of half the mothers were abnormal, (2) depression scores were higher in the adenotonsillotomy group, and (3) anxiety and depression scores were lower in the mothers with more education and in the mothers who had a personal or family history of previous surgery. At 3 days postoperatively, anxiety and depression scores were again lower in the more educated mothers, and lower in the absence of postoperative fever. We conclude that mothers whose children are undergoing adenoidectomy or adenotonsillotomy, particularly the latter, and those with less education may require some psychological intervention. Such help may also be needed when postoperative complications occur.

Tinnitus pitch and minimum masking levels in different etiologies.

OBJECTIVE: We sought to determine whether the results of audiological tests and tinnitus characteristics, particularly tinnitus pitch and minimum masking level (MML), depend on tinnitus etiology, and what other etiology-specific tinnitus characteristics there are. DESIGN: The patients answered questions concerning tinnitus laterality, duration, character, aggravation, alleviation, previous treatment, and circumstances of onset. The results of tympanometry, pure-tone audiometry, distortion-product otoacoustic emissions, tinnitus likeness spectrum, MML, and uncomfortable loudness level were evaluated. STUDY SAMPLE: Patients with several tinnitus etiological factors were excluded. The remaining participants were divided into groups according to medical history: acute acoustic trauma: 67 ears; chronic acoustic trauma: 82; prolonged use of oral estrogen and progesterone contraceptives: 46; Ménière's disease: 25; congenital hearing loss: 19; sensorineural sudden deafness: 40; dull head trauma: 19; viral labyrinthitis: 53; stroke: 6; presbycusis: 152. Data of 509 ears were analysed. RESULTS: Tinnitus pitch was highest in patients with acute acoustic trauma and lowest in patients receiving estrogen and progesterone. MML was lowest after acute acoustic trauma and in congenital hearing loss, and highest after a stroke and in the case of presbytinnitus. CONCLUSIONS: Tinnitus pitch and MML are etiology dependent.

Subacute rhinitis in infants: gastroesophageal reflux must be considered.

OBJECTIVES: The study sought to evaluate the influence of gastroesophageal reflux disease (GERD) and allergy on subacute rhinitis in infants. METHODS: Mothers of 74 infants with subacute rhinitis completed the Infant Gastroesophageal Reflux Questionnaire Revised. Participants with GERD were randomized to undergo one of the following regimens for 10 days: use of fluorometholone nasal drops with positional and feeding changes; positional and feeding changes; or a placebo. RESULTS: The daily amount of nasal secretion decreased by 75.9% (p < 0.001), the intensity of swallowing difficulty by 79.2% (p < 0.001), and the incidence of uneasiness by 92.0% (p < 0.001) in infants treated with nasal glucocorticoid and positional and feeding changes; and the percentage differences in the amount of nasal secretion (p < 0.001), feeding difficulty (p < 0.001), and uneasiness (p < 0.001) were greater than those in the group treated with positional and feeding changes. The infants treated with placebo did not improve. The influence of nasal allergy was nonsignificant. CONCLUSIONS: Gastroesophageal reflux disease might contribute to aggravation of subacute rhinitis in infants.

Perioperative antibiotic in adenoidectomy with partial tonsillectomy: a randomized trial.

OBJECTIVES: To examine potential benefits of perioperative antibiotic therapy in children undergoing adenotonsillotomy. METHODS: Adenoidectomy with tonsillotomy was performed in 124 children with obstructive symptoms, aged 5-7 years. Of these, 120 completed the study. Intraoperative intravenous and postoperative oral clindamycin, or placebo for 7 days, were administered. RESULTS: There were significant differences between the groups regarding pain intensity (p < 0.001) and duration (p < 0.05), day of return to normal physical activity (p < 0.05), occurrence and duration of oral malodor (p < 0.001), number of doses of additional analgesic (p < 0.001), healing grading (p < 0.05) and parents'/caregivers' satisfaction scores on the 4th postoperative day. There were indications for antibiotic in 2 individuals in the placebo group. CONCLUSIONS: There are significant differences in the course of convalescence related to perioperative antibiotic in children after adenotonsillotomy, but strict indications for antibiotics in these patients are rare.

Factors affecting outcome of inferior turbinate mucotomy in treatment of postnasal drip syndrome.

BACKGROUND: Postnasal drip syndrome may result from isolated hyperplasia of nasal inferior turbinates due to chronic rhinitis. Mucotomy (conchotomy) performed in such patients is generally effective but in some individuals the problem persists after surgery. OBJECTIVE: The aim of this study was to determine factors influencing outcome of the therapy. METHODS: One hundred six patients aged 17-60 years (mean = 34, SD = 12) with hyperplasia of the inferior turbinates underwent bipolar diathermy mucotomy. Nonallergic noninfectious rhinitis was diagnosed in 18, neutrophilic in 58, allergic in 18 and NARES in 14 patients. The participants were questioned about postnasal drip (PND) intensity before and 2 months after surgery. RESULTS: Results of mucotomy significantly depended on the etiology of chronic rhinitis and were worst in patients with NARES (p < 0.05). Percent values of reduction of PND intensity after mucotomy and percent of daytime with PND persisting after surgery depended on Staphylococcus aureus colonization of the nose (the results were worse in patients with the colonization, p < 0.001). Satisfaction scores were also dependent on S. aureus nasal colonization (p < 0.001) and significantly correlated with percent values of subjective reduction of PND intensity after surgery (p < 0.001) and reduction of PND daily duration (p < 0.001). CONCLUSIONS: Results of mucotomy performed for postnasal drip depend on etiology of rhinitis and are worse in S. aureus nasal colonization.

Hemorragia postamigdalectomía: ¿tienen las pruebas de coagulación y el historial de coagulopatía un valor predictivo? / Post-tonsillectomy haemorrhage—Do coagulation tests and coagulopathy history have predictive value?

Objetivos: La determinación de los factores de riesgo de la hemorragia postamigdalectomía (HPA) es esencial para su prevención. El objetivo del estudio ha sido el de analizar los resultados de las pruebas de coagulación y los historiales preoperatorios familiares y médicos de desórdenes de coagulación, a fin de establecer si estos tienen un valor predictivo para la HPA. Métodos: Se analizaron los valores de TTPA (tiempo de tromboplastina parcial activada), ratio protrombina/INR y recuento de plaquetas, así como otros historiales médicos, en 222 pacientes de edades comprendidas entre 15–60 años. Se produjeron 15 episodios de HPA secundaria. Esto incluyó a 3 de 9 (33,3%) pacientes con historial médico de propensión a hematomas tras traumas menores y a todos (4) los pacientes que declararon tanto historial médico relevante de propensión a la formación de hematomas tras traumas menores, como propensión a sangrado prolongado tras lesiones. Resultados: Cinco personas mostraron elevados valores de TTPA y propensión a la formación de hematomas tras traumas menores, y otros seis pacientes mostraron valores elevados de TTPA, historial relevante de epistaxis frecuentes y desórdenes familiares de coagulación. En ninguno de estos pacientes se produjo HPA. Se produjo un episodio de HPA primaria y no secundaria en 15 pacientes con elevados valores de TTPA, superiores a menor o igual al 10% respecto al valor normal. No se produjo HPA en 6 personas con TTPA elevado, superior al >10% respecto al valor normal. El porcentaje de hemorragias se correlacionaba con los resultados de TTPA, propensión a la formación de hematomas y a sangrado tras lesiones. Los valores de especificidad de las epistaxis recurrentes, historial de hematomas tras traumas menores y sangrado prolongado tras lesiones fueron significativos. Conclusiones: En adultos sanos, los resultados de las pruebas de coagulación son irrelevantes para el curso de la amigdalectomía y los casos de sangrado postoperatorios. El historial médico personal es importante para la predicción de la HPA (AU)

Objectives: Determining post-tonsillectomy haemorrhage (PTH) risk factors is crucial for preventing it. The aim of the study was to analyse results of coagulation tests and preoperative family and medical history of coagulation disorders in order to establish if they have predictive value for PTH. Methods: In 222 patients aged 15–60 years, values of APTT (Activated Partial Thromboplastin Time), prothrombin/INR ratio and platelet count as well as medical history were analysed and 15 episodes of secondary PTH occurred. This includes 3 of 9 (33.3%) patients with medical history of proneness to bruises after minor trauma and in all (4) patients who declared both relevant medical history of proneness to bruise formation after minor trauma and proneness to prolonged bleeding after injury. Results: Five individuals had elevated APTT values and proneness to bruise formation after minor trauma, and other six patients had elevated APTT values, relevant history of frequent epistaxis and family coagulation disorders. In none of these patients PTH occurred. There was one episode of primary and no secondary PTH in 15 patients with values of APTT elevated minor=10% of the normal value. No PTH occurred in 6 individuals with APTT elevated by >10% of the normal value. Haemorrhage rate correlated with APTT results, proneness to bruise formation and to bleeding after injuries. Values of specificity of recurrent epistaxis, history of bruises after minor trauma and prolonged bleeding after injury were significant. Conclusions: In healthy adults, coagulation tests results are irrelevant for the course of tonsillectomy and postoperative bleeding event. Personal medical history is important in predicting PTH (AU)

[Post-tonsillectomy haemorrhage--do coagulation tests and coagulopathy history have predictive value?]. / Hemorragia postamigdalectomía: tienen las pruebas de coagulación y el historial de coagulopatía un valor predictivo?

OBJECTIVES: Determining post-tonsillectomy haemorrhage (PTH) risk factors is crucial for preventing it. The aim of the study was to analyse results of coagulation tests and preoperative family and medical history of coagulation disorders in order to establish if they have predictive value for PTH. METHODS: In 222 patients aged 15-60 years, values of APTT (Activated Partial Thromboplastin Time), prothrombin/INR ratio and platelet count as well as medical history were analysed and 15 episodes of secondary PTH occurred. This includes 3 of 9 (33.3%) patients with medical history of proneness to bruises after minor trauma and in all (4) patients who declared both relevant medical history of proneness to bruise formation after minor trauma and proneness to prolonged bleeding after injury. RESULTS: Five individuals had elevated APTT values and proneness to bruise formation after minor trauma, and other six patients had elevated APTT values, relevant history of frequent epistaxis and family coagulation disorders. In none of these patients PTH occurred. There was one episode of primary and no secondary PTH in 15 patients with values of APTT elevated < or =10% of the normal value. No PTH occurred in 6 individuals with APTT elevated by >10% of the normal value. Haemorrhage rate correlated with APTT results, proneness to bruise formation and to bleeding after injuries. Values of specificity of recurrent epistaxis, history of bruises after minor trauma and prolonged bleeding after injury were significant. CONCLUSIONS: In healthy adults, coagulation tests results are irrelevant for the course of tonsillectomy and postoperative bleeding event. Personal medical history is important in predicting PTH.