Combined effect of obstructive sleep apnea and age on daytime blood pressure.

Epidemiologic studies have shown obstructive sleep apnea (OSA) is an independent risk factor for systemic hypertension. The prevalence of systemic hypertension also increases gradually with age. The purpose of this study was to assess the combined effect of OSA and age on daytime blood pressure. Patients who received nocturnal polysomnography in Tainan Municipal Hospital were invited between October 2008 and February 2010. Daytime blood pressure was measured. Participants were classified into three groups: nonapnea (n = 14, 18%) with RDI <5 episodes/h; mild to moderate OSA (n = 34, 43%) with RDI ≧ 5 and <30; and severe OSA (n = 31, 39%) with RDI ≧ 30. Seventy-nine patients (79/101, 78.2%) (63 males) completed the study. The mean of age, severity of OSA (RDI) and systolic blood pressure (SBP) was 40.3 ± 15.4 years, 28.1 ± 26.0/h and 132.6 ± 19.7 mmHg, respectively. RDI and age were significant risk factors for SBP (P < 0.05). SBP became severe when patients were older in the group of mild to moderate OSA (p = 0.0067) and diastolic blood pressure (DBP) became severe when patients were older in the group of nonapnea and mild to moderate OSA (P = 0.0042 and 0.0168, respectively). But the daytime blood pressure and age were not correlated significantly for the severe OSA subjects. This study revealed that age and RDI were risk factors in development of daytime hypertension. For patients with mild to moderate OSA, SBP was significantly worse when getting older and for patients with nonapnea and mild to moderate OSA, DBP was significantly worse with increasing age.

The alternative ear-piercing technique by using superpulsed carbon dioxide laser: a comparative study with spring-loaded gun.

Ear piercing (EP) is increasing in popularity among teenagers. Techniques for EP should be selected carefully to prevent possible complications. The purpose of this study is to compare the clinical outcomes of EP techniques between CO(2) laser and spring-loaded gun. This is a prospective and comparative clinical trial. Under local anesthesia, EP was performed on left ear with CO(2) laser (20 watt/single mode) and on right ear with spring-loaded gun. With visual analog scale (VAS, 0-10) and questionnaire, post-operative pain and wound healing status were assessed immediately, 1, 2, 4 and 8 weeks after EP procedure. Fourteen subjects (14/17, 82.4%) completed the whole study. Immediately after the procedure, the level of post-operative pain (VAS) was 3.2 for CO(2) laser and 1.5 for spring-loaded gun (p < 0.05). In CO(2) laser group, pain severity decreased to 0.4, 0.1, 0, and 0, while in spring-loaded gun group, the decrease was only to 0.7, 0.6, 0.3 and 0 at 1, 2, 4, and 8 weeks, respectively. Duration of post-operative pain was 3.8 and 17.5 days for CO(2) laser and spring-loaded gun, respectively (p < 0.05). There was no major complication like infection, bleeding or hypertrophic scar. Our study suggests that CO(2) laser is a precise, simple, safe and aseptic technique for EP. It has a lower level and shorter duration of post-operative pain, when compared with spring-loaded gun. Therefore, CO(2) assisted EP is an alternative and feasible technique in our daily clinical practice. The level of evidence: 2b.

Tone discrimination and speech perception benefit in Mandarin-speaking children fit with HiRes fidelity 120 sound processing.

OBJECTIVE: To compare tone discrimination, speech perception, and general listening benefit in Mandarin-speaking children using standard HiRes and after 1, 3, and 6 months of HiRes 120 use. The HiResolution Bionic Ear is an implantable prosthesis designed to provide access to sound and to improve perception of speech via electrical stimulation of the auditory nerve. The newest sound-processing strategy is HiRes with Fidelity 120 (HiRes 120). In HiRes 120, the input signal is analyzed in greater spectral detail than with original HiRes to achieve a maximum of 120 spectral bands. HiRes 120 is expected to provide more benefit than the original HiRes because of the increased spectral resolution. SETTING: Cochlear implant/tertiary referral center. SUBJECTS: Seven children, aged 5 to 12 years, who had been implanted with a CII or 90K implant with a fully inserted electrode array and at least 10 contiguous programmable electrodes. DESIGN: Tone discrimination, consonant identification, the Mandarin lexical neighborhood test (M-LNT), and the speech perception in noise (SPIN) tests were administered in 4 sessions: at a baseline visit with standard HiRes before being fit with HiRes 120 and at 1, 3, and 6 months after using HiRes 120. Each subject and his or her parents also completed a strategy preference questionnaire after using HiRes 120 for 6 months. RESULTS: Statistically significant improvements from baseline with HiRes to 6 months with HiRes 120 were found for tone discrimination (61.4 to 73.2%, p = 0.006) and for SPIN low predictability (65.7 to 74.7%, p = 0.039). Mean score changes of 47.4 to 50.4% (p = 0.499) for consonant perception, 82.9 to 86.4% for M-LNT (easy words; p = 0.322), 77.1 to 81.0% for M-LNT (hard words; p = 0.423), and 72.3 to 78.5% for SPIN high predictability (p = 0.427) showed trends for improvement but were not statistically significant. Questionnaire results indicated that all children and parents preferred HiRes 120 to HiRes. Strength of preference was 8.9 for children and 8.1 for parents on a scale of 1 to 10 (1 = weak preference, 10 = strong preference). CONCLUSION: Taken together, the improved tone discrimination and speech perception results, along with subjective improvements in speech fluency, discrimination, and music appreciation, indicate a trend toward superior listening benefit with HiRes 120 compared with standard HiRes in Mandarin-speaking children.

Tissue-specific immunoglobulin E in maxillary sinus mucosa of allergic fungal sinusitis.

OBJECTIVE: The objectives of this prospective study were to analyze the specific immunoglobulin E (sIgE) in maxillary sinus mucosa and to determine the importance of local tissue sIgE in the patients with allergic fungal sinusitis (AFS). METHODS: We investigated tissue-specific IgE in the maxillary sinus mucosa. Thirty-four patients with rhinosinusitis and nasal polyposis were included in the study. The patients were divided into three groups--AFS, fungal sinusitis and chronic rhinosinusitis (CRS). The sIgE profile of the maxillary sinus mucosa was studied by the CAP method. Other parameters, such as allergic symptoms, presence of fungi hyphae and eosinophilic mucin in the sinus cavities as well as computed tomography (CT) scanning findings were also evaluated in all groups. RESULTS: All patients in the AFS group had allergic symptoms, and the serum IgE test was positive to mites or house dust, but none had a positive serum IgE response to Aspergillus. However, 85.7% of this group had tissue sIgE to Aspergillus. CONCLUSIONS: The local tissue sIgE profile is more specific than the systemic sIgE profile in determining the allergic status of AFS patients. Tissue sIgE for fungi may be considered as a part of AFS diagnostic criteria.