Initial antimicrobial effect of controlled-release doxycycline in subgingival sites.

OBJECTIVES: To determine the ability of a 10% doxycycline hyclate controlled-release polymer (Atridox) to suppress periodontopathic bacteria when placed subgingivally following scaling and root planing (Sc/Rp). METHODS: Eight males and seven females, mean age 48 years, with moderate to advanced periodontitis participated in the study. In each patient, bilateral periodontal pockets probing 6-7 mm were randomly assigned to treatment by Sc/Rp + doxycycline polymer or by Sc/Rp alone. Subgingival placement of doxycycline polymer was carried out according to the manufacturer's instructions. Sc/Rp was performed with hand instruments for at least 10 min in each study tooth. Subgingival samples were collected by paper-points at baseline, at 2 weeks and at 4 weeks post-treatment. Culture methodology was used to isolate and identify putative periodontal pathogens, including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Dialister pneumosintes, Tannerella forsythia, Prevotella intermedia/Prevotella nigrescens, Campylobacter species, Eubacterium species, Fusobacterium species, Peptostreptococcus micros, Eikenella corrodens, Staphylococcus species, enteric gram-negative rods, beta-hemolytic streptococci and yeasts. The microbiologic examination was carried out blindly. Microbiological data were analyzed using a General Linear Model Analysis of Variance for within and between group effects. RESULTS: Sites receiving Sc/Rp + doxycycline polymer and sites receiving Sc/Rp alone exhibited similar levels of periodontal pathogens at baseline and did not differ significantly in total viable counts and proportional recovery of periodontopathic bacteria post-treatment. CONCLUSIONS: Controlled-release doxycycline placed in moderate to deep periodontal pockets caused no significant additional reduction in the subgingival pathogenic microbiota compared to thorough Sc/Rp alone. Since controlled-release doxycycline may not significantly suppress several subgingival pathogenic microorganisms and seems to possess no distinct advantage over broad-spectra, safe and inexpensive antiseptics, the rationale for its employment in periodontal therapy remains unclear.

William F. House Lecture. Neurotologic manifestations of microvascular hypoperfusion.

Some forms of dizziness, imbalance, and hearing change have been suspected to result from a vertebral basilar artery circulatory deficit. Microvascular hypoperfusion of the central nervous system (CNS) is proposed as a more likely mechanism than thromboembolic phenomena of the parent arteries. Symptoms of end-organ pathology must be differentiated from CNS causes to assure implementation of an appropriate treatment strategy. Guidelines for the evaluation of these patients are provided. Changes in platelet and red and white blood cell morphology are proposed as more significantly influencing blood flow than blood pressure or vessel caliber. Medications that alter blood rheology, have been found to alleviate the acute symptoms of microvascular hypoperfusion. Residual balance deficits from presumed long-term CNS ischemia have then been relieved by balance rehabilitation training. With the recognition of this disease entity there appears another means of aiding patients with dizziness and balance problems who have previously experienced long-term disability. The results of a preliminary study of 378 patients merits further investigation of the proposed pathophysiology and treatment measures.

Clinical comparisons of posturography and electronystagmography.

A retrospective study was conducted of 103 balance-disturbed patients of mixed etiologies tested with electronystagmography (ENG) and computerized dynamic posturography (CDP). CDP was abnormal for 83% of the group as compared to 42% abnormal ENG results. In cases of otolithic dysfunction, ENG was more sensitive and gave specific information. Results of this preliminary study indicate that CDP has merit when used in the evaluation of patients with undifferentiated balance complaints. ENG testing is still needed in cases of vestibular dysfunction to establish anatomic level and laterality as well as for lesions involving the otolith. Additional study will be needed to verify these findings and to develop a means of detecting otolith dysfunction with CDP.

The pitfalls of limiting ENG testing to patients with vertigo.

A high incidence of patients who do not experience vertigo with unilateral vestibular disease has been observed. Recognizing that many clinicians perform electronystagmographic vestibular testing on only patients who describe vertigo, a retrospective study of 229 patients was designed to study the potential pitfalls of this practice. The results confirm a preliminary study and show that 66% of the patients described no vertigo. Included were 13 intracranial lesions of which only one had the classic symptom. Differences in cortical perception and adaptation are postulated as factors responsible for these and other observations relative to caloric stimulation, torsion swing testing, and the presence of spontaneous nystagmus.

Remote monitoring of evoked potentials.

The clinical value of evoked potential testing is now well established. The general availability of this form of testing is currently limited by cost of the equipment and availability of personnel not only to operate it but also to interpret the results. These limiting factors can be reduced by remote monitoring, a technique that utilizes a data program designed to transmit processed responses via standard telephone lines to a central location. The practicality of this method of testing and the considerations that should be given with regard to development of such a program are discussed.

Cordless telephones: a threat to hearing.

Several patients with documented permanent sensorineural hearing losses secondary to the use of cordless telephones have been evaluated. In the interests of saving space and weight, these units have the ear receiver double as the ringing or bell device. The output of the bell on all of the units we have tested to date has been in the 140-dB range on the A scale. In each instance, the patient held the telephone against the ear when ringing occurred, and in three instances a loud extraneous crack was transmitted. Unlike regular cord-type telephones, these devices have no automatic gain control in the receiver circuit.

Comparison of symptoms and laboratory findings in unilateral vestibular dysfunction.

Although vertigo is the expected symptom of unilateral vestibular disease, exceptions have been observed. To determine the relative frequency of this observation, a retrospective study of patients seen over a 1-year period was done. Of the 126 patients found to have unilateral labyrinthine impairment with bithermal caloric testing, only 58 (46%) characterized their symptoms as vertigo. The ramifications of these findings are discussed, and a question is raised as to the propriety of reserving vestibular testing for only those patients describing vertigo.

Malignant change of laryngeal papillomas: a case report.

A major controversy surrounding juvenile papilloma is whether or not these lesions ever spontaneously undergo malignant change. One view contends that malignant change never takes place unless the lesion is irradiated. Presented is a 22-year-old man who suddenly develops features of extensive malignant invasion of his neck and mediastinum but has no history of irradiation.

Detection of middle ear disease in cleft-palate patients.

A prospective study of 17 cleft-palate patients under the age of 37 months was performed. The otoscopic findings, as reported by the primary physician and otolaryngologist, were compared with the results of tympanometry. Preoperatively, all tympanograms were abnormal. Ears with an AS pattern were not described as abnormal by any physician, and postoperatively, these ears all progresses to a more advanced stage of disease.

Thermal hazards in mastoid surgery: an evaluation of instruments and irrigation techniques.

Study of the mechanical properties of three commonly used mastoid drills disclosed major differences in their power and potential for heat production. Based on available information regarding heat tolerance of neural tissue, all drills were found capable of producing hazardous temperature elevations. After testing several irrigation techniques, continuous and copious suction irrigation was found to be most effective in preventing bone heating.

Thermal hazard during mastoid surgery.

Torque speed characteristics of two mastoid drills were measured. Potential temperature elevations in temporal bones were calculated from these measurements. Measured temperature elevations in temporal bones drilled without irrigation agreed well with predictions. Irrigation was demonstrated to be of critical importance in minimizing thermal hazard from mastoid drills.

Meningitis: the influence of routine otolaryngologic consultation on morbidity and mortality in 290 cases.

A prospective study was designed to obtain data on all meningitis patients admitted to a large county Communicable Disease Unit. The epidemiologic and clinical features of 290 cases were analyzed to ascertain the effect of routine O.R.L. consultation on the morbidity and mortality of this disease. The results of physical examination provided current statistics as to the existence of ear, nose, and throat diseases associated with meningitis.

How aging affects the ear.

With aging, a different variety of ear diseases becomes more common. External ear disease is often a local reflection of generalized skin problems aggravated by retained water or local manipulation. Hearing loss may be the result of long-standing middle ear disease rather than aging. In this situation, the inconveniences and possible dangers of a chronically infected ear may be resolved with surgical intervention. Nasopharyngeal or lymphomatous disease must be suspected in any geriatric patient manifesting middle ear disease for the first time. Like presbyopia, presbycusis is a normal consequence of aging. It may be severe, but it does not lead to total deafness and equally involves both ears. Early discovery of the condition and institution of hearing rehabilitation methods will minimize the individual's communicative handicap and tendency to withdraw from society. Unilateral or asymmetric sensorineural hearing loss should be thoroughly evaluated for the purpose of identifying a curable and potentially life-threatening disease.

Common ear diseases: recognition and management.

External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.

Blink nystagmus.

A pattern of eye movement similar to vestibular nystagmus associated with blink is characterized. This artifact can be seen in asymptomatic, otologically normal subjects and is considered to have different meaning than lateral conjugate deviation of the eyes on forced closure of the lids (Cogan sign). Since this nystagmus artifact is most evident during electronystagmographic testing for spontaneous and semispontaneous nystagmus, its importance can be overestimated. Simultaneous monitoring of horizontal and vertical eye movement presently provides a definitive means of identification.