An ultrasound device in the diagnosis of acute maxillary sinusitis.

This multicenter study comprised 161 consecutive and unselected patients with suspected acute maxillary sinusitis (AMS). Altogether 322 maxillary sinuses were examined radiologically and by untrasound device (US). Of these, 234 antra were punctured, aspirated and irrigated. The volume of secretion coming out by irrigation was evaluated. The results of US, x-ray and irrigation were compared. For US, the proportion of correct positive results was 82.7% when the secretion volume was heavy, 78.6% when the secretion volume was moderate and 84.3% when the secretion volume was slight. When US finding was compared with the puncture result, the US gave false positive results in 8% of the cases and false negative results in 18.5% of the cases. Out of 187 positive irrigation findings, radiographs revealed fluid retention in 99 cases (score 3-6) (53%). Similarly, 11 radiographs showed fluid retention in 47 cases of negative irrigation findings (23.4%). Statistical calculation shows that both US and radiology were equally reliable in diagnosing fluid retention and sinusitis, when the results are compared with the findings of the sinus puncture. US and radiology gave false positive findings almost equally (p > 0.05). On the other hand, when the volume of secretion was slight (< 1 ml), US gave a fluid echo finding more often than radiology showed fluid retention.

Bacterial findings in acute maxillary sinusitis--European study.

Bacteriology of acute maxillary sinusitis was studied in 569 patients in 16 centers of 6 countries located throughout Europe during 1992-1994 by ENT specialists. Patients with symptoms of acute sinusitis lasting less than 3 weeks with ongoing purulent nasal discharge were included. Diagnosis was verified by sinus x-ray or ultrasonography and a positive aspiration finding in maxillary sinus puncture. One or more pathogens were isolated from the maxillary sinus aspirates of 375 (66%) patients. Fifty-six percent of patients harboured 1 pathogen and 10% multiple pathogenic organisms, respectively. Haemophilus influenzae was the most common pathogen isolated (148 isolates), occurring as a single pathogen in 14% of the patients. The occurrence of H. influenzae was highest in Finnish military hospital patients (43-48%), as compared with the non-military Finnish patients (9-11%) or to patients from other European centers (mean 13%). H. influenzae was more frequently beta-lactamase positive in other European centers (22%) than in Finnish centers (7%). Streptococcus pneumoniae was the most common pathogen isolated in other European centers (20%) but second most common in Finnish centers (13%). Moraxella catarrhalis occurred at quite similar frequency among Finnish centers (9-14%), but clearly less often in other centers (mean 4%). S. aureus, which in acute maxillary sinusitis is regarded as a contaminant from the nasal cavity, was more prevalent in other European centers (12%) than in Finnish centers (4%). In patients with acute maxillary sinusitis reliable bacteriological samples should be taken by antral aspiration directly from the diseased sinus.

Perforation in hypopharynx and deep cervical emphysema caused by blunt external trauma.

We present a case in which a blunt external trauma caused a perforating wound in the hypopharynx without any superficial damage on the skin of the neck. Deep cervical emphysema and general signs of systemic infection followed. The wound was sutured through an endoscope and the patient recovered uneventfully. The importance of the early diagnosis is emphasized.

Does posturography differentiate malingerers from vertiginous patients?

Voluntary, simulated vertigo and acute vertigo due to vestibular neuritis were examined by means of static posturography in 81 tests to evaluate the extent to which intentional malingering can be detected. Thirty healthy, normal subjects were first instructed to stand as still as possible on a static force platform and then to simulate dizziness. The true cases consisted of 21 patients with vestibular neuritis. The parameters analyzed included body sway velocity (BSV), body sway area of ellipse (BSE), and the Romberg quotient. Both the simulated and pathological posturographic BSV and BSE values differed from normal values under all test conditions, but they did not differ from each other, whereas the simulated values could be differentiated from the pathological ones with the Romberg quotient based on BSV. Five staff members of our audiological department were able to differentiate between the simulations and pathological cases quite well, with a median sensitivity of 0.77 and a specificity of 0.71 in a blinded test. A posturographic measurement, even performed once, can be useful to some extent for detecting simulation, but more investigation and development of the analysis system is required to obtain more specific results. For the present, the results obtained by trained observation of the subject in the test situation are at least as reliable as those obtained through the analysis of statistical measurements.

Ultrastructural changes in human nasal cilia caused by the common cold and recovery of ciliated epithelium.

Changes in the ultrastructure of human respiratory cilia caused by the common cold were studied in 12 patients. The nasal mucosa was studied three times: on the first or second day after the beginning of symptoms, and 1 week and 3 weeks after the first biopsy. The damage was most severe at 1 week. The most remarkable finding was the loss of cilia and ciliated cells. However, the ultrastructure was usually normal, without any increase in tubular anomalies, as compared with the normal material of the previous reports. Three weeks after the beginning of the disease the number of cilia and ciliated cells had increased to nearly normal. However, as a sign of regeneration, immature short cilia (0.7 to 2.5 microns in length) were often seen. The ciliary orientation was uniform, dynein arms were normal, and there was no increase in the number of tubular anomalies. The results suggest that the impaired mucociliary function during viral infections is due to the loss of cilia and ciliated cells, rather than to ultrastructural anomalies in the cilia. The development of tubular anomalies and random ciliary orientation may require more extensive exposure to factors affecting ciliary function.

Noise-induced low- and high-frequency hearing losses in Finnish conscripts.

Thirty-nine otologically healthy military conscripts were examined at the beginning and at the end of their 1-year service. On entry, they all showed normal findings during clinical otolaryngological examinations. The test battery included both conventional (0.25-8 kHz) and high-frequency "electric bone-conduction" (0.5-20 kHz) audiometry (EBC). The median pure-tone right ear thresholds at the end of service were 5 dB worse over the frequency range of 2-8 kHz compared with the thresholds at the beginning of the service. The difference was statistically highly significant (p = 0.00035). The median left ear pure-tone thresholds at frequencies of 0.25, 2, and 8 kHz were 5 dB worse at the end of the service compared to the thresholds at the beginning of the service. However, the difference was not statistically significant (p = 0.23). The median curves for the high-frequency (EBC) thresholds measured after the service showed worse thresholds over the whole frequency range compared to the median curves measured before the service. The greatest difference was seen in the highest frequencies (15-17 kHz) in both ears. The differences were statistically significant in both ears (p = 0.03 in the right ears; p = 0.01 in the left ears) when threshold values over the whole frequency range were analyzed. Since the otolaryngological history of these conscripts was uneventful during their service, the hearing deteriorations were considered to be caused by shooting practice.

Speech intelligibility in difficult signal/noise circumstances.

In practice, subjects wearing ear protectors often give contradictory statements about the possible distorting effects of ear protectors. We tried to simulate some difficult background circumstances by arranging five different signal/background noise combinations (five S/N ratios). Speech discrimination tests made in these circumstances with and without ear protectors could reflect the real capacity to understand orders or messages in difficult hearing situations. 52 Finnish speaking conscripts with normal hearing from 18 to 24 years age were selected to participate in the test on a day without any noisy training duties. The test words in the Finnish speech discrimination test in combination with corresponding white noise were produced by equipment consisting of a high quality tape recorder, an audiometer, an amplifier and loud speakers. The test were performed individually in free field in a sound proof room in the Hearing Centre of the University Central Hospital of Oulu. The subjects listened to the test words with all the S/N ratios [S/N = 60/70, 55/70, 65/70, 60/75 and 65/75 dB (A)] with and without ear protectors. At the signal/noise ratios 60/70 and 60/75 dB the words were perceived relatively poorly with and without hearing protectors. At the signal/noise levels of 65/70 and 65/75 dB the protectors turned out to produce highly significantly better word discrimination. At the signal/noise level of 55/70 dB the discrimination is very poor in both cases but significantly better without ear protectors.

Speech discrimination of patients with high frequency hearing loss.

Mean speech discrimination curves were measured in three groups of patients having severe, moderate and mild high-tone hearing losses in pure-tone audiograms, 20 patients being tested in each group. The audiograms sloped linearly by 22 dB/oct. Recruiting ears in Reger's test were excluded. The group with moderate hearing loss achieved significantly poorer discrimination scores at high sound pressure levels than the group with severe hearing loss, a phenomenon not reported before. However, the results agree with preceding work in which equivalent sensorineural hearing losses were simulated with filter equipment. The causes of the phenomenon and its significance for hearing aid selection are discussed.

Long-term speech spectra. A computerized method of measurement and a comparative study of Finnish and English data.

Long-term speech spectra from Finnish and English are analysed by a computer-based method which offers a rapid and accurate way of measuring these spectra from recorded material (single words, list of words, music, etc.). The signal processing scheme is illustrated. The speech spectra of a single Finnish word and the summation spectra from 50 phonetically balanced English and Finnish words are presented. A significant difference in the distribution of speech power is shown between. English and Finnish which is thought to be due to the difference in the vowel/consonant ratio between these languages. The value of the method as an aid to the comparative audiometric study of clinical findings and diagnoses between different languages is discussed.

Simulation of low-pass hearing loss in a Finnish speech discrimination test.

Three different degrees of clinical hearing loss of low-pass type were stimulated by a filter apparatus. The equipment to simulate a given hearing loss is described. The speech discrimination curves corresponding to the normal hearing and to the three degrees of hearing loss were measured in normal hearing adults using Finnish PB-words. The stimulation of a light hearing loss of low-pass type yielded a two-staged discrimination curve. The discrimination curves of a moderate and a severe hearing loss crossed at a very high output level. The cause of this phenomenon is discussed on the ground of the exceptional vowel/consonant relation and intensity/frequency distribution in the Finnish language.