Characteristics of COVID-19 smell and taste dysfunction in hospitalized patients.

The effects of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exist on a spectrum. Clinical symptoms of smell and taste dysfunction are prominent features of COVID-19. The objective of this study was to elucidate the factors associated with smell and taste dysfunction amongst hospitalized COVID-19 patients. A retrospective review of a multi-hospital health network's COVID-19 database between March and June 2020 was performed. Patients with self-reported smell or taste loss were included. Demographic information, patient comorbidities, and mortality data was obtained. There were 2892 patients included in this analysis and 117 reported smell or taste loss (4.0%, 95% confidence interval [CI]: 3.4%-4.8%). The proportion of females with smell or taste loss was significantly higher than males (6.3% vs. 2.5%, P < 0.001), whereas no differences existed between ethnicity or smoking status. When compared with age of 30-40 years, the age group of 10-20 years were most likely to present with smell or taste dysfunction (odds ratio [OR] 6.59, 95% CI 1.32-26.12; P = 0.01). The majority of specific comorbidities were not associated with increased incidence of smell or taste dysfunction. Outpatient healthcare workers were more likely to present with smell or taste loss (OR 3.2, CI 1.8-5.47; P < 0.001). The mortality rate among COVID-19 patients with smell or taste dysfunction was significantly lower than those without (0% vs. 20.3%; P < 0.001). Smell or taste loss is more prevalent in women, younger age groups, and healthier individuals. It may be associated with lower mortality and a milder disease trajectory compared to the overall cohort.

Association Between Rhinitis and Depression in United States Adults.

BACKGROUND: Growing evidence suggests a link between allergic disorders and depression, but literature assessing the association between rhinitis and depression is conflicting, and large population-based studies are lacking. OBJECTIVE: To assess the association between depression and rhinitis in a representative sample of United States adults. METHODS: We performed a cross-sectional analysis of 4320 participants in the 2005-2006 National Health and Nutrition Examination Survey. Rhinitis was defined as self-reported hay fever and/or nasal symptoms in the past 12 months. Rhinitis was further stratified as allergic rhinitis (AR) if participants had a positive serum IgE or nonallergic rhinitis (NAR) if participants did not have a positive serum IgE to any aeroallergen. The outcome variable was depression, defined as a score ≥10 on the Patient Health Questionnaire-9. RESULTS: The odds of depression were 42% higher in subjects with rhinitis compared with those without rhinitis (odds ratio [OR]: 1.42, confidence interval [CI]: 1.03-1.95, P = .04) and 2 times higher in subjects with NAR compared with those without rhinitis (OR: 1.99, CI: 1.34-2.96, P = .002). Subjects with NAR had 64% higher odds of mild depression (OR: 1.64, CI: 1.32-2.02, P < .001) and 2.4 times higher odds of moderate depression (OR: 2.43, CI: 1.39-4.26, P = .004) compared with subjects with no rhinitis. CONCLUSIONS: Rhinitis is significantly associated with depression, and patients with NAR may be at higher risk of depression than those with AR. Although further studies are required to elucidate the relationship between rhinitis and depression, these findings reinforce the need to consider depression in patients undergoing evaluation for rhinitis.

Association between allergic rhinitis and poor sleep parameters in U.S. adults.

BACKGROUND: Evidence suggests relationships between allergic rhinitis (AR) and poor sleep parameters, but population-based studies in the United States are lacking. This study investigates the relationship between AR and sleep parameters in a representative sample of U.S. adults. METHODS: Cross-sectional study of 5563 participants ≥18 years old from the 2005-2006 National Health and Nutrition Examination Survey who participated in the allergy and sleep questionnaires. The predictor variable was AR (self-reported hay fever and/or nasal symptoms in the past 12 months). The outcome variables were individual sleep parameters (sleep latency, sleep duration, sleep disorders, sleep habits, sleep medication use, daytime dysfunction). Covariates included age, gender, race, and obesity. RESULTS: The population-weighted prevalence of AR was 36.5%. Adjusting for covariates, subjects with AR had higher odds of sleep latency ≥30 minutes (OR 1.24; 95% CI, 1.01 to 1.51; p = 0.04), sleep apnea (OR 1.86; 95% CI, 1.22 to 2.82; p < 0.01), insomnia (OR 1.85; 95% CI, 1.04 to 3.32; p = 0.04), trouble falling asleep (OR 1.43; 95% CI, 1.17 to 1.75; p < 0.01), waking up during the night (OR 1.49; 95% CI, 1.11 to 1.99; p = 0.01), waking up too early in the morning (OR 1.46; 95% CI, 1.20 to 1.79; p < 0.01), feeling unrested during the day (OR 1.76, 95% CI, 1.43 to 2.16; p < 0.01), feeling overly sleeping during the day (OR 1.54; 95% CI, 1.25 to 1.90; p < 0.01), not getting enough sleep (OR 1.68; 95% CI, 1.41 to 1.99; p < 0.01), using sleep medication (OR 1.69; 95% CI, 1.23 to 2.33; p < 0.01), difficulty concentrating (OR 1.93; 95% CI, 1.30 to 2.88; p < 0.01), remembering (OR 1.91; 95% CI, 1.22 to 2.97; p < 0.01), managing finances (OR 1.68; 95% CI, 1.09 to 2.56; p = 0.02), working (OR 2.16; 95% CI, 1.45 to 3.22; p < 0.01), and getting things done (OR 2.35; 95% CI, 1.36 to 4.06; p < 0.01) due to daytime sleepiness. CONCLUSION: This analysis of a representative sample of U.S. adults revealed associations between AR and poor sleep parameters including prolonged sleep latency, insomnia, sleep apnea, sleep disturbances, sleep medication use, and daytime dysfunction. These findings reinforce the need to assess sleep quality in patients undergoing evaluation for AR.

Household pet exposure, allergic sensitization, and rhinitis in the U.S. population.

BACKGROUND: The effect of animal dander exposure on allergic sensitization may be age-dependent. A comparison between the association of the levels of exposure to pet allergen with rhinitis symptoms and allergic sensitization in children and adults is yet to be performed in the U.S. METHODS: Cross-sectional study of 3034 adults (age, 20 to 85 years) and 2104 children (age, 6 to 19 years) in the National Health and Nutrition Examination Survey, 2005-2006. Samples of household dust were collected to measure the amounts of indoor allergens in the participants' homes. Self-reported rhinitis was based on symptoms during the past 12 months, and allergen sensitization was defined as a positive response to any of the 19 specific immunoglobulin E (IgE) antigens tested. RESULTS: Higher levels of exposure to dog dander were associated with a higher prevalence of any allergic sensitization in adults (prevalence ratio [PR] 1.19; 95% confidence interval [CI], 1.01 to 1.39), but a lower prevalence in children (PR 0.84; 95% CI, 0.73 to 0.096), p-interaction by age group 0.02. Cat exposure was associated with an increased prevalence of rhinitis symptoms in adults (PR for the 3rd vs lowest tertile of cat dander concentrations: 1.14; 95% CI, 1.05 to 1.23) but not in children (PR for the 3rd vs lowest tertile of cat dander IgE concentrations: 0.86; 95% CI, 0.70 to 1.07), p-interaction 0.01. CONCLUSION: Allergic sensitization and symptomatic response to pet dander exposure may vary based on age. Further studies are necessary to assess the mechanisms for these apparent differences.

Secondhand smoke and rhinitis.

PURPOSE OF REVIEW: The article reviews the most recent literature on the association between secondhand tobacco smoke exposure and rhinitis. The discussion will focus on the biologic links between tobacco exposure and rhinitis symptoms, evaluating this relationship in different populations. RECENT FINDINGS: Significant associations between tobacco smoke exposure and rhinitis symptoms have been identified in US children and adults. This association is not just a US public health concern, as similar analyses have also recently been performed in other populations. Although pediatric data show a significant trend to greater prevalence of rhinitis with greater levels of secondhand smoke exposure, the adult data on secondhand smoke exposure are less consistent. The exact biological mechanism for these associations is likely multifactorial, but does not appear to be driven by an allergic, IgE-mediated reaction. SUMMARY: The associations between secondhand tobacco smoke exposure and various upper respiratory inflammatory conditions, including rhinitis, have been observed. The causative biologic mechanisms, however, remain elusive and are a likely target for future research. At this point, evidence points toward nonallergic inflammation as the most likely mechanism. Clearly, further research is necessary before this mechanism is fully established.

The association between airline flight and sinonasal symptoms.

BACKGROUND: Airplane cabin supply air has been shown to contain multiple possible respiratory irritants. In addition, changes in barometric pressure in flight may contribute to specific respiratory conditions. Therefore, there may be an association between commercial airline flight and sinus disease. METHODS: Participants of the Secondhand-Smoke, Air Quality and Respiratory Health Among Flight Attendants Study were administered an online questionnaire pertaining to their flight experience and respiratory health. Working years, working days per month, and number of trips per month were quantified, as well as smoking exposure and self-reported physician diagnoses of sinusitis, asthma, and rhinitis. The sinonasal outcomes were quantified using a Respiratory Questionnaire Survey (RQS) score. Multivariable analyses were performed to evaluate the associations between flight time and sinus disease. RESULTS: A total of 579 participants met the inclusion criteria for this study, with cohort prevalence of sinusitis, asthma, and rhinitis of 25.3%, 14.4%, and 20.5%, respectively. Tertiles 2 and 3 of working days per month were associated with higher RQS scores compared to tertile 1 (p for trend <0.01). Individual symptoms significantly associated with increasing number of working days per month included "need to blow nose," "sneezing," and "thick nasal discharge," and the number of international trips per month was significantly associated with "coughing" and "facial pain and pressure," among other symptoms. CONCLUSION: This is the largest study to analyze the relations between airline flight time and sinonasal disease. The results suggest a possible association between sinusitis diagnosis, symptom scores, and specific sinonasal symptoms, and airline flight time.

Ethmoid pneumocele presenting with exophthalmos 15 years after endoscopic sinus surgery.

INTRODUCTION: A pneumocele is an abnormal dilation of an air-containing sinus beyond the normal margins of bone, with associated bony thinning. A delayed ethmoid pneumocele after sinus surgery has not previously been reported. METHODS: A case report of a patient with a delayed ethmoid pneumocele after sinus surgery. The diagnostic workup, operative approach, and postoperative results were evaluated. RESULTS: A 57-year-old female with a history of endoscopic sinus surgery 15 years prior presented with right eye proptosis and severe orbital and facial pressure. A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a dehiscent lamina papyracea, consistent with a pneumocele. Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position. The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks. CONCLUSIONS: This case demonstrates that a pneumocele can present even years after endoscopic sinus surgery, and acute but temporary development or worsening of diplopia can result from surgical decompression of the pneumocele as the eye returns to its natural position.

Allergic Sensitization, Rhinitis and Tobacco Smoke Exposure in US Adults.

INTRODUCTION: Tobacco exposure has been linked with sinonasal pathology and may be associated with allergic sensitization. This study evaluates the association between exposure to active smoking or secondhand smoke (SHS) and the prevalence of rhinitis and allergic sensitization in the US adult population. METHODS: Cross-sectional study in 4,339 adults aged 20-85 in the National Health and Nutrition Examination Survey, 2005-2006. Never smoking was defined as reported lifetime smoking less than 100 cigarettes and serum cotinine levels <10ng/ml, while active smoking was defined as self-reported smoking or serum cotinine concentrations > 10 ng/mL. Self-reported rhinitis was based on symptoms during the past 12 months, and allergen sensitization was defined as a positive response to any of the 19 specific IgE antigens tested. RESULTS: Almost half of the population (43%) had detectable levels of IgE specific to at least one inhaled allergen and 32% reported a history of rhinitis. After multivariate adjustment, there was a statistically significant association between the highest serum cotinine tertile and rhinitis in active smokers (OR 1.42; 95%CI 1.00-2.00). The association between active smoking and rhinitis was stronger in individuals without allergic sensitization (OR 2.47; 95%CI 1.44-4.23). There was a statistically significant association between increasing cotinine tertiles and decreased odds of inhaled allergen sensitization (p-trend <.01). CONCLUSION: Tobacco smoke exposure was associated with increased prevalence of rhinitis symptoms, but not with allergic sensitization. The results indicate that the relationship between tobacco smoke exposure and sinonasal pathology in adults may be independent of allergic sensitization.

Allergic sensitization, rhinitis, and tobacco smoke exposure in U.S. children and adolescents.

BACKGROUND: Childhood tobacco exposure has been linked with sinonasal pathology, and may be associated with allergic sensitization. This study evaluates the association between exposure to active smoking or secondhand smoke (SHS) and the prevalence of rhinitis and allergic sensitization in the U.S. pediatric population. METHODS: Cross-sectional study in 2714 children and adolescents aged 6 to 19 in the National Health and Nutrition Examination Survey (NHANES), 2005-2006. Active smoking was defined as self-reported smoking or serum cotinine concentrations >10 ng/mL. SHS was defined as nonactive smokers who reported living with ≥1 smokers or had serum cotinine ≥0.011 ng/mL. Self-reported rhinitis was based on symptoms during the past 12 months, and allergen sensitization was defined as a positive response to any of the 19 specific immunoglobulin E (IgE) antigens tested. RESULTS: About half of the population (54%) had detectable levels of IgE specific to at least 1 of the tested allergens, and 25% reported a history of rhinitis. After multivariate adjustment, an increased prevalence rate ratio (PRR) of self-reported rhinitis was seen in individuals in the highest cotinine tertile among active smokers (PRR, 1.73; 95% confidence interval [CI], 1.23 to 2.43), with a significant trend between increasing cotinine levels in individuals exposed to either secondhand smoke or active smoking (p = 0.05 for both analyses). Significantly less food allergen sensitization was observed in participants in the highest cotinine tertile of secondhand smoke (PRR, 0.61; 95% CI, 0.43 to 0.85). CONCLUSION: Tobacco smoke exposure was associated with increased prevalence of rhinitis symptoms, but decreased prevalence of allergic sensitization. The results highlight the complex relationship between tobacco exposure and sinonasal pathology.

Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks.

BACKGROUND: Elevated intracranial pressure (ICP) is an inciting factor for cerebrospinal fluid (CSF) leaks and can be measured by CSF pressure (CSFP) monitoring. Current CSFP literature is limited to the assessments of opening pressure. This study reinvestigates a previously discussed monitoring approach that evaluates continuous CSFP parameters, physiologic measurements, and treatment outcomes in patients undergoing endoscopic repair of spontaneous CSF leaks. METHODS: Retrospective review of patients undergoing endoscopic endonasal repair of spontaneous CSF leaks. All participants had a lumbar catheter placed for 24-hour continuous preoperative pressure monitoring, and 24 hours of continuous monitoring starting 48 hours after repair. In addition to patient characteristics, mean and peak CSFP, pulse waveform amplitudes (PWAs), and related parameters were calculated. RESULTS: Twenty-five patients underwent monitoring between 2004 and 2013, with a mean follow-up of 526 days. The mean age was 49.2 years, the mean body mass index (BMI) 38.5, and 8 of 25 (32%) had obstructive sleep apnea. Although mean CSFP and PWA decreased after the repair, mean peak CSFP increased by 1.56 cmH2O (1.15 mmHg). Six patients (24%) had elevation in their CSFP >25 cmH2O (18.4 mmHg) for a minimum of 4% of the recording time. Based on their continuous pressure monitoring data, 9 patients (36%) underwent treatment for high ICP, either with acetazolamide or a ventricular shunt. There were no CSF leak recurrences. CONCLUSION: Continuous perioperative CSFP monitoring provides valuable insight into multiple physiologic parameters. Systematic continuous CSFP monitoring can identify individuals in need of ICP-lowering therapy, possibly improving the outcomes in CSF leak repair surgeries.

Topical intranasal corticosteroids and growth velocity in children: a meta-analysis.

BACKGROUND: There is no consensus regarding the effects on growth velocity of intranasal topical corticosteroid (ITC) use in children. The objective of this study was to determine whether ITC use reduces growth velocity in children with allergic rhinitis (AR). METHODS: A literature search of the National Center for Biotechnology Information PubMed, EMBASE, SCOPUS, and Cochrane databases from January 1, 1988 to October 7, 2013. The study selection was composed of randomized clinical trials investigating ITC for treatment of AR in children (age <18 years of age) with appropriate controls. Studies must have included interval change in growth as an outcome. Two authors independently extracted data and assessed study quality. Eligible studies were pooled using a random-effects approach. RESULTS: Eight studies with 755 participants from 3 countries provided data for the meta-analysis (knemometry, n =342 participants; stadiometry, n =413 participants). Study duration ranged from 2 to 4 weeks for trials evaluating knemometry outcomes, and 12 months for trials evaluating stadiometry outcomes. Age of participants ranged from 3 to 12 years. The pooled standardized mean difference showed that among studies using knemometry, mean growth was statistically significantly lower among children using ITC vs placebo (-.223 mm/week; 95% confidence interval [CI], -0.429 to -0.017; p < 0.034).The pooled standardized mean difference showed that among studies using stadiometry, there was no significant growth difference among children using ITC vs placebo (-0.053 cm/year; 95% CI, -0.491 to 0.385; p = 0.813). The limitations of this study were the difficulty in predicting longer-term or catch-up growth in children. CONCLUSION: Meta-analytic pooling of trials suggest that short-term ITC for the treatment of AR in children may decrease short-term growth velocity using knemometry; however, the effect on longer-term growth velocity as measured by stadiometry is unclear.

Lead exposure and increased food allergic sensitization in U.S. children and adults.

BACKGROUND: Whether blood lead levels are associated with sensitization to food allergens in adults and children is unclear. Prior studies have shown that exposure to lead is associated with atopic sensitization and modulation of several cytokines (eg, interleukin [IL]-12, IL-10, interferon [IFN]-γ, and IL-4 production) and with T-cell dysregulation and bias toward T helper 2 (Th2) activity. The objective of this work was to assess whether exposure to lead is independently associated with allergic symptoms and sensitizations in a large nationally representative sample of children and adults. METHODS: We studied 2712 children and 4333 adults enrolled in the 2005-2006 cycle of the National Health and Nutritional Examination Surveys (NHANES). Participants were tested for serum-specific immunoglobulin E (IgE) levels to food allergens as well as blood lead levels. Food allergens tested included shrimp, egg, peanut, and milk. Logistic regression models adjusted for demographic factors, body mass index, history of asthma, smoking, housing characteristics, and current exposure to animals in the home, to assess the association of blood lead levels with sensitization to food allergens. RESULTS: Median (interquartile range [IQR]) for serum blood was 0.87 µg/L (0.61 to 1.31) in children and 1.48 µg/L (0.92 to 2.34) in adults. At baseline, 672 (24.7%) of children participants and 719 (16.6%) of adult participants tested positive for increased sensitization to food allergens. A 2-fold increase in blood lead levels in adult participants was associated with increased sensitization to food allergens (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02 to 1.22). Blood lead was not associated with sensitization to food allergens among pediatric participants (OR, 0.95; 95% CI, 0.82 to 1.10). CONCLUSION: Exposure to lead was associated with increased odds of sensitization to food allergens in adult but not children participants.

Outcomes analysis in epistaxis management: development of a therapeutic algorithm.

OBJECTIVE: This study explored the outcomes of epistaxis treatment modalities to optimize management and enable the development of a therapeutic algorithm. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: Adult patients presenting between 2005 and 2011 with epistaxis underwent cauterization, tamponade, and/or proximal vascular control. Outcomes of treatment modalities were compared. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for coagulopathy, hypertension, and bleeding site. RESULTS: The population included 147 patients (94 men, 53 women). For initial epistaxis, nondissolvable packing demonstrated the highest initial treatment failure rate of 57.4% (OR, 3.37; 95% CI, 1.33-8.59 compared with cautery). No significant differences were noted among initial posterior epistaxis treatment modalities. Length of nondissolvable pack placement for 3, 4, or 5 days had no significant impact on recurrence. Among patients who failed initial management, those who next underwent cautery or proximal vascular control required a significantly shorter inpatient stay of 5.3 vs 6.8 days compared with those who underwent packing (OR, 0.16; 95% CI, 0.04-0.68). There were no treatment failures following surgical arterial ligation. CONCLUSION: Initial management of anterior epistaxis with chemical cautery had a higher success rate and a lower number of total required interventions than did nondissolvable packing. Duration of packing did not affect recurrence. In patients who failed initially, progression to cautery or proximal vascular control led to significantly shorter inpatient stays than did packing.

Analgesic use and the risk of hearing loss in women.

Use of analgesics is common and is associated with increased risk of hearing loss in men; however, the relation has not been examined prospectively in women. The authors prospectively examined the relation between frequency of aspirin, ibuprofen, and acetaminophen use and risk of hearing loss among 62,261 women aged 31-48 years at baseline (1995) in Nurses' Health Study II. The outcome was self-reported hearing loss (n = 10,012), and the follow-up period was 1995-2009. Cox proportional hazards regression was used to adjust for potential confounders. During 764,247 person-years of follow-up, ibuprofen use and acetaminophen use were independently associated with increased risk of hearing loss, but aspirin use was not. For ibuprofen, the multivariate-adjusted relative risk of hearing loss was 1.13 (95% confidence interval (CI): 1.06, 1.19) for use 2-3 days/week, 1.21 (95% CI: 1.11, 1.32) for use 4-5 days/week, and 1.24 (95% CI: 1.14, 1.35) for use ≥6 days/week (P-trend < 0.0001), compared with use less than once per week. For acetaminophen, the corresponding relative risks were 1.11 (95% CI: 1.02, 1.19), 1.21 (95% CI: 1.07, 1.37), and 1.08 (95% CI: 0.95, 1.22), respectively (P-trend = 0.0007). In this study, use of ibuprofen or acetaminophen (but not aspirin) 2 or more days per week was associated with an increased risk of hearing loss in women.

Dexamethasone and postoperative bleeding after tonsillectomy and adenotonsillectomy in children: A meta-analysis of prospective studies.

OBJECTIVES/HYPOTHESIS: Tonsillectomy and adenotonsillectomy are common pediatric surgical procedures. Although perioperative administration of dexamethasone is common, recent data indicate a possible association between dexamethasone and increased risk of postoperative hemorrhage. STUDY DESIGN: Meta-analysis of prospective studies. METHODS: Meta-analysis using MEDLINE and EMBASE, including all placebo-controlled prospective studies with perioperative dexamethasone as the intervention and postoperative bleeding as the outcome, in children age <18 years undergoing tonsillectomy or adenotonsillectomy. The association between any dexamethasone dose and bleeding outcomes was quantified. Dexamethasone dose analyses were performed using meta-regression and stratified dose analysis models. Individuals were pooled using the random effects model, and Mantel Haenszel odds ratios (OR) were used to assess the associations. All P values were two-sided. RESULTS: Twelve studies with 1,180 total participants were included in the meta-analysis. There was no significant association between dexamethasone at any dose and odds of bleeding compared to placebo (OR = 1.07; 95% confidence interval [CI], 0.58-1.98; P = .82). There was no significant association between increasing dexamethasone dose and bleeding (regression slope = -1.47, P = .10). Stratifying by dose ranges, studies comparing dexamethasone doses in 0.4 to 0.6 mg/kg range to placebo showed significantly increased odds of bleeding (OR = 3.14; 95% CI, 1.14-8.65; P = .03). Higher or lower doses were not associated with a difference in bleeding. CONCLUSIONS: There was no overall association between dexamethasone administration and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy. However, this study cannot exclude the possibility of an association between specific dexamethasone doses and increased odds of bleeding. The results underscore the need for more dedicated prospective studies of this very common intervention.

Heavy metals exposure and hearing loss in US adolescents.

INTRODUCTION: Hearing loss is common and, in young persons, can compromise social development and educational achievement. Exposure to heavy metals has been proposed as an important risk factor for hearing loss. METHODS: We evaluated the cross-sectional associations between blood lead, blood mercury, and urinary cadmium and arsenic levels and audiometrically determined hearing loss in participants aged 12 to 19 years in the 2005-2008 National Health and Nutrition Examination Survey after accounting for the complex survey design. There were 2535 individuals available for analysis of blood lead and mercury levels, 878 for urinary cadmium levels, and 875 for urinary arsenic levels. Multivariate logistic regression was used to calculate adjusted odds ratios (ORs) and 95% CIs. RESULTS: A blood lead level greater than or equal to 2 µg/dL (to convert to micromoles per liter, multiply by 0.0483) compared with less than 1 µg/dL was associated with increased odds of high-frequency hearing loss (OR, 2.22; 95% CI, 1.39-3.56). Individuals in the highest quartile of urinary cadmium levels had significantly higher odds of low-frequency hearing loss than those in the lowest quartile (OR, 3.08; 95% CI, 1.02-9.25). There was no overall association between quartiles of blood mercury or urinary arsenic levels and hearing loss. CONCLUSION: Blood lead levels well below the current recommended action level are associated with substantially increased odds of high-frequency hearing loss.

A meta-analysis of Th2 pathway genetic variants and risk for allergic rhinitis.

There is a significant genetic contribution to allergic rhinitis (AR). Genetic association studies for AR have been performed, but varying results make it challenging to decipher the overall potential effect of specific variants. The Th2 pathway plays an important role in the immunological development of AR. We performed meta-analyses of genetic association studies of variants in Th2 pathway genes and AR. PubMed and Phenopedia were searched by double extraction for original studies on Th2 pathway-related genetic polymorphisms and their associations with AR. A meta-analysis was conducted on each genetic polymorphism with data meeting our predetermined selection criteria. Analyses were performed using both fixed and random effects models, with stratification by age group, ethnicity, and AR definition where appropriate. Heterogeneity and publication bias were assessed. Six independent studies analyzing three candidate polymorphisms and involving a total of 1596 cases and 2892 controls met our inclusion criteria. Overall, the A allele of IL13 single nucleotide polymorphism (SNP) rs20541 was associated with increased odds of AR (estimated OR=1.2; 95% CI 1.1-1.3, p-value 0.004 in fixed effects model, 95% CI 1.0-1.5, p-value 0.056 in random effects model). The A allele of rs20541 was associated with increased odds of AR in mixed age groups using both fixed effects and random effects modeling. IL13 SNP rs1800925 and IL4R SNP 1801275 did not demonstrate overall associations with AR. We conclude that there is evidence for an overall association between IL13 SNP rs20541 and increased risk of AR, especially in mixed-age populations.

Prospective study of alcohol use and hearing loss in men.

OBJECTIVE: Hearing loss is a common and disabling sensory disorder, yet prospective data on potentially modifiable risk factors are limited. Previous studies suggest that alcohol consumption may influence the development of hearing loss, yet results have been inconsistent. The purpose of this study was to prospectively examine the relation between alcohol use and hearing loss in men. DESIGN: We examined prospectively the independent association between alcohol intake and self-reported professionally diagnosed hearing loss in 26,809 men aged 40 to 74 yrs at baseline in 1986. Study participants completed detailed questionnaires at baseline and every 2 yrs thereafter. Incident cases of hearing loss were defined as those professionally diagnosed after 1986. Cox proportional hazards multivariate regression was used to adjust for potential confounding factors. RESULTS: During 386,081 person-years of follow-up, 3447 incident cases of hearing loss were reported. Overall, there was no association between level of alcohol intake and risk of hearing loss. Compared with those who did not consume alcohol, the multivariate-adjusted hazard ratios (95% confidence interval) were 1.00 (0.89 to 1.12) for those who consumed 5.0 to 9.9 g/day, 1.08 (0.96 to 1.21) for 10.0 to 14.9 g/day, and 0.98 (0.85 to 1.13) for 30.0 to 49.9 g/day. The results did not differ by age group or folate intake. Among those with lower intake of vitamin B12, however, higher consumption of alcohol, specifically liquor, was associated with an increased risk of hearing loss. CONCLUSIONS: Our data suggest that low or moderate alcohol consumption does not influence the risk of hearing loss in older men. A possible relation between vitamin B12 intake, alcohol consumption, and hearing loss merits further investigation.