Secondary otalgia in an adult population.

OBJECTIVE: To analyze the associations of secondary otalgia with general health, stress, insomnia, bruxism, and recurrent head and neck region pains. DESIGN: A population-based survey. SETTING: General community. SUBJECTS: A total of 391 randomly selected subjects (186 men, 205 women) aged 25, 35, 45, 55, or 65 years. METHODS: Standardized interview and self-report questionnaires of general health and stress. RESULTS: Otalgia was statistically significantly associated with all the studied factors. However, in the whole study group, independent predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and bruxism. When analyzed in women, the predictors of otalgia were the obvious need for temporomandibular disorder treatment, high frequency of stress symptoms, and age. When analyzed in men, recurrent neck pain was a predictor of otalgia. CONCLUSIONS: We suggest that after ruling out otorhinolaryngologic infectious diseases and temporomandibular disorder in patients with secondary otalgia, the next step is to explore the frequency of stress symptoms, bruxism, and recurrent neck pain. Furthermore, women and men may need a different approach in diagnostics of secondary otalgia. By diagnosing and treating these predictors of otalgia, it may be possible to reach a more successful outcome.

In vivo model for frontal sinus and calvarial bone defect obliteration with bioactive glass S53P4 and hydroxyapatite.

An in vivo model was developed to investigate the usability of a frontal sinus and a calvarial bone defect obliteration with bioactive glass S53P4 (BG) and hydroxyapatite (HA) granules. Roofs of 21 Elco rabbit frontal sinuses were drilled open from 4 separate holes using a standard method, and the sinuses, located in pairs, in frontal bone were filled with BG on one side and with HA on the other side. Two parallel posterior defects were covered with a pedicled periosteum flap, and 2 anterior defects with a free flap. The stability of materials, new bone, and connective tissue formation were observed with histomorphometry, scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDXA), and X-ray pictures at 1, 3, 6, and 12 months postoperatively. The results showed more rapid resorption of filling material (p = 0.019) and new bone formation (p = 0.0001) in the defects filled with BG than in the corresponding HA-filled defects studied by histomorphometry throughout the study. New bone formation and resorption of materials were faster in defects covered by a pedicled flap than by a free periosteum flap. The results were supported by SEM histomorphometric and radiologic analysis. Both bioactive materials studied were well tolerated in frontal sinuses and in calvarial bone defects. The experimental model showed the influence of early periosteum vascularization on accurate frontal sinus filling and the healing process in rabbit frontal sinuses.

Clinical follow-up method for frontal sinus obliteration with bioactive glass S53P4.

A clinical follow-up method was developed to investigate the behavior of a massive amount of bioactive glass S53P4 (BG) clinically used in frontal sinus obliteration. Two sizes of granules (0.63-0.8 mm or 0.8-1.0 mm) in 16 separate BG amounts, weight 25 g, were tested both in simulated body fluid (SBF) and in a buffer containing tris-hydroxymethyl aminomethane citric acid (TRIS-c.a) in standard conditions. The dissolution of silicon (Si) and phosphate (P) was detected with direct current plasma atom emission spectroscopy (DCP-AES) monthly up to 6 months. The BG masses were scanned both wet in the solutions and dried by computer tomography (CT), and the scans were analyzed by Region of Interest (ROI) technique. Calcium phosphate (CaP)- and silica (Si)-gel-layers were studied by scanning electron microscopy (SEM) at 1, 3, and 6 months. Cumulative loss of Si and P was stronger in TRIS-c.a than in SBF (p < 0.0001), and it was higher with smaller than with larger granules in both solutions (p < 0.0001). This was shown correspondingly by the decrease of Hounsfield units (HUs) in ROI analysis (p < 0.0001). The level of HUs was lower with dried than with wet BG (p < 0.0001). The results were compared for clinical ROI analysis of patients with obliterated frontal sinuses up to 48 months and they were parallel. The follow-up method seems to indirectly reveal the behavior of BG and the healing process in the obliterated cavity.

In vitro model for frontal sinus obliteration with bioactive glass S53P4.

An in vitro model was used to investigate the behavior of a massive frontal sinus obliteration with bioactive glass S53P4 (BG) for clinical purposes. Two sizes of granules (0.63-0.8 mm or 0.8-1.0 mm) in 16 separate BG amounts, weight 25 g, were tested both in simulated body fluid (SBF) and a buffer containing trishydroxymethyl aminomethane citric acid (TRIS-c.a) in standard conditions. The dissolution of silicon (Si) and phosphate (P) was detected with direct current plasma atom emission spectroscopy (DCP-AES) monthly up to 6 months. The BG masses were scanned by computer tomography (CT) and the scans analyzed by Region of Interest (ROI) technique. Calcium phosphate (CaP)- and silica (Si)-gel-layers were studied by scanning electron microscopy (SEM) at 1, 3, and 6 months. Cumulative loss of Si and P was stronger in TRIS -c.a than in SBF (p < 0.0001), and it was higher with smaller than with larger granules in both solutions (p < 0.0001). This was shown correspondingly by the decrease in Hounsfield units (HU) by ROI analysis (p < 0.0001). In SBF-soaked BG masses, the CaP-layer occurred on the uppermost granules, and in TRIS-c.a at 3-6 months, on the granules in the center and lower parts. The decrease of HU seems to reveal indirectly the resorption of BG.

C1-tuning fork tests in school-aged children.

The Rinne and the Weber tests were carried out using a 256-Hz tuning fork on 687 6- to 15-year-old school children, the majority of whom were normally hearing subjects. The Rinne test was positive in 97% of ears with normal hearing or sensorineural hearing loss and negative in 72% of ears with conductive hearing loss. The Rinne test changed from positive to negative at 13 dB when performed using the normal loudness comparison method. In midline Weber results, the mean value of the air conduction difference at 0.25 kHz between the right and left ear was 1.4 dB. The lateralization in the Weber test occurred at a difference of 2.5 dB between the right and left ear. The Weber test was in midline in 96-98% of ears with bilateral normal hearing or sensorineural hearing loss. It lateralized to the poorer ear in 63% of ears with unilateral conductive hearing loss. The values of the Rinne and Weber tests were not good in the diagnosis of mild conductive hearing loss when the air-bone gap was 5-35 dB.

Prevalence of septal deviations in school-aged children.

A total of 687 school children, aged 6-15 years, were examined for nasal septal deviations with anterior rhinoscopy and maxillary sinus radiography. Septum deviations were divided into four different categories and the final evaluation included the clinically significant deviation, based on purely morphological findings. Columella deviation was an exceptional condition in 0.7% of children, septum spurs were found in 3.8%, bending of the quadrilateral cartilage was present in 13.4%, and premaxillary luxation in 28.7%. A clinical diagnosis of septum deviation was made in 9.5% of children. The occipitomental projection of the maxillary sinus X-ray was a good diagnostic tool in evaluating the clinical significance of septum deviation.

Influence of tympanic membrane changes on audiometric and immittance findings in school-aged children.

Six-hundred-and-eighty-seven 6 to 15-year-old children were examined for the association between tympanic membrane (TM) changes and audiometric or immittance findings. The hearing thresholds were between 20 and 30 dB in ears with amber TM, but between 25 and 45 dB in ears with adhesive TM. When the TM was retracted or the mobility decreased, the hearing thresholds were about 10 dB poorer than in ears with normal TM position or mobility. Thick TM caused hearing loss in the high-frequency areas. The hearing loss was only marginal (3-4 dB) in ears with retracted pars flaccida compared with ears with normal position of pars flaccida. The mean and median middle ear pressure value was lower than -200 da Pa in ears with dull, amber, retracted, poorly movable, adhesive or thick TM. It was between -100 and -200 da Pa in ears with red TM, locally retracted pars tensa or retracted pars flaccida. Stapedius reflex thresholds were higher in ears with one or several abnormal findings than in normal ears.

A new Finnish computerized rhinomanometer.

We introduce a new sophisticated Finnish rhinomanometer in which the need for routine work has been minimized. Technical information about the instrument is given, recording procedure is described and a normal material and reproducibility test is analyzed.