Meningioma in the middle ear: An unusual case of hearing loss

@#<p style="text-align: justify;">When evaluating patients presenting with progressive unilateral hearing loss without a history of trauma or infection, it is important consider the clinical correlation of physical examination findings, imaging and audiograms. It is crucial that all findings are correctly reviewed and analyzed to provide an accurate assessment and appropriate management for the patient.</p>

Genetic polymorphisms in CYP1A1, GSTM1, GSTP1, GSTT1, NAT1 and NAT2 and oral cavity cancer risk among Filipinos

Polymorphisms in metabolic genes have been shown to modulate susceptibility to oral cavity cancer. Cases (n=176) and controls (n=317) from the Filipino population were genotyped for selected polymorphisms in CYP1A1, GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subjects. The CYP1A1m1/m1 genotype is protective against oral cancer, while being homozygous for the GSTP1 c.313G genotype and heterozygous for the NAT1*10 homozygotes and non-homozygotes for the CYP1A1 m1 allele. The risk from heterozygosity for the NAT1*10 allele was limited to subjects who were not homozygous for the GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental variables, the homozygous GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental risk factors, such as smoking, passive smoking, inverted smoking and tobacco chewing, and environmental protective factors, i.e. moderate consumption of fish sauce (patis) and shrimp paste (bagoong). The GSTP1 c.313G polymorphism increases susceptibility for oral cavity cancer in the Filipino population.

Technique of multi-planar CT image reconstruction for the evaluation of superior semicircular canal dehiscence syndrome

@#Superior semicircular canal dehiscence (SSCD) syndrome is an unusual cause of vertigo that was first identified by Minor in 1998. The patients initially described by Minor presented with vertigo, oscillopsia and/or dysequilibrium related to sound, changes in middle ear pressure and/or changes in intracranial pressure due to an absence of the bony layer that normally covers the superior semicircular canal.1Subsequent clinical studies have shown that the condition may lead to a variety of vestibular and/or auditory symptoms that mimic other otologic disorders. These symptoms include autophony, ear blockage or fullness, conductive hearing loss, pulsatile tinnitus, dizziness or vertigo with head movements and general disequilibrium.

Training of nurses in ear examination and hearing screening in the school setting (Phase II): A cross-sectional study

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Probabilities of ossicular discontinuity in chronic suppurative otitis media using pure-tone audiometry.

OBJECTIVE: To analyze the likelihood ratios (LRs) and predictive values of preoperative air-bone gap (ABG) levels on the presence of gross ossicular discontinuity (OD) among chronic suppurative otitis media (CSOM) patients. SETTING: Tertiary hospitals. METHODS: Records of 276 patients with CSOM 7 to 75 years old undergoing their first tympanomastoidectomy were reviewed. Association of preoperative audiogram on the presence of OD was analyzed using logistic regression analysis and chi 2 tests. Frequency-specific ABG values were compared with the presence of OD. RESULTS: In CSOM without cholesteatoma, the ABG of 20 dB or less at 500 Hz (LR [-], 0.119; 95% confidence interval [CI], 0.016-0.867) and 30 dB or less at 1 kHz (LR [-], 0.276; 95% CI, 0.087-0.876) decreased probability of OD from 33 to 5.6% and 15.5%, respectively. Air-bone gap levels of greater than 30 dB at 2 kHz (LR [+], 2.8; 95% CI, 1.4-5.9) and greater than 40 dB at 4 kHz (LR [+], 2.2; 95% CI, 1.2-3.9) increased the probability of OD from 33 to 51 to 89%. In the presence of cholesteatoma, the chance of OD was 88%. The ability of ABG to alter probability of OD was not significant in the presence of cholesteatoma. CONCLUSION: Narrow ABG at lower frequencies suggested absence of OD. Wide ABG at higher frequencies suggested presence of OD. Simple tympanoplasty can be done to patients with a small chance of OD as assessed by pure-tone audiometry, whereas a mandatory exploration of the ossicular chain with possible reconstruction was suggested on subjects with a high chance of OD. The presence of cholesteatoma warrants ossicular chain exploration.

Comparative study of cochlear damage with three perimodiolar electrode designs.

OBJECTIVE: To describe intracochlear insertion trauma caused by three perimodiolar cochlear implant electrodes. STUDY DESIGN: Descriptive histological study of 15 human cadaver temporal bones. METHODS: Fifteen cadaver temporal bones underwent surface preparation and were implanted with one of the following perimodiolar electrode arrays: Combi 40+PM (MedEl Corporation), HiFocus II (Advanced Bionics Corporation), or Contour (Cochlear Corporation). A cryosectioning technique was used to study horizontal sections at 200 microm intervals with the electrode in place. Image-enhanced videofluoroscopy and computer-assisted morphometrics were used to assess the mechanism of insertion trauma and to determine electrode position within the modiolus. RESULTS: Histological examination revealed varying degrees of damage to the spiral ligament, basilar membrane, and osseous spiral lamina. Using a novel grading system for electrode trauma, there was no statistically significant difference among the three electrodes. A literature search of histological studies of a commonly used "standard" electrode showed damage equal to or greater than that seen in the current study. CONCLUSIONS: Insertion trauma caused by periomodiolar electrodes occurs to an acceptable degree. Refinement of electrodes based on mechanisms of trauma may be able to further reduce damage.