Documented otological findings in lightning-injured patient include sensorineural hearing loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the mastoid bone, burns to the external auditory canal, and peripheral facial nerve palsy, though the most common otological finding noted was tympanic membrane perforation (Ogren & Edmund, 1995)..

Microotological findings (Frayne & Gilligan, 1987) documented include widespread inner-ear changes with absent organs of Corti, rupture and collapse of Reissner's membrane, strial degeneration, and a decreased spiral ganglion cell population.

 A recent case report from Pittsburg, USA (Sun, Simons & Mandel, Laryngoscope, Volume 116(6), June 2006, pp 1039-1042 ) observed bilateral clear otorrhoea, following lightning strike in an 11 year old male, which was negative to beta2 transferin assay, and exploratory tympanotomy revealed bilateral round window and tympanic membranes rupture, successfully treated with temporalis muscle and fascia graft plus tympanoplasty. This report recommended otomicroscopic examination, collection of drainage for [beta]2-transferrin testing, serial audiometric evaluation, CT imaging of the temporal bone, and consideration of systemic broad-spectrum antibiotic therapy, especially if mental status changes are present in patients that sustained lightning strike

This report put to question the earlier recommendation of Ogren & Edmund (Semin Neurol. 1995 Sep;15(3):256-62) that, following lightning injury, tympanoplasty should be delayed for 6 to 12 months because of the frequent delay in spontaneous healing, since the surgical procedure carried out in this reported case was done few days following the lightning injury.

. Text Box: Editor's Choice:    Lightning Strike, & Hearing ...? Text Box: Abreast of Ear, Nose, Throat, Head & Neck Advances

Text Box: Volume 4, N0. 2 Text Box: July 7, 2006

Text Box: Otorhinolaryngology News

Text Box: Inside This Issue · LigLightning strike & hearing · Nasal polyp & steroid? · TinAgeing & Cricopharyngeal protrusion *     Case of the Week

 

 

 Case Review

 Clinical Audiogram of The Week

A 34-year old female presented with sudden onset of right tinnitus of 2 months duration. She described the tinnitus as sounding like 'bird chirping in the ear' and occasionally like 'cricket sound' . The tinnitus does not disturb sleep, and is not associated with otorrhoea, or noticeable hearing loss or vertigo. She experienced similar symptom following Quinine ingestion a year earlier. She has no nasal or throat symptom. ENT / Head - Neck examination was negative. Pure tone audiogram for right ear revealed the finding on the picture shown.

 

    

What is the Diagnosis?
Text Box: Coming Events of Importance to Otorhinolaryngologists in Africa

1. 110th American Academy of ORL, Head & Neck Surgery Annual Meeting & OTO EXPO, September 17-20, 2006; Toronto, Canada.

2.          42nd South African ENT Congress joint meeting with the British Association of Otolaryngology - Head & Neck Surgery, October 8 - 11, 2006; Cape Town, South Africa. Click HERE for More Info

3.         16th Annual oto-rhino-laryngological society of Nigeria (ORLSON) General Meeting & Scientific Conference; November 22nd - 25th, 2006; Kaduna, Nigeria
 
A common research question in medical, biological, or engineering (failure time) research is to determine whether or not certain continuous (independent) variables are correlated with the survival or failure times. Introduced by D. R. Cox, the Proportional Hazards (PH) model was developed in order to estimate the effects of different covariates influencing the times-to-failure of a system and has been widely employed for medical and biomedical research purposes. Cox's model allows both the identification of prognostically relevant variables and the quantification of their prognostic influence. These characteristics make it a helpful tool for analysis as well as for prognostication, and it has been employed in such diverse aspect of otolaryngology as in prognosticating the outcome in upper aerodigestive tract carcinomas. This recent paper from Liverpool, UK (Jones et al, European Archives of Oto-Rhino-Laryngology, Issue:  Volume 263, Number 6, 541 - 547 )stresses the superiority of artificial neural network over the Cox's PH Model in prediction of survival of patients with Ca. Larynx

Abstract: The accepted method of modelling and predicting failure/survival, Cox’s proportional hazards model, is theoretically inferior to neural network derived models for analysing highly complex systems with large datasets. A blinded comparison of the neural network versus the Cox’s model in predicting survival utilising data from 873 treated patients with laryngeal cancer. These were divided randomly and equally into a training set and a study set and Cox’s and neural network models applied in turn. Data were then divided into seven sets of binary covariates and the analysis repeated. Overall survival was not significantly different on Kaplan–Meier plot, or with either test model. Although the network produced qualitatively similar results to Cox’s model it was significantly more sensitive to differences in survival curves for age and N stage. We propose that neural networks are capable of prediction in systems involving complex interactions between variables and non-linearity.

 

     Journal Watch :Comparison of performance by otolaryngologists, pediatricians, and general practioners on an otoendoscopic diagnostic video examination, Pinchero & Poole, 2005

  1.  Reviewers wanted for otolaryngology news journal's watch page. If you are an Otolaryngologist in Africa and will like to be our journal reviewer, please feel free to email orl-mailer@otolaryngologyinafrica.net

  2.   DODA 2006, capable of advanced hearing measure, and also paediatric hearing assessment is being developed. If you requested for and got a free copy of DODA, you may also look out for this latest version dubbed DODA-i, as well as for an additional page on outcome of hearing assessment using DODA.

 3.  A subweb of this site, dedicated to online publications of otorhinolaryngological grand round presentations across Institutions all over Africa will soon take off. The subweb once active can be accessed at http://www.otolaryngologyinafrica.net/grandround/ . Watch out, and please take advantage of this to send in your grand round presentations. Also watch out for online discussion forum for discussion of issues concerning otolaryngologists, but not really of clinical nature at http://otolaryngologyinafrica.net/discussionforum/ 

 Till Next Week,

 Biodun

This is a free email newsletter circulating to Otolaryngologists in Africa, and interested Otolaryngologists elsewhere. If you know anyone interested in receiving this free newsletter, feel free to forward a copy to such person or encourage them to email orl-mailer@otolaryngologyinafrica.net for free subscription

 

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