otorhinolaryngology news

This new study from Japan (Kakehata et al, Otology & Neurotology, Vol. 27, No. 5, 2006) designed to compare the efficacy of intratympanic and intravenous dexamethasone in diabetics with sudden sensorineural hearing loss observed that IT-DEX is as effective as IV-DEX with the added advantage of no observable worsening of hyperglycemia in the IT-DEX group.

Abstract: Objective: The purpose of this study was to evaluate the efficacy of intratympanic administration of dexamethasone (IT-DEX) treatment on sudden sensorineural hearing loss (SSNHL) patients with diabetes by comparing the results with intravenous administration of dexamethasone (IV-DEX) treatment. Study Design: Comparative study. Setting: University hospital and affiliated hospital. Patients: Ten sequential SSNHL patients with diabetes receiving IT-DEX and 21 sequential SSNHL patients with diabetes receiving IV-DEX. Patients with low tone hearing loss were excluded. Intervention: In the IT-DEX group, two methods were applied to deliver DEX (4 mg/ml): injection through a perforation made by laser-assisted myringotomy or through a tympanostomy tube. IT-DEX administration was performed on 8 sequential days. In the IV-DEX group, DEX was administrated intravenously starting from an amount of 8 mg/d followed by taped doses for 10 days. Main Outcome Measures: Preprocedure and postprocedure hearing levels and complications. Results: In the IT-DEX group, the average hearing level before the treatment was 79 dB. Overall, all 10 patients showed improvement of more than 10 dB in the pure-tone audiogram, with amean improvement of 41 dB. Seven patients (70%) demonstrated successful results, and four recovered completely. In the IV-DEX group, 14 (67%) of the 21 patients showed improvement of more than 10 dB with a mean improvement of 25 dB. Thirteen patients (62%) demonstrated successful results. Free blood sugar during and after the IT-DEX treatment remained below the pretreatment levels, whereas four patients in the IV-DEX group demonstrated worsening of the hyperglycemia. Conclusion: IT-DEX treatment is at least as effective as IV-DEX
treatment for SSNHL patients with diabetes. .

Journal Watch :The South African experience with ingestion injury in children. van As Ab et al, 2003

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

Erratum: Vol4,No2: Nasal Polyposis...Not Cox Model..!

The third report of the last issue of otorhinolaryngology newsletter was to be captioned "Nasal polyposis & steroids", but the "Neural Network Vs Cox's Model" which was carried in the preceding issue (Vol4,No1) was mistakenly repeated. This error is regretted. The intended story was chosen out of concern for the etiologically poorly understood yet clinically quite common story of nasal polyposis. The report was of a paper from Spain (Benitez et al, Laryngoscope. 2006 May;116(5):770-5. ) that observed that a short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps.

Abstract: BACKGROUND: Nasal polyposis is an inflammatory disease of unknown etiology. This study aimed to evaluate the effect of a short course of oral prednisone followed by intranasal budesonide on nasal symptoms, polyp size, nasal flow, and computed tomography scan. METHODS: Eighty-four patients with severe nasal polyps were included. After a steroid washout period, patients were randomized into two groups: group A (n = 63) received oral prednisone for 2 weeks and group B (n = 21) did not receive any steroid treatment. Patients from group A received intranasal budesonide for 12 weeks. RESULTS: Atopy was positive in 36.8% of patients. Blood eosinophilia was higher in asthmatic (7.2 +/- 0.7%, P < .05) than in nonasthmatic (3.0 +/- 0.4%) patients. Asthmatic patients showed higher scores on nasal obstruction and loss of smell than nonasthmatics. Oral steroids caused a significant improvement in all nasal symptoms and improved polyp size (2.1 +/- 0.1, P < .05) and nasal flow (560 +/- 35 cm/s, P < .05) compared with nontreated patients (2.8 +/- 0.1 and 270 +/- 34 cm/s, respectively). Intranasal budesonide maintained the improvement on nasal symptoms, polyp size, and nasal flow. Steroid treatment reduced the computed tomography scan score (15.4 +/- 1, P < .05) compared with before treatment (18.2 +/- 0.8). CONCLUSION: A short course of oral steroids improved all nasal symptoms, polyp size, and nasal flow, whereas intranasal steroid maintain this effect.

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