Work-Related Upper-Airway Disorders

Work-related rhinitis and laryngeal disorders are common and can significantly contribute to work absences and presenteeism. Each can cause respiratory symptoms that may be misdiagnosed as asthma symptoms, and each may occur as an isolated disorder or may also accompany asthma. Suspicion of these disorders and correct management require a careful medical and occupational history. Investigations for work-related rhinitis include examination of the nose, allergy skin tests, and in some cases, monitoring of peak inspiratory nasal flows at work and off work, or specific challenge tests. Work-related laryngeal disorders require assistance from an otolaryngologist and speech language pathologist.

Benzene-Exposed Army Soldiers: Nasal Cytology as a Screening Tool

OBJECTIVE

Assessment of the nasal cytology in revealing early nasal mucosa alteration of workers exposed to benzene.

METHODS

Nasal cytology was compared among non-exposed and exposed workers to benzene. A comparison of the two groups was performed considering rhino-cytological features.

RESULTS

In the exposed group neutrophils count range was 14 to 70, compared to 2 to 5 in control group. Ciliated cells ratio range was respectively 0.28 to 2.8 and 0.25 to 0.31. In subjects exposed to benzene >10 years, nasal mucosa showed an inflammatory status and an ongoing mucipar metaplasia, defined by an alteration of mucipar/ciliated cells ratio.

CONCLUSIONS

Nasal cytology may be a useful research tool for the health surveillance of workers exposed to benzene and may be applied to study the effects of other upper airways chemicals irritants.

Influence of Exhaust System Setup on Working Zone Pollution by Dust during Sawing of Particleboards

Air pollution by wood dust in furniture production sites is an important hygiene issue. The dust is created by all types of wood and wood-based material machining, and its concentration in the working zone surrounding the machining stand depends on the effectiveness of the dust exhaust system. In present research, three setups of the dust extraction system for a conventional table sawing machine are considered while machining particleboards. The results showed a high impact of the exhaust system connection setup on the dust concentration in the air surrounding the sawing machine work stand. The use of both main and auxiliary sawdust extraction connectors together ensured the highest clearness of the air, with only 0.5 mg/m³ of dust concentration. Closing the upper hood leads to a concentration five times higher, while disconnecting it results in a ten times higher dust content. The finest dust particles (<1 µm), however, are the most numerous in the case of closing the hood.

Hosseini H, Adeli SH, Wang T. Prevalence of respiratory symptoms and spirometric changes among non-smoker male wood workers

Objective

To assess the effects of workplace exposure to hardwood dust on lung function and determine a prevalence of respiratory symptoms among wood workers.

Study design

Cross-sectional observational study.

Setting

Tertiary referral center.

Subjects and methods

Two hundred seventy-six, non-smoker male wood workers and equal number of non-smoker male office workers, referred to pulmonology clinic included in this study. Evaluation of study participants included completion of a questionnaire regarding respiratory symptoms and baseline spirometry was measured according to the actual recommendations.

Results

Respiratory symptoms including cough, phlegm, chest tightness, and wheezing were significantly higher in wood workers than office workers (40.2% versus 29.3% for cough, p = 0.0073; 40.6% versus 23.6% for phlegm, p<0.0001; 38.0% versus 23.1% for chest tightness, p = 0.0001; 25.3% versus 14.5% for wheezing, p = 0.0014).

No statistically significant differences were observed for Dyspnea, and upper respiratory tract symptoms among wood workers compared to office workers. While wood workers were more likely to require spirometry test than office workers (21.4% versus 5.4%, p<0.001) the obstructive changes were more prevalent on spirometry test in wood workers (71.4% obstructive pattern versus 28.6% restrictive pattern). Spirometry test revealed the mean values of FEV₁ and FEV₁/FVC ratio were significantly lower in the wood workers, compared to their mean values in the control group.

Conclusion

Respiratory symptoms associated with work, are more prevalent among wood workers than office workers. Our data revealed that workplace exposure to hardwood dust may compromise respiratory function, indicating the importance and the need for optimizing preventive measures in workplace to protect the respiratory health among exposed workers. Obstructive changes on pulmonary function test is a dominant pathologic pattern in pulmonary function test among wood workers. Further investigation is required by current available tools such as nasal cytology to detect influence of wood dust exposure on the upper respiratory airway.

Measurement of mucociliary clearance in the patients with multiple sclerosis

OBJECTIVES

The aim of the present study was to measure nasal mucociliary clearance (NMC) time in the patients with MS and to compare the findings with healthy population.

METHODS

Totally 97 individuals including 47 patients with relapsing-remitting multiple sclerosis and 50 healthy volunteers were enrolled into the study. Saccharin clearance test was performed on both groups and NMC time was measured. Data analysis was performed by SPSS version 24.0 statistics program (SPSS Inc., Chicago, Illinois, USA). Statistical tests were interpreted at p < 0.05 significance level.

RESULTS

The NMC time averages in MS patients and healthy control group were 12.43 ± 4.05 min and 8.14 ± 2.87 min, respectively; the difference between the groups was significant (p < 0.001). There was a statistically strong association between NMC time values and Expanded Disability Status Scale (EDSS) values in MS patients (r = 0.817, p < 0.001).

CONCLUSION

We found nasal mucociliary transport time longer in MS patients than healthy population in the present study. To the best of our knowledge, there is not any study conducted about this topic in the literature. We believe that our findings would shed a light on further studies.

Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10

OBJECTIVES

The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy.

METHODS

Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling ( k-nearest neighbors model) were applied.

RESULTS

Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model's misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%.

CONCLUSIONS

Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients.

Outcomes of Recurrent Acute Otitis Media in Children Treated for Dental Malocclusion: A Preliminary Report

Aim. To investigate the role of dental malocclusion treatment in the outcomes of Recurrent Acute Otitis Media (RAOM). Materials and Methods. The clinical outcome (number of acute recurrences in 12 months) of 61 consecutive children treated medically for RAOM was analysed. Children underwent an odontostomatologic evaluation, a fiberoptic endoscopy, and skin-prick tests. Results. 32 children (group A) were diagnosed with dental malocclusion and treated with a mandibular repositioning plate. Dental malocclusion was ruled out in the other 29 patients with RAOM, and they were used as controls (group B). The two groups were homogeneous in terms of sex, exposure to RAOM risk factors, skin test results, and adenoid hypertrophy, while age was significantly higher in group A. Age, sex, exposure to RAOM risk factors, adenoid hypertrophy, and skin test results were not associated with RAOM outcome. Children in group A treated for dental malocclusion were strongly associated with a lower number of acute episode recurrences at both univariate (p < 0.0001) and multivariate analysis (p = 0.001). Conclusions. RAOM showed better outcomes in children with dental malocclusion wearing a mandibular repositioning device. Dental malocclusion in children with RAOM may play a role in the pathogenesis of Eustachian tube dysfunction.