Improvement of the aerobic performance in endurance athletes presenting nasal valve compromise with the application of an internal nasal dilator

PURPOSE

We investigated the effects of an internal nasal dilator on nasal airflow and cardio-respiratory capacity in adult endurance athletes, while performing controlled exhaustive physical exercise.

METHODS

Prospective observational study. Participants were 38 adult endurance athletes, 23 with and 15 without nasal valve compromise. Nasal patency was objectively evaluated with anterior rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow (PNIF). Maximum oxygen uptake (VO2max), maximum pulmonary ventilation, time to exhaustion and total time of nasal respiration were recorded during a submaximal treadmill test. Dyspnea intensity and fatigue perception were evaluated using a labeled visual analog scale. All assessments were performed with and without the application of the internal nasal dilator.

RESULTS

All the parameters related to aerobic capacity were significantly reduced in the group of athletes with nasal valve compromise (p. <0.05 for all variables). The internal nasal dilator improved statistically significantly the nasal patency (p. <0.001), VO2max and aerobic performance and self-rating of dyspnea and fatigue (p. <0.05 for all parameters) only in athletes with nasal obstruction. PNIF correlated significantly with VO2max (rho = 0.4, p. <0.05).

CONCLUSIONS

Internal nasal dilation improves nasal patency and aerobic performance during submaximal exercise in adult endurance athletes with nasal obstruction symptoms due to nasal valve compromise.

Developmental Feeding Stages and Their Impact on Child Feeding Behavior

OBJECTIVES

Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems.

METHODS

A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history.

RESULTS

Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on.

CONCLUSIONS

The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.

Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy

Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.

Does Lexical Stress Pattern Affect Learning and Producing New Words in Greek for Children With Cochlear Implants?

PURPOSE

Τhe lexical stress pattern (trochaic vs. iambic) may affect various aspects of word learning and word production in children with cochlear implants (CIs). This study aimed to investigate lexical stress effects in word learning by Greek-speaking children with CIs.

METHOD

A word learning paradigm, consisting of a word production and a word identification task, was used. A test list of eight pairs of disyllabic nonwords with identical phonological composition and contrasting lexical stress (eight trochaic and eight iambic), along with their referent pictured objects, was constructed and administered to 22 Greek-speaking children with CIs (ages 4;6-12;3 [years;months]) with normal nonverbal IQ and to 22 age-matched controls with normal hearing (NH) and no other difficulties.

RESULTS

Overall, children with CIs exhibited lower performance than their hearing peers in all word-learning tasks, regardless of lexical stress pattern. Specifically, they identified significantly fewer words and exhibited significantly lower accuracy in word production than those of the controls. In the group with CIs, lexical stress pattern affected their production of words but not their word identification. Children with CIs showed more accurate production of iambic than trochaic words, a fact attributed to better vowel production. Yet, production of stress was less accurate for iambic than for trochaic words. Μoreover, stress assignment of iambic words was highly correlated with speech and language tests in children with CIs.

CONCLUSIONS

Greek children with CIs exhibited lower performance in the word-learning task administered than children with NH did. In addition, the performance of children with CIs indicated a dissociation between the perception and production mechanisms and revealed complex relations between the segmental and prosodic aspects of words. Preliminary findings suggest that stress assignment in iambic words can serve as an indicator of speech and language growth.

Smell as a Disease Marker in Multiple Sclerosis

Existing data suggest that people with multiple sclerosis (pwMS) are at an elevated risk for experiencing olfactory impairment. We investigated if smell dysfunction can be used as an MS disease marker. This is a cross-sectional, case−control study. All data were collected prospectively from 171 participants, 115 pwMS and 56 controls (age and sex stratified and matched to the patients), who reported smell, taste, and nasal breathing, and completed the Greek-validated questionnaires for nasal obstruction (NOSE), nasal-symptoms QoL (SNOT-22), and olfaction-associated QoL (QOD). The smell was assessed with the “Sniffin’ sticks” (odor threshold (OT), discrimination (OD), identification (OI) test, and total TDI). We recorded the pwMS disease characteristics (Expanded Disability Status Scale-EDSS, the disease type and duration), cognitive function, emotional status, fatigue, and impact of MS in everyday activities. A TDI < 30.75 (hyposmia) was detected in 30.8% of the patients. The patients’ OD and TDI scores were significantly lower than the controls’ (p = 0.005, and 0.015, respectively). The hyposmia correlated with disease severity and duration. The EDSS score correlated negatively with OD (r = −0.299, p = 0.001) and TDI (r = −0.242, p = 0.01). The disease duration correlated negatively with OD (r = −0.305, p = 0.001, OI (r = −0.253, p = 0.008) and TDI (r = −0.3, p = 0.001). The information processing speed (SDMT) correlated with OD, OT, and TDI (r = 0.302, p = 0.002; r = 0.242, p = 0.016; r = 0.326, p = 0.001). The olfactory function is changing in MS in accordance with disease progression.

Video Head Impulse Test (vHIT): Value of Gain and Refixation Saccades in Unilateral Vestibular Neuritis

The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in the horizontal and vertical planes in patients after the onset of unilateral acute vestibular neuritis (AVN). Thirty-five patients were examined in the acute stage of AVN and at follow-up (range, 6–30 months); a control group of 32 healthy subjects also participated. At onset, the mean gain was significantly lower on the affected side in all of the semi-circular canal planes, mainly in the horizontal canal plane, and saccades (covert and overt) were more prevalent in the horizontal compared to the vertical canal planes. Multi-canal affection occurred more frequently (80% for gain, 71% for saccades) than isolated canal affection. At follow-up, which ranged from 6 to 30 months, the gain was recovered in all of the canals (anterior in 50%, horizontal in 42.8%, and posterior canal in 41.1% of cases), while covert and overt saccades were reduced in the horizontal and vertical planes. However, covert saccades were still recorded in a greater proportion (69%) than overt saccades (57%) in the horizontal plane and at a lower rate in the vertical planes. The compensatory mechanisms after AVN mainly involve the horizontal canal, as the refixation saccades—especially covert ones—were more frequently recorded in the horizontal than vertical canals.

Swallowing disorders after thyroidectomy: a systematic review and meta-analysis

PURPOSE

Swallowing disorders following thyroidectomy are common, even after surgery without confirmed complications. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease).

METHODS

The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms "dysphagia", "swallowing disorder", "deglutition disorder", "thyroidectomy" and "thyroid surgery" in the appropriate combinations. A quantitative synthesis of the results followed.

RESULTS

The systematic review of the literature resulted in 35 articles, which met the inclusion criteria and were analyzed regarding their type, sample, follow-up and results regarding post-thyroidectomy dysphagia in multiple follow-up times. A significant increase of swallowing impairment compared to baseline was recorded shortly after surgery. Dysphagia reverted to pre-operative levels 2-3 months later. Dysphagia continued to be reported in a significantly lower proportion of patients, even 1 year after surgery. No significant difference was noticed between open and endoscopic thyroid surgery at 2-3 months post-surgery.

CONCLUSIONS

The swallowing disorders reported after thyroidectomy should be expected, but are not always detectable through objective methods. This should not lead to underestimation of symptoms, since the patients' quality of life is negatively affected by the symptomatology.

Factors Associated with Feeding Problems in Young Children with Gastrointestinal Diseases

Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

PURPOSE

The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life.

METHODS

Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6 months after septoplasty.

RESULTS

Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively).

CONCLUSION

Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.

Feeding Problems in Typically Developing Young Children, a Population-Based Study

Feeding problems have been estimated to occur in approximately 25–45% of normally developing children. The aim of this study was to investigate the prevalence of feeding problems in typically developing young children in Greece. Child feeding behavior, parents’ feelings about their child’s feeding patterns, and parental feeding practices were also explored. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Data on 742 healthy, typically developing children aged two to seven years are presented. Overall, the majority of children in the sample showed high frequency of desirable mealtime behaviors and low frequency of undesirable mealtime behaviors. However, a significant proportion of the cohort presented with food neophobia and low consumption of vegetables. When applying test cut-off scores, it was found that 8.2% of the sample had abnormal Total Frequency Score (TFS) and 26.6% had abnormal Total Problem Score (TPS). The study showed that parent-reported feeding problems are quite common in children of typical development in Greece. Moreover, while the majority of the sample displayed a high frequency of favorable behaviors, specific child feeding behaviors are amenable to improvement.

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases

Parental feeding practices and mealtime routine significantly influence a child’s eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case–control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child’s food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals.

Tongue strength, dysphagia questionnaire, pharyngeal secretions and FEES findings in dysphagia management in amyotrophic lateral sclerosis

OBJECTIVE

Dysphagia is common in Amyotrophic lateral sclerosis (ALS). ALS shows significant phenotypic variability. It is characterized by progressive weakness and/or spasticity of muscles. Dysphagia symptoms vary. Aspiration is often silent and cognitive dysfunction is common. The purpose of the study was to evaluate tongue strength measurements, dysphagia questionnaire, the presence of pharyngeal secretions, and FEES findings in dysphagia management in ALS.

METHODS

Twenty-five patients completed the Eating Assessment Tool-10 (EAT-10), had their Maximum Isometric Tongue Pressure (MITP), and endurance measured and underwent Flexible Endoscopic Evaluation of Swallowing (FEES) providing 31 examinations.

RESULTS

Out of 25 patients, 76% were self-reported as dysphagic (EAT-10≥3) with a mean EAT-10 at 14.95 (±7.96). ALS patients had significantly decreased tongue strength (mean MITPanterior: 31.69 ± 17.32kPa). Comparing examinations of dysphagic and non-dysphagic status the mean MITPa of non-dysphagic was significantly greater (52.33 ± 10.97 kPa versus 20.6 ± 12.67 kPa), p<0.001. FEES detected aspiration in 10 out of 31 examinations [Penetration Aspiration Scale(PAS) ≥6]. Aspirator status examinations showed statistically significantly worse cough (p = 0.001), tongue strength (p = 0.001) and endurance (p = 0.003), pharyngeal secretions (p<0.001), velopharyngeal sufficiency (p = 0.006), pharyngeal squeeze (p = 0.009), vocal cords' movements (p = 0.001), pharyngeal pooling (p<0.001), EAT-10 (p = 0.001) and bulbar subscale of ALS Functioning Rating Scale-Revised (b-ALSFRS-R) scores (p = 0.014) compared to non-aspirator status. Correlation analysis indicated that the feeding status had strong statistically significant correlations with the EAT-10 score (rho = -0.816), anterior tongue strength (rho = 0.735), secretions (rho = -0.811), pharyngeal pooling (rho = -0.712) and PAS (rho = -0.676) at FEES, and b-ALSFRS-R score (rho = 0.791), all p<0.001. The EAT-10 had strong statistically significant correlations with the MITPa (r = -0.794, p<0.001), secretions (rho = 0.668, p<0.001), and b-ALSFRS-R score (rho = -0.766, p = 0.001). The FEES findings had strong statistically significant correlations with the anterior tongue strength (pooling: rho = -0.784), and secretions (PAS: rho = 0.723; pooling: rho = 0.671), all p<0.001. For the questionnaire, tongue strength and pharyngeal secretions, ROC analysis assessed cut-off points and discriminating ability to predict aspiration status (Area Under the Curve: 0.838; 0.845 and 0.93, respectively). EAT-10 with a cut-off at 8 was able to predict aspirator status with a sensitivity of 100% and a specificity of 42.9% (negative predictive value-NPV = 100%). A cut-off value of 22KPa for the MITPa discriminated aspirator status (sensitivity = 80%, specificity = 89.5%, NPV = 89.5%). The quantity of secretions observed upon endoscopy with a cut-off value at 1 was able to predict aspirator status (sensitivity = 90%, specificity = 80%, NPV = 94.1%).

CONCLUSION

Reduced tongue strength, questionnaire-reported symptoms, pharyngeal secretions, and FESS findings can guide identification of patients with ALS at risk of inefficient and unsafe swallowing.

Parental feeding practices data in healthy children and children with gastrointestinal diseases

Parental feeding practices significantly influence child eating behavior. The data for this article was from a cross-sectional case control larger study that aimed to record parental practices to manage feeding problems in children with typical development and children with gastrointestinal diseases. A set of 23 Likert-type questions was used to investigate parental practices. Demographic and anthropometric data were obtained via a structured set of questions. In total 765 parents of healthy children and 136 parents of children with gastrointestinal diseases aged one to seven years participated in the study. Healthy controls were recruited from kindergartens located in various geographical areas in Greece. Children with gastrointestinal diseases were recruited from a Pediatric Gastroenterology Outpatient Clinic. Descriptive measures (i.e. frequencies, percentages, means and standard deviations) alongside with statistical analysis measures are presented in this article. Chi-square tests and U-tests were performed for the purpose of the comparison between the two groups. Spearman's rho correlation coefficient was also calculated for inter-item correlations among the 23-items of the questionnaire.

The role of self-reported smell and taste disorders in suspected COVID‑19

Purpose

The sudden onset of smell and taste loss has been reported as a symptom related to COVID-19. There is urgent need to provide insight to the pandemic and evaluate anosmia as a potential screening symptom that might contribute to the decision to test suspected cases or guide quarantine instructions.

Methods

Systematic review of the PubMed/Medline, Cochrane databases and preprints up to May 3, 2020. Combined search terms included: “COVID-19”, “SARS-CoV-2”, “coronavirus”, “nose”, “anosmia”, “hyposmia”, “olfactory loss”, “smell loss”, “taste loss”, and “hypogeusia”.

Results

Our search identified 18 reviewed articles and 6 manuscript preprints, including a large epidemiological study, four observational case series, five case–controlled studies, five cross-sectional studies, five case series of anosmic patients and four electronic surveys. Great methodological differences were noted. A significant prevalence of anosmia is reported in COVID-19 patients. Controlled studies indicate that anosmia is more common in COVID-19 patients than in patients suffering from other viral infections or controls. Most of the studies reported either smell loss or smell plus taste loss. Less severe COVID-19 disease is related to a greater prevalence of anosmia. A quick recovery of the smell loss may be expected in most COVID-19 cases.

Conclusion

Anosmia is more prevalent in COVID-19 patients than in patients suffering from other respiratory infections or controls.

The clinical course of smell and taste loss in COVID-19 hospitalized patients

BACKGROUND

Recent studies have demonstrated an association between a new onset of smell or taste loss and COVID-19. We investigated the prevalence of smell and/or taste loss and the clinical characteristics and recovery in a comprehensive cohort of consecutive patients treated by two COVID-19 reference hospitals and evaluated late persistence of hyposmia.

METHODS

A retrospective observational questionnaire study was conducted. All consecutive RT-PCR diagnosed patients who had been hospitalized in March-April 2020 in the COVID-19 care wards were contacted, excluding patients with cognitive disorders and severe deconditioning. The patients responded to a survey about the loss of smell and taste, nasal blockage, and rhinorrhea, rated the symptoms' severity from 0 to 4, and reported the recovery of smell and taste with time. Demographic and clinical characteristics were recorded.

RESULTS

We contacted 117 patients. Ninety responded to the questionnaire; 38.9 % of them reported olfactory and 36.66 % gustatory disorders during their disease. Smell loss prior to other symptoms was reported by 42.86 %, and severe hyposmia/anosmia by 74.28 % of the hyposmic. Among the non-ICU treated patients, 43.75 % reported hyposmia. Only 8.89 % had nasal blockage, and 6.66 % rhinorrhea. Most of the patients (85.71 %) recovered their sense of smell in 3-61 days (median: 17; IQR: 24), but 8.57 % had persistent hyposmia. For one out of four, the olfactory loss lasted longer than a month.

CONCLUSION

Smell and taste loss are highly prevalent and early symptoms in hospitalized COVID-19 patients. The great majority recover their smell, but nearly one out of ten have not recovered in two months.  HIPPOKRATIA 2020, 24(2): 66-71.

The Impact of Olfactory Dysfunction on the Psychological Status and Quality of Life of Patients with Nasal Obstruction and Septal Deviation

Introduction  Olfactory dysfunction may be present in patients with nasal obstruction and septal deviation. The impact of olfactory dysfunction on the psychological profile and quality of life (QoL) of these patients remains unexplored.

Objective  The present study aimed to investigate the emotional status and QoL of patients with olfactory dysfunction and septal deviation and to identify predictors associated with clinically significant improvement of psychological status and QoL, focusing mainly on the role of olfactory recovery after septoplasty.

Methods  The olfactory function was quantitatively assessed using the ‘‘Sniffin’ sticks'' test (Burghart Messtechnik GmbH, Wedel, Germany) in 60 patients and 25 controls enrolled in this prospective study. The participants completed validated questionnaires specific for general health (Short Form-36), nasal-symptom related QoL (SinoNasal Outcome Test-22), olfaction-associated QoL (Questionnaire of Olfactory Deficits) and for assessing their psychological state (Short Anxiety Screening Test and Beck Depression Inventory) preoperatively and 6 months postoperatively. The patients used the Glasgow Benefit Inventory to evaluate their personal benefit after septoplasty with.

Results  Septoplasty led to significantly improved olfactory function. Patients with olfactory impairment had significantly lower nasal-symptom related QoL, higher stress levels, and more depressive mood compared with normosmics and controls before and after septoplasty. Postoperatively, personal benefit from surgery was higher in normosmic patients. Improvement of nasal-symptom related QoL was significantly associated with higher likelihood of clinically significant improvement of patients' psychological profile and more personal benefit from surgery. Olfactory dysfunction was negatively correlated with the emotional status of the patients.

Conclusion  Olfactory dysfunction appears to significantly affect the psychological status of patients with nasal obstruction, and olfactory recovery improves the patients' perception of personal benefit from septoplasty.

Olfaction and quality of life in patients with nasal septal deviation treated with septoplasty

OBJECTIVE

Patients with septal deviation-induced nasal obstruction may experience olfactory impairment. This study aimed to evaluate septoplasty-related changes in olfactory function and their effect on patients' quality of life (QoL).

METHODS

Prospective study of sixty patients with nasal obstruction and septal deviation and 25 healthy controls. Objective measurements were performed for the evaluation of nasal patency and "Sniffin' sticks" tests were used for quantitative assessment of lateralized and bilateral olfactory performance. All participants self-assessed their smell using a visual analog scale and completed validated questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation: NOSE), for nasal symptoms QoL (SinoNasal Outcome Test-22: SNOT-22), for olfaction-associated QoL (Questionnaire of Olfactory Deficits: QOD) preoperatively and six months after septoplasty and reported personal benefit after surgery (Glasgow Benefit Inventory: GBI), six months postoperatively.

RESULTS

Smell was significantly compromised due to septal deviation especially in the more obstructed nasal cavity side. Smell improved significantly after septoplasty (subjective report and olfactory measurements), along with increased nasal patency. Increased nasal cavity volume was significantly correlated with olfactory thresholds but not with suprathreshold measurements. Subjective hyposmia and lateralized olfaction were significantly reduced postoperatively. Postoperatively, normosmic patients reported higher personal benefit from surgery than patients with olfactory disorders. The patients' QoL improved significantly, but it remained lower than the controls' group. Olfaction-associated QoL was not significantly different between patients and controls before and after septoplasty.

CONCLUSION

Septoplasty leads to improvement in smell perception, and patients with improved smell report greater personal benefit from septoplasty than patients with remaining olfactory deficits.

Dysphagia diagnosis with questionnaire, tongue strength measurement, and FEES in patients with childhood-onset muscular dystrophy

INTRODUCTION

Dysphagia in progressive muscle diseases is primarily due to muscle weakness. Objective of our study is to investigate the prevalence and phenotypes of dysphagia in patients with childhood onset muscular dystrophy (MD) with the use of a validated questionnaire, the measurement of tongue strength and Flexible Endoscopic Evaluation of Swallowing (FEES).

METHODS

Prospective observational longitudinal study of dysphagia in a cohort of 58 patients attending the Pediatric Department Center for Neuromuscular Diseases. Control participants were 56 age and sex matched healthy volunteers. Dysphagia was evaluated with the Eating Assessment Tool-10 (EAT-10), and the measurement of Maximal Isometric Tongue Pressure (MITP) and tongue endurance (Iowa Oral Performance Instrument-IOPI). Dysphagic patients were submitted to FEES. Recorded data included demographic and anthropometric characteristics, type of MD, feeding status, and spirometry.

RESULTS

Our patients' cohort consisted of 41 children, 11 adolescents, and 6 adults. Based on EAT-10, 20.7% of the patients were dysphagic: 14.63% of children, 27.3% of adolescents and 50% of adults. The main complain was solid food dysphagia. Spirometry parameters mean values for children and adolescent patients corresponded to lower than the fifth percentile. Means of FVC and FEV1 expressed as % predicted for adult patients were 27.8 (SD:25.05) and 28.8 (SD:28.44) respectively. Reduced tongue strength was measured to children aged 9-10, adolescent and adult MD patients. The main FEES findings were pharyngeal residue, spillage of food before the swallow, and supraglottal penetration.

DISCUSSION

This is the first study to use a validated questionnaire to evaluate dysphagia in childhood onset MD and report dyphagia prevalence at different patients' age. This is the first study reporting MITP in children and adults with generalised MD. Tongue pressures are reduced well before clinical signs of dysphagia are present.

CONCLUSION

Screening of potentially dysphagic MD patients can be based on a validated questionnaire. Patients with an EAT-10 score suggestive of dysphagia at regular follow-up can have the MITP measured and in the case of reduced values a thorough dysphagia evaluation with FEES is indicated.

Speech and language intervention for language impairment in patients in the FTD-ALS spectrum

Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease that belongs to the group of motor neuron diseases. Motor deficits like reduce in tongue strength, may coexist with cognitive deficits compatible with frontotemporal dementia (FTD), also known as frontotemporal lobar degeneration (FTLD). FTD is a neurodegenerative syndrome with two main clinical variants: behavioral (bvFTD) and language or Primary Progressive Aphasia (PPA). ALS and FTD have significant clinical and neuropathological overlapping so that for some researchers they are "the ends of the same disease spectrum". A key intervention in this patient population is the speech language therapy (SLT), a specific form of cognitive intervention, which evaluates communication skills and designs a personalized intervention plan to improve communication abilities. It has been used in patients with aphasia of different etiologies and has been shown to be effective. There is limited research in SLT interventions in patients in FTD-ALS spectrum, and the initial findings indicate success to some extent. Due to progressive neurodegeneration in FTD-ALS spectrum, the main goal of the intervention is not the complete rehabilitation of linguistic deficits but the reduction and, if possible, the delay of language decline in order to improve patient's communication and the quality of his/her life. In this paper, we critically review the reported approaches of speech language therapy (SLT) for monitoring language impairments and the impact of interventions in patients with FTD-ALS spectrum. Initial findings are supporting more systematic treatment of speech and language impairment in patients in the FTD-ALS spectrum.

Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer-related oropharyngeal dysphagia

PURPOSE

Dysphagia is a symptom associated with significant morbidity and mortality, with profound impact on physical ability and quality of life. Many questionnaires have been used to assess patient-reported dysphagia, but issues related to developmental and measurement properties affect their wide applicability. The purpose of this study was to assess the validity and reliability of the Eating Assessment Tool-10 (EAT-10, Greek adaptation) in neurogenic and head and neck cancer-related dysphagia.

METHODS

The study consisted of: item generation in the Greek language, internal consistency and reliability analysis, normative data generation, and validity analysis. Data were collected prospectively from 421 participants: 144 asymptomatic subjects, 146 patients with dysphagia, and 131 patients with dysphagia-related diagnoses. Validity was assessed by comparing scores of healthy and dysphagic participants, by comparing pre- and post-treatment scores, and by correlating the Greek-EAT-10 with fibreoptic endoscopic evaluation of swallowing (FEES).

RESULTS

The mean participants' age was 52.85 years (ranging from 18 to 85 years). All questionnaires were completed in less than 3 min. The overall internal consistency (assessed with Cronbach's alpha) was 0.963. The test-retest reliability was excellent with Spearman's rho ranging from 0.937 to 1. Dysphagic patients had a significantly higher score compared to healthy participants (p < 0.001). The mean EAT-10 improved significantly after treatment (Wilcoxon signed rank, p < 0.001). The Greek-EAT-10 and FEES scores were significantly correlated (Spearman's rho = 0.69).

CONCLUSIONS

The EAT-10 is a valid, reliable, symptom-specific tool for the assessment of dysphagia, easily self-administered, and practical for clinical use.

Reliability and validity of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis (Greek version) and proposed modification

BACKGROUND

Recent research confirmed that at least a third of people with multiple sclerosis (MS) are suffering from swallowing difficulties. Dysphagia is associated with significant morbidity and mortality, and has profound impact on physical ability and quality of life. Dysphagia related complications can be prevented through an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is the first dysphagia questionnaire developed specifically for patients with MS. The aim of the present study was the cultural adaptation of DYMUS for the Greek population, evaluation of the questionnaire's reliability and validity and normative data generation for DYMUS, which has not been published before.

METHODS

DYMUS was completed by 200 participants: 108 MS patients and 92 asymptomatic subjects (60 male and 140 female). Patients with MS were consecutively recruited from the Multiple Sclerosis Centre during regular visits. Asymptomatic participants were community-dwelling healthy persons. All data were collected prospectively. MS patients were invited to complete DYMUS and the Greek versions of the Eating Assessment Tool-10 (EAT-10), and the Swallowing-Quality of Life (SWAL-QoL) questionnaires. Healthy subjects completed DYMUS and the Greek EAT-10. The study consisted of item generation for the Greek DYMUS, internal consistency and reliability analysis, normative data generation, and validity analysis. Criterion validity was assessed by comparing scores between groups with expected differences: MS patients and healthy participants. Construct validity was assessed by comparison of DYMUS scores of dysphagic and non dysphagic patients. DYMUS was also validated against EAT-10, and SWAL-QoL to assess its convergent validity.

RESULTS

DYMUS was completed by all participants in less than 3 min. The internal consistency was excellent (Cronbach's alpha was 0.866). Test-retest reliability was good (Pearson's correlation coefficient was 0.637). The mean DYMUS score for the healthy cohort was 0.23 ± 0.471. The upper limit of normal was 1.172. MS patients had statistically significantly higher score than controls (Mann Whitney test, p < 0.001). DYMUS mean score was statistically significantly higher in the dysphagic compared to the non dysphagic MS patients (Mann Whitney test, p < 0.001). There was a strong positive and statistically significant correlation between DYMUS and EAT-10 (Pearson's Correlation coefficient, r = 0.754, p = 0). In the MS patients cohort 25.9% reported themselves as dysphagic, 34.3% were classified as dysphagic according to EAT-10 and 44.4% according to DYMUS. The DYMUS score had a statistically significant positive correlation with the EDSS score, (Mann Whitney, p < 0.001) whereas age, sex, type of MS and disease duration were not significantly correlated. Based on our data analysis we propose the modification of DYMUS to a 9-items tool eliminating the question about weight loss. A DYMUS score of 2 or higher is indicating dysphagia for both the original DYMUS and the modified DYMUS.

CONCLUSIONS

The Greek version of DYMUS was found to be a valid, reliable and practical for clinical use questionnaire for the detection of dysphagia in Multiple Sclerosis. The first reported normative data for DYMUS suggest a cut-off for the diagnosis of dysphagia at 2 and our findings support a modification of DYMUS eliminating the question about weight loss.

Cricotracheal separation with multiple cricoid fractures after blunt neck injury: a case report

BACKGROUND/AIM

Cricotracheal separation is a rare injury with fatal results in most cases. Clear guidelines are not available and several dilemmas are to be faced during patient management in such cases.

DESCRIPTION OF CASE

We present a case of cricotracheal separation with multiple cricoid fractures in a 16-year-old male with blunt neck trauma.

CONCLUSION

Early recognition based on an index of clinical suspicion is necessary in order to establish this rare diagnosis. Intervention should preserve the laryngeal function as much as possible.

Stroboscopy for benign laryngeal pathology in evidence based health care

BACKGROUND AND AIMS

Voice disorders are common. The aim of this study is to evaluate the diagnostic value of stroboscopy for voice disorders related with benign pathology and apply results in evidence based health care.

METHODS

Prospective study. Tertiary care hospital. Voice Clinic. One hundred and fifty consecutive patients with an initial diagnosis of benign laryngeal disease or dysphonia of no clarified cause (normal laryngoscopy) were examined stroboscopically and studied prospectively until a final diagnosis was reached. Sixty-six men, eighty women and four children met the selection criteria for the study and had adequate follow-up. The initial laryngoscopic diagnosis was compared to the stroboscopic diagnosis. The diagnostic value of stroboscopy was rated at a scale of 0 to 3. A score 3 describes the diagnostic value of stroboscopy in the cases where the stroboscopic examination resulted to a change of the therapeutic modality offered to the patient.

RESULTS

For one third of the study's population the diagnostic value of stroboscopy was very significant, since it established the laryngeal pathology responsible for the voice disorder (28.8%) and for a small number of patients it changed the choice of treatment (4.7%). For about one third of the cases (32.2%) stroboscopy offered additional information regarding the cause of dysphonia. The diagnostic value of stroboscopy correlated with the type of laryngeal pathology.

CONCLUSIONS

Patients expected to benefit from stroboscopic examination are patients with small lesions of the vocal fold edge, dysphonic patients with unremarkable indirect laryngoscopy, and professional voice users.

Assessing Laryngopharyngeal Reflux Symptoms with the Reflux Symptom Index

Objective. To validate the Reflux Symptom Index (RSI) in Greek patients and estimate the prevalence of laryngopharyngeal reflux (LPR) symptoms in the Greek population.

Study Design. Prospective, controlled validation study.

Setting. Tertiary referral hospital and primary care.

Subjects and Methods. For validation purposes, the instrument was administered to 53 patients with confirmed LPR. Sex- and age-matched controls with no LPR or gastroesophageal reflux disease (GERD) symptoms presenting in a primary care setting composed the control group. Reliability and construct validity were statistically appraised. Using the RSI, the authors estimated the prevalence of LPR in a randomly selected sample of the Greek adult population.

Results. The mean (SD) RSI score of the 172 sex- and age-matched controls was 3.2 (3.5). The mean (SD) RSI score of the 53 confirmed LPR patients was 19.9 (6.8). Cronbach α was 0.865. Factor analysis verified that the RSI instrument consists of 2 principal factors. To estimate the prevalence of LPR, a representative sample of the Greek adult population (188 subjects) completed the RSI questionnaire: 36.3% were male, and 29.6% were smokers. Mean (SD) age was 53.4 (17.7) years. The instrument was able to discriminate 16 patients with LPR symptoms with a mean (SD) score of 18.91 (6.39).

Conclusion. The authors evaluated the internal consistency, reliability, and construct validity of the RSI for the Greek population. Factor analysis of the Greek translation of the RSI demonstrated that it can be a reliable tool in the diagnostic approach of LPR patients. Using the RSI, the authors recorded that the prevalence of LPR in a representative sample of the Greek population is 8.5%.

Nodular basal cell carcinoma is associated with increased hyaluronan homeostasis

BACKGROUND

Basal cell carcinoma (BCC) is one of the most frequent forms of malignancy in humans. Although BCC is a tumour of low degree of malignancy, if left untreated, it can be locally aggressive, eat away at tissues and cause ulceration. Nodular is the most common subtype of BCC (>50%). Although apparently non-invasive, micronodular, a certain subgroup of nodular, is likely to recur. Glycosaminoglycans (GAGs), such as hyaluronic acid (HA), are extracellular matrix molecules of high importance in malignant transformation, metastasis and other complex remodelling processes.

OBJECTIVES

To investigate the expression of GAGs and their metabolizing enzymes in nodular BCC, when compared with adjacent healthy human skin tissue specimens.

METHODS

Total GAGs were isolated and purified from nodular BCC and normal adjacent human skin tissue specimens. GAGs were subsequently fractionated by electrophoresis on cellulose acetate membranes and characterized using specific GAG-degrading enzymes. The content of HA in total GAGs was measured using ELISA and the expression of HA synthases (HAS), hyaluronidases (HYAL) and HA receptors (CD44 and receptor hyaluronic acid-mediated motility (RHAMM) was assessed using RT-PCR.

RESULTS

Nodular BCC is associated with increased levels of HA concomitant with upregulation of gene expression of HAS3, HYAL3 and RHAMM, when compared with normal adjacent skin.

CONCLUSION

These results indicate that HA homeostasis in nodular BCC shows distinct features which may be helpful in understanding the complex behaviour of nodular subtype of BCC, thus eventually leading to new treatment strategies.

Extrinsic ageing in the human skin is associated with alterations in the expression of hyaluronic acid and its metabolizing enzymes

Extrinsic skin ageing or 'photoageing', as opposed to intrinsic skin ageing, is the result of exposure to external factors, mainly ultraviolet irradiation. Glycosaminoglycans (GAG) and particularly hyaluronic acid (HA) are major components of the cutaneous extracellular matrix involved in tissue repair. However, their involvement in extrinsic skin ageing remains elusive. In this study, we investigated the expression of HA and its metabolizing enzymes in photoexposed and photoprotected human skin tissue specimens, obtained from the same patient. Total GAG were isolated, characterized using specific GAG-degrading enzymes and separated by electrophoresis on cellulose acetate membranes and polyacrylamide gels. Quantitation of HA in total GAG was performed using ELISA. Gene expression of hyaluronan synthases (HAS), hyaluronidases (HYAL) and HA receptors CD44 and receptor for HA-mediated motility (RHAMM) was assessed by RT-PCR. We detected a significant increase in the expression of HA, of lower molecular mass, in photoexposed skin as compared with photoprotected skin. This increase was associated with a significant decrease in the expression of HAS1 and an increase in the expression of HYAL1-3. Furthermore, the expression of HA receptors CD44 and RHAMM was significantly downregulated in photoexposed as compared with photoprotected skin. These findings indicate that extrinsic skin ageing is characterized by distinct homoeostasis of HA. The elucidation of the role of HA homoeostasis in extrinsic skin ageing may offer an additional approach in handling cutaneous ageing.

An alternative manoeuvre for posterior canal BPPV treatment

OBJECTIVES

The aim of this study is to evaluate the effectiveness of a new manoeuvre in the treatment of posterior canal benign paroxysmal positional vertigo (p-BPPV) based on the idea that highly accelerated endolymphatic flow may lead a mass of otoconia to collide with the walls of the posterior semicircular canal, resulting in its disintegration and/or in the expulsion of the free particles from the posterior semicircular canal.

MATERIAL-METHODS

Our study group included 146 patients with a diagnosis of p-BPPV. All patients underwent the new manoeuvre, which consisted of several high-acceleration successive head movements in the horizontal plane performed by the same physician. The results of the study group were compared with those of a sham control group of 30 patients with p-BPPV undergoing placebo treatment. The patients of both groups were reviewed in a follow-up appointment 1 month and 1 year after the initial treatment.

RESULTS

Complete resolution of symptoms immediately after the manoeuvre was observed in 92% of patients. At 1-month and 1-year follow-up assessment, all the patients in the study group reported complete relief from their symptoms compared with only 13% and 43% of control patients respectively. Recurrence of symptoms was reported in 12 patients (8%) from the study group, who responded successfully to one additional session.

CONCLUSIONS

This study establishes the efficacy of the new manoeuvre in the short- and long-term management of p-BPPV. It is a quick office procedure, usually resolving this disorder with a single session, although there some limitations in patients with underlying cervical spine pathology.

Nasal mucosal melanoma presenting as central type vertigo: a case report

Nasal mucosal melanoma presents usually with epistaxis, nasal obstruction and facial pain. However melanoma tends to give distant metastases at an early stage, having rare clinical presentations.

We present a 74-year old female patient with symptoms of central type vertigo caused by brain metastases. Clinical assessment for the detection of the primary site revealed a nasal mucosal melanoma originating from the posterior end of the left inferior turbinate. The patient received a combination of radio and chemotherapy being in relatively good condition 8 months later. This is the first reported case of a nasal mucosal melanoma with vertigo as the first presenting symptom.

Cultural adaptation of an olfactory identification test: the Greek version of Sniffin' Sticks

OBJECTIVE

Sniffin sticks battery is a well-validated olfactory test in German speaking population. However adaptation of this test in the cultural background of a country is mandatory before use.

MATERIALS AND METHODS

In total 258 subjects were tested in two stages. The first stage included assessment of 60 healthy subjects with the exact translation of Sniffin' Sticks list and recognition of problematic items. In the second stage a modified list after linguistic changes was tested in a representative for the Greek population study group of 198 healthy subjects. Their results were correlated with a sample of 198 Germans of similar age and sex distribution from the German normative data of Sniffin' Sticks.

RESULTS

The use of the initial list showed decreased odour identification (< 70%) of 6 items (anis, turpentine, liquorice, apple, lemon, cinnamon). After the appropriate changes the results of the modified list presented significantly increased identification of all problematic items. Identification ability of Greek population showed significant correlation with the German study group having similar behaviour regarding age and gender differences.

CONCLUSION

This study provides cultural adaptation of the Sniffin' Sticks olfactory identification test and normative data for the Greek population.

Application of Glottal Disturbogram as a novel tool for the description of vocal disturbances

The paper introduces "Glottal Disturbogram" as a new tool for the discrimination, evaluation and representation of glottal disturbances which may be met in pathological voicing or singing. The "Glottal Disturbogram's" principles and related features also suit similar applications such as the acoustics of some families of musical instruments. Disturbogram's computational and display characteristics are presented with the use of both synthetic glottal patterns and real signals obtained from subjects with voice disorders. Results show that Disturbogram may efficiently discriminate and quantify perturbation types, offering a valuable tool in clinical or laboratory investigation of both voice disorders and normal voicing types.

Is pepsin detected in the saliva of patients who experience pharyngeal reflux?

OBJECTIVES

To investigate if pepsin is detected, with an activity assay, in the saliva of patients with a clinical diagnosis of laryngopharyngeal reflux (LPR) and can therefore be used as a diagnostic marker of laryngopharyngeal reflux.

STUDY DESIGN

Pilot, prospective study.

METHODS

Adult participants with a clinical diagnosis of LPR collected whole saliva samples on regular intervals for a day, and upon experiencing symptoms attributed to LPR. Patients were selected on the basis of presence of severe symptoms and laryngoscopic findings of laryngopharyngeal reflux and symptoms of gastroesopharyngeal reflux. They reported voice disorders, dysphagia, throat clearing, excessive secretions, breathing difficulties, cough, globus sensation and throat pain. Control participants reported the absence of pharyngeal and laryngeal symptoms and of symptoms of gastroesophageal reflux. Saliva samples were assayed with fibrinogen on an agarose gel plate. The detection of pepsin was based on the presence of peptic activity which was qualitatively evaluated.

RESULTS

The control participants had negative assays. No saliva samples from the LPR patients, collected at regular sampling, tested positive for pepsin. All the samples collected at the presence of symptoms and following regurgitation episodes tested negative for pepsin. Saliva samples pH ranged from 7 to 8.

CONCLUSIONS

Pepsin was not detected, with an activity assay, in the saliva of patients with a clinical diagnosis of LPR. A concentration method might be more sensitive although saliva and swallowing physiology renders the detection of pepsin in the saliva difficult.

Olfactory dysfunction in nasal polyposis: correlation with computed tomography findings

AIMS

This study evaluates if a computed tomography (CT) scan is useful to assess the olfactory loss in sinonasal disease, and if a preoperative CT scan has a predictive value for the long-term outcome regarding olfaction.

METHODS

Thirty-one patients with nasal polyposis were included. Olfactory function was assessed with the 'Sniffin' Sticks' test and subjective perception recorded with a visual analogue scale. CT scans were assessed with the Lund-Mackay system and the Damm nasal segmentation. Patients were retested after endoscopic sinus surgery in a follow-up appointment at least 1 year later.

RESULTS

Disease in the upper meatus and the posterior portion of the middle meatus strongly affects olfactory function. Lund-Mackay scores were significantly correlated with preoperative olfactory test results. Preoperative subjective ratings had a significant correlation only with present disease in the anterior upper meatus. Postoperative results were significantly decreased. Their relative percentage change was correlated only with the preoperative presence of disease in the anterior upper meatus. No correlation was found between the Lund-Mackay score and the postoperative olfactory results.

CONCLUSIONS

Olfactory dysfunction in nasal polyposis is strongly related to specific obstructed nasal areas. A CT scan has no predictive value for the long-term surgical outcome regarding olfaction.

Trichoblastic carcinoma of the pinna. A rare case

Adnexal tumors of the hair follicle can be regarded as lesions that show similar differentiation to one or more portions of the hair follicle. Trichoblastic carcinoma is a rare malignant adnexal tumor, which usually occurs on the scalp. There have been reported cases with regional lymph node metastasis. We report a case of a 65 years old man with a painless irregular mass of the posterior surface of the right pinna, which was slowly growing over a 5-year period. He had a history of a similar lesion on the same site, which was removed 8 years before he presented to us. We excised the lesion and the defect was covered with an advancing flap. Because of the histology result the patient was re-operated and reviewed for over 3 years and there wasn't any sign of recurrence.

Ossicular necrosis following head injury

PROBLEMS/OBJECTIVES

The aim of this study is to report on ossicular necrosis in the middle ear occurring shortly after head injury.

METHODOLOGY

Our sample included 3 males and 2 females aged 9 to 37 years who complained of unilateral hearing loss after a head trauma that had occurred 3 to 6 months previously. The tympanic membranes were intact, and a CT-scan did not show fracture of the temporal bone. Audiometry showed a unilateral conductive hearing loss in all cases.

RESULTS

On tympanotomy exploration, 4 of the 5 patients had a necrosis of the lenticular process of the incus and one patient had a necrosis of the posterior and anterior crura of the stapes. Additionally, the incus was displaced at the incudomalleolar joint towards the promontory in two patients. The long process of the incus was surgically aligned and adjusted to the head of the stapes through interposition of either temporal fascia or a bone chip. At the 2-year-postoperative follow-up, the pure tone audiometry showed that the preoperative air-bone gap was almost closed with a mean of 11.8 dB.

CONCLUSIONS

It is possible that the head injury resulted in ossicular displacement in the middle ear with disturbance of the local vascular supply. Due to the tenuous blood supply to the lenticular and long processes of the incus, this portion of the ossicular chain, including the stapes suprastructure, may become more vulnerable to an ischemic process and subsequent necrosis shortly after the head trauma.

Prognoseabschätzung der peripheren Fazialisparese

BACKGROUND

In this retrospective study, we assessed the long-term prognostic value of the minimal nerve excitability test (NET) by comparing the results it yielded with the House-Brackmann (HB) index in patients with the most common types of facial paralysis, Bell's palsy and traumatic facial palsy.

PATIENTS AND METHODS

Three hundred and fifty patients aged 9-85 years (mean age 42.4 years; 156 male and 194 female), all of whom were treated initially with the same steroid therapy, entered on study. Patients in whom decompression surgery had been performed were excluded so as to avoid falsely optimistic prognoses. The 350 study patients were divided into two groups: group 1 was made up of 250 with Bell's palsy and group 2, of 100 with nonpenetrating traumatic facial palsy following temporal bone fracture. The NET was conducted repeatedly in all patients for 3 weeks from the start of day 3 of treatment, the value recorded on day 14 being used in the evaluation. For each patient, the result of the NET was recorded as 'normal', 'diminished' or 'without response' according to the difference between the two sides of the face. The final HB grading was determined after 1 year to check for the agreement between the electrical prognosis and the clinical outcome and thus the reliability of the prognosis indicated by the NET.

RESULTS

The results indicate that a normal NET forecast a satisfactory outcome that could be classed as HB I-II in almost all the patients in both groups. Among patients who had no response on NET, 85% of those with Bell's palsy and 90% of those with traumatic facial palsy failed to recover nerve function. Diminished nerve excitability proved to be a sign of a relatively favourable prognosis: 74% of patients in each group recovered normal facial function.

CONCLUSION

The NET is a method of investigation that is easily applied and can make a positive contribution to the assessment of prognosis in Bell's palsy and in traumatic facial palsy, reflecting the functional state of the facial nerve reliably in most of cases.

Does listening to the sound of yourself chewing increase your enjoyment of food?

BACKGROUND

Anecdotal evidence suggests that listening to oneself eating results in a more pleasurable eating experience. Maximising the sensory experience of eating can result in increased oral intake and is potentially valuable in improving nutritional status in at-risk patients.

OBJECTIVE

This pilot study investigates the association between listening to the sound of oneself eating and the consequences on enjoyment of eating.

DESIGN

Prospective, randomized, controlled, cross-over trial of 10 fit, adult volunteers. Participants were timed eating a standardised amount of bread, and were randomized to eat in silence or whilst listening to their own amplified chewing and swallowing. Measurements of pulse and blood pressure were recorded throughout the procedure. Subjective pleasure scores were documented and the procedure repeated in the alternate study arm.

RESULTS

There was no significant relationship demonstrated between listening to oneself chewing and the enjoyment of eating.

CONCLUSION

Although this small pilot study was unable to demonstrate a significant relationship between listening to oneself chewing and enjoyment of eating, other evidence suggests that distraction techniques have a beneficial effect on dietary intake. Such techniques can be applied in a clinical setting and further work in this area has valuable potential.

Assessment of patient benefit from septo-rhinoplasty with the use of Glasgow Benefit Inventory (GBI) and Nasal Symptom Questionnaire (NSQ)

Septorhinoplasty is the most difficult and complicated procedure in facial plastic surgery. Because of the complex interdependency of the anatomical parts, alteration of one may have an impact on another. Form and function are completely interwoven in septorhinoplasty. The selection of appropriate candidates involves an understanding of their expectations. Outcome research is a new concept in clinical medicine and its importance is increasingly recognized for the patient management and policy decisions. This study includes an analysis of patients' subjective opinion of the surgical outcome after septo-rhinoplasty, with the use of Glasgow Benefit Inventory (postoperatively) and the Nasal Symptom Questionnaire (pre- and postoperatively). In this study we analyze the patient subjective rating of benefit in 41 consecutive patients who underwent septo-rhinoplasty within the first 8 months of 2001, and had completed a follow up period of more than 6 months postoperatively. The early complication rate was recorded and analyzed along with data regarding the patient satisfaction rate using GBI and NSQ. The response rate was 80%, which is high. Patients had significant improvement in all subscales of GBI (General, Social, Physical) related with a decreased number of nasal symptoms postoperatively and a good aesthetic result.

Olfactory neuroblastoma. A report of 3 cases

Olfactory neuroblastoma is a rare malignant tumour, usually diagnosed at advanced stages. We studied 3 patients who were treated at our Institute between 1991 and 1999. One patient presented with a stage A and 2 with a stage B tumour. One patient presented with coma due to inappropriate secretion of antidiuretic hormone associated with a stage B tumour. All 3 patients were treated with complete surgical resection via a lateral rhinotomy approach and postoperative radiotherapy. There was no involvement of the cribriform plate. One patient developed a metachronous regional metastasis and was treated with neck dissection and radiotherapy. All 3 patients are free from recurrence with a follow-up period of 9 years, 18 months and 1 year, respectively. Combination therapy is the cornerstone of treatment for olfactory neuroblastoma. Complete surgical resection is the most important prognostic factor and can be accomplished via lateral rhinotomy for early stage tumours.

Cartilage-sparing otoplasty: our experience

Prominent ears are the most frequent congenital deformity in the head and neck area. Otoplasty has undergone important developments and numerous techniques have been employed to address the anatomical defects, namely the lack of antihelix and the overdevelopment of the concha. We present a cartilage-sparing technique involving scapha--conchal sutures insertion to recreate the antihelix, conchal setback and cartilage weakening. No cartilage is excised. Prior to creating the antihelix, the medial surface of the cartilage is superficially scored. Occasionally a tangential excision of the posterior prominence of the cartilage prior to the placement of set back sutures is employed for an excessively large conchal bowl. A series of 86 consecutive patients underwent otoplasty with this technique. According to our experience the described technique gives good and predictable long-term results with a natural-appearing ear. Significant complications are rare. In case of loss of correction, revisional surgery is straightforward on the intact pinna cartilage.

Tuberculous otitis media: a difficult diagnosis and report of four cases

Tuberculous otitis media is a rare disease. Due to the condition's rarity and its usually indolent course, the diagnosis is often delayed. This can lead to irreversible complications, such as permanent hearing loss or facial nerve paralysis. Tuberculosis of the middle ear cleft, as this disease's first presentation, is indeed very rare. Surgery may be carried out prior to diagnosis occasionally, i.e., middle ear exploration for chronic middle ear disease. We present four cases of tuberculous otitis media which occurred as the first presentation of the disease. The patients did not present with the classic symptoms of middle ear tuberculosis. The diagnosis was based on the histology following middle ear exploration for chronic middle ear disease. None of the patients presented any other systemic involvement. We present a review of this disease's clinical symptoms and the diagnostic tests available.