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Pauwels S, Casters L, Lemkens N, Lemmens W, Meijer K, Meyns P, van de Berg R, Spildooren J. Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis. J Neurol Phys Ther 2023; 47:127-138. [PMID: 36897200 PMCID: PMC10521788 DOI: 10.1097/npt.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND PURPOSE Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. METHODS Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. RESULTS Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. DISCUSSION AND CONCLUSIONS BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking.Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421 ).
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Affiliation(s)
- Sara Pauwels
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Laura Casters
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Nele Lemkens
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Winde Lemmens
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Kenneth Meijer
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Pieter Meyns
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Raymond van de Berg
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Joke Spildooren
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
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Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Van Hoecke H, De Leenheer E, Rombaut L, Boudewyns A, Desloovere C, Vinck AS, de Varebeke SJ, Verschueren D, Verstreken M, Foulon I, Staelens C, De Valck C, Calcoen R, Lemkens N, Öz O, De Bock M, Haverbeke L, Verhoye C, Declau F, Devroede B, Forton G, Deggouj N, Maes L. Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss. Pediatrics 2022; 150:188271. [PMID: 35698886 DOI: 10.1542/peds.2021-055340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results. METHODS Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included. RESULTS Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26). CONCLUSIONS The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.
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Affiliation(s)
- Sarie Martens
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Cleo Dhondt
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - An Boudewyns
- Faculty of Medicine and Translational Neurosciences, Department of Otorhinolaryngology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Anne-Sophie Vinck
- Department of Otorhinolaryngology, AZ Sint-Jan Bruges, Bruges, Belgium
| | | | | | | | - Ina Foulon
- Department of Otorhinolaryngology, University Hospital Brussels, Brussels, Belgium
| | | | - Claudia De Valck
- Department of Otorhinolaryngology, AZ Turnhout, Turnhout, Belgium
| | | | - Nele Lemkens
- Department of Otorhinolaryngology, ZOL Genk, Genk, Belgium
| | - Okan Öz
- Ear, Nose, and Throat Clinic, The Eargroup, Antwerp, Belgium
| | | | - Lisa Haverbeke
- Department of Otorhinolaryngology, ASZ Aalst, Aalst, Belgium
| | - Christoph Verhoye
- Department of Otorhinolaryngology, AZ Sint-Lucas Bruges, Bruges, Belgium
| | - Frank Declau
- Department of Otorhinolaryngology, GZA Sint-Vincentius, Antwerp, Belgium
| | - Benoit Devroede
- Department of Otorhinolaryngology, Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Glen Forton
- Department of Otorhinolaryngology, AZ Delta Roeselare, Roeselare, Belgium
| | - Naima Deggouj
- Institute of Neurosciences and Department of Otorhinolaryngology, Université Catholique de Louvain, Brussels, Belgium
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Michiels E, Pullinx L, Desticker C, Lemkens N, Lemkens P. Unexpected overnight stay following ENT day-case surgery: a 5-year audit. B-ENT 2017; 13:51-55. [PMID: 29557563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
UNLABELLED Unexpected overnight stay following ENT day-case surgery: a 5-year audit. PROBLEMS/OBJECTIVES Recent decades have seen a steady reduction in the average duration of hospitalization for all surgical patients, including those undergoing ENT procedures. Correspondingly, the proportion of day surgeries relative to in-patient surgeries has progressively increased. In the present observational study, we aimed to evaluate the proportion of unplanned overnight stays following planned day surgeries in our ENT unit, and the major causes of these unexpected overnight admissions. METHODS From databases, we collected data from all patients who underwent ENT day-case surgery in Ziekenhuis Oost- Limburg between January 2008 and December 2013. RESULTS A total of 10,440 patients underwent ENT day-case surgery during this period. The overall rate of unexpected overnight admission was 1.86%, with these overnight admissions most commonly due to anaesthetic (46.91%), surgical (19.59%), and organizational (17.01%) reasons. The types of ENT surgery at the greatest risk for prolonged hospitalisation were hemithyroidectomy (12.50%), tympanoplasty (12.15%), and uvulopalatopharyngoplasty (UPPP) (7.81%). We further identified a clear difference in the rate of unexpected overnight stay between surgery scheduled in the morning (1.17%) versus in the afternoon (12.98%). CONCLUSIONS Our present findings highlight the various reasons for unexpected overnight admission after day-case surgery. To reduce the rate of unexpected overnight stays, we need to better understand these different reasons to support the ongoing search for possible solutions.
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Dhaeze T, Peelen E, Hombrouck A, Peeters L, Van Wijmeersch B, Lemkens N, Lemkens P, Somers V, Lucas S, Broux B, Stinissen P, Hellings N. Circulating Follicular Regulatory T Cells Are Defective in Multiple Sclerosis. J I 2015; 195:832-40. [DOI: 10.4049/jimmunol.1500759] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/18/2015] [Indexed: 12/29/2022]
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Lammens F, Lemkens N, Laureyns G, Lemmens W, Van Camp L, Lemkens P. Epidemiology of ENT emergencies. B-ENT 2014; 10:87-92. [PMID: 25090805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER). METHODS Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated. RESULTS Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy. The second most frequent conditions observed were infections of the pharynx and tonsils. Nasal fractures and vertigo were also frequently observed. CONCLUSION Epistaxis and its treatment were the most frequent ENT diagnosis and therapy seen in the ER. Infections are the main cause of hospitalisation. Referral to other disciplines and revisits seldom occurred.
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Bogaerts M, Schrooten W, Lemkens N, Indesteege F, Postelmans T, Lemkens P. Patient reported outcome measures (PROMs) in children with sleep-disordered breathing undergoing adenotonsillectomy. B-ENT 2013; 9:185-191. [PMID: 24273949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES Patient reported outcome measures (PROMs) asses the health status or health related quality of life from the patient's perspective. The aims of this study were to assess the effect of adenotonsillectomy on symptoms and daily functioning in children with sleep-disordered breathing (SDB) using an electronic questionnaire, and to determine if this is a feasible method to evaluate treatment outcome in this patient population. METHODS The electronic questionnaire was administered to the parents of children undergoing adenotonsillectomy for SDB on the day of surgery (T0), and two weeks (T1) and six months (T2) after surgery. The questionnaire scored symptoms in 5 different fields (snoring, sleepiness, behaviour, appetite, and apnoea). Higher scores indicated more pronounced symptoms. The score on T0 measured the preoperative symptoms. The main outcome measure (the change in scores between the postoperative measurements and the preoperative measurement) was analysed using the Wilcoxon signed-rank test. RESULTS Eighty-eight percent of invited patients participated in the study. Six percent had no access to internet, and another 6% did not wish to participate. Language problems were not reported. Response rates for T1 and T2 were 82.6% and 79.7% respectively. The T1 and T2 scores were significantly lower than the scores on T0 for snoring, behaviour, apnoea, and sleepiness. The T2 appetite score was significantly higher than on T0, which indicates an improvement of appetite. CONCLUSION A comparison of pre- and postoperative results from an electronic disease-specific questionnaire indicated significantly improved symptoms and daily functioning in children undergoing adenotonsillectomy for SDB. High participation and response rates indicated it was feasible to assess treatment outcome by means of an electronic questionnaire.
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Affiliation(s)
- M Bogaerts
- Department of Otorhinolaryngology and Head and Neck Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
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Piessens P, Hens G, Lemkens N, Schrooten W, Debruyne F, Lemkens P. Effect of adenotonsillectomy on the use of respiratory medication. Int J Pediatr Otorhinolaryngol 2012; 76:906-10. [PMID: 22456167 DOI: 10.1016/j.ijporl.2012.02.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Recurrent tonsillitis and upper respiratory tract obstruction due to adenotonsillar hypertrophy are the most common indications for (adeno)tonsillectomy ((A)TE). Symptoms of upper respiratory tract infection and obstruction can, however, be attributed to lower airway pathology and thus treated with respiratory medication - this is non-antimicrobial medication used for lower respiratory diseases like bronchitis, bronchiolitis, asthma and episodic wheezing. The aim of this study is to investigate the effect of the current (A)TE practice in Belgium on the use of respiratory medication in subjects aged 0-15. METHODS Retrospective data on 11.114 subjects aged 0-15 years old who underwent (A)TE from January 1st 2002 until Sept 30th 2003 were retrieved from the database of the Christelijke Mutualiteit, the largest mutual health insurance society in Belgium. We compared the use of respiratory medication 12 months before and 12 months after (A)TE. RESULTS Out of 11.114 subjects, 4.654 received at least one prescription for respiratory medication in the year before and/or after (A)TE. In this subgroup, the median respiratory medication use reduced with 32% in the year after surgery. CONCLUSION Compared with the year before surgery, the median use of respiratory medication in subjects aged 0-15 drastically reduces in the year after (A)TE. A possible reason for this reduction is that children with upper airway obstruction and infections are often wrongly diagnosed as having lower airway problems.
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Affiliation(s)
- P Piessens
- Department of Otorhinolaryngology and Head and Neck Surgery, Ziekenhuis Oost Limburg, Schiepse Bos 6, Genk, Belgium
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Mansbach AL, Brihaye P, Casimir G, Dhooghe I, Gordts F, Halewyck S, Hanssens L, Lemkens N, Lemkens P, Leupe P, Mulier S, Van Crombrugge L, Van Der Veken P, Van Hoecke H. Clinical aspects of chronic ENT inflammation in children. B-ENT 2012; 8 Suppl 19:83-101. [PMID: 23431613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
In children, all ENT cavities are particularly prone to the development of chronic inflammation. This is due to many predisposing factors, of which the most common are unfavourable anatomy, absence of nasal blowing, day care attendance, allergy, immature immunity, gastro-oesophageal reflux and tobacco smoke exposure. The aim of this paper is to outline the most specific paediatric clinical aspects of chronic pharyngo-tonsillitis, rhinosinusitis, otitis media, adenoiditis and laryngotracheitis and the important influence that some of these pathologies exert on the others.
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Affiliation(s)
- A L Mansbach
- Department of Otolaryngology, Head and Neck Surgery, University Children's Hospital Queen Fabiola (Université Libre de Bruxelles), Brussels, Belgium.
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Boudewyns A, Antunes J, Bernheim N, Claes J, De Dooy J, De Leenheer E, De Roeck K, Hellings P, de Varebeke SJ, Jorissen M, Ketelslagers K, Lemkens N, Lemkens P, Leupe P, Malfroot A, Maris M, Michiels E, Van Crombrugge L, Vandenplas Y, Verhulst S, Eloy P, Watelet JB. Specific medical and surgical treatment for chronic inflammatory diseases in children. B-ENT 2012; 8 Suppl 19:135-166. [PMID: 23431617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Treatment for chronic inflammatory conditions in children should take into account the specific pathophysiological and clinical processes underlying these disorders. These guidelines provide a framework for both the medical and surgical treatment of chronic inflammatory diseases such as otitis media, allergic rhinitis and chronic rhinosinusitis, chronic inflammation of tonsils and adenoids, and laryngitis. In addition, the role of vaccinations and immunomodulatory therapies is discussed. Whenever possible, the evidence levels for specific treatments comply with the Oxford Levels of Evidence.
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Affiliation(s)
- A Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, Antwerp, Belgium.
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Leupe P, Hox V, Debruyne F, Schrooten W, Claes NV, Lemkens N, Lemkens P. Tonsillectomy compared to acute tonsillitis in children: a comparison study of societal costs. B-ENT 2012; 8:103-111. [PMID: 22896929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION AND AIM Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. MATERIALS AND METHODS The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were calculated based on resource use and personnel input at the participating hospital. The cost of work-related disability for both treatments was measured based on a questionnaire filled in by 275 parents of children undergoing a tonsillectomy. Data from two Belgian institutions (NIS and FOD) were used to calculate the cost of parents' absenteeism. RESULTS An episode of acute tonsillitis in the child results in a longer period of parents' work absenteeism (mean of 3.1 +/- 0.3 days) compared to tonsillectomy (2.2 +/- 0.2 days). The cost of economic productivity loss amounts to 613 Euros (NIS) or 759 Euros (FOD) for acute tonsillitis and 435 Euros (NIS) or 539 Euros (FOD) for a tonsillectomy. The medical costs linked to the surgical procedure at the local department correspond to 535 Euros and for an acute tonsillitis to 46 Euros. CONCLUSIONS From societal perspective, a tonsillectomy costs the equivalent of 1.4 times the cost of a severe throat infection. This indicates that in children suffering from recurrent acute tonsillitis, watchful waiting results in a higher cost compared to tonsillectomy, given the cumulative costs of parents' absenteeism.
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Affiliation(s)
- P Leupe
- Department of Otorhinolaryngology, Head and Neck surgery, Ziekenhuis Oost Limburg, Genk, Belgium
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Lemkens N, Lemkens P, Egondi TW, Schrooten W, Jorissen M, Mertens R, de Raeve G, Preal R, Debruyne F. Antibiotic use and doctor visits are reduced after adenotonsillectomy. B-ENT 2010; 6:239-243. [PMID: 21302684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care. STUDY DESIGN AND METHODS The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the use of antibiotics during the 12 months before and the 12 months after (A)TE. We also compared the number of visits to pediatricians and general practitioners during the 12 months before and the 12 months after surgery. RESULTS The median antibiotic use dropped from 4 boxes in the year before the operation to 1 box in the year after the operation. The median number of doctor visits also dropped from 7 visits in the year before to 4 visits in the year after (A)TE. CONCLUSION Although there are no generally accepted guidelines on the indications for (A)TE in Belgium, the current practice effectively reduced the need for medical care.
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Affiliation(s)
- N Lemkens
- Department of Ear, Nose and Throat, Ziekenhuis Oost Limburg, Genk, Belgium.
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Fransen E, Topsakal V, Hendrickx JJ, Van Laer L, Huyghe JR, Van Eyken E, Lemkens N, Hannula S, Mäki-Torkko E, Jensen M, Demeester K, Tropitzsch A, Bonaconsa A, Mazzoli M, Espeso A, Verbruggen K, Huyghe J, Huygen PLM, Kunst S, Manninen M, Diaz-Lacava A, Steffens M, Wienker TF, Pyykkö I, Cremers CWRJ, Kremer H, Dhooge I, Stephens D, Orzan E, Pfister M, Bille M, Parving A, Sorri M, Van de Heyning P, Van Camp G. Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study. J Assoc Res Otolaryngol 2008; 9:264-76; discussion 261-3. [PMID: 18543032 PMCID: PMC2492985 DOI: 10.1007/s10162-008-0123-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/21/2008] [Indexed: 11/27/2022] Open
Abstract
A multicenter study was set up to elucidate the environmental and medical risk factors contributing to age-related hearing impairment (ARHI). Nine subsamples, collected by nine audiological centers across Europe, added up to a total of 4,083 subjects between 53 and 67 years. Audiometric data (pure-tone average [PTA]) were collected and the participants filled out a questionnaire on environmental risk factors and medical history. People with a history of disease that could affect hearing were excluded. PTAs were adjusted for age and sex and tested for association with exposure to risk factors. Noise exposure was associated with a significant loss of hearing at high sound frequencies (>1 kHz). Smoking significantly increased high-frequency hearing loss, and the effect was dose-dependent. The effect of smoking remained significant when accounting for cardiovascular disease events. Taller people had better hearing on average with a more pronounced effect at low sound frequencies (<2 kHz). A high body mass index (BMI) correlated with hearing loss across the frequency range tested. Moderate alcohol consumption was inversely correlated with hearing loss. Significant associations were found in the high as well as in the low frequencies. The results suggest that a healthy lifestyle can protect against age-related hearing impairment.
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Affiliation(s)
- Erik Fransen
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Jan-Jaap Hendrickx
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Lut Van Laer
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Jeroen R. Huyghe
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Els Van Eyken
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
| | - Nele Lemkens
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Samuli Hannula
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Elina Mäki-Torkko
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Mona Jensen
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Kelly Demeester
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Anke Tropitzsch
- Department of Otorhinolaryngology, University of Tübingen, 72074 Tübingen, Germany
| | - Amanda Bonaconsa
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Manuela Mazzoli
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Angeles Espeso
- College of Medicine, Cardiff University, CF14 4XW Cardiff, UK
| | - Katia Verbruggen
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Joke Huyghe
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Patrick L. M. Huygen
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Sylvia Kunst
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Minna Manninen
- Department of Otorhinolaryngology, University of Tampere, 33014 Tampere, Finland
| | - Amalia Diaz-Lacava
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Michael Steffens
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Thomas F. Wienker
- Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, 53105 Bonn, Germany
| | - Ilmari Pyykkö
- Department of Otorhinolaryngology, University of Tampere, 33014 Tampere, Finland
| | - Cor W. R. J. Cremers
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hannie Kremer
- Department of Otorhinolaryngology, St. Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, University Hospital of Ghent, 9000 Ghent, Belgium
| | - Dafydd Stephens
- College of Medicine, Cardiff University, CF14 4XW Cardiff, UK
| | - Eva Orzan
- Department of Oto-Surgery, University Hospital Padova, 35128 Padova, Italy
| | - Markus Pfister
- Department of Otorhinolaryngology, University of Tübingen, 72074 Tübingen, Germany
| | - Michael Bille
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Agnete Parving
- Department of Audiology, Bispebjerg Hospital, 2400 NV Copenhagen, Denmark
| | - Martti Sorri
- Department of Otorhinolaryngology, University of Oulu, 90014 Oulu, Finland
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, University Hospital of Antwerp, 2650 Antwerp, Belgium
| | - Guy Van Camp
- Department of Medical Genetics, University of Antwerp, Universiteitsplein, 2610 Antwerp, Belgium
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Van Eyken E, Van Laer L, Fransen E, Topsakal V, Lemkens N, Laureys W, Nelissen N, Vandevelde A, Wienker T, Van De Heyning P, Van Camp G. KCNQ4: a gene for age-related hearing impairment? Hum Mutat 2006; 27:1007-16. [PMID: 16917933 DOI: 10.1002/humu.20375] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Age-related hearing impairment (ARHI) is the most common sensory impairment among the elderly. It is a complex disorder influenced by genetic as well as environmental factors. SNPs in a candidate susceptibility gene, KCNQ4, were examined in two independent Caucasian populations. Two quantitative trait locus (QTL) values were investigated: Zhigh and Zlow, a measure of high and respectively low frequency hearing loss. In the first population, the statistical analysis of 23 genotyped SNPs spread across KCNQ4 resulted in significant p-values for two SNPs for Zhigh-SNP9 (NT_004511:g.11244177A > T) and SNP15 (NT_004511:g.11257005C > T; NP_004691:p.Ala259Ala), and one SNP for Zlow-SNP12 (NT_004511:g.11249550A > T). The linkage disequilibrium (LD) structure of KCNQ4 was subsequently determined in a 34-kb region surrounding the significant SNPs, resulting in three LD-blocks. LD-block 1 contains SNP9 and covers an area of 5 kb, LD-block 2 measures 5 kb and surrounds SNP13 (NT_004511:g.11253513A > G) to SNP18 (NT_004511:g.11257509G > A; NP_004691:p.Thr293Thr), and LD-block 3 spans 7 kb. Five tag-SNPs of block 1 and 2, and 2 extra SNPs were subsequently genotyped in the second population. Again, several SNPs were positively associated with ARHI: one SNP (SNP18) for the high frequencies and three SNPs (SNP9, SNP12, and SNP18) for the low frequencies, although only a single SNP (SNP12) resulted in significant p-values in both populations. Nevertheless, the associated SNPs of both populations were all located in the same 13-kb region in the middle of the KCNQ4 gene.
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Affiliation(s)
- E Van Eyken
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
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Fransen E, Van Laer L, Lemkens N, Caethoven G, Flothmann K, Govaerts P, Van de Heyning P, Van Camp G. A Novel Z-Score–Based Method to Analyze Candidate Genes for Age-Related Hearing Impairment. Ear Hear 2004; 25:133-41. [PMID: 15064658 DOI: 10.1097/01.aud.0000120362.69077.0b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Approximately half of the variance of Age-Related Hearing Impairment (ARHI) is attributable to environmental risk factors, and the other half to genetic factors. None of these genes has ever been identified, but the genes involved in monogenic nonsyndromic hearing impairment are good candidates. Here we define and validate a quantitative trait value for ARHI, correcting for age and gender, to allow the genetic study of ARHI as a quantitative trait. DESIGN Based on the ISO 7029 standard, we convert audiometric data into a Z-score, an age- and gender-independent value expressing to what extent a person is affected by ARHI. The validity of this approach is checked using a test population of randomly collected subjects. The power to evaluate the contribution of a candidate gene to ARHI is assessed using simulated populations. As an example, one ARHI candidate gene is analyzed. RESULTS In our test population, Z-scores were normally distributed although the mean did not equal zero. Z-scores were independent of age, and there was no difference between men and women. Power studies using simulated populations indicated that to detect moderate genetic effects, sample sizes of at least 500 random subjects are necessary. CONCLUSION The Z-score conversion appears to be a valid method to describe to what extent a subject is affected by ARHI, allowing to compare persons from different age and gender. This method can be the basis of future, powerful studies to identify ARHI genes.
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Affiliation(s)
- Erik Fransen
- Department of Medical Genetics, University of Antwerp, Belgium
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Lemkens N, Vermeire K, Brokx JPL, Fransen E, Van Camp G, Van De Heyning PH. Interpretation of pure-tone thresholds in sensorineural hearing loss (SNHL): a review of measurement variability and age-specific references. Acta Otorhinolaryngol Belg 2003; 56:341-52. [PMID: 12528251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
When assessing a patient with a sensorineural hearing impairment, the most simple and most widely available technical investigation is pure-tone audiometry. Although it is a subjective measure, the test is very reliable if the patient is cooperative. In this paper we review standards and test-retest reliability for pure-tone audiometry. A pure-tone threshold measurement at a single frequency has a chance of 90% to be repeated between -10 dB and +10 dB compared to the first measurement, assuming no real change in hearing thresholds has occurred. It is also of great importance to use correct gender- and age-specific reference values when interpreting pure-tone threshold measurements. Several large-scale epidemiological studies have been conducted during recent years, and have provided us with reliable gender- and age-specific references. A method to take into account the age-related deterioration is presented. In this method, Z-score audiograms represent traditional thresholds in an age- and gender-independent way. At each frequency, the Z-score value is the number of standard deviation units that the threshold differs from the median value for the otologically normal population (ISO 7029).
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Affiliation(s)
- N Lemkens
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Antwerp (UZA), Belgium
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Abstract
This paper reviews what is known about the environmental risk factors and medical conditions that contribute to age-related hearing impairment (ARHI), and evaluates which analyses could be performed to identify genetic factors that are involved. Although hearing acuity declines with aging in everybody, the variation in hearing thresholds is large. Part of this variation can be explained by medical conditions, and by a different exposure to environmental factors. In particular, many studies have been dedicated to the influence of occupational noise on hearing. The importance of other environmental risk factors is less clear and often controversial. In contrast, almost nothing is known about the genetic compound of ARHI. Heritability estimates have shown that approximately half of the variance in ARHI is due to heritable factors, which indicates that ARHI is a complex trait, influenced by an interplay between genetics and environment. Although several genes for monogenic hearing impairment have been identified in mouse and man, no susceptibility genes for ARHI have been identified yet. The methodology to dissect the genetics of complex traits is still developing. Possible study designs to unravel the genetics of ARHI are discussed.
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Affiliation(s)
- Erik Fransen
- Department of Medical Genetics, University of Antwerp (UIA), Universiteitsplein 1, B-2610 Antwerp, Belgium
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Vermeire K, Brokx JP, Lemkens N, D'Haese P, Van de Heyning PH. Speech recognition tests in sensorineural hearing loss. Acta Otorhinolaryngol Belg 2003; 57:169-75. [PMID: 14571649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The ability to understand speech must be considered the most important measurable aspect of human auditory function. Due to the innovative developments in hearing aids and cochlear implants, there has been a renewed interest in speech recognition testing. During recent years, the start of several multi-centre studies have increased the urge to come to some consensus on the use of different speech materials. In this article a global overview of existing types of speech material in Dutch will be given. For each type, there is a reference to similar speech audiometric tests in French, English and German.
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Affiliation(s)
- K Vermeire
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, University of Antwerp (UA), Belgium
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