David J. Mener

Hearing loss and depression in older adults

TO THE EDITOR Hearing loss (HL) is a common, but underappreciated health issue affecting older adults. The functional consequences of HL for older adults are now surfacing in epidemiological studies demonstrating that HL may be independently associated with depression1 and loneliness.2 Compared to other medical co-morbidities, HL is more strongly associated with the development of depression in older adults.1 Whether hearing rehabilitative treatment may mitigate the possible effects of HL on depression remains unclear. We investigated the association of HL and hearing aid use with major depressive disorder (MDD)in a nationally representative study of older patients.

Topical intranasal corticosteroids and growth velocity in children: a meta‐analysis

There is no consensus regarding the effects on growth velocity of intranasal topical corticosteroid (ITC) use in children. The objective of this study was to determine whether ITC use reduces growth velocity in children with allergic rhinitis (AR).

Tobacco Smoke Exposure and Eustachian Tube Disorders in US Children and Adolescents

Objectives To describe the association between active, environmental tobacco smoke (ETS) exposure and the prevalence of eustachian tube dysfunction (ETD) in the U.S. pediatric population. Study Design Cross-sectional. Setting U.S. representative demographic and audiometric data from the National Health and Nutrition Examination Survey (NHANES);2005–2010. Subjects and Methods The study consisted of 2,977 children aged 12–19 years. ETD was defined as middle ear pressure <100mm H20. ETS was defined as non-active smoking in individuals with serum cotinine over the limit of detection (≥0.015 ng/mL) and <10 ng/mL(N = 1559). Results The prevalence of ETD was 6.1%. After multivariate adjustment for age, sex, body mass index, education level, ethnicity, or having a cold, sinus problem or earache during the last 24 hours, compared to unexposed children, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 12–15 in the first, second and third tertile of cotinine concentrations were, respectively, 1.38 (0.53–3.60), 0.99 (0.53–3.60) and 2.67 (1.12–6.34). Similarly, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 16–19 in the first, second and third tertile of cotinine concentrations were, respectively, 1.28 (0.48–3.41), 0.99 (0.40–2.48) and 2.86 (1.19–6.88). Conclusion These data suggest that children and adolescents exposed to high concentrations of ETS may have an increased prevalence of ETD.

Lead exposure and increased food allergic sensitization in U.S. children and adults

Whether blood lead levels are associated with sensitization to food allergens in adults and children is unclear. Prior studies have shown that exposure to lead is associated with atopic sensitization and modulation of several cytokines (eg, interleukin [IL]‐12, IL‐10, interferon [IFN]‐γ, and IL‐4 production) and with T‐cell dysregulation and bias toward T helper 2 (Th2) activity. The objective of this work was to assess whether exposure to lead is independently associated with allergic symptoms and sensitizations in a large nationally representative sample of children and adults.

Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy

Asthma and allergic rhinitis are 2 of the most prevalent chronic medical diseases. Asthma is estimated to affect 8% of adults and 9% of children, with nearly 300 million people affected worldwide. Poorly controlled allergic rhinitis may be associated with worsening asthma symptoms over time. Various treatments have been proposed in the improvement and prevention of asthma in children and adults with allergic symptoms, which have included pharmacotherapy with antihistamines and topical intranasal corticosteroids, as well as allergen‐specific immunotherapy.

Otolaryngological Progression of Granulomatosis with Polyangiitis after Systemic Treatment with Rituximab

Objective Rituximab is used for the treatment of granulomatosis with polyangiitis (GPA), historically known as Wegener’s granulomatosis. However, the otolaryngological progression of GPA after systemic treatment with rituximab (Rituxan) is unclear. We therefore examined the disease sequelae of patients with GPA who were treated with rituximab. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods Patients with a diagnosis of GPA who were treated with rituximab between 2006 and 2012 were included in this study. Systemic and otolaryngological symptomatology, prednisone usage, and procedural interventions following B-cell depletion were analyzed. Results We identified 11 patients who met our inclusion criteria. The average length of follow-up after treatment with rituximab was 23.5 months. After treatment with rituximab, there was a significant decrease in daily prednisone dose at 3, 12, and 18 months postinfusion (P < .05). However, there was no observed improvement in patients’ otolaryngological complaints as measured by the Birmingham Vasculitis Activity Score. Furthermore, patients treated with rituximab underwent numerous otolaryngological interventions during follow-up. Patients with a history of subglottic stenosis (n = 6) underwent an average of 3.40 laryngoscopies and 0.58 dilations per year during rituximab remission, and patients with sinusitis also underwent multiple nasal endoscopies (4.54 per year, n = 9) and nasal debridements (1.34, n = 9). Conclusions While rituximab has been shown to be noninferior to cyclophosphamide with respect to remission from systemic GPA, these patients continue to have chronic otolaryngological manifestations of their disease. Otolaryngologists must continue to play a supportive role throughout their maintenance period.

Apolipoprotein e allele and hearing thresholds in older adults

Background: Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown. Methods: We studied 1833 men and women enrolled in the Health, Aging and Body Composition study. Regression models adjusted for demographic and cardiovascular risk factors were used to assess the cross-sectional association of APOE-E4 status with individual pure tone hearing thresholds and the 4-frequency pure tone average (0.5-4 kHz) in the better hearing ear. Results: Compared to participants with no APOE-E4 alleles, participants with 1 allele had better thresholds at 4.0 kHz (β = −2.72 dB, P = .013) and 8.0 kHz (β = −3.05 kHz, P = .006), and participants with 2 alleles had better hearing thresholds at 1.0 kHz (β = −8.56 dB, P = .021). Conclusion: Our results suggest that APOE-E4 allele status may be marginally associated with better hearing thresholds in older adults.

Temporal bone involvement in Hand-Schuller-Christian disease.

A 29-year-old man with an 18-month history of diabetes insipidus (DI) presented with several months of left otalgia, aural fullness, and otitis media that did not resolve with multiple courses of antibiotics. Otoscopic examination and facial nerve function were normal. Audiometry revealed a mild left conductive hearing loss, absent acoustic reflexes to broadband stimuli presented at 95 dB HL, and 100% word discrimination. A computed tomography (CT) scan of the temporal bones revealed a 2.4 2.3Ycm soft tissue mass within the left mastoid, with erosion through the sigmoid plate (Fig. 1A). Magnetic resonance imaging (MRI) of the skull base revealed a 2.4 2.3Ycm enhancing soft tissue mass with evidence of central necrosis abutting the left sigmoid sinus (Fig. 1B). An MRI from 18 months before workup of DI revealed thickening and enhancement of the pituitary stalk without appreciable T1 intensity within the sella turcica, without any evidence of a soft tissue mass (Fig. 2A). Pertinent laboratory work revealed an eosinophil number/percent of 1020/8.5% (range, 120Y300/1.0Y4.0%). This patient’s clinical presentation, laboratory tests, and imaging findings led to the presumed diagnosis of Langerhans’ cell histiocytosis (LCH). His previous MRI at the time of his initial presentation of DI further clarified the diagnosis as most consistent with Hand-SchullerChristian disease (HSCD). A left transmastoid approach through a postauricular incision for resection was performed (Fig. 2B). Pathology revealed Langerhans’ cells positive for CD1a. A postoperative positron emission tomography scan revealed multiple pulmonary nodules and pulmonary function tests were consistent with obstructive pathology; these findingswere suspicious for systemic disease. Hewas subsequently discharged home, and adjuvant chemotherapy was initiated.

Sublingual Immunotherapy in Children

Allergic rhinitis and food allergies are two of the most prevalent chronic medical diseases affecting children. Poorly controlled allergic rhinitis symptoms may impact quality of life and missed school days. Recent clinical trials have demonstrated that sublingual immunotherapy is effective in decreasing hypersensitivity to allergens such as dust mite, pollens, and cockroach. Research evaluating efficacy of sublingual immunotherapy for peanuts is promising; however, sublingual immunotherapy for food allergy should only be performed in a research setting until further evidence demonstrates consistent safety. Sublingual immunotherapy is an effective and safe alternative to more traditional subcutaneous immunotherapy, is well tolerated, and has good compliance among pediatric patients. The majority of adverse events with sublingual immunotherapy are reported as minor and have a lower systemic complication rate compared to subcutaneous immunotherapy, an important consideration among children.

Granulomatosis with polyangiitis‐associated acute subglottic stenosis in a 13‐year‐old boy: a case report

We present a case of a child with granulomatosis with polyangiitis, admitted with acute respiratory distress attributed to subglottic stenosis. The anesthetic management and potential complications are described.