Fwj Albers

Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy : A prospective, randomized, double-blind clinical trial

A subclinical viral labyrinthitis has been postulated in the literature to elicit idiopathic sudden sensorineural hearing loss (ISSHL). An etiologic role for the herpes family is assumed. Corticosteroids possess a limited beneficial effect on hearing recovery in ISSHL. In this study, we evaluated the therapeutic value of the antiherpetic drug acyclovir (Zovirax) on hearing recovery in 91 patients with ISSHL who received prednisolone in a prospective, randomized, double-blind, placebo-controlled, multicenter trial. The audiometric parameters included pure tone and speech audiometry. Subjective parameters studied included hearing recovery, a pressure sensation in the affected ear, vertigo, and tinnitus. A 1-year follow-up was obtained. Hearing recovery for the whole group averaged about 35 dB and was independent of the severity of the initial hearing loss or vestibular involvement. Speech audiometry improved from 49% to 75%. After 12 months, pressure sensation and vertigo decreased to 15.6% (acyclovir) and 10.3% (placebo) and 12.5% (acyclovir) and 10.7% (placebo), respectively. Tinnitus decreased slightly, to 46.9% (acyclovir) and 55.2% (placebo), in the same period (p > .05 for all parameters). We conclude that no beneficial effect from combining acyclovir with prednisolone can be established in patients with ISSHL.

Effect of probiotic bacteria on prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses in vitro.

The proliferation of yeasts in the mixed bacterial and fungal biofilms colonising silicone rubber voice prostheses in laryngectomised patients is the main cause of malfunctioning of the valve mechanism on the oesophageal side of the prostheses. Indwelling voice prostheses usually have to be replaced every 3-4 months. The consumption of probiotic bacteria is largely motivated by health claims related to the urogenital and lower digestive tract, but not to the upper digestive tract. The present study examined the influence of probiotic bacteria on the prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses, as formed in a modified Robbins device. Exposure of oropharyngeal biofilms on voice prostheses to suspensions of Bifidobacterium infantis 420 or Enterococcus faecium 603 did not significantly reduce the number of yeasts in the biofilm. However, suspensions of Lactobacillus fermentum B54, L. rhamnosus 744 or L. lactis cremoris SK11 led to a reduction in the number of yeasts harvested from the voice prostheses. Suspensions of L. casei Shirota and Streptococcus thermophilus B significantly reduced the number of yeasts in the biofilm to 39% and 33%, respectively. The reduction brought about in yeast prevalence in the mixed biofilm was greatest by exposure to a suspension of L. lactis 53, with yeast prevalence only 4% of the control. In conclusion, the study demonstrated that the prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses might be controlled by consumption of probiotic bacteria.

Chemoprophylaxis of fungal deterioration of the Provox silicone tracheoesophageal prosthesis in postlaryngectomy patients

A double-blind randomized trial was conducted among 36 laryngectomees to assess the influence of a buccal bioadhesive slow-release tablet containing miconazole nitrate on the lifetime of the Provox voice prosthesis. All patients colonized with Candida spp and treated with miconazole showed a significant decrease of colonization at the end of the study. Intratracheal phonatory pressures were remarkably higher after 2 months of follow-up in the placebo group. No local or systemic adverse reactions to miconazole were observed during this study. Patient compliance was acceptable according to regular miconazole determination in saliva samples. The device lifetime was significantly higher in patients treated with miconazole even after 1 y ear of follow-up. The use of a buccal bioadhesive slow-release tablet containing an antimycotic agent proves to be an adequate method of preventing fungal colonization and deterioration of silicone voice prostheses.

Intratemporal and intracranial complications of acute suppurative otitis media in children: renewed interest

In recent years, a rise in the incidence of intratemporal and intracranial complications of acute otitis media (AOM) has been mentioned in the literature. Lack of a well-developed immune system and difficulties in diagnosing AOM, can account for part of the rise in the incidence of complications of purulent middle ear infections in young children. Antibiotic treatment of AOM is certainly not an absolute safeguard against the development of complications. Antibiotic therapy may have a masking effect on significant signs and symptoms of complications, causing delay in diagnosis. Myringotomy, especially in young children, should not be forgotten for drainage and to provide material for culture. Increased virulence of the causative pathogens cannot be ruled out, but to date there is no evidence suggesting it. We have to maintain a high level of clinical awareness. If there is insufficient improvement of the patient with the appropriate conservative treatment, radioimaging followed by the necessary surgical procedures should be performed.

Deterioration of the Provox(TM) silicone tracheoesophageal voice prosthesis: Microbial aspects and structural changes

Device life of tracheoesophageal voice prostheses is limited due to deterioration of the polymers. A group of 55 postlaryngectomy patients fitted with a Provox voice prosthesis have been studied prospectively during 6 months. Thirty-seven prostheses were replaced due to a dysfunctional valve mechanism. Although colonization with Candida species was highly associated with destruction of the silicone material, other upper respiratory tract commensals, e.g. Staphylococcus aureus, were also demonstrated. Electron microscopy of the contaminated devices showed colonization and disruption of the silicone material by penetrating yeast hyphae. During the study a remarkable increase of intratracheal phonatory pressures was assessed with progressive colonization of the prostheses.

Cineradiography of the Pharyngoesophageal Segment in Postlaryngectomy Patients

The use of tracheoesophageal voice prostheses has gained wide acceptance in the field of vocal rehabilitation after total laryngectomy. In a randomized study with 3 arms, alaryngeal speech proficiency was assessed in 60 postlaryngectomy patients: 20 patients underwent primary unilateral pharyngeal myotomy, 21 patients underwent neurectomy of the pharyngeal plexus in addition to pharyngeal myotomy, and 19 patients did not undergo an additional surgical procedure. Pharyngoesophageal (PE) dynamics were examined during esophageal and tracheoesophageal speech. A single vibrating PE segment was seen in good alaryngeal speakers. Hypertonicity, spasm, strictures, and hypotonicity of the PE segment were correlated significantly with poor or moderate alaryngeal speech. Unilateral myotomy with or without unilateral neurectomy prevented hypertonicity or spasm of the PE segment. The acquisition of alaryngeal speech did not differ significantly between the 2 groups who had undergone an additional surgical procedure. Evaluation of anatomic and physiological factors may be helpful in subsequent clinical management to achieve effective alaryngeal speech.

Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer.

Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how they adversely affect the patients survival, it becomes imperative to analyze how the clinician can intervene effectively. One such approach is to detect multiple primaries as early as possible. As such, panendoscopy as a part of the tumor-staging procedure has been advocated by many investigators to search for simultaneous second primary malignant neoplasms in patients presenting with head and neck cancer. In a 24-month period, data were gathered from 127 consecutive patients referred to University Hospital, Ghent with previously untreated, squamous cell carcinomas of the head and neck. One hundred-eighteen patients underwent an endoscopic examination under general anesthesia, during which 4 simultaneous second primary tumors were found in 3 patients. This represents an incidence of 3.4% of simultaneous second primary neoplasms. The results for the different parts of the endoscopy are discussed and compared with literature findings. Guidelines are given for the initial evaluation of the head and neck cancer patient.

Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro.

Objective--This study investigates the effect of regular airflow, as an isolated single factor, through Groningen and Provox®2 voice prostheses on biofilm formation. Material and Methods--Groningen and Provox2 voice prostheses were placed in a modified Robbins device and inoculated with the total microflora from an explanted Groningen voice prosthesis. After 3 days, prostheses were either flushed 3 times per day with the Provox flush®, treated with an airflow using an increasing order of air pressure (10, 15 and 20 cmH2O) or vigorously perfused by means of imitated coughing (air pressure 20 cmH2O). As a control, prostheses were left undisturbed to promote biofilm growth. Following flushing, blowing or coughing, each artificial throat was perfused with 200 ml of phosphate-buffered saline. This procedure was repeated three times a day for 9 days. At the end of each day, the artificial throats were filled with growth medium for 30 min and left empty during the night after draining. After 12 days the microflora on each voice prosthesis was quantified by plating on blood agar for bacteria and on de Man, Rogosa and Sharpe agar for yeasts. Results--The use of the Provox flush reduced bacterial prevalence on Groningen and Provox2 voice prostheses to 71% and 45% of the control values, respectively, without affecting the number of yeasts. Increasing airflows and imitated coughing yielded reductions of 45-70% in bacterial and yeast prevalence on Provox2 voice prostheses. On the Groningen voice prostheses the effects of increasing airflows and imitated coughing were less pronounced: reductions in bacterial and yeast prevalence of 56-87% were observed. Conclusion--This study shows that use of the Provox flush has a cleansing effect, especially on Provox2 voice prostheses, and furthermore suggests that daily airflow through voice prostheses as part of a daily maintenance scheme reduces biofilm formation and can be expected to prolong the life of these devices.

Caffeinated soft drinks reduce bacterial prevalence in voice prosthetic biofilms

Laryngectomized patients use indwelling silicone rubber voice prostheses, placed in a surgically created fistula in between the trachea and the esophagus, for voice and speech rehabilitation. At the esophageal side, these voice prostheses rapidly become colonized by a thick biofilm consisting of a variety of oral and skin bacteria and yeasts, and on average, after 3–4 months a prosthesis has to be replaced. In this study, the influence of caffeinated soft drinks on biofilm formation on silicone rubber voice prostheses has been investigated in a modified Robbins device. Robbins devices were first inoculated with the total cultivable microflora from an explanted voice prosthesis for 3 d, after which the devices were perfused three times daily over a 12 day period with 650 ml of either phosphate buffered saline or carbonated mineral water (controls), caffeinated soft drinks (two types), or a decaffeinated and a sugar‐free version of one of the caffeinated soft drinks. At the end of a day, during the experimental period, the devices were filled with growth medium for 30 min. Both caffeinated soft drinks reduced bacterial prevalence in the biofilms to 1–5% of the control, while yeasts thrived in voice prosthetic biofilms exposed to caffeinated soft drinks. Neither the controls, nor the decaffeinated soft drink, nor the sugar‐free version of this showed these effects on bacterial prevalence.

Cartilage interposition in ossiculoplasty with hydroxylapatite prostheses: A histopathologic study in the guinea pig

In this experimental animal study, a cartilage disk was interposed between a synthetic middle ear prosthesis and the tympanic membrane in guinea pigs to investigate its effect on the extrusion process of the implant. Two groups of guinea pigs were studied. One group consisted of animals in which the prosthesis was directly in contact with the tympanic membrane, and the other group consisted of animals in which a cartilage disk had been inserted between the head of the prosthesis and the tympanic membrane. Before histologic processing, in situ inspection was performed with an operating microscope. After fixation and embedding, light microscopic and transmission electron microscopic examination were performed. We studied the histopathologic aspects of the tympanic membrane with regard to the protrusion and extrusion processes of the middle ear implant. In this experimental model, protrusion and extrusion of a hydroxylapatite middle ear prosthesis was greatly reduced by interposition of a cartilage disk. Further clinical evaluation of these experimental results is needed in the human middle ear.