J. Claes

A Review of Medical Treatment for Ménière's Disease

A review of the literature on drug therapy for Ménières disease was made using Medline to search for all publications between January 1978 and September 1998. A total of 152 publications were identified that specifically dealt with medical treatment for Ménières disease. Only betahistine and diuretics appear to have proven efficacy in double-blind studies on the long-term control of vertigo. No treatment has a proven beneficial effect on hearing levels or on the long-term evolution of the disease. Recent publications have proposed a role for the intratympanic use of medication, mainly aminoglycosides, for control of vertigo. We conclude this review by proposing a strategy for the medical treatment of Ménières disease.

Lack of ciprofloxacin ototoxicity after repeated ototopical application.

The possible side effects of ototopically applied ciprofloxacin on inner ear function were investigated. The hearing function of pigmented guinea pigs was evaluated by daily frequency-specific evoked response audiometry after repeated application of the drug to both ears. Ciprofloxacin appeared to have no statistically significant effect on the hearing thresholds of the experimental animals. Images

Medical Treatment of Meniere's Disease: A Review of Literature

A review of the literature on drug therapy for Menières disease was made using the Medline on-line biomedical database to screen publications between January 1978 and April 1995. In total there were only 118 publications in this 17-year period which specifically dealt with medical therapy for Menières disease. It appears that only betahistine and diuretics have a proven effect in double-blind studies on long-term control of vertigo in Menières disease. No medical therapy, however, has a proven effect on hearing or long-term evolution of the disease. There are multiple reports, especially in the recent literature, regarding the intratympanal use of aminoglycosides for vertigo control. Based on this literature review and on empirical findings, a strategy for medical treatment of Menières disease is proposed.

Clinical practice: an approach to stridor in infants and children.

Stridor is the sound caused by abnormal air passage during breathing. The cause of stridor can be located anywhere in extrathoracic airway (nose, pharynx, larynx, and trachea) or the intrathoracic airway (tracheobronchial tree). Stridor may be acute (caused by inflammation/infection or foreign body inhalation) or chronic. It may be congenital or acquired. Stridor is a sign from which the underlying cause must be sought; it is not a diagnosis. The role of the pediatrician faced with a child or infant with noisy breathing is: (1) to determine the severity or respiratory compromise and the need for immediate intervention (to prevent respiratory failure); (2) to decide based upon history and clinical examination whether a significant lesion is suspected and, in the latter situation, to refer the child to an ENT surgeon for an upper and lower airway endoscopy; (3) to understand the consequences and management strategies of the underlying lesion and to collaborate with colleagues from related disciplines for follow-up and subsequent management of the child.

Definition, Classification and Reporting of Meniere's Disease and its Symptoms

This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Menieres disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.

Prospective effectiveness of stapes surgery for otosclerosis in a multicenter audit setting: feasibility of the Common Otology Database as a benchmark database.

Introduction: The Common Otology Database (COD) is a joint effort by an international group of otologists to organize audit with a standardized reporting method in middle ear surgery. The first results on hearing outcome of the COD are presented in this article. Objective: The primary objective was to confirm the validity of the benchmark group by comparing hearing outcome results with previously reported results. The secondary objective was to describe the population, technical aspects, and hearing outcomes of stapes surgery. Study Design: Nonrandomized prospective multicenter audit. Setting: Twenty tertiary-referral otologic centers. Patients and Intervention: Primary and revision stapes operations in patients with otosclerosis. Main Outcome Measures: Air-bone gap (ABG), bone-conduction (BC) thresholds, and air-conduction (AC) thresholds were evaluated at 3 and 12 months according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. Raw data were displayed in an Amsterdam Hearing Evaluation Plot. Results: In primary stapes surgeries, the postoperative ABG was closed to 10 dB or less in 63.6% and to 20 dB or less in 92.6% (median, 8.75 dB). In revision stapes surgeries, the postoperative ABG was closed to 10 dB in 41.2% and to 20 dB in 76.5% of cases (median, 11.25 dB). The overall mean postoperative ABG at 12 months was 10.38 dB compared with 28.75 dB preoperatively. Using laser to perform the fenestration results in a less pronounced BC improvement when compared with procedures without laser assistance. No statistically significant difference in ABG pure-tone average at 3 months could be demonstrated between the different prosthesis types. Conclusion: Results of hearing outcome are similar to previous, primarily retrospective, single-center studies. Our data confirm the effectiveness of stapes surgery in patients with otosclerosis.

Histamine nasal provocation test. An evaluation of active anterior rhinomanometry and of threshold criteria of provocative dose.

This study is a methodological approach to histamine nasal provocation. The test uses active anterior rhinomanometry and a histamine titration method, challenging both nasal cavities with a metered dose pump. It has been confirmed that the histamine nasal provocation test can differentiate between controls and non‐allergic rhinitis patients. This study shows, moreover, that the method is more sensitive in assessing response to histamine provocation when a 25% increase of post‐saline nasal airway resistance (PD25) is considered than a PD50 or PD100 criterion. The histamine response, was found to be independent of the baseline nasal airway resistance value. Pronounced unilateral responsiveness was frequently noticed. Both nasal cavities should be challenged and the most reactive side considered.

Allograft tympanoplasty: Predictive value of preoperative status

The functional and anatomical results of a series of 181 consecutive allograft tympanoplasties for ears with drum perforation and an intact ossicular chain were retrospectively reviewed and related to preoperative factors. Drum closure was realized in 92% (166 of 181 cases evaluated 1 year after surgery), and 96.6% of the reconstructed drums were still intact 3 years after surgery (118 cases evaluated). An air‐bone gap of less than 21 dB was reached in 79.6% (of a total of 162 cases) 1 year after surgery, and in 78% (of a total of 118 cases) 3 years after surgery. Age, contralateral pathology, the wet or dry status of the ear preoperatively, and the preoperative air‐bone gap had no influence on anatomical results. The preoperative air‐bone gap did not predict the postoperative air‐bone gap. The influence of age and existence of contralateral pathology on hearing gain was only visible in some of the strictly defined patient groups. The wet preoperative status of the ear generally predicted lower functional gain.

A pharyngeal hairy polyp causing neonatal airway obstruction: a case study

A case of neonatal respiratory distress due to an oropharyngeal hairy polyp is reported with its MRI assessment. The place of hairy polyps in the differential diagnosis of upper respiratory tract obstruction is discussed. Early and rapid diagnosis and treatment may be lifesaving for the newborn.

Stridor due to a bridge-like subglottic stenosis in a 10-week-old male infant

We present an infant with post-intubation stridor caused by a bridge-like subglottic stenosis. At the age of 6 weeks he suffered from a RSV infection with the need for endotracheal intubation. At week 10 acute respiratory distress required a re-intubation. Flexible endoscopy was suggestive for laryngomalacia. Rigid endoscopy revealed a subglottic laterolateral mucosal bridge resulting in a doubling of the airway lumen. Histopathological examination showed a fibrinoid pseudomembrane. Follow up endoscopy showed a grade 1 posterior subglottic stenosis without respiratory compromise. This is the first case in the literature of an infant with a post-intubation bridge-like fibrinoid pseudomembranous subglottic lesion.