Marjan H. Wieringa

Gender differences in respiratory, nasal and skin symptoms : 6-7 versus 13-14-year-old children

ISAAC questionnaires were completed by the parents of 6432 children, aged 6–7 y and by themselves by 2864 children 13–14‐y‐old. Prevalence rates of respiratory and nasal symptoms and a diagnosis of asthma and hay fever were higher in 6–7‐y‐old boys than in girls, while girls aged 13–14 y had higher rates for most symptoms, except asthma. Underdiagnosis of asthma in 13–14‐y‐old girls cannot be excluded as an explanation, but our data suggest under‐reporting of respiratory and nasal symptoms in 13–14‐y‐old boys.

Increased occurrence of asthma and allergy: critical appraisal of studies using allergic sensitization, bronchial hyper-responsiveness and lung function measurements

Background Many studies have reported an increase in the occurrence of asthma and respiratory allergies in recent decades, but this increase is mostly based on studies using rather subjective measurements of asthma and allergies, such as questionnaires and doctors diagnosis. None of the reviews specifically focused on studies using more ‘objective’ measurements, such as sensitization (specific IgE or skin prick testing (SPT)), bronchial hyper‐responsiveness (BHR) or lung function (LF).

Influence of age and gender on the dysphonia severity index. A study of normative values.

Attempts have been made to find objective parameters for assessing voice quality for many years. Objective measurements such as the dysphonia severity index (DSI), using four parameters (highest frequency, lowest intensity, maximum phonation time and jitter), appear to correlate well with perceptual evaluation. The aim of this study was to investigate the influence, if any, of age and gender on the DSI. The DSI of 118 non-smoking adults (69 females, 49 males, age range 20–79 years) without voice complaints was measured. Age has a significant effect on the DSI and on its parameters highest frequency and lowest intensity (only in females). Gender has no effect on the DSI, although it has a significant effect on the parameters highest frequency and maximum phonation time. To be able to distinguish between the effects of (normal) ageing and a voice disorder, normative data of a wide age range are essential. As a result of this study normative DSI values for gender and age have been made available.

Reproducibility of the Dutch Version of the Voice Handicap Index

Objective: To investigate the reproducibility of the Dutch translation of the Voice Handicap Index (VHI) by performing a test-retest study. To determine the relationship between the test-retest differences and the VHI scores. Patients and Methods: A group of 104 patients (56 male, 48 female) with voice complaints completed the VHI twice with a mean interval of 13 days. Results: There were no differences in scores between male and female patients. There was a good correlation between the first and the second measurement (r = 0.95). The difference between two VHI scores of any one patient and the total score were not related. We found that a 14-point difference in total score of the Dutch VHI for 1 patient at two points in time is significant. Conclusion: The Dutch version of the VHI has a good reproducibility. When used for clinical evaluation studies of patients with voice complaints, a difference of 14 points between two measurements is significant.

The applicability of the dysphonia severity index and the voice handicap index in evaluating effects of voice therapy and phonosurgery.

The objective was to investigate the applicability of the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI) in evaluating effects of intervention between groups of patients and for intrasubject differences and whether DSI and VHI are complementing measurements. Analyses of measurement data before and after intervention of 171 patients with voice disorders. The voice quality was measured objectively with the DSI. The perceived voice handicap was measured with the VHI. Three groups of patients were used: patients who had voice therapy, phonosurgery, or no intervention. DSI and VHI improved significantly after intervention in the voice therapy and the surgery group (median difference DSI 1.19 and 3.03, VHI -8 and -26, respectively). The intrasubject results were analyzed based on the test-retest variability of DSI and VHI. Significant better DSI and VHI scores after intervention were found in, respectively, 22% and 38% of the patients with voice therapy, and 56% and 78% of the patients with surgery. In the no intervention group, this was 11% and 12%. In 37% of the patients, the differences before and after intervention in DSI and VHI were in discordance. The DSI and VHI are able to show significant differences after intervention for voice disorders between groups of patients. The DSI and VHI can be used to determine a significant intrasubject result of intervention. The DSI and VHI measure each different aspects of the voice and are complementing measurements. The DSI is therefore applicable in clinical practice for objective evaluation of voice quality and the VHI for subjective evaluation of the perceived handicap by the patient self.

Pre‐ and post‐natal exposure to antibiotics and the development of eczema, recurrent wheezing and atopic sensitization in children up to the age of 4 years

Background Little data are available on the relationship between indirect antibiotic exposure of the child in utero or during lactation and allergic diseases. On the other hand, several studies have been conducted on the association with direct post‐natal antibiotic exposure, but the results are conflicting.

Higher asthma occurrence in an urban than a suburban area: role of house dust mite skin allergy

Understanding of geographical differences in asthma prevalence may be helpful in explaining recent increases in the occurrence of asthma. We wondered whether differences in allergic sensitization or other factors could explain differences in reported occurrence of asthma between an urban centre and a neighbouring suburban area. From the European Community Respiratory Health Survey (ECRHS) questionnaire, responses on asthma symptoms and risk factors and results of 11 skin allergy tests were available from 656 young adults living in urban or south suburban Antwerp, Belgium. Answers to five asthma questions were selected as dependent variables, and eight personal or environmental risk factors, as well as house dust mite (HDM) allergy, as independent variables. The effect of each independent variable on the association of asthma variables with area was assessed. Prior asthma diagnosis, present asthma symptoms, the selected risk factors and HDM allergy were all more frequently recorded in urban Antwerp. Difference in HDM allergy accounted for most of the difference in prior (mostly childhood) asthma diagnosis, since correction for it decreased the odds ratio from 2.10 to 1.65. On the contrary, the regional differences in recent asthma symptoms were not explained by HDM allergy differences nor by any other factor under study. This urban-suburban comparison indicated that house dust mite allergy is a major determinant of prior (childhood) asthma, whereas factors contributing to higher urban prevalence of present asthma symptoms could not be identified. Furthermore, our results indicate that it may be inappropriate to combine data from neighbouring areas, when their similarity has not been verified.

Nasal nitric oxide and nasal allergy

Measurements of nasal nitric oxide (nNO) are attractive because they are completely noninvasive and can easily be performed. The measurements may be useful in the early diagnosis of patients with chronic airway disorders such as Kartagers syndrome and cystic fibrosis. The possible use of nNO measurements in the diagnosis and treatment of allergic rhinitis still needs to be further evaluated because of the variable and also contradicting findings of nNO concentrations in this disease. In this review we will discuss the origin, production and measurement of nNO as well as the effect of allergic rhinitis, nasal allergen challenge and medication on nNO. Subsequently, we examine published data on allergic rhinitis and nNO, and summarize the effect of treatment of rhinitis on nNO. Finally, we discuss the potential future role for nNO in the diagnosis and management of allergic rhinitis.

Early exposure to solid foods and the development of eczema in children up to 4 years of age.

Sariachvili M, Droste J, Dom S, Wieringa M, Hagendorens M, Stevens W, van Sprundel M, Desager K, Weyler J. Early exposure to solid foods and the development of eczema in children up to 4 years of age.
Pediatr Allergy Immunol 2010: 21: 74–81.
© 2009 John Wiley & Sons A/S

Surgery for recurrent laryngeal carcinoma after radiotherapy: Partial laryngectomy or total laryngectomy for a better quality of life?

OBJECTIVE To investigate the quality of life after partial laryngectomy versus total laryngectomy for recurrent laryngeal carcinomas after radiotherapy. STUDY DESIGN AND SETTING: A retrospective study performed at least one year after treatment. This study was performed in a university hospital. RESULTS: Twenty-three patients (N = 12 partial laryngectomy, N = 11 total laryngectomy) with recurrent laryngeal cancer after radiotherapy were included in the study. Three different questionnaires, 1) EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, 2) EORTC-H & N 35, and 3) the Voice Handicap Index, were sent to all patients. The only major difference in quality of life of patients after partial laryngectomy versus total laryngectomy was found to be smell and taste related. No other differences were found. CONCLUSION: We did not find much difference in quality of life after treatment with a partial laryngectomy or a total laryngectomy in patients with recurrent laryngeal cancer after radiotherapy.