Niramon Navacharoen

Extracranial and intracranial complications of suppurative otitis media. report of 102 cases

During the eight-year period, 1983-1990, 102 cases of intracranial (IC) and extracranial (EC) complications from 17 144 suppurative otitis media were reviewed. The prevalence of each complication was 0.24 and 0.45 per cent respectively. Facial paralysis, subperiosteal abscess and labyrinthitis were the common complications among the EC group, while meningitis and brain abscess were common in the IC group. Twenty five per cent of the EC group and 44 per cent of the IC group had more than two complications. The reliable warning signs and symptoms for IC complications were fever, headache, earache, vestibular symptoms, meningeal signs and impairment of consciousness. Proteus spp., Pseudomonas aeuruginosa and Staphylococcus spp. were the commonest organisms isolated from both groups. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both patient groups. Mortality rate in the IC group was 18.6 per cent. Morbidity rate in each group was 14.3 per cent (EC) and 27.9 per cent (IC) respectively. Epidemiological presentations, clinical features and the result of treatment are discussed.

Hearing and vestibular loss in Streptococcus suis infection from swine and traditional raw pork exposure in northern Thailand.

OBJECTIVES To describe a series of 40 culture-proven, Streptococcus suis infected patients, focusing on route of entry and on hearing and vestibular dysfunction. METHODS Retrospective study of patient records in a tertiary care hospital in northern Thailand, 2003-2007. RESULTS The majority (75 per cent) of cases were men with heavy drinking habits. A past history of the consumption of raw pork and/or pigs blood was found in 62.5 per cent of cases, whereas contact with swine products was found in 25 per cent. Thirty patients presented with sepsis, 19 with meningitis and 10 with infective endocarditis. The overall mortality rate was 20 per cent. After a mean follow up of 17 months, 73 per cent of the surviving meningitis cases had persistent sensorineural hearing loss and 50 per cent demonstrated vestibular impairment. In one patient, roentgenographic studies of the temporal bone were compatible with labyrinthitis ossificans. CONCLUSIONS Permanent hearing loss and vestibular impairment occur frequently in persons surviving meningitis caused by Streptococcus suis.

Cervical Vestibular-Evoked Myogenic Potentials: Norms and Protocols

Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function. Parameters of VEMP testing include VEMP threshold, latencies of p1 and n1, and p1-n1 interamplitude. Less commonly used parameters were p1-n1 interlatency, interaural difference of p1 and n1 latency, and interaural amplitude difference (IAD) ratio. This paper recommends using air-conducted 500 Hz tone burst auditory stimulation presented monoaurally via an inserted ear phone while the subject is turning his head to the contralateral side in the sitting position and recording the responses from the ipsilateral sternocleidomastoid muscle. Normative values of VEMP responses in 50 normal audiovestibular volunteers were presented. VEMP testing protocols and normative values in other literature were reviewed and compared. The study is beneficial to clinicians as a reference guide to set up VEMP testing and interpretation of the VEMP responses.

The Complications of Sinusitis in a Tertiary Care Hospital: Types, Patient Characteristics, and Outcomes

Objective. To study the complications of sinusitis in a referral hospital and the outcome of the treatment according to the type of complication. Methods. A retrospective study was performed on patients with sinusitis who were admitted to a referral hospital from 2003 to 2012. The data for the sinusitis patients who had complications were reviewed. Results and Discussion. Eighty-five patients were included in the study, of whom 50 were male (58.8%). Fourteen of the cases were less than 15 years old, and 27 of the patients (31.7%) had more than one type of complication. The most common complication was of the orbital type (100% in the children, 38% in the adults). After the treatment, all of the children and 45 of the adults (63.4%) recovered, eight of the adult patients died (11.3%), and 18 of the adults were cured with morbidity (25.3%). The patients with more numerous complications had poorer outcomes. When the types of complications were compared (adjusted for age, gender, and comorbidities), the intracranial complication was the only one that was statistically significant for mortality. Conclusion. The outcomes of the treatment depended on the number and type of complications, with the poorest results achieved in cases of intracranial complications.

Role of cervical vestibular evoked myogenic potential response in identifying vestibular dysfunction.

OBJECTIVES To analyse cervical vestibular evoked myogenic potential response parameters in normal volunteers and vertiginous patients. SUBJECTS AND METHODS A prospective study of 50 normal subjects and 50 patients with vertigo was conducted at Chiang Mai University Hospital, Thailand. Cervical vestibular evoked myogenic potential responses were measured using air-conducted, 500-Hz, tone-burst stimuli with subjects in a sitting position with their head turned toward the contralateral shoulder. RESULTS The mean ± standard deviation age and male:female ratio in the normal (44.0 ± 9.3 years; 12:38) and vertigo groups (44.7 ± 9.8 years; 17:33) were not significantly different. The prevalence of absent responses in the normal (14 per cent) and vertigo ears (46 per cent) differed significantly (p < 0.0001). Other cervical vestibular evoked myogenic potential parameters (i.e. response threshold, P1 and N1 latency, P1–N1 interlatency and interamplitude, inter-ear difference in P1 threshold, and asymmetry ratio) showed no inter-group differences. CONCLUSION The absence of a cervical vestibular evoked myogenic potential response is useful in the identification of vestibular dysfunction. However, patients should undergo a comprehensive battery of other vestibular tests to supplement their cervical vestibular evoked myogenic potential response findings.

Risk factors for hearing loss in infants under universal hearing screening program in Northern Thailand

Objective To define the risk factors for hearing loss in infants (aged 3 months) under universal hearing screening program. Materials and methods A total of 3,120 infants (aged 3 months) who underwent hearing screening using a universal hearing screening program using automated otoacoustic emission test between November 1, 2010 and May 31, 2012 in Uttaradit Hospital, Buddhachinaraj Hospital, and Sawanpracharuk Hospital (tertiary hospitals) located in Northern Thailand were included in this prospective cohort study. Results Of the 3,120 infants, 135 (4.3%) were confirmed to have hearing loss with the conventional otoacoustic emission test. Five of these 135 infants (3.7%) with hearing loss showed test results consistent with auditory brainstem responses. From the univariable analysis, there were eleven potential risk factors associated with hearing deterioration. On multivariable analysis, the risk factors independently associated with hearing loss at 3 months were birth weight 1,500–2,500 g (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1–2.6), APGAR score <6 at 5 minutes (RR 2.2, 95% CI 1.1–4.4), craniofacial anomalies (RR 2.5, 95% CI 1.6–4.2), sepsis (RR 1.8, 95% CI 1.0–3.2), and ototoxic exposure (RR 4.1, 95% CI 1.9–8.6). Conclusion This study concluded that low birth weight, APGAR score <6 at 5 minutes, craniofacial anomalies, sepsis, and ototoxic exposure are the risk factors for bilateral hearing loss in infants (aged 3 months) and proper tests should be performed to identify these risk factors. As an outcome, under the present circumstances, it is suggested that infirmary/physicians/general practitioners/health action centers/polyclinics should carry out universal hearing screening in all infants before 36 weeks. The public health policy of Thailand regarding a universal hearing screening program is important for the prevention of disability and to enhance people’s quality of life.

Hearing loss screening tool (COBRA score) for newborns in primary care setting

Purpose To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool. Methods This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score. Results Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69–43.26), 58.52 (95% CI, 36.26–94.44), and 51.56 (95% CI, 33.74–78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59–34.66). Conclusion A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.

Cervical VEMP: Its Sensitivity and Specificity

Objective: 1) Analyze the sensitivity and specificity of cervical vestibular evoked myogenic potential (VEMP) in evaluation vestibular function. 2) Compare the cervical VEMP response in normal volunteers and vertiginous patients. Method: A prospective study in 50 normal subjects and 50 vertigo patients was conducted at Chiang Mai University Hospital from February to December 2009. Cervical VEMP responses using air-conducted 500-Hz tone-burst stimuli with the subjects in a sitting position and head turned to contralateral shoulder were analyzed. Results: Average age and men-to-women ratio in the normal group (44.0 ± 9.3 years; 12:38) and in the vertigo group (44.7 ± 9.8 years; 17:33) were not different. The rate of absent response between normal ears (15%) and disease ears (47.4%) showed a significant difference (p value < 0.0001). Conclusion: To identify vestibular dysfunction using cervical VEMP, the absence of response was the most diagnostic parameter. Other vestibular test batteries should be added to confirm the cervical VEMP responses.