Seppo Savolainen

Characteristics of Tinnitus Induced by Acute Acoustic Trauma: A Long-Term Follow-Up

We investigated the prevalence, characteristics and subjective perceived handicap caused by long-term tinnitus induced by acute acoustic trauma (AAT) in 418 former military conscripts. They had been treated between 1984 and 1989 because of AAT from exposure to impulse noise caused by firearm shooting. All 418 patients reported tinnitus after the AAT. At discharge from the military service, 122 (29%) still reported tinnitus. In 1999, of these 122 patients, 101 were reached and 66 still had tinnitus. The Tinnitus Handicap Questionnaire demonstrated various difficulties in life because of tinnitus, not attributable only to tinnitus loudness. Psychological factors also seem to play an important role. The effects of AAT and possible compensation have been evaluated so far mostly by audiometric findings, but in some cases tinnitus may be an even more serious threat to life satisfaction than mild hearing impairment.

Bacterial Findings in Acute Maxillary Sinusitis—European Study

Bacteriology of acute maxillary sinusitis was studied in 569 patients in 16 centers of 6 countries located throughout Europe during 1992-1994 by ENT specialists. Patients with symptoms of acute sinusitis lasting less than 3 weeks with ongoing purulent nasal discharge were included. Diagnosis was verified by sinus x-ray or ultrasonography and a positive aspiration finding in maxillary sinus puncture. One or more pathogens were isolated from the maxillary sinus aspirates of 375 (66%) patients. Fifty-six percent of patients harboured 1 pathogen and 10% multiple pathogenic organisms, respectively. Haemophilus influenzae was the most common pathogen isolated (148 isolates), occurring as a single pathogen in 14% of the patients. The occurrence of H. influenzae was highest in Finnish military hospital patients (43-48%), as compared with the non-military Finnish patients (9-11%) or to patients from other European centers (mean 13%). H. influenzae was more frequently beta-lactamase positive in other European centers (22%) than in Finnish centers (7%). Streptococcus pneumoniae was the most common pathogen isolated in other European centers (20%) but second most common in Finnish centers (13%). Moraxella catarrhalis occurred at quite similar frequency among Finnish centers (9-14%), but clearly less often in other centers (mean 4%). S. aureus, which in acute maxillary sinusitis is regarded as a contaminant from the nasal cavity, was more prevalent in other European centers (12%) than in Finnish centers (4%). In patients with acute maxillary sinusitis reliable bacteriological samples should be taken by antral aspiration directly from the diseased sinus.

The Cochlear Nerve in Various Forms of Deafness

Operative specimens of cochlear nerve of 56 patients with profound deafness of varying origin were examined under the light microscope and the number of myelinated nerve fibers in each specimen was counted. The transverse fascicular area of each nerve was also determined. When the resulting neuron populations were evaluated with regard to the cochlear implant program the only truly unsuitable ears for artificial stimulation were found to be those with cholesteatoma involving the cochlear nerve and ears with local pathology in the internal auditory canal severe enough to cause atrophy of the cochlear nerve.

The Bacteriology of Acute Maxillary Sinusitis

Sinus secretions obtained by antral aspiration from 347 patients with acute maxillary sinusitis were examined bacteriologically. Special attention was paid to the method by which anaerobic bacteria could be recovered. On the total, 485 sinus secretion samples were examined, of these 336 were aspirates, 149 yields of injection-aspirations. Aerobic bacteria were cultured from 263 aspirates and from 100 injection-aspiration samples. Only anaerobes were recovered from 6 sinuses. Bacterial culture was negative in 115 sinuses (24%). The most common pathogens isolated were Haemophilus influenzae (50.5%), Streptococcus pneumoniae (18.5%), Streptococcus pyogenes (5%) and Branhamella catarrhalis (1.5%). A true anaerobic infection was considered to be present in only 7 sinuses (1.5%) indicating that anaerobes are not a significant cause of acute maxillary sinusitis. According to this study the most common pathogen in acute maxillary sinusitis in young adults is H. influenzae. From this follows that in such patients aminopenicillins may be a more appropriate choice than conventional penicillin in the antimicrobial treatment of acute maxillary sinusitis.

The effect of improved hearing protection regulations in the prevention of military noise-induced hearing loss.

Conclusion. Hearing protection regulations have improved the hearing test results of soldiers in the Finnish Defense Forces. Objectives. To investigate the effect of revised regulations regarding usage of hearing protectors of professional soldiers in the Finnish Defense Forces. Subjects and methods. The medical records of non-commissioned officers and officers examined at the Central Military Hospital ENT Department from 1984 to1986 (Period I) and 2003 to 2005 (Period II) were reviewed. The study group comprised 252 persons. Changes in hearing between the two time periods, during which regulations were revised, were investigated. Results. Hearing test results improved both in non-commissioned officers and in officers between the two study periods, in accordance with tightened hearing protection regulations. Improvement was found, especially in the high frequencies; however, the results were milder than expected, particularly in officers.

Bacterial Flora in the Nasopharynx and Nasal Cavity of Healthy Young Men

The bacterial flora of the nose and nasopharynx was studied in 86 healthy young men. Common pathogens (Haemophilus influenzae and Streptococcus pneumoniae) were isolated from only 6% of all 172 nasal cavities. The same pathogens were isolated from 27% of 86 nasopharyngeal samples. H. influenzae dominated over S. pneumoniae both in the nose and the nasopharynx. No culture either from the nose or nasopharynx grew Streptococcus pyogenes. Potentially pathogenic bacteria, non-group-A hemolytic streptococci and various groups of Neisseria meningitidis were isolated from the nasopharynx in 20% of the subjects. According to the present study healthy adults do not carry group-A hemolytic streptococci in the nose and seldom if ever in the pharynx. Thus, isolation of S. pyogenes by bacterial culture is suggestive of a bacterial infection by this agent at these sites. Isolation of hemolytic streptococci other than group A from the pharynx does not necessarily indicate bacterial infection, and the same holds true for H. influenzae and S. pneumoniae.

Treatment of Sinus Empyema in Adults: A Coordinated Nordic Multicenter Trial of Cefixime vs. Cefaclor

In sinus empyema, H. influenzae is the most prevalent pathogen in some subpopulations and in case of therapeutic failure. Cefixime, the first oral cephalosporin of the 3rd generation, is highly potent in vitro against H. influenzae. To study the efficacy and safety of cefixime in adults with acute sinusitis, a coordinated, double-blind multicenter trial was designed for purulent cases, as confirmed by antral aspiration. A total of 364 patients were enrolled in the study with 125 cases randomized to the reference group, assigned to treatment with cefaclor. Evaluation was based on clinical outcome and on antral reaspiration (86% of the cases). No significant differences between the treatment groups were found, as regards short-term or long-term clinical outcome. However, the clinical examination overestimated the therapeutic results. Only 4% of the patients were considered as failures, but the re-aspiration demonstrated remaining suppuration in 14% of all cases (p less than 0.001). Based on re-aspiration, the failure rate among patients with initial growth of pathogens was lower for cefixime (8%) than for cefaclor (20%) (p less than 0.05). Such a difference was not found among patients with growth of H. influenzae. No serious adverse reactions were recorded, but loose stools and diarrhoea were significantly more frequent in the cefixime treatment group. Five patients (2%) in the cefixime treatment group discontinued their treatment due to adverse events.

The effect of tightened hearing protection regulations on military noise-induced tinnitus

The objective of this study was to investigate the effect of tightened hearing protection regulations on tinnitus in the Finnish Defence Forces. The initial study group comprised 252 officers and non-commissioned officers (NCOs), of which 229 were included in the final study group. Subjective symptoms of tinnitus and audiometric test results for these officers and NCOs examined before retirement, from 1984 to 1986 (Period I), and 2003 to 2005 (Period II), were reviewed. Changes in tinnitus reports between the two time periods, during which regulations had been revised, were investigated. Prevalence of tinnitus showed a decline both in officers (from 68% to 63%) and in NCOs (from 76% to 72%) between the two study periods, in accordance with tightened hearing protection regulations. The Cox regression analysis showed a significantly decreased hazard ratio for constant or disturbing tinnitus for Period II. Tinnitus prevalence, especially constant or disturbing tinnitus, in the Finnish Defence Forces was diminished by tightened hearing protection regulations. Tinnitus might be more persistent than hearing loss and does not necessarily improve in direct relation to hearing loss after protective measures.