Vasilios Danielides

Transtympanic Injections of N-acetylcysteine for the Prevention of Cisplatin-induced Ototoxicity A Feasible Method With Promising Efficacy

Objectives:Ototoxicity is a common and irreversible adverse effect of cisplatin treatment with great impact on the patients’ quality of life. N-acetylcysteine is a low-molecular-weight agent which has shown substantial otoprotective activity. The role of transtympanic infusions of N-acetylcysteine was examined in a cohort of patients treated with cisplatin-based regimens. Patients and Methods:Twenty cisplatin-treated patients were subjected, under local anesthesia, to transtympanic N-acetylcysteine (10%) infusions in 1 ear, during the hydration procedure preceding intravenous effusion of cisplatin. The contralateral ear was used as control. The number of transtympanic infusions was respective to the number of administered cycles. Hearing acuity was evaluated before each cycle with pure tone audiometry by an audiologist blinded to the treated ear. Results:A total of 84 transtympanic infusions were performed. In treated ears, no significant changes in auditory thresholds were recorded. In the control ears cisplatin induced a significant decrease of auditory thresholds at the 8000 Hz frequency band (P=0.008). At the same frequency (8000 Hz), the changes in auditory thresholds were significantly larger for the control ears than the treated ones (P=0.005). An acute pain starting shortly after the injection and lasting for a few minutes seemed to be the only significant adverse effect. Conclusions:Transtympanic injections of N-acetylcysteine seem to be a feasible and effective otoprotective strategy for the prevention of cisplatin-induced ototoxicity. Additional studies are required to further clarify the efficiency of this treatment and determine the optimal dosage and protocol.

Allergic rhinitis and aspirin-exacerbated respiratory disease as predictors of the olfactory outcome after endoscopic sinus surgery.

Background Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS). Methods A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin’ Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18). Results Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic. Conclusion The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.

Treatment of the horizontal semicircular canal canalithiasis: pros and cons of the repositioning maneuvers in a clinical study and critical review of the literature.

Objective: Several repositioning maneuvers have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV) due to canalithiasis of the horizontal semicircular canal (HSC). However, comparisons between these canalith repositioning procedures as well as a generally accepted algorithm for the management of HSC canalithiasis are currently lacking. The aim of this study was to compare the efficacy of 3 different treatment proposals and review the relevant literature. Study Design: Prospective clinical study. Setting: Tertiary neurotology department. Patients: Sixty patients diagnosed with HSC canalithiasis. Interventions: A single application of Balohs maneuver (n = 13), Vannucchis forced prolonged position (n = 29), or Asprella-Gufoni maneuver (n = 18). Main Outcome Measures: Bilateral geotropic nystagmus. Results: The first application of the Balohs maneuver seemed to be significantly less effective than both Vannucchis forced prolonged position (p = 0.035) and the Asprella-Gufoni maneuver (p = 0.006). No significant difference was detected in the efficiency of Vannucchis forced prolonged position and the Asprella-Gufoni maneuver for this population (p = 0.4). Conclusion: The Asprella-Gufoni maneuver and Vannucchis forced prolonged position both seem to be significantly more effective than the Balohs maneuver in the treatment of HSC canalithiasis. The important pros of the Asprella-Gufoni maneuver versus Vannucchis forced prolonged position are patients convenience and maximal use of gravitational and angular acceleration forces. Controlled clinical studies are needed to conclude to an evidence-based proposal for the therapeutical steps that should be followed after the diagnosis of HSC canalithiasis.

Canalithiasis of the anterior semicircular canal (ASC): Treatment options based on the possible underlying pathogenetic mechanisms

Abstract Benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC) is an uncommon disorder currently diagnosed with the Dix-Hallpike (D-H) examination. According to the literature, nystagmus and vertigo may be more pronounced when the affected ear is either up or down. In some patients, both right and left D-H tests can trigger nystagmus with the same direction. The proposed treatment options with the addition of a different manoeuvre applied by the authors of the present study in cases of ASC lithiasis, seem to present a respective variety regarding the position of the affected ASC during the procedure of canalith repositioning. The aim of this study is to analyse the mechanisms underlying both the proposed treatment options and the clinical findings in the D-H examination. The results of this analysis stimulate further investigation, since they probably imply that repositioning manoeuvres might vary in their effectiveness when applied to different clinical subgroups of ASC BPPV. Sumario El vértigo postural paroxístico benigno (BPPV) del canal semicircular anterior (ASC) es un desorden poco común que actualmente se diagnostica mediante la prueba de Dix-Hallpike (D-H). De acuerdo con la literatura, el nistagmus y el vértigo pueden ser más pronunciados cuando el oído afectado está tanto arriba como abajo. En algunos pacientes, la maniobra de D-H a la derecha como a la izquierda pueden desencadenar nistagmus con la misma dirección. Las opciones de tratamiento propuestas con la adición de una maniobra diferente aplicada por los autores de este estudio en casos de litiasis del ASC, parece presentar una variedad respectiva de acuerdo a la posición del ASC afectado durante el procedimiento de reposición canalicular. El propósito de este estudio es analizar los mecanismos subyacentes tanto de las opciones terapéuticas propuestas como de los hallazgos clínicos de la prueba D-H. Los resultados de este análisis estimulan una mayor investigación puesto que probablemente impliquen que la efectividad de las maniobras de reposicionamiento puede variar cuando se aplican a diferentes subgrupos clínicos de ASC BPPV.

The Role of Diabetes Mellitus in the Clinical Presentation and Prognosis of Bell Palsy

Background: Bell palsy is considered to be an entrapment neuropathy resulting from inflammation, edema, and strangulation. Diabetes, hypertension, and hypercholesterolemia have all been related to microangiopathies. However, the relationship between the frequency, severity, and recovery course of Bell palsy in patients with these pathologies is a matter of controversy. Methods: Fifty-six patients with Bell palsy were evaluated according to the House-Brackmann grading system a few days after the onset of the disease and 6 months later and correlated to their hypertension, hypercholesterolemia, and diabetes records. Diabetes was evaluated by the use of serum glycosylated hemoglobin (HbA1c). Results: The 20 patients with abnormal HbA1c values were more frequently diagnosed with Bell palsy of grade V/VI (P = .008; odds ratio, 4.7; 95% CI, 1.4–15.2). However, their House-Brackmann scores were not found to be worse at the 6-month follow-up visit (P = .9). No correlations were found for hypertension and hypercholesterolemia. Conclusions: A relationship between the severity of Bell palsy and abnormal HbA1c values seems to be demonstrated. However, the prognosis of these patients does not seem to be worse because at the 6-month follow-up visit they present similar scores to nondiabetic patients.

Is the width of the labyrinthine portion of the fallopian tube implicated in the pathophysiology of Bell's palsy?: A prospective clinical study using computed tomography

The pathogenetic mechanisms underlying Bells palsy remain obscure, despite the extensive relevant research. Magnetic resonance imaging (MRI) studies have strongly indicated that facial nerve edema cannot be regarded as the sole etiologic factor, because it might persist long after full clinical recovery, or might be demonstrated in the clinically unaffected side or healthy controls. The aim of this study was to investigate the hypothesis that a narrow facial canal might be implicated in the pathophysiology of Bells palsy.

Chronic Pharyngitis is Associated with Severe Acidic Laryngopharyngeal Reflux in Patients with Reinke's Edema

Objectives: We evaluated the association between pathological acidic laryngopharyngeal reflux (LPR) events and chronic pharyngitis in patients with Reinkes edema. Methods: We performed a prospective controlled study in 20 consecutive patients with Reinkes edema without pathological acidic LPR events (group A) and 40 consecutive patients with Reinkes edema with both clinical symptoms and 24-hour pH-metry suggesting acidic LPR (group B). The severity of acidic LPR was assessed by use of the Reflux Finding Score (RFS), the Reflux Symptom Index (RSI), and dual antimony probe 24-hour pH-metry. The patients were evaluated for the presence of chronic pharyngitis by clinical examination and biopsy specimens taken from the posterior pharyngeal wall. The χ2 test was used to compare the groups for the presence of pharyngitis. In group B, the RSI, the RFS, and the total duration and number of acidic LPR events on 24-hour pH-metry were compared between patients with and without concomitant pharyngitis by use of the Mann-Whitney test. Results: Five patients of group A and 20 patients of group B had chronic pharyngitis. Therefore, more patients with Reinkes edema and clinical signs of LPR tended to have chronic pharyngitis than did those with Reinkes edema and no clinical signs of LPR, but the difference was not statistically significant (p = 0.064; odds ratio, 3.0; 95% confidence interval, 0.9 to 9.8). Among group B patients, those with pharyngitis had significantly more acidic LPR events (p < 0.001) and a greater exposure time to gastric fluid (p = 0.008) than did those without pharyngitis. Their RFS and RSI did not differ significantly (p = 0.692 and p = 0.914, respectively). Conclusions: Only in the subgroup of patients with Reinkes edema and LPR was there a statistically significant correlation between the pH probe results and the incidence of clinical pharyngitis. Awareness should increase among physicians about addressing chronic pharyngitis in therapy for acidic LPR and/or Reinkes edema.