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Audiometry results and TEOAE and DPOAE amplitudes in men taking a phosphodiesterase type 5 inhibitor for erectile dysfunction

July 18, 2017  |  Sertan Ontepeli, MD; Nuray Bayar Muluk, MD; Devrim Tuglu, MD; Timucin Sipal, MD


We conducted a prospective study of transient evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) in men who were taking an oral phosphodiesterase type 5 (PDE5) inhibitor for erectile dysfunction. Our study group was made up of 30 men (60 ears), aged 34 to 60 years (mean: 50.9). They were randomly divided into three groups; 10 men were given sildenafil (Viagra) at 50 mg twice a week, 10 were given tadalafil (Cialis) at 20 mg twice a week, and 10 were given vardenafil (Levitra) at 20 mg twice a week. All patients took their drug for 3 weeks, for a total of 6 tablets for each patient. Audiometric tests and TEOAE and DPOAE measurements were performed before and after treatment. Post-treatment audiometry demonstrated improvement in hearing in all three groups. However, post-treatment TEOAE amplitudes and DPOAE amplitudes differed among the three groups; they were significantly higher in the sildenafil group at 1.0 kHz and the same in the tadalafil group; in the vardenafil group, the DPOAE amplitude was significantly lower at 3.0 kHz while there was no change in the TEOAE amplitude. We speculate that the possible mechanism for these findings is that PDE5 inhibitors block degradation of cyclic guanosine monophosphate (cGMP) and induce dilation of the cochlear microcirculation, resulting in an increase in cochlear blood flow. We also believe that the decrease in DPOAE amplitudes at 3.0 kHz seen in the vardenafil group may be related to an accumulation of nitric oxide/cGMP complex, which is toxic to the cochlea; however, since there was no change in TEOAE amplitude in the vardenafil group, this influence may be minimal. Further studies are needed to obtain a more comprehensive assessment of the effects of PDE5 inhibitors on hearing with the use of higher doses and longer durations of therapy.

Community triage of otology patients using a store-and-forward telemedicine device: A feasibility study

July 18, 2017  |  Nishi Gupta, MD; Neeraj Chawla, MD; Digant Gupta, MD, MPH; Nidhi Dhawan, MD; Vidya R. Janaki, MD


Chronic otitis media is a major contributor to acquired hearing loss in developing countries. Developing countries such as India, with huge populations and poor health infrastructures, have always felt the shortage of trained specialists who can provide quality care to meet the enormous demand for treatment of this disease. This pilot study assessed the feasibility of empowering trained health workers equipped with ENTraview, a store-and-forward telemedicine device that integrates a camera- enabled smart phone with an otoscope. This device allows the screening of otology patients within the community. Three months of extensive training was provided to five community health workers on primary ear and hearing care, including training on the use of the ENTraview device. Community otology screenings were conducted to triage otology patients and provide them with specialized ENT care at a tertiary hospital. In the initial 6 months of the project, 45 screening camps were organized, which screened 3,000 patients free of cost. Of these 3,000 screened patients, 54% (1,619) were referred for ENT consultation and 215 patients reported. Nearly 50% (103) of the 215 reporting patients required surgical intervention, and 29 patients underwent surgery. Reaching out to the community by remote screening of ear diseases by trained technicians with a telemedicine device seems to be an effective and cost-effective way to triage patients with otologic pathologies.

Positron-emission tomography enhancement after vocal fold injection medialization

June 20, 2017  |  Nazaneen Grant, MD; Richard J. Wong, MD; Dennis H. Kraus, MD; Heiko Schoder, MD; Ryan C. Branski, PhD


The potential for the misinterpretation of positron-emission tomography (PET) scans in the context of a possible malignancy has been confirmed in a case report showing increased 18F-fluorodeoxyglucose (FDG) uptake after unilateral vocal fold augmentation medialization. We sought to expand these findings by investigating FDG uptake in a larger cohort of patients via a retrospective chart review. We examined the records of 15 adults-8 men and 7 women-who had undergone vocal fold augmentation for unilateral vocal fold paralysis and at least one subsequent PET scan. The differences in PET standard uptake value (SUV) between the injected and noninjected vocal folds were assessed via the Wilcoxon signed-rank test. A Spearman rank correlation coefficient was then used to estimate the relationship between differences in PET uptake and the length of time between the injection and the follow-up PET scan. The mean SUV of the injected vocal folds was 3.70, and the mean in the noninjected folds was 2.97. The difference did not achieve statistical significance (p = 0.34). In addition, the rank correlation coefficient with regard to the association between the difference in PET uptake and the duration between injection and PET was -0.24, suggesting an inverse relationship. However, the correlation coefficient did not differ significantly from zero (p = 0.34). We conclude that PET uptake after vocal fold augmentation medialization is variable and that it can increase substantially. This information should be considered in the context of the diagnostic accuracy of malignancy on PET.

Initial experience of a hereditary hemorrhagic telangiectasia center of excellence

June 20, 2017  |  Christopher F. Thompson, MD; Jeffrey D. Suh, MD; Justin McWilliams, MD; Gary Duckwiler, MD; Marilene B. Wang, MD


Our objectives in reviewing the initial experience of a hereditary hemorrhagic telangiectasia center of excellence (HHT COE) were to better understand the interventions being performed in the comprehensive care of these patients and to present the early data as a reference for other tertiary centers considering starting an HHT COE. We conducted a retrospective review of consecutive patients referred to our newly developed HHT COE for evaluation and treatment between May 2010 and June 2013. Clinical presentation, otolaryngologic treatments, and other operative interventions were analyzed. One hundred forty-four of the 198 patients (73%) evaluated at the HHT COE had definite HHT based on the Curaçao diagnostic criteria, with 20 additional patients possibly having HHT and undergoing further evaluation to confirm the diagnosis. Sixteen of the 31 patients (52%) referred to otolaryngology required intervention in the operating room for epistaxis. Seventy-two of the 164 (44%) patients with definite or possible HHT required other interventions for internal organ arteriovenous malformations (AVMs), with interventional radiology embolization of pulmonary AVMs being the most common procedure. An HHT COE is important in providing comprehensive care for patients with this rare disease, which has significant clinical sequelae. Having an HHT COE allows for early screening and subspecialty referral within a system of specialists experienced in preventing the morbidity and mortality associated with severe epistaxis and internal organ AVMs.

June is National Dysphagia Awareness Month

June 20, 2017  |  Amanda Hu, MD, FRCSC

The Agency for Healthcare Research and Quality has estimated that 60,000 people in the United States die annually from complications associated with swallowing disorders.

Results of endonasal dacryocystorhinostomy in pediatric patients

June 20, 2017  |  Sat Paul Gulati, MS; Raman Wadhera, MS; Ashok Kumar Khurana, MS; Nidhi Singh, MS; Vijay Kalra, MS; Anju Ghai, MD


We conducted a prospective interventional study to evaluate the role of endoscopic endonasal dacryocystorhinostomy in children. Our study population was made up of 20 patients-18 boys and 2 girls, aged 2 to 12 years (mean: 5.3)-who presented with signs and symptoms suggestive of nasolacrimal duct blockage that was refractory to conventional medical treatment. In all cases, blockage was confirmed by nasolacrimal duct syringing that demonstrated regurgitation from the opposite punctum. The primary outcome measures for success were resolution of symptoms and duct patency on lacrimal irrigation. At 6 months, 17 patients (85%) experienced complete symptomatic relief, 1 (5%) had partial relief, and 2 (10%) reported no relief. Moreover, the nasolacrimal duct was patent in 17 patients, partially patent in 2, and blocked in 1. We conclude that endoscopic endonasal dacryocystorhinostomy is a safe and effective procedure in children with nasolacrimal duct blockage when medical therapy and probing have been unsuccessful.

Vocal fold hemorrhage into a physiologic sulcus

June 20, 2017  |  Daniel A. Benito, MD; Jonathan J. Romak, MD; Robert T. Sataloff, MD, DMA, FACS

Predisposing factors include traumatic vocal activities such as aggressive singing, throat clearing, coughing, or shouting, especially with the use of anticoagulants.

Endoscopic view of a dumbbell-shaped sphenoid fungal mass

June 20, 2017  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

In cases of sinus mycetoma, endoscopic debridement and adequate drainage of the sinus is a very effective course of treatment.

Infestation of mites in external auditory canal

June 20, 2017  |  Denis Massatsugu Ueda, MD; Ricardo Borges, MD; José Eduardo Poloni da Silva, BS

Dermatophagoides spp comprise one of the most prevalent genera of house mites that, although well-known as allergens, rarely also parasitize the human body.

Salivary epidermal growth factor concentrations in patients with Sjogren syndrome and laryngopharyngeal reflux

June 20, 2017  |  Claudia A. Eckley, MD; Marco Antônio dos Anjos Corvo, MD; Luis Roberto Sardinha, PhD; Bianca Liquidato, MD; Luiz Vicente Rizzo, MD


Sjögren syndrome was chosen as a clinical model to study acinar salivary deficiencies in the development of laryngopharyngeal reflux (LPR). The objective of this prospective cohort study was to compare salivary epidermal growth factor (EGF) concentrations of patients with Sjögren syndrome with and without LPR and gastroesophageal reflux disease (GERD) with normal controls. LPR was diagnosed with positive scores on the Reflux Symptom Index and Reflux and Reflux Finding Score, corroborated by esophagogastroduodenoscopy and/or 24-hour pH-metry. Salivary EGF concentrations of both unstimulated and mechanically stimulated saliva were established using enzyme-linked immunosorbent assay, and the significance level was set at 95%. Twenty-one patients and 19 controls were studied. All patients had LPR and 60% also had GERD. The mean salivary EGF concentration of unstimulated and stimulated saliva in the control group was 1,751.37 pg/ml and 544.76 pg/ml, respectively. Unstimulated and stimulated salivary EGF concentrations in the study group were 2,534.65 pg/ml and 920.69 pg/ml, respectively. These differences were not statistically significant. Body mass index, presence of erosive esophagitis, or severity of hyposalivation did not significantly influence salivary EGF concentrations. LPR and GERD are highly prevalent in patients with Sjögren syndrome. Unlike previous studies in which significant EGF deficiencies were found in patients with reflux laryngitis and GERD, patients with Sjögren syndrome seem to have reflux caused by a decrease in clearance capacity and not in specific salivary components.