A computer data bank system for otolaryngologic and audiologic data

A data bank system has been in routine clinical operation for more than two years in our department. It is used to record histories, physical findings, and audiometric data; to produce reports that are sent with short covering letters to referring physicians, and to establish a data bank for research. Although originally created for noise-induced hearing loss claimants referred by the Workmen's Compensation Board, the system was designed, from the start, to be applicable to a wide range of clinical conditions. This report describes the conceptual approach to the data bank and certain practical details involved. The system is quick and effective to use, and it can be run on a relatively small microcomputer.     

Computerized data collection and processing of graphic cephalometric data in dentomaxillofacial orthodontics

The authors present a graphic program adapted to cartography for the acquisition and processing of graphic data from x-rays and graphics used in dento-maxillo-facial orthopaedic cephalometry. They demonstrate the performance obtained in the automation of cephalometry, in the real-time edition of the results, in the processing of graphic images and the resulting alpha-numerical results.     

Computer analysis of electronystagmographic data

Manual calculation of the parameters of nystagmus is imprecise and time consuming. Therefore, a computer program for analysis for analysis of nystagmus has been built up in our laboratory. The program is based on automatic extraction of the minimum and maximum values of nystagmus. These values are stored for calculations of duration, amplitude and velocity of the fast and slow phase. The distinction between the slow and fast phase is based on the duration of the phases. The program is thus able to accept nystagmus in different directions.     

Cochlear implants: histological data

We have performed a histological examination of the pars petrosa of 13 implanted patients. Morphological data were confronted with the clinical findings. The results of this study show that the nerve elements stimulated by the electrode are the cells of the spiral ganglion, and that a small number of ganglionic cells, as few as 10% of the normal figure, is compatible with auditory perception by electrical stimulation. Furthermore, all the implanted pars petrosa were the seat of a fibrosis and neo-ossification reaction around and sometimes even beyond the tip of the electrode. The trauma caused by the insertion of the electrode into the cochlea involved the sensorial cells of the organ of Corti and the dendritic populations in the lamina spiralis, but the cells of the spiral ganglion were spared. Prolonged electrical stimulation (14 years in 1 case) does not appear to have any deleterious effect on the survival of the spiral ganglion, of the cochlear nerve or of the cochlear nucleus.     

Symposium: new data for noise standards. I. New data for noise standards

Continuous and impulse noises, considered “safe” by existing damage risk criteria were combined to model more realistic noise environments. Monaural chinchilla were exposed to one of the following conditions: a. 50 impulses with a 40 m?, sec A-duration at 158 db SPL peak pressure, 1/ minute; b. 95 db SPL continuous noise at 2–4 kHz for one hour; and c. superimposed combination of the continuous and impulse noise. Quiet thresholds were measured before and after exposure using the auditory evoked response, and histology was obtained, using the surface preparation technique. The audiometric and histological findings agree in showing that the superimposed combination of two “safe” noises produces traumatic effects that more than exceed the additive effects of either component. The existing damage risk criteria do not provide guidelines for such noise combinations.     

Computerized electronystagmography: normative data revisited

This study provides normative data from computerized electronystagmography (ENG) testing of 40 healthy subjects with an average age of 45 years. The clinical test protocol comprises an extensive vestibular examination with oculomotor, positional, rotary chair and caloric tests. The results show that with a computerized ENG set-up considerable variabilities of 22% for rotary chair asymmetry and 19% for caloric labyrinth asymmetry remain.     

Normative multifrequency tympanometric data on otosclerosis

Acoustic resistance, reactance and phase angle were assessed for the two probe tone frequencies (220 and 660 Hz) on 29 otosclerotic middle-ear systems under accurately defined experimental conditions. Only otosclerotics with normal tympanic membranes were accepted in this statistical survey. The main purpose of these measurements was to provide numerical data for middle-ear modelling. If nevertheless a diagnostic parameter is sought from these data, the immittance values can be compared with data obtained on 30 normals under identical experimental conditions. The phase angle at 660 Hz seems the best choice, but the discrimination power is still poor.     

Computerized electronystagmography: normative data revisited

This study provides normative data from computerized electronystagmography (ENG) testing of 40 healthy subjects with an average age of 45 years. The clinical test protocol comprises an extensive vestibular examination with oculomotor, positional, rotary chair and caloric tests. The results show that with a computerized ENG set-up considerable variabilities of 22% for rotary chair asymmetry and 19% for caloric labyrinth asymmetry remain.     

Analysis of rhinomanometric data based upon a model of nasal airflow and logarithmic transformation of the data

Estimation of nasal airflow, flow asymmetry and nasal valve stiffness was performed using anterior rhinomanometry in a group of 12 normal subjects and a group of 12 patients suffering from nasal obstruction. The method, based upon a simplified mathematical model of nasal airflow and utilizing logarithmic transformation of inspiratory pressure and flow data, improved the sensitivity and specificity of rhinomanometry and gave a more comprehensive index of nasal function.     

Prognostic value of tumor volumetry data of routine imaging data in a head and neck cancer registry

The purpose of this study was to analyze the impact of tumor volume (TV) measurements as prognosticator for recurrence-free survival (RFS) and overall survival (OS) from data of head and neck cancer (HNC) registries. TV measurements were performed in pre-treatment computed tomography (CT) or magnetic resonance images (MRI) of 392 unselected HNC patients. TV measurements were feasible in 275 patients (70 %). Median CT TV and MRI TV were 11.43 and 10.4 cm³, respectively. The CT TV was significantly different only between T1 and T4. CT TV was significantly different only between T1 and T4 (p = 0.041). MRI TV was significantly different between T1 and T4 (p = 0.003) as well as between T2 and T4 (p = 0.002). Median follow-up was 26.1 months. Median RFS was 80.7 months. Median OS was 66.5 months. On univariate analysis, significant prognostic factors for decreased RFS were advanced T stage (p = 0.010); M1 (p = 0.001) and an MRI TV > 10.4 cm³ (p = 0.001). Significant prognostic factors for a decreased OS were advanced T stage (p = 0.001), N+ (p = 0 006), M+ (p < 0.001), tumor recurrence (p < 0.001), CT TV (p = 0.005), and MRI TV (p = 0.012). On multivariate analysis for RFS, MRI TV was the best independent prognosticator (p = 0.003). On multivariate analysis for OS, T stage (p = 0.006) was a better prognosticator than CT or MRI TV. Using CT and MRI data sets of an unselected series of HNC patients in a cancer registry, TV measurements were not feasible in all patients. MRT TV was a powerful prognosticator for RFS.     

Nasometry normative data for young Dutch children

Objective

Hypernasality is a common problem in cleft care. It should be treated before the age of six, because of the impact it can have on speech sound development in young children. An objective method of nasalance evaluation is nasometry. To decide whether a nasometer test result is normal or abnormal, normative data and cut off points are needed. Normative data for children are not available for every language and age. For Dutch children two sets of Dutch speech stimuli, the Van Zundert sentences or the Moolenaar-Bijl, sentences, are often used in the diagnostic process for hypernasality. Primary goal of this study is to determine normative data and cut off points for two sets of Dutch speech stimuli for Dutch children from four to six years of age. Secondary is to compare those two sets of oral sentences.

Method

Children without clefts were recruited from schools. According to their teachers their speech was normal. They were tested with the nasometer with the two sets of speech stimuli. The set from Van Zundert has oral and oronasal sentences, the Moolenaar-Bijl set only has oral sentences.

Results

118 children were recruited. Out of these children, 55 produced recording samples which were suitable for analysis. There were no significant differences between age groups or gender. The two different sets of speech stimuli used were significantly different, but the confidence intervals overlapped.

Conclusions

Normal nasalance scores of the tested sentences are between 3 and 19% for oral sentences and between 17 and 37% for oronasal sentences. The Moolenaar-Bijl speech sentences are preferred to evaluate hypernasality in young Dutch children, because of the shortness and intelligibility. Normative nasalance scores are applicable to the whole group of children from four to six years of age.     

Resource implications of SNOT22 data submission

Background: Continuous clinical audit tools are important in the maintenance of good medical practice and will doubtlessly be used for revalidation purposes. Accordingly, ENT.UK and BRS developed The Rhinology Minimum Electronic Dataset, which is completed via online submission of pre‐ and postoperative SNOT22 scores of patients visiting the outpatient department. According the web tool guidance notes, once familiar with the system, any data entry relating to a single patient should take between 30 and 60 s. It also advises entering data in real time rather than at a later date to save time. Aim: This study assesses the resource requirements for submitting patients’ SNOT22 data using the Rhinology Minimum Electronic Dataset web tool. Method: SNOT22 scores were collected over a week of ENT outpatient sessions in April 2011. The number of patients (n) was 31. The data were submitted in a single sitting for each OPD session to avoid delays arising from automatic website logout. The study was carried out using a fast Internet connection (20 Mb) and an advanced computer operating system (Windows 7^®, Intel core i3), compared with those available locally. Results: The number of SNOT 22 scores collected was 31. The total submission time for SNOT22 results was 125 min, with an average time of 4 min per single patient’s data. The automatic logout time for the website was 20 min. Discussion: Our results show that the time required to enter patients’ data to the website is far longer (300% delay per patient) than the time suggested by the guidance notes. This would be even longer in real time using clinic‐based computers and Internet connection. The study suggests that the best results would be achieved by entering patients’ data at one sitting, rather than individually, following every OPD session, as a result of automatic logout time of the web browser. If our rhinology service were to use the web tool to register patients’ data, it would have a significant impact on our service resource and OPD consultation time.     

Case history data on unilaterally hearing-impaired children

This paper presents the data from medical and educational case histories on a group of 60 unilaterally hearing-impaired children. The case history data revealed that approximately one-half of the 60 children with unilateral sensorineural hearing loss exhibited some difficulty in educational progress. More specifically, 35% had failed at least one grade and an additional 13% were in need of some special resource assistance. Similar findings were obtained on a subset of 25 unilaterally hearing-impaired children who satisfied rather stringent criteria for age, hearing level, intelligence, length of time the impairment was present, history of middle ear disease, and general growth and development.     

Normative data for a solution-based taste test

The aim of our study was to study gustatory function in a large portion of the general population using liquid tastants, extending previous research. Further, we investigated the test–retest reliability of the test used. Data from 944 healthy subjects were used (498 women and 446 men, mean age 45 years; age range 5–90 years). For lateralized assessment of gustatory function, liquid taste solutions were used with different concentrations of each tastant (sweet 0.03, 0.1, 0.4, 2 g/mL sucrose solution; sour 0.01, 0.05, 0.1, 0.15 mL citric acid; salty 0.025, 0.075, 0.15, 0.36 mL sodium chloride solution; bitter 0.0002, 0.0005, 0.001, 0.01 mL quinine hydrochloride). A drop (approximately 20 μL) of liquid tastant was applied on the right side or on the left side of the anterior/posterior third of the extended tongue. The taste test had a good test–retest reliability r ₃₀₄ = 0.78 (P < 0.001) for the total score and r ₃₀₄ = 0.77 (P < 0.001) for the right-sided measures and r ₃₀₄ = 0.75 (P < 0.001) for the left-sided measures, respectively. Gustatory sensitivity was found to decrease with age; women were more sensitive to gustatory stimuli than men. Irrespective of the sex-related differences, the total score at the 10th percentile was 28 in subjects younger than 15 years, 26.1 for ages from 16 to 35 years, 25 for ages from 36 to 55 years, and 24 for subjects older than 56 years of age. In conclusion, this test is recommended for clinical assessment of the ability to taste. The test provides reliable data, which is easy to handle, inexpensive, timesaving and can be self-made.