Ten-year longitudinal study of the effect of impulse noise exposure from gunshot on inner ear function

This longitudinal study investigated how chronic gunshot noise exposure affects cochlear and saccular function in police officers who engaged in regular target shooting practice using dual protection (ear plugs plus earmuffs) for >10 years. In 1997, 20 male police officers underwent audiometry before and two weeks after shooting. Twelve of the original subjects were re-examined by audiometry coupled with vestibular evoked myogenic potential (VEMP) test in 2007. Significant deterioration of mean hearing thresholds at frequencies of 500 Hz through 4000 Hz was noted ten years later, affecting both ears. However, only the frequencies of 4000 and 6000 Hz on the left ear revealed significant difference in mean hearing thresholds compared with healthy controls. Abnormal VEMP responses were evident in nine police officers (75%), including absent VEMPs 7 and delayed VEMPs 2. In conclusion, deterioration to hearing may occur after long term exposure to gunshots, even when double hearing protection is used. Further study is in progress regarding how to preserve both cochlear and saccular function during long term gunshot exposure.     

Transoral management of pharyngeal ballistics

ObjectiveTo present a case of a ballistic foreign body in the pharynx after a gunshot wound to the maxillofacial area, an accompanying review of relevant literature, and our approach to management.MethodA 68-year-old male with no prior medical history presented to our trauma center with gunshot wounds to the left chin, left wrist, right chest, and sternum. A CT Angiogram of the neck revealed a bullet fragment left neck and additional fragment adjacent to the L hypopharynx at the level of the hyoid. The patient was taken to the operating room for direct laryngoscopy with foreign body removal and esophagoscopy.ResultsWe document our workup and successful surgical removal of the pharyngeal ballistic foreign body via our video abstract, compiling preoperative imaging, intraoperative imaging, and video. Literature review of the subject accompanying our video abstract highlights the extensive complications that can occur from a retained foreign body in this area, supporting surgical removal of the foreign body if safely possible.ConclusionGiven the demonstrated feasibility and success of endoscopic foreign body removal from the pharyngoepiglottic space, in addition to overwhelming support for removal in the literature we recommend surgical extraction of ballistic foreign bodies located in the upper aerodigestive tract in stable patients to avoid early and long-term complications that can impact swallowing function, airway stability and the vital structures contained within the neck.     

Premalignant changes in nasal and sinus polyps: a retrospective 10 year study (1979-1988)

One hundred and seventy cases of nasal and/or sinus polyps diagnosed in the Pathology Service of the Hospital Militar Central GOMEZ/ULLA of Madrid (Spain) between 1.9.79 and 1.9.88 are reviewed. In two cases areas of 'carcinoma in situ' in the epithelium covering the polyps were demonstrated. The literature is reviewed for reports of malignant transformation and dysplastic changes in nasal and sinusal polyps. We suggest that precancerous changes may occasionally be noted in inflammatory lesions, a fact that pathologists should keep in mind.     

Using cluster analysis to classify audiogram shapes

Abstract

The purpose of this study was to design a statistical classification system of audiogram shapes in order to improve and integrate shape recognition across clinical settings. The study included 1633 adult subjects with normal hearing or symmetric sensorineural hearing impairment who underwent pure-tone audiometry between July 2007 and December 2008. K-means cluster analysis was employed to categorize audiometric shapes. Eleven audiogram shapes were identified: rising, flat, peaked 8-kHz dip, 4-kHz dip, 8-kHz dip, mild sloping, severe 8-kHz dip, sloping, abrupt loss, severe sloping, and profound abrupt loss. By using the classification system and nomenclature identified for audiogram shapes as outlined in this study, errors based on personal experiences can be reduced and a consistency can be developed across clinics.

Sumario

El propósito de este estudio fue diseñar un sistema de clasificación estadística de formas de audiogramas para mejorar e integrar el reconocimiento de formas en los diferentes contextos clínicos. El estudio incluyó 1633 sujetos adultos con audición normal o con hipoacusias sensorineurales simétricas, que se sometieron a una audiometría tonal entre julio del 2007 y diciembre del 2008. El análisis en grupo con medios K fue utilizado para organizar las formas audiométricas. Se identificaron once formas audiométricas: en ascenso, planas, con caída puntiaguda en 8 kHz, con caída en 4 kHz, con caída en 8 kHz, con pendiente suave, con caída severa en 8 kHz, con pendiente, pérdida abrupta, pendiente severa y pérdida profunda abrupta. Utilizando el sistema de clasificación y la nomenclatura identificada para las formas de audiograma conforme se delinea en este estudio, los errores basados en la experiencia personal pueden reducirse y puede desarrollarse consistencia entre las clínicas audiológicas.     

Speech-evoked brainstem responses in Arabic and Hebrew speakers

Abstract

Based on studies in English speakers, it has been proposed that speech-evoked brainstem responses (ABRs) may be used clinically to assess central auditory function. Whether the same procedure can be used across speakers of different languages remains unclear, because recent findings suggest that language experience affects even subcortical processing of speech. The goal of the present study was to characterize brainstem responses to the syllable /da/ in Arabic and Hebrew speakers using the US developed BioMARK procedure. To that end, ABRs evoked by clicks and the syllable /da/ were collected from 37 normal-hearing students from the University of Haifa. Neither the transient nor the sustained components of the brainstem response differed significantly between Arabic and Hebrew speakers. Across the two groups, timing of the major components of the speech-evoked response as well as the correlations between the speech- and click indices were well within the US norms. Therefore, brainstem processing of the syllable /da/ does not differ between speakers of English and speakers of Semitic languages such as Arabic and Hebrew.

Sumario

Con base en los estudios realizados en hablantes del inglés se ha propuesto que las respuestas del tallo cerebral evocadas por lenguaje (ABR) pueden utilizarse clínicamente para evaluar la función auditiva central. Aun no queda claro si el mismo procedimiento puede utilizarse (transversalmente) entre los hablantes de diferentes lenguas ya que algunos hallazgos recientes sugieren que la experiencia lingüística afecta incluso el procesamiento subcortical del lenguaje. El objetivo del presente estudio fue caracterizar las respuestas del tallo cerebral ante la sílaba /da/ en hablantes del árabe y el hebreo utilizando el procedimiento BioMARK desarrollado en EUA. Para tal fin, se colectaron respuestas de ABR evocadas por clicks y por la sílaba /da/ de 37 estudiantes normoyentes de la Universidad de Haifa. Ni los componentes basales ni los transitorios de las respuestas evocadas difirieron significativamente entre los hablantes del árabe y del hebreo. A través de los dos grupos la temporalidad de los componentes mayores de las respuestas evocadas por lenguaje así como la correlación entre los índices con lenguaje y con clicks estuvieron dentro de las normas de los EUA. Por lo tanto, el procesamiento del tallo cerebral de la sílaba /da/ no difiere entre los hablantes del inglés y los hablantes de las lenguas semíticas como el árabe y el hebreo.     

Labyrinthine concussion following gunshot injury: A case report

Objective: Labyrinthine concussion due to a postauricular gunshot wound has not been well reported. Design: Retrospective chart review. Study sample: We describe an otherwise healthy 22-year-old male who received a gunshot wound to the left mastoid and subsequently reported hearing loss and rotational vertigo. Results: Audiometric testing demonstrated significant inverted scoop shaped sensorineural hearing loss. Vestibular diagnostic testing indicated a significant uncompensated left peripheral vestibulopathy. Imaging demonstrated no structural changes to the middle ear or labyrinth, suggesting that the auditory and vestibular losses noted on diagnostic examination were likely due to labyrinthine concussion. Conclusions: Labyrinthine concussion may lead to reduced vestibular reflex pathway following gunshot wounds to the temporal bone. Clinical presentation is likely to vary significantly among cases.     

Facial wounds. Statistical and aetiological study of 1488 cases (author's transl)

Study of 1,488 cases of facial injuries treated in the Department of Maxillofacial surgery of the Montpellier Teaching Hospital Centre, led the authors to draw certain conclusions with regard to causes one the one hand and secondly the individuals involved. Road accidents were by far the largest cause, accounting for 70.2% of facial wounds. Domestic accidents took second place at 13%, followed by brawls and attacks as well as work accidents (each approximately 5%).     

Therapiezufriedenheit mund-, kiefer- und gesichtschirurgischer Patienten nach Operationen unter Klinischer Hypnose

The Department of Maxillofacial Surgery of the University Hospital Schleswig-Holstein/Campus Lübeck offers intraoperative hypnosis since 2002. Besides clinical evaluation by controlled studies, patients attitudes should be included in the judgement on such adjuvant procedure not established in general.70 patients of the department treated under combined local anaesthesia/hypnosis rated their individual postoperative patient satisfaction by standardised questionnaires. A control group of equal size and demographic/surgical features consisted of patients that were treated without hypnosis in the same interval.Results of the inquiry indicate that intraoperative hypnosis increases significantly postoperative satisfaction of oral and maxillofacial patients. Satisfaction is attributed decisively on the adjuvant procedure.     

Injuries due to foreign body aspirations in Georgia: A prevention perspective

BackgroundSuffocation due to foreign bodies (FB) is a leading cause of death in children aged 0–3. No data from the former U.S.S.R. are available in the international scientific literature.MethodsConsecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies’ inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis.Results2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the “High-Income” countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data.ConclusionsSince Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective.Level of evidenceLevel V, Epidemiological case series.     

Induced membrane technique in oral & maxillofacial reconstruction

Maxillofacial defects reconstruction represents a formidable challenge to achieve both functional and aesthetic goals. To succeed, numerous parameters must be taken into account: patient's general conditions, defect's location, width and type of the defect and eventual donor sites which can provide the tissues. Routine reconstructions include bone transplantation (autologous, homologous or heterologous), implantation of biomaterials and osteogenic distraction. The advantages of these techniques are evident, but they are usually limited by their complexity in patients with bad general health. The technique of induced membranes needs to be more known in maxillofacial surgery.     

Audiogram configurations among older adults: Prevalence and relation to self-reported hearing problems

Abstract

Objective: There are only a few population-based epidemiological studies on audiogram configurations among adults. The aim of this study was to investigate the prevalence of different audiogram configurations among older adults. In addition, audiogram configurations among subjects reporting hearing problems were examined. Design: Cross-sectional, population-based, unscreened epidemiological study among older adults. Study sample: The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: The most prevalent audiogram configuration among men was high-frequency steeply sloping (65.3% left ear, 51.2% right ear) and among women, high-frequency gently sloping (33.0% left ear, 31.5% right ear). There were significantly more flat configurations among women than among men. Unclassified audiograms were common especially among women (17.5%). Subjects reporting hearing difficulties, difficulties in following conversation in noise, or tinnitus, more often had a high-frequency steeply sloping configuration than those not reporting. Conclusions: High-frequency sloping audiogram configurations were common among older adults, and a high-frequency steeply sloping configuration was common among those reporting hearing problems.

Sumario

Objetivo: Existen pocos estudios epidemiológicos poblacionales sobre la configuración de los audiogramas en adultos. El objetivo de este estudio fue investigar la prevalencia de diferentes configuraciones audiométricas entre los adultos mayores. Además se examinaron las configuraciones audiométricas de los sujetos que reportaban problemas auditivos. Diseño: Estudio epidemiológico transversal basado en población no tamizada entre adultos mayores. Muestra: Los sujetos (n = 850), con edades entre 54 y 66 años fueron escogidos al azar de un registro poblacional. Se les aplicó un cuestionario y se realizó un examen otológico y una audiometría tonal. Resultados: la configuración audiométrica más prevalente en hombres fue la de caída abrupta en frecuencias agudas (65.3% oído izquierdo, 51.2% oído derecho) y entre las mujeres fue la caída suave en frecuencias agudas (33% oído izquierdo y 31.5% oído derecho). La configuración plana fue significativamente más frecuente en mujeres que en hombres. Los audiogramas no clasificados fueron comunes, especialmente entre las mujeres (17.5%). Los sujetos que reportaban dificultades auditivas, dificultad para seguir una conversación en ruido o acúfeno presentaban con mayor frecuencia una caída abrupta en frecuencias agudas que aquellos que no lo reportaban. Conclusiones: Las configuraciones audiométricas con caída abrupta en frecuencias agudas fueron más comunes entre quienes reportaron problemas auditivos.     

Acoustic and psychoacoustic analysis of the noise produced by the police force firearms

Police officers are exposed to impact noise coming from firearms, which may cause irreversible injuries to the hearing system.AimTo evaluate the noise exposure in shooting stands during gunfire exercises, to analyze the acoustic impact of the noise produced by the firearms and to associate it with tonal audiometry results.Study designCross-sectional.Materials and methodsTo measure noise intensity we used a digital sound level meter, and the acoustic analysis was carried out by means of the oscillations and cochlear response curves provided by the Praat software. 30 police officers were selected (27 males and 3 females).ResultsThe peak level measured was 113.1 dB(C) from a .40 pistol and 116.8 dB(C) for a .38 revolver. The values obtained for oscillation and Praat was 17.9±0.3 Barks, corresponding to the rate of 4,120 and 4,580 Hz. Audiometry indicated greater hearing loss at 4,000Hz in 86.7% of the cases.ConclusionWith the acoustic analysis it was possible to show cause and effect between the main areas of energy excitation of the cochlea (Praat cochlear response curve) and the frequencies of low hearing acuity.     

Management of penetrating neck injuries at a London trauma centre

Penetrating neck injuries (PNIs) are uncommon in the UK. The majority of guidelines are from the USA or South Africa. No UK national guidelines exist. Increasing urban violence in the UK has lead to an increase in PNIs. There is a need to develop a PNI guideline that reflects the pathology and experience in the UK. A retrospective review of all PNIs managed at St George’s Hospital over an 18 month period was undertaken. Data collected included patient demographics, mechanism of injury, investigations, multidisciplinary team involvement and management. Clinical activity data was correlated to current worldwide literature and a flow-chart style clinical guideline was produced. 25 neck wounds were managed over an 18 month period. 68 % were male, 32 % female with a mean age of 36 years. The mechanism of injury included deliberate self-harm (48 %), stab wounds (32 %), gunshot wounds (4 %), shotgun wounds (4 %) and other accidental causes (12 %). 52 % of wounds were superficial to platysma. 58 % of deep wounds had CT. 42 % of patients with deep wounds also had panendoscopy. Interventional radiology was used in one case (8 %) and a single case was managed jointly with the vascular team (8 %). UK ENT surgeons have limited exposure to neck trauma and dedicated head and neck out-of-hours cover is uncommon. There is a need for UK PNI guidelines that reflect local pathology and experience. The St George’s PNI guideline can be used to facilitate assessment, documentation and management of a relatively infrequent emergency presentation.     

Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals

OBJECTIVE: Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia. METHODS: Patients' records of three selected hospitals in Malaysia (National University of Malaysia Hospital, Kajang Hospital and Seremban Hospital) from January 1999 to December 2001 were reviewed. Data associated with demographics, etiology of injury in relation to age group, type of injuries whether soft tissues of hard tissue in relation to age group and treatment modalities were collected. RESULTS: A total of 521 pediatric patients' records were reviewed. Malays made up the majority of patients with maxillofacial injuries in the three hospitals. Males outnumbered females in all the three hospitals. Injuries commonly occur in the 11-16 years old. MVA was the most common etiology followed by fall and assault. Soft tissue injuries were the most common type of injuries in all the hospitals. In relation to fractures, mandible was the most common bone to fracture with condyle being the most common site. Orbital fracture was the most common fracture in the midfacial area. Most of the fractures were managed conservatively especially in the younger age groups. Open reduction with or without internal fixation was more frequently carried out in the 11-16 years old group. CONCLUSION: Children exhibit different pattern of clinical features depending on the etiology and stage of their bone maturation. A dedicated team, who is competent in trauma and aware of the unique anatomy, physical and psychological characteristics of children, should manage pediatric patient with trauma.     

A case of cerebellar infarction caused by vertebral artery injury from a stab wound to the neck

Vertebral artery injuries are the least common arterial injuries because of the deep location of the vessel in a bony canal. Injury of this vessel has not been associated with neurological deficits, and it is thought that many of these injuries are not recognized. The incidence of vertebral artery injury occurring after a penetration wound to the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. However, even with vertebral artery injury in penetration wounds of the neck the association with cerebellar infarction is a rare occurrence. We describe a case of cerebellar infarction caused by vertebral artery injury from a stab wound that severed the vessel between the transverse processes of C3 and C4 with a hypoplastic contralateral vertebral artery. The patient ultimately suffered infarction of the cerebellum due to the lack of preservation of the posterior inferior cerebellar artery blood flow. Management is discussed and the medical literature is reviewed.     

Gunshot wounds to the head and neck.

The types of injury which occur as a result of the civil disturbances in the north of Ireland are described. Four cases of gunshot wounds to the head and neck are described, each of particular clinical interest. The recent literature on the subject is reviewed and the consensus of opinion appears to be that the safest policy is to explore all cases of penetrating wounds of the neck     

Penetrierende Schussverletzung im Halsbereich

Penetrating gunshot neck injuries present a serious challenge for the primary attending surgeon. By means of a case treated in the German Field Hospital in Mazar-e-Sharif (northern Afghanistan) and a review of the literature, the principles of diagnosis and treatment of penetrating zone II neck injuries due to gunshots or shrapnel are presented.     

Evaluation of hearing protection used by police officers in the shooting range

IntroductionImpact noise is characterized by acoustic energy peaks that last less than a second, at intervals of more than 1 s.ObjectiveTo quantify the levels of impact noise to which police officers are exposed during activities at the shooting range and to evaluate the attenuation of the hearing protector.MethodsMeasurements were performed in the shooting range of a military police department. An SV 102 audiodosimeter (Svantek) was used to measure sound pressure levels. Two microphones were used simultaneously: one external and one insertion type; the firearm used was a 0.40 Taurus^® rimless pistol.ResultsThe values obtained with the external microphone were 146 dBC (peak), and a maximum sound level of 129.4 dBC (fast). The results obtained with the insertion microphone were 138.7 dBC (peak), and a maximum sound level of 121.6 dBC (fast).ConclusionThe findings showed high levels of sound pressure in the shooting range, which exceeded the maximum recommended noise (120 dBC), even when measured through the insertion microphone. Therefore, alternatives to improve the performance of hearing protection should be considered.     

Peripheral osteoma of the maxillofacial region: a study of 10 cases

Peripheral osteoma is a benign neoplasm, with low recurrence rate. Its incidence is rare in the jaws and the mandible is more affected than the maxilla. In most cases it is discovered during routine radiographic examinations.ObjectiveThe aim of this study is to show the author's experience regarding the treatment of this neoplasm.MethodsA retrospective study from January 2002 to December 2007 including ten cases of peipheral osteoma in the maxillofacial region which were treated surgically by removal of the lesion followed by histological confirmation. None of the cases were correlated with Gardner's syndrome.ResultsIn this series the incidence of this neoplasm was higher in females (1.5:1) with a mean age of 39, without age preference. One of the patients had lesion recurrence two years after the first surgery, having been submitted to another intervention, with no signs of relapse after three years and six months of follow-up.ConclusionSurgical treatment is effective for peripheral osteoma with a low recurrence rate.     

Vestibular rehabilitation with biofeedback in patients with central imbalance

Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now.ObjectiveThe aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort.Materials and MethodsThis is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP) and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all.Results75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients.ConclusionThe patients were able to use the electrotactile stimulus to improve their balance control.