Perspectives of pharmacological treatment in otosclerosis

Liktor B, Szekanecz Z, Batta TJ, Sziklai I, Karosi T; European Archives of Oto-Rhino-Laryngology (Jul 2012)
To review our current knowledge of the pathologic bone metabolism in otosclerosis and to discuss the possibilities of non-surgical, pharmacological intervention.

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New aspects of HPV-positive head and neck cancer : Highlights from the 2011 ASCO Congress

Kofler B, Uecker FC, Muenscher A, Knecht R; Hals-Nasen-Ohrenheilkunde (HNO) 60 (5), 404-9 (May 2012)

HPV-positive head and neck carcinoma is significantly different than tobacco- and alcohol-induced cancer. Between 30% and 50% of oropharyngeal cancers are associated with human papillomavirus (HPV). Studies still show an increasing incidence. HPV-positive head and neck cancer patients have a better prognosis due to a better response to therapy. Especially patients with gene overexpression of immunological proteins in the antigen presentation are suggested to benefit from radiotherapy. A current retrospective study shows better outcomes for patients treated with radiotherapy in combination with biological targets compared to radiochemotherapy.

Reduction of Tinnitus Severity by the Centrally Acting Muscle Relaxant Cyclobenzaprine: An Open-Label Pilot Study

Coelho C, Figueiredo R, Frank E, Burger J, Schecklmann M, Landgrebe M, Langguth B, Elgoyhen AB; Audiology & Neuro-Otology 17 (3), 179-188 (Jan 2012)

Tinnitus, the phantom perception of sounds, is a highly prevalent disorder. Although a wide variety of drugs have been investigated off label for the treatment of tinnitus, there is no approved pharmacotherapy. We report an open-label exploratory pilot study to assess the effect of muscle relaxants acting on the central nervous system on tinnitus patients. Cyclobenzaprine at high (30 mg) and low doses (10 mg), orphenadrine (100 mg), tizanidine (24 mg) and eperisone (50 mg) were administered to a maximum of 20 patients per group over a 12-week period. High-dose cyclobenzaprine resulted in a significant reduction in the Tinnitus Handicap Inventory (THI) score between baseline and week 12 in the intention-to-treat sample. On the other hand, other treatments were not effective. These results were confirmed in an explorative analysis where baseline corrected THI and Clinical Global Impression scores at week 12 were compared between groups. The present open trial presents a new promising pharmacotherapy for tinnitus that should be validated in placebo-controlled double-blind trials.

Acute bilateral blindness as a presenting symptom of Non-Hodgkin's lymphoma

 Emami N, Daniel SJ; International Journal of Pediatric Otorhinolaryngology (Mar 2012)

NHL usually presents with lymphadenopathy or symptoms related to compression by the primary tumor of surrounding structures. While the head and neck region is a common site of involvement, blindness is rarely a presenting symptom. We report here the case of a child who presented to the emergency room with acute bilateral loss of vision and no other symptoms. Cranial imaging studies revealed a solid mass of the skull base with compression on optic nerves. Diagnosis of Burkitt's lymphoma was confirmed after biopsy. The patient had partial vision improvement two days after optic nerve decompression which was done immediately at the night of presentation.




Lemierre syndrome

Wright WF, Shiner CN, Ribes JA; Southern Medical Journal 105 (5), 283-8 (May 2012)


ABSTRACT: Lemierre's syndrome is an uncommon complication of pharyngitis in the United States and caused most commonly by the bacterium Fusobacterium necrophorum

. The syndrome is characterized by a history of recent pharyngitis followed by ipsilateral internal jugular vein thrombosis and metastatic pulmonary abscesses and is a disease for which patients will seek medical care and advice. As most patients are admitted to the hospital under internal medicine, practitioners should be familiar with the usual signs and symptoms of Lemierre's syndrome along with its diagnosis and treatment. Controversy involves the choice and duration of antimicrobial therapy used for treatment and anticoagulation therapy for internal jugular vein thrombosis. As the diagnosis and management of this syndrome has generated controversy, an updated review of the literature and treatment recommendations may be helpful for providing optimal care for patients with this often unrecognized and confusing infection.

L-N-Acetylcysteine treatment is associated with improved hearing outcome in sudden idiopathic sensorineural hearing loss

 Angeli SI, Abi-Hachem RN, Vivero RJ, Telischi FT, Machado JJ; Acta Oto-Laryngologica (Jan 2012)

Abstract Conclusion: Combination therapy corticosteroids plus an oral antioxidant L-N-acetylcysteine (LNAC) was associated with improved hearing over corticosteroids alone, particularly at the 6-month follow-up and at high frequencies (i.e. 4000 Hz). This is the first report of a beneficial effect of LNAC in sudden idiopathic sensorineural hearing loss (SISNHL)

. Objective: To determine the association between antioxidant treatment and functional outcomes in SISNHL. Methods: This was a case-control study of adult patients with SISNHL, treated with oral prednisone plus intratympanic dexamethasone either alone or in combination with LNAC. The outcome measure was change in pure-tone thresholds at 500-4000 Hz. Hearing recovery was also recorded as the percentage of subjects with final pure-tone threshold average (PTA) within 50% of the difference between the initial value of the affected ear and the value of the unaffected ear. Comparisons were made between combination (corticosteroids plus LNAC) and single (no LNAC use) therapy groups. Results: At 6 months, the mean PTA improvements were 26.1 dB and 15.1 dB for the combination and single therapy groups, respectively (p = 0.046). Higher gains at 4000 Hz were noted with LNAC use. The percentage of patients with at least 50% recovery was 63% and 35% for the combination and single therapy groups, respectively (p = 0.0319).

A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis

Taylor MB, Tan IT, Chan KT, Shen L, Shi L, Wang DY; Rhinology 50 (2), 139-46 (Jun 2012)

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts.

A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.