Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults

Assessment of potential effects of the electromagnetic fields of mobile phones on hearing

BACKGROUND: Mobile phones have become indispensable as communication tools; however, to date there is only a limited knowledge about interaction between electromagnetic fields (EMF) emitted by mobile phones and auditory function. The aim of the study was to assess potential changes in hearing function as a consequence of exposure to low-intensity EMF's produced by mobile phones at frequencies of 900 and 1800 MHz. METHODS: The within-subject study was performed on thirty volunteers (age 18–30 years) with normal hearing to assess possible acute effect of EMF. Participants attended two sessions: genuine and sham exposure of EMF. Hearing threshold levels (HTL) on pure tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAE's) were recorded before and immediately after 10 min of genuine and/or sham exposure of mobile phone EMF. The administration of genuine or sham exposure was double blind and counterbalanced in order. RESULTS: Statistical analysis revealed no significant differences in the mean HTLs of PTA and mean shifts of TEOAE's before and after genuine and/or sham mobile phone EMF 10 min exposure. The data collected showed that average TEOAE levels (averaged across a frequency range) changed less than 2.5 dB between pre- and post-, genuine and sham exposure. The greatest individual change was 10 dB, with a decrease in level from pre- to post- real exposure. CONCLUSION: It could be concluded that a 10-min close exposure of EMFs emitted from a mobile phone had no immediate after-effect on measurements of HTL of PTA and TEOAEs in young human subjects and no measurable hearing deterioration was detected in our study

Diagnostic sensitivity and specificity of laryngoscopic signs of reflux laryngitis

Objective. To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis. Material and methods. Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in this study. Summing up all evaluations of laryngeal changes, laryngoscopic reflux index was proposed. Results. Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch were found to be most significant for diagnostics of reflux laryngitis. Presence of mucosal lesions of the interarytenoid notch (roughness, hypertrophy, keratosis, granuloma) increases the odds ratio to attribute the patient to the reflux laryngitis patient group 21 times (OR=21.32, 95% CI 4.38–103.93; P<0.001). Mucosal lesions (hypertrophy, keratosis, granuloma) and edema of vocal cords were determined as the most sensitive and rather specific laryngoscopic signs. Roughness and grade II hypertrophy of interarytenoid notch were found to be the most specific (98%) and sensitive (56%) laryngoscopic signs of reflux laryngitis. Abnormal values of laryngoscopic reflux index (higher than 5 points) reflect a diagnostic sensitivity of 96% and specificity of 97% differentiating patients with reflux laryngitis from healthy persons. Conclusions. Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch are found to be the most significant laryngoscopic signs for diagnostics of reflux laryngitis. Laryngoscopic reflux index was found to be the most sensitive and specific diagnostic criterion for reflux laryngitis

Expression of matrix metalloproteinases (MMP-2 and MMP-9) in vocal fold polyps

Objective. Vocal fold polyps are the most common benign laryngeal lesions. Matrix metalloproteinases (MMP) play an important role in the physiological and pathological remodeling of tissues. The most important subgroup of MMP family consists of gelatinases A and B (MMP-2 and MMP-9). The objective of this study was investigation of the expression of MMP-2 and MMP-9 in vocal fold polyps and normal tissue of vocal folds. Material and methods. The immunohistochemical expression of MMP-2 and MMP-9 was investigated in specimens taken by endolaryngeal microsurgery from vocal fold polyps (n=30) and normal tissue of vocal fold (n=13, control group). Expression of MMP-2 and MMP-9, both in epithelium and stroma cells, was graded on a semiquantitative scale, ranging from 0 (no expression) to 6 points (high expression). Results. A statistically significant increase was observed in the expression of MMP-2 in stroma cells (P=0.0176) of vocal fold polyps compared to control vocal fold group, whereas no significant difference in the expression of MMP-2 was found in epithelium cells (P=0.1487). Comparison of expression of MMP-2 and MMP-9 in epithelium cells revealed a statistically significant increase in MMP-9 expression (P<0.01) in both groups. However, there was no statistically significant difference in the expression of MMP-9 between groups of vocal fold polyps and control vocal folds. Conclusion. Expression of MMP-2 in stroma was significantly higher in polyps than in normal tissue of vocal folds. Our data draw attention to the role of MMP-2 in the development of vocal fold polyps and necessity of further investigations to define its function in morphogenesis of laryngeal benign, premalignant, and malignant lesions

Correlation between throat-related symptoms and histological examination in adults with chronic tonsillitis

Objective: The aim of the study was to evaluate correlations between throat-related symptoms and histological findings in adults with chronic tonsillitis. Materials and methods: A prospective cohort study was carried out. Throat-related symptoms (complaints, tonsillitis rate, and pharyngeal findings) of 81 adults with histologically proven chronic tonsillitis followed by tonsillectomy were analyzed. Four types of histological changes in removed tonsils were determined: (1) pure hyperplasia, (2) chronic inflammation, (3) chronic inflammation with hyperplasia, (4) chronic inflammation with scarring/fibrosis. The power of correlation was tested using the Pearson contingency coefficient (CC). Results: Recurrent throat infections were the most common complaint (74.1%). The mean tonsillitis rate was 3.6 (SD 1.9) episodes per year. Tonsillar cryptic debris (61.7%) and hyperemia of the anterior pillars (59.3%) were the most common pharyngeal findings. Chronic inflammation with hyperplasia was predominant (38.3%) histological type of chronic tonsillitis. The statistically significant correlations between histological type and combination of tonsillitis rate ≥3 times per year with cryptic debris (CC = 0.346; P = 0.010) and cryptic debris alone (CC = 0.294; P = 0.051) were detected. Conclusions: Assessment of throat-related symptoms is complementary to histological examination in adults with chronic tonsillitis

Modern attitude towards management of laryngopharyngeal form of gastroesophageal reflux disease. Lithuanian clinical practice guidelines for adults

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem

Model of human recurrent respiratory papilloma on chicken embryo chorioallantoic membrane for tumor angiogenesis research

We aimed to develop a chick embryo chorioallantoic membrane (CAM) model of recurrent respiratory papilloma (RPP) and to evaluate its morphological and morphometric characteristics, together with angiogenic features. Fresh RRP tissue samples obtained from 13 patients were implanted in 174 chick embryo CAMs. Morphological, morphometric, and angiogenic changes in the CAM and chorionic epithelium were evaluated up until 7 days after the implantation. Immunohistochemical analysis (34βE12, Ki-67, MMP-9, PCNA, and Sambucus nigra staining) was performed to detect cytokeratins and endothelial cells and to evaluate proliferative capacity of the RRP before and after implantation on the CAM. The implanted RRP tissue samples survived on CAM in 73% of cases while retaining their essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM (241-560%, p=0.001) and the chorionic epithelium (107-151%, p=0.001), while the number of blood vessels (37-85%, p=0.001) in the CAM increased. The results of the present study confirmed that chick embryo CAM is a relevant host for serving as a medium for RRP fresh tissue implantation. The CAM assay demonstrated the specific RRP tumor growth pattern after implantation and provided the first morphological and morphometric characterization of the RRP CAM model that opens new horizons in studying this disease

Psychometric properties of the Lithuanian version of Sleep Apnea Quality of Life Index (a pilot study)

Objective. To arrange and test for its psychometric properties Lithuanian version of Sleep Apnea Quality of Life Index and assess quality of life among snoring and obstructive sleep apnea patients before and after the treatment. Material and methods. Cross-cultural adaptation of Lithuanian version of Calgary Sleep Apnea Quality of Life Index was accomplished according to generally accepted methodology. In total, 36 (29 males and 7 females) patients (mean age, 41.1±9.7 years) suffering from socially disturbing snoring and obstructive sleep apnea were included into the study. All patients underwent complete full-night polysomnography (mean apnea/hypopnea index, 12.7±11.2) and were treated with two sessions of radiofrequency tissue ablation at the palatal and tong base (if it was necessary) levels. Lithuanian version of the Calgary Sleep Apnea Quality of Life Index was presented before the treatment with radiofrequency tissue ablation and in the period of 2 to 3 months after the treatment. Thirty-five patients repeated the same questionnaire after three weeks to assess the reliability of scores. Results. The Cronbach’s α coefficients of internal reliability were above the standard (0.7 for groups) in all subdomains and domains. Test-retest correlation coefficients for each domain (ranged from 0.92 to 0.94) were statistically significant (P<0.0001). Lithuanian version of the questionnaire was found to be responsive to clinical change. A statistically significant difference in the mean Sleep Apnea Quality of Life Index scores in the study group patients before and after the surgery was found in all daily functioning subdomains and social interactions domains. Conclusions. Overall, the results of the present pilot study demonstrate that the Lithuanian version of Sleep Apnea Quality of Life Index is applicable for clinical purposes