Nasal mucosal melanoma presenting as central type vertigo: a case report

Nasal mucosal melanoma presents usually with epistaxis, nasal obstruction and facial pain. However melanoma tends to give distant metastases at an early stage, having rare clinical presentations

Does listening to the sound of yourself chewing increase your enjoyment of food?

BACKGROUND: Anecdotal evidence suggests that listening to oneself eating results in a more pleasurable eating experience. Maximising the sensory experience of eating can result in increased oral intake and is potentially valuable in improving nutritional status in at-risk patients. OBJECTIVE: This pilot study investigates the association between listening to the sound of oneself eating and the consequences on enjoyment of eating. DESIGN: Prospective, randomized, controlled, cross-over trial of 10 fit, adult volunteers. Participants were timed eating a standardised amount of bread, and were randomized to eat in silence or whilst listening to their own amplified chewing and swallowing. Measurements of pulse and blood pressure were recorded throughout the procedure. Subjective pleasure scores were documented and the procedure repeated in the alternate study arm. RESULTS: There was no significant relationship demonstrated between listening to oneself chewing and the enjoyment of eating. CONCLUSION: Although this small pilot study was unable to demonstrate a significant relationship between listening to oneself chewing and enjoyment of eating, other evidence suggests that distraction techniques have a beneficial effect on dietary intake. Such techniques can be applied in a clinical setting and further work in this area has valuable potential

Dysphagia Management in Children: Implementation and Perspectives of Flexible Endoscopic Evaluation of Swallowing (FEES)

Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children’s health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child’s diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that comprises three parts: the evaluation of the anatomical and physiological parameters of swallowing, testing of food and liquids of a range of different consistencies, and evaluation of treatment methods. Pediatric FEES involves adaptations for infants, and special considerations about readiness for nutritive trials and the infant’s ability to sustain a coordinated feeding pattern. Varying consistencies and volumes of food or liquids are tried. Care of the dysphagic child involves team work. FEES, as a part of the assessment and management of dysphagia, enables the evaluation of the safety, efficiency, and adequacy of oral food and liquid intake. Future perspectives include standardized training in clinical FEES protocols to ensure clinical competency of the pediatric FESS team members and the development and validation of standardized examination and interpretation protocols for pediatric FEES

Contribution of Distortion Product Otoacoustic Emissions (DPOAEs) to the study of aminoglycoside induced ototoxicity

Objectives: The ototoxic effects of aminoglycosides, such as gentamicin and amikacin, are well-established. Otoacoustic emissions have been reported to be more sensitive in early detection of hearing loss than other methods, such as the conventional pure tone audiometry. This study aimed to investigate the ability of the Distortion Product Otoacoustic Emissions (DPOAEs) to detect early changes of the cochlear activity following administration of aminoglycosides.Materials and method: This is a prospective experimental study. Eight rabbits were included in the study. Three of the subjects were injected intramuscularly with amikacin and another three with gentamicin. One rabbit from each group was injected with a combination of aminoglycoside and fourosemide. All the animals were subjected to DPOAEs every two days since the beginning of the experiment for 14 days. Two animals were used as a control group.Results: Differences in the time of detection of changes of cochlear function were noticed between the animals that received gentamicin, gentamicin and furosemide, amikacin or amikacin and furosemide. The control animals did not present changes of cochlear function over the 14 days of the experiment.Conclusions: DPOAEs are objective, noninvasive and rapid measures used to determine cochlear function. As a method it has the ability to detect abnormal cochlear activity in early stages when hearing impairment caused by ototoxic drugs, such as aminoglycosides has not been established

Olfactory dysfunction in nasal polyposis: Correlation with computed tomography findings

Aims: This study evaluates if a computed tomography ( CT) scan is useful to assess the olfactory loss in sinonasal disease, and if a preoperative CT scan has a predictive value for the long-term outcome regarding olfaction. Methods: Thirty-one patients with nasal polyposis were included. Olfactory function was assessed with the ‘Sniffin’ Sticks’ test and subjective perception recorded with a visual analogue scale. CT scans were assessed with the Lund-Mackay system and the Damm nasal segmentation. Patients were retested after endoscopic sinus surgery in a follow-up appointment at least 1 year later. Results: Disease in the upper meatus and the posterior portion of the middle meatus strongly affects olfactory function. Lund-Mackay scores were significantly correlated with preoperative olfactory test results. Preoperative subjective ratings had a significant correlation only with present disease in the anterior upper meatus. Postoperative results were significantly decreased. Their relative percentage change was correlated only with the preoperative presence of disease in the anterior upper meatus. No correlation was found between the Lund-Mackay score and the postoperative olfactory results. Conclusions: Olfactory dysfunction in nasal polyposis is strongly related to specific obstructed nasal areas. A CT scan has no predictive value for the longterm surgical outcome regarding olfaction. (C) 2007 S. Karger AG, Basel

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases

Parental feeding practices and mealtime routine significantly influence a child’s eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case–control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child’s food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals

Smell as a Disease Marker in Multiple Sclerosis

Existing data suggest that people with multiple sclerosis (pwMS) are at an elevated risk for experiencing olfactory impairment. We investigated if smell dysfunction can be used as an MS disease marker. This is a cross-sectional, case–control study. All data were collected prospectively from 171 participants, 115 pwMS and 56 controls (age and sex stratified and matched to the patients), who reported smell, taste, and nasal breathing, and completed the Greek-validated questionnaires for nasal obstruction (NOSE), nasal-symptoms QoL (SNOT-22), and olfaction-associated QoL (QOD). The smell was assessed with the “Sniffin’ sticks” (odor threshold (OT), discrimination (OD), identification (OI) test, and total TDI). We recorded the pwMS disease characteristics (Expanded Disability Status Scale-EDSS, the disease type and duration), cognitive function, emotional status, fatigue, and impact of MS in everyday activities. A TDI < 30.75 (hyposmia) was detected in 30.8% of the patients. The patients’ OD and TDI scores were significantly lower than the controls’ (p = 0.005, and 0.015, respectively). The hyposmia correlated with disease severity and duration. The EDSS score correlated negatively with OD (r = −0.299, p = 0.001) and TDI (r = −0.242, p = 0.01). The disease duration correlated negatively with OD (r = −0.305, p = 0.001, OI (r = −0.253, p = 0.008) and TDI (r = −0.3, p = 0.001). The information processing speed (SDMT) correlated with OD, OT, and TDI (r = 0.302, p = 0.002; r = 0.242, p = 0.016; r = 0.326, p = 0.001). The olfactory function is changing in MS in accordance with disease progression

Video Head Impulse Test (vHIT): Value of Gain and Refixation Saccades in Unilateral Vestibular Neuritis

The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in the horizontal and vertical planes in patients after the onset of unilateral acute vestibular neuritis (AVN). Thirty-five patients were examined in the acute stage of AVN and at follow-up (range, 6–30 months); a control group of 32 healthy subjects also participated. At onset, the mean gain was significantly lower on the affected side in all of the semi-circular canal planes, mainly in the horizontal canal plane, and saccades (covert and overt) were more prevalent in the horizontal compared to the vertical canal planes. Multi-canal affection occurred more frequently (80% for gain, 71% for saccades) than isolated canal affection. At follow-up, which ranged from 6 to 30 months, the gain was recovered in all of the canals (anterior in 50%, horizontal in 42.8%, and posterior canal in 41.1% of cases), while covert and overt saccades were reduced in the horizontal and vertical planes. However, covert saccades were still recorded in a greater proportion (69%) than overt saccades (57%) in the horizontal plane and at a lower rate in the vertical planes. The compensatory mechanisms after AVN mainly involve the horizontal canal, as the refixation saccades—especially covert ones—were more frequently recorded in the horizontal than vertical canals