Update on the Diagnosis and Treatment of Spontaneous Intracranial Hypotension

Abstract

Purpose of Review

The purpose of this study is to provide an update on recent developments in the understanding, diagnosis, and treatment of spontaneous intracranial hypotension (SIH).

Recent Findings

SIH is an important cause of headaches caused by spinal cerebrospinal fluid (CSF) leaks, with an increasingly broad spectrum of clinical presentations and diagnostic findings. A simple conception of the condition as being defined by the presence of low CSF pressure is no longer sufficient or accurate. A number of etiologies for spinal CSF leaks have been identified, including the recent discovery of CSF-venous fistulas, and these various etiologies may require different diagnostic and therapeutic pathways in order to affect a cure.

Summary

Familiarity with the spectrum of presentations and causes of SIH is critical to accurate and timely diagnosis and management. Challenges exist in both diagnosis and treatment, and require understanding of the underlying pathogenesis of the condition in order to appropriately select testing and treatment. Prospective studies are needed going forward in order to inform workup and guide treatment decisions.

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Prevalence of Hearing Loss Among Children 9 to 11 Years Old: The Generation R Study.

Prevalence of Hearing Loss Among Children 9 to 11 Years Old: The Generation R Study.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: le Clercq CMP, van Ingen G, Ruytjens L, Goedegebure A, Moll HA, Raat H, Jaddoe VWV, Baatenburg de Jong RJ, van der Schroeff MP

Abstract
Importance: Hearing loss (HL), a major cause of disability globally, negatively affects both personal and professional life.
Objective: To describe the prevalence of sensorineural hearing loss (SNHL) among a population-based cohort of 9- to 11-year-old children, and to examine potential associations between purported risk factors and SNHL in early childhood.
Design, Setting, and Participants: The study was among the general, nonclinical, pediatric community within the city of Rotterdam, the Netherlands, and was conducted between 2012 and 2015 as a cross-sectional assessment within the Generation R Study, a population-based longitudinal cohort study from fetal life until adulthood. Participants are children of included pregnant women in the Generation R Study with an expected delivery date between April 2002 and January 2006. They form a prenatally recruited birth cohort.
Main Outcomes and Measures: Pure-tone air-conduction hearing thresholds were obtained at 0.5, 1, 2, 3, 4, 6, and 8 kHz, and tympanometry was performed in both ears. Demographic factors and parent-reported questionnaire data, including history of otitis media, were also measured.
Results: A total of 5368 participants with a mean age of 9 years 9 months (interquartile range, 9 years 7 months-9 years 11 months) completed audiometry and were included in the analyses. A total of 2720 were girls (50.7%), and 3627 (67.6%) were white. Most of the participants (4426 children [82.5%]) showed normal hearing thresholds 15 dB HL or less in both ears. Within the cohort, 418 children (7.8%) were estimated to have SNHL (≥16 dB HL at low-frequency pure-tone average; average at 0.5, 1, and 2 kHz or high-frequency pure-tone average; average at 3, 4, and 6 kHz in combination with a type A tympanogram) in at least 1 ear, most often at higher frequencies. In multivariable analyses, a history of recurrent acute otitis media and lower maternal education were associated with the estimated SNHL at ages 9 to 11 years (odds ratio, 2.0 [95% CI. 1.5-2.8] and 1.4 [95% CI, 1.1-1.7], respectively).
Conclusions and Relevance: Within this cohort study in the Netherlands, 7.8% of the children ages 9 to 11 years had low-frequency or high-frequency HL of at least 16 dB HL in 1 or both ears. A history of recurrent acute otitis media and lower maternal education seem to be independent risk factors for presumed SNHL in early childhood.

PMID: 28750130 [PubMed - as supplied by publisher]

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Variations in the Prevalence of Hearing Loss in Children: Truth or Artifact?

Variations in the Prevalence of Hearing Loss in Children: Truth or Artifact?

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Lieu JEC

PMID: 28750124 [PubMed - as supplied by publisher]

http://ift.tt/2tOYcSn

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010.

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Su BM, Chan DK

Abstract
Importance: There have been concerns about increasing levels of hearing impairment in children and adolescents, especially in relation to noise exposure, because even mild levels of hearing loss can affect educational outcomes.
Objective: To further characterize changes in prevalence of hearing loss and noise exposures in the US pediatric population over time.
Design, Setting, and Participants: This is a retrospective analysis of demographic and audiometric data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), NHANES 2005-2006, NHANES 2007-2008, and NHANES 2009-2010. The NHANES are nationally representative survey data sets collected and managed by the US National Center for Health Statistics, and this study includes a total of 7036 survey participants ages 12 to 19 years with available audiometric measurements.
Exposures: Hearing-related behaviors and risk factors such as history of ear infections, noise exposures, firearm use, and hearing protection use.
Main Outcomes and Measures: Level of hearing loss measured by pure-tone audiometry, as well as high-frequency and low-frequency hearing loss and noise-induced threshold shifts.
Results: Overall, data from 7036 survey participants ages 12 to 19 years with available audiometric measurements were analyzed. The prevalence of hearing loss increased from NHANES III to NHANES 2007-2008 (17.0% to 22.5% for >15 dB hearing loss; absolute difference, 5.5%; 95% CI, 6.1%-10.3%) but decreased in the NHANES 2009-2010 to 15.2% (absolute difference, 7.2%; 95% CI, 2.0%-12.4%) with no significant overall secular trend identified. There was an overall rise in exposure to loud noise or music through headphones 24 hours prior to audiometric testing from NHANES III to NHANES 2009-2010. However, noise exposure, either prolonged or recent, was not consistently associated with an increased risk of hearing loss across all surveys. The most recent survey cycle showed that nonwhite race/ethnicity and low socioeconomic status are independent risk factors for hearing loss.
Conclusions and Relevance: This analysis did not identify significant changes in prevalence of hearing loss in US youth ages 12 to 19 years over this time period despite increases in reported noise exposures. No consistent associations were shown between noise exposure and hearing loss, though there was an association between racial/ethnic minority status and low socioeconomic status and increased risk of hearing loss. Ongoing monitoring of hearing loss in this population is necessary to elucidate long-term trends and identify targets for intervention.

PMID: 28750123 [PubMed - as supplied by publisher]

http://ift.tt/2v3CzgN

Exercise-Induced Vertigo in Vestibular Schwannoma.

Exercise-Induced Vertigo in Vestibular Schwannoma.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Foster E, Chen L

PMID: 28750117 [PubMed - as supplied by publisher]

http://ift.tt/2u4qV0E

Comparison between Primary and Secondary Tracheoesophageal Puncture Prosthesis: A Systematic Review

Introduction: Since the introduction of tracheoesophageal puncture (TEP) and placement of voice prosthesis, this has become the method of choice to achieve speech rehabilitation after total laryngectomy. Objective: To compare the complications and success in speech rehabilitation of patients undergoing rehabilitation after primary and secondary TEP (TEP1 and TEP2) through a systematic review. Methods: The literature survey included research in MedLine, Scielo, Lilacs, Cochrane and Websco until June 2016. Results: The rate of leakage around the prosthesis was higher in TEP1 (22.5 vs. 6.9%, p = 0.03). There were higher rates of wound infection (9.1 vs. 3.9%) and tracheal stenosis (8.5 vs. 4.5%) in the TEP1 group compared to TEP2, however with no statistical significance. The evaluation of speech quality was not possible due to the heterogeneity of the studies. Conclusion: There is a reduction in the risk of leakage around the prosthesis among TEP2 patients.
ORL 2017;79:222-229

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Inflammatory Bowel Disease in Primary Immunodeficiencies

Abstract

Purpose of Review

Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease.

Recent Findings

The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis.

Summary

This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

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