The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125 mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.
BackgroundThere is still controversy regarding the influence of aging on medial olivocochlear (MOC) system function. The main objective of this study is to measure age-related changes of MOC system function in people with normal hearing thresholds.MethodBilateral assessment of the MOC effect for click-evoked otoacoustic emissions (CEOAEs; at 70±3 dB peak sound pressure level [pSPL], click at 50/second, 260 repeats, 2.5–20 millisecond window) and for distortion product otoacoustic emissions (DPOAEs; with [frequencies] f2/f1=1.22, [levels of primary tones] L1=65 dB SPL and L2=55 dB SPL; DP-grams for 2f1–f2 were collected for the f1 frequencies varying from 977 Hz to 5,164 kHz, with the resolution of four points per octave) was performed in a group of 146 (n=292 ears) healthy, right-handed subjects aged from 10–60 years with a bilateral hearing threshold from 0.25–4.0 kHz, not exceeding 20 dB hearing level; normal tympanograms; and a threshold of the contralateral stapedial reflex for broadband noise (BBN) of 75 dB SPL or higher. The MOC inhibition was assessed on the basis of changes in OAE level during BBN contralateral stimulation at 50 dB sensation level (mean, 65±3 dB SPL).ResultsComparative analysis of the MOC effect for CEOAE and DPOAE showed the weakest effect in the oldest age group (41–60 years) at almost all tested frequencies. Moreover, a weak, albeit significant, positive correlation between the level of OAE and the size of the MOC effect was documented.ConclusionOn the basis of our study, we have found a decrease in the strength of the MOC system with increasing age in normally hearing subjects, as reflected by a decrease of the OAE suppression effects in older individuals and an increase of the number of CEOAE and DPOAE enhancements during contralateral acoustic stimulation in the elderly, especially in the high-frequency range.
Background. Computational fluid dynamics (CFD), a rapidly developing instrument with a number of practical applications, allows calculation and visualization of the changing parameters of airflow in the upper respiratory tract.
On the basis of the patients' voice quality self-assessment and the perceptive assessment of the voice quality based on the GRBAS scale, no significant differences between the groups were found. Furthermore no statistically significant differences were found for the phonation closure and maximal phonation time in both groups.
The paper presents a case study of a transsexual patient who underwent a voice pitch elevation surgery performed in Poland for the first time. The human voice is a reflection of the working of hormones and human psyche. This fact is of particular importance in transsexualism, a disorder consisting in incongruence between the individual's biological sex and their identified gender. For many transsexual people, especially of the MTF (male to female) type, who have undergone hormonal and surgical sex change, the voice still presents a major problem, causing difficulties in everyday life. Hormonal treatment does not influence feminisation of the larynx. In the described MTF case, the patient's low androphonic voice was perceived as a male voice. In order to feminise the patient's voice a phonosurgical procedure was performed: the length of the vibrating portion of the vocal folds was shortened by over 50% of their total length by means of suturing of the anterior part of the vocal fold. As a result of the surgical treatment the pitch of voice was raised considerably, with F0 of spoken voice increased from 109 Hz to 209 Hz. The voice range also changed towards female tones, from 59-146 Hz to 148-343 Hz. Pitch elevation positively influenced the patient's subjective voice assessment: total score of the Voice Handicap Index (VHI) improved from 99 to 19 points, and the score of its emotional sub-scale: 39 and 2 points, respectively. The described case of a surgical male-to-female voice change presents one of the dilemmas faced by modern medicine.
StreszczeniePrzedstawiono przypadek pacjentki transseksualnej, u której po raz pierwszy w Polsce przeprowadzono zabieg chirurgiczny zmiany głosu z męskiego na żeński. Głos ludzki -drugorzędowa cecha płciowa -jest odzwierciedleniem działania hormonów i psychiki. Fakt ten nabiera szczególnego znaczenia w transseksualizmie, zaburzeniu polegającym na niezgodności płci biologicznej z płcią psychiczną. Dla wielu osób transseksualnych, szczególne w postaci transseksualizmu M/K (mężczyzna/kobieta) po hormonalnej i chirurgicznej zmianie płci biologicznej ważnym problemem nastręczającym trudności w życiu codziennym pozostaje głos, gdyż leczenie hormonalne nie wpły-wa na feminizację krtani -aparatu głosowego. W opisywanym przypadku niski androfoniczny głos pacjentki był percepowany przez otoczenie jako męski. W celu feminizacji głosu wykonano leczenie fonochirurgiczne: skrócono fałdy głosowe o ponad 50% ich długości poprzez założenie szwów zespalających w ½ przedniej części głośni. W wyniku zabiegu podwyższono znacząco głos: przedoperacyjna częstotliwość głosu mówionego wyraźnie przesunęła się po operacji w górę z wartości 109 Hz do 209 Hz. Zakres głosu także zmienił się w kierunku tonów żeńskich z 59-146 Hz do 148-343 Hz. Zmiana wysokości głosu u pacjentki wpłynęła pozytywnie na jej subiektywną ocenę głosu: wynik kwestionariusza VHI (Voice Handicap Index) poprawił się z 99 pkt -przed operacją do 19 pkt -po operacji. Na poprawę jakości życia wskazuje także spadek problemów emocjo...
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