We present an autochthonous infection in Israel. The patient presented with hoarseness and weight loss. Pathology findings and molecular tests confirmed the diagnosis, and the patient responded to antifungal therapy. Because the patient had an atypical presentation of histoplasmosis, it is likely that other more typical cases have gone unreported. To our knowledge, no other cases have been previously reported from Israel or the Middle East region.
OBJECTIVE:To compare the hearing and otoacoustic emissions (OAE) outcome of stapedotomy employing 0.4 and 0.6 mm diameter prostheses. MATERIALS and METHODS:In total, 18 patients with otosclerosis participated in a prospective, double-armed, randomized cohort study. All the patients underwent small fenestra drill stapedotomy employing the Causse fluroplastic large loop piston prostheses. The patients were randomly assigned to groups of 0.4 mm (n=9) and 0.6 mm (n=9) diameter prostheses. The results of pure tone air and bone audiometries, speech audiometry, and OAE conducted 12 months post operatively were compared within and between the groups. RESULTS:The within-group analysis showed significant post-stapedotomy improvements in the average air conduction pure tone thresholds in both groups (52.9±9.6 vs. 25.6±5.2 dB HL; p<0.0001 and 54.6±10.4 vs. 22.2±8.2 dB HL; p<0.0001 for the 0.4 and 0.6 mm groups, respectively) and average air-bone gap (ABG; 37.1±8.5 vs. 8.1±3.9 dB HL; p<0.0001 and 38.3±7.5 vs. 9.9±4.5 dB HL; p<0.0001 in the 0.4 and 0.6 mm groups, respectively). No significant differences were found between the groups in these outcome measures, as well as in the rate of ABG closure within 10 dB HL and the word recognition scores. Favorable outcome in the post-stapedotomy bone conduction (BC) was found for the 0.6 mm prosthesis group, reflecting superior cancellation of the Carhart phenomenon for the 500-3000 Hz pure tone thresholds average (−1.7±3.7 vs. 3.9±6.2 dB HL for the 0.4 and 0.6 mm groups, respectively; p<0.04) and 1000, 2000, and 4000 Hz average (−2.6±4.33 vs. 3.9±7.8 dB HL for the 0.4 and 0.6 mm groups, respectively; p<0.05). Small signal-to-noise ratio (SNR) values of the transient-evoked OAE (TEOAE) and distortion product OAE (DPOAE) were found at baseline and follow-up evaluation with no consistent changes post stapedotomy.CONCLUSION: Similar post-stapedotomy hearing results were found for the 0.4 and 0.6 mm prostheses with small but statistically significant advantage in BC gain and the overclosure parameter for the 0.6 mm prosthesis. OAE testing was not found to be of clinical value in the evaluation of stapedotomy hearing outcome.
Introduction: Previous studies have reported an association between reduced bone mineral density and the occurrence of benign paroxysmal positional vertigo, balance impairment, and saccular dysfunction. Furthermore, the results of recent animal studies have raised the possibility that vestibular dysfunction could affect bone remodeling and bone mass. The goal of the study was to compare bone mineral density of patients suffering from definite Ménière's disease to that of a matched control group. Methods: We conducted a case-control cross-sectional study in a tertiary referral center. The study group included 23 patients suffering from definite Ménière's disease, and the control group was comprised of 23 patients matched in their race, gender, and age parameters in whom no vestibular pathology could be found. Dual energy X-ray absorptiometry of the femoral head was used for the assessment of bone mineral density. The T and Z scores of the femoral heads' bone mineral density were compared. Results: The average T scores were -1.53 ± 1.08 in the study and -0.39 ± 0.72 (p = 0.016) in the control groups, and the Z scores were -0.4 ± 0.63 and 0.33 ± 0.31 (p = 0.018), respectively. Seventeen patients (74%) of the study group and 9 (39%) of the control group had T scores less than -1.0, indicating osteopenia/osteoporosis (p = 0.036). Conclusions: The results showed a significant association between Ménière's disease and reduced bone mineral density of the femoral head. Bone mineral density studies of the weight-bearing bones are warranted in Ménière's disease for the early diagnosis and treatment of osteopenia/ osteoporosis on the one hand and possible benefit of this treatment for the evolution of Ménière's disease on the other hand.
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