BACKGROUNGFor a long time, laryngopharyngeal reflux disease (LPRD) has been treated by proton pump inhibitors (PPIs) with an uncertain success rate.AIMTo shed light the current therapeutic strategies used for LPRD in order to analysis the rationale in the LPRD treatment.METHODSThree authors conducted a PubMed search to identify papers published between January 1990 and February 2019 about the treatment of LPRD. Clinical prospective or retrospective studies had to explore the impact of medical treatment(s) on the clinical presentation of suspected or confirmed LPRD. The criteria for considering studies for the review were based on the population, intervention, comparison, and outcome framework.RESULTSThe search identified 1355 relevant papers, of which 76 studies met the inclusion criteria, accounting for 6457 patients. A total of 64 studies consisted of empirical therapeutic trials and 12 were studies where authors formally identified LPRD with pH-monitoring or multichannel intraluminal impedance-pH monitoring (MII-pH). The main therapeutic scheme consisted of once or twice daily PPIs for a duration ranged from 4 to 24 wk. The most used PPIs were omeprazole, esomeprazole, rabeprazole, lansoprazole and pantoprazole with a success rate ranging from 18% to 87%. Other composite treatments have been prescribed including PPIs, alginate, prokinetics, and H2 Receptor antagonists.CONCLUSIONRegarding the development of MII-pH and the identification of LPRD subtypes (acid, nonacid, mixed), future studies are needed to improve the LPRD treatment considering all subtypes of reflux.
Branchio-oto-renal syndrome (Melnick-Fraser Syndrome) is a rare Autosomal Dominant disorder characterized by the syndromic association of branchial cysts or fi stulae along with external, middle & inner malformations and renal anomalies. Incomplete penetrance and variable expressivity are common with the phenotypic variation ranging from mild to severe forms & consisting of various eye, ear, oral and craniofacial abnormalities. Mutations in the EYA1 gene on chromosomal site 8q13.3 are identifi ed as the primary cause of BOR syndrome. We present a 3year old child with BOR syndrome, who came to us with bilateral low set, malformed ears & profound cochlear hearing loss along with bilateral branchial fi stulae & unilateral renal agenesis. This child underwent successful cochlear implantation recently. The clinical presentation, pre-operative investigations, intra-operative fi ndings & post-op habilitation status are presented with special highlights on the unique facial nerve course along with middle and inner ear anomalies which posed a surgical challenge during cochlear implantation.
Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioral responses may be tedious for audiologists in such cases, wherein matching an effective MAP and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed, (a) to study the trends in multi-modal electrophysiological tests and behavioral responses sequentially over the first year of implant use, (b) to generate normative data from the above, (c) to correlate the multi-modal electrophysiological thresholds levels with behavioral comfort levels, and (d) to create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. This prospective study included ten profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, Impedance Telemetry, Neural Response Imaging, Electrically Evoked Stapedial Response Telemetry and Electrically Evoked Auditory Brainstem Response tests at 1, 4, 8 and 12 months of implant use, in conjunction with behavioral Mapping. Trends in electrophysiological and behavioral responses were analyzed using paired t test. By Karl Pearson's correlation method, electrode-wise correlations were derived for NRI thresholds versus Most Comfortable Levels (M-Levels) and offset based (apical, mid-array and basal array) correlations for EABR and ESRT thresholds versus M-Levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-Levels were compared with the behaviorally recorded M-Levels among the cohort, using Cronbach's Alpha Reliability test method for confirming the efficacy of this method. NRI, ESRT and EABR thresholds showed statistically significant positive correlations with behavioral M-Levels, which improved with implant use over time. These correlations were used to derive predicted M-Levels using regression analysis. Such predicted M-Levels were found to be in proximity to the actual behavioral M-Levels recorded among this cohort and proved to be statistically reliable. When clinically applied, this method was found to be successful among subjects of our study group. Although there existed disparities of a few clinical units, between the actual and predicted comfort levels among the subjects, this statistical method was able to provide a working MAP, close to the behavioral MAP used by these children. The results help to infer that behavioral measurements are mandatory to program cochlear implantees, but in cases where they are difficult to obtain, this study method may be used as reference for obtaining additional inputs, i...
There seems to be a resurgence in tuberculous otitis media in India. Microbiological, histopathological and polymerase chain reaction tests for tuberculosis are helpful for its diagnosis.
Balloon Sinuplasty is a new technique which has revolutionized sinus surgery in recent times.
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