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ABSTRACT: To investigate the relationship between tonsillar and peritonsillar infections.
Retrospective population-based study and a retrospective case series review.
Tertiary academic medical facility.
All individuals hospitalized with peritonsillar abscess (PTA) or peritonsillar cellulitis (PTC) during 2004-2008 were reviewed. Patient age, gender, diagnosis of PTA or PTC, recurrence, and date of presentation were recorded. In addition, a database of patients diagnosed in the community with acute tonsillitis (AT) was reviewed for the same time period. The weekly number of patients with AT was recorded, and a comparison between incidence of tonsillar infections and peritonsillar infection was performed.
A total of 685 patients were hospitalized with either PTA (467) or PTC (218). Incidence of both upper respiratory infections and AT peaked in January and February of every year with a nadir in August. In contrast, PTA and PTC showed a consistent rate of infection throughout the year. Likewise, assessment based on weekly intervals showed that peaks of PTA and PTC did not follow those of acute tonsillitis with a 1 to 2 weekly lag as would be expected if peritonsillar infection is a complication of AT. Rather, an association between peritonsillar infection and tonsillitis was found within the same week (P = .04).
Higher rates of occurrence of PTA or PTC following AT outbreaks were not found. These results lend further support to the theory that peritonsillar infection is associated not only with complications of AT but may occur from infection of Weber glands or other unknown causes.
Otolaryngology Head and Neck Surgery 08/2011; 145(6):940-5. · 1.72 Impact Factor
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ABSTRACT: The purpose of our study was to evaluate the influence of epidural anesthesia on the hearing system in women undergoing normal labor.
We examined two groups of patients: women with epidural anesthesia underwent four tests of distortion product otoacoustic emissions(DPOAEs): on admission, and fifteen minutes, one hour, and three hours after the last epidural bolus of local anesthetic. Auditory brainstem response (ABR) tests were performed on admission, and one hour, and three hours after the last epidural bolus. Women who gave birth without epidural anesthesia underwent DPOAEs tests on admission, during a uterine contraction, during active delivery, and three hours after labor. ABR tests were performed on admission, during a uterine contraction, and three hours after labor.
twenty patients participated in the study. Twelve gave birth with epidural anesthesia and eight without anesthesia.
No significant changes in DPOAEs and ABR recordings were found between the two groups.
Epidural anesthesia does not impair the sensory or the neural elements of the hearing system and therefore does not influence hearing.
International journal of audiology 04/2011; 50(8):519-22. · 1.34 Impact Factor
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ABSTRACT: Preliminary data suggests that caloric vestibular nerve stimulation (CVS) single session application of cold water to the left ear induces a clinically significant, short-lived beneficial effect on specific types of illness denial (i.e., anosognosia) and delusions (i.e., somatic type).
We recently studied the effect of left versus right ear ice water (4°C) CVS on delusions and insight of illness in a patient with manic episode due to schizoaffective disorder. The patient was evaluated at baseline, immediately after the CVS, and then at 20 minutes, 60 minutes, and 24 hours. The method was first applied to one ear and 4 days later to the other. To assess whether the effect is specific to mania we employed the same procedure in two other patients with schizophrenia who also demonstrated delusions and impaired insight.
All three patients showed a difference favoring left versus right ear CVS that was maintained for 20 minutes, and diminished over a 60 minute period. EEG analyses showed a numerically non-significant increase in bilateral frontal and central alpha EEG band activation (more pronounced in the right hemisphere) with left but not right ear CVS 5 minutes after the CVS, and that diminished after 20 minutes.
The results suggest that left versus right CVS may have a short lived beneficial effect on manic delusions and insight of illness that seem to appear in other types of psychoses (i.e., schizophrenia).
These preliminary results suggest that single session CVS may have short lived beneficial effects in mania and perhaps in other types of psychoses. Further research is mandatory.
Brain Stimulation 04/2011; 5(3):267-73. · 3.76 Impact Factor
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ABSTRACT: The dizziness handicap inventory (DHI) has become a well accepted method for specifically assessing the quality of life among dizzy patients and in evaluating the results of different types of therapy, especially of vestibular rehabilitation programs.
To assess the reliability of a translated Hebrew version of the DHI (HDHI) on a cohort of patients attending a tertiary dizziness clinic.
A double translation method was applied on the original DHI. Consecutive patients with symptoms of dizziness lasting at least six months were included. HDHI questionnaires were completed by patients on three occasions: while waiting to be examined, after the examination and one week later. Internal consistency reliability of each questionnaire and test- retest reliability between the questionnaires were analyzed on the total score and for each of the emotional, functional and physical subgroups of the questionnaires.
Thirty-one patients completed all three questionnaires. Internal consistency reliability of the three subgroups of questions: physical, emotional and functional in each of the three questionnaires were all high (Cronbach's Alpha coefficient 0.83-0.96). The test- retest reliability, the correlation between the total DHI scores of the first and second questionnaire (same day) showed a correlation coefficient of 0.96, and between the first and third questionnaire (7 days apart) was 0.94, with P values of < 0.01. The correlation coefficient of the subgroups ranged from 0.93 to 0.97.
The HDHI is a reliable test of dizzy patients' symptoms and may be applied in patient care and for reporting on their follow-up.
Harefuah 11/2010; 149(11):697-700, 750, 749.
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ABSTRACT: Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy.
A prospective randomized double-blind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis.
Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate pain, ability to eat and analgesics consumption for 10 days after surgery.
Ninety-six patients returned for postoperative follow up and filled in the questionnaire. As our medical center is the only hospital in the southern district of Israel and we hospitalize every person who presents with post-tonsillectomy bleeding, we can assume that any patient from either group who presented with post-tonsillectomy bleeding would be familiar to us. Analysis showed that no statistically significant differences relating to postoperative pain, bleeding, use of analgesics and postoperative eating resumption were detected between the patients treated with fibrin glue and controls.
We cannot substantiate a significant beneficial effect of fibrin glue in post-tonsillectomy pain control, prevention of bleeding or facilitating eating and thus find no indication for the routine use of fibrin glue in tonsillectomy.
International Journal of Pediatric Otorhinolaryngology 05/2008; 72(4):469-73. · 1.17 Impact Factor
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ABSTRACT: To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus.
One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups.
Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups.
Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.
Otolaryngology Head and Neck Surgery 12/2007; 137(5):772-5. · 1.72 Impact Factor
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ABSTRACT: We evaluated the correlation of asymmetric hearing loss, in a random population of patients with mild to moderate sensorineural hearing loss, to several clinical factors such as age, sex, handedness, and noise exposure.
We randomly selected, from 8 hearing institutes in Israel, 429 patients with sensorineural hearing loss of at least 30 dB at one frequency and a speech reception threshold not exceeding 30 dB. Patients with middle ear disease or retrocochlear disorders were excluded. The results of audiometric examinations were compared binaurally and in relation to the selected factors.
The left ear's hearing threshold level was significantly higher than that of the right ear at all frequencies except 1.0 kHz (p < .05). One hundred fifty patients (35%) had asymmetric hearing loss (more than 10 dB difference between ears). In most of the patients (85%) the binaural difference in hearing threshold level, at any frequency, was less than 20 dB.
Age, handedness, and sex were not found to be correlated to asymmetric hearing loss. Noise exposure was found to be correlated to asymmetric hearing loss.
The Annals of otology, rhinology, and laryngology 01/2007; 116(1):7-10. · 1.05 Impact Factor
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ABSTRACT: To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome.
All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits.
Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully.
BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed.
C.
Otolaryngology Head and Neck Surgery 12/2005; 133(5):769-73. · 1.72 Impact Factor
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ABSTRACT: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and may occur following recent head trauma. Bilateral involvement in BPPV is considered rare and has received little attention in the medical literature. We describe an unusual case of bilateral BPPV in a middle-aged woman that presented during a dental implantation, performed with the use of osteotomes. We discuss the diagnostic and therapeutic challenge of this entity.
The Journal of Laryngology & Otology 05/2003; 117(4):312-3. · 0.60 Impact Factor
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ABSTRACT: Repair of orbital floor fractures may require the placement of a graft or implant. Both autogenous and alloplastic materials have been used for this purpose. This article reports the use of nasal septal cartilage for the repair of orbital floor defect secondary to blunt facial trauma in children.
Three children with disruption of the orbital floor after facial trauma were included in this prospective review. All children underwent open reduction with rigid fixation of the facial fractures and reconstruction of the orbital floor with nasoseptal cartilage.
All of the cases were successfully treated by restoration of the orbital floor continuity. On follow-up clinical examination, one patient had persistent mild enophthalmus.
Nasal septal cartilage is a readily accessible autogenous material with minimal donor site morbidity, and should be considered when an autogenous orbital implant is needed for the repair of a traumatic orbital floor defect.
International Journal of Pediatric Otorhinolaryngology 08/2002; 64(3):187-92. · 1.17 Impact Factor
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Otolaryngology - Head and Neck Surgery.
