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Biomedical subjects

Dimitrios G Balatsouras

Publications and source records attributed to Dimitrios G Balatsouras.

At least 19 recordsLinked to original sources
PubMed2007

Pneumatized superior turbinate as a cause of headache.

BACKGROUND: A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis. CASE PRESENTATION: We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained. CONCLUSION: Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.

Adult↗
PubMed2007

Etiology of vertigo in children.

OBJECTIVE: To detect the most common causes of vertigo in children. METHODS: Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. RESULTS: Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. CONCLUSIONS: A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered.

Adolescent↗
PubMed2007

Cochlear function in facioscapulohumeral muscular dystrophy.

OBJECTIVE: Facioscapulohumeral muscular dystrophy (FSHD) is commonly associated with high-frequency hearing impairment. Our objective was to evaluate a group of normally hearing patients with FSHD using otoacoustic emissions. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: A tertiary University-based referral center in Athens, Greece. PATIENTS: The study group consisted of a consecutive sample of 24 patients diagnosed on clinical, histopathologic, and genetic grounds as having FSHD. All subjects were selected on the basis of normal to near normal audiometric pure tone thresholds. Controls consisted of 40 age-matched healthy volunteers. INTERVENTIONS: Transiently evoked otoacoustic emissions were performed. Whole reproducibility and total response were measured, as well as partial scores at the octave bands centered at 1, 2, 3, 4, and 5 kHz. MAIN OUTCOME MEASURES: Transiently evoked otoacoustic emission measurements were compared between the two groups. RESULTS: The audiometric findings were normal to near normal for both groups. Compared with controls, most patients had diminished scores in both whole and partial reproducibility scores and overall and partial response scores. CONCLUSION: Despite normal hearing, subclinical involvement of the cochlea is quite common in patients with FSHD. Our findings support the genetic homogeneity of this disorder and its association with cochlear damage. Otoacoustic emissions might provide a useful tool in the clinical workup and follow-up of these patients.

Acoustic Stimulation↗
PubMed2006

The use of trichloroacetic acid in the treatment of acute external otitis.

The purpose of this study was to evaluate the effectiveness of 5% trichloroacetic acid (TCA) in the treatment of acute external otitis (AEO) in comparison with a standard clinical treatment. All patients who consecutively presented in our emergencies with AEO during the summer months of the previous year were included in the study. They were randomly divided into two groups: the study group included 117 patients treated with TCA and the control group included 98 patients treated with ear drops containing antibiotic and corticosteroid. Occasionally, an antibiotic was administered orally for 7 days, in severe cases of AEO. All patients were evaluated on days 1, 3, 5, 7 and 10, whereas another review appointment was given 20 days later. Outcome measures included evaluation of efficacy using a six-step infection score and tolerability by visual analogue scale. Additionally, adverse reactions, complications and recurrencies were recorded. Treatment was successful for all patients of the study group, whereas 8 failures were found in the control group. The infection score improved faster in the study group than in the control group, resulting in an earlier clinical cure (mean 4.1 and 8.6 days, respectively). Tolerability was significantly better in the study group, on all points of evaluation. Complications and adverse reactions were minimal on both groups. Our results show that TCA is a very effective and nontoxic agent for the treatment of AEO. Rapid pain relief and prevention of recurrencies are its main advantages.

Acute Disease↗
PubMed2006

Bilateral spontaneous hemotympanum: case report.

BACKGROUND: The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. CASE PRESENTATION: A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. CONCLUSION: Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.

Aged↗
PubMed2006

A comparison of automated auditory brainstem responses and transiently evoked otoacoustic emissions for universal newborn hearing screening.

BACKGROUND: The aim of this study was to compare the performance of automated auditory brainstem responses (a-ABR) and automated transiently evoked otoacoustic emissions (a-TEOAEs). MATERIAL/METHODS: A prospective, case-control study in a group of newborns was performed in a maternity hospital carrying out universal newborn hearing screening. Two groups of full-term newborns were examined. The first group included 50 newborns (100 ears) who underwent: 1) a-TEOAEs, 2) a-ABR, and 3) transiently evoked otoacoustic emissions (TEOAEs). The second group consisted of the same number of newborns who underwent identical testing, but in a different order: 1) a-ABR, 2) a-TEOAEs, and 3) TEOAEs. All a-TEOAE and a-ABR testing was performed using the AccuScreen device and all standard TEOAE testing was performed using the ILO88. The pass-fail results of each method were recorded and compared. RESULTS: a-ABR yielded lower referral rates than the otoacoustic emission tests, but the differences were not statistically significant. Comparison between the two groups of study showed higher "pass" rates in the second group, indicating an order effect. CONCLUSIONS: Either method might be useful in universal newborn hearing screening. However, the lower referral rate obtained by a-ABR and its potential to recognize infants at risk for auditory neuropathy and central pathology should be considered.

Audiometry, Evoked Response↗
PubMed2005

Success rate of newborn and follow-up screening of hearing using otoacoustic emissions.

OBJECTIVE: During the last 6 years, and after a long period of pilot study, a universal newborn hearing screening program based on otoacoustic emissions is implemented in Iaso Maternity Hospital. Our purpose is to present the success rate of otoacoustic emission testing on discharge from the hospital and 1 month later. METHODS: All full-term newborns who were screened during a period of 2 years and failed testing after one or more sessions of transiently evoked otoacoustic emissions, on discharge from the hospital, were included in the study. These newborns were retested approximately 1 month after discharge. RESULTS: Twenty-five thousand and thirty-two newborns were examined in total. We found 534 (2.1%) 'refer' cases. Only 223 of them (41.8%) returned to retest in follow-up after 1 month. From the rescreening, 59 (2.3 per thousand) newborns failed in the test again and were referred for diagnostic audiological evaluation. CONCLUSIONS: The rate of referrals was small, but efforts should be made to decrease it further. The final number of 'failures' found, approaches the expected rate of definitely diagnosed deafness reported from other settings. The main problem we have still to confront is the high missed to-follow-up rate.

Acoustic Stimulation↗
PubMed2005

The efficacy of transiently evoked otoacoustic emissions in the detection of middle-ear pathology.

BACKGROUND: Transiently evoked otoacoustic emissions (TEOAEs) is an objective diagnostic method of assessing the cochlear status. The aim of this study was to present the results of hearing screening in children and to evaluate TEOAEs in the diagnosis of middle-ear pathology compared with tympanometry and pure-tone audiometry. MATERIAL/METHODS: A group of school-aged children underwent otolaryngological evaluation, tympanometry, TEOAEs, and audiometry. We analyzed data from both ears with abnormal tympanograms and ears with normal tympanograms but abnormal otoscopic findings or positive otologic history. Included in our study were 497 ears. RESULTS: Two hundred ten (42%) ears had a tympanogram of type A, 102 (20.5%) of type B, and 185 (37.5%) of type C. Otoacoustic emissions were found in 200 (95%), 37 (36%), and 145 (78%) of these ears, respectively. In ears with a tympanogram of B type and present otoacoustic emissions, a pure-tone average (PTA) worse than 30 dB HL was found in 16 ears (43%), whereas in ears with a tympanogram of B type and absent otoacoustic emissions, PTA worse than 30 dB HL was found in 47 ears (72.3%). The respective numbers for ears with a tympanogram of C type were 18 (12.4%) and 19 (47.5%). CONCLUSIONS: TEOAEs may be recorded in significant percentages of ears with abnormal tympanograms and middle-ear pathology. Although the sensitivity of this method is low, it may be used in conjunction with other methods of evaluating the middle ear and may give some information about the hearing status of the ear.

Acoustic Impedance Tests↗
PubMed2005

The effect of the number of averaged responses on the measurement of transiently evoked otoacoustic emissions in newborns.

OBJECTIVE: The aim of this study was to examine the effect of the number of averaged responses on the measurement of transiently evoked otoacoustic emissions (TEOAEs). METHODS: The study was performed on the background of a universal newborn hearing screening program implemented in Iaso Maternity Hospital. Two groups of full-term newborns with normal otoacoustic emissions were studied. The first group included 58 newborns (115) ears, in which 260 low-noise samples, provided by the default setting of the equipment used (ILO88), were presented. The second group included 58 newborns (113) ears, in which 20-50 averaged responses were presented, until the "pass" criteria would be met. Statistical comparison between the following parameters recorded during TEOAE measurement was performed: Overall response, signal-to-noise ratios, reproducibility (whole and partial), stimulus intensity, stimulus stability, input noise, noise rejection level and duration of testing. RESULTS: Statistically significant differences were found in most of these parameters, except for overall response, stimulus intensity and noise rejection level. CONCLUSIONS: Although a smaller number of clicks is usually sufficient to obtain a "pass" in newborn hearing screening programs, the quality of recording of TEOAEs is significantly improved by increasing the number of averaged low-noise responses.

Acoustic Stimulation↗
PubMed2005

Making universal newborn hearing screening a success.

OBJECTIVE: Following a long period of pilot study, Iaso maternity hospital established a universal newborn hearing screening program based on transiently evoked otoacoustic emissions (TEOAEs). The aim of this study is to present the improvement of outcome measures of this program, comparing the results of two groups of newborns screened successively. METHODS: We analyzed data from two groups of full-term newborns screened at our setting. The first group included all newborns born and screened during the initial 3 years of application of the program and the second group included all newborns born and screened during the next 2 years. TEOAEs were performed during the first days after birth. All newborns who failed the initial test underwent repeat testing with TEOAEs before hospital discharge. Newborns with absence of otoacoustic emissions were referred to follow-up test after 1 month. Results were compared between the two groups. RESULTS: The first group included 22,195 newborns-examined during 3 years and the second group included 25,032 newborns-examined during 2 years, due to reduction of the rate of newborns who missed screening. Refer rate was 3.1% for the first group and 2.1% for the second group. "Missed to follow-up" rate was reduced from 72.2% in the first group to 58.2% in the second group. CONCLUSIONS: The rate of newborns who did not undergo screening and the rate of "missed to follow-up" newborns were reduced in time, due to various modifications of the protocol. Universal newborn hearing screening may be, thus, a feasible and cost effective method of identifying congenital hearing loss.

Evoked Potentials, Auditory, Brain Stem↗
PubMed2005

Drug eruptions in children with ENT infections.

OBJECTIVE: A common problem for the clinician in an outpatient clinic is to distinguish a drug eruption from a viral exanthem in a child. The aim of this study was to describe the common drug eruptions seen in children with ENT infections, suggesting an approach to this problem. METHODS: We studied the cases of ENT patients aged 15-years-old and below, with the clinical diagnosis of cutaneous adverse reactions. Main variables in the assessment of drug etiology in skin eruptions were previous experience with the drug in the general population, alternative explanation for the eruption, timing between the ingestion of the drug and the appearance of the lesions, drug levels or evidence of overdose or long-acting drug, subsequent progression of the eruption and reactions to dechallenge and rechallenge. RESULTS: A total of 47 children were examined during a period of 11 months. The indications for drug prescribed were tonsillitis, pharyngitis, rhinitis, otitis and sinusitis. The most usually implicated drugs were amoxycillin-clavulanic acid, cephalosporin, clindamycin, erythromycin, clarithromycin and paracetamol. The main clinical patterns of the eruptions seen were urticaria, maculopapular rash, fixed drug eruption and erythema multiforme. CONCLUSIONS: Careful clinical examination, detailed history, knowledge of the numerous clinical patterns of the eruptions and the drugs specific reaction rates, as well as oral drug rechallenge, RAST and patch tests if indicated, are essential factors in the management of patients with drug eruptions.

Acetaminophen↗
PubMed2005

Correlation of transiently evoked to distortion-product otoacoustic emission measures in healthy children.

OBJECTIVE: Transiently evoked (TEOAEs) and distortion-product otoacoustic emissions at the 2f1-f2 frequency (DPOAEs) are being used as a clinical tool for diagnosis of peripheral auditory pathology. Because both tests are fast and non-invasive, they may be an excellent method for hearing screening in infants and children. The purpose of this study was to compare the TEOAE and DPOAE measures obtained in a group of healthy children. METHODS: Sixty-six school-aged children with normal hearing were included in the study. Subjects with recent otologic disease or abnormal tympanograms were excluded. TEOAEs and DPOAEs were performed using a DP Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. Correlation between TEOAE amplitudes and DPOAE levels was estimated. RESULTS: Correlation between TEOAE amplitudes and DPOAE levels was highly significant across all measured frequencies. Correlation was more significant at the middle frequencies than at the low and high frequencies. CONCLUSIONS: Although frequency specific information may be obtained by both tests, most reliable results were obtained at the middle frequencies. TEOAE values were more prominent at low frequencies, whereas DPOAEs were more effective at high frequencies. Both methods are reliable, objective, fast and useful tests of the cochlear status and should be included in the standard audiological diagnostic work-up of children.

Acoustic Stimulation↗
PubMed2005

The effect of impulse noise on distortion product otoacoustic emissions.

The aim of this study was the evaluation of distortion product otoacoustic emissions (DPOAEs) before and after noise exposure from shooting, and the comparison of DPOAEs with pure-tone audiometry. Thirteen young male police officers were exposed to impulse noise from shooting, without using earplugs. Standard pure-tone audiometry, tympanometry, and DPOAEs were performed before exposure and at one hour post- and 24 hour post-exposure. In the one hour post-exposure testing mean pure-tone thresholds were elevated in the 1-8 kHz frequency zone and DPOAE levels were reduced at several frequencies. DPOAEs were more affected at 3 kHz or lower, whereas pure-tone thresholds were more affected at higher frequencies. After the final examination, non-significant partial shifts at high frequencies on both tests remained. Pure-tone audiometry was overall more sensitive, but DPOAEs provided additional information about the cochlear status of certain ears. These data suggest that besides behavioral testing, DPOAEs may play a role as a fast, objective, and easy to perform test for monitoring subjects exposed to impulse noise.

Acoustic Stimulation↗
PubMed2004

The evaluation of noise-induced hearing loss with distortion product otoacoustic emissions.

BACKGROUND: Distortion product otoacoustic emissions (DPOAEs) is an objective, sensitive test of cochlear function. The aim of this study was the evaluation of noise-induced hearing loss in a group of industrial workers, using this method in conjunction with standard pure-tone audiometry (PTA). MATERIAL/METHODS: Thirty-four subjects (68 ears) were included in the study. Standard PTA, tympanometry, and DPOAEs were performed. DPOAEs were recorded in the format of the DP-gram, using an ILO Otodynamics analyzer (ILO292 DP Echoport) connected to a portable personal computer. Results were analyzed and compared with the data of 30 normal persons of similar age and sex, examined at the same laboratory, using identical stimulation and recording conditions. RESULTS: Most subjects had normal hearing thresholds for lower frequencies, but presented with a notched pattern in the 3000 to 6000 Hz region. The DPOAEs of the patients had reduced amplitudes compared with controls, or were even absent, in one or more frequencies. Across the frequency range of 1000 to 6000 Hz, a higher proportion of subjects showed abnormalities in DPOAEs than in the audiogram. CONCLUSIONS: From our data it may be concluded that cochlear dysfunction in noise-induced hearing loss may extend beyond the frequency region suggested by the audiogram, and that DPOAEs is a sensitive test of this damage.

Adult↗
PubMed2004

Lingual abscess: diagnosis and treatment.

BACKGROUND: Lingual abscesses are very rare, and as a result, the individual surgeon usually lacks experience in the diagnosis and therapy of this entity. We present four cases of abscesses of the tongue diagnosed and treated during the past 2 years. METHODS: The medical records, films, and charts of four patients with lingual abscess were retrospectively reviewed. The clinical presentation, radiographic features, treatment, and outcome of the cases were examined. RESULTS: Diagnosis was obtained by clinical examination and CT. In all cases, we avoided incision and drainage and preferred draining the abscess and aspirating pus with a large-bore needle through the inferior surface of the tongue. All patients responded remarkably well and did not have any recurrence. CONCLUSIONS: Lingual abscesses are rare conditions. In contrast to the approach in cases of most deep neck space infections, a more conservative therapeutic approach by needle-aspiration is effective and has the advantages of not exacerbating the edema of the tongue and of avoiding airway compromise.

Abscess↗
PubMed2004

Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the development of appropriate therapeutic maneuvers resulted in its effective treatment. However, involvement of the horizontal or the anterior canal has been found in a significant rate and the recognition and treatment of these variants completed the clinical picture of the disease. This paper describes the advances in understanding how this disease is generated and discusses the current therapeutic modalities.

Humans↗
PubMed2004

Electronystagmographic findings in benign paroxysmal positional vertigo.

The aim of this study was to investigate the electronystagmographic findings in patients with benign paroxysmal positional vertigo. A retrospective review of the records of 168 patients with this disease during the past 3 years was performed. Epidemiological data and results from the audiological and neuro-otologic workup, including electronystagmography, were recorded. One hundred fifty-one patients had involvement of the posterior canal, 14 of the horizontal canal, and 3 of the anterior canal. Seventy-two patients (42.8%) had abnormal findings on the caloric tests. Thirty-seven of them (22%) had canal paresis and 23 (13.7%) had directional preponderance, whereas in 12 patients (7.1%) both unilateral weakness and directional preponderance were found. Finally, 21 patients (12.5%) had spontaneous nystagmus. It may be thus concluded that electronystagmographic abnormalities are quite common in patients with benign paroxysmal positional vertigo. Their presence may be explained according to several mechanisms, which are further discussed herein.

Audiometry, Pure-Tone↗