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Biomedical subjects

Eleftherios Ferekidis

Publications and source records attributed to Eleftherios Ferekidis.

At least 19 recordsLinked to original sources
PubMed2007

Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications?

INTRODUCTION: Otitis media with effusion is one of the most frequent diseases in children, and its management requires the attention of general practitioners, pediatricians and ear, nose and throat (ENT) surgeons. The main complications associated with tympanostomy tube insertion, are: (1) purulent otorrhea (10-26% of cases), in which local otic preparations might be effective, and biofilm-resistant tubes may decrease this complication in the future; (2) myringosclerosis (39-65% of operated ears), with usually no serious sequelae; (3) segmental atrophy (16-75% of cases); (4) atrophic scars and pars flaccida retraction pockets (28 and 21% of operated ears, respectively); (5) tympanic membrane perforations (3% of cases, although with T-tubes, the incidence may be as high as 24%); (6) cholesteatoma (1% of cases), although tympanostomy tubes may sometimes prevent, rather than contribute to its development; (7) granulation tissue (5-40% of instances), when the duration of tube retention is prolonged. CONCLUSION: It would appear that the complications associated with tympanostomy tube insertion are more frequent than anticipated, reaching 80% of operated ears under specific circumstances and in certain subgroups of children. These complications may resolve with conservative management, but in persistent cases surgical removal of the tubes is mandatory.

Child↗
PubMed2007

Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management.

Juvenile recurrent respiratory papillomatosis (RRP) is the most common benign neoplastic disease of the larynx in children and adolescents and has a significant impact on patients and the health care system with a cost ranging from $60,000 to $470,000 per patient. The aim of this paper is to review the current literature on RRP and summarize the recent advances. RRP is caused by human papillomavirus (HPV; mainly by types 6 and 11). Patients suffer from wart-like growths in the aerodigestive tract. The course of the disease is unpredictable. Although spontaneous remission is possible, pulmonary spread and malignant transformation have been reported. Surgical excision, including new methods like the microdebrider, aims to secure an adequate airway and improve and maintain an acceptable voice. Repeated recurrences are common and thus overenthusiastic attempts to eradicate the disease may cause serious complications. When papillomas recur, old and new adjuvant methods may be tried. In addition, recent advances in immune system research may allow us to improve our treatment modalities and prevention strategies. A new vaccine is under trial to prevent HPV infection in women; the strongest risk factor for juvenile RRP is a maternal history of genital warts (transmitted from mother to child during delivery). Better understanding of the etiology of the disease and the knowledge of all available therapies is crucial for the best management of the affected patients.

Child↗
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↗
PubMed2006

Inverted papilloma of the sphenoid sinus: presentation of three cases.

INTRODUCTION: Inverted papilloma deriving originally from the sphenoid sinus is extremely rare. Three such cases are presented aiming to show the particularities and diagnostic clues of this clinical entity. CASE REPORTS: All three patients were male, and presented mainly with nasal symptoms. In all three cases imaging shows the sphenoid sinus was completely occupied by the tumor. Additionally the ethmoids and nasal cavities have been invaded in contiguity to the site of the initial appearance of the tumor. In particular one of the cases was of even more interest as a malignant transformation of the inverted papilloma of the sphenoid sinus was histologically observed. Endoscopic sinus surgery was the therapeutic approach chosen for all three cases, with very good results. Follow up 30 months after the operation has not revealed any signs of recurrence of the disease. CONCLUSION: Inverted papilloma of the sphenoid sinuses--and even more malignant transformation--although quite rare, may present occasionally. The ENT surgeon should be aware of this condition. Preoperative imaging with CT scan and MRI and the experience of the surgeon will dictate the appropriate surgical approach.

Adult↗
PubMed2006

Correlation of clinical and surgical findings to histological features (koilocytosis, papillary hyperplasia) suggesting papillomavirus involvement in the pathogenesis of cholesteatoma.

BACKGROUND: The clinical course of cholesteatoma is rather unpredictable, as some cases show aggressive development, while others have a mild, more 'benign' nature. The aim was to correlate the clinical course and surgical findings of cholesteatomas with histological features. MATERIAL/METHODS: The study included 45 patients with cholesteatoma, 29 of whom had surgically aggressive and 16 simple (not surgically aggressive) cholesteatoma. All patients underwent mastoid surgery and the cholesteatoma specimens were sent for histological examination. RESULTS: The clinical course of the cholesteatomas had a statistically significant association (p < 0.001) with the 'aggressiveness' found in surgery, suggesting that clinical history correlates well with surgical findings. All 29 specimens of patients with surgically aggressive cholesteatoma had characteristic papillary hyperplasia of the epithelium and marked koilocytosis, suggesting papillomavirus-incduced lesions. In contrast, none of the specimens of the 16 patients with simple (non-aggressive) cholesteatoma had papillary hyperplasia and there was no marked koilocytosis, as few koilocytes could occasionally be found. The difference was statistically significant (p < 0.001). In situ hybridization for human papillomnavirus (HPV) was performed in 14 specimens (7 each with aggressive and simple cholesteatomna). Positive staining was found in three aggressive cholesteatomas. All seven simple cholesteatomas were negative for HPV. CONCLUSIONS: The results of the present paper suggest that papillomaviruses may play an important role in the pathogenesis of cholesteatomas. Further studies with controls and the development of new methods to identify known and unknown types of papillomavirus are needed to explore their exact role.

Adult↗
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

Transient otoacoustic emissions in the detection of olivocochlear bundle maturation.

OBJECTIVE: The medial olivocochlear bundle, forms a neural pathway connecting the superior olivary complex to the outer hair cells of mainly the contralateral cochlea. Although the biological significance of the bundle remains ambiguous, it is clear that activation of medial olivocochlear fibers alters cochlear output and this can be experimentally evident through a series of changes on otoacoustic emissions, called otoacoustic emission suppression. The aim of this study is to observe the maturation of the medial olivocochlear bundle by measuring the suppression effects on transient otoacoustic emissions. METHODS: The study population consisted of 27 premature babies (53 ears) from the P&A Kyriakou Neonatal Intensive Care Unit (conceptional age: 31-36 weeks) and 43 fullterm babies (61 ears) (conceptional age: 37-42 weeks) from the same unit. The ILO-92 system is used to deliver both the linear clicks to the ear examined (producing the emissions) and the white noise to the contralateral ear. The mode used is based on the alternating on and off presence of the white noise in the contralateral ear. RESULTS: 12/53 (22%) ears of preterm babies presented suppression > or =1 dB. 32/61 (52.4%) ears of fullterm babies presented suppression > or =1 dB. The mean suppression for the ears of premature infants was 0.52 dB, (+/-0.1 S.E.M.). The mean suppression for the ears of fullterm infants was 0.90 dB, (+/-0.09 S.E.M.). At the second half of the time window, suppression of fullterms rises above 1 dB (a pattern similar to that of adults), whereas it remains below 1 dB for preterms. CONCLUSIONS: Suppression of otoacoustic emissions helps us to study the function of the medial olivocochlear bundle in different populations. It appears in premature babies but becomes stronger as the postconceptional age advances.

Acoustic Stimulation↗
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

Factors influencing the presence of otitis media with effusion 16 months after initial diagnosis in a cohort of school-age children in rural Greece: a prospective study.

OBJECTIVE: Few studies have specifically assessed the risk factors for persistence or recurrence of OME in a cohort of school-age children. The generally accepted etiological factors for OME occurrence may not apply in the same way when the presence of OME over a year from original diagnosis is assessed. METHODS: A cohort of 250 school-age children with unilateral or bilateral OME, identified through screening of 5121 asymptomatic children was re-examined 16 months later. All were assessed for a variety of demographic, family and medical factors. Measures included tympanometry, acoustic reflexes and a complete otolaryngologic examination. RESULTS: At 16 months after initial confirmation of OME, 56 out of 250 children (22.4%) suffered from OME, 21 bilateral and 31 unilateral. Presence of OME at 16 months was not associated with gender, blood group, gestational age and weight, history of breast feeding, paternal education level and smoking history, history of allergy, previous use of antibiotics, or with surgery (myringotomy, insertion of ventilation tubes or adenotonsillectomy). In multiple backward-eliminating logistic regression, the only factors associated with OME presence after 16 months were episodes of AOM during the study period (odds ratio 2.75 (95% CI: 1.13-8.17), p=0.04) and younger age (odds ratio 0.53 (95% CI: 0.32-0.79), p=0.002 for each 2 years of increase in age). CONCLUSION: Seventy-eight percent of school-age children identified with OME through screening will be free of disease 16 months later. The threshold for referral, or surveillance could however justifiably be lower in children who (a) have once been identified with OME and (b) are (relatively) younger, or have experienced an episode of acute otitis media.

Child↗
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↗
PubMed2003

Newborn hearing screening resources on the Internet.

Starting as a small military and academic network, the Internet has gradually evolved into a worldwide web, which connects most local networks as well as millions of personal computers from individual users. It is of interest to the medical practitioner, that ever more biomedical resources are becoming available on-line to assist in clinical medicine, research and education. In this paper a detailed list of the World Wide Web sites accessible through the Internet is provided, in which data about newborn hearing screening may be found. Web resources of medical equipment and suppliers and sites including otoacoustic emissions topics, are presented as well. This review is intended to present the wealth of the accessible information on the Internet and to promote further presentation on the web of any available hearing screening data from hospitals and Audiology Departments in which such programs are implemented.

Audiology↗
PubMed2003

Detection of pseudohypacusis: a prospective, randomized study of the use of otoacoustic emissions.

OBJECTIVES: This study was designed to evaluate the effectiveness of transient otoacoustic emissions in an audiological protocol used in the evaluation of patients suspicious of pseudohypacusis. DESIGN: This was a prospective study of 72 adult patients suspicious of pseudohypacusis on the grounds of case history and inconsistent audiometric results. The subjects were randomly assigned to a treatment group or control group. The treatment group consisted of 42 patients who underwent a four-stage protocol that included (1) standard speech and pure-tone audiometry, (2) transiently evoked otoacoustic emissions (TEOAEs) and tympanometry, (3) repeat modified pure-tone audiometry, and (4) auditory brain stem response (ABR) audiometry. The control group consisted of 30 patients, who underwent an identical protocol except that Stage 2 (TEOAEs and tympanometry) was omitted. The main outcome measure was the mean exaggeration level defined as the difference in mean pure tone average (PTA) between the initial and the repeat session (mean PTAinitial minus mean PTArepeat). RESULTS: The mean PTA (average threshold at 1, 2, 3, and 4 kHz) on repeat audiometry was significantly better than the mean PTA obtained on the initial evaluation for each group. However, the mean exaggeration level was significantly greater for the treatment group (35.2 dB HL) than for the control group (11.0 dB HL). In addition, there was no significant difference between the mean PTArepeat (32.7 dB HL) and the mean click-evoked ABR threshold (31.6 dB nHL) for the treatment group whereas the mean PTArepeat (52.9 dB HL) was significantly poorer than the click evoked ABR threshold (29.2 dB nHL) for the control group. CONCLUSIONS: The inclusion of TEOAEs and tympanometry in an audiological protocol used in the evaluation of patients suspicious of pseudohypacusis resulted in a significantly greater threshold improvement on repeat modified pure-tone audiometry when compared to the improvement observed for a control group in which these tests were not performed.

Acoustic Impedance Tests↗
PubMed2003

Otoacoustic emissions in patients with hypotension.

The aim of this study was to investigate the relation between hypotension and slowly developing hearing impairment, using otoacoustic emissions. A group of 42 patients was examined, with diastolic blood pressure < or = 60 mmHg and systolic blood pressure < or = 105 mmHg. The subjects underwent biochemical, cardiological, ENT and audiological examinations. Distortion product otoacoustic emissions (DPOAE) were recorded in the format of DP-gram. The results were compared to the data of 30 normal persons of similar age and sex, examined at the same laboratory. Audiometric results showed that 18 patients had mild or moderate symmetrical hearing loss in one or more frequencies, mainly in the lower frequency range. DPOAE of the patients had reduced amplitude as compared to controls or were even absent, in one or more frequencies. It may be concluded that a hypotensive condition could be a possible factor in the origin of cochlear damage and DPOAE may be useful in monitoring hypotensive patients.

Adult↗
PubMed2002

Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo.

OBJECTIVES: To study the occurrence of each variant of benign paroxysmal positional vertigo (BPVV) and to present some specific clinical features and the results of their treatment by appropriate repositioning maneuvers. STUDY DESIGN: A retrospective review of the records of patients with BPPV. SETTING: Neurotology clinic of the ear, nose, and throat department of a general hospital. PATIENTS: One hundred twenty-two patients were included in the study, 54 male and 68 female, mean ages 61.8 and 59.6 years, respectively, ranging in age from 25 years to 86 years and with symptoms lasting for an average of 124 days. The diagnosis of each type of BPPV was based on the history of the patients and on the positive results of the appropriate provoking maneuver. METHODS: From all the patients, a comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination, including electronystagmography. All patients were treated with an appropriate repositioning maneuver, depending on the type of BPPV. RESULTS: Of 122 patients, 110 had posterior canal involvement, 10 had horizontal canal involvement, and only 2 had the anterior canal variant. The canalith repositioning procedure was immediately successful in 106 patients and in 8 more patients proved successful after its repetition in a second session, resulting in a total success rate of 93.4%. CONCLUSIONS: All the BPPV variants shared the same clinical and demographic characteristics and responded equally well to treatment. However, differential diagnosis was necessary to apply the appropriate canalith repositioning procedure. Although data from clinical and histologic studies do not fully account for the observed relative occurrence of each variant of BPPV, a satisfactory explanation may be provided by the anatomic location of each semicircular canal and additionally by self-treatment of most cases of the horizontal and the anterior canal variety.

Adult↗
PubMed2002

Internet resources available to otolaryngologists.

During recent years, the Internet has evolved into the largest computer network in the world, allowing access to vast amounts of information and services. Medical information is increasingly available to both patients and professionals, and ever more biomedical resources are becoming available on-line to assist in research, clinical medicine, and education. The Internet has always provided useful resources to otolaryngologists, implemented at various academic departments and national organizations or by specialists or specific medical web sites offering technical, scientific, and biomedical information. The purpose of this article is to provide as complete a list as possible of the World Wide Web sites accessible through the Internet that are of interest to otolaryngologists. It summarizes different types of resources available, including educational material, audiology sites, outcomes research, discussion lists, research laboratories, publications, medical libraries, news and medical conferences, organizations, academic departments, otolaryngological and medical resources, medical and surgical equipment and suppliers, and miscellaneous other sites of interest to otolaryngologists. This review is intended to present the wealth of the accessible information on the Internet and to promote the use of the network to otolaryngologists who do not have extensive experience in computers or telecommunications.

Computer User Training↗