The effect of screen time on hearing and balance in 6-16 aged children

BACKGROUND

The increase in screen time and the decrease in physical- activity cause balance problems as well as many systemic handicaps.

AIMS/OBJECTIVES

This study aimed to determine the effect of screen time on balance and the effect of headphone usage time on hearing.

METHOD

Thirty-four individuals aged 6-16 years who applied to our clinic with complaints of dizziness and/or balance disorder were included in the study. Participants were divided into 2 groups according to their screen time: Group 1 (4-8 h/day) and Group2(>8 h/day). The other two groups are grouped according to headphone usage time as Group A (2-4 h/day) and Group B (>4hours/day). Pure-tone audiometry, extended high frequency-audiometry, Videonystagmography (VNG) and Computerized Dynamic Posturography (CDP) tests and Pediatric Berg Balance Scale and Visual Analogue Scale were applied to all individuals. CDP scores and pure tone hearing thresholds between groups were compared.

RESULTS

A significant difference was observed between Group 1 and Group 2 according to the CDP test (visual, vestibular and composite scores), and according to the VAS-dizziness and PBS (p ≤ .05). Pure tone average and pure tone thresholds at high frequencies were compared between Group A and Group B according to headphone usage time. Pure tone thresholds of Group B were worse at high frequencies than Group A (p ≤ .05).

CONCLUSIONS

It has been observed that prolonged screen time may cause balance impairment in children and prolonged use of headphones may affect high-frequency hearing thresholds.

The effects of diet and physical activity induced weight loss on the severity of tinnitus and quality of life: A randomized controlled trial

BACKGROUND & AIMS

Subjective tinnitus is the most common and manifest auditory symptom of an existing pathology in the auditory system. Although the effect of obesity on tinnitus is still uncertain, it is known that increased fat tissue increases the severity and symptoms of tinnitus. In this study, it was aimed to evaluate the effect of weight loss through diet and physical activity on tinnitus.

METHODS

Forty-six obese subjects diagnosed with tinnitus were randomized into the diet + physical activity (PA) (n = 13), diet (n = 16) and the control groups (n = 17). The anthropometric measurements, tinnitus severity scores, tinnitus handicap inventory (THI) scores and short form quality of life (SF-36) scores of the individuals were recorded and compared at the beginning and at the end of the study.

RESULTS

In the diet + PA and diet groups; body weight (diet + PA:-6.5 ± 2.6; diet: -4.1 ± 1) tinnitus severity (diet + PA:-11.0 ± 7.0; diet: -9.0 ± 8.7) and THI scores (diet + FA:-15.0 ± 9.5; diet: -14.0 ± 10.0) significantly decreased compared to the control group (p < 0.01). This decline was more in those with weight loss of ≥5.0% than those with <5.0%. SF-36 score was significantly increased in the diet + PA and diet groups (respectively 10.0 ± 5.5 and 6.0 ± 2.7) compared to the control group (p < 0.05).

CONCLUSIONS

Diet and physical activity intervention ameliorated the tinnitus severity and quality of life in obese patients with tinnitus. However to generalize this findings further studies are needed. REGISTERED UNDER CLINICALTRIALS.

GOV IDENTIFIER NO

NCT00123456.

Pseudomonas Aeruginosa Sepsis in a Previously Healthy Infant with Subcutaneous Nodules and Mastoid Bone Destruction

Pseudomonas aeruginosa septicemia is rare in previously healthy children. Skin lesions such as subcutaneous nodules and ecthyma gangrenosum may be the first manifestation of Pseudomonas infection that have rarely been reported. Herein we reported a previously healthy 6-month-old boy patient who presented with suppurative otitis media, multiple nodules, septic shock, and P. aeruginosa was identified in cultures of the blood, skin lesions, and purulent material of his ears.

Genetic Causes of Inner Ear Anomalies: a Review from the Turkish Study Group for Inner Ear Anomalies

Inner ear anomalies diagnosed using a radiological study are detected in almost 30% of cases with congenital or prelingual-onset sensorineural hearing loss. Inner ear anomalies can be isolated or occur along with a part of a syndrome involving other systems. Although astonishing progress has been made in research aimed at revealing the genetic causes of hearing loss in the past few decades, only a few genes have been linked to inner ear anomalies. The aim of this review is to discuss the known genetic causes of inner ear anomalies. Identifying the genetic causes of inner ear anomalies is important for guiding clinical care that includes empowered reproductive decisions provided to the affected individuals. Furthermore, understanding the molecular underpinnings of the development of the inner ear in humans is important to develop novel treatment strategies for people with hearing loss.

Effect of Bone Marrow-Derived Mesenchymal Stem Cells on Cochlear Function in an Experimental Rat Model

Mesenchymal stem cell (MSC) therapy is an emerging treatment modality for various human diseases. Although induced pluripotent stem cells have been explored for the restoration of hearing, the potential of MSCs as a therapeutic strategy for various cochlear insults is not precisely known. MSCs possess anti-inflammatory, anti-apoptotic and neuroprotective properties, making them an attractive target for the treatment of inner ear disorders such as hair cell damage in response to inflammation. Most of the previous studies have used immunosuppression or the complex surgical techniques to deliver stem cells into the cochlea. However, no information is available regarding the biocompatibility and safety of MSCs in the inner ear in immunocompetent cochlea. The aim of the present study was to determine the effect of non-surgical administration of rodent bone marrow derived MSCs (BM-MSCs) through transtympanic delivery on the cochlear function and to assess any adverse effects on the auditory system employing a rat model without immunosuppression. We observed that the transtympanic administration of BM-MSCs has no significant effect on the hearing thresholds as determined by auditory brainstem response and distortion product otoacoustic emissions. Histopathological examination revealed no recruitment of inflammatory leukocytes and edema in the cochlea of BM-MSCs administrated rats. The results of this study suggest that transtympanic administration of BM-MSCs is safe and can be explored in providing otoprotection against cochlear insults. Anat Rec, 303:487-493, 2020. © 2019 American Association for Anatomy.

A Noteworthy Pathology in Children with Learning Disabilities: Late Latency Response Failure in Central Auditory Processing

OBJECTIVES

This study investigates the cortical auditory pathways in children with and without learning disability (LD).

MATERIALS AND METHODS

A prospective, controlled clinical study was conducted on patients diagnosed with LD and was followed-up for a minimum period of 6 months in the Department of Child and Adolescent Psychiatry were included as study group. The control group comprised of age- and gender-matched healthy individuals. After otolaryngological and psychiatric examination, all participants were tested using pure-tone audiometry, tympanometry, acoustic reflex, and cortical auditory evoked potentials. Test results were evaluated and compared for each group.

RESULTS

The study included a total of 60 children (30 children with LD as study group and 30 healthy children as control group) who met the inclusion criteria. When event-related potentials were taken into consideration, P2 and P300 mean amplitudes for right ears and N1 and P300 mean amplitudes for left ears were significantly lower in study group than those in the control group. Likewise, P2 and P300 mean latency in right ears and P1, N1, and P300 mean latency in left ears were prolonged in study group (p<0.05).

CONCLUSION

Patients with LD may have disorders of the cortical auditory processing even if they have normal hearing screening tests. Pathologies in late-latency evoked potentials may have a role in the etiology of these patients.

Management of Facial Nerve Schwannoma: A Multicenter Study of 50 Cases

Objective  In the management of facial nerve schwannoma (FNS), surgical tumor resection is now often being replaced with more conservative approaches, such as observation with serial imaging or stereotactic radiosurgery (SRS). Given the scarcity of these lesions, determining the optimal management of FNS remains challenging and subject of debate with multiple treatment approaches supported in the literature. Methods  A retrospective chart review was performed in two academic centers for patients diagnosed with FNS between 1996 and 2017. The clinical presentation, treatment modalities employed, tumor control rates, and facial nerve function (FNF) outcomes (House-Brackmann system) were assessed and analyzed. Results  The study comprised 50 adult patients. Initial treatment modalities included observation with serial clinicoradiologic review in 27 patients (54%), surgery in 17 patients (34%), and SRS in 6 patients (12%). The FNF were decreased in more than half of the patients who had surgery. Nonetheless, more than 80% of the patients who were initially managed with observation or SRS had stable or improved FNF. Conclusion  A prevailing trend toward more conservative treatment modalities for FNS has evolved over time, providing relatively long-term preservation of FNF. As there are multiple management options available, it is of paramount importance that the treating physician be familiar with all treatment modalities and outcomes and counsel patients appropriately. The surgery should be reserved for large tumors and poor FNF at initial presentation or follow-up while watchful observation with imaging is the treatment of choice for rest of the patients.

Effects of early postoperative nasal decongestant on symptom relief after septoplasty

BACKGROUND

A randomized, prospective, double-blinded clinical study was conducted at a single, tertiary referral center. The aim of the study was to evaluate the effects of nasal decongestant use in the early postoperative period after septoplasty.

METHODS

After septoplasty, patients who met the study inclusion criteria were randomized into 2 groups to receive either physiologic saline irrigation (saline group) or physiologic saline irrigation plus oxymetazoline hydrochloride 0.05% nasal spray (saline+oxymetazoline group). Visual analog scale (VAS) scores for bleeding, pain, and nasal crusting; Nasal Obstruction Symptom Evaluation (NOSE) scores; and rhinomanometric measurements were assessed pre- and postoperatively.

RESULTS

The VAS scores for bleeding and nasal crusting of patients in the saline+oxymetazoline group were significantly lower compared with the saline group (p < 0.005). VAS scores for pain were similar between the groups (p > 0.05). Total nasal resistance and NOSE scores of patients in the saline+oxymetazoline group were significantly lower than in saline group after surgery (p < 0.005).

CONCLUSION

The use of nasal decongestant sprays in the very early postoperative period is beneficial to reduce the postsurgical nasal crusting and bleeding symptoms and also for decreasing nasal resistance in this edematous period.

MPZL2 is a novel gene associated with autosomal recessive nonsyndromic moderate hearing loss

While recent studies have revealed a substantial portion of the genes underlying human hearing loss, the extensive genetic landscape has not been completely explored. Here, we report a loss-of-function variant (c.72delA) in MPZL2 in three unrelated multiplex families from Turkey and Iran with autosomal recessive nonsyndromic hearing loss. The variant co-segregates with moderate sensorineural hearing loss in all three families. We show a shared haplotype flanking the variant in our families implicating a single founder. While rare in other populations, the allele frequency of the variant is ~ 0.004 in Ashkenazi Jews, suggesting that it may be an important cause of moderate hearing loss in that population. We show that Mpzl2 is expressed in mouse inner ear, and the protein localizes in the auditory inner and outer hair cells, with an asymmetric subcellular localization. We thus present MPZL2 as a novel gene associated with sensorineural hearing loss.

Central Auditory Processing Disorders in Individuals with Autism Spectrum Disorders

The etiology and the underlying pathogenetic mechanisms of autism spectrum disorders are still largely unknown. This article provides a comprehensive review of the studies that are relevant to autism spectrum disorders and central auditory processing disorders and also discusses the relationship between autism spectrum disorders and central auditory processing disorders in the light of recent studies on this subject, which may provide new pathways in a therapeutic perspective. Several studies confirm that most of the individuals with an autism spectrum disorder have some degree of sensory dysfunction related to disorders of processing auditory, visual, vestibular, and/or tactile stimuli. Among these studies, some have addressed central auditory processing disorders. There is an increasing amount of effort for studies regarding the link between autism spectrum disorders and central auditory processing disorders. Most of the studies investigating central auditory processing disorders in patients with autism spectrum disorders have used electrophysiological measurements such as mismatch negativity and P300 event-related potentials. In addition to these, several studies have reported deterioration in speech perception and expression in patients with autism spectrum disorders, which may also be related to central auditory processing disorders in this unique group of individuals.

Radiological Evaluation of Inner Ear with Computed Tomography in Patients with Unilateral Non-Pulsatile Tinnitus

OBJECTIVE

The objective of this research was to investigate the possible relationship between tinnitus and certain bony inner ear structures using computed tomography (CT).

MATERIALS AND METHODS

This was a prospective, controlled, double-blind study. The subjects of the study were divided into the following three groups: group 1 (G1), patients with unilateral sensorineural hearing loss (SNHL) and unilateral non-pulsatile tinnitus in the same ear; group 2 (G2), patients with normal hearing and unilateral non-pulsatile tinnitus; and group 3 (G3), healthy volunteers with neither tinnitus nor hearing loss. The basal turn length, internal acoustic canal (IAC) width and length, bony cochlear nerve canal (BCNC) width, and IAC diameter at the porus acousticus internus (PAI) were measured.

RESULTS

The mean BCNC width was significantly narrower in G1 and G2 than in the control group (G3) (p<0.001). For patients in G2, BCNC width was significantly narrower in ears with tinnitus (p<0.001) than in ears without tinnitus. The mean IAC diameter at PAI was also narrower in the G1 patients (p=0.007) compared with the other groups.

CONCLUSION

The results of this study suggest that CT evaluation of the inner ear structures is important in patients with tinnitus. According to the results, a narrow BCNC may cause phantom sensations and be related to cochlear nerve dysfunction. Therefore, it is recommended that clinicians evaluate BCNC carefully while assessing such patients.

How can we improve medical adherence to intranasal corticosteroids in children?

OBJECTIVE

To evaluate the factors which may be related to nonadherence to intranasal corticosteroids (ICS) in the treatment of allergic rhinitis (AR) in children.

METHODS

A prospective study was conducted on children with AR diagnosis in a tertiary referral hospital. All participants were provided with mometasone furoate nasal sprays for 30 days after the diagnosis. Caregivers were called back when the therapy was over and completed a questionnaire about the factors that may influence the adherence to the treatment. Afterwards each caregiver completed the Turkish language validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor was evaluated according to MMAS-8 score and all variables were analyzed statistically.

RESULTS

A total number of 76 children with a mean age of 7.82 years were included in the study. The mean overall MMAS-8 score was 2.80. There was only one factor significantly related to low adherence; the number of dependent children to the caregiver (p = 0.011). Besides this 71.51% of the answers to MMAS-8 scale were compatible with good adherence.

CONCLUSION

The clinician must consider the factors which may lead to non-adherence while setting up a treatment plan. The demographic and sociocultural factors must be taken into consideration and treatment schedule should be made in respect of daily activities of the children. Moreover the father can be involved in the therapy plan and back up the mother as they are usually the responsible parent for children's medical therapy.

Medical adherence to intranasal corticosteroids in adult patients

Introduction

The adherence to medical treatment in allergic rhinitis is poorly evaluated in clinical practice.

Objectives

To evaluate adherence to intranasal corticosteroids in the treatment of allergic rhinitis patients.

Methods

This prospective study was conducted on adult patients who were admitted to the outpatient clinic of the otolaryngology department tertiary hospital. Patients diagnosed with moderate to severe persistent AR and who had not used any nasal sprays were enrolled in the study. The patients were provided with mometasone furoate nasal sprays. On the 30th day, all participants filled out a questionnaire regarding the factors that may have influenced their adherence to the treatment. Afterwards, each patient filled out the Turkish-language-validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor that may have affected adherence to the prescribed medication was evaluated according to the MMAS-8 score and all variables were analyzed statistically.

Results

Fifty-nine adult patients with a mean age of 32.5 years (range 21–52 years) were included in the study. The mean overall MMAS-8 score was 3.64. Two factors were significantly related to low adherence: number of dependent children (p = 0.001) and benefit from the medication (p = 0.001). In addition, patients with higher education levels seemed to be more adherent than the rest of the group.

Conclusion

Clinicians must keep in mind the factors related to non-adherence in order to achieve better treatment outcomes. Therefore, based on our results, patients must be informed that medications should be taken properly regardless of the benefit, and the treatment should be scheduled with respect to daily activities, particularly for patients caring for more than two children.

Cartilage reinforcement graft versus fascia graft in tympanoplasty

Background/aim: The purpose of this study was to compare cartilage reinforcement graft results with temporalis fascia graft alone in terms of hearing and anatomical outcomes in tympanoplasty. Materials and methods: Patients who underwent tympanoplasty with/without ossiculoplasty and/or mastoidectomy at a university hospital from 2006 through 2013 were reviewed retrospectively. The patients were divided into those grafted with temporalis muscle fascia alone and with fascia reinforced with cartilage. The postoperative air bone gap, gain in hearing thresholds, and graft status were evaluated for each group. Results: The study subjects included 179 patients. There were 82 patients in the fascia group and 97 patients in the cartilage group. Successful hearing results were elicited in 79.2% of the fascia group and 85.5% of the cartilage group. There was no significant difference in overall graft success. The graft was intact in 82.9% of the fascia group and 86.5% of the cartilage group. Conclusion: In this comparative study the use of cartilage to reinforce the temporalis muscle fascia was analyzed, showing better hearing and anatomical results than sole use of fascia in tympanoplasty both for primary and revision cases. Thus, in the light of our results, when performing tympanoplasty we recommend the use of cartilage reinforcement grafting whenever needed and indicated.

Retroauricular Approach for Targeted Cochlear Therapy Experiments in Wistar Albino Rats

Background:

As the idea of stem cell technology in the treatment of sensorial hearing loss has emerged over the past decades, the need for in vivo models for related experiments has become explicit. One of the most common experimental models for inner ear stem cell delivery experiments is the Wistar albino rat.

Aims:

To investigate the surgical anatomy of the temporal bone of the Wistar albino rat with respect to the dissection steps, operative techniques and potential pitfalls of surgery.

Study Design:

Animal experimentation.

Methods:

Adult Wistar albino rats were operated on via the retroauricular approach under an operation microscope. The anatomy of the temporal bone, the surgical route to the temporal bulla and the inner ear were investigated. Technical details of surgical steps, complications and potential pitfalls during the surgery were noted.

Results:

The study group consisted of 40 adult Wistar albino rats. The mean times to reach the bulla and to achieve cochleostomy were 4.3 (2-13 min) and 7.5 min (3.5-22 min), respectively. The mean width of the facial nerve was 0.84 mm (0.42-1.25 mm). The stapedial artery lay nearly perpendicular to the course of the facial nerve (88-93 °C). There were three major complications: two large cochleostomies and one massive bleed from the stapedial artery.

Conclusion:

The facial nerve was the key anatomical landmark in locating the bulla. By retrograde tracing of the facial nerve, it was possible to find the bulla ventral (inferior) to the main trunk. The facial nerve trunk was the upper limit when drilling the bulla. By dissecting the main trunk of the facial nerve and retracting cranially, a large drilling space could be achieved. Our results suggest that the retroauricular approach is an effective, feasible route for inner ear drug delivery experiments in Wistar albino rats.

Study of mouse induced pluripotent stem cell transplantation intoWistar albino rat cochleae after hair cell damage

BACKGROUND/AIM

As the regeneration capacity of hair cells is limited, inner ear stem cell therapies hold promise. Effects of mouse induced pluripotent stem cells (IPSCs) on Wistar albino rats (WARs) with hearing impairment were investigated.

MATERIALS AND METHODS

Thirty-five adult WARs with normal hearing were divided into 4 groups. Excluding the study group (n = 15), the other three groups served as control groups for ototoxicity and IPSC injection models. IPSC injections were performed via cochleostomy after a retroauricular approach. Auditory functions were evaluated with auditory brainstem responses (ABRs) before and after the injections. After a final hearing assessment the WARs were sacrificed and cochleae were extracted to see the biologic behavior of IPSCs in the inner ear by light microscopy and immunohistochemistry.

RESULTS

There were no significant differences in the click-ABR thresholds in the study group after IPSC transplantation. The mean hearing threshold in the study group after ototoxic agent injection was 53.2 dB (10-90 dB). There was no significant difference between groups (P > 0.05) and no differentiated stem cells were observed immunohistochemically.

CONCLUSION

Transplanted IPSCs did not show a therapeutic effect in this trial. We discuss potential pitfalls and factors affecting the therapeutic effect.

The relationship between senile hearing loss and vestibular activity

Introduction

A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms.

Objective

To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL) in adult patients.

Methods

Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP). Patients were divided into two groups: a study group (patients with SNHL) and a control group (patients without SNHL). VEMP results of the groups were calculated and compared.

Results

Mean P1 (23.54) and N1 (30.70) latencies were prolonged in the study group (p < 0.001) and the amplitudes of the study group were significantly reduced (p < 0.001). Both parameters of the VEMP test were abnormal in the study group when compared to the control group.

Conclusions

These findings suggest that age-related SNHL may be accompanied by vestibular weakness without any possible predisposing factors for vestibulopathy.

An unusual entry site for a nasal foreign body: a neglected trauma patient

Foreign body (FB) in the nose is a frequent situation seen generally among children. A variety of objects left in different sites of the nose has been reported in the literature. Insertion of a FB to the nose is generally via the anterior nares. In this report, an unusual entry site for a nasal FB in a neglected trauma patient is presented. FB should be suspected and investigated in children after penetrating facial injury.

Reliability of Frozen Section Pathology in Transoral Laser Laryngectomy

Objective

To evaluate the reliability of frozen section analysis in transoral laser laryngectomy (TOLL).

Methods

A retrospective analysis was conducted for patients who underwent TOLL in a university hospital between January 2012 and February 2014. The grade of the tumor and the histopathological diagnosis were noted. The results of frozen section pathologies and routine histological examinations were compared.

Results

A total number of 84 sections from 21 patients with a mean age of 57.3 years were included in the study. All the patients were operated with superpulse continuous mode carbon dioxide laser with a power of 5-8 watts. Squamous cell carcinoma was histologically diagnosed in all patients. The tumor was grade 1 in 80.95% of the patients, grade 2 in 9.52%, and grade 3 in 9.52%. A routine histopathological examination confirmed the frozen section in 94.04% of the patients.

Conclusion

Laser surgery is a commonly preferred treatment modality in early-stage laryngeal carcinomas, in particular. However, a safe surgical margin is a debate in transoral laser surgery. In light of our results, we can conclude that frozen section pathology is a reliable method to achieve safe surgical margins in TOLL.

Titanium versus Hydroxyapatite Prostheses: Comparison of Hearing and Anatomical Outcomes after Ossicular Chain Reconstruction

Objective

This study aimed to compare hearing and anatomical outcomes after ossicular chain reconstruction with titanium or hydroxyapatite prostheses.

Methods

In this study, patients who underwent tympanoplasty and ossicular chain reconstruction with titanium or hydroxyapatite prostheses at a university hospital from January 2007 to February 2013 were retrospectively reviewed; they had a minimum follow-up period of 6 months. Patients were divided into 4 groups according to the type of prostheses. The surgical procedure, follow-up examinations, preoperative, and postoperative audiometry results were noted and evaluated for partial and total prostheses. The results were compared both for titanium and hydroxyapatite prostheses.

Results

The study subjects included 51 patients. Titanium had better hearing results in partial prostheses (p<0.05), while the anatomical outcomes were similar. Nevertheless, both types had similar results in total prostheses (p>0.05). The extrusion rate was 5.8% for all patients.

Conclusion

Both types of prostheses had satisfactory functional and anatomical results and no preponderance could be stated, except for the hearing results of partial titanium prostheses.

Immunoserologic pepsin detection in the saliva as a non-invasive rapid diagnostic test for laryngopharyngeal reflux

BACKGROUND

The most common tool for the diagnosis of laryngopharyngeal reflux (LPR) is still 24-hours esophageal pH monitoring; there is lack of non-invasive, less expensive and accurate diagnostic tools for this frequent disease.

AIMS

To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR.

STUDY DESIGN

Cross-sectional study.

METHODS

A two channeled 24-hour esophageal pH monitoring catheter was placed in patients with a suspicion of LPR. During the 24-hour period, each patient gave one sample of sputum for the immunoserologic pepsin detection test. Pathologic gastroesophageal reflux (GER) findings, LPR findings, pH score in the proximal and distal probes when the sputum sample was given were recorded. The sensitivity, specificity, positive and negative predictive values of the pepsin detection test were analyzed and compared to pH monitoring scores.

RESULTS

The study group consisted of 20 patients who met the criteria. A positive pepsin detection test was elicited from 6 patients. The sensitivity and specificity of the pepsin detection test was 33% and 100%, respectively. A positive predictive value of 100% was recorded. When the pH results of the pepsin positive patients (PPP) and the rest of the study group in the proximal probe at the sample time were compared, the PPP had an apparent acidic pH value compared to the pepsin negative patients (pH: 3.26 for the PPP, pH: 6.81 for the pepsin negative patients).

CONCLUSION

Pepsin detection in the saliva is a recent method and becoming increasingly popular. Because of the benefits and ease of application, a positive salivary pepsin test in a patient suspected of having LPR can be a cost effective, accurate and alternative diagnostic method. Increasing the daily number of sputum samples may increase the sensitivity of the test.

Comparison of risk factors in newborn hearing screening in a developing country

The aim of this study is to evaluate the results of the newborn-hearing screening program (NHSP) in our institute, investigate the risk factors and their correlation to congenital hearing loss (CHL). Newborns who admitted to our clinic for NHSP from June 2014 to December 2014 were included in the study. After the test parents were asked to fill a questionnaire about the risk factors of CHL. Test results and referral rate were compared with risk factors. One thousand consecutive babies were included in the study. The overall referral rate was 3.5%. Mechanic ventilation, history of familial CHL and familial consanguinity were found to be significantly related to CHL.In the light of our results we can conclude that getting access to every newborn for hearing screening is mandatory and targeting the risk factors and informing the family about the follow-up period is important for diagnosing the delayed hearing impairment.

Accuracy of Internet guidance on pediatric otolaryngology procedures

OBJECTIVES

To evaluate the reliability and accuracy of the most visited Internet websites for the frequently performed surgical pediatric otorhinolaryngology procedures.

STUDY

A google.com search was used to determine the top 20 Internet sites for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery'. The DISCERN plus questionnaire was used to score each website. Furthermore, a 'hit list' of reliable and accurate websites was created depending on the most clicked healthcare organizations with corporate identities and the personal websites of the otolaryngologists with academic titles who were members of the Turkish Society of Otolaryngology Head and Neck Surgery. The pages were also investigated as if they were in this list of accurate websites.

RESULTS

Of the 60 websites viewed for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery', only 23.3% were matching the list of accurate websites. The mean DISCERN plus score was 35.70 (16-58), 38.02 (16-80) and 39.08 (16-58) for adenoidectomy, tonsillectomy and ventilation tube surgery respectively. There was no significant difference between the three groups (p>0.05). The mean DISCERN plus score for all the websites was 37.37 out of the maximum score of 80.

CONCLUSIONS

In the light of our results we can conclude that the quality of data on the Internet is not adequate enough to obtain information about the most frequent surgical procedures in pediatric otorhinolaryngology. Clinicians must be aware about this fact and warn the parents about the disinformation which may lead to wrong decisions.