Prevalence of OME Is Reduced in Young Children Using Chewing Gum

OBJECTIVE

The present study investigates a possible relationship between use of chewing gum and otitis media with effusion (OME) in children. Chewing obviously activates jaw movements, increases salivary flow, and, by the way, the rate of swallowing and the rate of activations of peritubal muscles and tubal openings. Chewing also requires nasal respiration, thus preventing mouth breathing.

DESIGN

Cross-sectional study: 1756 children (2 to 6 yr of age), apparently in good health and visiting different Dutch child health centers in the region of Utrecht were examined between September 1999 and April 2002. OME was diagnosed by combined tympanometry and otoscopy. The criterion for OME was unilateral or bilateral type B tympanogram, according to Jerger. The parents had to fill out a questionnaire with a question pertaining to the chewing habits of their child.

RESULTS

Logistic regression points out that age and season as well as chewing gum-consuming habits significantly influence the prevalence of OME. The strongest effects are age (OME becomes less frequent with age) and season (OME occurs less when climate is more favorable), but -- ceteris paribus -- a child consuming daily or at least weekly chewing gum shows significantly less chance for OME than a child who seldom consumes or consumes no chewing gum (p = 0.023).

CONCLUSIONS

In the case of regular use of chewing gum, the probability of having OME in children is reduced by 40%. It seems plausible that children with immature oral motorics do not like chewing gum.

Efficacy of voice therapy assessed with the Voice Range Profile (Phonetogram)

INTRODUCTION

Voice Range Profile (VRP), or Phonetography, is a widely used method of acoustic voice assessment: it explores and documents the extreme possibilities or capabilities of the voice by producing a chart displaying the intensity dynamics as a function of the fundamental frequency range.

OBJECTIVES

In the present study VRP is used for investigating the efficacy of (isolated) functional voice therapy, and for defining the best suited VRP criteria for this purpose.

MATERIAL AND METHOD

30 adult voice patients with complaints of chronic dysphonia (> 4 months) fitted the acceptance--and exclusion criteria, and received functional voice therapy for 2 sessions/week during 3-6 months therapy (2x/week). VRP was performed before and after therapy, and a follow-up VRP was conducted 3 months after completion of the therapy.

RESULTS

The parameters "softest intensity" and "VRP--area" seem the most sensitive parameters: they show an average highly significant improvement after therapy, and still an average significant improvement between the end of treatment and the follow-up measurement.

CONCLUSION

For daily practice, an index (3 points-index) combining Fo-range and softest intensity is proposed.

Implementation of the European Laryngological Society (ELS) basic protocol for assessing voice treatment effect

OBJECTIVES

93 patients with various kinds of organic benign voice pathology (vocal fold nodules, polyp, Reinke's oedema, unilateral paralysis, sulcus/scar) and/or with muscle tension dysphonia, were evaluated before and after their voice treatment (phonosurgery with voice therapy, antireflux medication, or voice therapy alone) in order to check the clinical relevance of a basic multidimensional protocol for assessing functional results of voice treatments, as developed by the Committee on Phoniatrics of the ELS.

MATERIAL AND METHOD

The protocol has been used in different university voice clinics. It comprises 5 dimensions: Perception: Grade, Breathiness and Roughness from the GRBAS-scale, rated by two experienced judges: a phoniatrician/laryngologist and a speech therapist. Acoustics: Jitter % and Shimmer % computed on a /a:/, at comfortable loudness and pitch. Also Fo-range and softest possible intensity. Videostroboscopy: Glottal closure, regularity, mucosal wave and symmetry, rated separately. Phonation quotient: computed by dividing the vital capacity (ml) by the maximum phonation time (s) (best value of 2x3 trials). Self rating by the patient: voice quality in itself and general social/occupational handicap due to the voice problem rated separately.

RESULTS

Results show that, at group level, the overall effects for each parameter indicate a significant improvement after treatment. However, the correlations between the pre/post changes for the different parameters are weak (low redundancy).

CONCLUSION

The assessment of voice pathology needs to be multidimensional, as these multidimensional informations about voice changes lead to a better understanding of the actual way in which a treatment works.

Acute tinnitus and permanent audiovestibular damage after hepatitis B vaccination

Yeast-derived recombinant DNA hepatitis B vaccine usage has been widely accepted since the early 1990s, especially for high-risk patients. Severe adverse effects have been reported infrequently. Certain neurological complications raise concern for hepatitis B vaccine: central nervous system demyelination, acute myelitis, acute cerebellar ataxia, and various peripheral mononeuropathies. Case reports on tinnitus, hearing loss, and vestibular damage are extremely scarce. The case presented here concerns a professionally active nurse, born in 1953, with a medical history of progressive renal failure and hemodialysis. Eleven hours after a second injection of the hepatitis B vaccine Engerix B, an acute left-sided tinnitus occurred and, a few hours later, severe left hearing loss and intense vertigo. Tinnitus and the sensation of vertigo regressed fairly quickly, but the hearing loss and the vestibular paresis were permanent. Increased interpeak intervals on auditory brain responses and lack of recruitment suggested that the lesion probably is located at the level of cranial nerve VIII. From a medicolegal point of view, this audiovestibular damage had to be considered an accident at work and not as an occupational disease.