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September 2006 News Archives
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September 19: Steroids for Treatment of Sudden Hearing Loss, PeerView Media Bar
ALEXANDRIA, VA -- September 19, 2006 -- Sudden sensorineural hearing loss (SSNHL) can occur suddenly in one ear, and generally within three days, cause a 30+ decibel (dB) hearing loss at three consecutive frequencies. The cause for this disorder is unclear, but research has indicated that viral infection, vascular compromise, and immunologic diseases could be key reasons for this hearing disorder.
A few celebrities have reported experiencing sudden hearing loss. In recent years, radio personality Rush Limbaugh and Rapper Foxy Brown both reported experiencing sudden hearing loss.
Treatment of SSNHL remains controversial. Different approaches such as steroids, vasodilator, antiviral agents, diuretics, and low-salt diets have been suggested. Nevertheless, spontaneous recovery rate without treatment ranges from 30 to 60%, most resolving within two weeks after onset.
As a result of its anti-inflammatory effect, high-dosage systemic steroid therapy is currently the mainstay of the treatment for SSNHL. Despite oral or intravenous steroid therapy for two weeks, approximately 30% to 50% of patients show no response. Animal studies have found that intratympanic steroid injections, introducing steroids through the tympanic membrane, results in reduced systemic steroid toxicity and higher perilymph steroid level selectively.
Past research has focused on use of these injections as a secondary-line therapy in SSNHL refractory cases. Other clinicians promote its use as first-line therapy in all SSNHL cases. Nevertheless, few controlled studies have been published comparing the results between intratympanic steroid treatment and other approaches.
A New Study
A new study evaluates the effect of intratympanic steroid injections in patients with SSNHL after failure to respond to systemic steroid treatment. Patients who refused this regimen were used as controls in this research. The authors of "Intratympanic Steroids for Treatment of Sudden Hearing Loss After Failure of Intravenous Therapy," are Guillermo Plaza MD PhD, from the Otolaryngology Department, Hospital de Fuenlabrada, and Carlos Herráiz MD PhD, with the Otolaryngology Department, Fundación Hospital Alcorcón, both in Madrid, Spain. Their findings are being presented at the 110th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, being held September 17-20, 2006, at the Metro Toronto Convention Centre, Toronto, Canada.
Methodology
From January 2000 to December 2004, a non-randomized prospective clinical trial was conducted for 50 patients diagnosed with unilateral (affecting one ear) SSNHL due to unknown reasons. All patients underwent a complete clinical history, physical and audiologic examination, syphilis serology, autoimmune antibody test, and magnetic resonance imaging, producing negative results. Patients were excluded if SSNHL might be caused by trauma, Meniere's disease, tumors, or autoimmune diseases. Also, those cases that were treated later than 30 days after onset of SSNHL were also excluded.
All cases were intravenously treated, with 120 mg of methlyprednisolone per day, for five days. Rest, stop smoking, and low-salt diet were also advised. Although antiviral agents or diuretic were not included in the standard protocol, intravenous pentoxyphylline was sometimes used with the steroids. After five days of intravenous treatment, pure-tone audiometry and speech discrimination tests (SDT) were performed. Pure-tone average (PTA) was calculated as the average of the thresholds at 0.5, 1, 2 and 3 kHz.
After this period of intravenous therapy, failures (18 cases) were offered intratympanic steroid treatment. Nine patients refused, and were treated with oral steroid tapering during 15 days. They were considered as internal controls, whereas the other nine patients received three weekly intratympanic injections of methylprednisolone. Intratympanic steroid treatment was started 5-7 days after onset of conservative treatment.
Pure-tone audiometry and SDT were performed just before each injection, and one week, one month and six months after the last injection. In the control group that refused intratympanic treatment, pure-tone audiometry and SDT were performed one month and six months after onset. Recovery of hearing was defined as improvement of more than 15 dBs in PTA or an increase in speech discrimination score (SDS) of 15% or more. Threshold differences were also analyzed at each frequency in PTA. Side effects and subjective symptoms were also recorded.
Results
The average age of the study patients the patients was 52.0 ± 15.8 years. Male to female ratio was 22:28. Time of onset to start of intravenous therapy averaged 5.6 ± 7.7 days. Tinnitus was present in 58% of the cases, whereas vertigo presented in 24%. Thirty-2% of cases had hypertension, and 14% had diabetes mellitus. Initial hearing impairment was average 76.5 ± 21.2 dB PTA, and 38 ± 12%.
After standard intravenous treatment, hearing improvement of 15 dB or more in PTA was noted in 32 cases (64%). In these responders, the mean improvement of the value of PTAs before and after intravenous treatment was 35.0 ± 16.56 dB. For the 18 failures, nine patients accepted intratympanic treatment, and were enrolled in the treatment group, whereas the other nine served as internal controls. There were no statistical differences in age, sex ratio, time of onset to therapy, presence of vertigo and tinnitus, initial hearing level, and final hearing level after intravenous treatment between the two groups.
In the treatment group, hearing improvement of 15 dB or more in PTA was noted in five cases (55%). The mean value of PTA before and one month after intratympanic injections treatment were 73.3 ± 20.8 dB and 40.2 ± 17.3 dB, respectively, so that an improvement in mean PTA after intratympanic treatment was 33 ± 12.55 dB.
Conclusions
This non-randomized prospective clinical trial shows that intratympanic methylprednisolone significantly improved the outcome of SSNHL after intravenous steroid treatment. As previously reported, intratympanic steroids actually are an effective and safe therapy in SSNHL cases that are refractory to standard treatment.
The researchers suggest that the number of injections, the type of steroid, and the most adequate doses must be defined in randomized prospective clinical trials. Also, these randomized studies will allow establishing an evidence-based treatment for idiopathic SSNHL. These trials should also evaluate outcomes after initial therapy for SSNHL comparing steroids that are administrated systemically or by intratympanic injections.
SOURCE: American Academy of Otolaryngology Head and Neck Surgery
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September 19: Balloons Bring Sinus Relief, Forbes.com
Leslie Sabbagh, HealthDay News
A new procedure that uses tiny balloon catheters to prop open inflamed sinuses is easing the misery of chronic sinusitis sufferers.
A report on the procedure was to be presented at the American Academy of Otolaryngology Head and Neck Surgery Foundation annual meeting Sunday, in Toronto.
"This new technology presents what seems to be faster healing, less postoperative care, minimal pain and bleeding, and improved quality of life for many patients who suffer with chronic sinusitis," said study investigator Dr. Howard L. Levine, director of the Cleveland Nasal Sinus and Sleep Center.
Chronic sinusitis, which can be due to infection, inflammation or anatomical obstructions, affects some 37 million Americans. Many people with the disorder are helped with antibiotics, but more severe cases call for surgery. In conventional endoscopic sinusotomy, an otolaryngologist uses an endoscope to examine the sinuses and inserts micro-shavers and delicate instruments to remove diseased bone and soft tissue.
"This enlarges the sinus and returns it to function," Levine explained.
From this concept, balloon catheterization was born. The investigators describe it as another technology that will augment the ability to preserve sinus function.
Dr. David Sherris, chairman of otolaryngology at the University at Buffalo in New York, agreed. "The study shows the balloon catheter is effective in opening some sinuses, and this may prove to be less invasive for certain aspects of sinus surgery," he explained.
Even though it is performed in the operating room under general anesthesia, the new procedure is shorter, with a quicker recovery, the researchers say. Using fluoroscopic imaging, a small flexible wire is guided into the sinus. Over this guide wire, a 3-millimeter, 5-millimeter or 7-millimeter balloon is passed into the sinus cavity. Once positioned, the balloon is dilated, the catheter is removed, and the dilated opening is inspected, Levine said.
The procedure takes from 30 minutes to two hours, depending on degree of pathology and the complexity of the patient's sinus anatomy. Depending on the disease, this procedure can be combined with traditional endoscopic sinus surgery.
The multi-center landmark study analyzed six-month data from 115 patients (41 male, 74 female). Mean patient age was 47.8 years, and ranged from 21 years to 76 years. Twenty-one patients (18.3%) had previous endoscopic sinus surgery. At 24 weeks, endoscopies showed that 82.1% (252 of 307 sinuses) were open. Patients showed consistent symptomatic improvement over baseline, the researchers reported.
No serious adverse events occurred, and there were no complications. Narrowing of dilated openings occurred infrequently, and revision surgery was rarely necessary, the researchers reported.
"Realistically, we know sinusitis is caused by many things--respiratory infections, allergies. And even with the best of surgical procedures, there are always ups and downs, with the possibility for recurrence," Levine said. "The hope is that (balloon sinusotomy) will lessen disease severity and frequency and, hopefully, cure it."
Patients who are not candidates are those with nasal polyps, previous sinus surgery with severe scarring or those with previous surgery who have new abnormal bone growth, said Levine.
In the end, people who live with the misery of chronic sinusitis now have a minimally invasive option that can preserve structure and function and allow return to normal activity faster, Levine said. He also speculated that the procedure could lower health care costs because patients would be back to work and school sooner. "It could reduce costs in the long run, with less postoperative care compared to conventional sinusotomy," he said.
Although he is not currently trained in the procedure, Sherris said he "would be interested in trying it in minor revision sinus surgery and some sinus surgery in children."
"Longer term studies and head-to-head comparisons with standard endoscopic sinus surgery techniques will be necessary to establish the place of balloon sinuplasty in the toolbox of endoscopic sinus surgeons" Sherris said.
Because it is minimally invasive, the procedure could be "ideal for children," Levine said, noting a prospective study is under way to evaluate its feasibility in pediatric cases. The U.S. Food and Drug Administration approved the procedure for adults last year, he noted.
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September 19: Study Adds to Links Between Sleep Loss and Diabetes, PeerView Media Bar
CHICAGO, IL -- September 19, 2006 -- Short or poor quality sleep is associated with reduced control of blood-sugar levels in African Americans with diabetes, report researchers from the University of Chicago in the Sept. 18, 2006, issue of the Archives of Internal Medicine.
The finding suggests that one inexpensive way to improve the health of patients with type 2 diabetes might be to improve the duration and quality of their sleep.
"Sleep is modifiable," said Kristen Knutson, research associate (assistant professor) in the department of health studies at the University of Chicago and first author of the paper. "We've known for some time that skimping on sleep can impair glucose tolerance even for healthy people. Now we have evidence connecting chronic partial sleep deprivation and reduced blood-sugar control in patients with diabetes."
"Although we can't be certain whether sleep loss makes diabetes worse or the diabetes interferes with sleep, it only makes sense for everyone, but especially patients with diabetes, to give themselves the opportunity to get enough sleep," Knutson said.
The study focused on 161 African-American patients being treated at the University of Chicago Hospitals for type 2 diabetes. The researchers asked participants how much sleep they thought they needed at night and how much sleep they managed to get on weeknights and weekends. They also assessed the quality of their sleep using a standard 19-item questionnaire, the Pittsburgh Sleep Quality Index (PSQI).
To assess blood sugar control they measured glycosylated hemoglobin, a standard tool for management of patients with diabetes. Glycosylated hemoglobin, or HbA1c, reflects the average blood glucose level over the previous three months. A normal HbA1c result is between four and six%. Higher levels represent poor glucose control. Patients with diabetes are considered to be under good control if they can keep their levels below seven%.
The researchers found that, on average, the 161 diabetes patients got very little sleep and had poor glucose control. Mean sleep duration was six hours a night. Only six% reported getting eight hours of sleep on weeknights and only 22% reported getting at least seven hours. Seventy-one% had poor sleep quality. The median HbA1c score was 8.3%.
Many patients with diabetes have painful complications that can interfere with sleep. Even after the researchers excluded 39 patients who reported such pain, however, two out of three of the remaining 122 patients reported poor quality sleep. The average HbA1c among those patients was almost as high: 8.2%.
Insufficient or poor quality sleep was closely associated with higher HbA1c results. For patients with no complications of their diabetes, a three-hour "perceived sleep debt" -- the difference between how much sleep they felt they needed and how much they think they got -- was associated with a 1.1%age-point increase in HbA1c levels, for example from 7.5% up to 8.6%.
For patients with at least one complication of diabetes -- such as nerve pain, kidney damage or coronary artery disease -- decreased sleep quality appeared to be more important. An increase of five points (out of 21) on the PSQI was associated with a 1.9%age-point increase in HbA1c, for example from 8.7% up to 10.6%.
"The magnitude of these effects," the authors note, "is comparable to those of widely used oral antidiabetic agents."
A long series of laboratory and epidemiologic studies has suggested that cutting back on sleep has a harmful effect on glucose control, insulin secretion and metabolism in ways that might increase diabetes risk, said Eve Van Cauter, professor of medicine at the University of Chicago and senior author of the study. The current study asks the question: is glucose control in subjects who already have diabetes adversely affected by too little sleep or poor sleep?
"Our findings suggest, at least in this study population, that short or poor sleep is associated with decreased blood-sugar control in patients who already have diabetes," she said. "The growing tendency to burn the candle at both ends may be a significant contributor to the current epidemic of diabetes. One way to slow down this epidemic may be to avoid building a chronic sleep debt."
The MacArthur Foundation, the American Diabetes Association and the National Institutes of Health funded this study. Additional authors are Armand Ryden, of the University of Chicago, and Bryce Mander, now at Northwestern University.
SOURCE: University of Chicago Hospitals
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September 19: Poor Sleep Contributes to Health Problems, Forves.com
TUESDAY, Sept. 19 (HealthDay News) -- New studies are discovering just how vital sleep is to overall health.
So, sleep habits should become a standard part of a complete check-up, researchers say.
"There is increasing evidence that there is a very strong relationship between sleep quality and physical and mental health," said Dr. Phyllis C. Zee, a professor of neurology at Northwestern University's Feinberg School of Medicine.
"If you have poor health, that is associated with poor sleep. Also, if you have poor sleep, there is an association between that and poor health," Zee said. "What we don't have yet is the research to categorically say that if you improve sleep, you will improve conditions, such as diabetes or hypertension, or other medical conditions."
Still, physicians should be asking their patients about the quality and quantity of their sleep, Zee said. "Sleep should be another vital sign," she said.
Zee wrote an editorial in the Sept. 18 issue of the Archives of Internal Medicine, a special, themed issue on sleep and its relationship to overall health.
In one study, led by Richard L. Nahin, a senior advisor for scientific coordination and outreach at the U.S. National Center for Complementary and Alternative Medicine, looked at why people had trouble sleeping and how many were using alternative drugs to help them sleep.
Insomnia and trouble sleeping are most often associated with high blood pressure, heart failure, anxiety and depression, according to a national survey of 31,044 adults. "That's unusual. It had been most often thought that insomnia was quite prevalent on its own, but only 4 percent of the people who said they had insomnia said they had it without any of those conditions," Nahin said.
The researchers also found that 1.6 million Americans are using alternative therapies, such as melatonin to treat their insomnia. "That's quite high when you consider that there is very little reliable data on the efficacy and safety of using the products people are using," Nahin said.
These findings have implications for treating sleep problems, Nahin said.
"Instead of treating the insomnia itself, a health-care provider might be better off treating one of these comorbidities," he said. "In addition, a physician seeing a patient for insomnia should ask if the patient is using any alternative and complementary treatments, because they might upset the treatments the health-care provider wants to apply."
Another study found that people who have sleep-related breathing disorder -- marked by frequent pauses in breathing, labored breathing, or reduced breathing during the night -- were two to 2.6 times more likely to develop depression. Moreover, the odds of depression increased as breathing disorders became more severe, according to researcher Paul E. Peppard and colleagues from the University of Wisconsin.
And a study by French researchers found that people with allergic rhinitis, caused by hay fever and other allergies, have more difficulty sleeping and more sleep disorders than people without allergies. "The results show a significant impact of allergic rhinitis on all dimensions of sleep quality and, consequently, a lower quality of life as reflected by more somnolence [sleepiness]; daytime fatigue and sleepiness; and impaired memory, mood and sexuality, with a significantly increased consumption of alcohol and sedatives in cases compared with the control group," the study authors wrote.
One expert agrees that sleep problems shouldn't be ignored.
"If you think insomnia is an annoyance and merely something you should tough out, that may be a mistake," said Michael L. Perlis, director of the Sleep Research Laboratory at the University of Rochester, in New York. "It may lead you down the path to other morbidities. It would also be a mistake because it's treatable."
Other studies in the same journal issue found that:
- Fewer hours of sleep may contribute to poor health in young adults.
- Those in rural areas who sleep fewer hours appear to weigh more.
- The immune system may play a role in narcolepsy, a disorder characterized by an uncontrollable urge to sleep.
- The immune system may be affected by a lack of sleep that contributes to inflammation and a variety of diseases.
More information
The National Sleep Foundation can tell you more about getting a good night's sleep.
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September 21: Adenotonsillectomy relieves sleep apnea in kids, Reuters
NEW YORK (Reuters Health) - Approximately 1 percent to 3 percent of children have obstructive sleep apnea (OSA), which interferes with their quality of life. Removal of the adenoids and tonsils, a procedure called adenotonsillectomy, to treat OSA in children is still controversial, but new research supports its use for long-term improvement.
This issue is important, Dr. Cristina Baldassari told the annual meeting of the American Academy of Otolaryngology Head and Neck Surgery in Toronto, because untreated OSA may lead to heart and respiratory sequelae and even growth retardation.
OSA is a disorder in which the airway repeatedly becomes blocked during sleep resulting in a temporary halt in breathing.
Baldassari, from Virginia Commonwealth University in Richmond, searched the PubMed database for studies focusing on the quality of life in children with OSA. She identified 10 studies involving 535 children with enlarged adenoids and tonsils.
A pooled analysis of the data revealed that children with OSA scored worse than healthy controls on several health measures including physical functioning, bodily pain, behavior, general health perceptions as well as their emotional interactions with others.
In fact, the impact of OSA resembled that of children with asthma or juvenile rheumatoid arthritis, Baldassari notes.
In seven studies that looked at outcomes among 342 children approximately 1 to 5 months after surgery, significant improvements were documented in sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns.
Two articles that included 91 children with OSA showed that these improvements maintained for up to 16 months.
The investigator concludes, "a complex relationship exists between pediatric OSA, behavior, neurocognition, and quality of life."
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September 26: No-Smoking Laws May Help Hearts, WebMD
Heart Attack Hospitalizations Drop Nearly 30% After Public Smoking Ban in Pueblo, Colo.
By Miranda Hitti
WebMD Medical News Reviewed By Louise Chang, MD
Banning smoking in public places may slash heart attack hospitalizations within months, a new study shows.
The study, published in Circulation's rapid access online edition, centers on Pueblo, Colo., located in southern Colorado.
In 2003, Pueblo residents voted to ban smoking in all buildings that are open to the public, including bars, restaurants, and bowling alleys.
Eighteen months later, Pueblo's hospitalization rates for heart attack were nearly 30% lower than they had been a year and a half before the ban began, report Carl Bertecchi, MD, and colleagues.
Bertecchi works in Pueblo at the University of Colorado Health Sciences Center.
Bertecchi's team checked heart attack hospitalizations of Pueblo residents over a three-year period, before and after the law took effect.
During that time, 855 Pueblo residents were hospitalized for heart attacks. Cases started dropping within months of the ban's launch.
"You can save lives with drugs and expensive, sophisticated devices, but this single community action lead to 108 fewer heart attacks in an 18-month period," Bertecchi says, in an American Heart Association news release.
Clearing the Air
The study doesn't prove that the no-smoking ban was solely responsible for the drop in heart attack hospitalizations.
But no such decline was seen in Colorado Springs -- located 45 miles from Pueblo -- or in El Paso County, which neighbors Pueblo County.
A prior, smaller study from Helena, Mont., also showed a drop in heart attack hospitalizations after a public smoking ban went into effect.
"Taken together, we suggest that these data indicate a smoking ordinance may be a vehicle for reducing the burden of ischemic heart diseaseheart disease," write Bertecchi and colleagues.
They predict that the health benefits of such laws will take decades to reach their full potential.
But when it comes to heart attacks, the perks "may be realized much more rapidly," Bertecchi's team writes, noting that the heart may be particularly sensitive to tobacco smoke.
SOURCES: Bartecchi, C. Circulation, Sept. 25, 2006; rapid access online edition. News release, American Heart Association.
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September 29: Study: Hotel rooms have unseen guests, USA Today
SAN FRANCISCO (AP) – Hotel guests leave behind more than just socks and old paperbacks: A new study found viruses on TV remotes, light switches and even hotel pens after cold sufferers checked out.
The germ testing was done before the rooms were cleaned, so it likely overstates the risks that most travelers would face. Nevertheless, it shows the potential hazards if a hotel's turnaround amounts to little more than changing the sheets and wiping out the tub.
"You sure hope the cleaning people were good," said Dr. Owen Hendley, the University of Virginia pediatrician who presented results of the study Friday at a meeting of the American Society for Microbiology.
Besides hotel hazards, the findings point out things that people may not think to clean in their homes when someone has a cold.
"We know that viruses can survive on surfaces for a long time - more than four days," said Dr. Birgit Winther, an ear, nose and throat specialist at the university who led the study.
Its aim was to test the survival of rhinoviruses, which cause about half of all colds, especially in children.
Researchers had 15 people with lab-confirmed rhinovirus colds spend a night in individual rooms at a nearby hotel and, after they checked out, tested 10 items they said they had touched. About one-third of the objects were contaminated with rhinovirus.
"We were surprised to find so many," Winther said.
Virus was found on 7 out of 14 door handles and 6 of 14 pens. Six out of 15 light switches, TV remotes and faucets tested positive, as did 5 of 15 phones. Shower curtains, coffee makers and alarm clocks also harbored viruses.
Surprisingly, virus turned up on only one of the 10 toilet handles tested.
Experts did not test items like bedspreads because cloth dries out germs, making them far less likely to survive than they do on smooth or moist surfaces.
Several months later, 5 of the 15 participants were asked to return to the hotel and visit rooms where certain items had been deliberately contaminated with their own mucus, which had been frozen previously when they had their colds.
Because they had developed immunity to these germs, doctors could study how easily they picked them up without putting them at risk of getting sick again.
Each volunteer visited two rooms and their hands were tested afterward for viruses. Results were positive on 60% of contacts in rooms where mucus had dried for at least an hour, and on 33% of those in rooms where mucus had dried overnight.
The study was sponsored by Reckitt-Benckiser Inc., makers of Lysol, but did not test any products. Doctors with no ties to the company designed the study to lay the groundwork for future research on germs and ways to get rid of them.
Some in the hotel industry say they have strict policies on how to disinfect rooms between guests.
"We do wipe everything down, from the remote control to the telephone," said Michelle Pike, corporate director of housekeeping for Hilton brand hotels, which has 1,900 hotels around the world. Most of them are independently operated but the chain does have rules for disinfection, she said.
Hilton, like many hotels, has taken steps to make common items easier to clean, like encasing phone books in plastic and replacing bedspreads with duvet covers than can be washed between each guest, she said.
And if germs are lingering on surfaces in hotel rooms, "you can be damn sure it's more likely to happen at home," Hendley said.
To wipe down home surfaces, doorknobs and light switches, "standard household cleaners will be adequate," said Dr. Frederick Hayden, a University of Virginia infectious diseases specialist who had no role in this study but has consulted extensively with companies developing viral vaccines and treatments.
Dr. Stuart Levy, a Tufts University physician who heads the Alliance for Prudent Antibiotic Use, advocates lots of hand washing and not going overboard trying to de-bug your home.
"How clean do you need to be? You don't go through with a blowtorch," he said.
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