Purpose: The purpose of this study was to validate the Greek version of the Tinnitus Handicap Inventory. Method: Eighty-six adult patients with chronic tinnitus participated in the study. Sociodemographic data and medical history were recorded during the interview. The patients underwent audiological examination and they were asked to fill in three questionnaires: the Greek version of the THI (THI-GR), the Greek version of the State-Trait Anxiety Inventory (STAI) and the brief Tinnitus Severity Scale Questionnaire (TSSQ). Results: The THI-GR showed good internal consistency, comparable to the original version. Cronbach’s alpha was equal to 0.92, which suggests a robust reliability. All THI-GR subscales along with total score were significantly and positively correlated with the TSSQ grade and the audiogram results indicating the existence of convergent validity. Furthermore, THI-GR’s subscales were significantly correlated with both State and Trait subscales, which indicates a correlation between tinnitus and stress. Conclusions: This study highlighted the high reliability and validity of the THI-GR as a self-report measure for the evaluation of tinnitus-related annoyance and psychological distress in clinical practice.

Cervicofacial subcutaneous emphysema is a rare complication of tonsillectomy that often resolves spontaneously but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax. The mechanisms by which subcutaneous emphysema and pneumomediastinum may develop after tonsillectomy are poorly understood. A case of a 21-year-old female undergoing routine adenotonsillectomy, who developed cervicofacial emphysema and pneumomediastinum, is presented. Possible pathogenetic mechanisms and treatment options are discussed.

Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

Benign tumors of the tonsils occur infrequently. Lymphangiomas are rare congenital tumors of the lymphatic system, and tonsillar lymphangioma is an extremely rare occurrence. Its pathogenesis is uncertain, but history, clinical examination, and histological examination should establish the diagnosis. We present a 17-year-old white male with lymphangioma of the right tonsil. The tonsils were excised and biopsy confirmed the diagnosis. Tonsillar lymphangioma is a rare clinical entity, which should be known to the otolaryngologist, in order to diagnose and treat it appropriately and avoid confusion with tonsillar malignancies.

Allergic rhinitis is common among children and quite often represents a stage of the atopic march. Although sensitization to food and airborne allergens may appear in infancy and early childhood, symptoms of the disease are usually present after age 3. The aim of this study was to determine the most frequent food and indoor and outdoor respiratory allergens involved in allergic rhinitis in children in the region of Piraeus. The study was performed in the outpatient clinic of otolaryngologic allergy of a general hospital. Fifty children (ranged 6–14 ) with symptoms of allergic rhinitis and positive radioallergosorbent test (RAST) for IgE antibodies or skin prick tests were included in the study. Thirty six (72%) of the subjects of the study had intermittent allergic rhinitis. The most common aeroallergens determined were grass pollens and Parietaria, whereas egg and milk were the food allergens identified. The detection of indoor and outdoor allergens in the region of Piraeus, based on skin prick tests and RAST tests, showed high incidence of grasses and food allergens, which is similar to other Mediterranean countries.

Introduction. Otitis media with effusion is a common pediatric disease whose diagnosis is based on pneumatic otoscopy, pure-tone audiometry, and tympanometry. The aim of this study was to evaluate transiently evoked otoacoustic emissions in the diagnosis of otitis media with effusion as compared to tympanometry. Patients and Methods. 38 children with bilateral otitis media with effusion were studied. 40 normal children of similar age and sex were used as controls. All subjects underwent pneumatic otoscopy, standard pure-tone audiometry, tympanometry, and transiently evoked otoacoustic emissions. Results. In the group of children with bilateral otitis media, transiently evoked otoacoustic emissions were absent in 51 ears (67%). In the remaining 25 ears (33%) the mean emission amplitude was reduced, as compared to the mean value of the control group. Conclusions. Transiently evoked otoacoustic emissions should be included in the diagnostic workup of otitis media with effusion because it is a fast, reliable, and objective test. Transiently evoked otoacoustic emissions should always be used in conjunction with tympanometry, because a more meaningful interpretation of transiently evoked otoacoustic emissions measures is possible.

Background and Aim: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. According to the canalolithiasis theory, it is caused by gravity-dependent movements of otoconial debris that collects in the endolymph of the posterior semicircular canal. The horizontal semicircular canal is occasionally affected, but involvement of the anterior canal is extremely rare. We report a case of bilateral BPPV involving the right horizontal and the left anterior semicircular canals.

Background and Aim: Vestibular neuritis is characterized by the acute onset of vertigo, with accompanying postural, oculomotor, and autonomic symptoms and signs, and usually lasts for several days. The aim of this presentation is to study patients with vestibular neuritis who were treated in the ENT Department during the last 3 years and were followed up for at least 1 year.

AIM:There has been a significant increase in the number of clinically useful biomedical resources available through the Internet over the last few years. The aim of this article is to present an updated list of all the worldwide web sites of rhinology.METHODS:All rhinologic links, which appear on the web site of the journal "Rhinology" were accessed and updated. Non-responding links were discarded and a new extensive survey of all rhinologic sites on the Internet was performed using on-line available search engines. All sites were accessed more than once at different times and their uniform resource locator (URL) address was recorded.RESULTS:The URL addresses of all rhinologic sites on the Internet appear in categories. Main categories include endoscopy and operative techniques, allergy, olfaction, rhinology clinics and research centers, organizations and societies, scientific journals, discussion groups, news and medical conferences, collective otolaryngology resources, and miscellaneous other sites of interest to rhinologists.CONCLUSIONS:This paper summarizes several types of resources available to rhinologists on the Internet. A complete universal list was composed, in which links to almost all interesting rhinologic links were included.

Aim: Distortion-product otoacoustic emissions (DPOAEs), as opposed to transiently evoked otoacoustic emissions, have not been extensively researched in hearing screening of pediatric and adult populations. The current study aimed to describe the range of DPOAE values obtained in two groups: a group of healthy children and a group of healthy adults.

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

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

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

Aim: Otitis media with effusion (OME) is a common pediatric disease and is considered the most common cause of hearing impairment among children. Transiently evoked otoacoustic emissions (TEOAEs) is a new diagnostic method of assessing the cochlear status objectively. In general, middle ear effusion reduces measured emission amplitudes and sometimes eliminates the response entirely. The aim of this study was to evaluate TEOAEs in the diagnosis of OME as compared to tympanometry.

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

Objective: Transiently evoked (TEOAEs) and distortion-product otoacoustic emissions at the 2f1-f2 frequency (DPOAEs) are being used as a clinical toot for diagnosis of peripheral auditory pathology. Because both tests are fast and non-invasive, they may be an excellent method for hearing screening in infants and children. The purpose of this study was to compare the TEOAE and DPOAE measures obtained in a group of healthy children.Methods: Sixty-six school-aged children with normal hearing were included in the study. Subjects with recent otologic disease or abnormal tympanograms were excluded. TEOAEs and DPOAEs were performed using a DID Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. Correlation between TEOAE amplitudes and DPOAE levels was estimated.Results: Correlation between TEOAE amplitudes and DPOAE levels was highly significant across all measured frequencies. Correlation was more significant at the middle frequencies than at the tow and high frequencies.Conclusions: Although frequency specific information maybe obtained by both tests, most reliable results were obtained at the middle frequencies. TEOAE values were more prominent at low frequencies, whereas DPOAEs were more effective at high frequencies. Both methods are reliable, objective, fast and useful tests of the cochlear status and should be included in the standard audiological diagnostic work-up of children. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective: Urbach–Wiethe disease (lipoid proteinosis) is a rare, recessively inherited disorder, characterized by infiltration of a hyalin-like material in skin, mucous membranes, brain and other internal organs. We present a case of a child with this rare disease. Case report: A 15-year-old boy was referred to our clinic because of a 10-year history of hoarseness. On clinical examination, waxy papules were seen on the face. The cutaneous lesions appeared early in childhood soon after the development of hoarseness and were located along the margin of both eyelids and on the upper lip on a beaded arrangement. Hyperkeratotic plaques were also found on the elbows and white–yellow infiltrates on the mucosae of the pharynx and the tongue. Full laboratory investigation was unremarkable. A biopsy from oral mucosae confirmed the diagnosis of lipoid proteinosis. Conclusion: Lipoid proteinosis is thought to be a multisystemic disorder due to deposition of hyaline material around the blood vessels in internal organs. Usual manifestations of the disease include recurrent parotitis related to the occlusion of the salivary duct, epilepsy owed to intracranial suprasellar calcification, malfunction of the eyelashes causing corneal ulceration or alopecia of the eyelashes and eyebrows. The most serious manifestation of lipoid proteinosis is the possible respiratory obstruction in infancy because of the enlargement of the tongue and the presence of hyaline infiltrates in pharynx. Otherwise, the disease is compatible with a normal life span. The disfiguring lesions and the permanent hoarseness can seriously impair quality of life. There is no effective therapy at the present time.

We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the right mastoid bone had eroded its wall and extended toward the middle and posterior cranial fossae. The macroscopic and microscopic appearance of an excised portion of the lesion established the diagnosis of mastoid fibromatosis. After a more detailed work-up, a second procedure involving extensive removal of the tumor was performed, and the diagnosis was confirmed. The patient's postoperative period was uneventful, and he showed no evidence of recurrence during 3 years of follow-up.

BACKGROUND:The presence of otoacoustic emissions is objective evidence of normal cochlear status. However, this test cannot be used to predict absolute auditory thresholds with accuracy. The criteria of normal otoacoustic emissions are not yet standardized and different measures of otoacoustic emissions have been used in various settings. In this study, the measures of reproducibility and otoacoustic emission amplitude are compared with regard to their correlation to pure-tone auditory (PTA) thresholds.MATERIAL/METHODS:One hundred and seventeen subjects with normal hearing were included in the study. Subjects with previous audiological, otolaryngologic, or vestibular disease were excluded. A complete ENT and audiological work-up was performed, including transiently evoked otoacoustic emissions (TEOAEs). The equipment used for TEOAE testing was a DP Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. A full 260 low-noise samples were averaged. Correlation between PTA thresholds and either overall TEOAE amplitude or whole reproducibility was estimated using multiple regression analysis.RESULTS:Correlation between acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz and either whole reproducibility or emission amplitude was highly significant for both measures. However, whole reproducibility was better correlated to acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz than was emission amplitude, and was more accurately predicted from multiple regression equations.CONCLUSIONS:Reproducibility measures performed better than TEOAE amplitude levels in the prediction of auditory thresholds.