Otolaryngology

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Bell's Palsy

(TL003)

Introduction

Bell's palsy (BP) also called facial nerve palsy, is usually a unilateral (one-sided) facial paralysis that occurs suddenly and worsens over a period of hours to days. Dysfunction of the facial nerve can occur through several different mechanisms: compromise of the blood supply to the nerve; inflammation and edema within the nerve; immune reaction; or viral infection.

BP is the most common cause of facial paralysis affecting approximately 65,000 persons every year in the United States. BP mostly affects young and middle-aged adults. The incidence rises again after the age of 60.

Recent research has provided evidence that the herpes simplex virus (HSV) may play an important role in as many as 70% of BP cases. HSV is the same virus that causes cold sores and lives in nerves.

Because most cases of BP resolve spontaneously, the need for treatment has been debated, especially in mild cases. The goals of therapy are to prevent or minimize significant and long-term paralysis, disfigurement and disability. Treatment may include medications and rarely, surgery.

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The Medifocus Guide on Bell's Palsy provides answers to the following important questions and medical issues:

What are the most common symptoms of Bell's palsy?

Are there any recognized risk factors for developing Bell's palsy?

What kinds of medical tests are used to establish the diagnosis of Bell's palsy?

What is the current standard of care for the treatment of Bell's palsy?

What treatment options are available for the management of Bell's palsy?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in Bell's palsy?

Where are the leading hospitals and centers of research for Bell's palsy?

What are the most important questions to ask my doctor about Bell's palsy?

What Your Doctor Reads:

This MediFocus Guide contains an extensive listing of citations and abstracts of recent journal articles that have been published about this condition in trustworthy medical journals. This is the same type of information that is available to physicians and other health care professionals. A partial selection of journal articles that are abstracted in this MediFocus Guide includes:

Bell's palsy: does anything help?.

Canadian Family Physician. 2000

Bell palsy complicating pregnancy: a review.

Obstetrical & Gynecological Survey. 2000

Bell's palsy and herpes viruses: to (acyclo)vir or not to (acyclo)vir?.

Journal of the Neurological Sciences. 1999

Bell's palsy and herpes simplex virus.

APMIS. 1997

Medical management of Bell's palsy.

Comprehensive Therapy. 1997

Bell's palsy: an update on idiopathic facial paralysis.

Nurse Practitioner. 1997

Differential diagnosis of facial paralysis and Bell's palsy identifiable for dental surgeons--a review of the literature.

Journal of the New Jersey Dental Association. 1996

Prognostic factors in patients with idiopathic facial paralysis (Bell's palsy): A prospective study.

1999

A comparative study of age and degree of facial nerve recovery in patients with Bell's palsy.

European Archives of Oto-Rhino-Laryngology. 1999

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Bell's palsy and prednisolone.

Journal of Accident & Emergency Medicine. 1999

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Chronic Otitis Media

(TL005)

Introduction

Otitis media (OM) is an inflammatory condition of the middle ear that is initiated by functional or mechanical obstruction of the eustachian tube, which leads to changing pressures of the gases in the middle ear. This subsequently allows fluid to flow into the middle ear followed by bacteria.

OM is a common childhood disease and is, in fact, the most frequent primary diagnosis at visits to US physicians by children younger than 15 years. OM primarily affects infants and preschoolers: almost all children experience one or more episodes of otitis media before age 6.

Acute otitis media (AOM) is defined as fluid in the middle ear accompanied by signs or symptoms of ear infection (bulging eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent or infectious material). Otitis media with effusion (OME) is defined as fluid in the middle ear without signs or symptoms of ear infection.

OME is defined as chronic when middle ear effusion (MEE) has been present for at least 3 months. Chronic OME, which arises from a complex series of inflammatory events in the middle ear, affects approximately 5-30% of children. The duration of MEE is 16-20 weeks during the first 2 years of life.

Most cases of otitis media with effusion resolve spontaneously. Persistence of OME longer than 6 weeks and/or the development of hearing loss are then reevaluated to determine the need for further evaluation, antibiotic therapy, or other interventions, which may include surgery.

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The Medifocus Guide on Chronic Otitis Media provides answers to the following important questions and medical issues:

What are the most common symptoms of otitis media?

Are there any recognized risk factors for developing otitis media?

What kinds of medical tests are used to establish the diagnosis of otitis media?

What is the current standard of care for the treatment of otitis media?

What treatment options are available for the management of otitis media?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in otitis media?

Where are the leading hospitals and centers of research for otitis media?

What are the most important questions to ask my doctor about otitis media?

What Your Doctor Reads:

Use of ototopical antibiotics in treating 3 common ear diseases.

Otolaryngology - Head & Neck Surgery. 2000

Nonimmune strategies for prevention of otitis media.

Pediatric Infectious Disease Journal. 2000

Conjugate pneumococcal vaccine and antibiotic-resistant Streptococcus pneumoniae: herd immunity and reduction of otitis morbidity.

Pediatric Infectious Disease Journal. 2000

Increasing antibiotic resistance among otitis media pathogens and their susceptibility to oral agents based on pharmacodynamic parameters.

Pediatric Infectious Disease Journal. 2000

Clinical course, complications and sequelae of acute otitis media.

Pediatric Infectious Disease Journal. 2000

Clinical epidemiology of otitis media.

Pediatric Infectious Disease Journal. 2000

Bacterial otitis media: pathogenetic considerations.

Pediatric Infectious Disease Journal. 2000

Otogenic intracranial inflammations: role of magnetic resonance imaging.

Topics in Magnetic Resonance Imaging. 2000

The judicious use of antibiotic agents in common childhood respiratory illness.

Nursing Clinics of North America. 2000

Otitis media: To treat or not to treat?.

Canadian Respiratory Journal. 1999

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Meniere's Disease

(TL008)

Introduction

Meniere's Disease (MD), also called endolymphatic hydrops, is a disorder of the inner ear associated with a change in fluid volume within a portion of the inner ear known as the labyrinth. When your head moves, nerve receptors in the labyrinth send signals to the brain about the body's motion.

Symptoms include hearing loss, dizziness, nausea and vomiting. Persons experience symptoms at varying frequencies, durations, and intensities. Symptoms may occur daily or as infrequently as once a year. Attacks commonly occur suddenly and may last several hours. The very first episode may last longer than 24 hours, but subsequent episodes do not.

While the disease may occur in children, it most commonly affects persons between the ages of 20 and 50. It occurs equally in men and women.

Treatment of Meniere's Disease consists of medication and possibly, surgery with much consideration given to preservation of hearing.

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The Medifocus Guide on Meniere's Disease provides answers to the following important questions and medical issues:

What are the most common symptoms of Meniere's Disease?

Are there any recognized risk factors for developing Meniere's Disease?

What kinds of medical tests are used to establish the diagnosis of Meniere's Disease?

What is the current standard of care for the treatment of Meniere's Disease?

What treatment options are available for the management of Meniere's Disease?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in Meniere's Disease?

Where are the leading hospitals and centers of research for Meniere's Disease?

What are the most important questions to ask my doctor about Meniere's Disease?

What Your Doctor Reads:

Update on intratympanic gentamicin for Meniere's disease.

Laryngoscope. 2000

Vestibular surgery for Meniere's disease in the elderly: a review of techniques and indications.

Ear, Nose, & Throat Journal. 1999

Immunologic aspects of Meniere's disease.

American Journal of Otolaryngology. 1999

Meniere's disease.

Advances in Oto-Rhino-Laryngology. 1999

Diagnosing and treating Meniere's disease.

Practitioner. 1998

Fortnightly review. Diagnosis and treatment of Meniere's disease.

BMJ. 1998

Titration streptomycin therapy in Meniere's disease: long-term results.

Otolaryngology - Head & Neck Surgery. 1998

Viral theory for Meniere's disease and endolymphatic hydrops: overview and new therapeutic options for viral labyrinthitis.

Annals of the New York Academy of Sciences. 1997

Use of sustained release vehicles in the treatment of Meniere's disease.

Otolaryngologic Clinics of North America. 1997

Vestibular rehabilitation strategies in Meniere's disease.

Otolaryngologic Clinics of North America. 1997

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Sleep Apnea Syndrome

(TL011)

Introduction

There are several disorders termed "sleep-related breathing disorders" (SRBDs). These include obesity-hypoventilation, central sleep apnea syndrome, and obstructive sleep apnea (OSA). OSA, occlusion of the upper airway with continued respiratory effort, is the most common and well-known of these disorders.

The primary mechanism leading to OSA is a repetitive narrowing of the upper airway during sleep, followed by an increase in upper airway resistance or complete cessation of ventilation for 10 to 120 seconds. In milder forms of OSA, the sleeping individual may maintain airflow at the expense of increased work of breathing and frequent arousals. As OSA progresses, the respiratory events become more severe; hypoxia (low oxygen level), hypercarbia (increased carbon dioxide level), and dramatic disruptions of sleep occur.

OSA has been strongly associated with several cardiovascular disorders such as systemic hypertension, and there is association with pulmonary hypertension, cardiac ischemia (impaired blood flow to the heart), dysrhythmias, and strokes.

Initial management of OSA emphasizes correction of medical conditions such as hypothyroidism or anatomical factors as well as weight control, and avoidance of sedative medications. Choices regarding treatment are often based on the individual's preference and lifestyle.

Get the Facts... With your MediFocus Guide

The Medifocus Guide on Sleep Apnea provides answers to the following important questions and medical issues:

What are the most common symptoms of sleep apnea?

Are there any recognized risk factors for developing sleep apnea?

What kinds of medical tests are used to establish the diagnosis of sleep apnea?

What is the current standard of care for the treatment of sleep apnea?

What treatment options are available for the management of sleep apnea?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in sleep apnea?

Where are the leading hospitals and centers of research for sleep apnea?

What are the most important questions to ask my doctor about sleep apnea?

What Your Doctor Reads:

New developments in the treatment of obstructive sleep apnoea.

Thorax. 2000

Cardiovascular disease and obstructive sleep apnea: implications for physicians.

Journal of the American Osteopathic Association. 2000

Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery.

Sleep. 2000

Sleep-related breathing disorders and cardiovascular disease.

American Journal of Medicine. 2000

Recent advances in the sleep apnoea/hypopnoea syndrome.

Hospital Medicine (London). 2000

Systematic review of the literature regarding the diagnosis of sleep apnea.

Evidence Report: Technology Assessment (Summary). 1999

Treatment of obstructive sleep apnea.

Respiratory Care Clinics of North America. 1999

Medical management of obstructive sleep apnea.

Progress in Cardiovascular Diseases. 1999

Cardiovascular morbidity in obstructive sleep apnea.

Progress in Cardiovascular Diseases. 1999

Diagnostic techniques in obstructive sleep apnea.

Progress in Cardiovascular Diseases. 1999

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Tinnitus

(TL015)

Introduction

Tinnitus is the perceived sensation of sound in the absence of auditory stimulation. As many as 35-45% of the adult population and 90% of persons with hearing loss experience tinnitus at least once in awhile, but only 1% of the population suffers from a chronic tinnitus that may be problematic. The majority of individuals who suffer from tinnitus are between 40 and 80 years of age with prevalence increasing with age. It affects women and men equally. Eighty to ninety percent of tinnitus sufferers have a coexistent hearing loss

Tinnitus is a symptom, not a disease, the cause of which is generally not known. There are, however, different ways to classify tinnitus, an important one being "objective" (experienced by the person and the examiner) versus "subjective" (experienced by the person alone).

Treatments and goals must be individualized for each person depending on their particular circumstances. The primary step is to treat any reversible underlying causes thereby eradicating the tinnitus. If this is not possible, then the goal is to minimize the discomfort and disability caused by the tinnitus and to develop coping strategies for the individual.

Relief of tinnitus may be obtained from medication, lifestyle and complementary interventions, and possibly surgery if needed to correct an underlying problem.

Get the Facts... With your MediFocus Guide

The Medifocus Guide on Tinnitus provides answers to the following important questions and medical issues:

What is tinnitus?

Are there any recognized risk factors for developing tinnitus?

What kinds of medical tests are used to establish the diagnosis of tinnitus?

What is the current standard of care for the treatment of tinnitus?

What treatment options are available for the management of tinnitus?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in tinnitus?

Where are the leading hospitals and centers of research for tinnitus?

What are the most important questions to ask my doctor about tinnitus?

What Your Doctor Reads:

Imaging of tinnitus: a review.

Radiology. 2000

A review of evidence in support of a role for 5-HT in the perception of tinnitus.

Hearing Research. 2000

Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients.

Journal of the American Academy of Audiology. 2000

Psychoacoustic measures of tinnitus.

Journal of the American Academy of Audiology. 2000

Neurophysiologic mechanisms of tinnitus.

Journal of the American Academy of Audiology. 2000

Similarities between severe tinnitus and chronic pain.

Journal of the American Academy of Audiology. 2000

Tinnitus in childhood.

International Journal of Pediatric Otorhinolaryngology. 1999

A review of randomized clinical trials in tinnitus.

Laryngoscope. 1999

Some psychological aspects of tinnitus.

Perceptual & Motor Skills. 1999

Tinnitus: etiology and management.

Clinics in Geriatric Medicine. 1999

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Vertigo

(TL016)

Introduction

The word "dizzy" is often used to describe a variety of sensations from lightheadedness to feeling weak or unsteady. Vertigo however, is dizziness that creates the sense that you or your surroundings are spinning or moving. It is defined as a false illusion of motion with a distinct sensation of rotation ("The room was spinning around me").

Acute attacks are well-defined isolated spells of vertigo with a distinct onset and offset, whereas chronic vertigo is defined as a continuous or chronic sensation. Recurrent attacks or vertigo are addressed as chronic vertigo.

Dizziness is the reason for over 7 million clinic visits in the United States each year. Dizziness is a common complaint among older persons, especially. Dizziness in the elderly has been associated with syncope, functional disability, nursing home placement, stroke, and even death.

There are a variety of conditions that can cause vertigo. The evaluation often focuses on uncovering any underlying medical problems.

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The Medifocus Guide on Vertigo provides answers to the following important questions and medical issues:

What is vertigo?

Are there any recognized risk factors for developing vertigo?

What kinds of medical tests are used to determine the cause of vertigo?

What is the current standard of care for the treatment of vertigo?

What treatment options are available for the management of vertigo?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in vertigo?

Where are the leading hospitals and centers of research for vertigo?

What are the most important questions to ask my doctor about vertigo?

What Your Doctor Reads:

Why history is the key in the diagnosis of vertigo.

Practitioner. 2000

Vertigo. Taking the spin out of life.

Mayo Clinic Health Letter. 2000

Neurology. 3: Dizziness.

Medical Journal of Australia. 2000

Efficacy of vestibular rehabilitation.