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Abstract Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.
RESUMO
Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3 rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.
RESUMO
ABSTRACT For computerized analysis of respiratory sounds to be effective, the acquired signal must be free from all the interfering elements. Different forms of noise which can degrade the quality of lung sounds are recording artifacts, power line/Radio Frequency (RF) interferences, ambient acoustic interferences, heart sound interference etc. Such interferences adversely affect the diagnostic interpretations. Powerful denoising techniques are necessary to resolve this issue. A denoising scheme for lung sounds, based on Savitzky-Golay (S-G) filter is proposed in this paper. The order and frame length of the SG filter is determined objectively using the Signal to Noise Ratio (SNR) and computational time as objective function. Maximum SNR is observed when the frame length is nearest to the value just higher than the polynomial order. This observation holds good for different levels of simulated addictive Gaussian noise. The polynomial order of 8 and frame size of 9 are found to be promising with SNR of 10.401db at computation time of 2.1ms.
RESUMO
A human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) intervention using indigenous outreach workers was implemented with Hispanic injection drug users (IDUs) and their sexual partners in three locations: Laredo, Texas; San Diego, California; and San Juan, Puerto Rico. A total of 2,169 subjects were contacted, given health education, HIV antibody testing, and follow-up counseling. This article reports on the 1,616 IDUs (75%) who completed the initial and follow-up interviews. The results indicated significant increases in health knowledge on AIDS, decreases in needle risk drug taking behaviors, some decreases in sex risk behaviors, and more realistic perceptions of personal AIDS risk. Using multivariate analyses, gender (male) and increasing age (older than age 25 years) were the strongest predictors of behavior change. Surprisingly, the identification of a positive HIV serostatus was not a significant predictor of behavior change. Although intended as a comparison study between contrasting levels of intervention, logistical and administrative problems undermined the use of a true quasi-experimental design. Nonetheless, the results from this research suggest that the use of indigenous outreach workers is an effective means of combatting the spread of HIV in this difficult to reach population. Some programmatic recommendations are provided for future efforts of this kind, particularly in relation to role conflicts experienced by outreach workers.