The 2009 AAO-HNSF Annual Meeting and OTO EXPO continues to offer the latest research findings and updates through its Scientific Program. Key findings presented Monday included the susceptibility of men to noise-induced hearing loss, the severity of non-allergic rhinitis symptoms, and regional variations in rhinosinusitis.

Men more susceptible to noise-induced hearing loss
A comprehensive study of the prevalence and risk factors for noise-induced hearing loss (NIHL) show that men, especially those who are white and married, are significantly more at risk than women, according to new research presented Monday by Shawn Zardouz; Hamid Djalilian, MD, Vanessa Rothholtz, MD, MSc, and Mohsen Barazgan.

The presentation on "Prevalence and Risk Factors for Noise-Induced Hearing Loss" addressed the study that analyzed the audiometric testing data from 5,290 people between the ages of 20 and 69 years, indicating that more than 13 percent of subjects suffer from NIHL, which would correspond with approximately 24 million Americans suffering from the ailment. The strongest association was of gender, where men are 2.5 times more likely to develop NIHL than women. Among that group, married white (non-Hispanic) men represent the highest risk group for developing NIHL.

NIHL is a preventable and increasingly prevalent disorder that results from exposure to high-intensity sound, especially over a long period of time.

The authors believe this is the first study of its kind to delve in to the demographics of NIHL using the most recent figures from 1999-2004 National Health and Nutrition Examination Surveys (NHANES). They believe this information can allow greater education, preventative, and screening efforts.

Chin augmentation to add balance to nose job
In order to ensure an aesthetically balanced face, surgeons performing rhinoplasty should also assess the patient's need for chin augmentation, according to new research addressed Monday by Jahangir Ahmed, MA, MRCS, Sachin Patil, MRCS, and Samuel Jayaraj, FRCS (ORL) in their the presentation on "Assessment of the Chin in Patients Undergoing Rhinoplasty." In fact, the research suggests that the focus has changed on what complications may arise.

The chin and nose form an important part of a patient's profile, and according to the authors, not addressing it could contribute to post operative disappointment with the rhinoplasty.

The study's authors evaluated pictures of their institution's 100 most recent patients to undergo rhinoplasty, using four popular assessment methods (Silver, Legan, Merriford, and Gonzales-Ulloa). Based on these evaluations, between 17 and 62 percent of men, and 39 and 81 percent of women, could have benefitted from further assessment with a view to chin augmentation. Twenty-one percent of men scored positive on three or more methods, 58 percent for women.

The authors contend that while the "perfect face" is a misnomer, balanced features are nonetheless valued in all cultures, and reflect substantially a patient's physical impression on others. In cases where surgical modifications are made, the authors believe the surgeon has a responsibility to inform their patients prior to the surgery of the impact the procedure will have on their overall look.

Non-allergic rhinitis symptoms more severe than allergic rhinitis
A comparison of symptoms in patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) revealed that those with the NAR experienced worse symptoms. These findings were addressed in Monday's presentation on "Quality of Life in Allergic and Non-Allergic Rhinitis" by Nick Debnath, MD, Rodney J. Schlosser, MD, Richard J. Harvey, Shaun A. Nguyen, MD, MA, Charley S. Coffey, MD, and Karen M. Drawdy, PA-C.

The study assessed 78 patients with AR and 31 patients with non-allergic rhinitis (NAR), measuring quality of life (QOL) in both groups using a common questionnaire. To the surprise of the authors, NAR patients experienced a significantly higher symptom severity than their peers with AR, including having their regular and recreational activities affected, disrupted sleep, tiredness, and watery eyes.

The study's authors believe that that many patients with allergy-type symptoms may have other, as-yet-undetermined causes of their symptoms, and that further research is warranted.

Regional variations in rhinosinusitis
A four-year study of the regional impact of chronic rhinosinusitis (CRS) indicates that African-Americans living in Southern states account for the highest proportion of CRS outpatient treatment, according to new research presented Monday by Wendy Smith, MD, Terence Davidson, MD, and Claire Murphy, PhD, in their paper on "Regional Variations in Chronic Rhinosinusitis, 2003-2006."

The NIH-supported study, which included 4,617 patient visits for CRS, found that the prevalence of female outpatients was significantly higher than that of men in all regions. Primary care specialties (which include internal medicine, general, family practice, and pediatrics) were most frequently visited, although approximately 20 percent of visits for CRS took place in the emergency room.

The study's authors also found that Northeast-based care providers ordered significantly fewer diagnostic services, and prescribed or continued fewer medications at the patient visit for all demographics. The authors believe this indicates that further research is warranted into regional differences of diagnosis and treatment of CRS, and how this impacts management of the disease.

Rhinosinusitis is estimated to affect approximately 14 percent of the U.S. adult population annually; the patient visits chronicled in this study represent approximately 91.2 million national outpatient visits for CRS. However, CRS accounts for only 2 percent of all outpatient visits in the U.S.

New recommendations on hoarseness for primary care physicians
Primary care physicians face limitations when evaluating patients for voice problems including hoarseness (dyphonia), according to new research presented Monday by Seth Cohen, MD, MPH, and Richard Turley, MD, in their presentation on "Primary Care Approach to Hoarseness."

The authors discovered that among 271 primary care physicians, only a third (36.5%) routinely evaluated their patients for voice problems. Nearly one in five (18.1%) never evaluate their patient for a voice disorder. These physicians cited a variety of reasons, including a lack of patient complaint, more pressing issues, or not feeling comfortable with assessing voice ailments. However, over two-thirds expressed an interest in learning more about voice problems.

Voice disorders will affect approximately 30 percent of patients in their lifetimes, severely impacting their qualities of life and contributing to significant decreases in work productivity. However, only a minority of these patients will seek treatment, highlighting the need for improved methods for identifying and treating these patients.

The research coincides with the AAO-HNS' release of the first multi-discipline clinical guidelines for treating hoarseness in patients.