Adenotonsillar enlargement is the major etiologic factor of obstructive sleep apnea in otherwise healthy children.^1,2 The American Academy of Pediatrics recommends adenotonsillectomy as the first-line treatment for most pediatric obstructive sleep apnea.³ Although this is well accepted conceptually, there is no specific definition of what constitutes larger-than-normal tonsils or adenoids. Part of the difficulty is that there is a complex and dynamic interaction among other airway variables, and there is no absolute cutoff for larger than normal size. Another major problem is the lack of a generally accepted, reliable, and valid grading system. This is particularly relevant for purposes of research that necessitates reproducible assessment of the size of the tonsils and adenoids.

Background: It is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV. Methods: Thirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response. Results: In the control group, abnormal cVEMPs responses were detected in 6.67 % and abnormal oVEMPs responses were detected in 3.34 %. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30 % and abnormal oVEMPs responses were detected in 56.7 %. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group ( p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients ( p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25 %) and recurrent BPPV patients (40 %) ( p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40 %; recurrent BPPV, 90 %) were significant ( p < 0.05). Conclusion: An increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.

Objective: To determine the incidence of otitis media with effusion and the associated hearing loss, the rate of ventilation tube insertion, and complications of ventilation tube insertion in Chinese cleft palate patients. Design: Retrospective review in a tertiary care hospital in Hong Kong. Patients: A total of 104 consecutive patients with cleft lip and/or cleft palate who were born between January 1996 and January 2006. Results: The incidence of otitis media with effusion in Chinese cleft palate patients for the first 2 years after birth was 76.1%. Of these patients, 16.9% had otitis media with effusion associated with a moderate hearing loss (40 decibels hearing level [dBHL]). Approximately half (53.2%) of our patients had ventilation tube insertion. Complications including retraction, tympanosclerosis, and perforation of the tympanic membrane were found in 15.7% of all ears with otitis media with effusion and ventilation tube insertion. Conclusions: The high incidence of otitis media with effusion in cleft palate infants found in this study is consistent with that reported in the Western literature. A small but significant proportion of otitis media with effusion was associated with moderate hearing loss that truly required surgical treatment. Cleft palate children are much more likely to develop otitis media with effusion than normal children, and they develop the condition at an earlier age. A protocol for the treatment of otitis media with effusion in cleft palate patients and further prospective studies are warranted.

Early epileptic seizure prediction (ESP) has informative challenges due to the complexity of electroencephalogram (EEG) signals, patient variability, privacy, security issues regarding consumer health data, and the on-time alarm triggers before an upcoming seizure to provide sufficient time for the patients and caregivers to take appropriate action. Therefore, the proposed study presents a novel patient-specific seizure prediction framework with the Consumer Internet of Things (CIoT) for the smart healthcare system to anticipate the onset of upcoming seizures and improve the quality of healthcare and early treatment. Initially, the multi-handicraft and deep features are extracted in feature engineering modules and then concatenated in the fusion module. The fused feature fed into the Bidirectional Long Short-term Memory (BiLSTM) network to present the temporal dependency of the EEG signals. The Attention Mechanism is applied to reduce the dimension of the feature. Moreover, the CIoT module is integrated for real-time seizure prediction and sending alerts to doctors and emergency units through the cloud platform. Testing via the Leave-One-Out cross-validation method revealed the model’s consistent performance across various seizure types, emphasizing real-time clinical applications. The model achieved 91.39± 3.34% accuracy, 91.30± 2.80% sensitivity, 90.06± 4.84% specificity, and a false positive rate (FPR) of 0.12± 0.04 h-1 in the case of seizure prediction Horizon (SPH) of 10 minutes. The CIoT remotely monitoring the patients ensures timely treatment, maintains data security and privacy, and improves the performance of real-time applications in smart consumer healthcare systems.

Cisplatin is a chemotherapy drug that has been used to treat a number of cancers for decades, and is still one of the most commonly used anti-cancer agents. However, some patients do not respond to...