Acta Oto Laryngologica 2021-02-20

The diagnostic value of computed tomography in delayed complications after cochlear implantation

Philipp Wolber,Sami Shabli,Andreas Anagiotos,Kathrin Moellenhoff,David Schwarz,Ruth Lang-Roth

Publication date 14-10-2020


Delayed complications after cochlear implant (CI) surgery can result in the need for revision surgery. Temporal bone computed tomography (tCT) is frequently used in the diagnostic work-up for these patients. We aimed to test for the value of tCT in delayed complications after CI surgery. Retrospective chart review including all patients with CI who were consecutively enrolled in our academic tertiary care centre and received a tCT due to delayed complications between January 2008 and December 2017. A total of 85 patients with a mean age of 28 years at CI surgery were identified. Mean time between CI and tCT was 4.3 years. Reasons for performance of tCT were device malfunction (20%), cephalgia (20%), scalp hematoma/seroma (15.3%), device failure (11.8%), vertigo (10.6%), local infection (7.1%), trauma (5.9%), meningism (3.5%), tinnitus (3.5%) and facial palsy (2.4%). No abnormalities in tCT were detected in 82.4%. However, an abnormal tCT was a predictor for surgical therapy ( We recommend the performance of tCT in CI patients with delayed complications to identify or rule out pathology in order to choose the most ideal and relevant individual treatment.

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The value of 3D-real IR MRI with intravenous gadolinium injection in the diagnosis of suspected Meniere’s disease in children

Wei Chen,Yuanyuan Chen,Yue Geng,Naier Lin,Siqi Luo,Zhengyue Wang,Sihui Yu,Yan Sha

Publication date 13-11-2020


Intravenous gadolinium injection (IV-method) can be used to visualize endolymphatic hydrops. This study was designed to use a three-dimensional inversion-recovery sequence with real reconstruction (3 D-real IR) sequence 4 h after the IV-method, images of the perilymph space were scored for endolymphatic hydrops in cases of suspected Meniere's disease (MD) in children to investigate its diagnostic value of MD in children. We collected 28 suspected MD children aged ≤17 years old, all of whom underwent the IV-method. After 4 h, inner ear 3 D-real IR magnetic resonance imaging (MRI) was performed and results were analyzed. Gadolinium contrast agent was seen distributed in the perilymphatic space with perilymphatic enhancement on 3 D-real IR MRI, allowing differentiation between the perilymphatic and endolymphatic spaces. Based on perilymph MRI diagnostic scoring, 64.3% (18/28) of the patients were categorized as having endolymphatic hydrops, who were followed and eventually diagnosed with confirmed MDs. Suspected MD children should undergo gadolinium-enhanced examinations of the inner ear while taking dynamic audiology examinations for the confirmed diagnosis.

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Central versus marginal tympanic membrane perforations: does it matter? An analysis of 792 patients

Fábio André Selaimen,Leticia Petersen Schmidt Rosito,Mauricio Noschang Lopes Silva,Alice Lang Silva,Valentina de Souza Stanham,Sady Selaimen Costa

Publication date 30-10-2020


There is a lack of studies concerning chronic otitis media without cholesteatoma. To perform an analysis of tympanic membrane perforations (TMP), compare the parameters of central and marginal TMP, combining both the traditional and more recent technologies available. 792 consecutive patients. The TMP subgroups were divided by central and marginal locations and compared based on signs suggestive of previous tympanic retraction, namely, medialized malleus, tympanic remnants over the promontory, tympanic remnants over the ossicular chain, and incus/stapes erosion. Analysis of the status of the contralateral ear (CLE). Central TMP was diagnosed in 79.8%. Compared with the central group, the marginal group had more reported hearing loss (95.6%), greater conductive hearing loss (pure tone average for air-conduction 43.3 dB and average air-bone gap of 28.7 dB), a larger perforated area (46.45%), more posteroinferior quadrant involvement, a greater number retraction signs prior to the TMP, and more changes in the CLE (71%). The differences between TMP subgroups are highlighted when we use all technologies available to compare them. Marginal TMPs have more altered parameters than central TMPs. There is a great possibility to enhance the knowledge of TMPs and to improve the pathogenesis-based treatment.

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Application of retrosigmoid sinus approach in Bonebridge implantation

Danni Wang,Ran Ren,Peiwei Chen,Jinsong Yang,Mengdie Gao,Yujie Liu,Shouqin Zhao

Publication date 04-11-2020


Bonebridge is an suitable option for conductive hearing loss, however, the traditional approach cannot accomplished a satisfying implantation for patients with congenital malformation or radical mastoidectomy. To evaluate the clinical application of retrosigmoid sinus approach in Bonebridge implantation and postoperative evaluation. 11 patients who underwent retrosigmoid sinus approach Bonebridge implantation from March 2016 to September 2019 were retrospectively analyzed, including 6 males and 5 females, aged 12-54 years old (30.6 in average). Among them, 4 cases had undergone bilateral radical mastoidectomy, 6 cases had bilateral congenital aural atresia or stenosis, and 1 case had unilateral congenital aural atresia. All patients underwent Bonebridge implantation through retrosigmoid sinus approach according to the preoperative image reconstruction and plan. There was no surgical injury of sigmoid sinus or cerebrospinal fluid leakage during the operation. The aided threshold obtained an increase of 32.32 dB HL; the speech recognition rates of bisyllabic words, monosyllabic words and sentence were 79.6%, 67.8% and 75.0%, respectively. After 11-53 months of follow-up, the hearing effect was stable and no long-term complications occurred. The retrosigmoid sinus approach is an effective surgical approach for patients with congenital ear deformities or radical cavity after mastoidectomy.

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Endoscopic versus microscopic type-I cartilage tympanoplasty for anterior perforation – a comparative study

Dipesh Shakya,Arun KC,Nirmala Tamang,Ajit Nepal

Publication date 30-10-2020


Chronic otitis media with anterior perforation is a challenging condition to treat with a microscope especially if the canal is narrow or has overhang. The endoscope provides the advantage of wide-angle view and transcanal access avoiding postauricular approach and canaloplasty. To compare the anatomical, functional outcomes, and surgical duration between endoscopic and microscopic type-I tympanoplasty performed for anterior perforation. A comparative study was conducted. The two groups, the microscopic (MT) and the endoscopic (ET) were created with 50 cases each and underwent type-I tympanoplasty. Results were evaluated at a minimum follow-up of 12 months. The graft uptake rate in MT and ET was 81.8% and 91.3% respectively and was not statistically significant. The mean operative time for MT and ET was 68.68 ± 18.79 min and 61.24 ± 11.18 min respectively which was significant ( The endoscopic tympanoplasty offered superior visualization avoiding postauricular incision and canaloplasty, with morphological and functional outcomes comparable to microscopic tympanoplasty. It offers significantly faster completion of procedure and provides minimally invasive surgery.

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Normative values for semicircular canal function with the video head impulse test (vHIT) in healthy adolescents

Tuğba Emekci,Kadriye Şerife Uğur,Deniz Uğur Cengiz,Fatma Men Kılınç

Publication date 06-11-2020


The vHIT device, which has a mechanism based on measuring the VOR gain, helps us to quickly evaluate six semicircular canals. The aim of this study was to establish normative values for semicircular canal function with the video head impulse test (vHIT) battery in normal adolescents. 100 (50 females, 50 males) individuals aged 11-18 years, with a mean age of 14.99 years, were included in the study. As a result of the vHIT evaluations performed with vHIT Otometrics ICS Impulse A/S Taastrup, Denmark, the mean lateral canal vestibulo-ocular reflex (VOR) gain value was 0.96, the mean anterior canal VOR gain value was 0.89, and the mean posterior canal VOR gain value was 0.87, all of which were within the normal value range. While the VOR gain values and asymmetry values are within the normal value range and are similar to the literature, no statistically significant correlation was observed between these values and age. As a result, the vHIT battery is an easy, fast, and practical test method that can be used in adolescents.

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Cervical vestibular evoked myogenic potentials in patients with the first episode of posterior canal benign paroxysmal positional vertigo before and after repositioning

Gülsüm Saruhan,Ahmet Gökçay,Figen Gökçay,Neşe Çelebisoy

Publication date 06-11-2020


Cervical vestibular evoked myogenic potentials (cVEMPs) are used to assess the sacculo-collic pathways. Benign paroxysmal positional vertigo (BPPV) is mainly a utricular disorder. To investigate cVEMPs in BPPV patients before and after repositioning maneuvers. Forty patients with posterior canal BPPV with new onset symptoms underwent cVEMP testing at the time of diagnosis and a month after successful repositioning maneuver. p13, n23 latency and amplitude ratio values were compared with the results of 40 healthy controls. p13 and n23 latencies of the affected side were significantly longer than the healthy controls more prominent for the p13 latency. Comparison of the affected side with the non-affected side revealed delayed p13 latency on the affected side. Though a significant improvement in p13 latency was observed after repositioning, it was still prolonged when compared with the healthy controls. An abnormality regarding amplitudes was not present. cVEMP abnormalities in patients with BPPV indicate saccular dysfunction accompanying utricular dysfunction which seems to be confined to the symptomatic side at least in the early phase of the disease. Partial recovery can be seen after treatment with residual findings following even the first attack.

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Therapeutic efficacy of super-high-dose steroid therapy in patients with profound sudden sensorineural hearing loss: a comparison with conventional steroid therapy

Mee Hyun Song,Su Young Jung,Ja Won Gu,Dae Bo Shim

Publication date 13-11-2020


In patients with sudden sensorineural hearing loss (SSNHL), steroid therapy is an optional treatment method, but there is controversy about its dose. We aimed to compare the efficacy of super-high-dose steroid therapy with that of conventional steroid therapy in patients with profound SSNHL (pSSNHL). Fifty-two patients diagnosed with pSSNHL between March 2010 and May 2017 were divided into the following groups based on their steroid regimen: a conventional steroid regimen (prednisolone at 1.0 mg/kg/day for 10 days) was applied in Group 1, and a super-high-dose steroid regimen (prednisolone at 1.5 mg/kg/day for 14 days) was applied in Group 2. The treatment outcomes were compared between the groups at 2 and 4 weeks after the initial treatment by use of Siegel's criteria. Of the 52 patients, 31 were classified into Group 1 and 21 into Group 2. When comparing the proportion of patients in complete or partial recovery by Siegel's criteria, the recovery rate was significantly higher in Group 2 than in Group 1 (19% vs 0%, Patients with pSSNHL treated using the super-high-dose steroid regimen demonstrated better recovery rates to serviceable hearing than did those treated using the conventional steroid regimen without significant complications.

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Effects of primary arterial hypertension on cochlear function

Arzu Kirbac,Bilgehan Boke

Publication date 18-12-2020


Hypertension (HT) is one of the most common chronic diseases. The existing literature on HT and hearing contains conflicting results, and no consensus has been reached yet. This study aimed to investigate cochlear function in hypertensive and normotensive groups. This study was conducted on 34 patients with primary HT and 17 healthy adults. The Cochlear function was assessed with conventional audiometry (0.125-8 k Hz), ultra-high frequency audiometry (10-16 k Hz), the transient evoked otoacoustic emission (TEOAE) test, and the distortion product otoacoustic emission (DPOAE) test. Hearing thresholds at 8, 10, 12.5, 14, and 16 k Hz were significantly poorer in the HT group than in the control group ( This study demonstrated significantly poorer high-frequency hearing and lower otoacoustic emission amplitudes for adults with HT. Impairment in hearing thresholds associated with HT begins at ultra-high frequencies in the cochlea. HT may be a potential risk factor for the development of hearing loss; therefore, individuals with HT should be screened for auditory function.

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Does the tinnitus pitch correlate with the frequency of hearing loss?

Natalia Yakunina,Eui-Cheol Nam

Publication date 05-11-2020


The tonotopic model of tinnitus claims that the tinnitus pitch corresponds to the audiometric edge; the homeostatic model suggests that it falls within the hearing loss (HL) area. The existing evidence mostly supports the homeostatic model, but the relationship between the tinnitus pitch and the HL frequencies has been insufficiently explored. To investigate the association between the tinnitus pitch and the audiometric profile in the largest study population to date. Three hundred and ninety-three patients with tonal or narrow-band tinnitus participated. HL frequencies included 30, 40, 50 (F50), 60 dB, and maximum HL. We defined edge frequencies in four different ways according to the existing studies. We assessed the association between all estimated frequencies and the tinnitus pitch using All calculated frequencies differed significantly from the tinnitus pitch except for F50. None were correlated with the tinnitus pitch. F50 was the only significant predictor among the estimated frequencies in multiple regression. The tinnitus pitch fell within the HL area, and was mildly associated with F50. Our results support the homeostatic tinnitus model, and provide reliable evidence that tinnitus pitch does not correspond to the audiometric edge.

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The coronavirus disease 2019: the prevalence, prognosis, and recovery from olfactory dysfunction (OD)

Seyed Hadi Samimi Ardestani,Mojtaba Mohammadi Ardehali,Mahtab Rabbani Anari,Benyamin Rahmaty,Reza Erfanian,Maryam Akbari,Zohre Motedayen,Fahimeh Samimi Niya,Radmehr Aminloo,Farbod Farahbakhsh,Ali Hosseininasab,Babak Hassanlouei,Naime Rezaian,Zahra Mokhtari

Publication date 13-11-2020


Many patients with coronavirus disease 2019 (COVID-19) complain from olfactory dysfunction (OD). In this study, patients with COVID-19 symptoms who were referred to six different tertiary referral centres were recruited after positive results for COVID-19. All patients were assessed for a one-month follow-up after the initial diagnosis of COVID-19. Three hundred and eleven patients with COVID-19 were recruited in the present study. Two hundred and seven patients (66.6%) had a recent history of OD. One hundred and seventy-eight patients had experienced OD as a primary symptom intercurrent to other COVID-19 symptoms or solely. Sixty-nine patients had OD at the time of presentation to referral centres. Headache and nasal obstruction had significant relationships with recovery from OD in this subgroup, and the platelet count was the most important predictor for the recovery from OD. One hundred seventy-nine (86.4%) patients were nearly or fully recovered from OD approximately a month after the onset of OD. Headache, nasal obstruction, and platelet count may have specific roles as prognostic factors in the recovery from OD.

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Autologous fibrin sealant co-delivered with antibiotics is a robust method for topical antibiotic treatment after sinus surgery

Kasper Aanaes,Kim G. Nielsen,Elisabeth Arndal,Christian von Buchwald,Tania Pressler,Niels Høiby

Publication date 07-11-2020


Most patients with cystic fibrosis have the risk of pathogenic bacteria being exchanged between their sinuses and lungs. A method for topical application of antibiotics where the antibiotics persist for a long period of time is needed. Ten patients with cystic fibrosis and bacterial sinusitis were included. Autologous platelet rich fibrin was mixed with an antibiotic solution and sprayed onto the mucosa at the end of an endoscopic sinus surgery; Colistin, a Ciprofloxacin-Colistin combination or Tobramycin was used. The antibiotic concentration was measured in the sinonasal mucus four, seven and 13 days after surgery. Nine patients had Autologous platelet rich fibrin co-delivered with antibiotics is a feasible method for topical antibiotic treatment in supplementary to sinus surgery. We expect that this treatment is successful for eradication of sinonasal bacterial infections in immunosuppressed patients suffering from recalcitrant sinus infections. The efficacy should be evaluated in randomized controlled trials.

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Influence of p16 status on indication and outcome of salvage neck dissection in oropharyngeal cancer

Sarina Katrin Mueller,Konstantinos Mantsopoulos,Sabine Semrau,Abbas Agaimy,Markus Eckstein,Maximilian Traxdorf,Antoniu Oreste Gostian,Miguel Goncalves,Matti Sievert,Marlen Haderlein,Philipp Grundtner,Markus Hecht,Michael Koch,Rainer Fietkau,Heinrich Iro,Claudia Scherl

Publication date 29-10-2020


Human papillomavirus (HPV)+ and HPV- oropharyngeal squamous cell carcinomas (OPSCC) are separate tumor entities. The aim of this study was to examine if the p16 status influences the need and outcome of a salvage neck dissection (SND) after primary radiochemotherapy (pRCT). Retrospective study of 164 patients ( Of the 56 p16+ patients, 17 (30.4%) patients were given an indication for a SND after pRCT with 4 (23.5%) patients showing persistent malignant nodes. Of the 108 p16- patients, 24 (22.2%) patients underwent a SND with 8 (33.3%) patients showing persistent malignant nodes. There was no significant association of the p16 status and neither the indication for SND (p(Chi There was neither a significant association between the p16 status and the indication for a SND nor for persistent malignant nodal disease after pRCT.

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Days alive and out of hospital after treatment for oropharyngeal squamous cell carcinoma with primary transoral robotic surgery or radiotherapy – a prospective cohort study

Susanne Irene Scott,Anne Kathrine Østergaard Madsen,Niclas Rubek,Henrik Kehlet,Christian von Buchwald

Publication date 06-11-2020


With the rising incidence of oropharyngeal squamous cell cancer, there is a need to assess the burden of treatment. This study assessed 'days alive and out of hospital' (DAOH) in a cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with either transoral robotic surgery (TORS) or radiotherapy (RT). A prospective cohort study conducted between May 2017-June 2019. Primary outcome was DAOH in the first 30 days after treatment (DAOH Forty-four patients were included, 31 treated with TORS and 13 with RT. Patients treated with TORS had a median DAOH DAOH has not been examined in oropharyngeal cancer before. We found, patients overall spent 92.5% of the first 180 days alive and out of hospital. Patients treated with TORS had high DAOH

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Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure

Qingxiang Zhang,Xiaohong Chen,Shuangba He,Lifeng Li

Publication date 30-10-2020


Management of early stage glottic carcinoma involving the anterior commissure is challenging. This study aimed to evaluate the efficacy of a thyroid cartilage window (TCW) technique for transoral laser resection of early glottic cancer with involvement of the anterior commissure. Twenty-one patient who underwent a TCW technique for transoral resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. The technical nuances, organ preservation rate and voice outcomes, local and regional recurrence, and perioperative comorbidities, were assessed. All 21 patients underwent a TCW technique for resection, both the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%, and the 5 years recurrence free survival was 90.5%. For two patients with subglottic involvement (9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was observed. Postoperative granuloma was detected in all 21 patients, 13 of whom spontaneously disappeared (61.9%); whereas the remaining 8 patients (38.1%) demonstrated a consistent presence of granuloma more than 12 weeks, and they accepted surgical extirpation of granuloma under surface anesthesia. The laryngeal web developed in all 21 patients, while no dyspnea and local recurrence were present. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement ( TCW technique is a valuable means for transoral resection of early glottic laryngeal cancer involving the anterior commissure, with acceptable voice quality and seemingly low comorbidities.

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The Mirror Effect Plus Protocol for acute Bell’s palsy: a randomised and longitudinal study on facial rehabilitation

Sarah Martineau,Akram Rahal,Éric Piette,Anne-Marie Chouinard,Karine Marcotte

Publication date 21-11-2020


Small but interesting evidences suggest that facial rehabilitation for acute Bell Palsy (BP) could improve facial outcomes in patients who benefited from optimal medication, but whose symptoms are still severe two weeks after BP's onset. This study aimed to provide preliminary evidence of the long-term effects of a new facial retraining based on motor imagery and mirror therapy, the Mirror Effect Plus Protocol (MEPP). Twenty BP patients received the standard medication for acute BP and were then randomly allocated to the treatment (MEPP) or control group, if their palsy was still at least moderate-to-severe at 14 days post onset. Three blind independent assessors graded the patients' evolution until 6 months after onset. Significant differences between the groups were not found for any measured variable; however, a trend toward better recovery was found in the treatment group for every measured variable. This trend grew bigger for patients with severe or total BP. This study suggests a promising effect of the MEPP on acute severe to total BP but requires further investigation with a larger number of participants. Facial rehabilitation should be considered as an adjunct to medication for acute and most severe degrees of BP.

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The role of electrochemotherapy with intratumoral bleomycin for early tongue carcinoma

Corinna E. Zimmermann,Henrike A. Faesser,Volker Gassling,Jörg Wiltfang

Publication date 17-02-2021


The role of electrochemotherapy (ECT) using intratumoral bleomycin and electroporation as a first line treatment for oral tongue carcinoma has not been defined. To evaluate the method of ECT in oral tongue carcinoma. Twenty-one successive patients with primary T1-T2 oral cancer predominantly of the oral tongue underwent either ECT (test; The 10-year local recurrence rate (44.4%) was higher and the tumour-specific survival rate (55.6%) was lower in the ECT group compared to the control group (17% and 91.6%, respectively). Postoperative haemorrhage, dysphagia, and pain were more frequent in ECT patients, treatment time was shorter, but treatment cost was higher. Quality of life was not improved by ECT. Our results indicate that ECT seems not as suitable for the treatment of early tongue cancer as it is for neoplastic and metastatic skin lesions and less favourable than standard surgical therapy.

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Vibration-induced nystagmus and head impulse test screening for vestibular schwannoma

Eduardo Martin-Sanz,Jonathan Esteban-Sánchez,Rocío González-Márquez,Alba Larrán-Jiménez,Ángela Cuesta,Ángel Batuecas-Caletrio

Publication date 16-02-2021


II-2. Vestibular schwannomas are benign tumors of the eight cranial nerve that may cause asymmetric sensorineural hearing loss (ASHL) and vestibular dysfunction. The aim of this study was to assess the role of the video head impulse test (vHIT) and vibration-induced nystagmus (VIN) test in diagnosing vestibular schwannoma in a population of patients with Asymmetric sensorineural hearing loss. For this prospective case-control study, 23 consecutive patients with ASHL and normal magnetic resonance were enrolled in the control group, and 33 consecutive patients with ASHL and vestibular schwannoma were enrolled in the case group. Gold standard was magnetic resonance imaging. Audiometry, vHIT, and VIN tests were performed for each patient. Significance of VIN and vHIT testing was determined by evaluation of their sensitivity, specificity, and correlation with vestibular function tests. Regarding the vHIT, sensitivity and specificity were 45.5% and 82.6%, respectively, for horizontal canal gain, 60.6% and 87.6%, respectively, for posterior canal gain, and 45.5% and 78.3%, respectively, when analyzing superior canal gains. Regarding the VIN test, the sensitivity and specificity were 81.8% and 73.9%, respectively, when based on the presence of a VIN with any mastoid stimulation. Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with ASHL.

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Non-radical primary diagnostic biopsies affect survival in cutaneous head and neck melanoma

Lennart Greiff,Ingela Skogvall-Svensson,Ana Carneiro,Anna Hafström

Publication date 16-02-2021


It is unclear if a non-radical diagnostic biopsy entails a higher risk for metastasis and poorer survival for patients with cutaneous head and neck melanoma (cHNM). To assess whether or not initial diagnostic biopsy modality and radicality (clear, positive, or narrow histopathological margins) influence recurrence and survival in patients with cHNM. Histopathological radicality of initial diagnostic biopsies and outcome for 368 consecutive cHNM patients, clinically asymptomatic of metastatic disease and referred to a tertiary care academic center for sentinel lymph node staging from 2004 through 2018, were retrospectively analyzed. Patients with positive ( Non-radical primary diagnostic biopsies increase the risk for metastatic disease and impair survival in cHNM. Accordingly, radical melanoma diagnostic procedures should be encouraged in the head and neck region when possible.

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Voice rehabilitation after total laryngectomy with the infrahyoid musculocutaneous flap

Changjiang Li,Yi Fang,Haitao Wu,Min Shu,Lei Cheng,Peijie He

Publication date 16-02-2021


It is important for the patients to reconstruct the voice phonic function by surgery after total laryngectomy in the developing countries. To investigate the clinical outcomes of voice reconstruction using an infrahyoid musculocutaneous flap for patients after total laryngectomies. Eighteen male patients recruited were laryngectomized. The infrahyoid musculocutaneous flap was designed. After total laryngectomy, the lower edge of the flap was sewed with the upper edge of the tracheostomy opening. Next, the lateral and medial edges of the flap were anastomosed to create a pronunciation tube. Finally, the remaining opening of the tube was sutured with the anterolateral wall of the hypopharynx to establish a communication with the pharyngeal cavity. A total of 17 cases of flaps were survived and only 1 necrosed. There were 17 patients without serious complications, except that 6 cases had mild irritable cough when gulping water. However, it could be relieved through blocking tracheostoma. One year after operation, all patients could more remarkably articulate clear, powerful, and consistent words. The articulatory configuration was existed under rigid laryngoscope and CT. The use of an infrahyoid myocutaneous flap is feasible for the voice restoration in the patients undergoing total laryngectomy.

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Risk factors for postoperative bleeding after endoscopic sinus surgery to treat chronic rhinosinusitis

Xuemei Qin,Qing Sun,Guohui Chen,Jian Liu,Tianle Gao,Guangping Bai,Zhiqiang Guo

Publication date 16-02-2021


Although there has been progress in improving endoscopic sinus surgery (ESS), patients undergoing ESS are still at risk of postoperative bleeding. Little attention has been given to identifying specific risk factors for postoperative bleeding after ESS to treat chronic rhinosinusitis (CRS). The aim of this study was to identify the incidence and risk factors associated with postoperative bleeding in patients who underwent ESS to treat CRS. Six hundred and five patients with CRS who underwent ESS between 2017 and 2020 were included in this retrospective analysis. Univariate and multivariate analysis was performed to assess the association between the incidence of postoperative bleeding and the background characteristics. Out of 605 ESSs, 36 (6.0%) patients developed postoperative bleeding. Multiple logistic regression revealed that the use of antiplatelet and/or anticoagulant drugs, the presence of hypertension and the Lund-Mackay CT score were significantly correlated with the occurrence of postoperative bleeding. Postoperative bleeding is a common complication following ESS.
The risk factors for postoperative bleeding were as follows: the use of antiplatelet and/or anticoagulant drugs, hypertension and the Lund-Mackay CT score.

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Outcome of cochlear implantation in the worse ear of post-lingual asymmetric hearing loss: elucidation of prognostic markers

Sang-Youp Lee,Goun Choe,Sang-Yeon Lee,Namju Justin Kim,Marge Carandang,Seung Ha Oh,Jun Ho Lee,Byung Yoon Choi

Publication date 16-02-2021


Specific correlations between the outcomes of cochlear implantation (CI) and hearing thresholds of the both ears in post-lingual asymmetric hearing loss (AHL) patients were not clear. To identify the variables influencing the outcome of CI in post-lingual AHL patients. We included 18 adult subjects who had CI in the worse ear due to post-lingual AHL with average hearing asymmetry of 36 dB. Speech perception scores were evaluated in the sound field with hearing aid on the better ear before CI, and with the cochlear implant in the worse ear at 3, 6, and 12 months after CI switch-on. Average increases in phonetically balanced word score, spondee word score, and everyday sentence score at 12 months from CI switch-on compared with those before CI were 38.9%p, 46.2%p, and 52.4%p, respectively. Multiple linear regression analysis showed that speech perception scores were negatively influenced by age at implantation and hearing threshold difference of both ears (HTD-Both) itself, rather than the worse or better ear hearing thresholds. Post-lingual AHL subjects with high average hearing asymmetry can benefit from CI in the worse ear, while CI outcomes can be adversely influenced by HTD-Both and age at implantation both in the short- and long-term follow-up.

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Weber test accuracy in sudden sensorineural hearing loss: which frequency is best?

Omer J. Ungar,Ophir Handzel,Yahav Oron,Anton Warshavsky,Gilad Horowitz,Daniel Yafit,Rani Abu Eta,Nidal Muhanna,Shahaf Shilo

Publication date 16-02-2021


Recent guidelines encourage the use of Webet test (WT) as a part of the physical examination of a newly suspected sudden sensorineural hearing loss (SSNHL) patient. However, the most sensitive tuning-fork frequency has never been identified. To identify the most sensitive frequency for initial WT of patients with suspected SSNHL. Medical records of patients with confirmed SSNHL, who underwent formal audiometry in which the WT was carried out with different frequencies were analyzed. 319 medical records were identified. The most sensitive WT frequency was 500 Hz, with a sensitivity of 94.49% (223/236. confidence interval 90.76-97.03). There was a non-significant difference between 1000 Hz EBO and 500 Hz EBO ( The most sensitive WT frequency for SSNHL diagnosis is 500 Hz. However, the sensitivity of this frequency is 94.49%. 512 or 1024 Hz should be used to better identified SSNHL. Even WT lateralization to the affected ear, does not preclude the diagnosis of SSNHL. Formal audiometry should be used in any case of medical history suspected for sudden hearing loss with normal otoscopy.

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Subcortical deafness as a subtype of auditory agnosia after injury of bilateral auditory radiations caused by two cerebrovascular accidents – normal auditory brainstem responses with I–VII waves and abolished consciousness of hearing –

Ryohei Akiyoshi,Mitsuko Shindo,Kimitaka Kaga

Publication date 13-02-2021


In central auditory disorders caused by damage of the cerebral hemispheres, there are cortical deafness and auditory agnosia. Although clinical cases of cortical deafness have been reported, little is known about the hearing problems and localized lesions associated with cortical deafness. The aims of our research are to elucidate lesion sites associated with cortical deafness and to clarify why patients with cerebral lesions are not aware of any sound at all. Three patients diagnosed as having total loss of hearing participated in this study. We conducted pure-tone audiometry, speech audiometry, distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), and brain magnetic resonance imaging (MRI) to diagnose cortical deafness with aphasia tests of these patients. Our studies showed that waves VI and VII as well as waves I to V have normal peak latencies in ABRs in all three patients. In brain MRI, we found complete damage of proximal parts of bilateral auditory radiations in the three patients. We propose 'subcortical deafness' as a subtype of auditory agnosia.

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Analysis of Dix-Hallpike maneuver induced nystagmus based on virtual simulation

Yanyan Zheng,Shuzhi Wu,Xiaokai Yang

Publication date 10-02-2021


How to interpret the various forms of nystagmus induced by the Dix-Hallpike maneuver has been the hotspot and difficulty of research. Analysis of the types of nystagmus induced by Dix-Hallpike maneuver, and establish a diagnosis strategy based on dynamic nystagmus observation. We observed the otolithic movements at different locations during the Dix-Hallpike maneuver through physical virtual simulation experiments and inferred the nystagmus performance, so as to establish the nystagmus interpretation rules for the repeated Dix-Hallpike maneuver. There are six types of nystagmus induced by the Dix-Hallpike maneuver. Nystagmus induced by the unilateral Dix-Hallpike maneuver does not accurately locate the otolith. The typical nystagmus that is consistent before and after the repetition of the Dix-Hallpike maneuver is the outward and upbeat nystagmus, considering the ipsilateral posterior semicircular canal BPPV. The atypical nystagmus often turns negative when the Dix-Hallpike maneuver is repeated. If the repeat test is positive and consistent with the results of the first diagnostic test, the otolith can be accurately located.

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One-stage cochlear implantation in patients with chronic otitis media using canal wall up mastoidectomy

Yeonsu Jeong,Young Kyun Hur,Jae Young Choi,Sung Huhn Kim,In Seok Moon,Jinsei Jung,Chan Il Song

Publication date 04-02-2021


Cochlear implantation (CI) with subtotal petrosectomy was recommended to avoid the complications for patients with chronic otitis media (COM). To evaluate the surgical outcomes of CI in patients with COM using a one-stage operation with canal wall up mastoidectomy (CWUM). Thirty-five patients with COM who underwent CI with CWUM as a one-stage between 2009 and 2017 were participated. They divided into those with inactive COM and active COM. The anatomical success rate, postoperative complication, and hearing outcomes were analyzed. Twenty-four patients had inactive COM and seven with active COM. Three of the 31 patients (9.7%) had otorrhea from the ear undergone surgery. Two of these three patients had myringitis after CI and their symptoms improved after conservative management. Although infection of the tympanic membrane in the third patient was controlled after conservative management, a perforation was left. Postoperative otorrhea occurred in two patients (8.3%) in the inactive COM group and one patient (14.3%) in the active COM group. This study indicates that infection control and successful implantation can be achieved through a one-stage CI operation with CWUM in selected patients with COM. HIGHLIGHTS Although COM was once considered a contraindication to CI, CI in patients with COM has been made feasible by STP before CI or simultaneously with CI. Simultaneous CI with CWUM was performed for 31 patients with COM. Three patients (9.7%) had minor complications after the surgery and only one patient experienced device explantation which was due to device failure.

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Long term results and evaluation of device satisfaction in patients used the vibrant sound bridge (VSB)

Abdullah Dalgic,Gorkem Atsal,Levent Olgun,Tayfun Kirazli

Publication date 03-02-2021


Patients' satisfaction with the device is as important as the audiological gains in patients using these devices. In this study, we aimed to evaluate the hearing aid satisfaction of individuals using The Vibrant Sound Bridge (VSB) (Vibrant Med-El, Innsbruck, Austria) and to compare this result with audiologic results ​​with and without devices. Patients who were using VSB were included in the study. Preoperative and postoperative pure tone averages and demographic datas of the patients to be included in the study were recorded. A shortened version of Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, was used to evaluate patients' device satisfaction. Fifteen patients with VSB were included in the study. The mean follow-up was 9.13 years. The preoperative air conduction threshold and the air-bone gap in all frequencies were significantly higher than postoperative values ( Patients with VSB give satisfactory results in auditory gains. In particular, good indication and long-term use of the device increases the suitability and satisfaction of the patients.

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Do otosclerosis and stapedotomy affect semicircular canal functions? Preliminary results of video head impulse test

Bülent Satar,Ceren Karaçaylı,Volkan Kenan Çoban,Songül Özdemir

Publication date 02-02-2021


Otosclerosis and stapedotomy have some effects on the vestibular system, but there are very limited data on their effects on semicircular canals (SCCs). The aim of the study is to investigate if otosclerosis and stapedotomy have an effect on SCCs and video head impulse test (vHIT). This retrospective study included 11 otosclerosis patients who had undergone stapedotomy and 30 healthy participants. Twenty-two ears of 11 patients with otosclerosis were divided into two groups based on whether the ear had been operated (12 ears) or not (10 ears). All participants underwent vHIT. We compared gains of all SCCs, presence of saccades among the operated ears, unoperated ears and control ears. Significant difference ( Otosclerosis and otosclerosis surgery may have some effects on SCC functions and thereby vHIT. Lateral SCC is the most affected SCC in terms of gain. These findings appear to add important contributions to our knowledge.

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High pretreatment platelet-to-lymphocyte ratio is related to poor prognosis in the squamous cell carcinoma of the larynx and hypopharynx in male patients

Han Zhou,Panpan Song,Yajun Gu,Junguo Wang,Hui Li,Xia Gao,Xiaoyun Qian

Publication date 30-01-2021


There were heterogeneous or even conflicting data regarding the ability of platelet-to-lymphocyte ratio (PLR) for predicting the prognosis of laryngeal/hypopharyngeal squamous cell carcinoma (LHSCC). The discrepancies were found to be largely due to the cutoff value of PLR. The aims of this study were to rationally select an optimal PLR cutoff value and to analyze the relationship between pretreatment PLR and the prognosis. A total of 180 male patients were eligible for this retrospective study. We included another 180 healthy male individuals as controls. The relationship between PLR and age in patients and the controls was determined. The optimal cutoff values of PLR were identified. PLR value was then dichotomized into two categories, and the relationship between PLR and the clinicopathologic parameters were calculated. Kaplan-Meier curves were used to evaluate the overall survival (OS), and the association between PLR and the OS was analyzed. The linear regression analysis showed a positive correlation between age and PLR in the control group, but not the patients. The optimal cutoff value of PLR was 112.5. The high PLR value group of patients exhibited significantly decreased OS. PLR was related to prognosis, as revealed by the univariate Cox regression. Patients with LHSCC have abnormal high PLR, and a high pretreatment PLR portends adverse survival.

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Decannulation after cricotracheostomy: a comparison of partial cricoid cartilage resection with conventional tracheostomy

Shigeyuki Murono,Kei Kakinouchi,Mitsuyoshi Imaizumi,Mika Nomoto,Masahiro Suzuki

Publication date 30-01-2021


Cricotracheostomy, a modified procedure to open the airway with partial cricoid cartilage resection, was recently reported to be useful in selected cases. To examine decannulation outcomes in patients who underwent cricotracheostomy by comparing it with a conventional tracheostomy. Data from 127 consecutive adult patients, who underwent either conventional tracheostomy or cricotracheostomy between 2016 and 2019, were collected and analyzed with respect to subsequent decannulation with stoma closure. Conventional tracheostomy and cricotracheostomy were performed in 94 and 33 patients, respectively. The most frequent reason for choosing cricotracheostomy was a physiological low-lying larynx ( Compared with a conventional tracheostomy, cricotracheostomy had an acceptable decannulation outcome. However, it should be emphasized that an appropriate selection of patients is required on considering the advantages of cricotracheostomy.

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Developmental performance between pediatric cochlear implantation candidates with and without large vestibular aqueduct syndrome

Yanhong Li,Yang Yang,Wanxia Zhang,Jihang Sun,Bing Liu,Min Chen,Wei Liu,Shanshan Liu,Xiaoxu Wang,Shilan Li,Jie Zhang,Xin Ni

Publication date 28-01-2021


We are inclined to pay special care and attention to children with large vestibular aqueduct syndrome (LVAS). However, it is not clear whether children with LVAS have more developmental delays than children without LVAS. To compare the developmental performance between pediatric cochlear implantation (CI) candidates with and without LVAS. Medical records of pediatric CI candidates were reviewed. Through propensity score matching analysis, 70 children with LVAS and 70 gender-, age-, and auditory-matched children were recruited as the LVAS and non-LVAS group, respectively. Developmental performances were compared between the two groups. Compared with normal developmental metrics, both LVAS and non-LVAS groups had developmental delay in multiple domains (both Pediatric CI candidates with LVAS had both verbal and nonverbal developmental delays. However, they exhibited similar overall developmental performances to those without LVAS.

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Application of a novel transcanal keyhole technique in endoscopic cholesteatoma surgery

Zhaohui Hou,Fangyuan Wang,Wenjing Zuo,Ya Liu,Wenjia Wang,Kun Hou,Jianping Jia,Shiming Yang

Publication date 28-01-2021


It is difficult to deal with epitympanic cholesteatoma in otologic surgery. The keyhole technique can realize minimally invasive surgery and reconstruct the middle ear canal. To explore the clinical application of keyhole technique in primary and second-look surgery in middle ear cholesteatoma. 34 cases were analyzed retrospectively in terms of residual and recurrence rate, safety (adverse events) and hearing performance at long-term follow-up. The application of the technique in primary or second stage operation was evaluated and the operation was performed by transanal endoscopy or combined approach. The cholesteatoma revealed by CT before operation was limited to the attic in 23 patients, of which 16 had the same imaging range as that of the keyhole technique. The preoperative imaging findings of 11 showed that the attic cholesteatoma may have extended into the mastoid, of which only 6 cases were confirmed by keyhole technique. An endoscopic second-look surgery using the keyhole technique was performed for these patients, 2 were confirmed to have residual lesions in the attic. The keyhole technique under otoendoscopy can be used flexibly and conveniently in the second-look surgery to make up for the shortage of diffusion-weighted magnetic resonance imaging.

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Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas

Konstantinos Mantsopoulos,Ann-Kristin Iro,Matti Sievert,Sarina Katrin Müller,Abbas Agaimy,Michael Koch,Heinrich Iro

Publication date 21-01-2021


Traditional surgical philosophy condemns extracapsular dissection for pleomorphic adenoma as a euphemism for the enucleation of this lesion. The aims of the study were to trace the development of surgical treatment by pleomorphic adenomas of the parotid gland over the last 15 years and explore its effects on the histopathology specimen. The medical records of all cases with pleomorphic adenomas of the parotid gland between 2006 and 2020 were examined for information on age, gender, and type of surgery. An experienced head and neck pathologist re-evaluated the histology slides from all the cases. The study included 844 patients. Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020), and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020). Our decision-making process reached its peak in the last study years, in terms of reduced surgical invasiveness and quality of the pathology specimen. Extracapsular dissection has gained a firm hold as an indispensable tool for the experienced parotid surgeon. Proper indication is based on careful selection of cases and the correct interpretation of preoperative features on palpation and imaging.

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"Post-lingual deaf adult cochlear implant users speech and voice characteristics: cochlear implant turned-on versus turned-off"

Peyman Zamani,Arash Bayat,Nader Saki,Elahe Ataee,Hossein Bagheripour

Publication date 20-01-2021


A time-period of turning off cochlear implant (CI) might affect the speech and voice features of the CI users due to loss of auditory feedback monitoring. To evaluate Persian-speaking CI users' speech and voice parameters in a device-on/off experiment. Forty-eight Persian-speaking adults with post-linguistic deafness who had received a unilateral CI and 50 normally-hearing counterparts were recruited. All CI users had to fulfill three phases of speech sampling, including the device-on, device-off (a 5-hourly period), and once again device-on phase. Their Fundamental frequency, Jitter, Shimmer, Harmonics-to-noise ratio, hyper-nasality score, and the percentage of speech intelligibility were assessed for both groups. The findings revealed that the CI-on/off conditions significantly changed cochlear implanted participants' F0, Shimmer, HNR, and hyper-nasality values. However, no statistical differences were observed in Jitter and the percentage of speech intelligibility between the CI and control groups. A short-term auditory deprivation in CI recipients could degrade the speech and voice quality in CI users, so that could change the quality of their speech resonance into hyper-nasality. However, when the CIs were turned on again, the quality of their speech and voice returned to normal-sounding.

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Bone-conduction hearing aid is effective in congenital oval window atresia

Mengdie Gao,Chunli Zhao,Jinsong Yang,Peiwei Chen,Yujie Liu,Danni Wang,Shouqin Zhao

Publication date 14-01-2021


Implantable bone-conduction hearing aids (BCHA) are effective in patients with congenital ear malformations.
However, there is no large sample study to verify the efficacy of Bonebridge in patients with congenital oval window atresia. To investigate efficiency of implantable bone-conduction hearing aids in Mandarin-speaking patients with congenital oval window atresia. We retrospectively analyzed 15 patients, who were confirmed with either unilateral or bilateral congenital oval window atresia by temporal bone CT. All patients were implanted with a bone-conduction hearing device between July 2016 and July 2019 at Beijing Tongren Hospital, Capital Medical University. Pure tone audiometry (PTA), air-bone gap (ABG), speech discrimination scores (SDSs), and hearing thresholds were performed. Postoperative complications including facial paralysis were particularly rare. Unaided mean sound field threshold was 62.2 ± 10.5 dBHL and that with implantable bone-conduction hearing aids was 39.1 ± 13.2 dBHL ( Patients with congenital oval window atresia often show moderate to severe conductive hearing loss. Implantable bone-conduction hearing aids are considerably safe and stable for hearing rehabilitation. It is a novel treatment modality for Mandarin-speaking patients with congenital oval window atresia.

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Identification of factors associated with tinnitus outcomes following the microsurgical treatment of vestibular schwannoma patients

Chi Zhang,Fangyuan Wang,Wei Cao,Xiaoyan Ma,Jiyue Chen,Weidong Shen,Shiming Yang

Publication date 14-01-2021


Tinnitus is common in vestibular schwannoma patients, but the postoperative tinnitus status of these patients and related factors remain unclear. To identify preoperative and operative factors associated with postoperative tinnitus status. Postoperative outcomes were retrospectively assessed in 237 vestibular schwannomas (VS) patients with preoperative tinnitus and 90 VS patients without tinnitus. When evaluating patients with preoperative tinnitus, there were significant differences in rates of improvement, no change, and worsening of tinnitus for the translabyrinthine (TL) and retrosigmoid (RS) approaches. Of patients without preoperative tinnitus, there was a significant difference in rates of not developing tinnitus and new-onset tinnitus. Similar results were observed with respect to preoperative hearing. Least-squares analyses revealed that surgical approach and preoperative hearing were independent predictors of postoperative tinnitus. Preoperative pure tone averages for TL group patients that did not develop postoperative tinnitus were 85.8 dB, whereas in patients that developed new-onset tinnitus they were significantly lower (54.9 dB). Tinnitus prognosis in VS patients is better following TL microsurgery relative to RS microsurgery and is also better in patients with worse preoperative hearing. New-onset tinnitus was more likely to occur in patients with better preoperative hearing that underwent tumor removal via a TL approach.

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Association between ABO blood group status and cochlear/neural function: auditory brainstem response findings

Yunqiu Yang,Linda J. Hood,Bradley McPherson

Publication date 12-01-2021


ABO blood group status may be a risk factor for some diseases, including hearing loss. Individuals with blood group O show a higher prevalence of hearing loss after industrial noise exposure. Group O individuals with normal hearing show reduced amplitudes in otoacoustic emission recordings. Whether blood group status affects auditory brainstem responses (ABR), which reflect cochlear hair cell and auditory nerve bioelectric activity, is unclear. To compare cochlear and peripheral neural function across ABO blood groups by recording cochlear microphonic (CM) and wave I ABR responses. Sixty normal-hearing young adults, with 15 participants from each blood group, completed 70 dB nHL click stimulus ABR measures. CM amplitude, wave I amplitude and wave I latency data were obtained for both ears. One-way ANOVA tests compared results across the ABO groups. A statistically significant difference for wave I peak-to-peak amplitudes across the four groups was found. Post-hoc comparisons revealed group O had significantly reduced wave I amplitudes compared to group A participants. A consistent trend of reduced CM amplitudes and prolonged wave I latencies was shown in group O participants. Emerging evidence exists that ABO blood group status may influence auditory function.

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Clinical characteristics of otogenic lateral sinus thrombosis in patients under 18 years old compared with that in adult patients

Yi-Bo Huang,Li Li,Yucheng Pan,Qing-Zhong Li,Huawei Li

Publication date 12-01-2021


Otogenic lateral sinus thrombosis (OLST) is a rare complication of otitis media. We do not know whether the disease progress between the pediatric and adult OLST patients is consistent. However, pediatric surgical methods always refer to the adults'. This study aimed to seek evidence for suitable surgical methods in pediatric patients. The clinical manifestation, laboratory findings, and findings in operation between children and adult groups were compared. Ten children and 17 adults OLST patients were included. Most pediatric patients had no history of chronic otitis media or cholesteatoma ( Conservative surgery is recommended to pediatric OLST to obliterate the diseases and improve middle ear and mastoid drainage, preserving hearing function.

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Peripheral blood eosinophil levels in chronic rhinosinusitis and its predictive value in eosinophilic chronic rhinosinusitis

Tingting Feng,Ting Li,Wanxin Cao,Ji Xu,Yanan Guo,Nana Ren,Dong Liu,Pei Zhou,Bin Liu,Ximing Bao,Jiping Li

Publication date 08-01-2021


The prevalence of eosinophilic CRSwNP in China has increased significantly over the last 20 years, noninvasive methods that could assist in diagnosis are urgently needed. The aim of this study is to explore the clinical significance of peripheral blood eosinophil in diagnosing ECRS. We conducted a prospective study of 221 patients diagnosed with CRS. Lund-Mackay score, peripheral blood eosinophil absolute count, peripheral blood eosinophil percentage were detection to compare the clinical features with ECRS and non-ECRS. ROC curve was performed to assess the efficiency of clinical index to predict ECRS. The ECRS group of patients had significantly higher scores compared with those of the non-ECRS group. Different extent and severity of mucosal thickening on total Lund-Mackay scores, anterior ethmoidal, posterior ethmoidal and ostiomeatal complex have confirmed different blood eosinophil levels in CRS patients. The combination of peripheral blood eosinophil percentage and posterior ethmoidal score to predict ECRS was 0.807. The increase in peripheral blood eosinophil percent indicates the deterioration the inflammation of chronic rhinosinusitis and the level of posterior ethmoidal score and peripheral blood eosinophil percentage have a positive predictive value regarding ECRS identification.

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Treatment of venous pulsatile tinnitus by compression reconstruction of sigmoid sinus

Jiyue Chen,Yu Su,Jing Dai,Chi Zhang,Jie Wu,Wenjia Wang,Dongyi Han

Publication date 07-01-2021


Surgical intervention can effectively treat venous pulsatile tinnitus. To assess the effectiveness of treating of venous pulsatile tinnitus (VPT) by compression reconstruction of sigmoid sinus (SSCR) under local anesthesia. This study retrospectively reviewed 41 patients with VPT in our otolaryngology department between September 2009 and February 2019. Under local anesthesia, all patients were received SSCR. Pre- and postoperative Tinnitus Handicap Inventory (THI) degree and scores were used to evaluate the efficacy of SSCR for VPT. Of the 41 patients, 36 patients were followed up from 9 months to 8 years and 5 patients were lost to follow-up and were excluded from the data analysis. SSCR was clinically effective in 86% of patients with complete disappearance in 18 patients (50%), partial remission in 10 patients (28%), slight alleviation in 3 patients (8%), and no change in 5 patients (14%). The pre- and postoperative THI degree and scores were significantly different ( SSCR under local anesthesia is effective for treating patients with VPT. It is critical to perform a rigorous pre-operative clinical and radiological evaluation to reduce intra- and postoperative complications.

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Prognostic factors for duration of vertigo after stapes surgery via a time-to-event analysis

Atsushi Fukuda,Keishi Fujiwara,Shinya Morita,Kimiko Hoshino,Hiroko Yanagi,Yuji Nakamaru,Akihiro Homma

Publication date 30-12-2020


Vertigo or dizziness after stapes surgery occurs sometimes, and it is generally temporary. However, while rare, it can be prolonged. To investigate the prognostic factors for duration of vertigo following stapedotomy using a time-to-event analysis. The present study included a total of 35 primary ears (26 with otosclerosis and nine with congenital stapes fixation) from 31 patients. We assessed residual rates of nystagmus and complaints of subjective vestibular symptoms using Kaplan-Meier time-to-event methods. Postoperative spontaneous nystagmus was observed in 23 (65.7%) ears, and postoperative subjective vestibular symptoms were confirmed in 27 (77.1%) ears. The total mean duration of postoperative spontaneous nystagmus and subjective vestibular symptoms was 9.8 (range: 0-158) and 33.9 days (0-732), respectively. A history of stapes surgery in the opposite ear was a significant predictive factor for prolonged nystagmus and subjective vestibular symptoms ( For individuals with a history of stapes surgery in the opposite ear, spontaneous nystagmus and vertigo/dizziness sensations following stapedotomy may persist for a longer duration than in those without a history of stapes surgery in the opposite ear.

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Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea

Natalia Filipek,Erin Kirkham,Maida Chen,Cheng Cheng Ma,David L. Horn,Kaalan E. Johnson,Sanjay R. Parikh

Publication date 30-12-2020


Obstructive sleep apnea affects approximately 1-4% of all children, with increased prevalence amongst overweight and obese children. To assess the effects of drug-induced sleep endoscopy (DISE)-directed surgery on polysomnography parameters in obese and overweight children. A retrospective case-series was performed on obese and overweight pediatric patients who underwent clinically indicated DISE-directed surgery. Forty children met the inclusion criteria, including: body mass index ≥85%, DISE-study, and pre- and post-DISE polysomnography. Patients were divided into surgically naïve ( Of 40 children with mean BMI 94% and mean age 8 ± 6 years old, 17 (43%) underwent a previous adenotonsillectomy. Overall, significant improvements were observed in the apnea-hypopnea index (AHI; 25.0 to 9.9 events/hour, Polysomnography parameters significantly improved following DISE-directed interventions in obese and overweight children with obstructive sleep apnea.

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Olfactory function and findings on chest computed tomography in COVID-19: is there any correlation?

Lucas Resende Lucinda Mangia,Marcelly Botelho Soares,Thiago Sasso Carmona de Souza,Patrícia Cristina Scarabotto,Roberta David João De Masi,Gabriel Lucca de Oliveira Salvador,Rogério Hamerschmidt

Publication date 22-12-2020


Olfactory dysfunction is frequent in COVID-19 and it might occur along with pulmonary involvement. These manifestations do not seem to share pathophysiological mechanisms, but clinical data on the subject is lacking. Aims/Objectives: This study aims to correlate the olfactory function (OF) and the radiological pulmonary involvement among in-hospital patients with COVID-19. Patients hospitalized with severe COVID-19 were consecutively recruited. They had their objective OF evaluated by the Alcohol Sniff Test and underwent a chest computed tomography (cCT). Qualitative and quantitative analyses of the cCT scans were performed by a blinded radiologist. The quantitative assessment included both the grade of involved parenchyma and the CT severity score (CT-SS). Data obtained were then compared. 57 patients were included. There was no correlation between the OF and the grade of lung involvement ( There is also clinical evidence that the olfactory disorder and the pulmonary disease in COVID-19 have distinct mechanisms. Supplemental data for this article is available online at here.

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Head and neck paragangliomas in Norway, importance of genetics, updated diagnostic workup and treatment

Mohammad Usman Rana,Arild André Østhus,Ketil Heimdal,Peter Jebsen,Mona-Elisabeth R. Revheim,Terje Andreas Osnes

Publication date 16-12-2020


Head and neck paragangliomas (HNPG) are rare and predominantly benign tumours, originating from the neuroendocrine paraganglionic system. A considerable proportion of HNPGs are hereditary, depending on the population. The purpose of this study was to estimate the rate of hereditary HNPGs in a Scandinavian (Norwegian) population, report long-term experience with HNPGs and offer all patients diagnosed an updated follow-up, with emphasis on identifying hereditary HNPGs through genetic screening and multifocality by 18 F-2-fluorodeoxyglucose positron emission tomography/computed tomography ( Our study was a partly retrospective and partly prospective cohort study. It included patients with HNPG diagnosed at Oslo University Hospital (OUH), Rikshospitalet between 1990 and 2017. The patients underwent genetic testing, Sixty-three patients were included in the study with a median age of 49 years (range 12 - 80). Cranial nerve dysfunction was present upon diagnosis in 13%, and 14% had multifocal paraganglioma (PG) disease. Fifty-six patients (89% of all the patients) underwent genetic testing, and 29% of these had a PG related mutation. Seven of the eight patients (88%) with multifocal PGs who underwent genetic testing had a mutation. In two of the patients, the This is the first study with systematic genetic workup and PET/CT imaging in Scandinavia of HNPG patients. The mutation rate was within the lower range reported in the literature with respect to HNPGs. Combining genetic testing and PET/CT imaging in the diagnostic workup of HNPGs is valuable.

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Development and validation of an iPad-based Japanese language monosyllable speech perception test (iCI2004 monosyllable)

Shin-ya Nishio,Tetsuya Tono,Takako Iwaki,Hideaki Moteki,Kumiko Suzuki,Yui Tsushima,Akinori Kashio,Yusuke Akamatsu,Hiroaki Sato,Keiko Yaegashi,Hidehiko Takeda,Fumiai Kumagai,Takahiro Nakashima,Yusuke Matsuda,Naohito Hato,Teppei Dairoku,Masae Shiroma,Ryosuke Kawai,Shin-ichi Usami

Publication date 16-12-2020


Speech perception tests are commonly used as indices reflecting hearing ability in daily life. In Japan, the CI-2004 test, first developed in 2004, is widely used as standard, but it was not validated against a large number of normal hearing controls and hearing loss patients. The primary objective of the present study was to develop and validate i Pad-based software for the Japanese monosyllable speech perception test, 'iCI2004'. Seven universities and two medical centers participated in this study. The hearing threshold and Japanese monosyllable speech perception test results of 77 people with normal hearing and 459 people with hearing loss were collected. All participants with normal hearing achieved almost perfect perception results both in quiet and in noise. For cochlear implant users, the average monosyllable speech perception score was 55.1 ± 19.6% in quiet and 40.3 ± 19.2% in noise (SNR + 10dB). We developed i Pad-based Japanese monosyllable speech perception test software and validated it by testing a large number of controls and hearing loss patients with cochlear implants or hearing aids. The developed monosyllable speech perception test has a sufficiently large dynamic range for assessing improvement in speech perception in Japanese cochlear implant users.

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Long-term outcome of concurrent coblator turbinoplasty with adenotonsillectomy in children with allergic rhinitis

In Kwon Mun,Shin Hyuk Yoo,Ji-Hun Mo

Publication date 15-12-2020


Allergic rhinitis (AR) is one of the most prevalent chronic diseases in children. Patients with AR tend to have more persistent symptoms after adenotonsillectomy (T&A). This study was aimed to evaluate the outcome of additional concurrent coblation-assisted turbinoplasty with adenotonsillectomy (T&A + T) in patients with AR. This study included 104 children who underwent T&A, and 67 who underwent T&A + T. All patients were diagnosed as AR and were aged < 12 years at the time of surgery. Symptoms (snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing) were evaluated preoperatively and postoperatively None of the six symptoms investigated differed significantly between the two groups preoperatively, and all evaluated symptoms exhibited dramatic improvements after the surgery in both groups. The T&A + T group showed significantly greater difference of improvement in mouth breathing and nasal obstruction than T&A group. There were no significant difference of improvements in snoring, rhinorrhea, itching and sneezing postoperatively between two groups. In multiple regression analysis, postoperative obstructive symptoms including mouth breathing and nasal obstruction were significantly associated with concurrent turbinoplasty. Concurrent turbinoplasty should be considered especially in patients who have AR and adenotonsillar hypertrophy to improve obstructive symptoms.

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Smell and taste loss in COVID-19 patients: assessment outcomes in a Victorian population

Lukas Horvath,Jason Wei Jun Lim,James W. Taylor,Tasfia Saief,Rhonda Stuart,Joanne Rimmer,Philip Michael

Publication date 15-12-2020


It has been noted that olfactory and gustatory disturbances may precede or accompany the typical features of COVID-19, such as fever and cough. Hence, a high index of suspicion is required when patients report sudden loss of smell or taste, in order to facilitate timely diagnosis and isolation.

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Prediction of hearing outcomes by auditory steady-state response in patients with sudden sensorineural hearing loss

Jung Hyun Ahn,Ji Eun Choi

Publication date 12-12-2020


There has been no report on the predictive value of auditory steady-state response (ASSR) in the hearing prognosis of sudden sensorineural hearing loss (SSNHL). To investigate whether ASSR can be a prognostic indicator of hearing outcome in patients with SSNHL after systemic steroid treatment. Fifty-three patients with unilateral mild to severe SSNHL (≤90 dB HL at 0.5k, 1k, 2k, and 4 k Hz, 4FA) were included. All patients received systemic high dose steroid therapy within one month after onset. The difference between the threshold levels measured by ASSR and PTA on the same day [ASSR - PTA] was calculated. The hearing recovery (HR) was defined as The HR (+) group showed significantly worse ASSR predicted threshold than pure-tone threshold in univariate ( Worse ASSR predicted threshold than pure-tone threshold predicted poor hearing outcome after systemic steroid treatment in mild to severe unilateral SSNHL.

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Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence

Xiaoyan Wang,Yifan Meng,Hongfei Lou,Kuiji Wang,Chengshuo Wang,Luo Zhang

Publication date 12-12-2020


The use of non-invasive clinical markers for predicting CRS recurrence is still not well investigated. The aim of this study was to investigate the comprehensive effects of non-invasive clinical markers on the recurrence of CRS with nasal polyps (CRSwNP). A total of 346 consecutive CRSwNP patients undergoing endoscopic functional sinus surgery were recruited. The demographic characteristics and clinical parameters were recorded. Machine learning algorithm were used for evaluating the predictive value of asthma history and blood eosinophils percentage. Finally, 313/346 patients completed the study. The average follow-up time was 24 months after the first surgery. For the CRSwNP with asthma patients, the blood eosinophils percentage cut-off value was 3.7%. However, for the CRSwNP without asthma patients, the blood eosinophils percentage cut-off value was high, at 6.9%. Combined asthma history and blood eosinophils percentage can predict CRSwNP recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict CRSwNP recurrence. For the CRS patients, combined asthma history and blood eosinophils percentage can predict recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict recurrence.

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Is gelfoam sealing necessary in stapes surgery?

Naif Bawazeer,Sandra Zaouche,Stéphane Tringali,Maxime Fieux

Publication date 08-12-2020


Sealing the oval window around the piston after fenestration with Gelfoam To analyse the effect of using or not using Gelfoam A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam

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Intratympanal administration of lidocaine in the management of Ménière’s Disease

Mattis Bertlich,Friedrich Ihler,Jennifer Lee Spiegel,Martin Canis,Bernhard G. Weiss

Publication date 17-11-2020


Ménière's Disease (MD) is a chronic condition where patients suffer recurrent vertigo attacks. Evidence for treatment concepts are to this date low. To evaluate the therapeutic effect of intratympanic lidocaine injections to reduce the number of attacks. Twenty patients diagnosed with definitive MD that were treated with 34 intratympanic lidocaine injections were included. Main outcome measures were the number of vertigo attacks in the previous four weeks, the attack free period and the subjective improvement of the condition. Mean follow up after first lidocaine injection was 25.3 months (±22.2; range 1.9-79.7). Patients expressed subjective improvement in overall situation, vertigo, and aural fullness. The number of vertigo attacks before each assessment decreased from 7.1 (±5.9; range 2-20) per months at baseline to 1.9 (±3.8; range 0-15). 25% of the patients suffered no further attacks, the other patients had an average attack free period of 7.8 months (±15.4; range 0.2-58.4). Hearing thresholds remained unaffected. Repetitive injections proved effective. Intratympanic lidocaine is an effective nonsurgical and non-ablative therapy for MD. When patients experience an increase of attacks repetitive injections promise improvement.

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Outcomes of ossicular disruption in traumatic facial paralysis: a case series

Xudong Yan,Pei Liu,Caili Ji,Min Zhang,Xiaoheng Zhang,Fugao Zhu,Tao Fu

Publication date 06-11-2020


As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored. This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach. The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty The average air-bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different. Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption.

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Comparative study of unilateral conductive hearing loss in patients with an intact tympanic membrane

Wenjin Wu,Fan Zhang,Qi Huang,Jingchun He,Yupeng Liu,Jun Yang

Publication date 30-10-2020


The ossicular chain status is directly associated with the severity of conductive hearing loss (CHL) when the tympanic membrane (TM) is intact. To analyze the relationship between intraoperative findings and audiological data in patients with unilateral CHL and an intact TM. Forty-three patients who underwent surgery at Xinhua hospital from January 1, 2012, to December 31, 2019, were included and categorized based on their intraoperative findings. Demographic data, intraoperative findings, and preoperative and postoperative audiological results of these patients were analyzed. Patients with ossicular chain disruption had significantly better outcomes than those with ossicular chain fixation (air conduction threshold [ACT]: 26.51 ± 8.82 vs. 44.08 ± 14.41 dB, Congenital ossicular chain anomalies had similar surgical outcome regardless of the pathology. In acquired cases, ossicular chain disruption had better audiological outcomes than ossicular chain fixation. Ossicular chain reconstruction can significantly improve the hearing in patients with UCHL with intact TM.

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