Acta Oto Laryngologica 2022-05-27

The value of vestibular evoked myogenic potential and electrocochleography in unexplained aural fullness

Li Zhu Jiang,Yi Qian

Publication date 22-04-2022


Unexplained aural fullness, after excluding external or middle ear diseases and vertigo, is not easily diagnosed. The aim of this study is to determine the vestibular evoked myogenic potential (VEMP) and electrocochleography (ECochG) abnormal rates in patients with unexplained aural fullness, and analyzed the relationship between unexplained aural fullness and endolymphatic hydrops (EH). The VEMP and EcochG abnormal rates in 54 patients with unexplained aural fullness and 21 healthy volunteers, and the VEMP and EcochG abnormal rates in the four hearing loss groups were compared. The distribution of abnormal of VEMP and EcochG in age, sex or hearing loss groups were investigated. The VEMP abnormal rate in patients was greater than that in healthy volunteers ( Abnormal of VEMP in a significant proportion of patients with unexplained aural fullness maybe indicative of EH, and EH was more likely to involve the utricle or saccule in patients with low- or high-tone hearing loss.

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Correlation between subjective and objective measures in bilateral vestibulopathy

Signe Bønløkke,Hanne Owen,Therese Ovesen,Louise Devantier

Publication date 16-03-2022


Bilateral vestibulopathy (BVP) is a chronic and potentially very disabling condition. The impact of the vestibular loss on quality of life (QoL) is variable and still up for discussion. However, previous studies have reported that BVP has a negative impact of QoL. The aim of the study was to evaluate the association between vestibulo-ocular reflex (VOR) gain and saccade pattern and patient reported QoL. Ten patients fulfilling the Bárány criteria of BVP were included in the study. All patients underwent vestibular evaluation using Head Impulse Paradigm (HIMP) and Suppression Head Impulse Paradigm (SHIMP) and responded to Dizziness Handicap Inventory (DHI). DHI was used as a measurement for QoL. Linear regression revealed a tendency to a correlation between lateral VOR-gain measured by HIMP or SHIMP and total DHI score. Covert saccades were related to low total DHI scores. No association was found between type of SHIMP saccade and QoL. No significant correlations were found. A tendency was found towards a relationship between lateral VOR-gain by HIMP or SHIMP and total DHI score. The study also indicates that covert saccades are related to low impact on QoL.

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Thulium laser in stapedotomy surgery

Edoardo Covelli,Haitham H. Elfarargy,Chiara Filippi,Valerio Margani,Luigi Volpini,Maurizio Barbara

Publication date 26-04-2022


Thulium laser use in stapedotomy surgery is usually associated with many doubts regarding the thermal effect on the vestibular area and the production of acoustic shock waves, which may result in permanent complications. We aimed to evaluate the efficacy and safety of the Thulium laser use in stapedotomy and its long-term effects on the clinical and audiological results. It was a retrospective randomized case-series study. We included 148 otosclerosis patients. They were divided randomly into two groups; group A (multiple shots) included 62 patients and group B (one shot with a manual perforator) included 86 patients. There was a statistically significant improvement of the ABG in both groups. ABG closure (<10 dB) occurred in 87.1% of patients in group A, and 89.5% of patients in group B. Intraoperative complications were more in group B ( According to our experience on a relatively large number of cases, the Thulium laser is a safe tool to be used in stapedotomy either in multiple shots or one shot with a manual perforator. It improved functional hearing efficiently without showing signs of inner ear impairment.

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Clinical application of MIIRMR as a salvage method in gadolinium-enhanced MRI after intra-tympanic injection

Jianjian Huang,Cheng Tang,Wei Xia,Yiwei Feng,Songhua Tan,Lihong Xie,Muliang Jiang,Yuhong Qin,Huiting Zhang,Anzhou Tang

Publication date 19-03-2022


Three-dimensional fluid-attenuated inversion-recovery (3 D-FLAIR) and real inversion-recovery (3 D-real IR) sequences are used to detect endolymphatic hydrops (EH), but medium inversion-time inversion-recovery imaging with magnitude reconstruction (MIIRMR) may be more sensitive. We investigated the inner-ear visualisation success rate and EH detection rates of 3 D-FLAIR and 3 D-real IR, and whether salvage MIIRMR could improve EH detection. Fifty-one patients (102 ears) with episodic or chronic vestibular syndrome were injected intra-tympanically with 8-fold diluted gadolinium, and 3 D-FLAIR and 3 D-real IR images obtained 24-h post-injection. If 3 D-FLAIR inner-ear visualisation failed, additional MIIRMR was performed. The success and EH detection rate increase by MIIRMR was calculated. The diagnostic performance of combined MIIRMR + 3D-FLAIR + 3D-real IR for Meniere's disease (MD) was evaluated. The success rates of 3 D-FLAIR and 3 D-real IR were 88.90% and 72.55%, respectively. MIIRMR increased the success and EH detection rates by 11.10% and 6.86%, respectively. In MD, MIIRMR increased these rates by 10.53% and 10.53%, respectively. 3 D-FLAIR + 3D-real IR + MIIRMR had 92.11% sensitivity, 79.68% specificity, 72.92% positive-predictive value, and 94.44% negative-predictive value for MD diagnosis. MIIRMR can improve success and EH detection rates when 3 D-FLAIR fails. Combined MIIRMR + 3D-FLAIR + 3D-real IR is more valuable for diagnosing MD than conventional sequences.

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Outcome of the ‘waiting until spontaneous extrusion’ strategy for long-term tympanostomy tube placement in children with cleft palate

Yuri Nomura,Hidetoshi Oshima,Kazuhiro Nomura,Risako Kakuta,Ryoukichi Ikeda,Ai Kawamoto Hirano,Jun Ota,Tetsuaki Kawase,Yukio Katori

Publication date 23-04-2022


Otitis media with effusion (OME) in children with cleft palate (CP) is known to be refractory to treatment and most of these patients undergo surgery for ventilation tube (VT) placement. To identify the outcomes of children with CP using long-term VT with a 'waiting until spontaneous extrusion' strategy. We retrospectively reviewed the medical records of all children with CP who visited our department from December 2016 to November 2017 and who received long-term VT placement in our department. Risk factors related to residual perforation and recurrence of OME were analyzed. A total of 106 children were included in this study. Our statistical analysis of 94 ears followed for more than three months after VT loss revealed that longer VT placement was associated with residual perforation, and shorter VT placement was associated with OME recurrence. Although a longer duration of VT placement was associated with an increased rate, extremely long-term VT placement was not associated with residual perforation, as expected. Half of the VTs were spontaneously extruded at 40 months after insertion. Long-term VT insertion using a waiting until spontaneous extrusion strategy is a potential option for children with CP.

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Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation

Ripu D. Arora,Neha Thakur,Payal Kamble,Monalisa Jati,Nitin M. Nagarkar,Jagdeep S. Thakur

Publication date 03-03-2022


Subannular tympanoplasty is a newer technique with limited research articles in the literature. These articles have limitation in terms of sample data. We reviewed outcome of subannular tympanoplasty performed during last five years in our center. To determine the surgical and hearing outcome of circumferential subannular tympanoplasty. A retrospective observational study was performed in a tertiary care academic center involving 224 subjects with mucosal chronic otitis media who underwent circumferential subannular type 1 tympanoplasty. Complete neo-tympanum was found in 213 cases (95.1%) at the end final follow period of 12 months after surgery. Eleven tympanic membranes did not take up the graft and considered failure at the end of 6 months after surgery. All of them were subjected for revision surgery and showed intact neo-tympanum after 12 months of surgery. The hearing outcome showed significant improvement in air conduction thresholds from 42.54 ± 13.04 dB to 30.48 ± 10.61 dB at the end of one year. No surgical complication was observed in the study group. The circumferential subannular tympanoplasty carries good surgical success and should be preferred in large and subtotal perforations. Randomized controlled trials are warranted to overcome the limitations in the present study. This is the first study showing outcome of subannular tympanoplasty in large sample size of more than 200.

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Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma

Jeong Hun Jang,Oak-Sung Choo,Hantai Kim,Hun Yi Park,Yun-Hoon Choung

Publication date 18-03-2022


We devised a surgical technique called 'atticosinuplasty' (AS) for the treatment of early-stage cholesteatoma. This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma. A total of 187 patients with either AS ( Hearing gain was significant in the AS group ( AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

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Postero-superior tube in a grooved bone vs. transtympanic tube for middle ear ventilation: a retrospective study comparing outcomes in the Lebanese pediatric population

Elie Bou Sanayeh,Charbel Medawar,Antoine Assaf,Souheil Hallit,Bassam Romanos

Publication date 01-04-2022


Myringotomy with trans-tympanic T-tube (TTT) placement is the most common surgical procedure performed in children. Finding a technique that provides longer aeration periods, lower complications rates, and less need for subsequent interventions will help the healthcare system from preventable events. To compare the efficiency and complications rates of the traditional TTT to those of the novel postero-superior tubes in a grooved bone (TGB) for long-term middle ear ventilation in children suffering from recurrent acute otitis media (RAOM), or chronic otitis media with effusion (COME). A total of 200 pretreated ears (96 by TGB and 104 by TTT), were examined after at least 3 years. Data concerning tube condition, and ear outcomes were collected. Pre- and post-operative audiograms were also performed. TGB remained in place for longer periods, and it resulted in significantly lower rates of persistent tympanic membrane (TM) perforation (0% vs. 30.8%), TM retraction (14.6% vs. 32.7%), myringosclerosis (12.5% vs. 38.4%), otorrhea (29.2% vs. 52.9%), and need for topical antibiotics (31.3% vs. 51%). It has also resulted in more significant reduction in the air-bone gap on audiograms. TGB could be an effective and safe option for middle ear ventilation following COME or RAOM in children.

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Diagnostic approach to patients at risk of otogenic skull base osteomyelitis

Jason Wei Jun Lim,Fiona C. E. Hill,Stephen Kerr,Robert Briggs,Tim McLean

Publication date 07-04-2022


Otogenic skull base osteomyelitis (OSBO) is rare and potentially fatal sequelae of otitis externa. Accurate and timely diagnosis is important due to rising incidence, morbidity and costs associated with treatment. Consensus on the diagnostic approach for OSBO has yet to be reached, in particular the utility of imaging modalities. This study reviews a single institution's high-volume experience of OSBO, with the aim of analysing clinicopathologic features and imaging studies to develop a diagnostic algorithm. A retrospective review of patients admitted with OSBO from 2009 to 2019, was performed. After applying inclusion and exclusion criteria, 103 patients with 106 unique episodes of suspected OSBO were selected. De-identified information including patient demographics, clinicopathologic features and imaging outcomes was recorded and analysed. HbA1c ≥ 7% significantly predicted for OSBO in univariate (OR 7.83, 95% CI 1.85-33.16, Once there is a clinical suspicion for OSBO, diagnosis is established by synthesising results from clinical assessment, pathologic investigations and imaging modalities. The imaging utilised to diagnose OSBO should vary according to the clinical situation and limitations of each modality.

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Static posturographic balance in neurotologic patients may be associated with middle–high-frequency hearing levels during ageing process

Yukihide Maeda,Soshi Takao,Iku Abe-Fujisawa,Shin Kariya,Mizuo Ando

Publication date 16-03-2022


Understanding how sensorineural hearing loss (SNHL) impacts postural balance in patients is important, as postural balance predicts the risk of falls. We aimed to clarify the relationship between characteristics in the configuration of audiograms and static postural balance as measured by posturography. We evaluated 385 outpatients (mean [± standard deviation] age, 58.4 ± 18.4 years) with SNHL by audiometry and posturography. Data were analysed by multiple regression models with the outcome of postural sway area with eyes closed (PSA) and predictive variables of audiometric data, adjusted for sex, age and the presence of nystagmus. The increased hearing threshold in the better hearing ear was associated with poorer or higher PSA (beta coefficient [ Postural balance in neurotologic patients may be associated with middle-high-frequency hearing levels during ageing.

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Asymmetric sensorineural hearing loss in children: progression and involvement of the contralateral ear

Sara Baganha,Tatiana Marques,Antonio Miguéis

Publication date 06-04-2022


Sensorineural hearing loss in child has a profound impact on their neurodevelopment and on language acquisition. Thus, the diagnosis and early intervention are critical, namely in unilateral or bilateral asymmetric hearing losses, which are diagnosed later than symmetric bilateral hearing losses. This study aims to examine the progression of asymmetric SNHL in children, and the link between hearing thresholds and the technological level of the hearing aid fitted. Eighteen children with asymmetric SNHL were submitted to a pure tone audiogram at the age of 5 years (T0) and reassessed at the age of 10 years (T1).
Children were divided according to the technological level of the hearing aid fitted: basic, medium, and advanced. A positive correlation was established between the hearing thresholds at T0 and T1, revealing an accelerated progression of hearing thresholds in the better ear after a 5-year period. Hearing thresholds in the worse ear influence the progression of the SNHL. Moreover, technologically advanced hearing aids led to a slower progression of the hearing thresholds over time.

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Virtual reality for the measurement of SVV and SVH during static head tilt in healthy adults: a novel vestibular test

Ying Cheng,Yuzhong Zhang,Feiyun Chen,Zichen Chen,Tingting Xue,Qing Zhang,Min Xu

Publication date 07-04-2022


Few previous studies have used virtual-reality (VR) technology to measure subjective visual vertical (SVV) and subjective visual horizontal (SVH) during static head tilt (0°, 30°, 45°, 60° and 90°). We propose a novel vestibular test for measuring the normal range of SVV and SVH during static head tilt in healthy adults. Eighty healthy adults were included in the study. SVV and SVH were calculated in nine head positions. With head tilt 90° to the right, SVV skewed to the right, and SVH skewed upward. With head tilt 90° to the left, SVV skewed to the left, and SVH skewed downward. SVV was asymmetrical only at a head tilt of 90°. SVV and SVH were similar at all degrees of head tilt, except for 30° to the right, 45° to the left, and 0°. VR measurements showed that SVV and SVH differed at various degrees of static head tilt. The standardized protocol proposed here may be used to establish a reference range for utricle function when evaluating acute, unilateral vestibular lesions.

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Hearing loss after bacterial meningitis, a retrospective study

Filip Persson,Nora Bjar,Ann Hermansson,Marie Gisselsson-Solen

Publication date 12-04-2022


Hearing loss is a common sequela after bacterial meningitis, but risk factors for this are poorly studied, particularly in relation to concurrent acute otitis media (AOM). The aim of this study was to investigate incidence and risk factors for hearing loss in patients treated for bacterial meningitis. In this retrospective study, medical records for patients admitted to hospital with bacterial meningitis in Skåne county, Sweden, between 2000 and 2017 were retrieved. The association between risk factors and hearing loss was estimated using logistic regression. During the 18 years, 187 cases of meningitis were identified. Hearing loss was confirmed in 71 of the 119 patients who had done an audiometry. It was significantly more common in adults. There was also evidence of an association between hearing loss and AOM, and between hearing loss and pneumococcal infection. Age, concurrent AOM and pneumococcal infection were risk factors for developing hearing loss. Despite being recommended in the national guidelines, more than a third of the patients had not done a hearing test after recovering from bacterial meningitis. The findings strengthen the demand for prompt ear examination and - if needed - tympanocentesis in meningitis patients.

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Speech perception in noise in patients with idiopathic sudden hearing loss

Ryosuke Kitoh,Shin-ya Nishio,Shin-ichi Usami

Publication date 28-05-2022


Patients with unilateral hearing loss have difficulties perceiving speech in a noisy environment. Unilateral severe to profound hearing loss is most commonly caused by idiopathic sudden sensorineural hearing loss (SSNHL). To assess speech perception in noise among patients with idiopathic unilateral SSNHL, and examine the factors affecting the results. We retrospectively enrolled 93 patients with idiopathic unilateral SSNHL. The speech signal was presented at a constant sound pressure level, while the noise signal varied from +5 dB to -5 dB signal-to-noise ratio (SNR) in units of 5 dB (S0/Nhe). As the SNR decreased, the percentage of correct answers also decreased. The correct answer rate decreased with increased hearing level at post-treatment. There was a correlation between age and speech perception, especially when dividing the patients into two groups: <65 years old and ≥65 years old. The results showed that speech perception clearly decreased in a noisy environment rather than in a quiet environment, and the correct answer rate of the speech perception test in noise was significantly correlated with hearing level at post-treatment. This study provides important data for future interventions for unilateral hearing loss, including cochlear implants.

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Etiology of hearing loss affects auditory skill development and vocabulary development in pediatric cochlear implantation cases

Shin-ya Nishio,Hideaki Moteki,Maiko Miyagawa,Tatsuya Yamasoba,Akinori Kashio,Satoshi Iwasaki,Masahiro Takahashi,Yasushi Naito,Keizo Fujiwara,Akiko Sugaya,Haruo Takahashi,Kyoko Kitaoka,Shin-ichi Usami

Publication date 29-04-2022


Cochlear implantation (CI) is an effective treatment for severe-to-profound hearing loss patients and is currently used as the standard therapeutic option worldwide. However, the outcomes of CI vary among patients. This study aimed to clarify the clinical features for each etiological group as well as the effects of etiology on CI outcomes. We collected clinical information for 308 pediatric cochlear implant cases, including the etiology, hearing thresholds, age at CI, early auditory skill development, total development, monosyllable perception, speech intelligibility and vocabulary development in school age, and compared them for each etiology group. Among the 308 CI children registered for this survey, the most common etiology of hearing loss was genetic causes. The genetic etiology group showed the most favorable development after CI followed by the unknown etiology group, syndromic hearing loss group, congenital CMV infection group, inner ear malformation group, and cochlear nerve deficiency group. Our results clearly indicated that the etiology of HL affects not only early auditory skill development, but also vocabulary development in school age. The results of the present study will aid in more appropriate CI outcome assessment and in more appropriate intervention or habilitation programs.

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Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator

Hirohiko Tachino,Hiromasa Takakura,Hideo Shojaku,Michiro Fujisaka,Shinsuke Ito,Yutaro Oi,Anh Tram Do,Chiharu Fuchizawa,Tatsuya Yunoki,Atsushi Hayashi

Publication date 07-04-2022


In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

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Development of a novel centrifugal extraction device to collect the olfactory cleft mucus

Dawei Wu,Junsheng Hong,Feifan Chang,Yongxiang Wei

Publication date 16-03-2022


Measuring olfactory cleft mucus biomarkers provides critical insights into the pathogenesis of the olfactory dysfunction. This study aimed to develop a novel centrifugal extraction device to collect the olfactory cleft mucus. The olfactory cleft mucus was collected from 18 patients with chronic rhinosinusitis (CRS) and 10 healthy controls using polyvinyl alcohol (PVA) sponges. Both novel centrifugal extraction devices and traditional devices which consisted of a falcon tube and a syringe shaft were utilized. Levels of Galectin-10 were assessed using the enzyme-linked immunosorbent assay. The olfaction was evaluated with Sniffin' Sticks. The average extraction efficiency of recovered volume for novel centrifugal extraction devices and traditional devices was 85.44 and 79.15%, respectively. Galectin-10 levels of the olfactory cleft mucus in patients with CRS were significantly higher than that in controls when extracted through novel devices ( The novel centrifugal extraction device with PVA sponges proved to be a feasible method to collect the olfactory cleft mucus.

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The effect of COVID-19 on nasal mucociliary clearance

Ebru Ozer Ozturk,Mehmet Aslan,Tuba Bayındır

Publication date 17-03-2022


The impacts of coronavirus disease-2019 (COVID-19) on nasal mucociliary clearance (MCC) have shown conflicting results. The aim of this study was to determine whether COVID-19 infections affect nasal mucociliary activity using the saccharin test to measure nasal MCC time. This prospective comparative investigation included 25 patients with COVID-19 infection and 25 healthy controls. The nasal MCC time was assessed using the saccharin test. Saccharin test was applied to COVID-19 patients between the 10th and 20th days of COVID-19 test positivity. Patients admitted to the otolaryngology outpatient clinic with non-nasal symptoms and no history of COVID-19 infection served as the control subjects. Age, gender distribution, smoking, and alcohol usage, and the existence of other systemic disorders had no statistically significant differences between the groups ( The COVID-19 infection negatively affects mucociliary activity and causes prolongation of MCC. As the nasal defense mechanism weakens in the early period after COVID-19 infection, susceptibility to respiratory infections may occur.

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Patterns of self-reported recovery from chemosensory dysfunction following SARS-CoV-2 infection: insights after 1 year of the pandemic

Dakheelallah M. Almutairi,Abdulaziz H. Almalki,Ahmad A. Mirza,Mohammed J. Khalifah,Ammar A. Aljefri,Khalid A. Alsalmi,Majid S. Al-Thaqafy,Mohammed A. Algarni

Publication date 28-05-2022


The coronavirus disease (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes chemosensory dysfunction. To determine the characteristics of chemosensory dysfunction and to identify factors associated with chemosensory complete recovery and time to recovery. This cross-sectional study included all patients presenting with chemosensory dysfunction and confirmed SARS-CoV-2 infection from May to August 2020 who underwent telemedicine follow-up after 1 year to assess their chemosensory recovery. A total of 372 patients were included, of which 53.8% were male. The mean age ± SD was 37.45 ± 13.44. The majority experienced combined (olfactory and gustatory) dysfunction (85.7%), and 315 patients (84.7%) had complete loss of chemosensory function. The independent predictors associated with a low likelihood of complete recovery were parosmia (aOR 0.16, A full recovery outcome was predominant. The presence of parosmia was linked to both an incomplete recovery and a long time to recovery. Parosmia and respiratory symptoms are implicated in the incomplete recuperation of chemosensory function.

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The fine-needle aspiration cytology and clinical findings of Kikuchi–Fujimoto disease in pediatric patients: a retrospective clinical study

Yuto Naoi,Tomoyasu Tachibana,Yoji Wani,Machiko Hotta,Katsuya Haruna,Yasutoshi Komatsubara,Kazunori Kuroda,Soichiro Fushimi,Tami Nagatani,Yuko Kataoka,Kazunori Nishizaki,Yasuharu Sato,Mizuo Ando

Publication date 03-03-2022


Histological evaluation of lymph node is crucial for the definitive diagnosis of Kikuchi-Fujimoto disease (KFD). However, lymph node biopsy under local anesthesia is often difficult in pediatric patients. We evaluated cytological findings for pediatric patients with prolonged cervical lymphadenitis clinically suggestive of KFD and investigated the clinical characteristics of patients diagnosed with KFD by fine-needle aspiration cytology (FNAC). This retrospective clinical study included 58 Japanese pediatric patients with cervical lymphadenitis who underwent FNAC. Cytological diagnosis was KFD for 22 and suspicion of KFD for 11 patients. The remaining 25 patients were diagnosed with non-specific lymphadenitis (NSL). Tenderness was independently associated with a higher frequency of both KFD in narrow and broad senses, compared with NSL ( This study indicated that the period from symptom onset to FNAC (<28 days) and the symptom of tenderness were associated with the cytological diagnosis of KFD.

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Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer

Kwang-Jae Cho,Min-Sik Kim,Jung-Hae Cho,In-Chul Nam,Choung-Soo Kim,Geun-Jeon Kim,Young-Hoon Joo

Publication date 06-04-2022


Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND). The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma. Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed. Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage ( This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.

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Preliminary dynamic observation of wound healing after low-temperature plasma radiofrequency ablation for laryngeal leukoplakia

Fang Hao,Liyan Yue,Xiaoyan Yin,Chunguang Shan

Publication date 27-04-2022


Low-temperature plasma ablation (LTPA) is an emerging technique for laryngeal leukoplakia (LL). To initially observe the healing process of trauma after LTPA for LL. Seventeen patients who underwent LTPA for LL were collected, and the degrees of wound healing were analyzed. Only 1 patient in who dysbiosis of the pharyngeal flora was induced by self-administered hormone nebulization treatment during the follow-up period. In the remaining patients, the wound healing was characterized by a crater-shaped defect on the vocal folds surface with pseudo-membranes, congestion, and mild edema on postoperative day 1. These symptoms became worse on postoperative day 7. On postoperative day 15, the pseudo-membrane was fully formed and some patients had granulomatous swelling of the vocal cords. These symptoms became better and better on postoperative day 30 and day 45. On postoperative day 60, the mucosa of the vocal folds had essentially returned to normal. On postoperative day 90, the vocal folds morphology and function had recovered well. It takes 2-3 months for the wound to heal completely after LTPA for LL. A proper understanding of the wound healing process can reduce unnecessary surgical and pharmacologic interventions and avoid excessive treatment.

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A retrospective study of 20 patients with Kimura’s disease from China

Suling Zhuang,Xiaoqiang Chen,Wei Chen,Chen Li,Taiqin Wang,Qin Lin,Desheng Wang

Publication date 07-04-2022


Kimura's disease (KD) is an eosinophilic proliferative lymphoid disease with rare incidence rate and nonspecific clinical symptoms. To investigate the clinical characteristics, diagnosis, treatment, and prognosis of KD. The clinical manifestations, laboratory examination, imaging examination, proposed treatment, and prognosis of 20 patients with KD treated in our hospital were retrospectively analyzed. All cases showed painless masses. The proportion of peripheral blood eosinophils rose in 18 cases (90%), the eosinophil count increased in 14 cases (70%) and the serum immunoglobulin E (IgE) levels were significantly increased in 5 patients (100%). Pathological examination revealed follicular hyperplasia, eosinophils infiltration, and tiny vessels proliferation in KD samples. KD should be considered when the patients suffered head and neck subcutaneous painless mass, increased peripheral blood eosinophils and raised serum IgE level. Pathological examination is the golden standard for diagnosing KD. Surgical intervention, medical treatments, and radiotherapy may be effective for KD treatment. This study might shed a light on improving the diagnosis and treatment for KD.

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Application of digital modeling and three-dimensional printing of titanium mesh for reconstruction of thyroid cartilage in partial laryngectomy

Hao Tian,Shuichao Gao,Jianjun Yu,Xiao Zhou,Xing Chen,Liang Zuo,Xu Cai,Bo Song,Kun Yu

Publication date 09-04-2022


Digital modeling and three-dimensional (3D) printing techniques have been used to assist the resection of the laryngeal lesions and repair the remnant larynx in glottic cancer patients with anterior commissure involvement. To evaluate the feasibility of digital modeling and 3D printing of titanium mesh for thyroid cartilage reconstruction in partial laryngectomy, and compare the advantages and disadvantages with crico-hyoido-epiglottopexy (CHEP). Forty-four glottic cancer patients with anterior commissure involvement were randomly assigned into group A and group B. The digital modeling and 3 D printing were used for patients in group A, and patients in group B underwent the modified CHEP. In group A, 10 patients underwent tracheotomy and tracheal tube was removed after 2 weeks. All the patients were discharged within 10 d after surgery, and the majority of them had a satisfactory level of pronunciation. In group B, the majority of the patients were discharged 2 - 3 weeks after surgery with a moderate level of pronunciation. The proposed surgical method, employing digital modeling and 3D printing to facilitate resection of laryngeal lesions and reconstruction of residual larynx, exhibited to be beneficial for accurate reconstruction of thyroid cartilage and soft tissues.

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The effect of laryngopharyngeal reflux on arousal in patients with obstructive sleep apnea

Peipei Ji,Lei Shi,Dengxiang Xing,Jie Qin,Chenhai Zheng,Shuhua Li,Dahai Wu

Publication date 28-05-2022


Laryngopharyngeal reflux (LPR) may be associated with the severity of obstructive sleep apnea (OSA). However, it is unknown whether LPR may be associated with arousal. To clarify the effect of LPR on arousal in OSA. This study included 120 OSA patients. The correlations between LPR scores and arousal index (ArI) were analyzed. Finally, to further clarify the effect of LPR on ArI, we analyzed the correlations between respiratory event-related arousal index (BERAI), leg-movement-related arousal index (LMRAI), snore-related arousal index (SRAI), spontaneous arousal index (SAI), and RSI score. Partial correlation analysis showed that the RSI score was positively correlated with ArI ( The effect of LPR symptoms on arousal in OSA exists. The more severe the LPR was, the more frequent the arousal in OSA patients was. Thereinto, respiratory event-related arousal and spontaneous arousal were the most obvious.

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Efficacy of steroid treatment for sudden sensorineural hearing loss in patients with vestibular schwannoma

Se A Lee,Shin Young Kim,Youngjeong Lee,Jong Dae Lee

Publication date 28-05-2022


Sudden sensorineural hearing loss (SSNHL) has several aetiologies and may be a presenting symptom of vestibular schwannoma (VS). The aim of this study was to investigate the recovery rate after steroid treatment and the prognostic factors of SSNHL with VS. This was a retrospective observational study wherein 32 patients with VS who presented with SSNHL were analysed at a tertiary referral centre. Hearing gain and prognostic factors were the main outcome measures for steroid treatment intervention. Among the 1698 patients presenting with SSNHL, VS was found in 43 (2.5%) patients. Eleven cases (34.3%) showed good recovery, with significant improvements in the pure-tone audiometry values. Even though age was a significant factor, there were no associations between steroid response and initial hearing level, presence of vertigo, tumour size, and tumour extension. Our study showed that hearing recovery of SSNHL does not exclude a VS diagnosis. We suggest that steroid treatment be considered in patients with VS presenting SSNHL.

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Covid-19 outbreak: does the use of a surgical mask impact the sense of smell?

Clémentine Hyvrard,Margaux Petitjean,Maxime Fieux,Françoise Zerah,André Coste,Sophie Bartier

Publication date 18-05-2022


The current context of Covid-19 pandemic has broadened mask use. Evaluate the impact of wearing a surgical mask on sense of smell by comparing the results of sniffin' sticks test (SST) with and without a surgical mask and evaluate the feasibility of practicing SST with a mask. A crossover prospective comparative study between two groups of volunteers.
The results of SST with a mask were compared to the results without a mask: group 1 first performed SST with a surgical mask and then one week later performed SST without a mask, while group 2 started without a mask. Twenty volunteers were included. In group 1 and 2, all the subjects, except one, had a significantly better total score (TDI) without a mask. The average TDI difference score with and without a mask, was inferior to 5. 8/20 (40%) subjects had a TDI difference superior to 5 with and without mask, while 4/20 (20%) were normosmic without a mask, while being recategorized as hyposmic with a mask. Wearing a surgical mask may reduce the sense of smell, in a cohort of normosmic patients. Further larger studies must be conducted in hyposmic subjects.

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Fluorescence in situ hybridization and microbial community profiling analysis of explanted cochlear implants

Leena Asfour,Daniel Smyth,Cynthia B. Whitchurch,Rosalia Cavaliere,J. Thomas Roland

Publication date 14-05-2022


Cochlear implant (CI) infections affect a small, but significant number of patients. Unremitting infections can lead to explantation. Fluorescence To describe the results and clinical significance of bacterial analyses conducted on explanted CIs. Between 2013 and 2017, 12 explanted devices underwent microbiological analysis in addition to the manufacturer's device failure analysis. Patients' clinical history, infection status and outcome were reviewed and correlated with microbial analysis results. From 2013 to 2017, 12 Cochlear™ devices from 11 patients underwent additional MCP or FISH analysis. Five devices were explanted due to suspected implant associated infection, and seven were explanted for other reasons. FISH analysis revealed biofilm presence on all infected devices, only partial correlation of cultures with biofilm composition and confirmation that biofilm formation occurs preferentially at particular device interfaces and geometries. MCP analysis presented challenges in data analysis inherent to its technique but correlated with cultures of infected devices and suggested a diverse microbial composition of explanted devices. Microbial analysis of explanted devices can aid in further elucidating treatment approaches to infected CIs.

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Endoscopic type 1 tympanoplasty: comparison of the effects of three different thicknesses grafts

Qinshuang Zhou,Lanlan Jin,Xiaoxiao Song,Haifeng Zheng,Yideng Huang

Publication date 14-05-2022


The effects of graft thickness on tympanoplasty is uncertain. To compare the results of endoscopic tympanoplasty using different thicknesses of autologous tissues. This retrospective analysis included 186 patients who received type I tympanoplasty, divided into three main groups based of grafting material: perichondrium (A), cartilage-perichondrium (B), or cartilage-perichondrium plus additional perichondrium (C). Group A was subdivided based on whether the placement was inside (A1) or outside (A2) of the malleus. The hearing improvement, graft success rate, and surgery duration were analysed. Statistical analysis showed significant hearing improvement in the three main groups ( Our results suggest that graft thickness affects hearing recovery; however, graft thickness does not affect the rate of grafting success. Endoscopic transplantation of the perichondrium is more difficult and requires more time.

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Efficiency of a novel middle ear pressure device for intractable definite Meniere’s disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan

Akira Nakazato,Hiromasa Takakura,Tram Anh Do,Naoko Ueda,Noriaki Takeda,Yukio Watanabe,Hideo Shojaku

Publication date 12-05-2022


Middle ear pressure therapy (MEPT) is effective in treating intractable vertigo in patients with definite Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) refractory to conservative treatment. A novel middle ear pressure device, the EFET01 To examine short-term therapeutic effect of MEPT using the ETET01 Patients selected according to Japan Society for Equilibrium Research (JSER) guidelines underwent MEPT using the EFET01 from September 2018 to July 2021, and 44 patients were enrolled in this retrospective study. Clinical data analysed at 4 months after the start of MEPT were compared with those of the previous clinical trial for the EFET01. MEPT using the EFET01 showed the same therapeutic efficacy as that of the previous clinical trial, i.e. improvement in the intensity and frequency of vertigo with no effect on hearing, even under JSER guidelines for proper use of MEPT. MEPT using the EFET01 provided an effective treatment option for intractable vertigo in patients with definite MD and DEH.

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Carotid interposition in patients with head and neck tumors: clinical experience of 13 cases reconstructed with a great saphenous vein autograft

Sherif Abolfotouh,Leif Bäck,Katri Aro,Patrik Lassus,Jyrki Vuola,Karri Mesimäki,Tommy Wilkman,Pirkka Vikatmaa

Publication date 03-05-2022


Carotid interposition graft (CIG) surgery in the setting of head & neck cancer (HNC) is a rare procedure with a limited number of cases described in the literature. To assess the outcomes of the surgery at Helsinki University Hospital. Patients who underwent CIG in a head and neck tumor surgery were retrospectively analyzed over 15 years. Overall-survival (OS) was calculated until 1 May 2020. The primary-outcome was to measure the 30-day OS, postoperative stroke rate, and other complications. The secondary-outcome was to measure 1-, 2-, and 5-year OS. Thirteen patients were identified, 11 with HNC and two with Shamblin III Carotid Body Tumors. The great saphenous vein was used for all vascular reconstructions, and shunting was routinely performed. The 30-day stroke incidence was nil. Two graft-blowouts were encountered, one of which lead to death and the other was successfully managed. For HNC patients, the locoregional recurrence-rate was 36%. The 5-year OS was 46.2%. CIG in HNC setting can achieve oncologic-control with an acceptable rate of complications. Routine shunting, heparinization, and elevating blood-pressure during closure seem to be safe protocols to maintain cerebral-circulation perioperatively. A moderate graft-blowout risk should be considered.

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The clinical outcome of the patients with horizontal semicircular canal variants of benign paroxysmal positional vertigo

Yasuo Ogawa,Taro Inagaki,Takahito Kondo,Atsuo Takeda,Noriko Nagai,Shigeto Itani,Koji Otsuka

Publication date 03-05-2022


Gufoni maneuver is known to be effective for horizontal canal benign positional vertigo (HC-BPPV), but there are some intractable patients that the treatment procedure does not work. The clinical outcomes of patients with HC-BPPV were investigated. We also investigated the characteristics of intractable patients which needed long time to the remission. Sixty-six patients with HC-BPPV receiving Gufoni maneuver at Tokyo Medical University Hachioji Medical Center were investigated. The patients were classified into geotropic DCPN group and apogeotropic DCPN group. The clinical outcomes in 2 groups were examined. There were 48 patients with geotropic DCPN and 18 patients with apogeotropic DCPN. There were significant differences between the geotropic HC-BPPV and apogeotropic HC BPPV in the period to remission. There were 7 intractable patients and the average ages of these intractable patients were higher than other patients. The patients with geotropic DCPN and the patients with the nystagmus conversion from apogeotropic to geotropic DCPN have tendency to easy to resolve, but in patients with apogeotropic type without nystagmus transformation have long time to resolve. The elderly patients whose nystagmus remains apogeotropic without nystagmus conversion have tendencies to become intractable.

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