Acta Oto Laryngologica 2021-04-08

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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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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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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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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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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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.
HIGHLIGHTSAlthough 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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Bimodal benefits in Mandarin-speaking cochlear implant users for music perception and tone recognition

Qian Zhou,Xin Gu,Bo Liu

Publication date 05-03-2021


Cochlear implant (CI) users have difficulty appreciating music and perceiving lexical tones in Mandarin Chinese. Wearing a hearing aid (HA) in the contralateral ear for bimodal hearing may provide additional benefits. To measure the bimodal benefits of music perception and tone recognition and to investigate the relationship between the two in Mandarin-speaking bimodal CI subjects. Sixteen Mandarin-speaking bimodal CI subjects (aged between 16 and 49 years) participated in the study. Music perception (pitch discrimination, melody discrimination and instrument identification) and lexical tone recognition were tested with electric stimulation (CI alone) or bimodal stimulation (CI + HA). Subjects showed a significant bimodal benefit in tone recognition in quiet and noise, and in all music perception tests. The bimodal benefit for tone recognition in noise was significantly correlated with that of pitch discrimination thresholds and instrument identification scores. Mandarin-speaking bimodal CI users achieved better music perception and tone recognition ability with CI + HA than with CI alone. The bimodal benefit of tone recognition was significantly correlated with that of music perception.

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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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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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Association between hearing status and tinnitus distress

Sebastian Waechter

Publication date 21-02-2021


Degree of distress perceived due to tinnitus is different in every individual. Underlying mechanisms for this are yet unclear. Investigating the relationship between hearing status and tinnitus distress. This is a case-control study. 38 individuals with tinnitus, divided into normal hearing (NHT, NHT group showed significantly lower degrees of tinnitus distress compared to HIT group ( The present study suggests hearing status may play critical role for experienced tinnitus distress, even in individuals with mild to moderate hearing impairment. This is the first study to investigate the relationship between behavioral hearing ability and tinnitus distress when controlling for age, sex, educational background and age at tinnitus onset. The results provide important information regarding management of tinnitus patients.

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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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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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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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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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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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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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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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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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Danish translation of the Neck Dissection Impairment Index

Susanne I. Scott,Marcus Wessman,Eva Lunderskov,Christian von Buchwald,Irene Wessel

Publication date 06-04-2021


Shoulder pain and impairment are known complications to neck dissections (NDs) as part of the surgical management of head and neck cancer (HNC). The Neck Dissection Impairment Index (NDII) is a validated shoulder function-related quality-of-life instrument and an important patient reported outcome measure after head-neck surgery. The correct translation of questionnaires into other languages is important for both individual assessment of patients and future research. Translation of the NDII into Danish. The NDII was translated from English into Danish using forward and backward translational procedures. Pilot-testing was performed on the pre-final version of the translated questionnaire. Pilot-testing found the translation easily comprehensible, but a few changes were made to improve language flow. NDII was successfully translated into Danish using forward and backward translations. Further validation on a larger scale is warranted. NDII is an important aid to identifying patients with impairments and optimize the aftercare following ND for HNC. Translation of validated questionnaires into other languages is important for future research and international comparison of surgery outcome.

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A new phenomenon of cochlear otosclerosis: an acquired or congenital disease? – A clinical report of cochlear otosclerosis

Simeng Lu,Xingmei Wei,Biao Chen,Jingyuan Chen,Lifang Zhang,Mengge Yang,Zhiming Sun,Ying Shi,Ying Kong,Sha Liu,Yongxin Li

Publication date 06-04-2021


No cochlear otosclerosis in infants with congenital bilateral SNHL has been reported. We report an infant male with bilateral cochlear otosclerosis, suggesting that cochlear otosclerosis may be a congenital disease and to further analyze the etiology of and genetic expression in congenital bilateral cochlear otosclerosis. We also describe the clinical characteristics and experience of patients with bilateral cochlear otosclerosis treated with cochlear implants (CIs). Seven patients, including an infant, who were diagnosed with cochlear otosclerosis underwent CI surgery. Their medical records, audiological and radiological results, surgical procedures, and CI outcomes were collected and reviewed. The median age at hearing loss was 38 years, ranging from 0 to 47 years. The child had bilateral hearing loss at birth and received a CI at 1 year of age. He also had growth retardation and was diagnosed with 3q+/3p- syndrome. All patients (8 ears) had better postoperative auditory performance than that preoperatively. Although cochlear otosclerosis often starts at middle age and progresses slowly, it may be a congenital disease that is related to chromosome abnormality. This disease presents with SNHL or MHL, and treatment with a CI is beneficial.

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Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of sinonasal inverted papilloma: a pilot study

Min Li,Zhenxiao Huang,Yan Wang,Yan Sun,Cheng Li,Jing Qu,Shunjiu Cui,Qian Huang,Bing Zhou

Publication date 03-04-2021


Storz Professional Image Enhancement System (SPIES) endoscopy is an optical method to enhance the visualization of microvasculature on the mucosal surface and characterize epithelial changes. In this study, we aimed to detect sinonasal inverted papilloma (SIP) in the microvasculature and/or mucosa using SPIES endoscopy. A total of 115 subjects, including 80 patients with SIPs or nasal polyps (NPs) and 35 healthy controls were investigated using white light endoscopy (WLE) and SPIES endoscopy. All lesions were diagnosed by histopathological examination. We used Kappa index ( NPs were histologically confirmed in 44 subjects (55%, 44/80), identified by WLE in 41 subjects (51.3%, 41/80), and identified by SPIES endoscopy in 43 subjects (53.8%, 43/80). SIPs were histologically confirmed in 36 cases (45%, 36/80), defined by WLE in 24 cases (30%, 24/80), and identified by SPIES endoscopy in 33 cases (41.3%, 33/80). Among 36 SIP patients, 33 cases (91.67%, 33/36) had a small lobular sign. The diagnosis of SIP by SPIES endoscopy was in excellent agreement with histopathological diagnosis ( SPIES endoscopy is a rapid and noninvasive live-imaging technique with a unique contrast to examine sinonasal mucosa, submucosa and microvasculature. Our study suggested SPIES endoscopy could detect SIP, and the small lobular sign could be a sensitive predictor of SIP diagnosis.

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Predicting the radiosensitivity of HPV-negative oropharyngeal squamous cell carcinoma using miR-130b

Hitoshi Inoue,Masataka Hirasaki,Yasunao Kogashiwa,Kiyomi Kuba,Yasuhiro Ebihara,Mitsuhiko Nakahira,Akihiro Sakai,Akihiko Okuda,Masashi Sugasawa

Publication date 03-04-2021


Human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma shows a higher rate of radiation resistance than HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). Radioresistant HPV-negative OPSCC is associated with unfavourable outcomes, but validated prognostic biomarkers remain lacking. This study investigated biomarkers for radioresistant HPV-negative OPSCC. The Cancer Genome Atlas included miRNA sequence and mRNA sequence data from 528 HNSCC tumours. Of these, we used gene expression data for HPV-negative head and neck squamous cell carcinoma for which data were available on the effects of radiation, and compared miRNA sequence and mRNA sequence data between radioresistant and radiosensitive groups. We subsequently estimated downstream miRNA from the results. Finally, we validated miRNAs related to the outcomes of radiotherapy in our clinical cases. Investigation of miRNA sequence revealed expression of miR-130b as the greatest difference between radiosensitive and radioresistant groups. We subsequently evaluated miR-130b expression in our clinical OPSCC cases. Values of miR-130b >5.372 (low expression), determined from receiver operating characteristic curve analyses, were associated with significantly longer progression-free survival and overall survival ( Our results suggest that miR-130b has potential as a biomarker for the radiosensitivity of HPV-negative OPSCC.

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Insertion trauma of a new cochlear implant electrode: evaluated by histology in fresh human temporal bone specimens

Qiang Du,Cheng Wang,Guangming He,Zengjun Sun

Publication date 01-04-2021


Combining acoustic and electrical stimulation has been successfully used in patients with low-frequency residual hearing. Electrode insertion trauma, such as electrode translocation could result in loss of residual hearing. The aim of the study is to evaluate the LCI-20PI electrode array insertion trauma to the intra-cochlear structures in fresh human temporal bone specimens. The LCI-20PI electrode arrays were inserted into scalae tympani through round window membrane in 10 cochleae from ten fresh human cadavers. The intracochlear trauma was evaluated histologically by a scale of 0-4: 0 - no observable trauma, 1 - elevation of basilar membrane, 2 - rupture of basilar membrane or spiral ligament, 3-dislocation into scala vestibuli and 4 - fracture of modiolus or osseous spiral lamina. The insertion depth was measured by radiography. Histological results revealed no observable trauma in seven specimens; basal membrane elevation and rupture in two specimens; the electrode array misled into scala vestibuli in one specimen. The insertion depth varied from 228° to 288°. The insertion of the LCI-20PI electrode arrays caused no trauma in the majority of the fresh temporal bone specimens. No translocation of the electrode arrays from the scala tympani to the scala vestibuli was observed.

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Visualization of horizontal canal benign paroxysmal positional vertigo using 3DCT imaging and its assessment

Hideo Yamane,Kazuo Konishi,Matti Anniko

Publication date 31-03-2021


There have been no useful imaging methods to diagnose benign paroxysmal positional vertigo (BPPV), a common cause of vertigo, depending on the characteristic symptom. To visualize horizontal canal (HC) BPPV using 3DCT and assess its clinical usefulness. Ten BPPV patients were diagnosed with distinct BPPV, canalolithiasis, and cupulolithiasis of the HC (hc-BPPV, hc-BPPV-cu), which were definitely diagnosed on the basis of criteria of BPPV by the Barany Society and 10 healthy subjects without a history of dizziness were investigated using 3DCT with several different CT window values (CTWVs). The HCs of BPPV patients were clearly visualized and the luminal aspects showed differences among ears with cupulolithiasis, canalolithiasis and no symptoms healthy subjects. 3DCT images visualized the characteristic changes of the HC of patients with BPPV compared to healthy subjects. The HC images were coincident with the clinical condition of cupulolithiasis and canalolithiasis. This imaging technique is clinically useful for diagnosing, treating and assessing the prognosis of HC BPPV.

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Sclerotherapy of ranulas with OK-432 – a prospective, randomized, double-blinded placebo-controlled study

Malin Wendt,Georgios Papatziamos,Eva Munck-Wikland,Linda Marklund

Publication date 30-03-2021


Ranula is a rare benign cystic lesion in the floor of the mouth, which can herniate through the mylohyoid muscle and become a plunging ranula. Treatment for ranulas is currently surgical excision of the sublingual gland. Sclerotherapy with OK-432 is a well-established treatment of lymphatic malformations, but not yet thoroughly evaluated on ranulas.
Objectives: To evaluate sclerotherapy of ranulas with OK-432 in a randomized double-blinded trial. 20 patients with plunging or intraoral ranula were randomized to two double-blinded injections with OK-432 or saline. Effect on the ranula and evaluation of symptoms and QOL were investigated. Treatment response differed significantly between OK-432 and placebo, This study suggests that sclerotherapy with OK-432 in ranula is a very effective treatment for intraoral ranulas, but possibly less useful in plunging ranulas. This is a limited study, but we believe that sclerotherapy with OK-432 should be recommended as primary treatment at least for intraoral ranulas.

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Correlation of pathogenic effects of laryngopharyngeal reflux and bacterial infection in COME of children

Lei Lei,Zhao Yu,Rong Yu,Hui Yang,Jian Zou,Jianjun Ren,Jie Zhang,Dalin Zhong

Publication date 19-03-2021


Bacteria infection and laryngopharyngeal reflux (LPR) were believed the important pathogenesis of chronic otitis media with effusion (COME). But no study researched the relationship between them on COME. To confirm bacterial could arrive middle ear through LPR and produced acid metabolites to activate the pepsinogen of LPR causing COME. Children (65) diagnosed COME with 122 middle ear effusions were included in COME group. Children (22) with congenital/acquired profound deafness with 22 middle ear lavage were included in CI group. Pepsin A concentration in the effusion and lavage fluid were measured. The DNA of the bacteria, IL-8 and TNF-α in the effusion were detected. The average concentration of pepsin A in the effusions and lavage were 176.65 ± 242.09 and 19 ng/ml. Bacterial infection rates were 75.76% and 24.24% in the pepsin A(+) and pepsin A(-) patients. In the bacterial (+), the patients of pepsin A(+) was 4.33 times higher than those of pepsin A(-). TNF-α in pepsin A(+) was higher than that in pepsin A(-). TNF-α and IL-8 were higher in bacteria(+) than those of bacteria(-). Bacterial infection and LPR might act in synergy in the pathogenesis of COME. First time to propose LPR and bacterial infection might work synergistically to cause COME.

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Validity and reliability of the COVID-19 symptom index, an instrument evaluating severity of general and otolaryngological symptoms

Jérôme R. Lechien,Carlos M. Chiesa-Estomba,Stephane Hans,Christian Calvo-Henriquez,Miguel Mayo-Yáñez,Manuel Tucciarone,Luigi A. Vaira,Sven Saussez,Alberto M. Saibene

Publication date 19-03-2021


There is no clinical instrument evaluating symptoms of COVID-19. To develop a clinical instrument for evaluating symptoms of COVID-19 mild-to-moderate forms. COVID-19 patients were recruited from EpiCURA Hospital (Belgium). They completed the COVID-19 Symptom Index (CSI) twice to assess the test-retest reliability. The internal consistency was evaluated with Cronbach's alpha. CSI was completed by healthy subjects to assess the internal validity. Patients completed CSI 6 weeks after the COVID-19 resolution to evaluate the responsiveness to change. Ninety-four COVID-19 patients and 55 healthy individuals completed the evaluations. Symptoms associated with the higher severity score were fatigue, headache and myalgia. The Cronbach's alpha value was 0.801, indicating high internal consistency. The test-retest reliability was adequate (r The CSI is a reliable and valid patient reported outcome questionnaire for the evaluation of symptom severity of COVID-19 patients.

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Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

Hiroyuki Ozawa,Mariko Sekimizu,Shin Saito,Shintaro Nakamura,Takuya Mikoshiba,Yoshihiro Watanabe,Yuichi Ikari,Masahiro Toda,Kaoru Ogawa

Publication date 19-03-2021


One of the major complications in endoscopic endonasal skull base surgery (EESBS) is postoperative cerebrospinal fluid (CSF) leaks. Recently, EESBS has been applied to various skull base diseases as well as more complicated cases influenced by previous treatment with or without various comorbidities. This study aimed to assess the factors that influence the results of postoperative CSF leak after EESBS with mixed patient backgrounds. We conducted a retrospective analysis of the clinical records of patients undergoing EESBS in our institution from 2012 to 2017. Out of a total of 230 cases of EESBS, 11 (4.8%) suffered from postoperative CSF leakage. The rate of CSF leakage for pituitary adenoma, Rathke's cleft cyst, chordoma, and meningioma was 3.5%, 0%, 3.6% and 8.0%, respectively. Multiple variate analysis revealed that repeated surgery ( The rate of postoperative CSF leakage in this study was comparable to previous reports, and repeated surgery may increase postoperative CSF leakage. The surgical strategy for tumor removal as well as skull base reconstruction should be given careful consideration according to tumor pathology and the patient's condition.

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Assessment of radiation-induced otitis media in patients with parotid gland malignancy

Gina Na,Kyung Hwan Kim,Hwa Kyung Byun,Seong Hoon Bae

Publication date 16-03-2021


Otitis media with effusion (OME) is a known side effect of radiation therapy in patients with head and neck cancer. To investigate the incidence rate and clinical course of radiation-induced OME, we have reported on the long-term characteristics of OME in patients with parotid gland malignancy. This cohort study assessed 200 patients who underwent post-parotidectomy radiation therapy from January 2010 to December 2019 in a tertiary referral center. Postoperative radiation therapy was performed at 6 weeks post-surgery. Serial magnetic resonance images were collected to detect otitis media. Two blinded otologists individually assessed data from radiation therapy initiation to 36 months of post-radiation therapy. A total of 121 patients were enrolled (male, 61 [50.4%]; mean age, 46.98 ± 15.69 years), of which 14 developed otitis media (11.6%) within 6 months after radiation therapy. Spontaneous remission occurred without intervention within 1 year, excluding one patient who sustained otitis media for 2 years. Radiation-induced OME occurred in 11.6% of patients and it remitted within 1 year without intervention. Therefore, cooperation between otolaryngologists and radiation oncologists is required and invasive intervention should be considered with careful risk-benefit evaluation.

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Expression of endoplasmic reticulum stress mRNAs in otitis media

Su Young Jung,Ki Jin Kwon,Hye Kyu Min,Dae Woong Kang,Dong Choon Park,Young Il Kim,Jeewon Ryu,Seung Geun Yeo

Publication date 02-03-2021


Endoplasmic reticulum (ER) stress is a cellular defense mechanism that occurs when ER function is impaired. This study was designed to evaluate the expression of major mRNAs of ER stress in patients with otitis media with effusion (OME), chronic otitis media (COM), and COM with cholesteatoma (CholeOM). Specimens were collected during surgery from patients with OME, COM, and CholeOM, and the levels of ER stress mRNAs measured by real-time polymerase chain reaction. Levels of ER stress mRNAs were compared in the three groups and correlated with clinical findings and pus culture results. The level of CHOP mRNA was higher, and the levels of sXBP1 and ATF6 mRNAs lower, in the OME than in the other two groups ( ER stress may be involved in the pathophysiology of OM and the levels of ER stress mRNAs were expressed differently in each type of otitis media according to bacterial culture test results.

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Video-head impulse test in superior canal dehiscence

Payal Mukherjee,Elodie Chiarovano,Kai Cheng,Leonardo Manzari,Leigh A. McGarvie,Hamish G. MacDougall

Publication date 02-03-2021


Superior Canal Dehiscence is classically diagnosed with typical abnormalities on Vestibular Evoked Myogenic Potentials (VEMPs) and Computed Tomography (CT) scans. This paper discusses the utility of the video Head Impulse Test (vHIT) in SCD. Data from 11 ears (8 patients) with SCD were retrospectively reviewed. Results from vHIT, VEMPs and CT and when possible, MRI scans were correlated. An audit of 300 vHIT from patients undergoing routine testing for any neurotological complaint was also conducted to look at the incidence of isolated abnormal superior canal function. 82% of patients (9 ears) with SCD showed abnormal vHIT (reduced gain and catch-up saccades) isolated to the affected superior semicircular canal. Correlation of the CT and VEMPs are important in forming a diagnosis of SCD. However, if isolated superior canal vHIT abnormalities are demonstrated, it is suggestive of SCD and such patients should be referred for further investigations.

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Manuscript title: the maxillary swing approach – the first Scandinavian experience

Hani Ibrahim Channir,Magnus Balslev Avnstorp,Irene Wessel,Jørgen Rostgaard,Niclas Rubek,Katalin Kiss,Christian von Buchwald,Jimmy Yu Wai Chan,Birgitte Wittenborg Charabi

Publication date 02-03-2021


The maxillary swing approach was introduced three decades ago in the head and neck field providing optimal surgical exposure for tumors in the nasopharyngeal and/or the retromaxillary space. To report the clinical experience, patient surgical morbidity and survival outcomes following the introduction of the maxillary swing approach in Denmark. A retrospective study including patients who underwent the maxillary swing approach from January 2012 - January 2020. Baseline and perioperative data, pathology, postoperative morbidity and survival outcomes were registered. Sixteen patients were included of which 15 had a malignant tumor with different histology, while one patient had a benign tumor. Most commonly reported short-term morbidity were trismus, cheek hypoesthesia, nasopalatal fistula, lacrimation and nasal stenosis (<3 months postoperatively) improving markedly at 12 months follow-up. For patients with malignant tumors, the 5-year overall survival and recurrence-free survival rates were 60% and 66.7%, respectively. The maxillary swing approach was safely implemented by a multidisciplinary team at a high-volume centralized head and neck cancer center in Denmark. The procedure may be considered for salvage surgery of recurrent nasopharyngeal carcinomas and selected malignant and benign tumors located in the nasopharynx and/or retromaxillary space inaccessible by other surgical modalities.

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Normal values for cervical and ocular vestibular-evoked myogenic potentials using EMG scaling: effect of body position and electrode montage

Navid Shahnaz,Eytan A. David

Publication date 02-03-2021


The clinical utility of cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) is limited by variability of testing protocols and a dearth of normative data using contemporary methods for amplitude scaling. To investigate the effect of body position and electrode montage on VEMP responses and to establish normative values. This is a repeated measures study of 44 healthy young adult subjects (22 men and 22 women). The highest response rate (99%) for cVEMP was achieved in the supine position with the head elevated and turned. For oVEMP, the highest response rate (90%) was achieved using nasal alar electrode montage with the subject in a sitting position. Scaled peak-to-peak amplitude was higher in males than in females for both cVEMP and oVEMP. Normative data for 44 young healthy adults was successfully collected for two body positions for cVEMP and two head positions and two electrode montages for oVEMP. Our findings describe VEMP protocols that efficiently detect VEMP responses, and we provide normative VEMP response data for young healthy subjects. We describe a potential difference in response between males and females, which may be clinically important.

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Peristapedial bulb: an indicator of spontaneous CSF leak in cochlear candidates with Mondini dysplasia

Xinbo Xu,Weiliang Chen,Xiao Han,Ruru Qiao,Xiaojie Ma,Yuanping Ding,Hanbing Zhang

Publication date 02-03-2021


Mondini dysplasia with spontaneous cerebrospinal fluid (CSF) leak is rare in cochlear implantation (CI) candidates but lethal. Detailed evaluation and surgical intervention are needed for these patients. To report our findings of the peristapedial bulb in computer tomography (CT) as diagnostic evidence of spontaneous CSF leak and discuss its clinical value to direct the surgical plan for patients with profound sensorineural hearing loss (SNHL) and meningitis. A retrospective review was conducted, including patients' demographic features, radiographic examination, operation records, auditory/speech evaluation. The patients presented with a peristapedial bulb were included. In 2775 CI recipients, 7 out of 219 (3.2%) patients with Mondini anomaly had detectable peristapedial bulbs in HRCT, among whom 6 patients have a history of meningitis. Surgical exploration verified the radiographic findings in 6 out of 7 patients. All patients received CI and vestibular obliteration. Control of meningitis was acceptable. The threshold of hearing significantly decreased from 74.1 dB ± 6.9 dB to 37.1 ± 4.8 dB after CI and the word recognition score elevated from 21.4 ± 14.9% to 78.6 ± 9.3%. Peristapedial bulb is an indicator of spontaneous CSF leak in patients with profound SHNL and Mondini anomaly. Patients will benefit from CI and surgical intervention.

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Effectiveness of salvage intratympanic dexamethasone treatment for refractory sudden sensorineural hearing loss classified by audiogram patterns

Bing Hu,Mo Chen,Xiaozhu Chen,Duanlong Zhao,Qingyin Zheng,Guohui Nie,Hongmiao Ren,Jihao Ren

Publication date 02-03-2021


Intratympanic dexamethasone is commonly conducted to treat refractory sudden sensorineural hearing loss (RSSNHL). However, no consensus has been reached on its effectiveness. The study aimed to evaluate the effectiveness of otoendoscope-assisted salvage intratympanic dexamethasone treatment (IDT) on RSSNHL with different audiogram patterns after failure of initial therapy. A total of 108 patients with unilateral RSSNHL were classified into 4 groups according to audiogram patterns. Hearing results were evaluated by pure-tone audiometry (PTA), which was performed at baseline and one month after otoendoscope-assisted salvage IDT. The effectiveness of otoendoscope-assisted salvage IDT was assessed in each group. The efficiency in low-frequency, high-frequency, flat, and deaf group was 48%, 24.1%, 46.2%, 17.9%, respectively. The efficacy did not differ between the high-frequency and deaf group. Notably, the efficacy in the low-frequency and flat group was significantly higher than that in the deaf group. Otoendoscope-assisted salvage IDT is a safe and effective treatment for RSSNHL. This treatment provided better results for patients with low-frequency damaged and flat curve audiogram than patients with other audiogram patterns. Audiogram patterns should be considered in the clinical management of patients with RSSHNL prior to salvage IDT.

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Evaluations on the stability and bio-compatibility of a new piezoelectric microphone for the implantable middle ear microphone

Yu Zheng,Xian-hao Jia,Na Gao,Xin-Da Xu,Ning Cong,Fang-lu Chi

Publication date 02-03-2021


A new floating piezoelectric microphone (NFPM), driven by the acoustic vibration of the ossicles, has been manufactured in the lab. This study aimed at exploring the stability and bio-compatibility of this NFPM. The NFPM was implanted into the cat tympanic cavity by clamping it to the handle of the malleus, and then a temporal bone computed tomography (CT) plain scan and three dimensional reconstruction were performed to observe its coupling with the handle of the malleus. After six months of implantation, cats' blood samples were taken for pro-inflammatory factor analysis. Then, the operative cavity was opened to check the NFPM, the auditory ossicular chain and some granulation tissue surrounding the NFPM. The NFPM was firmly clamped to the handle of the malleus of the cats during the six months of implantation. Besides, there was no obvious systemic inflammatory response in the experimental animals. In addition, local proliferation of granulation tissue occurred in the tympanic cavity without hampering the movement of the auditory ossicle,or causing ischemia of the auditory ossicle. The NFPM could be implanted in our experimental cats for a long period of time and had good bio-compatibility.

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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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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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