Acta Oto Laryngologica 2020-11-20

Comparison between high-resolution 3D-IR with real reconstruction and 3D-flair sequences in the assessment of endolymphatic hydrops in 3 tesla

Víctor Manuel Suárez Vega,Pablo Dominguez,Fanny Meylin Caballeros Lam,Jose Ignacio Leal,Nicolás Perez-Fernandez

Publicatie 22-07-2020


The main sequences used to assess degree of endolymphatic hydrops (EH) are the 3D- inversion-recovery (IR) with real reconstruction and the 3D- fluid-attenuated inversion recovery (FLAIR). The purpose of this study is to describe and compare both sequences. Forty-two consecutive patients diagnosed with probable or definite Ménièr´s disease were referred for hydrops MR examination. Vestibular and cochlear EH in both sequences were read by two independent radiologists, unaware of the patient's clinical status. The primary study endpoint was the concordance in the hydrops detection and severity with both imaging sequences. This was assessed using the Cohen's kappa Κ statistic for disease grading and Pearson Χ We obtained an excellent overall concordance, with a kappa of 0.821, ( The 3D-IR sequence seems to be superior to the 3D-FLAIR for the assessment of EH.

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Prevalence of occult cochlear basal turn patency

Varun V. Varadarajan,Orrin L. Dayton,Reordan O. De Jesus,Patrick J. Antonelli

Publicatie 18-08-2020


Perilymph gusher (PLG) is a rare complication of otologic surgery attributed to a communication between the cochlea and the internal auditory canal (IAC). Subtle patency between the cochlear basal turn and IAC has recently been identified on computed tomography (CT) as a risk factor, specifically when the defect is > 0.75 mm. Investigate the prevalence of radiographic cochlear basal turn patency. Patients with CT of the temporal bones and inner ears interpreted as "normal" were included. An otologist and a radiologist independently reviewed CTs to measure radiographic dehiscence in an oblique plane along the interface of the cochlea and IAC. Known PLGs were excluded. Two hundred and ten ears were included (88 conductive or mixed hearing loss, 62 sensorineural hearing loss, 41 audiometrically normal ears). 71 ears (33.8%) were radiographically patent. Mean defect width was 0.41 mm (0.15-0.7 mm). Defect width was not associated with type of hearing loss, age, or gender. No defects were wider than 0.75 mm. Radiographic patency of the cochlear basal turn may be present in patients with hearing loss and normal hearing, but patency > 0.75 mm (i.e. risk for PLG) is rare.

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Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques

Zhengcai Lou

Publicatie 12-07-2020


Although myringoplasty is performed in pediatric patients, there is still no consensus on the graft material and surgerical procedure. To compare the short-and long- term graft take rates of the cartilage push-through and fascia graft techniques employed during pediatric myringoplasty. 93 pediatric patients with perforation who underwent myringoplasty were randomized into the cartilage push-through and underlay fascia graft group. The outcomes evaluated were hearing gains, and graft success rates at 12 and 24 months. The graft success rate was similar between two groups (95.7% vs 91.3%, Endoscopic cartilage push-through and underlay fascia graft myringoplasty afforded comparable hearing results in pediatric patients; however, the push-through technique without the elevation of a tympanomeatal flap exhibited better long-term graft success rate compared to underlay fascia graft.

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Measurement of stapes footplate thickness in otosclerosis by ultra-high-resolution computed tomography

Yukinori Akazawa,Akira Ganaha,Teruyuki Higa,Shunsuke Kondo,Yoshiki Oyakawa,Hitoshi Hirakawa,Mikio Suzuki,Tsuneo Yamashiro

Publicatie 24-07-2020


Ultra-high-resolution computed tomography (U-HRCT) utilizes a 1024 × 1024 matrix with 0.25-mm section thickness, offering better spatial resolution than conventional multi-detector row CT to detect anatomic data for otologic surgery. We examined stapes footplate thickness using U-HRCT in relation to stapedotomy to predict the difficulty of the surgical procedure. Subjects were 12 otosclerosis patients and 25 controls who underwent diagnostic U-HRCT. A profile curve (Hounsfield units) was used to measure stapes footplate thickness along a perpendicular line across the stapes footplate in a plane parallel to the lateral semicircular canal. Footplate thickness was smaller at the midpoint than just before the anterior crus and just after the posterior crus. Interobserver variability was lowest at the midpoint, where foot plate thickness was significantly greater in the affected ear in otosclerosis patients compared with controls (0.60 ± 0.09 mm vs 0.46 ± 0.04 mm; Footplate thickness on U-HRCT correlated with temporal bone anatomy and corresponded to surgical difficulty.

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Scutum reconstruction technique and classification in endoscopic middle ear cholesteatoma surgery

Nan Wu,Wenjing Zuo,Fangyuan Wang,Kun Hou,Shiming Yang,Zhaohui Hou

Publicatie 22-07-2020


Endoscopy has been increasingly used in middle ear cholesteatoma surgery. It can increase the proportion of canal wall up (CWU) surgery and effectively control the recurrence and residual rates. However, there is a lack of systematic description on scutum reconstruction technique in endoscopic middle ear cholesteatoma surgery. The technique and classification of scutum reconstruction in endoscopic cholesteatoma surgery were proposed, and the outcomes were preliminarily evaluated. According to the development of mastoid and the way of hearing reconstruction, the reconstruction of scutum was classified into three types. The rates of residual and recurrence and hearing outcomes were observed and analyzed. A total of 57 patients underwent endoscopic cholesteatoma surgery, all of which were CWU surgery. The reconstruction of the scutum was performed using tragal cartilage according to three types. The residual of cholesteatoma was observed in three cases. The recurrence of cholesteatoma and retraction pocket was detected in two cases and five cases, respectively. Postoperative hearing results were generally satisfied in all three types of surgeries. The technique of scutum reconstruction in endoscopic cholesteatoma surgery in this work can effectively control the recurrent disease after CWU surgery.

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Topography of the lesion in idiopathic sudden sensorineural hearing loss

Ayse Pelin Yigider,Mehmet Keskin,Levent Kufeciler,Hasan Emre Kocak

Publicatie 15-09-2020


Etiology of ISSNHL includes cessation of vascular perfusion, viral infection and cochlear membrane injury. Precise location of injury should be defined for a target-oriented treatment. Vestibular complaints in ISSNHL are hypothesized as involvement of vestibule. Vestibular complaints can be either due to involvement of inner ear or neural tract at any level. In the present study we aimed to demonstrate involvement of vestibular organs in the absence of vestibular symptoms. It was aimed to evaluate superior and inferior vestibular neural pathways. c-vemp and o-vemp were applied to patients suffering ISSNHL without vertigo. Pure tone averages, audiogram configurations, degree of hearing loss were analyzed. Latencies of P1 and N1 waves, amplitudes of P1-N1 waves were evaluated. Asymmetrical vemp wave patterns were compared between two ears regarding difference of PTA. Latencies of c-vemp waves were longer and amplitudes were smaller. o-vemp parameters were similar on both sides. Positive correlation was observed between c-vemp latencies and degree hearing loss. Inferior vestibular nerve pathway is affected in the absence of vertigo in ISSNHL with spared superior vestibular nerve pathway. Damage in IVN pathway correlates with degree of ISSNHL.

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Surgical management of cochlear implant in chronic otitis media patients: safe and sound

Bee See Goh,Dayaabaran Marimuthu,Wan Fazlina Wan Hashim,Asma Abdullah

Publicatie 22-07-2020


Cochlear implantation (CI) in cases with chronic otitis media (COM) was previously contraindicated but recent advances have made it possible. To review surgical and audiological outcomes of COM patients that underwent CI. Retrospective review of patients above 18 years old. Ten patients with complete data were included. Patients were aged 24-69 years old. Tympanoplasty and mastoidectomy were performed before CI. Imaging was performed to rule out ossifications. Eight patients underwent a standard canal wall up with either cochleostomy or round window approach. One patient had additional canalplasty and tympanoplasty and another one had blind sac procedure respectively. Analysis of the hearing aided level with CI and hearing aid showed significant benefit provided by the CI ( Creating a dry and safe ear is important prior to CI. Definite hearing improvement is seen in all our cases that helped them to become independent again in their daily life. Hearing aid usage pre-CI might not be important as the hearing aids may continue to cause discharging ears and the benefits of hearing aids in severe to profound hearing loss are very minimal. Cochlear implant is safe and effective in COM patients.

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Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study

Yao Song,Danni Cheng,Ke Qiu,Xiaohong Yan,Jianjun Ren,Jianqing Qiu,Di Deng,Yufang Rao,Yongbo Zheng,Wendu Pang,Yijun Dong,Qiurui Liu,Yanming Ren,Yu Zhao

Publicatie 18-08-2020


Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial. To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years. Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments. Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26-48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0-0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02-1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01-0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44-0.93). Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.

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Clinical application of 3D-VOG analysis for quantitative evaluation of Otolith-Ocular reflex in the roll and pitch planes

Tomoki Ooka,Jing Bay,Takamori Takeda,Keiji Honda,Takuo Ikeda,Takeshi Tsutsumi

Publicatie 08-10-2020


Management of vestibular falls requires precise evaluation of otolithic function and gravity recognition. Tilt of the head in the roll plane causes ocular counter rolling (OCR) with a gain of 5-10%, which can be a quantitative parameter related to the otolith-ocular reflex (OOR) in that plane. However, the OOR in the pitch plane is indiscernible because of our ability to voluntarily gaze and pursue. 3 D eye movements and its Listing's plane description can provide novel parameters with which to evaluate OOR, even in the pitch plane. To evaluate the utility of 3 D eye movement analysis in video oculography (VOG) as a quantitative parameter reflecting otolithic function during head movements associated with daily life. In healthy subjects, we analyzed the changes in 3 D eye movements and the Listing's plane that occur with static gravitational modification. OOR during head tilt in the roll plane revealed that OCR amplitude had a saturating/peaked conformation and was not fitted by a sine curve. OOR in the pitch plane revealed anteroposterior leaning of the Listing's plane. These novel tools for minimally invasive evaluation of OOR in a clinical setting could potentially enable us to quantitatively evaluate peripheral static disequilibrium.

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The impact of stapes surgery on osteogenesis imperfecta: a retrospective comparison of operative outcomes with those for patients with otosclerosis

Xiaoyan Ma,Fangyuan Wang,Weidong Shen,Shiming Yang

Publicatie 22-07-2020


While stapes surgery has long been employed as a means of improving hearing in patients with otosclerosis, it remains controversial as to whether such surgical intervention is of value in patients with osteogenesis imperfecta (OI). This study was therefore designed to determine whether stapes surgery could still be reliably performed in OI patients as it is in otosclerosis patients. Seventeen OI patients and 18 matched otosclerosis patients were included. In both of these groups, 22 ears underwent primary stapes surgery. Audiometric follow-up data for patients in these two treatment groups were available for between 2 weeks and 25 years post-surgery. We detected significant improvements in both the short- and long-term mean air conduction threshold and reduced air-bone gap (ABG) in both treatment groups as measured via postoperative follow-up audiometry. There was no difference between the OI and otosclerosis patient groups with respect to short- and long-term postoperative audiometric.

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Nordic results of cochlear implantation in adults: speech perception and patient reported outcomes

Niels Cramer West,Abigail Anne Kressner,Line Husted Baungaard,Matilde Grønborg Sandvej,Michael Bille,Per Cayé-Thomasen

Publicatie 23-09-2020


Although cochlear implantation (CI) is widely performed in postlingually hearing-impaired adults in the Nordic countries, the literature on hearing outcomes remains scarce. Aims/objectives: To evaluate and correlate hearing outcomes after implantation. Prospective evaluation of 40 adult first-implantation recipients pre- and post-implantation with Dantale, the Danish Hearing in Noise Test (HINT), the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the Speech, Spatial and Qualities of Hearing Scale (SSQ12). Dantale The study documents a high auditory performance and patient-perceived improvement after implantation and advocate broader awareness of implantation as treatment option in the growing population of severe-to-profound hearing-impaired adults. Correlations between hearing measures may influence future evaluation practices.

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Impact of the ethmoid volume on endoscopic medial wall decompression outcomes in Graves’ orbitopathy

Pedro Clarós,Agnieszka Waląg,Marta López-Fortuny,Andrés Clarós

Publicatie 23-09-2020


Endoscopic orbital decompression is a well-established technique for Graves orbitopathy treatment. Measurement of the ethmoid volume and its correlation with proptosis reduction in patients undergoing endoscopic orbital decompression for Graves' orbitopathy. We retrospectively reviewed clinical charts of 209 patients (319 orbits) operated by a surgeon at our institution between 1998 and 2019. Average age was 46.9 years. About 83.3% of the patients were female, 54.6% were smokers, 93.8% were euthyroid at the time of decompression, 3.8% were hypothyroid and 2.4% were hyperthyroid. About 77.5% of the patients underwent bilateral surgery, the remainder and unilateral. Subsequent stages included strabismus surgery in 22.5% patients, Müllerectomy 37.8%, with or without canthoplasty (14.8 vs. 23%). Mean proptosis reduction was 4.61 mm. Mean ethmoid volume was 5.57 mm We advise evaluating ethmoid sinus pneumatization on computed tomography before decompression to estimate possible anatomical limitations. Additional wall decompression might be advocated in most severe cases.

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Radiotherapy versus laser microsurgery in the treatment of early glottic cancer

Yolanda Lois-Ortega,Fernando García-Curdi,José Miguel Sebastián-Cortés,Félix De Miguel-García,Héctor Vallés-Varela,Ana Muniesa-del Campo

Publicatie 18-07-2020


Glottic squamous cell carcinoma (SCC) in stages I or II can be treated by transoral CO To compare the oncological results of patients treated with TLM, to those treated with RT, in a tertiary hospital. Data from patients diagnosed with glottic SCC in stages I and II between 2004 and 2018 were analyzed. Response to treatment was studied in terms of recurrence, local control and laryngeal preservation. Of 164 patients, 63.41% received treatment with TLM and 36.58% with RT. 26.21% presented a recurrence or progression of the tumor. Both treatments obtained good local control rates (84.15% in the case of TLM and 89.6% in the case of RT) and no significant association was found between tumor recurrence and type of treatment, nor with the involvement of the anterior commissure. However, treatment with RT obtained worse laryngeal preservation rate compared to TLM (81.6% and 100% respectively) (

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Incidence and risk factors for radioactive iodine-induced sialadenitis

Alvaro Sánchez Barrueco,Fernando González Galán,Ignacio Alcalá Rueda,Jessica Mireya Santillán Coello,María Pilar Barrio Dorado,José Miguel Villacampa Aubá,Manuel Escanciano Escanciano,Lucía Llanos Jiménez,Ignacio Mahillo Fernández,Carlos Cenjor Español

Publicatie 21-08-2020


Radioactive iodine ( To determine the incidence of RAIS, analysing the epidemiological data and tumour- and treatment-related factors that may influence the development of the disease. 197 patients who received radioiodine treatment between 2015 and 2017 were studied (76.6% women). The variables studied were age, gender, weight, height, and body mass index; presence of high blood pressure, dyslipidemia, diabetes, and thyroid diseases; cumulative radioiodine dose, presence of sialadenitis, affected salivary gland, and the time of onset. 14 patients developed sialadenitis (78.6% women), all with DTC. The incidence of sialadenitis was 3.4% overall and 6.3% among DTC patients. Furthermore, we found that higher cumulative radioiodine doses confer a greater risk of developing sialadenitis, with a hazard ratio of 1.009 ( In this series, a dose-dependent relationship was found between radioiodine treatment and sialadenitis.

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Incidence and impact of dysplasia at final resection margins in cancers of the oral cavity

Arjun Singh,Manish Mair,Hitesh Singhvi,Natarajan Ramalingam,Munita Bal,Komal Lamba,Deepa Nair,Sudhir Nair,Pankaj Chaturvedi

Publicatie 15-07-2020


The literature often cites margin status as being free, close or involved by tumor but there is very sparse evidence of the relevance of dysplasia at resection margin. This is a retrospective review of 1700 treatment naïve oral squamous carcinoma patients who underwent surgery between January 2012 and December 2015. The study arm consisted of patients with dysplasia at final resection margin (D-FRM). Each of these patients were double propensity matched to obtain positive (P-FRM), close (C-FRM) and free final resection margins (F-FRM). There was no hazard discrimination in survival among the D-FRM and C-FRM (vs F-FRM; p-0.597, HR-1.207 (0.621-2.346) and p-0.075, HR-1.594 (0.947-2.684), respectively). A decreasing survival trend was observed as the grade and number of D-FRM margins increased. Although not significant, the addition of adjuvant therapy for D-FRM showed a trend towards improved survival outcomes compared to C-FRM, especially with chemotherapy.

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

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

Publicatie 21-11-2020


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

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

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

Publicatie 17-11-2020


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

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Preliminary experience and feasibility test using a novel 3D virtual-reality microscope for otologic surgical procedures

Merlin Schär,Christof Röösli,Alexander Huber

Publicatie 14-11-2020


Current surgical microscopes suffer from inherent constraints in achievable viewing angles and require manual interaction to control settings. Overcoming these limitations may provide benefits for otologic surgical procedures. We present a first feasibility and usability assessment of a novel commercial surgical microscope featuring a virtual-reality interface and hands-free control of a robot-mounted 3D-camera. feasibility tests were conducted in a human cadaveric head sample based on common otologic procedures. Usability metrics were obtained from feedback forms. In a first clinical case, the device was used to perform a tympanoplasty in a 68-year-old patient with a subtotal tympanic membrane perforation. Overall practicability of using the device for otologic procedures could be confirmed in the The novel virtual reality 3D-microscope bears potential to provide benefits for various otologic procedures, which will be evaluated more quantitatively in clinical follow-up studies.

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

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

Publicatie 13-11-2020


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

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

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

Publicatie 13-11-2020


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

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

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

Publicatie 13-11-2020


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

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

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

Publicatie 07-11-2020


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

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

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

Publicatie 06-11-2020


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

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

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

Publicatie 06-11-2020


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

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

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

Publicatie 06-11-2020


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

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

Gülsüm Saruhan,Ahmet Gökçay,Figen Gökçay,Neşe Çelebisoy

Publicatie 06-11-2020


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

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EABR measurements during cochlear implantation in one-year-old, infant, child, adult, and elderly patients

Chieko Enomoto,Shujiro Minami,Kimitaka Kaga

Publicatie 05-11-2020


Clinical application of electrically-evoked intracochlear auditory brainstem responses (eABRs) for evaluation of brainstem maturity or aging changes has not been well investigated. We compare the eV latencies of intraoperative eABR measurements in one-year-olds, infants, children, adults, and the elderly, with the goal of investigating the changes in the brainstem auditory pathway due to development and aging. We studied 58 ears of 51 patients who underwent cochlear implantation between 2013 and 2019 using MED-EL's Concerto or Synchrony implants with Flex28 or Flex soft electrodes. EABRs were recorded during cochlear implantation. The stimuli were delivered by the MED-EL Maestro to the apical, middle, and basal turn electrodes at stimulus levels 1000, 800, and 600 cu, with a pulse width of 30 µs. In eABRs recorded from electrodes installed at both the mastoid and nape, there was no difference in latency between age groups within each stimulus level. ABR latency was not affected by development after age one and aging of the brainstem auditory pathway. Our study will be useful as a control in identifying abnormal eABR wave configurations in patients with cochlear malformations, cochlear nerve deficiencies, or auditory neuropathy, regardless of age.

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

Natalia Yakunina,Eui-Cheol Nam

Publicatie 05-11-2020


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

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Application of retrosigmoid sinus approach in Bonebridge implantation

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

Publicatie 04-11-2020


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

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

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

Publicatie 30-10-2020


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

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

Qingxiang Zhang,Xiaohong Chen,Shuangba He,Lifeng Li

Publicatie 30-10-2020


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

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

Dipesh Shakya,Arun KC,Nirmala Tamang,Ajit Nepal

Publicatie 30-10-2020


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

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

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

Publicatie 30-10-2020


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

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

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

Publicatie 29-10-2020


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

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Days alive and out of hospital a validated patient-centred outcome to be used for patients undergoing transoral robotic surgery: protocol and perspectives

Mikkel Hjordt Holm Larsen,Susanne Irene Scott,Henrik Kehlet,Christian von Buchwald

Publicatie 28-10-2020


Days Alive and Out of Hospital (DAOH) has been validated as a suitable clinical trial outcome. It can be used as a proxy for surgical quality and reflects both procedure specific morbidity and mortality. We propose DAOH as a supplement to established patient-related and objective outcomes, since it adds information on health care burden. Two upcoming studies incorporating DAOH are planned and will report DAOH for patients undergoing transoral robotic surgery. Firstly, a multicentre national prospective cohort study investigating DAOH with a 1-year follow-up after TORS is planned. Secondly a retrospective study of DAOH with a 1-year follow-up period will be performed using our institute's, the largest TORS center in Scandinavia, transoral robotic surgery (TORS) database. The database consists of more than 250 patients with more than 300 procedures performed between 2013 and 2018. The planned studies of DAOH may, when applied to TORS, contribute to a better interpretation of post-treatment morbidity and provide a basis for further interventional studies to enhance recovery, perioperative optimization, and serve as a comparison tool between treatment modalities.

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Can secondary lymphoid organs exert a favorable effect on the mild course of COVID-19 in children?

Merih Onal,Ozkan Onal,Alparslan Turan

Publicatie 28-10-2020


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Feasibility of p16 surrogate biomarker as adjunct diagnosis of oral and oropharyngeal malignancy in a resource-constrained country

Marlinda Adham,Noval Aldino,Saffanah Zahra,Lisnawati Rachmadi,Saptawati Bardosono

Publicatie 22-10-2020


Cases of Human papillomavirus (HPV)-associated oral and oropharyngeal cancer are increasing. Proper diagnostic tools are required to detect HPV among patients, especially in areas where high technology is lacking. To provide mapping of HPV prevalence in Southeast Asia and to determine the effectivity of p16 as a surrogate biomarker for HPV infection in oral and oropharyngeal cancer. Medical records of 56 patients diagnosed with oral and oropharyngeal squamous cell carcinomas (SCC) were reviewed. HPV PCR DNA and p16 immunohistochemistry (IHC) examination were performed to detect HPV positivity. HPV PCR prevalence in oropharyngeal SCC is 42.9% and 28.6% in oral SCC. P16 IHC has 67% sensitivity and 75% specificity in detecting HPV in oropharyngeal cancer, and 33% and 72% in oral cancer. We conclude that p16 IHC with a 5% cut-off can be used as a surrogate biomarker for oropharyngeal SCC, but not oral SCC, in areas where resources are restricted. However, further diagnostic tools may be needed.

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Intraoperative auditory brainstem response monitoring during semicircular canal plugging surgery in treatment of Meniere’s disease

Xiaofei Li,Yafeng Lv,Ruijie Wang,Xiuhua Chao,Zhaomin Fan,Haibo Wang,Daogong Zhang

Publicatie 20-10-2020


Three semicircular canal plugging (TSCP) is an optimized treatment for intractable Meniere's disease (MD). However, 20-30% of patients experience hearing loss after TSCP, for reasons that remain unclear. To evaluate hearing loss resulting from TSCP. This study included 12 patients, which were diagnosed with definite MD and consented to TSCP surgery. Intraoperative auditory brainstem response (ABR) was monitored in each surgical procedure. After opening the mastoid cavity, the ABR threshold increased to 77.08 ± 9.88 dB nHL. The ABR threshold almost recovered to preoperative levels, to 68.33 ± 7.78 dB nHL, after completing TSC outlining. Exposure of three semicircular canal 'blue lines' had little effect on ABR threshold. The most prominent change on hearing loss was observed after mastoid outlining, when 41.67% of patients showed hearing loss ≥10 dB nHL. None of the patients showed a threshold shift ≥10 dB nHL following the last step. TSCP operation itself caused little hearing damage. Ruled out hearing loss as a result of the surgery itself. The reason why 20-30% of patients showed hearing loss in 2-year follow-up visit was not clear, although it may be due to serous fibrous labyrinthitis.

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The effect of using a PORP to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle

Min Zhang,Xiaoyun Chen,Yideng Huang,Zifei Yang,Yue Zhang,Xianmin Wu

Publicatie 17-10-2020


There are many reports on the role of the malleus handle in ossicular chain reconstruction (OCR). However, the effect of the presence of the malleus handle is not clear. To compare the hearing outcomes of using a partial ossicular replacement prosthesis (PORP) to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle. Records of 57 patients requiring OCR were retrospectively analyzed. They were divided into the malleus handle-present group (group 1) and the malleus handle-absent group (group 2). The audiometric results were analyzed pre- and postoperatively. A postoperative air-bone gap (ABG)≤20 dB was considered successful. The mean improvement in air conduction hearing thresholds was 19.80 dB in group 1 and 16.70 dB in group 2. The mean ABG improvement was 18.09 ± 12.79 dB for group 1 and 17.20 ± 16.44 dB for group 2. The malleus handle-present group achieved higher success (65.63%) than the malleus handle-absent group (52%; Improvements in hearing outcomes were similar for the two groups. However, the malleus handle-present group showed a better reconstruction success rate. Our results suggest that if there is no lesion in the malleus handle, it is recommended to be retained.

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Developmental performance among pediatric candidates for cochlear implantation

Yanhong Li,Wanxia Zhang,Yang Yang,Bing Liu,Min Chen,Wei Liu,Bei Li,Yi Zhou,Jie Zhang,Xin Ni

Publicatie 17-10-2020


Developmental evaluation of deaf children before cochlear implantation (CI) has not been given enough attention. This study was designed to evaluate the comprehensive developmental performance of deaf children who are CI candidates. The medical records of pediatric candidates for CI were reviewed. Five hundred children (287 boys; median age: 21.00 months; range: 6-72 months) with a diagnosis of severe-to-profound hearing loss were included. Preoperative developmental evaluation, including gross motor, fine motor, adaptability, language and social skill were retrieved. Comprehensive developmental performances including verbal and nonverbal skill were assessed. Multivariate linear regression analysis was used to analyze the related developmental factors. Compared with normal developmental metrics, deaf children had developmental delay ( Pediatric candidates for CI had both verbal and nonverbal developmental delay. Age of intervention was a risk factor for the developmental level. Comprehensive developmental evaluation of deaf children before cochlear implantation (CI) should be paid enough attention. Early intervention for improving hearing was of significance.

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

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

Publicatie 14-10-2020


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

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Active middle ear implant (vibrant soundbridge) in children with unilateral congenital aural atresia

Masahiro Takahashi,Satoshi Iwasaki,Sakiko Furutate,Shinichiro Oka,Shogo Oyamada,Kazunori Yasumura

Publicatie 13-10-2020


Detailed studies have not been conducted on sound localization and speech perception in noise in patients with unilateral congenital aural atresia (UCAA). To evaluate the benefits of the use of the Vibrant Soundbridge (VSB) for UCAA by performing audiometric and sound localization tests. Four children with UCAA underwent VSB (VORP 503) implantation from 2018 to 2019. Speech perception tests in noise were conducted using the Japanese monosyllable test. The spatial configuration for speech testing consisted of speech presented from the front and noise presented into the normal ear (S The children's speech perception in noise 6 months after VSB activation was significantly better than before activation ( The benefits of VSB use in children with UCAA were revealed using audiometric and sound localization tests.

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Comorbidity of cerebellopontine angle meningioma with other primary neoplasms

Yi-Ting Xue,Hsin-Lin Chen,Yi-Ho Young

Publicatie 13-10-2020


Meningioma is known to be accompanied by other primary neoplasms, yet has been evaluated less than these. This study investigated comorbidity of cerebellopontine angle (CPA) meningioma with other primary neoplasms. Overall 1,085 meningioma cases including 16 meningiomas at the CPA were enrolled for investigating the presence of other primary neoplasms. Another 16 age-, sex-, and size-matched CPA schwannoma were also included for comparison. Of a data-base cohort study of overall 1085 meningioma cases, 165 cases (15%) were associated with other primary neoplasms. In contrast, 8 (50%) of 16 CPA meningioma and one (8%) of 16 CPA schwannoma showed other primary neoplasms. Except for one patient who had oral cancer prior to the diagnosis of CPA meningioma by 4 years, the interval from diagnosis of CPA meningioma to that of other primary neoplasm ranged 0-6 (mean, 3.1 ± 2.5) years. Prevalence of comorbidity with other primary neoplasms is significantly higher in CPA meningioma (50%) than overall meningioma (15%) and CPA schwannoma (8%). In addition to follow-up MR imaging to visualize both residual tumor and regional brain environment after treatment of CPA meningioma, long-term systemic screening for other primary neoplasm is also mandatory.

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Lesion-specific prognosis by magnetic resonance imaging in sudden sensorineural hearing loss

Cheng-Jui Yang,Tadao Yoshida,Satofumi Sugimoto,Masaaki Teranishi,Masumi Kobayashi,Naoki Nishio,Shinji Naganawa,Michihiko Sone

Publicatie 13-10-2020


High signals in the inner ear of idiopathic sudden sensorineural hearing loss (ISSNHL) on magnetic resonance imaging (MRI) have been reported, but no quantitative evaluation has yet been done. To evaluate hearing outcomes and cochlear signal intensities on 3-T heavily T Twenty-nine patients with ISSNHL were included. Patients underwent hT Hearing improvements at high-tone frequencies in ears with HLs ≥60 dB were significantly worse in those with high SIRs at the basal turns on pre-contrast images. Similarly, hearing improvements at low-tone frequencies in ears with HLs ≥60 dB were significantly worse in those with high SIRs at the apical-middle turns on post-contrast images. High SIRs on hT

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Simultaneous bilateral stapes surgery after follow-up of 13 years

Topi Jutila,Ville Sivonen,Timo P. Hirvonen

Publicatie 13-10-2020


Eighteen patients underwent simultaneous bilateral stapes surgery in 2003-2006. We evaluated the long-term outcomes in this patient group, and assessed their hearing in noise and binaural hearing. Fifteen patients returned questionnaires concerning their hearing, taste function, and balance. Thirteen patients underwent pure-tone and speech audiogram, Finnish matrix sentence test, video head impulse test, and clinical examination on average 13 years after surgery. We found no significant difference in air- and bone conduction pure-tone average, speech audiometry, and the air-bone gap between the 1-year and the late postoperative visits. One patient had bilaterally a partial loss of the vestibulo-ocular reflex of unknown cause. The hearing results 13 years after simultaneous bilateral stapes surgery remained good without any significant delayed complications. Simultaneous bilateral stapes surgery is a viable treatment option in selected patients with otosclerosis.

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Long-term outcomes in children with and without cleft palate treated with tympanostomy for otitis media with effusion before the age of 2 years

Maki Inoue,Mariko Hirama,Shinji Kobayashi,Noboru Ogahara,Masahiro Takahashi,Nobuhiko Oridate

Publicatie 09-10-2020


Long-term outcomes of children with and without cleft palate receiving early treatment for otitis media with effusion (OME) are unclear. To compare long-term otological and audiological outcomes between children with and without cleft palate treated with tympanostomy for OME before the age of 2 years. Ninety-five children (180 ears) with cleft palate (study group) and 97 children (185 ears) without (control group) were followed-up to a maximum age of 7 years. We retrospectively analyzed the audiological outcomes at the age of 7 years, and the otological outcomes at the last examination. The percentages of children with OME resolution before the age of 7 years were 47.4% and 60% in the study and control groups, respectively, and those of ears with healed tympanic membrane were 71.7% and 79.5% in the corresponding groups. Significantly more ears were subjected to retympanostomy in the study (31.1%) than in the control group (21.6%). Mean pure-tone average (0.5‒4 kHz) was 15.6 dB HL and 14.3 dB HL for the corresponding groups. Otological and audiological outcomes in both groups were similar. The audiological prognosis was favorable regardless of the cleft palate condition.

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Comparison of clinical outcome between endoscopic and postauricular incision microscopic type-1 tympanoplasty

Yonglan Zhang,Wei Wang,Kaixu Xu,Ming Hu,Yuanxu Ma,Peng Lin

Publicatie 07-10-2020


Microscopic type-1 tympanoplasty (T1T) is a classical method for the treatment of chronic otitis media. However, it has its limitations. The development of otoendoscopy provided a new method for T1T. To investigate the difference between endoscopic T1T and microscopic T1T. Seventy-four patients who underwent T1T were evaluated retrospectively. About 52 cases underwent endoscopic T1T, and 22 cases accepted microscopic T1T. Parameters including operative duration, incision size, graft site, duration of postoperative hospitalization, visual analog scale (VAS) score, complications, hearing improvement, and expenses were compared. Operative duration of endoscopic T1T (47.0 ± 8.2 min) was shorter than microscopic T1T (58.0 ± 9.3 min) ( Endoscopic T1T is a minimally invasive surgery with similar graft success rate, comparable hearing improvement, fast recovery, low cost, and high patient satisfaction compared to microscopic T1T.

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Air and bone-conducted vestibular evoked myogenic potentials in children with large vestibular aqueduct syndrome

Xuhui Liu,Lili Ren,Jianan Li,Fei Ji,Xingjian Liu,Yi Du,Weiwei Guo,Ziming Wu,Shiming Yang

Publicatie 24-09-2020


There are few studies focused on vestibular symptoms and function of the children with LVAS. This study aimed to find the characteristics of air and bone-conducted VEMPs among children with LVAS, and to investigate the relationship between VEMPs and vestibular symptoms. A total of 44 children with LVAS and 10 healthy children were recruited as the case group and control group. Air and bone-conducted VEMP were performed to the participants. For air-conducted measurement, there was elevated amplitude of cVEMP in case group than control group. There was no significant difference at oVEMP parameters between the case group and control group. For bone-conducted measurement, significantly longer P1 latency and shorter P1-N1 latency of cVEMP were observed among the case group; there were a series of changes in oVEMP parameters among the case group. Logistic regression model revealed that air-conducted oVEMP asymmetric ratio was valuable to predict vestibular symptoms' development among the kids with LVAS. Asymmetric ratio of oVEMP could be used as one predictor of developing vestibular symptoms of the children with LVAS. Applying bone-conducted VEMP as one alternative parameter of vestibular syndrome is novel and will certainly remain an area of continued investigation.

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The influence of type of visual image and gender on the perception of horizontality: a subjective visual horizontal (SVH) study

Mohd Normani Zakaria,Adnan Tahir,Zuraida Zainun,Rosdan Salim,Nurul Syarida Mohd Sakeri,Nor Haniza Abdul Wahat

Publicatie 23-09-2020


The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH. The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults. In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device. The arrow pattern produced significantly bigger SVH angles than the solid line ( The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.

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The value of p16 and HPV DNA in non-tonsillar, non-base of tongue oropharyngeal cancer

Lalle Hammarstedt,Stefan Holzhauser,Mark Zupancic,Fani Kapoulitsa,Ramona G. Ursu,Torbjörn Ramqvist,Linnea Haeggblom,Anders Näsman,Tina Dalianis,Linda Marklund

Publicatie 18-09-2020


Oropharyngeal squamous cell carcinoma (OPSCC) is dominated by tonsillar and tongue base carcinomas (TSCC/BOTSCC), but there are carcinomas at other sites, such as uvula/soft palate/pharyngeal wall here defined as other OPSCC. Human papillomavirus (HPV) positive TSCC/BOTSCC have favorable outcome, and the TNM-classification separates OPSCC into HPV mediated (p16 This study therefore aimed to further investigate the prognostic role of p16+, presence of HPV DNA, or both combined in other OPSCC. 195 other OPSCC, from patients diagnosed 2000-2018 were tested for p16, and/or presence of HPV DNA and the data correlated to outcome. Neither overall survival, nor disease free survival correlated to presence of p16+ or HPV DNA in other OPSCC. p16+ and HPV DNA presence were correlated ( The data suggest that p16+ (and p16+/HPV DNA) positive other OPSCC should be analyzed cautiously and possibly separately from the HPV mediated OPSCC staging group.

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Outcomes of frontolateral vertical partial laryngectomy in T1b glottic carcinomas

Rawad Jadeed,Martin Westhofen

Publicatie 18-09-2020


The treatment of T1b glottic carcinomas with invasion of the anterior commissure (AC) is still a challenge in larynx oncology. The diversity in treatment protocols is due to the difficulty in achieving safety margins of resection, especially in the AC. The treatment success rate of frontolateral vertical partial laryngectomy (FVPL) for the treatment of stage T1b squamous cell carcinoma of the glottic larynx infiltrating the AC. Clinical data of patients, who were diagnosed with stage T1b squamous cell carcinoma of the glottic larynx and who underwent a FVPL from 01/2003 to 12/2016 in our ENT clinic were retrospectively evaluated. Clinical and oncological outcomes were analyzed. 39 patients were included in this study. The mean follow-up duration was 79.95 ± 20.59 months. Intraoperative R0 resection was achieved in all patients. In 33.3% patients, documented complications were tissue granulation and synechia formation in the glottic area. The 5-year recurrence-free survival was 82.1%, the 5-year overall survival rate 97.4%, and the 5-year laryngeal preservation rate 94.8%. Our clinical data demonstrate that T1b glottic carcinomas with invasion of the AC can be effectively treated with FVPL. The outcome is similar to other methods such as transoral laser microsurgery, supracricoidal partial laryngectomy, and radiotherapy.

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The characteristics of vHIT gain and PR score in peripheral vestibular disorders

Yi Du,Lili Ren,Xingjian Liu,Weiwei Guo,Ziming Wu,Shiming Yang

Publicatie 16-09-2020


Clinical application of vHIT is limited due to a lack of interpretation of vHIT gain and saccades. This research focuses on comparing common vertigo diseases on vHIT gain and saccade divergence(PR score). We retrospectively reviewed 165 patients who have one definite diagnosis, good data quality, and can be read by MATLAB software. All patients were grouped into unilateral vestibular dysfunction (UVD), Meniere's disease (MD), vestibular migraine (VM), Ramsay Hunt Syndrome (RHS), bilateral vestibular hypofunction (BVH), benign paroxysmal positional vertigo (BPPV), and acoustic neuroma (AN). PR score was calculated by an open-source software HitCal. The saccade detection rate is higher than the abnormal vHIT gain on UVD, MD, VM, RHS, BVH and BPPV. PR score combined with vHIT gain could separate the affected side in UVD and RHS. In the MD group, both vHIT gain and PR score have inconspicuous performance. We also found that different compensation levels and hearing loss status affect results. vHIT gain combined with PR score enables a proper distinction among common vertigo diseases. PR score is more sensitive than the gain value on evaluating the physiological situation, vestibular compensation and disease progression.

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Advanced osteoradionecrosis of the maxilla: a 15-year, single-institution experience of surgical management

Zimeng Li,Shangping Liu,Shang Xie,Xiaofeng Shan,Lei Zhang,Zhigang Cai

Publicatie 15-09-2020


Osteoradionecrosis (ORN) of the maxilla is a rare disease. In contrast with a mandibular predominance, maxillary ORN has not been widely reported. To review clinical features, surgical treatments, and results of maxillary ORN and offer recommendations for surgical decision-making. We retrospectively reviewed medical records of maxillary ORN at our hospital between 2002 and 2017. Clinical data were collected, including age, sex, primary tumor characteristics, radiotherapy dose, clinical findings of maxillary ORN, and treatment outcomes. Descriptive statistics and multiple factors were analyzed. Twenty-four patients were included for analysis. The primary symptoms of maxillary ORN were pain, trismus, pus, bone exposure, and skin fistula. Twenty (83.3%) patients were completely cured after single-operation. Thirteen patients underwent sequestrectomy, and the cure rate was 76.9% (10/13). Eleven patients received segmental osteotomy and flap reconstruction, with the cure rate of 90.9% (10/11). There was no significant statistical difference in the cure rate between these two groups ( Compared with mandibular ORN, the surgical effect of maxillary lesions is better and the choice of operation methods can be relatively conservative. Both sequestrectomy and segmental osteotomy with flap reconstruction can achieve good results in appropriate conditions.

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What diagnosis should we make for long-lasting vertiginous sensation after acute peripheral vertigo?

Tomoyuki Shiozaki,Masaharu Sakagami,Taeko Ito,Ichiro Ota,Yoshiro Wada,Tadashi Kitahara

Publicatie 15-09-2020


Differential diagnosis of persistent vertigo/dizziness in patients with a past history of vestibular neuritis (VN) and sudden deafness with vertigo (SDV) could sometimes be difficult for physicians due to variable vertiginous symptoms from rotatory to floating sensation. The main purpose of the present study was to examine the associations between the findings of otology/neurotology examinations in patients at the chronic stage after VN and SDV. We encountered 1789 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University between 2014 and 2018. Eighty-five patients were diagnosed as showing VN and 60 showed SDV according to the diagnostic guideline . The VN and SDV patients included 75 and 45 patients with chronic-stage of persistent vertigo/dizziness, of which 55 and 40 were enrolled into the present study. Persistent vertigo/dizziness after VN was attributable to delayed vestibular compensation (dVC: 33/55; 60.0%), secondary benign paroxysmal positional vertigo (sBPPV: 20/55; 36.4%), and secondary endolymphatic hydrops (sEH: 2/55; 3.6%), while that after SDV was attributable to sBPPV (20/40; 50.0%), sEH (16/40; 40.0%), and dVC (4/40; 10.0%). The present results could allow to simplify differential diagnosis of persistent vertigo/dizziness after VN and SDV such diseases as dVC, sBPPV, or sEH.

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The safety of posterior tympanotomy in otitis media with effusion during cochlear implantation: clinical retrospective cohort study

Saad Elzayat,Ihab Nada,Hossam El sherif,Ali Mahrous

Publicatie 15-09-2020


Posterior tympanotomy (PT) is an important step in cochlear implant (CI) surgery, as it is the main access to the round window. Some CI candidates, especially children, may have concomitant otitis media with effusion (OME) which may result in technical issues during PT. There is still a debate whether to wait for OME resolution preoperatively or to proceed to surgery with suspected difficulties. To evaluate the safety of PT during CI surgery in patients with OME. we included 102 consecutive pediatric candidates in this retrospective study with an age range of 12 months to 6 years. All the patients underwent CI surgery using trans-mastoid, PT to access round window (RW) area. We investigated the effect of the pathology caused by OME on the operative procedure in PT and post-operative consequences. out of 102 patients included in this study, there were 22 patients with OME who had unilateral cochlear implantation with no major operative or post-operative events. Nevertheless, some minor intra operative events and difficulties were encountered. The presence of OME in CI surgery indicates possible surgical challenges such as difficult PT, minor intra-operative risks and with no major post-operative events.

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Surgical treatment of otosclerosis using a unique stapes prosthesis without a hook

Sho Kanzaki,J. Kanzaki,K. Ogawa

Publicatie 15-09-2020


During stapes surgery, the Teflon wire piston prosthesis is prone to postoperative 'slips' and subsequent necrosis and fracture of the long process of the incus. We invented and used a novel cup-shaped apatite prosthesis to reduce the incidence of necrosis of the long process of the incus and analysed the postoperative results. Thirty-one ears in 25 patients with otosclerosis who underwent stapes surgery with our apatite prosthesis were evaluated. The air conduction improved by 24.0 dB (the average) from pre- to post-operation. Additionally, 84.8% of patients achieved an air-bone gap of ≤10 dB for the 4-frequency measurements ( Our findings indicate that our new prosthesis was associated with a good postoperative prognosis in patients with otosclerosis. Our unique prosthesis yielded good outcomes for the treatment of otosclerosis even in the short term.

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Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series

Zhengcai Lou

Publicatie 15-09-2020


The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation. To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation. In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months. The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4-6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up. Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.

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Circulating microRNAs as potentially new diagnostic biomarkers of idiopathic sudden sensorineural hearing loss

Sun Mok Ha,Kyu Rin Hwang,Il Hwan Park,Sunyoung Park,Jin Sil Choi,Dong Jun Park,Jeong-Eun Park,Su Hoon Lee,Hye Young Lee,Young Joon Seo

Publicatie 03-09-2020


Early detection of inner ear cell damage can reduce the chances of permanent damage to hearing ability. However, current inner ear cell damage detection methods can detect damage only after the patient has lost hearing ability. MicroRNA expression levels in circulating systems are affected in diseases or conditions arising from the distant lesions. Therefore, detection of circulating microRNA expression levels could be one of the best ways to obtain information on inaccessible lesion sites. This study aims to establish a method for monitoring idiopathic sudden sensorineural hearing loss (ISSNHL) by analyzing circulating microRNA expression levels. 21 ISSNHL patients and 24 healthy controls were enrolled. Real-time quantitative polymerase chain reaction was performed for detecting expression levels of circulating microRNAs. Among eight circulating microRNAs, expression levels of five circulating microRNAs significantly differed between ISSNHL patients and healthy controls. circulating microRNA expression levels correlates with treatment outcomes and hearing ability. Using methods combining the evaluation of miR-183, miR-210, miR-18b, and miR-23a cut-off values identified in ISSNHL patients and healthy controls during receiver operating characteristic curve analysis, sensitivity and specificity of 80.95% (17/21) and 87.50% (21/24) were obtained, respectively.

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Evaluation of high frequency horizontal VOR parameters in patients with chronic bilateral and unilateral peripheral vestibulopathy: a preliminary study

Gulce Kirazli,Sevinc Hepkarsi,Tayfun Kirazli

Publicatie 31-08-2020


Caloric test is one of the tests which evaluates the low frequency component of vestibular system for both diagnosis of the BPV and UPV. The main objectives are to determine and increase the diagnostic value of BPV and UPV by evaluating the high frequency horizontal VOR parameters with HIMP, SHIMP and fHIT, to compare test results with healthy controls, and to evaluate correlation of these tests with vertigo dizziness imbalance (VDI) questionnaire results in these patients. Six patients with BPV, ten patients with UPV and fifteen healthy controls were recruited. High frequency hVOR were evaluated with HIMP, SHIMP and fHIT. Vestibular symptoms and quality of life were assessed with VDI Questionnaire. Lower percentage of correct answers, and lower VOR gains were obtained in affected sides for BPV and UPV. HIMP elicited compensatory saccades in patients, whereas SHIMP elicited large anticompensatory saccades in controls and unaffected side of UPV, but no saccades in BPV. No correlation was found between VDI outcomes and all tests. The results show that all tests are complementary each other and able to identify the affected labyrinth and to show residual vestibular function. These tests are thought to be important in the vestibular rehabilitation process.

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Endoscopic sphenopalatine artery electrocoagulation for refractory epistaxis: a clinical study

Liang Yu,Xiaofei Li,Shujuan Sun,Li Shi,Yuzhu Wan

Publicatie 01-09-2020


The electrical coagulation of sphenopalatine artery(SPA) under nasal endoscopy has gradually become an important surgical intervention for epistaxis. To investigate the effectiveness and complications of SPA electrocoagulation for epistaxis. The clinical data of 47 patients undergoing SPA electrocoagulation were analyzed, retrospectively. Forty-seven patients were enrolled, with a male to female ratio of approximately 3:1. 11of 36 were under 45 years old, 25 of 36were 45 years old and above. Among female patients, one was under 45 years old, and the others were 45 years old and above, but there was no significant difference in gender composition between different age groups ( Refractory epistaxis has no relationship with age and sex, SPA electrcoagulation can effectively control refractory epistaxis and is an effective surgical method.

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Skull vibration-induced nystagmus in vestibular neuritis

Angel Batuecas-Caletrío,Ramón Martínez-Carranza,Gianni Mercy García Nuñez,Maria José Fernández Nava,Hortensia Sánchez Gómez,Santiago Santacruz Ruiz,Vanesa Pérez Guillén,Nicolás Pérez-Fernández

Publicatie 01-09-2020


As described by Dumas, an 80-100 Hz vibration applied to the mastoid produces a horizontal nystagmus, with quick phases beating away from the affected side in patients with unilateral vestibular loss (UVL). To elucidate the characteristics of skull vibration-induced nystagmus (SVIN) in patients suffering from vestibular neuritis and how these characteristics are related to information provided by the video head impulse test (vHIT). Sixty-three patients were enrolled to perform a vHIT to measure the gain in both ears. SVIN was induced with stimulation at 30 Hz, 60 Hz, and 100 Hz. The slow phase velocity (SPV) of the SVIN was measured. The SVIN test was positive in 25/63 patients at 30 Hz, 36/63 at 60 Hz and 46/63 at 100 Hz. Mean gain difference between both ears to obtain a positive SVIN at 30 Hz was observed to be 0.38 ± 0.25, decreasing to 0.35 ± 0.23 at 60 Hz, and 0.31 ± 0.24 at 100 Hz ( There is a close relationship between the difference in the gains of both ears as measured using VHIT and the SPV of the nystagmus induced by SVIN at 100 Hz.

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Facial nerve paralysis in malignant otitis externa: comparison of the clinical and paraclinical findings

Sasan Dabiri,Narges Karrabi,Nasrin Yazdani,Ahmad Rahimian,Azita Kheiltash,Mehrdad Hasibi,Elham Saedi

Publicatie 28-08-2020


Malignant otitis externa is an uncommon but critical challenging disease with some degree of cranial nerve involvement. to examine the factors leading to facial paralysis in these patients and clarify indications for aggressive treatment in the group most at risk. In a case-control study, demographic, clinical, laboratory, audiometric, imaging, and treatment characteristics of 139 patients in groups with and without facial paralysis were analysed. 45 patients (32.4%) had facial paralysis. Compared to patients without facial nerve involvement, patients with facial palsy had a higher rate of inflammatory markers (mean erythrocyte sedimentation rate on admission [67.71 vs 51.16 mm/h], and the average of total ESR [64.27 vs 54.46 mm/h], as well as the mean C-reactive protein [38.96 vs 27.53 mg/L]). Also, the involvement of the facial canal ( Nasopharyngeal extension of the inflammation and facial nerve canal erosion might be useful as predictors of facial nerve dysfunction. The elevated erythrocyte sedimentation rate is correlated with the increased risk of facial paralysis, and aggressive medical management is more crucial. Improvement in predicting the outcome of patients with malignant otitis externa.

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Olfactory dysfunction in patients after recovering from COVID-19

Martin Sylvester Otte,Hans Nikolaus Caspar Eckel,Leonard Poluschkin,Jens Peter Klussmann,Jan Christoffer Luers

Publicatie 28-08-2020


Smell and taste disorders occur in COVID-19 with a high prevalence, but little is known about the duration of the symptoms. In particular, studies using validated olfactory tests are very rare to date. The aim of this study was to determine the olfactory function of COVID-19 recoveries by a detailed olfactory test. 91 patients with PCR-confirmed, past COVID-19 disease were included. Olfactory history was taken using a questionnaire. Olfactory function was evaluated with the sniffin' sticks test, tasting function with taste sprays. 80 patients had experienced sudden olfactory loss during the course of disease and at the time of testing, 33 patients subjectively still had an impaired olfactory sense. Around 8 weeks had passed since the onset of symptoms. 45.1% of the tested individuals were still hyposmic according to the olfactory test while 53.8% showed an olfactory performance within the normal range. Patients' self-assessment correlated poorly with the measured olfactory performance. Half of the patients with an olfactory loss as a symptom of COVID-19 still have olfactory impairments after two months, although not all of these patients subjectively notice a restriction. Long-term measurements must confirm whether all affected patients will make full recovery.

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Design and application of submental island flap to reconstruct non-circumferential defect after hypopharyngeal carcinoma resection: a prospective study of 27 cases

Wenting Pang,Aobo Zhang,Cheng Lu,Jun Tian,Wan-xin Li,Zhenxiao Wang,Yanbo Dong,Shuoqing Yuan,Zihao Niu,Yiyuan Zhu,M. Shahed Quraishi,Liangfa Liu

Publicatie 19-08-2020


This study investigated the effects of reconstruction of hypopharyngeal non-circumferential defects with a submental island flap after ablation of hypopharyngeal carcinoma. The purpose of our study was to identify advantages and limitations of the submental flap for reconstruction of non-circumferential hypopharyngeal defects. A total of 27 patients who had stage II-IV hypopharyngeal cancer and underwent pharyngeal reconstruction with a submental flap by the senior author in both Department of Otolaryngology Head Neck Surgery, Chinese PLA General Hospital and Department of Otolaryngology Head Neck Surgery, Beijing Friendship Hospital, Capital Medical University. 96.3% (26/27) cases of submental island flap survived. There were two pharyngocutaneous fistulas, one recovered spontaneously, and the other was associated with flap necrosis, underwent neck debridement and flap removal. All except for one patient had decannulation of their nasogastric tube 2 weeks postoperatively. There was no evidence of a stricture or stenosis of the laryngopharynx, nor any sign of aspiration, except for one with esophageal inlet stricture caused by radiotherapy. There were two cases of obvious paraesthesia pharynges due to beard growth at the submental flap after reconstruction. 63.0% (17/27) patients are alive and 37% (10/27) have died of disease. The 3-year survival rate is 56.3% and the 5-year survival rate is 50.0%. The submental flap reconstruction for moderately sized non-circumferential hypopharyngeal defects is a recommended treatment option.

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Nystagmus in patients with lateral semicircular canal dysplasia

BoYoon Choi,Dong-Han Lee,Jung Eun Shin,Chang-Hee Kim

Publicatie 19-08-2020


Dizziness is not a common symptom in the lateral semicircular canal (LSCC) dysplasia, and nystagmus findings has been rarely described in LSCC dysplasia. To investigate the characteristics of spontaneous and positional nystagmus in patients with LSCC dysplasia. Patterns of spontaneous and positional nystagmus of twelve patients with LSCC dysplasia, who visited our clinic with a chief complaint of dizziness, were investigated. LSCC dysplasia was observed unilaterally in 4, and bilaterally in 8 patients. Non-rotatory dizziness with various onset times was the most common description of dizziness, and unilateral caloric weakness was observed in 82% of patients. Direction-fixed nystagmus, in which the direction of spontaneous nystagmus was same with that of positional nystagmus, was observed in 9 patients, and direction-changing positional nystagmus, in which the direction of nystagmus was changed from that of spontaneous nystagmus by positioning maneuvers, was observed in 3 patients, of whom down-beating or direction-changing spontaneous nystagmus was observed in one patient each. While direction-fixed horizontal nystagmus is the most commonly observed type of nystagmus in LSCC dysplasia, atypical spontaneous nystagmus, such as down-beating nystagmus or direction-changing spontaneous nystagmus, may be observed in patients with bilateral LSCC dysplasia.

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Self-reported course of olfactory impairment determines outcome for successful surgical intervention in nasal polyps with anosmia

Wei Zhang,Yifan Meng,Chengshuo Wang,Feifei Cao,Luo Zhang

Publicatie 19-08-2020


Olfactory impairment is one of important symptoms of Chronic rhinosinusitis with nasal polyps (CRSwNP). However, the relationship between course of olfactory impairment and postoperative symptom improvement was still unclear. The aim of this study was to assess the relationship between the self-reported course of olfactory loss and the degree of improvement in olfaction to determine the timing for successful surgical intervention in improving olfaction in patients with CRSwNP. A total of 86 CRSwNP patients with loss of smell and undergoing functional endoscopic sinus surgery (FESS) were recruited consecutively. The self-reported course of smell lose before treatment was recorded. Olfactory function was recorded before and after FESS using T&T Olfactometry. Fifty-seven patients demonstrated recovery of olfaction and 29 patients no-recovery. The average recovery time of smell loss in the study was 2.6 weeks. The course of smell loss showed moderate accuracy as a marker for determining the timing for successful FESS; with up to 4.5 years of self-reported smell loss being the cut-off point for recovery of smell following FESS. This study suggests that FESS in CRSwNP patients with self-reported significant olfactory impairment for less than 4.5 years may lead to improvement in olfaction. FESS in CRSwNP patients with self-reported significant olfactory impairment persisting for less than 4.5 years may lead to considerable improvement in olfaction in these patients.

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Clinical outcome in recurrent and/or metastatic head and neck cancer patients after discontinuation of nivolumab monotherapy due to immune-related adverse events

Ryuji Yasumatsu,Mioko Matsuo,Takahiro Wakasaki,Muneyuki Masuda,Toranoshin Takeuchi,Tomomi Manako,Rina Jiromaru,Ryutaro Uchi,Kazuki Hashimoto,Takashi Nakagawa

Publicatie 19-08-2020


Significant immune-related adverse events (irAEs) requiring therapy discontinuation sometimes occur. The influence of discontinuation on disease control after an irAE is unclear. The aim of this study was to investigate whether or not patients continued to show a response or durable disease control even after stopping therapy following an irAE. The response after nivolumab monotherapy discontinuation was examined for 14 patients in whom therapy was stopped without progression. The best response was CR in 5 (36%) patients, PR in 8 (57%) patients and SD in 1 (7%) patient. The estimated 1-year overall and progression-free survival rates were 92.9% and 78.6%, respectively. The best response during nivolumab therapy in patients who developed PD was CR in 0 of 5 patients (0%), PR in 3 of 8 patients (38%) and SD in 1 patient (100%). Patients obtaining CR tended to have a lower risk of PD than those with PR or SD. Patients with CR status may continue to show a response or durable disease control even after stopping therapy due to an irAE.

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Comparison of frequency-specific hearing outcomes after endoscopic and microscopic tympanoplasty

Lingchao Ji,Suoqiang Zhai

Publicatie 18-08-2020


Hearing results of endoscopic and microscopic tympanoplasty have been compared using the average pure tone threshold which could conceal subtle differences at a specific frequency. To compare frequency-specific hearing outcomes of endoscopic and microscopic tympanoplasty. The study included 42 patients who underwent endoscopic or microscopic type I tympanoplasty. The medical charts of these patients were reviewed retrospectively. We evaluated the pure tone audiometry at 250, 500, 1000, 2000 and 4000 Hz, including bone conduction (BC), air conduction (AC) and air-bone gap (ABG) before and after the surgery. The main outcome measures were frequency-specific pre- and post-operative hearing thresholds and the corresponding changes. We also assessed the graft success rate and surgical complications. BC revealed a significant aggravation at 4000 Hz in microscopic tympanoplasty group, but no significant differences between the two groups at any frequencies. Both groups showed improvements in AC and ABG at all frequencies, without significant differences between the two groups at any single frequency. The maximum improvement of AC and ABG was found at 250 Hz. The graft success rate and operative complications were also similar. The frequency-specific hearing outcomes of endoscopic and microscopic tympanoplasty are similar.

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Video head impulse testing in patients with benign paroxysmal positional vertigo

Ziya Saltürk,Sertaç Yetişer

Publicatie 18-08-2020


Vestibulo-ocular reflex (VOR) function is expected to be normal in patients with benign paroxysmal positional vertigo (BPPV) during sudden head rotations. The aim of this study is to analyze VOR by video head impulse test (vHIT) in patients with BPPV in order to determine the potential value of clinical application of vHIT in BPPV. Sixty patients with BPPV were included for the study from out-patient admissions. The main outcome measures were the gain of VOR, gain asymmetry, and refixation saccades. Fifteen healthy subjects with no history of dizziness were selected as normal control. Mean VOR gain during lateral head impulse in patients with geotropic type LC BPPV was 0.85 ± 0.22. Mean VOR gain during lateral head impulse in patients with ageotropic type LC BPPV was 0.78 ± 0.16. Fourteen patients with PC BPPV (35%; 40/13) had low gain during ipsilesional head impulses. Seven patients had low gain during counterlesional head impulses. Mean VOR gain during vertical head impulse in patients with PC BPPV was 0.73 ± 0.24. Nine patients with posterior canal BPPV (25%; 9/40) and 2 patients with LC BPPV (11%; 2/18) had corrective saccades. None of the results showed significant difference in comparison to control group. VHIT analysis demonstrated that VOR function was normal on the BPPV side.

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