Acta Oto Laryngologica 2021-09-06

Effects on cervical vestibular-evoked myogenic potentials of four clinically used head and neck measurement positions in healthy subjects

Kanako Masuda,Masatsugu Masuda,Yoshiharu Yamanobe,Kohei Mizuno,Tatsuo Matsunaga,Koichiro Wasano

Publication date 28-07-2021


The most reliable head and neck position for cervical vestibular-evoked myogenic potentials (cVEMPs) measurements yet to be determined. To assess how four body positions used during clinical recordings of cVEMPs affect cVEMP parameters. cVEMPs of 10 healthy subjects (26-50 years old) were recorded in four body positions: Mean background sternocleidomastoid muscle (SCM) electrical activity was significantly higher in positions C and D than in positions A and B. The latencies of p13 and n23 differed significantly among the four positions. Raw p13-n23 complex amplitude was significantly greater in positions C and D than in A and B. These differences were reduced when amplitudes were corrected by SCM activity. For positions A and B, one and two subjects, respectively, had an abnormal raw asymmetry ratio (AR). After correction, all subjects had normal ARs in all positions. Body positions in which the head is elevated produce a quicker and larger cVEMP response compared to positions in which the head is not elevated. The difference in ARs among positions can be ignored as long as the correction is made.

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Evaluation of the blood–perilymph barrier in ears with endolymphatic hydrops

Tadao Yoshida,Masumi Kobayashi,Satofumi Sugimoto,Masaaki Teranishi,Shinji Naganawa,Michihiko Sone

Publication date 05-08-2021


Otological diseases including Meniere's disease (MD) involve endolymphatic hydrops (EH), which can be visualized by magnetic resonance imaging (MRI) with gadolinium contrast agents, but the temporal changes of contrast in the inner ear have not been evaluated. We investigated the permeability of the blood-perilymph barrier (BPB) in ears with EH to evaluate the severity of the inner ear disturbances. The study included 32 ears from 16 patients with EH or related diseases who underwent MRI. The permeability of the BPB was assessed by the signal-intensity ratio (SIR) at four-time points: before and at 10 min, 4 h, and 24 h after administration of gadolinium for assessing EH. Cochlear EH was found in 25 of the 32 ears, and vestibular EH in 11. The rate of EH was significantly higher in symptomatic ears; however, the existence of EH was not related to SIR values. Nevertheless, SIR values in the basal turn were significantly higher 4 and 24 h after injection of gadolinium in patients aged ≥50 years. Higher SIR values observed in older patients with EH indicate severe disturbances of the BPB in the cochlea, which may account for intractable inner ear disturbances in older patients.

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Prognostic factors of early-onset otitis media with effusion in children treated using tympanostomy

Maki Inoue,Kouji Yamamoto,Mariko Hirama,Noboru Ogahara,Masahiro Takahashi,Nobuhiko Oridate

Publication date 13-08-2021


Predicting the prognosis of early-onset otitis media with effusion (OME) in children is difficult. To investigate the prognostic factors of OME in children undergoing tympanostomy at 1 year of age. We examined 66 children (123 ears) followed up to 6 years of age. OME prognosis was determined by a history of re-tympanostomy at the last examination. We retrospectively analysed the prognostic factors based on the duration of first ventilation tube (VT) placed, history of otorrhea, asthma, adenoidectomy, and mastoid air cell system (MACS) size at 1 year before tympanostomy and at 3 years. While 25 ears underwent re-tympanostomy (group 1), 98 did not (group 2). The mean duration of VT placed was 21 months and 25, and the mean MACS size at 3 years was 314 mm The most probable prognostic factor was the combination of the MACS size at 3 years and duration of VT placed.

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Possible pathomechanisms accounting for both sound/pressure-induced eye movements and video head impulse test data in superior canal dehiscence

Andrea Castellucci,Salvatore Martellucci,Pasquale Malara,Cecilia Botti,Valeria Del Vecchio,Cristina Brandolini,Gian Gaetano Ferri,Angelo Ghidini,Enrico Armato

Publication date 09-07-2021


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Characteristic manifestation of ocular and cervical vestibular evoked myogenic potentials findings in severe obstructive sleep apnea patients

Hui-Ping Luo,Jing Yu,Xin-Da Xu,Jing Wang,Qing Zhang,Hai-Tao Wu,Fang-Lu Chi

Publication date 22-07-2021


Studies of saccular and utricular function in patients with obstructive sleep apnea (OSA) are rare. We noticed that some OSA patients also had positive results in vestibular function tests, and this inspired our interest in exploring the vestibular function patterns of OSA patients. To investigate otolithic organ function in severe OSA patients who lack vestibular symptoms and systemic disease. 32 patients (64 ears) with severe OSA and 22 healthy controls (44 ears) were enrolled. The ocular and cervical vestibular-evoked myogenic potentials (oVEMP and cVEMP) and the caloric test were recorded and analyzed. The response rates of oVEMP (73.4%) and cVEMP (82.8%) in patients with severe OSA were significantly lower than those in controls. In oVEMP, elevated thresholds ( Disappearance or impairment of VEMPs could be observed in patients with severe OSA, and reflects different degrees of impairment in the utricle and saccule.

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Characteristics of hearing loss in elderly outpatients over 60 years of age: an annual cross-sectional study

Siyang Li,Hui Ye,Aiting Chen,Lan Lan,Shiming Yang,Fei Ji

Publication date 29-07-2021


The prevention and treatment of presbycusis becomes a serious health challenge and socio-economic problem. We performed a cross-sectional analysis of the audiometry results of all elderly patients who visited our department throughout the year of 2018.
A total of 5520 people aged 60 and over were included and divided into three groups: young-old group (60-74 years old), old-old group (75-89 years old), and longevous group (over 90 years old). Pure-tone audiometry results of all patients were analyzed. Among the 5520 patients, there were 4445 cases in the young-old group, 1029 cases in the old-old group, and 46 cases in the longevous group, accounting for 80.53, 18.64, and 0.83%, respectively. In the young-old group, normal hearing and mild-moderate hearing loss were the most common, while moderate and severe hearing loss were more common among the old-old group and the longevous group. The hearing curve showed typical age-related hearing loss with a drop at high frequencies. With an increase in age, patients tend to suffer from more serious hearing disorders. Presbycusis was associated with specific frequency and age characteristics. Understanding these characteristics is of great significance for the prevention and treatment of age-related hearing loss.

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Temporal processing, spectral processing, and speech perception in noise abilities among individuals with chronic kidney disease undergoing hemodialysis

Kaushlendra Kumar,Livingston Sengolraj,Mohan Kumar Kalaiah

Publication date 22-07-2021


In the literature, the effect of chronic kidney disease on the peripheral auditory system has been well documented. But studies investigating the effect of chronic kidney disease on speech perception and auditory processing abilities are limited. The present study investigated the effect of chronic kidney disease on different auditory processing tasks and speech perception in noise among adults. A total of 28 adults participated in the study. Group 1 included 14 individuals with chronic kidney disease undergoing hemodialysis, and Group 2 included 14 individuals with no known kidney complications. Amplitude modulation detection threshold, gap detection threshold, spectral ripple discrimination threshold, and speech recognition threshold in noise were measured. Independent samples Results showed poorer gap detection threshold, amplitude modulation detection threshold, spectral ripple discrimination threshold, and speech recognition threshold in noise among individuals with chronic kidney disease compared to individuals with no known kidney complications. The present study showed poorer auditory processing and speech perception abilities in individuals with chronic kidney disease.

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Effectiveness of hearing aids in treating patients with chronic tinnitus with average hearing levels of <30 dBHL and no inconvenience due to hearing loss

Noriomi Suzuki,Seiichi Shinden,Naoki Oishi,Masafumi Ueno,Daisuke Suzuki,Kaoru Ogawa,Hiroyuki Ozawa

Publication date 10-08-2021


The effectiveness of hearing aids for tinnitus patients without hearing loss in conversation-comprehension range and inconvenience in daily communication is unknown. We aimed to evaluate their therapeutic effect. We included 91 patients with average hearing levels <30 dBHL. To determine the effects, self-reported questionnaires were used. Data were collected at the entry and 3 months ( All scores (mean ± standard deviation) decreased significantly ( Hearing aids may be useful for tinnitus patients without hearing loss and inconvenience in daily communication. Our findings provide a treatment option for tinnitus patients with an average hearing level of <30 dBHL.

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Underwater posterior nasal neurectomy compared to resection of peripheral branches of posterior nerve in severe allergic rhinitis

Seiichiro Makihara,Mitsuhiro Okano,Syotaro Miyamoto,Kensuke Uraguchi,Munechika Tsumura,Shin Kariya,Mizuo Ando

Publication date 13-08-2021


Several surgical procedures for posterior nasal neurectomy have been reported, but no conclusion has been reached about which procedure is best. The aim is to evaluate the improvement in symptom medication scores for resection of the posterior nasal nerve trunk in an underwater environment, with submucous inferior turbinectomy, without injuring the sphenopalatine artery (SPA) in severe allergic rhinitis. Improvements in symptom medication scores were retrospectively compared between 27 consecutive cases who underwent resection of the posterior nasal nerve trunk with turbinoplasty in an underwater environment without injuring the SPA (Underwater group) and, as a historical control, 16 consecutive cases who underwent resection of peripheral branches of the posterior nasal nerve with turbinoplasty (Control group). The improvements in symptom medication scores in the Underwater group were significantly better than in the Control group (3.07 vs. 1.96, By using underwater posterior nasal neurectomy, we can easily and safely resect the posterior nasal nerve trunk under a clear surgical view without injuring the SPA. This technique with submucous inferior turbinectomy may, more than resection of peripheral branches of the posterior nasal nerve, be able to reduce the medication score and symptom medication score.

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Changes in olfactory bulbus volume and olfactory sulcus depth in the chronic period after COVID-19 infection

Bünyamin Güney,Ferda Bacaksızlar Sarı,Murat Yunus Özdemir,Neşat Çullu,Emrah Doğan,Turhan Togan

Publication date 22-07-2021


Although there are a limited number of studies investigating the changes in olfactory bulb volume (OBV) and olfactory sulcus depth (OSD) values in the acute and subacute periods after COVID-19 infection, there are no studies conducted in the chronic period. The aim of this study is to reveal the changes in OBV and OSD after COVID-19 in the chronic period. A total of 83 people were included in our study, including 42 normal healthy individuals (control group) and 41 patients with COVID-19 infection (10-12 months after infection). The COVID-19 group included 41 patients with the mean age 40.27 ± 14.5 years and the control group included 42 individuals with the mean age 40.27 ± 14.4. The mean OBV was 67.97 ± 14.27 mm Our findings show that COVID-19 infection causes a significant decrease in the OBV and OSD measurements in the chronic period.

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Stress reactions in a tertiary oto-rhino-laryngological department during the first wave of the COVID-19 pandemic in the Danish Capital region

Maiken Wissing Brejnebøl,Lena Walvik,Anders Korsgaard Christensen,Ramon Gordon Jensen,Christian von Buchwald

Publication date 04-08-2021


Health care workers (HCW) at otorhinolaryngological departments have an increased risk of contracting COVID-19, due to aerosol-inducing diagnostic and surgical procedures in the airways. The ongoing exposure to physical and psychological stressors could impact the mental health of HCW. To investigate the impact on mental health in an otorhinolaryngological department during the COVID-19 pandemic. Cross-sectional questionnaire study, assessing symptoms of depression (PHQ-9) and anxiety (GAD-10). Physicians, nurses, and secretaries were included at a tertiary department of otorhinolaryngology in the Capital Region of Denmark during the COVID-19 lockdown in spring 2020. Positive screenings for stress reactions were found in 22% for depressive symptoms and 15.5% anxiety. 27% feared becoming infected, 47% feared infecting their families in relation to work. 27% felt others were distancing from them, and 38% isolated themselves from others because of their work. Women had an odds ratio of 9.18 (CI 1.49-179) for depressive stress reactions. HCW were primarily concerned with transmitting COVID-19 to their relatives. Secondarily, there was a concern about becoming infected despite feeling adequately protected by personal protective equipment. Women were at higher risk of more severe depressive symptoms when corrected for professions.

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Narrow-band imaging combined with salivary pepsin to diagnose patients with laryngopharyngeal reflux

Li Guo,Yuehong Liu

Publication date 24-07-2021


Laryngopharyngeal reflux (LPR) is a prevalent disease in the ENT outpatient department. Methods of LPR diagnosis differ much. Narrow-band imaging (NBI) and Salivary pepsin-level measurements have been considered as totally new ways for the diagnosis of LPR in recent years. We aimed to identify the specific manifestation of LPR and assess the correlation between NBI views and pepsin levels in LPR diagnosing. 130 Patients enrolled in our study were divided into LPR group and non-LPR group according to the scores of RSI and RFS. All individuals received endoscopic NBI tests and salivary pepsin measurements. NBI views of the larynx were divided into four grades based on the existing descriptive guidelines and our clinical observations, and the correlation between NBI grading and salivary pepsin levels was calculated. NBI grading and pepsin levels are significantly correlated with RFS/RSI scores. The diagnostic concentration of salivary pepsin was 33 ng/ml. There was a significant correlation between NBI grading and salivary levels. NBI grading system was proved to provide a better diagnostic value in the diagnosis of LPR. There was a possibility that a combination of these two methods might increase the diagnostic accuracy of this disease.

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Laryngoscopic characteristics related to the risk of cancerization of vocal cord leukoplakia

Li-Juan Li,Zhan Yu,Ji-Qing Zhu,Mei-Ling Wang,Zhi-Xiang Li,Cong Yang,Xiao-Guang Ni

Publication date 28-07-2021


The diagnosis of vocal cord leukoplakia mainly relies on laryngoscopy. The morphology of vocal cord leukoplakia under laryngoscope is closely related to the pathological nature of leukoplakia. The specific manifestations associated with high-risk vocal cord leukoplakia remain to be explored. To investigate the characteristics of low-risk and high-risk vocal cord leukoplakia under conventional white light imaging (WLI) laryngoscopy and its correlations with narrow band imaging (NBI) laryngoscopy. One hundred and seventy-five cases of vocal cord leukoplakia were divided into low-risk and high-risk groups. The characteristics of low-risk and high-risk vocal cord leukoplakia under WLI laryngoscopy and its correlations with NBI laryngoscopy were analyzed. Logistic regression analysis showed that thickness and hyperemia were independent factors ( The sign of hyperemia under WLI laryngoscopy is significantly correlated with the visualized spots under NBI laryngoscopy. Hyperemia is an important feature for predicting malignant potential of vocal cord leukoplakia.

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The role of frozen section biopsy for submandibular gland tumors

Masahiro Suzuki,Yuta Nakaegawa,Tomotaka Kawase,Masakazu Ikeda,Shigeyuki Murono

Publication date 28-07-2021


Although there have been several reports of the diagnostic accuracy of frozen section biopsy (FSB) for parotid gland tumors, few studies have focused on its diagnostic accuracy for submandibular gland tumors. This study aimed to investigate the necessity of FSB with regard to its diagnostic accuracy for submandibular gland tumors (SGTs). About 42 SGT patients underwent both fine-needle aspiration cytology (FNAC) and FSB between 2005 and 2020. The results of FNAC and FSB were analyzed and compared with the final histological diagnoses. The respective sensitivity and specificity in detecting malignant tumors in 38 cases, excluding the four indeterminate FNAC cases, they were 0 and 97% for FNAC, and 100 and 97% for FSB. Considering the four indeterminate FNAC cases to be malignant, the respective sensitivity and specificity in detecting malignant tumors in the 42 cases were 50 and 92% for FNAC, and 100 and 95% for FSB. FSB may be useful for malignancy detection as a final histological diagnosis in cases that are diagnosed as benign or indeterminate by FNAC in SGTs.

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Clinicopathologic characteristics of Burkitt lymphoma of the head and neck in a non-endemic region—a Danish nationwide study

Cecilie Dupont Harwood,Patrick René Gerhard Eriksen,Erik Clasen-Linde,Jakob Schmidt Jensen,Peter Asdahl,Malin Rasmussen,Lisa Lyngsie Hjalgrim,Steffen Heegaard,Christian von Buchwald

Publication date 20-07-2021


Burkitt lymphoma rarely presents in head and neck (H&N) in Western countries. We aimed to characterise clinicopathological features of H&N Burkitt lymphoma in Denmark representing a non-endemic region. Clinical records were reviewed for a nationwide cohort of patients diagnosed with H&N Burkitt lymphoma in Denmark between 1980 and 2018. The diagnosis was histologically validated. Thirty-four patients with H&N Burkitt lymphoma (highest incidence in age group 0-9 years, male-to-female ratio 4.7:1) were included. Thirty-three lymphomas (97%) were extranodal. The tumour was visible at the clinical examination in 81% ( Due to the rarity of Burkitt lymphoma of the H&N, there is a high risk of clinical misdiagnosis. Our findings suggest which symptoms and clinical presentations to be aware of in the diagnostics work up that could lead to the diagnosis of Burkitt lymphoma.

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Practical aspects of sentinel node biopsy in oral cavity cancer: all nodes that emit a signal are important

Elina Panula,Jussi Hirvonen,Tero Vahlberg,Aleksi Schrey,Heikki Irjala

Publication date 20-07-2021


Sentinel node biopsy (SNB) is a safe and effective way to examine an N0 neck in early-stage oral cavity cancer (OCC). In this study, we evaluated the variables of SNB detection, surgery, and outcome. Ninety-two patients with N0 OCC examined with SNB were included. Number and brightness of nodes detected on preoperative imaging and during surgery were analyzed and compared with histological findings. Patients with recurrent disease were evaluated separately and the effect of smoking and alcohol consumption was analyzed. Eighteen patients had at least malignant cells in the sentinel lymph node (SLN); 18 patients had recurrent disease and nine patients died from the cancer. The negative predictive value of SNB was 95%. Six patients did not have metastases in the node with the strongest signal, but metastases were found in an SLN with a weaker signal. Smoking and alcohol consumption did not affect disease-specific or overall survival. SNB has been confirmed to be safe and effective in early stage N0 OCC. However, it is important to carefully harvest up to four hottest SLNs that emit a signal. Treatment of patients with only isolated tumor cells (ITC) in the SLN appears to be necessary.

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Trapezius muscle branch of the spinal accessory nerve without penetrating the sternocleidomastoid muscle as a pitfall in neck dissection: prevalence in a Japanese institution and a protocol for the prevention of iatrogenic injury

Koji Sakamoto,Hiroyuki Ozawa,Marie Shimanuki,Amina Kida,Tsubasa Kitama,Kaho Iwabu,Masashi Nakaishi,Atsuko Sakanushi,Takeshi Matsunobu,Kimihiro Okubo,Yoichiro Sato,Seiichi Shinden,Kaoru Ogawa

Publication date 14-08-2021


The spinal accessory nerve (SAN) has several anatomical variations, which may be a pitfall in neck dissection (ND). These include the trapezius muscle branch (TB), which stems from the common trunk before entering the sternocleidomastoid muscle (SCM). To investigate the prevalence of this variation and suggest a protocol for preventing unexpected injury of the TB in ND. We conducted a retrospective cohort study for 93 patients who had undergone neck dissection (117 sides) without resection of the SCM nor SAN. We recorded the division of the TB after and before penetration of the SCM by the common trunk (penetrating type TB [PTB]) and non-penetrating type TB [NPTB], respectively). Among NDs, PTB and NPTB were observed in 61 (52%) and 56 (48%) sides, respectively. In the subgroup of 24 cases with bilateral ND, PTB/PTB, NPTB/NPTB, and NPTB/PTB were observed in eight (33%), nine (38%), and seven (29%) cases, respectively. The prevalence of PTB/NPTB did not differ according to age, sex, or laterality. NPTB is a common anatomical variation. The presence or absence of a branch from the common trunk must be initially checked to avoid unexpected damage to the TB.

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Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients

Nidhin Das,Darwin Kaushal,Sourabha Kumar Patro,Puneet Pareek,Abhinav Dixit,Kapil Soni,Nithin Prakasan Nair,Bikram Choudhury,Amit Goyal

Publication date 07-09-2021


One of the debilitating complications of head and neck cancer radiotherapy is hearing loss. To quantify the magnitude of sensory neural hearing loss (SNHL) in the head and neck cancer patients undergoing chemoradiation therapy. This is a prospective study. Eighty patients with head and neck cancers and undergoing volumetric arc therapy were taken up for the study. Regular audiological evaluation was done. The changes in audiological parameters from baseline are correlated with cochlear dose. Cochlea received maximum doses of up to 28.52 Gy without causing SNHL in the absence of chemotherapy. But in concurrent chemoradiotherapy, hearing loss was found at least dose of 9 Gy at frequency range of 4 KHz-8 KHz. The risk of SNHL is independent of cumulative doses of Cisplatin. In 106 ears receiving concurrent chemoradiation, 82.1% and 74.5% ears had sensorineural hearing loss at 4 KHz and 8 KHz respectively, following the completion of treatment. Otoacoustic emissions in the chemoradiation group showed a significant change at the completion of treatment. Volumetric arc therapy have facilitated sparing of cochlea (< 40 Gy). This has resulted in better clinical outcome in terms of SNHL. The inclusion of concurrent cisplatin chemotherapy is a significant risk factor for the development of SNHL at higher frequencies.

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Impact of tonsillectomy on COVID–19 pandemic: an observational study of the incidence and prognosis

Ahmet Kara,Halil Elden,Engin Okur,Mahmut Sinan Yilmaz,Fuldem Mutlu,Mehmet Guven,Deniz Demir

Publication date 07-09-2021


Due to many different reasons such as possible coronavirus colonization in tonsillar tissue, decreased enzymatic antiviral activity, decreased cytokine activity from palatine tonsil tissue and reduced humoral and cellular immune response, tonsillectomy may alter the incidence of Covid-19. To reveal the frequency of Covid-19 in patients who underwent tonsillectomy and to analyze the effect of tonsillectomy on the severity of the disease. Patients aged between 15 and 65 and had a history of tonsillectomy were compared with control group in terms of incidence and severity of Covid-19 disease. A 4% Covid rRT-PCR test positivity rate was detected in patients with tonsillectomy whereas; it was 6.8% in the control group with a statistically significant difference. However, in terms of disease severity there was no difference between the two groups. It has been proven that tonsillectomy surgery does not pose an additional risk in terms of COVID 19 disease severity. The positive effect of tonsillectomy in terms of disease frequency has been even demonstrated for the first time in the literature.

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Surgical treatment of T2-3 posterior hypopharyngeal carcinoma with preservation of laryngeal function

Ling Chen,Yu Si,Peiliang Lin,Zhong Guan,Wenying Zhu,Haifeng Liang,Qian Cai

Publication date 31-08-2021


Posterior hypopharyngeal carcinoma indicates a poor prognosis. Previous treatments predicted negative influence to the pronunciation and swallowing function. The present study focuses on improving survival rate while improving quality of life. To investigate on the surgical techniques of the preservation of laryngeal function of posterior hypopharyngeal carcinoma. Eighteen patients with posterior hypopharyngeal carcinoma of T2-T3 were studied. All primary lesions were removed and the defects were repaired with the radial forearm free flap (RFFF). The 3-year overall survival rate was 51.9%. All patients could maintain daily caloric intake by feeding orally, and remove the gastric tube 28-61 days after operation. Assessed swallowing function by Fiberoptic endoscopic evaluations of swallowing. When eating solid food, 66.67% patients had food residue; no food entered airway, and all patients had Penetration-Aspiration Scale of level 1. As for liquid, 11.11% patients had level 5, 16.67% level 4, 27.78% level 2 and 44.44% level 1. By preserving the integrity of larynx and superior laryngeal nerve with repairing the defects of posterior wall of hypopharynx with RFFF, patients with T2 and T3 stage posterior hypopharyngeal carcinoma could live a better quality of life.

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A nationwide epidemiologic, clinical, genetic study of Usher syndrome in Japan

Hidekane Yoshimura,Shin-ya Nishio,Yuichi Isaka,Toru Kurokawa,Shin-ichi Usami

Publication date 29-08-2021


Usher syndrome (USH) typically leads to deaf-blindness, requiring the provision of extensive education and rehabilitation services. Therefore, investigating the prevalence is crucial to requests for proper government support for USH patients. The aim was to perform a nationwide epidemiologic survey of USH in Japan to estimate the prevalence of USH and reveal the relative frequency and characteristics of the three USH subtypes. To estimate the number of USH patients visiting hospitals over a 1-year period, 1,628 hospitals were randomly selected from all Departments of Otorhinolaryngology and Ophthalmology in Japan. Subsequently, we collected data regarding the clinical characteristics of each patient treated and the results of genetic testing, if performed. We found that the prevalence of USH was at least 0.4 per 100,000 population. The frequency of clinical subtypes and causal genes for USH were consistent with previous reports. Also, we demonstrated the feasibility of genetic counseling for USH patients based on the results of genetic testing. USH is a rare disease, but requires social support due to the severity of symptoms. To minimize these issues, understanding the clinical characteristics and performing comprehensive genetic testing could allow early and accurate diagnosis as well as medical intervention.

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Radiological classification of the mastoid portion of the facial nerve: impact on the surgical accessibility of the round window in cochlear implantation

Mahmoud Mandour,Saad Elzayat,Haitham H. Elfarargy,Rasha Lotfy,Ahmed ELnaggar

Publication date 24-08-2021


Mastoid portion of the facial nerve plays an important role in the round window approach of cochlear implantation. This study aimed to predict the anterior displacement of the mastoid portion of the facial nerve in the preoperative HRCT coronal cuts. We also aimed to detect the implication of anterior displacement of MPFN on the R.
W. accessibility through the posterior tympanotomy during cochlear implantation. It was a retrospective observational cohort study in tertiary referral hospitals. We included 246 pediatric patients who underwent cochlear implantation due to bilateral severe to profound SNHL through a posterior tympanotomy approach. Type I MPFN was present in 84 cases, type II MPFN was present in 149 patients, and type III MPFN was present in 13 cases. R.
W. was inaccessible in 3 cases with MPFN type II and in 11 subjects with MPFN type III. There was a statistically significant difference regarding the R.
W. accessibility between the three types of MPFN ( Mandour radiological classification of the mastoid portion of the facial nerve in the preoperative HRCT coronal offers an easily applicable method to detect the anterior displacement of the facial nerve by using easy and well-known landmarks. This classification can also predict R.
W. accessibility through posterior tympanotomy during cochlear implantation with 97.97% accuracy.

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Endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation for tympanic membrane perforation

Fengming Gu

Publication date 24-08-2021


The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage. To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation. A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery. The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively ( It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations.

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Vestibular nerve deficiency and vestibular function in children with unilateral hearing loss caused by cochlear nerve deficiency

Keita Tsukada,Shin-ichi Usami

Publication date 19-08-2021


High-resolution MR imaging enables the visualization of individual nerves in the internal auditory canal (IAC). Cochlear nerve deficiency (CND) is recognized as one of the major causes of sensory neural hearing loss (SNHL), especially in cases of unilateral hearing loss in childhood. Some patients with CND are thought to have accompanying vestibular nerve deficiency (VND). However, there have been few reports focusing on VND and vestibular function in these children. The aim of this study was to evaluate the frequency of VND and vestibular dysfunction in children with unilateral SNHL caused by CND. Thirty-eight children with unilateral SNHL, who were diagnosed with CND by 3 T-MRI, were evaluated for VND and underwent caloric testing and cervical vestibular evoked potential (cVEMP). Fourteen of 38 patients (37%) had VND, and eleven (29%) of the patients [ten of the patients (71%) with VND] had at least one vestibular dysfunction. The patients with VND had significantly worse hearing and an IAC of smaller diameter than did patients without VND. We should pay attention to VND as well as vestibular dysfunction in hearing loss patients with CND.

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The prognostic value of thyroid gland invasion in locally advanced laryngeal cancers

Mustafa Aslıer,Bahar Ezgi Uçurum,Hilmi Cem Kaya,Hakan Coskun

Publication date 19-08-2021


Locally advanced laryngeal cancers can spread to the thyroid gland by direct invasion of cricothyroid membrane. The prevalence of thyroid gland invasion (TGI) and the predictive factors of TGI were well described in literature. However, the association of TGI with survival was undetermined yet. The aim of this study is to analyze the effects of TGI on survival rates in patients with locally advanced laryngeal cancer. Medical records of 91 patients who underwent total laryngectomy with thyroidectomy were retrospectively reviewed. Demographical, clinical, and histopathological characteristics of the patients were noted. Kaplan-Meier test was used for survival analysis. Histopathology reports revealed the prevalence of TGI as 14.3% (13/91). Survival analyses showed that TGI did not affect recurrence free ( Thyroid gland invasion is one of the characteristic features of locally aggressive laryngeal tumors. In this study, TGI is not a statistically significant prognostic factor that has impact on survival of the patients with locally advanced laryngeal cancer.

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Circulating fatty acids in patients with head and neck cancer after treatment: an explorative study with a one-year perspective

Constantina Nadia Christou,Ylva Tiblom Ehrsson,Erik Lampa,Ulf Risérus,Göran Laurell

Publication date 17-08-2021


Unintended weight loss and nutritional problems are often seen in patients with head and neck cancer, but changes in lipid metabolism are poorly studied. The present study aimed to explore the longitudinal changes in circulating fatty acid (FA) composition in patients with head and neck cancer. This study included 27 patients with head and neck cancer. Treatment consisted of single modality or combined modality treatments. The patients were assessed by repeated blood sampling and body weight assessments before treatment started and on three occasions after the start of treatment. FA profiling included gas chromatography analysis of unsaturated FAs and saturated FAs in serum. The values of three fatty acids - FA 14:0, FA 18:3n3, and FA 20:3n6 - changed in a specific pattern over the course of the study and the change in FA 14:0 correlated with weight changes. This study showed altered profiles of both saturated and unsaturated FAs. An improved understanding of the metabolic pathways in patients with head and neck cancer supports the development of better nutritional surveillance and nutritional treatments.

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Feasibility of an inexperienced examiner using trans-cervical ultrasound in the diagnosis of peritonsillar abscesses

Mathias von Beckerath,Joacim Svensson,Fredrik Landström

Publication date 17-08-2021


A peritonsillar abscess (PTA) is a common complication to acute tonsillitis. Needle aspiration (NA) is the gold standard for diagnosis of PTA. NA is usually painful and not risk-free. Ultrasound (US) is a noninvasive, portable radiological modality that could potentially be used in the diagnosis of PTA and selection of patients for NA. The reliability of US is dependent on the experience of the examiner which limits is usefulness. To evaluate the reliability of US in the diagnosis of PTA by an inexperienced examiner. Thirty patients with suspected PTA were included. They were first examined with trans-cervical US by a medical student then clinically examined by a physician that performed a NA if clinically motivated. They were then followed for at least two days. Three patients were excluded from analysis because no NA was performed. In these patients, US correctly classified them as negative for PTA. In the remaining 27 patients, the sensitivity and negative predictive value was 100%. The specificity was 64.3% and the positive-predictive value was 72.2%. US can be very useful in the diagnosis of PTA and the selection for NA even with an inexperienced examiner. The results highlight the usefulness of ultrasound in otolaryngology.

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Feasibility of conducting type III home sleep apnoea test in children

Tina Kissow Lildal,Jannik Buus Bertelsen,Therese Ovesen

Publication date 30-06-2021


To test the feasibility of conducting unattended paediatric type III HSAT and to identify issues for improvements to optimize signal quality. Parents were instructed in setting up the unattended HSAT and reported their experiences. Signal quality and causes of signal failure of recordings were assessed. Forty children were included. Mean age was 5.2 years. Predefined success criteria were met in 53% of recordings. Main causes of signal failure were nasal cannula, pulse-oximetry and battery failure. Sensor fixation techniques were developed and implemented during the study and hence signal quality improved. Seventeen (94%) parents reported HSAT to be either easy or medium hard to use.

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