Clinical Otolaryngology 2022-06-30

A novel risk score for disease control prediction of chronic rhinosinusitis

Lijie Jiang, Kanghua Wang, Tengjiao Lin, Yifeng Jiang, Wenxiang Gao, Cong Li, Zhaoqi Huang, Chuxin Chen, Zhiyin Nie, Rui Zheng, Yueqi Sun, Jianbo Shi, Yinyan Lai

Publication date 30-06-2022


Abstract Objectives To assess the impact of risk factors on the disease control among chronic rhinosinusitis (CRS) patients, following 1 year of functional endoscopic sinus surgery (FESS), and combining the risk factors to formulate a convenient, visualised prediction model.
DesignA retrospective and nonconcurrent cohort study.
Setting and ParticipantsA total of 325 patients with CRS from June 2018 to July 2020 at the First Affiliated Hospital of Sun Yat-sen University, the Third Affliated Hospital of Sun Yat-sen University, the Seventh Affiliated Hospital of Sun Yat-sen University.
Main Outcomes Measures Outcomes were time to event measures: the disease control of CRS after surgery 1 year. The presence of nasal polyps, smoking habits, allergic rhinitis (AR), the ratio of tissue eosinophil (TER) and peripheral blood eosinophil count (PBEC) and asthma was assessed. The logistic regression models were used to conduct multivariate and univariate analyses. Asthma, TER, AR, PBEC were also included in the nomogram. The calibration curve and area under curve (AUC) were used to evaluate the forecast performance of the model.
Results In univariate analyses, most of the covariates had significant associations with the endpoints, except for age, gender and smoking. The nomogram showed the highest accuracy with an AUC of 0.760 (95% CI, 0.688–0.830) in the training cohort.
Conclusions In this cohort study that included the asthma, AR, TER, PBEC, which had significantly affected the disease control of CRS after surgery. The model provided relatively accurate prediction in the disease control of CRS after FESS and served as a visualised reference for daily diagnosis and treatment.

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Durable complete response rates following radiotherapy and immunotherapy combination in recurrent and metastatic head and neck squamous cell carcinoma: A retrospective single centre cohort study

Raj Khera, Laura Feeney, Martin Swinton, Sam Rack, Andrew Sykes, Robert Metcalf

Publication date 23-06-2022


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Normal salivary production using a swab method in clinical settings

Patrick Rønde Møller, Mathias Lyngbye Kærsgaard, Jolanta Grydehøj, Therese Ovesen

Publication date 20-06-2022


Abstract Objectives The purpose of the study was to generate age- and gender based normative data for unstimulated salivary flow rate (uSFR) by means of a swab method, and to provide preliminary results of using the test in patients suspected of reduced salivary function.
Methods130 healthy participants without subjective xerostomia or suspicion of reduced salivation were recruited. Measurements of unstimulated salivary flow rate (uSFR) were conducted three times per subject and mean uSFR was calculated for the entire population and stratified according to age and gender. The method was applied in a pilot population of 25 patients suffering from either Sjögrens syndrome or had underwent irradiation of the head and neck.
Results Mean uSFR in the healthy group was 0.808 g/minute (range: 0.165-2.442). Not significant trends towards declining uSFR with increasing age and higher uSFR in women were seen. Mean uSFR in the patients was 0.429 g/minute (range: 0.111-1.448), which was significantly lower than normative values. Use of xerogenic drugs correlated to lower uSFR.
Conclusion Age and gender based normative data of uSFR was presented using a fast and readily implementable swab test. The test was able to objectively verify hyposalivation among patients suffering from Sjögrens syndrome or having been exposed to head and neck radiation.

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Long‐term audiologic outcomes and potential outcome predictors of cochlear implantation in cochlear aplasia with dilated vestibule: A case series

Bong Jik Kim, Hyoungwon Jeon, Yehree Kim, Sang‐Yeon Lee, Jin Hee Han, Nayoung Yi, Jong Woo Chung, Seung‐Ha Oh, Byung Yoon Choi

Publication date 14-06-2022


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Establishing the relationship between MRI and histological tonsil size measurement in patients undergoing tonsillectomy: Our experience in 11 patients

Erdinc Soylu, Rachael Harrison, Matthew Taylor, Ho Ming Yuen, Eleanor Sproson

Publication date 13-06-2022


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Feasibility of face mask spirometry during decannulation in head and neck surgery: Prospective cohort study

José Antonio Sánchez‐Guerrero, Maria Àngels Cebrià i Iranzo, Francisco José Ferrer‐Sargues, Sophie Périé

Publication date 13-06-2022


Abstract Objectives To analyse the relationship between spirometric parameters measured with a face mask versus a mouthpiece, as well as the feasibility of face mask spirometric evaluation in a head and neck surgery (HNS) decannulation context. Furthermore, we examine peak inspiratory flow (PIF) cut-off values before and after decannulation.
Design Prospective cohort study.
Setting Otolaryngology HNS Department of a university teaching hospital.
Participants Twenty-four patients were selected. A maximal flow-volume loop was conducted before (with mouthpiece) and after (with mouthpiece and face mask) decannulation.
Main outcome measures Recorded outcomes were forced vital capacity (FVC), forced expiratory volume in the first second, peak expiratory flow, PIF, forced expiratory flow at 50% of FVC and forced inspiratory flow at 50% of FVC. Spearman correlation coefficients between spirometric parameters measured with a face mask versus a mouthpiece were calculated. Wilcoxon test was used to check differences between mouthpiece and face mask values.
Results Correlation between mouthpiece and face mask spirometric values was moderate to high (r = 0.46–0.95). All parameters measured by spirometry were significantly lower with a face mask than those obtained with a mouthpiece (p < 0.05). Before decannulation, the lowest PIF value (tested with mouthpiece) that allowed successful decannulation was 1 L/s. After decannulation, the lowest PIF value tested with mouthpiece and face mask for successful completion of the decannulation process were 0.77 and 0.56 L/s, respectively.
Conclusion Face mask is a feasible option to perform a spirometry when face diseases hinder spirometric evaluation through a mouthpiece in an HNC surgery context.

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Laryngoscopic findings of age‐related vocal fold atrophy are reliable but not specific

Jin Soo Song, Ross Campbell, Rui Jun Lin, Caroline C. Jeffery

Publication date 13-06-2022


Abstract Objectives We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists.
Design Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymised laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patients age, provide an opinion about the presence of age-related vocal fold atrophy and specify which laryngoscopy features were present to make the diagnosis.
Setting Tertiary care laryngology practice.
Participants Two fellowship-trained laryngologists and three trainee otolaryngologists.
Main outcome measures Accuracy of age categorisation was determined and Kappa analysis was performed to assess inter-rater agreement.
Results The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds and prominent vocal processes were all identified with high agreement (>80.0%).
Conclusion Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.

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A cross‐sectional analysis of facial palsy‐related quality of life in 125 patients: Comparing linear, quadratic and cubic regression analyses

Rucháma Verhoeff, Tessa E. Bruins, Koen J. A. O. Ingels, Paul M. N. Werker, Martinus M. Veen

Publication date 13-06-2022


Abstract Introduction Facial function correlates with quality of life in facial palsy. Previous studies have examined a linear relationship; based on clinical experience, we hypothesize a curved regression (i.e. quadratic or cubic) will be more fitting to show the correlation between quality of life and facial function.
Methods We compared the fit of a linear regression model between Sunnybrook scores (facial function) and FaCE and FDI scores (quality of life) to a quadratic and cubic regression model in 125 patients cross-sectionally.
ResultsA total of 125 patients were included, 53.6% female with a mean (standard deviation) age of 56.6 (16.7) and a median (interquartile range) duration of palsy of 6.6 (1.5; 18.3) years. The quadratic regression proved a significant improvement over a linear regression analysis in the model using the FaCE total score (linear R2 =.346, quadratic R2 = .378, p = .033) and the FDI physical score (linear R2 = .245, quadratic R2 =.276, p = .034). The cubic regression analysis was no significant improvement over a quadratic regression.
Discussion The relationship between facial function and quality of life in facial palsy is not linear meaning that there is a lot of variation in QoL in cases with severe and moderate facial impairment. This is most applicable to patients suffering from post-paralysis synkinesis, proving the highly individually experienced burden of synkinesis. As the relationship is not linear it should not be included as such in future research studies.

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The application of polyethylene glycol‐coated collagen patches in nasal surgery

Po‐Hsuan Wu, Chia‐Hsiang Yen, Kai‐Min Fang, Tsung‐Wei Huang

Publication date 13-06-2022


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Quality of life in children receiving treatment for Mycobacterium abscessus otomastoiditis

Theresa Y.S. Leow, Stijn Bekkers, Arno M. Janssen, Sjoert A.H. Pegge, Henricus P.M. Kunst, Jerome J. Waterval, Thijs T.G. Jansen, Stefanie S.V. Henriet, Koen J. Aerde, Jakko Ingen, Myrthe K.S. Hol

Publication date 13-06-2022


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Issue Information

Publication date 13-06-2022


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Corrigendum

Publication date 13-06-2022


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Efficacy of topical steroids for the treatment of olfactory disorders caused by COVID‐19: A systematic review and meta‐analysis

Do Hyun Kim, Sung Won Kim, Minju Kang, Se Hwan Hwang

Publication date 13-06-2022


Abstract Objectives The aim of this study was to assess the effect of topical steroids on acute-onset olfactory dysfunction in patients infected with COVID-19.
Design and Setting Systematic review and meta-analysis of cohort studies.
Participants Patients infected with COVID-19.
Main outcome measures Pub Med, Embase, the Web of Science, SCOPUS, Cochrane database and Google Scholar were searched for articles up to September 2021. We analysed studies comparing the improvement of olfactory dysfunction between topical steroid treatment and control groups (placebo or no treatment). In addition, we performed a subgroup analysis by study type.
Results The improvement of olfactory score at 2 (standardised mean difference SMD = 0.7272, 95% confidence interval = 0.3851, 1.0692, p < .0001, I2 = 62.1%) and 4 weeks post-treatment (SMD = 1.0440 0.6777, 1.4102, p < .0001, I2 = 61.2%) was statistically greater in the treatment than control group. However, there was no significant difference (odds ratio OR = 1.4345 0.9525, 2.1604, p = .0842, I2 = 45.4%) in the incidence of fully recovery from anosmia/hyposmia between the treatment and control groups. In subgroup analysis, there were no significant differences in the improvement of olfactory score at 4 weeks post-treatment (OR = 0.6177 0.1309, 1.1045 vs. 0.1720 0.8002, 1.5438, p = .0761) or the incidence of full recovery from anosmia/hyposmia (OR = 1.8478 0.6092, 5.6053 vs. 1.3784 0.8872, 2.1414, p = .8038) between randomised and non-randomised controlled trials.
Conclusions Although this meta-analysis found that topical steroids improved the acute-onset olfactory dysfunction caused by COVID-19, there was no difference in the rate of full olfactory recovery between treated and control patients.

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Comparison of sinus distribution between nasal irrigation and nasal spray using fluorescein‐labelled in patients with chronic rhinosinusitis: A randomised clinical trial

Yosita Muenkaew, Navarat Tangbumrungtham, Boonsam Roongpuvapaht, Kangsadarn Tanjararak

Publication date 10-06-2022


Abstract Objective This study aims to compare the potential sinus distribution between high-volume nasal irrigation and nasal spray in chronic rhinosinusitis (CRS) patients who have not undergone sinus surgery.
Design and SettingA randomised clinical study was conducted at the Otolaryngology-Head & Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University.
Participants Forty patients undergoing endoscopic sinus surgery (ESS) for CRS. Thirty-eight patients met the inclusion criteria and were randomly assigned to receive nasal irrigation or nasal spray mixed with fluorescein sodium preoperatively.
Main Outcome Measures The primary outcome was the mean difference in the staining score of fluorescein in all sinuses between the two groups.
Results The total fluorescein staining score for all sinuses in the nasal irrigation group was significantly higher than the score from the nasal spray group, with a mean difference score of 2.90, 95% confidence interval: 1.22–4.58, p = .001. The most significantly affected sinuses were the maxillary and the anterior ethmoid sinuses, while the frontal and sphenoid sinuses had only minimal staining from both techniques.
Conclusion Nasal irrigation is a potential route to deliver drugs into the sinus in unoperated CRS patients. However, it is not considered a superior method to nasal spray in the most challenging anatomical areas, that is, the frontal and sphenoid sinuses.

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Early hearing loss detection in gout using extended high frequency audiometry

Abdulkadir Sahin, Korhan Kilic, Muhammed Sedat Sakat, Meltem Alkan Melikoglu, Koksal Sarihan

Publication date 10-06-2022


Abstract Objective The study aimed to analyse the hearing levels of patients with gout using extended high frequencies (EHFs) audiometry. Thus, we aimed to reveal the early detectability of potential hearing losses.
Design Comparative cross-sectional study.
SettingsA single centre patient was diagnosed with gout disease.
Participants Two groups consisted of 32 patients with gout and 32 healthy volunteers.
Main Outcome Measures The primary outcome was hearing thresholds in pure tone (PT) audiometry and EHFs audiometry. Also, the association between audiometric results and haematological and biochemical parameters were evaluated.
Results There was no significant difference between groups in terms of mean hearing thresholds in PT audiometry. But, at all frequencies above 4000 Hz (4000–18 000 Hz), the hearing thresholds were significantly higher in patients with gout. Also, the hearing thresholds above 8000 Hz were positively correlated with serum uric acid levels. Hearing thresholds at higher frequencies were positively correlated with haemoglobin levels and negatively correlated with high-density lipoprotein levels.
Conclusion To our knowledge, this is the first study in the literature demonstrating the high frequency of hearing loss in patients with gout using EHFs audiometry. We consider that using EHFs audiometry should have an important place in the early detection of potential hearing losses in gout patients.

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No difference in wound complications with or without a post‐operative pressure dressing: Our experience in 135 children undergoing mastoidectomy

Shadi Shinnawi, Arie Gordin, Iyad Zaroura, Bahaa Rafoul, Majd Khoury, Mauricio Cohen‐Vaizer

Publication date 09-06-2022


Abstract Objectives To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and post-operative pain.
DesignA retrospective controlled study.
Setting All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD.
Participants Children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010 to 2021.
Main Outcome Measures Wound-related complications and Visual Analogue Scale (VAS) pain scores at discharge were compared between children who had an MPD applied following surgery and those who did not.
Results One hundred thirty-five cases were included. The demographic characteristics of the patients and surgical techniques employed were similar for both groups. There were 91 patients in the MPD group and 44 in the non-mastoid dressing (NMPD) group. In the MPD group, five patients developed minor wound dehiscence, eight experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had an SSI, one patient suffered from a keloid scar, wound dehiscence was observed in one patient, and another one had a local hematoma. Therefore, there were no differences between the groups in relation to post-operative complications (p = .32). Despite these similitudes, the NMPD patients suffered less post-operative pain, as measured by the VAS (p = .02).
Conclusion This study shows that no significant benefit is derived from using an MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent post-operative wound complications. Our study supports the abandonment of routine MPD in children following mastoidectomy.

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Symptom‐based remote assessment in post‐treatment head and neck cancer surveillance: A prospective national study

Henry Zhang, John C. Hardman, Theofano Tikka, Paul Nankivell, Hisham Mehanna, Vinidh Paleri, ENT UK, BAHNO, INTEGRATE (The UK ENT Trainee Research Network)

Publication date 09-06-2022


Abstract Objectives To report the incidence of locoregional recurrence in head and neck cancer (HNC) patients under surveillance following treatment undergoing symptom-based remote assessment.
DesignA 16-week multicentre prospective cohort study.
SettingUK ENT departments.
ParticipantsHNC patients under surveillance following treatment undergoing symptom-based telephone assessment.
Main outcome measures Incidence of locoregional recurrent HNC after minimum 6-month follow-up.
Results Data for 1078 cases were submitted by 16 centres, with follow-up data completed in 98.9% (n = 1066). Following telephone consultation, 83.7% of referrals had their face-to-face appointments deferred (n = 897/1072). New symptoms were reported by 11.6% (n = 124/1072) at telephone assessment; 72.6% (n = 90/124) of this group were called for urgent assessments, of whom 48.9% (n = 44/90) came directly for imaging without preceding clinical review. The sensitivity and specificity for new symptoms as an indicator of cancer recurrence were 35.3% and 89.4%, respectively, with a negative predictive value of 99.7% (p = .002). Locoregional cancer identification rates after a minimum of 6 months of further monitoring, when correlated with time since treatment, were 6.0% (n = 14/233) <1 year; 2.1% (n = 16/747) between 1 and 5 years; and 4.3% (n = 4/92) for those >5 years since treatment.
Conclusions Telephone assessment, using patient-reported symptoms, to identify recurrent locoregional HNC was widely adopted during the initial peak of the COVID-19 pandemic in the United Kingdom. The majority of patients had no face-to-face reviews or investigations. New symptoms were significantly associated with the identification of locoregional recurrent cancers with a high specificity, but a low sensitivity may limit symptom assessment being used as the sole surveillance method.

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Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

Siri Gowda, Wei S. Leong, Ovie Edafe

Publication date 04-06-2022


Abstract Objectives Obstructive sleep apnoea (OSA) is a common indication for adenoidectomy and tonsillectomy in children. Traditional practice involves overnight admission to monitor for respiratory complications. However, there is a shift towards same-day discharge in selected patients. This systematic review aims to critically evaluate day-case criteria and safety in children with OSA undergoing adenotonsillectomy.
Design We performed a systematic search of EMBASE, Medline and the Cochrane library. All data collected were independently validated for accuracy. Quality assessment of included articles was performed. The protocol was registered with PROSPERO.
ResultsA total of 15 studies were included (10 731 patients). There was heterogeneity in methods used to ascertain OSA, day-case discharge criteria and lack of prospective discharge protocol. The proportion of children considered for planned day-case surgery ranged from 28.7%–100% based on individual criteria, with an average rate of successful same-day discharge of 96.1% in these patients. The reported rates of post-operative respiratory adverse events and need for airway intervention were 0%–27.3% and 0.4%–6.8%, respectively. There was no reported mortality. The studies were considered low to medium on quality assessment.
Conclusion There is a lack of prospective data on day-case criteria and systematic assessment of post-operative complications in children with OSA undergoing adenoidectomy and tonsillectomy. However, current literature suggests that day-case surgery is safe in carefully selected patients. Better characterisation of patient-specific risk factors is needed to develop an optimal criteria-based timeline for safe discharge. This has the potential to improve confidence and uptake across units.

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Second window indocyanine green for oropharyngeal tumours: A case series and comparison of near‐infrared camera systems

Emma De Ravin, Ryan M. Carey, Vanessa C. Stubbs, Samantha Jaffe, John Y. K. Lee, Karthik Rajasekaran, Jason G. Newman

Publication date 01-06-2022


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Inner ear MRI enhancement based on three dimensional‐real IR sequence in patients with Meniere’s disease after intravenous gadolinium injection: Comparison of different doses used and exploration of an appropriate dose

Wei Chen, Yue Geng, Yue Niu, Naier Lin, Xiaolin Wang, Yan Sha

Publication date 23-01-2022


Abstract Objectives Three-dimensional inversion-recovery sequence with real reconstruction (3D-real IR) magnetic resonance imaging (MRI) can detect endolymphatic hydrops of the inner ear. We aimed to explore a appropriate dose for intravenous gadolinium injection.
Design Observational prospective study.
Setting Tertiary referral centre.
Participants We collected 90 unilateral definite Menieres disease patients.
Main outcome measures All enrolled patients were divided into three groups randomly (patients in group A, B and C received gadolinium injection in 1/1.5/2 times doses respectively). After 4 h, inner ear MRI scans were applied.
Results The signal intensities of B-affected ears and C-affected ears were significantly higher than A-affected ears (p < .05); however, no difference was found between B-affected ears and C-affected ears (p = .267). The same conditions also appeared in the three unaffected-ear groups. Moreover, the signal intensities of affected-ear in group A, B and C were significantly higher than that of the corresponding unaffected-ear groups (p < .05). Besides, the subjective visual evaluation scores of group B and C were significantly better than that of group A (p < .05).
Conclusions Intravenous injection of gadolinium in a single dose may be unbefitting for the inner ear imaging based on 3D-real IR MRI, both the applications of gadolinium in 1.5 times and double doses can have a good perilymphatic enhancement effect of inner ear. In order to minimise the use of dose for avoiding or mitigating the adverse reactions and renal damage, 1.5 times dose may be preferred in clinical practice.

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Role of the endoscope in cochlear implantation: A systematic review

Alexandros Poutoglidis, Georgios Fyrmpas, Konstantinos Vlachtsis, George K. Paraskevas, Nikolaos Lazaridis, Stergiani Keramari, Konstantinos Garefis, Christodoulos Dimakis, Nikolaos Tsetsos

Publication date 11-01-2022


Abstract Objective To review the role of the endoscope in cochlear implantation (CI).
MethodsMEDLINE, Science Direct, Google Scholar and the Cochrane Library databases, as well as other sources, were searched by two independent reviewers. Studies including patients undergoing either exclusively endoscopic or endoscopically assisted CI were eligible for inclusion. Endoscopic CI approaches and postoperative complications were the primary outcomes. Secondary endpoints included the degree of round window (RW) microscopic visualisation according to St Thomas’ Hospital classification and type of cochleostomy for electrode insertion in the scala tympani (ST).
Results Fourteen studies met the inclusion criteria comprising 191 endoscopic or endoscopically assisted CI cases. The endoscope was used for better visualisation of the RW across all included studies, facilitated the insertion of the electrode in the ST and spared a mastoidectomy in a number of cases. No facial nerve palsy was reported in any of the studies. The most common complication was external auditory canal/tympanic membrane tear followed by chorda tympani injury.
Conclusion The microscopic CI approach is still the gold standard. The endoscope facilitates the recognition of the RW area and leads to successful and safe implantation, particularly in difficult anatomical scenarios, ear malformations and advanced otosclerosis. Endoscopically assisted CI procedures offer the opportunity to avoid a posterior tympanotomy and reduce the risk of facial nerve injury. To date, the lack of long-term data does not permit the widespread adoption of completely endoscopic CI procedures without a mastoidectomy.

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Exoscopic visualisation with VITOM® 3D in paediatric cochlear implantation: Preliminary results

Yury Rusetsky, Natalia Chuchueva, Irina Meytel, Uliana Malyavina, Seitmurat Farikov

Publication date 21-12-2021


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