European Archives of Oto Rhino Laryngology 2020-11-01

Letter to the Editor regarding “Single-sided deafness after sudden hearing loss: late effect on cochlear nerve size” by Islamoglu et al. European Archives of Oto-Rhino-Laryngology (2020) 277:2423–2426

OJ Ungar

Publicatie 01-11-2020


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Sıngle sıded deafness after sudden hearıng loss: late effect on cochlear nerve sıze

Y Islamoglu,GG Kesıcı,K Ercan,MA Babademez

Publicatie 01-11-2020


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Correction to: Two different therapies for the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis

M Zhu,Y Yan,H Gong,Y Wu,G Tan

Publicatie 01-11-2020


In the original publication of the article, Fig. 1a was missing and caption of Fig. 1a was published as caption of Fig. 1b. The correct Fig. 1 and captions are provided below.

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Pathological evaluation of the accuracy of a fluorescence spectroscopy system for detecting parathyroid glands

H Idogawa,T Sakashita,T Yagi,K Segawa,A Homma

Publicatie 01-11-2020


Abstract Purpose A fluorescence-based technique for the detection of parathyroid glands (PGs) intraoperatively was previously reported. The technique was based on the phenomenon in which PGs emit autofluorescence when exposed to near-infrared light and we undertook an evaluation to consider the pathological accuracy of the method. Methods The study comprised 17 patients (18 specimens) who underwent thyroid surgery at Kushiro City General Hospital between November 2018 and June 2019. We searched for PGs intraoperatively using a fluorescence spectroscopy system and evaluated the pathological accuracy of the system. We statistically evaluated the clinical factors associated with the accuracy of the system, including age, gender, body mass index, laterality, disease state, renal function, and comorbidity. Results Eighteen specimens were evaluated pathologically, with 13 specimens confirmed as PGs. These were evaluated as “true positive,” giving a positive predictive value of 72.2% (13/18). Among the false-negative cases, one specimen was a metastatic lymph node in a patient with papillary thyroid carcinoma. There was a significant difference in the true-positive rates between malignant (25%) and benign (85.7%) disease (P = 0.044). Conclusion We consider that this technique is useful, however, we have to exercise care in malignant cases as the true-positive rate may be low.

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Response to the Letter to the Editor: “Histological type homogeneity—a cornerstone in analyzing temporal bone malignancies data”

P Correia-Rodrigues,S Ramalho,P Montalvão,M Magalhães

Publicatie 01-11-2020


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Etiologies of olfactory dysfunction in a pediatric population: based on a retrospective analysis of data from an outpatient clinic

VA Schriever,T Hummel

Publicatie 01-11-2020


Abstract Purpose Although the prevalence of olfactory dysfunction in children is thought to be lower compared to adults, little is known about the actual frequency of etiologies of smell dysfunction in children. Aim of the study was (i) to describe the epidemiology of olfactory dysfunction in a pediatric population and (ii) to compare the distribution of etiologies to adults. Material and methods Data of patients consulting a smell and taste clinic between 2000 and 2017 were retrospectively analyzed. Frequency of major causes of olfactory dysfunction was examined with a focus on the pediatric population. Results A total of 7153 patients (164 children) were included in the analysis. Most children presented with congenital olfactory dysfunction (67%), or head-trauma (12%). In contrast, the cumulative frequency of olfactory loss associated with sinonasal disorders or acute infections of the upper airways was 6%. The frequency of etiologies of olfactory dysfunction changed with age: While the frequency of patients with congenital anosmia decreased, the frequency of causes related to infections of the upper respiratory tract and idiopathic causes increased. Conclusion About 2/3 of olfactory dysfunction in children are congenital while 1/3 is acquired. The frequency of etiologies causing olfactory dysfunction change significantly from children to an adult population.

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The utilization of Chronic Otitis Media Questionnaire-12 in chronic otitis media with or without cholesteatoma

B Demir,A Sahin,A Binnetoglu,C Batman

Publicatie 01-11-2020


Abstract Objective This study aimed to compare patients who had chronic otitis media with and without cholesteatoma in terms of the quality of life related to health. Methods The Turkish version of the Chronic Otitis Media Questionnaire-12 (COMQ-12) was completed by totally 100 healthy subjects and 100 patients who had chronic otitis media (COM). The COM group was divided into cholesteatoma and without cholesteatoma dry tympanic membrane perforation (TMP) and draining ear groups. Results COMQ-12 score = 3.6 for healthy people. The average scores of dry TMP, draining ear, and cholesteatoma groups were 32.90, 27.34, and 45.95, respectively. A significant difference was between the cholesteatoma and without cholesteatoma groups in total scores (p = 0.001). No difference was found between the groups in age (p = 0.518) and gender (p = 0.975). Conclusion The COMQ-12 could be a useful tool to differentiate chronic otitis media with or without cholesteatoma.

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Further arguments against both the first description of cholesteatoma by Hippocrates, and the allusion to the tympanic membrane in the Ebers Papyrus

A Mudry

Publicatie 01-11-2020


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Histological type homogeneity: a cornerstone in analyzing temporal bone malignancies data

L Franz,E Zanoletti,A Mazzoni,G Marioni

Publicatie 01-11-2020


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COVID-19: what happened to all of the otolaryngology emergencies?

M Gelardi,L Iannuzzi,EMC Trecca,B Kim,NAA Quaranta,M Cassano

Publicatie 01-11-2020


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Endoscope holder-assisted endoscopic coblation tonsillectomy

SR Parab,MM Khan

Publicatie 01-11-2020


Abstract Background Tonsillectomy is being performed either with a headlight, surgical loupe magnification or with microscopic aid. We report the technique of endoscope holder-assisted endoscopic tonsillectomy using coblation. Coblation tonsillectomy has the primary advantage of limited thermal damage compared with alternative forms of surgery. Methods Our endoscope holder, primarily designed for endoscopic ear surgery, has been extrapolated for the use in two-handed technique of tonsillectomy. The method is described in detail. Conclusion Endoscope gives a panoramic view, better optics, magnified image of the bleeders and hence there is applicability of the endoscope holder for endoscopic tonsillectomy.

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Endoscopic endonasal approach for repairing an outwardly herniated blow-out fracture lateral to the infraorbital nerve

S Takaishi,J Iimura,N Otori

Publicatie 01-11-2020


Abstract Background To repair a blow-out fracture, the endonasal approach is indicated when the center of the fracture occurs in the orbital floor medial to the infraorbital nerve, or when the orbital tissue is herniated inwards; additionally, the combined endonasal and transmaxillary approach is indicated for fractures of the anterior and lateral parts of the orbital floor. Method and conclusion The use of endoscopic modified medial maxillectomy and special instruments enabled the surgeon to repair an outwardly herniated blow-out fracture by the endonasal approach alone, despite the center of the fracture being in the orbital floor lateral to the infraorbital nerve.

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Isolated enhancement of the superior semi-circular canal on inner ear MRI: acute vestibular syndrome or superior semi-circular canal dehiscence?

M Eliezer,M Toupet,JP Guichard,E Houdart,C Hautefort

Publicatie 01-11-2020


Abstract Purpose Recently, it has been reported that patients with acute vestibular syndrome (AVS) could present a marked enhancement of the semi-circular canals, involving mostly the superior semi-circular canals on delayed inner ear MRI. Methods We reported one patient having AVS and another one having superior semi-circular canal dehiscence syndrome (SCDS) who underwent delayed inner ear MRI performed 4 h after contrast media administration. Results On delayed inner ear MRI, a marked enhancement of the superior semi-circular canal was observed in both patients. Although the clinical presentation is clearly not the same, the co-existence between these two disorders is possible. For this reason, in patients with AVS, the presence of a marked enhancement of the superior semi-circular canal should rule out the presence of a co-existing SCDS on temporal bone CT, particularly if the patient reported cochlear symptoms such as pulsatile tinnitus and/or autophony. Conclusion To our knowledge, this is the first report showing this finding on delayed inner ear MRI in a patient with SCDS. In AVS patients, this radiological anomaly could be particularly disturbing and should rule out the presence of a co-existing SCDS.

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History of medicine is not a game

P Charlier,N Benmoussa,C Prêtre,C Fabre

Publicatie 01-11-2020


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Bencycloquidium bromide nasal spray is effective and safe for persistent allergic rhinitis: a phase III, multicenter, randomized, double-blinded, placebo-controlled clinical trial

Z Jiang,H Xiao,S Liu,G He,G Hu,X Zhang,Q Zhang,J Chen,C Lin,J Liang,M Guo,X Xiao,W Xue,P Dong,Y Huang,Z Lian,G Tan,J He,Y Pan,J Meng

Publicatie 01-11-2020


Abstract Purpose To investigate the efficacy and safety of bencycloquidium bromide nasal spray (BCQB) in patients with persistent allergic rhinitis (PAR). Methods We enrolled 720 patients from 15 hospitals across China and randomly assigned them into BCQB group or placebo group (90 μg per nostril qid) to receive a 4-week treatment. Visual analog scale (VAS) for rhinorrhea, sneezing, nasal congestion, itching and overall symptoms were recorded by patients every day. Anterior rhinoscopy scoring was completed by doctors on every visit. Adverse events were recorded in detail. Results A total of 354 and 351 patients were included in BCQB group and in placebo group. Baseline information was comparable. At the end of the trial, the decrease of VAS for rhinorrhea from baseline was 4.83 ± 2.35 and 2.46 ± 2.34 in BCQB group and placebo group, respectively (P < 0.001). The change ratio from baseline of VAS for rhinorrhea in BCQB group was 72.32%, higher than 31.03% in placebo group (P < 0.001). VAS for other symptoms and overall symptoms also improved significantly in the BCQB group, while no inter-group difference was found in anterior rhinoscopy scoring. The incidence of adverse reaction was similar between the two groups. Most reactions were mild and no severe reactions happened. Conclusion 90 μg BCQB per nostril four times daily is effective and safe in the treatment of rhinorrhea as well as sneezing, nasal congestion and itching for patients with PAR. Retrospectively registered ChiCTR2000030924, 2020/3/17.

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Platelet-rich plasma for laryngotracheal reconstruction: an experimental study

S Sahin Onder,A Sahin Yilmaz,B Erkmen,CS Topal,O Gergin,MS Canpolat

Publicatie 01-11-2020


Abstract Objectives/hypothesis This study was designed to evaluate the graft healing effect of topical application of platelet-rich plasma (PRP) for laryngotracheal reconstruction (LTR) in a rabbit model. Study design It is a prospective randomized control animal study. Materials and methods Sixteen healthy New Zealand White rabbits were assigned to two groups of eight animals each. The control group underwent LTR with anterior auricular cartilage graft. The PRP group underwent the same surgical procedure plus PRP application over the anastomosis and surgical field. Two animals in the PRP group and two animals in control group died due to severe respiratory distress on postoperative days 10, 12, 15, and 18. Six rabbits (n = 3 for control group and n = 3 for PRP group) were sacrificed at 4 weeks, and six rabbits (n = 3 for control group and n = 3 for PRP group) were sacrificed at 8 weeks. Laryngotracheal regions were evaluated histopathologically. Results Macroscopically, the average anteroposterior and lateral diameter of the reconstructed region and the degree of lumen patency on postoperative 4th week and 8th week were not statistically different among two groups. There was no significant difference between the groups in terms of any of the microscopic findings when the analysis was made separately. However, analysis of the total number of rabbits has shown that new cartilage formation and angiogenesis were more pronounced in PRP group than control group. Conclusions Application of PRP contributed to better healing in airway surgery by promoting a release of growth factors that stimulate new cartilage formation and angiogenesis.

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Prematurity and associated future paediatric airway pathology: experience from a single tertiary paediatric ENT centre

N Vakharia,A Maity,G Bajaj,Y Bajaj,A Hall

Publicatie 01-11-2020


Abstract Purpose Enhanced management of the pre-term patient has resulted in improved survival rates in increasingly premature patients. Although prematurity predisposes to congenital airway pathology, there is also increased risk of endotracheal intubation, and therefore acquired subglottic pathology. We sought to evaluate airway pathology in children outside the neonatal period with a history of prematurity to explore the relationship between prematurity and upper airway pathologies. Methods Data for patients undergoing elective microlaryngobronchoscopy (MLB) at our centre were collected prospectively over a 5-year period. Patients identified as premature were sub-classified by the grade of prematurity. Results 339 patients over 1 month of age underwent MLB, of which 56 (16.5%) were born prematurely. Of those with identified airway pathology, 49 (23.4%) were born prematurely, accounting for 32.6% of subglottic stenosis (n = 30), 24% of laryngomalacia (n = 13) and 19% of laryngeal cleft diagnoses (n = 16). 49 premature patients (87.5%) had one or more airway pathologies diagnosed. Multi-level airway pathology was seen in twelve premature infants (21.4%), demonstrating a statistically significant association (odds ratio 3.396; 95% CI 1.697–6.842; p value < 0.0016). Incidence of airway pathology, the severity of airway disease and multi-level airway pathology were not related to the grade of prematurity. Conclusions Premature patients account for a significant proportion of the workload within our tertiary centre due to improving neonatal care and survival in pre-term infants. We suggest early paediatric ENT evaluation for ex-premature patients with symptoms of airway pathology, with a low threshold for MLB. Improving neonatal survival rates in ever-increasing prematurity will require the further provision of specialist paediatric ENT services to manage their ongoing care.

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Surgical resection of oral cancer: en-bloc versus discontinuous approach

G Tirelli,A Piccinato,P Antonucci,A Gatto,AV Marcuzzo,M Tofanelli

Publicatie 01-11-2020


Abstract Objectives In the past literature agreed on treating oral carcinomas, using an “en-bloc” resection (EBR) but recently minimally invasive transoral surgery has spread as the preferable treatment for selected cases. This latter technique, which is performed with a discontinuous resection (DR), allows for a satisfactory postoperative quality of life (QoL) maintaining good survival rates. Materials and methods In this study, we analyzed data about 147 surgically treated patients with oral cancer involving tongue and floor of the mouth. The sample was divided according to the surgical approach: EBR and DR group which were compared in terms of recurrence, overall survival, disease-free survival, and QoL. Results In the DR group, survival analysis showed better results in term of survival, locoregional control, and postoperative anxiety, while the other QoL scores were similar in the two groups. Conclusion The more invasive approach does not correlate to a better outcome. In selected cases, DR is an oncologically safe technique; EBR is still a valid option to treat advanced oral cancers

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LncRNA-MALAT1 is a promising biomarker for prognostic evaluation of tongue squamous cell carcinoma

Y Hu,L Zheng,J Zhang,Y Shen,X Zhang,L Lin

Publicatie 01-11-2020


Abstract Purpose MALAT1 is recognized as an oncogenic lncRNA in various malignancies. Here, the authors aim to explore the association of MALAT1 expression and prognostic implication in tongue squamous cell carcinoma (SCC). Methods The tongue tissues of 128 tongue SCC cases satisfying strict follow-up criteria and 28 normal cases were subjected to qRT-PCR assay for monitoring MALAT1 expression. Chi-square test was applied to explore the correlation between MALAT1 expression and clinicopathological features of tongue SCC. Kaplan–Meier analysis was used to calculate survival rates. Cox proportional hazard analysis was adopted to analyze the relationship between prognostic factors and patient survival. Results The expression of MALAT1 was upregulated in tongue SCC, compared to normal tongue tissues. The expression level of MALAT1 was correlated to differentiation and stage of tongue SCC, and high MALAT1 expression was associated with low disease-free survival and overall survival rates. Moreover, advanced tongue SCC patients with high MALAT1 level had lower disease-free survival and decreased overall survival rate than patients with low MALAT1 level. These results revealed that MALAT1 overexpression can be considered as a significant prognostic factor to independently predict the disease-free survival and overall survival rate of tongue SCC. Conclusions The expression level of MALAT1 is closely related with progression of tongue SCC. Furthermore, MALAT1 can serve as an independent biomarker for prognostic evaluation of tongue SCC.

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Current management of arytenoid sub-luxation and dislocation

A Frosolini,G Marioni,L Maiolino,C de Filippis,A Lovato

Publicatie 01-11-2020


Abstract Purpose To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. Methods The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). Results All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients. Conclusion AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.

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