Journal of Laryngology and Otology 2021-11-26

Impact of coronavirus disease 2019 on otolaryngological practice, effect of presbylarynx and presbycusis in the elderly, and suicidal ideation in patients with tinnitus

Fishman, Jonathan,Fisher, Edward W

Publication date 26-11-2021


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"Impact of coronavirus disease 2019 on ENT clinical practice and training: the residents perspective"

Kapoor, D,Ramavat, A S,Mehndiratta, M,Agrawal, A,Arora, V,Goel, A

Publication date 06-10-2021


Background The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training.
Methods The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty.
Results Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies.
Conclusion While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.

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Suicidal ideation in people with tinnitus: a systematic review and meta-analysis

Tailor, B V,Thompson, R E,Nunney, I,Agius, M,Phillips, J S

Publication date 25-10-2021


Objective Tinnitus is associated with a variety of cognitive, psychosocial and psychiatric disorders, and may contribute to suicidality. However, the prevalence of suicidal ideation (SI) in tinnitus populations has not previously been systematically reviewed.
Method Medline, Embase and Psych Info were searched in August 2020 to identify studies that assessed suicidal ideation in people aged 16 years and above with subjective tinnitus.
Results Six cross-sectional studies were included, representing 7192 tinnitus sufferers across 4 countries. The pooled prevalence of suicidal ideation in tinnitus populations was 20.6 per cent (95 per cent confidence interval, 10.8–30.3 per cent; I2 = 88 per cent). Two studies included a control population, in which the prevalence of suicidal ideation was significantly lower. The quality of included studies was variable.
Conclusion It is not possible to arrive at any reasonable conclusion given the lack of quality studies, meaning the pooled prevalence should be interpreted very cautiously. Suicidal ideation may be more prevalent in tinnitus populations. Further large-scale epidemiological research investigating this relationship is needed, which may help psychiatric risk stratification.

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How do presbylarynx and presbycusis affect the Voice Handicap Index and the emotional status of the elderly? A prospective case–control study

Rodrigues Dias, D,Santos, M,Sousa, F,Azevedo, S,Sousa e Castro, S,Freitas, S,Almeida e Sousa, C,Moreira da Silva, Á

Publication date 28-09-2021


Objective To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status.
MethodsA case–control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap.
Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form).
Results The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores.
Conclusion Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.

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Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region

Leedman, S,Wormald, R,Flukes, S

Publication date 29-09-2021


Objectives To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure.
MethodsA retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia.
Results Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30).
Conclusion Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.

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No lasting impact of Covid-19 on the auditory system: a prospective cohort study

Hassani, S,Lazem, M,Jafari, Z

Publication date 01-10-2021


Objective Otological complications are considered early symptoms of severe acute respiratory syndrome coronavirus-2; however, it is unknown how long these symptoms last and whether the virus leaves any hearing disorders post-recovery.
Methods This prospective cohort study comprised 31 mild or moderate confirmed coronavirus disease 2019 patients and 26 age-matched control peers (21–50 years old). Patients were questioned about their otological symptoms, and their hearing status was assessed during one month post-diagnosis.
Results Patients showed a significantly higher rate of otological symptoms (hearing loss, ear fullness, ear pain, dizziness or vertigo, communication difficulties, and hyperacusis) versus the control group (p ≤ 0.022). The symptoms resolved early, between 2 and 8 days after their appearance. No significant differences were observed between the two groups in pure tone and extended high-frequency audiometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, or auditory brainstem response following recovery.
Conclusion The findings indicate that, in mild to moderate coronavirus disease 2019 cases, otological symptoms resolve within a week, and the virus has no lasting impact on the auditory system.

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Disability from chronic ear disease in Nepal assessed using the World Health Organization Disability Assessment Schedule 2.0 instrument

Rudd, J,Bohara, R,Youngs, R,Mcleod, R W J,Elhassan, H A,Gurung, U

Publication date 09-09-2021


Objective Globally, South Asia has the highest proportion of disabling hearing loss. There is a paucity of data exploring the associated hearing loss and disability caused by chronic middle-ear disease in South Asia in the setting of surgical outreach. This study aimed to measure disability using the World Health Organization Disability Assessment Schedule 2.0 in patients undergoing ear surgery for chronic middle-ear disease in an ear hospital in Nepal.
Method The World Health Organization Disability Assessment Schedule 2.0 was translated into Nepali and administered by interview to patients before ear surgery, and results were correlated with pre-operative audiograms.
Results Out of a total of 106 patients with a mean age of 23 years, the mean World Health Organization Disability Assessment Schedule 2.0 score was 17.7, and the highest domain scores were for domain 6 ‘participation in society’ at a score of 34. There was a positive correlation of World Health Organization Disability Assessment Schedule 2 score with hearing level (r = 0.46).
Conclusion Patients with ear disease in Nepal have had their disability measured using the World Health Organization Disability Assessment Schedule 2.0. Our study demonstrated a correlation between impaired hearing and disability in a surgical outreach context, which was an expected but not previously reported finding.

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Quantitative analysis of tegmen bone mineral density in obese and non-obese patients

Holmes, S,Geimadi, A,Mamilly, A,Hamiter, M,Cuellar, H,Mankekar, G

Publication date 01-10-2021


Background Certain factors have been linked to lateral skull base demineralisation or erosion, which may predispose to spontaneous cerebrospinal fluid leak. There are relatively few quantitative reports of skull base changes in patient populations.
MethodA novel refined measurement algorithm for quantification of tegmen bone mineral density was developed, and bone mineral density between obese and non-obese patient groups was compared. Computed tomography scans were analysed by three blinded reviewers, and tegmen bone mineral densities were compared.
Results There were 23 patients in the obese group and 27 matched controls in the non-obese group. Inter-rater reliability was ‘strong’ to ‘near complete’ (κ = 0.75–0.86). No differences in tegmen bone mineral density were found between the groups (p = 0.64). The number of active blood pressure medications correlated positively with lateral skull base bone mineral density.
ConclusionA novel, refined, quantitative measurement algorithm for the assessment of tegmen bone mineral density was developed and validated. Obesity was not found to significantly affect tegmen bone mineral density.

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Characteristics and outcomes of emergency department patients with a foreign body that entered through the ear, nose or mouth: a 10-year retrospective analysis

Lee, J H,Kim, S J

Publication date 22-10-2021


Background Foreign bodies in the ear, nose and throat commonly necessitate emergency department visits.
Method This retrospective study was conducted on emergency department visits from January 2010 to December 2019 to determine characteristics and clinical prognoses of ENT patients. Patients were divided into three groups according to foreign-body entry route; patient characteristics and clinical findings were compared between groups.
Results Of 676 142 emergency department visits, 10 454 were because of ENT-related foreign bodies. The mean (± standard deviation) age of subjects was 24.0 (± 23.4) years, and 5176 patients were male (49.5 per cent). The most common entry route was the mouth (74.5 per cent). Most patients (97.1 per cent) were discharged after emergency treatment. Intensive care and in-hospital mortality occurred only in the mouth group.
Conclusion Clinical findings differ depending on foreign-body entry route. After emergency treatment, most patients were discharged; some cases presented serious complications.

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Chronic rhinosinusitis: microbiology and treatment of acute exacerbations in patients after endoscopic surgery

Woźniak, A,Nowak, K,Wnuk, J,Kaczmarczyk, J,Król, P,Stręk, P,Składzień, J,Szaleniec, J

Publication date 06-10-2021


Objective Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis, and treat with amoxicillin or amoxicillin-clavulanate.
Method Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.
Results The most common bacterial species present were Staphylococcus aureus (36 per cent), Pseudomonas aeruginosa (13 per cent) and Escherichia coli (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.
Conclusion Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.

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The effect of fascia and free skin graft on the healing of mastoid cavity after canal wall down mastoidectomy

Bongale, K R,Bhat, V K,Shetty, A M

Publication date 06-10-2021


Objective Post-mastoidectomy delayed cavity healing is a challenge to manage. This study aimed to cut down healing time with a simple technique (fascia with a skin graft) and compared it with controls without this technique.
Method The current study was a prospective non-randomised controlled study, conducted in a tertiary referral hospital. Thirty cases and 30 controls with squamosal type chronic otitis media were studied.
Results By the end of first month, 23.3 per cent of cases had healed compared with 3.3 per cent of controls. At the third month follow up, 83.3 per cent of cases and 53.3 per cent of controls had healed. At the sixth month follow up, 93.3 per cent of cases and 86 per cent of controls had healed.
Conclusion Healing of the mastoid cavity, as evidenced by epithelialisation and formation of a dry cavity, was faster in cases that received the graft when compared with controls without the graft.

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"Unmitigated negative nasopharyngeal pressure is associated with attic retraction pocket formation: LaPlaces law in action"

Mahajan, Nilesh H,Vijayendra, H,Vijayendra, Vinay Kumar,Redleaf, Miriam

Publication date 11-10-2021


Background Decades of clinical observation have led our subspecialty team to suspect that negative nasopharyngeal pressure is associated with attic retraction pocket formation. Furthermore, La Places law, which states that the pressure within a sphere varies with the inverse of the radius, provides the dynamic explanation for why the attic area of the tympanic membrane tends to retract more frequently than the pars tensa.
Methods The attic retraction pockets of 154 patients were classified into grades of severity (grades I–V). Impedance audiometry of middle-ear pressure was measured in the resting state, and after sniffing, swallowing and the Valsalva manoeuvre.
Results Negative nasopharyngeal pressure (sniffing) caused a diminution of middle-ear pressure of −5 da Pa on average in normal ears, and of −24 da Pa to −45 da Pa for tympanic membranes with attic retraction pockets of grade I to grade V.
Conclusion Attic retraction pockets are associated with greater collapse of middle-ear volume when negative pressure is created in the nasopharynx. La Places law, and the composition of the pars flaccida, suggests an explanation for why the attic region retracts more than the pars tensa.

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Reconstruction of ear canal wall with superior pedicled composite multi-fractured osteoperiosteal flap: a new technique and preliminary outcomes

Özgür, A,Yemiş, T,Turgut, N F,Özdemir, D,Mehel, D M,Akgül, G,Çelebi, M

Publication date 22-10-2021


Objective This study evaluated the functional results of the superior pedicled composite multi-fractured osteoperiosteal flap technique. This method is a novel technique for the reconstruction of the external auditory canal. The study also examined the effect of the superior pedicled composite multi-fractured osteoperiosteal flap technique on patients’ disease-related quality of life.
MethodA total of 37 patients who underwent the superior pedicled composite multi-fractured osteoperiosteal flap technique were enrolled in the study. Their functional hearing results and disease-related quality of life scores were evaluated.
ResultsA significant improvement was observed in the patients’ hearing scores at the post-operative sixth month relative to the pre-operative period, and the patients’ disease-related quality of life increased significantly.
Conclusion The superior pedicled composite multi-fractured osteoperiosteal flap method can be safely used, especially in patients undergoing retrograde mastoidectomy because of limited cholesteatoma. This method contributes to improving patients’ hearing levels and disease-related quality of life.

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Sudden sensorineural hearing loss: what can we learn from examining Reddit posts?

Manchaiah, V,Deshpande, A K,Bellon-Harn, M L,Boyd, R L

Publication date 20-10-2021


Background Many patients with sudden sensorineural hearing loss may seek hearing health information and social support online, although little is known about the online information seeking behaviour.
Objective The present study aimed to examine the discussions around sudden sensorineural hearing loss in Reddit posts.
MethodA total of 526 Reddit posts about sudden sensorineural hearing loss were extracted and analysed using qualitative and quantitative methods.
Results The content analysis identified eight main categories.
Most of the posts were on topics of: sharing personal experiences (34 per cent), describing symptoms (31 per cent), discussing treatment options (36 per cent) and discussing possible causes (19 per cent) of sudden sensorineural hearing loss. The sudden sensorineural hearing loss Reddit posts varied significantly in terms of linguistic variables when compared to baseline Reddit posts. Reddit posts by individuals with sudden sensorineural hearing loss had significantly higher engagement, higher authenticity and made more references to their body when compared to other users.
Conclusion The study results provide insights that can be helpful for professionals during clinical interactions.

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Effects of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials

Satar, B,Karaçaylı, C,Çoban, V K,Özdemir, S

Publication date 11-10-2021


Objective Limited data are available on the effects of otosclerosis and otosclerosis surgery on the utricle and saccule. This study aimed to determine the effect of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials.
Methods This retrospective study included 16 otosclerosis patients and 18 controls. Thirty-two ears of 16 patients with otosclerosis were divided into 2 groups based on whether the ear had been operated on or not. All patients and subjects underwent 500 Hz air- and bone-conducted ocular and cervical vestibular-evoked myogenic potentials testing.
Results Overall comparison of response rates showed a significant difference among the groups. Further statistical tests showed that this difference arose from differences between both operated and unoperated groups and the control group, for air-conducted cervical and ocular vestibular-evoked myogenic potentials.
Conclusion Otosclerosis and stapedotomy may affect the elicitability of vestibular-evoked myogenic potentials. Otosclerosis is associated with lower response rates for air-conducted ocular and cervical vestibular-evoked myogenic potentials, regardless of whether operated on. Having been operated on does not significantly increase the response rate of air-conducted vestibular-evoked myogenic potentials.

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Complications of combination intranasal corticosteroids and anti-retroviral therapy

James, J,Caulley, L,Collins, J,Hopkins, C

Publication date 28-09-2021


Background Intranasal corticosteroids are widely used for management of many upper airway diseases because of their ability to effectively deliver local relief of inflammation.
Case report This paper presents the case of a 51-year-old man with human immunodeficiency virus treated with ritonavir who was started on fluticasone intranasal spray for presumed chronic rhinosinusitis. Months after starting this therapy, he developed symptoms of Cushings syndrome and avascular necrosis of the shoulder due to the pharmacological interactions between fluticasone and ritonavir.
Conclusion Although intranasal corticosteroids are deemed a low-risk route of drug administration, clinicians need to be vigilant in appropriately prescribing corticosteroids in the setting of drug potentiators, particularly in these high-risk patients. Alternative corticosteroids such as beclomethasone dipropionate should be considered in such cases.

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Step-by-step illustrated guide to central neck dissection

Chu, F,De Berardinis, R,Pietrobon, G,Tagliabue, M,Giugliano, G,Ansarin, M

Publication date 01-10-2021


Background The incidence of thyroid carcinoma has been increasing worldwide and surgery is the primary treatment. Central compartment dissection of the neck is a very delicate procedure given the risks of recurrent laryngeal nerve injury and hypoparathyroidism.
Methods This paper gives a detailed description of this surgical technique in a patient affected by papillary carcinoma of the thyroid gland, supported by highly representative iconographic materials from a tertiary department.
ResultsA stepwise description is provided, along with high-quality pictures and specific tips and tricks. Although neck dissection is a well-codified procedure, the fine details of this surgical technique are not currently available and are still the prerogative of the expert surgeon.
Conclusion The central neck compartment contains several vulnerable structures; damage to these structures would affect patients’ lives, possibly permanently. Anatomical knowledge and standardisation are needed for all surgeons, particularly new surgeons (such as residents) who cannot rely simply on experience.

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JLO volume 135 issue 12 Cover and Front matter

Publication date 26-11-2021


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JLO volume 135 issue 12 Cover and Back matter

Publication date 26-11-2021


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