Publication date 08-04-2021
Introduction: Laryngeal squamous cell carcinoma (LSCC) is diverse in its natural history and responsiveness to treatments. There is an urgent need to generate candidate biomarkers for the stratification and individualization of treatment to avoid overtreatment or inadequate treatment. Long noncoding RNA nuclear paraspeckle assembly transcript 1 (NEAT1) has been identified as an oncogenic gene in multiple human tumors entitles, and dysregulation of NEAT1 was tightly linked to carcinogenesis and cancer progression.
Methods: One hundred two paraffin samples of LSCC patients were collected. Furthermore, in situ hybridization (ISH), Kaplan-Meier, and MTT were used to analyze the relationship between NEAT1 and the progress of LSCC.
Results: In this study, ISH revealed that NEAT1 was strongly expressed in the nucleus. The increased expression of NEAT1 was correlated with T grade, neck nodal metastasis, clinical stage, drinking history, or smoking history of LSCC. The Kaplan-Meier analysis indicated that patients with higher NEAT1 expression had a worse overall survival in LSCC patients. In addition, NEAT1 knockdown significantly inhibited the growth of LSCC cells.
Conclusion: Together, these results suggested that NEAT1 involved in the progress of LSCC and might act as a tumor oncogenic gene. This study provides a potential new marker and target for gene therapy in the treatment of LSCC. ORL
JL Treviño-Gonzalez,F Maldonado-Chapa,JA Becerra-Jimenez,GA Soto-Galindo,JA Morales-Del Angel
Publication date 01-04-2021
Introduction: Pneumatization of the sphenoid sinus (SS) varies widely among different ethnic groups. Information regarding the prevalence and significance of SS variants among Hispanic groups is limited. This study aims to describe and analyze pneumatization and septation patterns of the SS in a Hispanic population.
Methods: A total of 160 paranasal sinus computed tomographies were reviewed by a head and neck-specialized radiologist and 2 otolaryngologists.
Results: The postsellar and sellar types were the most frequent patterns of pneumatization observed, with a prevalence of 52.5 and 40%, respectively. Accessory septations were present in 59.4% of the patients. Septa were inserting over the internal carotid artery (ICA) in 43.8% and over the optic nerve in 17.5% of the population. No significant association (p #x3e; 0.05) was observed when comparing the different accessory septation patterns among the types of the SS. The frequency of septa inserting on the ICA was significantly higher in postsellar types (p #x3c; 0.001). Pneumatization of the anterior clinoid process, pterygoid processes, and greater wing was present in 20, 17.5, and 45.9% of the sinuses, respectively. Onodi cells were encountered in 40% of the sinuses. There were no significant differences in any of the pneumatization and septation variables when compared by gender and age (p #x3e; 0.05). Discussion/Conclusion: Differences regarding anatomical variants and septations of the SS were observed in our study when compared with findings reported in other ethnic groups. Preoperative assessment of the anatomical variants of the SS in Mexican patients is imperative to select the most optimal surgical approach and prevent iatrogenic injuries to related neurovascular structures. ORL
LV Comini,G Mannelli,A Tamburini,M Innocenti,G Spinelli
Publication date 31-03-2021
Introduction: Mandibular defects reconstruction could result challenging in childhood, due to facial and mandibular growth patterns. For these reasons, the choice of the most suitable reconstructive option in pediatric patients, affected by mandibular malignancies, still objects of debate.
Objective: The aim of our study was to compare our reconstructive schedules to the existing literature in order to give a personal contribute to the present panorama.
Methods: We performed, in October 2019, a retrospective evaluation of pediatric patients treated for biopsy-proven mandibular malignancies at our Institute between January 2013 and December 2016. All of them received multimodal therapy in accordance with standard guidelines and their demographic, clinical, treatment, and outcome parameters were collected and analyzed.
Results: We observed a shorter duration of surgery, a faster tracheostomy tube and feeding-tube removal, and a minor hospitalization in patients who received grafts transfer compared to those who underwent microsurgical mandibular reconstruction. After a 36-month period of follow-up, osteochondral grafts showed a pattern of growth similar to the mandibular epiphysis (condilylion-gonion linear and vertical ratio ranging to 0.96–1.03 and 1–1.02 at orthopantomogram, respectively). No bone consolidation delays and functional impairment were recorded.
Conclusions: Free flaps mandibular reconstruction in children needs to be better assessed and proximal fibular epiphyseal free flap indication might deserve further studies. Osteochondral grafts find indication for lateral defects, 50–55 mm in maximum length and located in the mandibular ramus, without massive teeth or soft tissue defect. Condyle involvement does not represent an absolute contraindication to rib graft use. ORL
J Schwab,CD Jensen,AW Fjaeldstad
Publication date 31-03-2021
Introduction: Chemosensory dysfunction (CD) has proven valuable in prediction of COVID-19, as it is a frequent and specific symptom of the disease. The aim of this study was to investigate the duration of CD in patients with sudden subjective olfactory and/or gustatory loss during the SARS-CoV-2 pandemic. The secondary aim was to identify possible prognostic factors for the duration of CD.
Methods: An online baseline questionnaire was designed to assess subjective CD. Three rounds of follow-up questionnaires were sent out to any participants with persistent CD in 6-week intervals, prospectively assessing subjective chemosensory function and extending the follow-up time of this cohort significantly.
Results: In total, 467 participants completed the baseline questionnaire. The most significant improvement and recovery of chemosensory function was observed within the first month after the initial loss. Rates became stagnant after about 2 months, and only little improvement and recovery was seen after 2–4 months. After a mean follow-up of 95.9 days (olfactory dysfunction) and 94.0 days (gustatory dysfunction), 86.7% of participants reported gustatory improvement and 82.6% reported olfactory improvement, while 55.0% reported full gustatory recovery and 43.8% reported full olfactory recovery. Female gender was associated with better improvement of gustatory function. High subjective severity of chemosensory loss was associated with lower rates of olfactory and gustatory recovery as well as improvement of olfactory function. Young age was not associated with a better prognosis. Discussion/Conclusion: Rates of improvement and recovery of chemosensory function decreased after 2–4 months after initial chemosensory loss, possibly indicating that prolonged and perhaps permanent chemosensory loss may be a complication of SARS-CoV-2 infections. High subjective severity of CD may worsen the prognosis for improvement and recovery of chemosensory function. ORL
N Gülhan Yaşar,R Karamert,H Tutar,MB Uğur,B Hazır,YA Bayazıt
Publication date 30-03-2021
Introduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs.
Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared.
Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p #x3e; 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p #x3e; 0.05).
Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable. ORL
C Scherl,J Stratemeier,N Rotter,J Hesser,SO Schönberg,JJ Servais,D Männle,A Lammert
Publication date 30-03-2021
Introduction: Augmented reality can improve planning and execution of surgical procedures. Head-mounted devices such as the Holo Lens® (Microsoft, Redmond, WA, USA) are particularly suitable to achieve these aims because they are controlled by hand gestures and enable contactless handling in a sterile environment.
Objectives: So far, these systems have not yet found their way into the operating room for surgery of the parotid gland. This study explored the feasibility and accuracy of augmented reality-assisted parotid surgery.
Methods: 2D MRI holographic images were created, and 3D holograms were reconstructed from MRI DICOM files and made visible via the Holo Lens. 2D MRI slices were scrolled through, 3D images were rotated, and 3D structures were shown and hidden only using hand gestures. The 3D model and the patient were aligned manually.
Results: The use of augmented reality with the Holo Lens in parotic surgery was feasible. Gestures were recognized correctly. Mean accuracy of superimposition of the holographic model and patient’s anatomy was 1.3 cm. Highly significant differences were seen in position error of registration between central and peripheral structures (p = 0.0059), with a least deviation of 10.9 mm (centrally) and highest deviation for the peripheral parts (19.6-mm deviation).
Conclusion: This pilot study offers a first proof of concept of the clinical feasibility of the Holo Lens for parotid tumor surgery. Workflow is not affected, but additional information is provided. The surgical performance could become safer through the navigation-like application of reality-fused 3D holograms, and it improves ergonomics without compromising sterility. Superimposition of the 3D holograms with the surgical field was possible, but further invention is necessary to improve the accuracy. ORL
S Eroglu,R Cevizci,H Turan Dizdar,HD Tansuker,E Bulut,A Dilci,S Ustun,S Sirvanci,OT Kaya,D Bayazit,BO Cakir,MF Oktay,YA Bayazit
Publication date 30-03-2021
Objective: The aim of the study was to evaluate the association of conductive hearing loss (CHL) with the structural changes in the organ of Corti.
Methods: Twenty ears of 10 healthy adult Wistar albino rats were included in the study. The right ears (n = 10) of the animals served as controls (group 1), and no surgical intervention was performed in these ears. A tympanic membrane perforation without annulus removal was performed under operative microscope on the left ears (n = 5) in 5 of 10 animals (group 2). A tympanic membrane perforation with annulus removal was performed under operative microscope on the left ears (n = 5) of the remaining 5 animals (group 3). Auditory brainstem response testing was performed in the animals before the interventions. After 3 months, the animals were sacrificed, their temporal bones were removed, and inner ears were investigated using scanning electron microscopy (SEM). The organ of Corti was evaluated from the cochlear base to apex in the modiolar axis, and the parameters were scored semiquantitatively.
Results: In group 1, the pre- and post-intervention hearing thresholds were similar (p #x3e; 0.05). In group 2, a hearing decrease of at least 5 dB was encountered in all test frequencies (p #x3e; 0.05). In group 3, at the frequency range of 2–32 k Hz, there was a significant hearing loss after 3 months (p #x3c; 0.01). After 3 months, the hearing thresholds in group 2 and 3 were higher than group 1 (p #x3c; 0.01). The hearing threshold in group 3 was higher than group 2 (p #x3c; 0.01). On SEM evaluation, the general cell morphology and stereocilia of the outer hair cells were preserved in all segments of the cochlea in group 1 with a mean SEM score of 0.2. There was segmental degeneration in the general cell morphology and outer hair cells in group 2 with a mean SEM score of 2.2. There was widespread degeneration in the general cell morphology and outer hair cells in group 3 with a mean SEM score of 3.2. The SEM scores of group 2 and 3 were significantly higher than group 1 (p #x3c; 0.05). The SEM scores of group 3 were significantly higher than group 2 (p #x3c; 0.05).
Conclusion: CHL may be associated with an inner ear damage. The severity of damage appears to be associated with severity and duration of CHL. Early correction of CHL is advocated in order to reverse or prevent progression of the inner ear damage, which will enhance the success rates of hearing restoration surgeries. Subjective differences and compliance of the hearing aid users may be due to the impact of CHL on inner ear structures. ORL
B Chen,C Benzien,V Faria,Y Ning,M Cuevas,J Linke,I Croy,A Haehner,T Hummel
Publication date 23-03-2021
Introduction: Patients with chemosensory dysfunction frequently report symptoms of depression. The current study aims to clarify whether the type (smell dysfunction, taste dysfunction, and mixed smell and taste dysfunction), severity, duration, or cause of dysfunction have differential impacts on the symptoms of depression.
Methods: 899 patients with chemosensory disorders and 62 controls were included. Following a structured interview and an otorhinolaryngological examination, subjects underwent olfactory tests (Sniffin’ Sticks), gustatory tests (taste sprays) and an assessment of depressive symptoms (Beck Depression Inventory). Information on the cause and duration of disorders was also collected.
Results: Patients with combined olfactory/gustatory dysfunction had higher depression scores than patients with smell dysfunction only and controls, and no significant difference was found between the smell dysfunction and controls. Anosmia patients, but not hyposmia patients, exhibited higher depression scores than controls. Among various causes of chemosensory disorders, patients from the posttraumatic group had higher depression scores than patients with other causes of chemosensory dysfunction (sinonasal, idiopathic, or postinfectious). Multiple linear regression analyses suggested that reduced olfactory function was associated with enhanced depression scores in the olfactory disorders group (B = −0.326, t = −2.294, and p = 0.02) and in all patients with chemosensory disorders (B = −0.374, t = −2.550, p = 0.017). Discussion/Conclusion: Simultaneously decreased input of olfaction and gustation seems to have an additive effect on the exacerbation of emotional dysfunction. Early intervention should be considered for depression symptoms in patients with mixed olfactory/gustatory dysfunction in clinical practice. ORL
OM Altuntaş,F Özer,O Kuşçu,N Süslü
Publication date 23-03-2021
Purpose: Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC).
Methods: A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II–IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared.
Results: Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group.
Conclusion: Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation. ORL
BE Mostafa,MA El Sawi,SM Sabry,DM Hassan,M Rezk Shafik
Publication date 23-03-2021
Objectives: The aim of this work was to assess the type and site of the 35delG gene mutation in patients presenting with profound SNHL and scheduled for cochlear implantation. The secondary objectives were to determine their geographical distribution throughout Egypt, screening of the parents for the mutation, and to correlate the type of mutation with clinical severity and outcomes after surgery.
Methods: The study was carried out on 100 consecutive patients scheduled for cochlear implantation. Patients with syndromic hearing loss or noncongenital hearing loss (trauma, infections, and ototoxicity) were excluded. All patients were subjected to detailed history taking including geographic tagging for their origins in Egypt, imaging (CT and MRI cochlear implantation protocols), full audiological evaluation (PTA, ABR, and TEOAE), and genetic screening for GJB2 mutation using Invitrogen PCR mix and ApaI restriction enzyme (North America, CA, 10572-014). The parents of mutation-positive patients were also subjected to audiological and genetic analysis. All patients were subjected to postimplantation evaluation of hearing after 6 and 12 months.
Results: There were 64 males and 36 females from 98 families. Ages ranged between 1.9 and 7 years (mean 3.72 years). They originated from all over Egypt but the majority came from the Giza and Cairo areas. The 35delG mutations were found in exon 2 in 31% of the cases and all were heterozygous. In the parents, 18 mothers and 13 fathers were positive but only 8 had mild to moderate SNHL. Hearing evaluation by pure tone and speech discrimination scores at 6 and 12 months showed that the 35delG children had a statistically better result compared to the children without this mutation.
Conclusion: The prevalence of the 35delG mutation in nonsyndromic children in this sample was 31% which is different from previous studies in the Egyptian population but close to the values found in other populations in the Mediterranean basin. ORL