ORL 2021-02-24

Relationship between Endolymphatic Hydrops and Symptoms of Meniere Disease in Acoustic Hearing

Publication date 24-02-2021


Hypothesis: The endolymphatic hydrops (EH) does not affect hearing loss significantly at low frequencies, whereas the hydrops affects the diplacusis.
Background: There have been many arguments whether the EH cause the Meniere disease. Despite a lot of experimental studies to investigate the Meniere disease, there have been little modeling studies, which are helpful to understand the mechanism.
Methods: A 3D finite element model of the human cochlea and the middle ear was used for investigation of the relationship between EH and hearing loss at low frequencies and diplacusis (2 specific symptoms of Meniere disease). While the cochlear geometry was simplified as a tapered box shape, the middle ear was based on the real geometry obtained from μCT images. EH is implemented by prestress on the basilar membrane surface in the simulation.
Results: The EH did not cause significant hearing loss at low frequencies in both air- and bone-conducted hearing. Rather, this disorder caused a shift in best frequency (BF) position to the base at low frequencies below about 250 Hz. The BF shift can explain the diplacusis because a low-frequency sound can be perceived as a slightly higher frequency so that Meniere patients can perceive 2 different frequency sounds corresponding to a given single-frequency sound.
Conclusion: The EH cannot be a sufficient condition for Meniere disease, whereas the hydrops can cause the diplacusis. ORL

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On the Nature of Hearing Loss in Méniere’s Disease

RR Gacek

Publication date 17-02-2021


Objective: To explain the pathophysiology of the hearing loss in Ménière’s disease (MD).
Background: In a previous report, we described a dramatic recovery of hearing in 12/31 patients with MD using antiviral (AV) drugs. The hearing loss in the remaining 19 patients with a longer history of MD remained unchanged or else worsened. Vertigo control was complete in the group with improved hearing but poorer in the group with greater hearing loss (and a longer MD history). Since achieving the recovery of hearing and control of the vertigo using AV drugs in these patients with a shorter history (≤2 years) of MD, we have continued to record dramatic hearing recovery in MD when patients have a shorter history of symptoms. We describe this here in 5 representative MD patients. We feel that the most likely explanation for the outcome is the removal of viral nucleic acids (NA) from the organ of Corti.
Summary: A likely explanation for the sensorineural hearing loss in MD is paralysis of the cochlear amplifier function of the outer hair cells due to the toxicity ofNA. These NA are released from neurotropic viruses located in the vestibular nerve ganglion.
Key Messages: (1) Viruses (Herpes family) are the cause of the symptoms in MD. (2) Hearing loss is the result of viral NA in the organ of Corti. (3) A short history of MD symptoms (#x3c;2 years) favors hearing recovery. ORL

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Is the Conductive Hearing Loss in NOG-Related Symphalangism Spectrum Disorder Congenital?

T Nakashima,A Ganaha,S Tsumagari,T Nakamura,Y Yamada,E Nakamura,SI Usami,T Tono

Publication date 15-02-2021


We describe a dominant Japanese patient with progressive conductive hearing loss who was diagnosed with NOG-related symphalangism spectrum disorder (NOG-SSD), a spectrum of congenital stapes fixation syndromes caused by NOG mutations. Based on the clinical features, including proximal symphalangism, conductive hearing loss, hyper­opia, and short, broad middle, and distal phalanges of the thumbs, his family was diagnosed with stapes ankylosis with broad thumbs and toes syndrome (SABTT). Genetic analysis revealed a heterozygous substitution in the NOG gene, c.645C#x3e;A, p.
C215* in affected family individuals. He had normal hearing on auditory brainstem response (ABR) testing at ages 9 months and 1 and 2 years. He was followed up to evaluate the hearing level because of his family history of hearing loss caused by SABTT. Follow-up pure tone average testing revealed the development of progressive conductive hearing loss. Stapes surgery was performed, and his post-operative hearing threshold improved to normal in both ears. According to hearing test results, the stapes ankylosis in our SABTT patient seemed to be incomplete at birth and progressive in early childhood. The ABR results in our patient indicated the possibility that newborn hearing screening may not detect conductive hearing loss in patients with NOG-SSD. Hence, children with a family history and/or known congenital joint abnormality should undergo periodic hearing tests due to possible progressive hearing loss. Because of high success rates of stapes surgeries in cases of SABTT, early surgical interventions would help minimise the negative effect of hearing loss during school age. Identification of the nature of conductive hearing loss due to progressive stapes ankylosis allows for better genetic counselling and proper intervention in NOG-SSD patients. ORL

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Patient-Reported Outcomes of Split-Thickness Skin Grafts for Floor of Mouth Cancer Reconstruction

AR Larson,M Han,KL Webb,E Ochoa,G Stanford-Moore,IH El-Sayed,JR George,PK Ha,CM Heaton,WR Ryan

Publication date 12-02-2021


Introduction: Patient-reported outcome measures (PROM) on quality of life (QOL) for early-stage floor of mouth carcinoma (FOM-CA) undergoing surgical resection and split-thickness skin graft (STSG) reconstruction have not been established. We have performed a cross-sectional QOL analysis of such patients to define functional postoperative outcomes.
Methods: Patients with pathologic stage T1/T2 FOM-CA who underwent resection and STSG reconstruction at a tertiary academic cancer center reported outcomes with the University of Washington QOL (v4) questionnaire after at least 6 months since surgery.
Results: Twenty-four out of 49 eligible patients completed questionnaires with a mean follow-up of 41 months (range: 6–88). Subsites of tumor involvement/resection included the following: (1) lateral FOM (L-FOM) (n = 17), (2) anterior FOM (A-FOM) (n = 4), and (3) alveolar ridge with FOM, all of whom underwent lateral marginal mandibulectomy (MM-FOM) (n = 3). All patients reported swallowing scores of 70 (“I cannot swallow certain solid foods”) or better. Ninety-six percent (23/24) reported speech of 70 (“difficulty saying some words, but I can be understood over the phone”) or better. A-FOM patients reported worse chewing than L-FOM patients (mean: 50.0 vs. 85.3; p = 0.01). All 4 A-FOM patients reported a low chewing score of 50 (“I can eat soft solids but cannot chew some foods”). Otherwise, there were no significant differences between subsite groups in swallowing, speech, or taste.
Conclusion: STSG reconstructions for pathologic T1–T2 FOM-CA appear to result in acceptable PROM QOL outcomes with the exception of A-FOM tumors having worse chewing outcomes. ORL

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Tubed Temporalis Fascia for Nasal Dorsal Contouring: A Novel Technique

JY Hudise,SA Aldhabaan,AA Alqabbani,RS Nassar,AM Alarfaj

Publication date 12-02-2021


Introduction: Nasal dorsum irregularities may occur after nasal trauma or as a postrhinoplasty complication. Here, we present a novel technique using temporalis fascia (TF) grafting for primary and revision rhinoplasty to repair the nasal dorsum, hide nasal irregularities, and improve nasal contouring.
Methods: This prospective cohort study was conducted from January 2019 to June 2019 and evaluated nasal dorsal contouring using the TF in a tubed form. The outcome variables were patient satisfaction, dorsal irregularity, and contour definition. The predictor variable was the use of tubed TF for dorsal augmentation. Other associated variables were age, sex, indication for surgery, surgery type, and graft size. Patient satisfaction was evaluated using the Rhinoplasty Outcome Evaluation questionnaire. A rhinoplasty specialist other than the surgeon who performed the procedure evaluated the dorsal augmentation outcomes by inspection and palpation of the dorsum. All statistical analyses were performed using the SPSS software.
Results: Seventy-four patients (21.6% men and 78.4% women) were treated with the tubed TF. The mean age was 28.97 years. Thin skin was the most common indication (48.6%) for using TF. The graft size was 2–5 cm; inspection and palpation revealed no irregularities. No reception site complications occurred. One patient had a mild hematoma at the donor site. The mean patient satisfaction score was 10.14 preoperatively and 19.95 postoperatively (p = 0.001). Discussion/Conclusions: Our novel technique of using the TF graft in a tubed form was easy to perform. Furthermore, the tubed TF covers all irregularities, is good for dorsal augmentation, and improves dorsal contouring and definition. ORL

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Platelet-Rich Plasma Injection in Patients with Atrophic Rhinitis

DH Kim,MH Lee,J Lee,EA Song,SW Kim,SW Kim

Publication date 09-02-2021


Objective: To investigate the effect of platelet-rich plasma (PRP) injection in patients with atrophic rhinitis.
Methods: Prepared PRP was injected into the inferior turbinate bilaterally, and nasal bacterial cultures were conducted. Improvement of symptoms was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) and the Sino-Nasal Outcome Test-22 (SNOT-22). Nasal mucociliary clearance was assessed using the saccharin transit time (STT).
Results: In the PRP-injected group (group A), NOSE (throughout the study) and SNOT-22 (1 month after injection) scores were significantly decreased during the study. However, the saline spray group (group B) showed no significant nasal symptom improvement during the study period. In group A, the STT was improved until 3 months after the injection. In contrast, group B showed STT improvement after 2 months that was maintained throughout the study.
Conclusion: PRP injections can improve nasal symptoms and nasal mucociliary function in patients with atrophic rhinitis. ORL

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Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

K Keseroglu,MM Gunay,S Alicura Tokgoz,B Ocal,C Saka,MH Korkmaz

Publication date 08-02-2021


Introduction: Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects #x3e;1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach.
Methods: The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed.
Results: The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered.
Conclusion: Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage. ORL

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A Rare Case of Pneumomediastinum after Eustachian Tube Dilation

S Long,A Obayemi,A Rameau

Publication date 05-02-2021


Eustachian tube dilation (ETD) is a relatively new intervention for the treatment of eustachian tube dysfunction. Though it previously had no assigned billing code, the American Medical Association recently accepted a new Category I Current Procedural Terminology code application for ETD to be effective in January 2021. Reported complications are uncommon and usually minor. Herein, we present a rare case of massive pneumomediastinum following this procedure. Such major complications are critical to report as ETD becomes a more commonly practiced procedure. ORL

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The Role of Keratin-8 and Keratin-18 Polymorphisms and Protein Levels in the Occurrence and Progression of Vocal Leukoplakia

Y Yang,J Zhou,P He,H Wu

Publication date 20-01-2021


Objective: This study aimed to evaluate the association between the single-nucleotide polymorphism (SNP) and tissue protein level of keratin-8/18 and the occurrence and progression of vocal leukoplakia.
Methods: The case-control study enrolled 158 patients with vocal leukoplakia, 326 patients with laryngeal squamous cell carcinoma (LSCC), and 268 healthy controls, which were tested for genotype analysis with keratin-8 and keratin-18 gene polymorphisms using pyrosequencing. The tissue protein expression levels of keratin-8 and keratin-18 were evaluated using immunohistochemistry.
Results: The keratin-8 SNP RS1907671 showed an obvious increased risk for vocal leukoplakia (OR 1.56, p = 0.002), while the other SNPs (RS2035875, RS2035878, RS4300473) were tested as protective factors for vocal leukoplakia and LSCC (OR #x3c;1, p #x3c; 0.05). In keratin-18 SNP test, both RS2070876 and RS2638526 polymorphisms demonstrated decreased risks for vocal leukoplakia and LSCC (OR #x3c;1, p #x3c; 0.05). The protein levels of keratin-8 and keratin-18 in vocal leukoplakia group were significantly higher than those of the LSCC group (p #x3c; 0.05).
Conclusions: Keratin-8 and keratin-18 polymorphisms and protein levels are associated with the occurrence and progression of vocal leukoplakia. ORL

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3D Technique-Based Nonsurgical Correction of Deformational Congenital Auricular Deformities

Y Zhu,Y Zhou,Q Zhao,Y Ma,Y Lu

Publication date 13-01-2021


Introduction: Congenital auricular deformity (CAD) is a common postpartum deformity, and nonsurgical correction of CAD has been recognized as a safe and effective approach. Three-dimensional (3D) technique has been used in surgical reconstruction of unilateral microtia; however, 3D technique used in nonsurgical correction for deformational CAD has not been reported.
Methods: In this study, 12 CAD patients aged from 0.6 to 7 months with 16 deformational CAD were treated with 3D technique-based personalized nonsurgical correction (3D-NSC). Patients’ CAD was photographed pre- and post-correction, and clinical outcome was evaluated as poor, fair, good, and excellent by comparing pre- and post-correction pictures. Different kinds of tests were used to analyze the data.
Results: All patients got an improved auricle shape (10 excellent, 2 good, and 4 fair). Multivariate regression analysis showed that CAD type was significantly associated with correction outcome, sex and age were significantly associated with correction outcome for the 11 constructed types of CAD, and age was significantly associated with the correction outcome when we focused on the male constructed auricles.
Conclusion: 3D-NSC provided a significant nonsurgical clinical treatment for CAD patients, with younger patients getting better clinical outcomes with shorter correction time. ORL

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