ORL 2021-09-06

Therapeutic Potential of Human Nasal Inferior Turbinate-Derived Stem Cells: Microarray Analysis of Multilineage Differentiation

Publication date 06-09-2021

Introduction: Human nasal inferior turbinate-derived stem cells (hNTSCs) are attractive sources of adult stem cells for medical application because they can be easily obtained and cultivated with a highly proliferative capacity. The ability of hNTSCs to differentiate into chondrocytes, osteocytes, and neural cells makes them potential replacement therapeutic candidates in intractable disease. Nevertheless, detailed expression pattern of genes associated with trilineage differentiation (osteogenesis, chondrogenesis, and neurogenesis) in hNTSCs has not been revealed yet.
Methods: In this study, we aimed to evaluate gene expression patterns of various transcription factors and marker genes associated with a particular lineage (osteogenesis, chondrogenesis, and neurogenesis) of differentiation of hNTSCs by DNA microarrays.
Results: In microarrays, 36 transcripts such as E2F transcription factor 1, activating transcription factor 5, and AKR1B10 were upregulated and 36 transcripts such as CA9, PPFIA4, HAS2, and COL4A4 were downregulated in osteogenically differentiated hNTSCs. In chondrogenically differentiated hNTSCs, 3 transcripts (NUDT14, CPA4, and heparin-binding epidermal growth factor-like growth factor) were upregulated and 82 transcripts such as PTGS1, CLEC2D, and TET1 were downregulated. In neurally differentiated hNTSCs, 61 transcripts such as insulin-like growth factor-binding protein-1, nerve growth factor receptor, FGF1, OLFML1, and EPGN were upregulated and 98 transcripts such as ACAN, RUNX2, and C21orf96 were downregulated. In gene ontology (GO) analysis, cell signal-related GO terms were highly expressed. By contrast, catalysis GO terms and GO terms related to oxidoreductase were overrepresented in chondrogenically differentiated hNTSCs and osteogenically differentiated hNTSCs, respectively.
Conclusion: Considering overall results, hNTSCs-specific genetic information may promote further studies on intracellular mechanisms defining key features of these cells. ORL

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A Prospective Study of the Effect of Tinnitus Sound Matching Degree on the Efficacy of Customized Sound Therapy in Patients with Chronic Tinnitus

Publication date 03-09-2021

Objectives: The aim of this study was to explore and compare the customized sound therapy effect between tinnitus sound matching and nonmatching patients in tinnitus customized sound therapy and therapy-related influencing factors.
Methods: This prospective study investigated a total of 100 patients with unilateral chronic tinnitus who received customized sound therapy. The participants were dichotomously divided into matching (group A) and nonmatching (group B) groups after 4 stages of tinnitus matching via the tinnitus assistant app (provided by Sound Ocean Company, Su Zhou, China). Each group consists of 50 participants. Before and 6 months after the treatment, Hospital Anxiety and Depression Scale (HADS), tinnitus handicap inventory (THI), and tinnitus loudness Visual Analog Scale (VAS) were used to evaluate the customized sound therapy effect and explore other related influencing factors.
Results: (1) The HADS-A, HADS-D, THI, and VAS scores of 2 groups were both significantly decreased after treatment. (2) The HADS-A and THI scores improved markedly in group A than that in group B, which could be related to the hearing loss of the tinnitus side ear before treatment; the lighter the degree of hearing loss, the better the improvement. No statistically significant differences were detected in HADS-D and VAS scores between the 2 groups, and also, these were not related to the degree of hearing loss. The differences in age, gender, and tinnitus duration did not show any statistically significant effect on the improvement of the 2 groups.
Conclusions: Both tinnitus sound matching and nonmatching of the customized sound therapy brought a significant effect to tinnitus participants. Our study also suggests that THI and HADS-A scores of those with tinnitus matching participants improved markedly as compared to those of nonmatching participants, and the customized sound therapy effect is negatively correlated with the severity of hearing loss. ORL

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Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe

P Andrews,L Anschuetz,PM Baptista,F Bast,AG Beule,J De Carpentier,D Fitzgerald,LMPC Furtado,B Knox,A Marzetti,NW Perkins,PS Randhawa

Publication date 31-08-2021

Background: European health-care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID-19 crisis. Routine rhinology surgery under general anaesthetic (GA) is now faced with significant challenges which include limited theatre capacity, the negative ramifications of surgical prioritization, reduced patient throughput in secondary care, and additional personal protective equipment requirements. Delayed surgery in rhinology, particularly with regards to chronic rhinosinusitis, has previously been shown to have poorer surgical outcomes, a detrimental effect on quality of life and long-term negative health socio-economic effects. Awake rhinology surgery under local anaesthetic (LA) provides an ideal alternative to GA. It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres, by utilizing satellite facilities, while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure. It also confers additional benefits in terms of shorter recovery time and hospital stay for patients.
Objectives: We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health-care professionals involved.
Methodology: International roundtable forums were conducted and supplemented by individual interviews. The international board consisted of 12 rhinologists experienced in awake rhinology surgery. Feedback was analysed and shared to develop a consensus of best practice.
Recommendations: Local and national guidelines need to be adhered to with specific focus on patient and clinician safety. When performing awake rhinology procedures in the COVID-19 recovery process, consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection.
Conclusion: Awake surgery potentially provides quicker access to routine rhinology surgery in the post-COVID-19 recovery phase, ensuring patients are treated in a timely matter, thereby avoiding higher downstream costs, and improving outcomes. ORL

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Survey of the Use of Diffusion-Weighted Imaging for Cholesteatoma in the United Kingdom

SD Sharma,A Hariri,RK Lingam,A Singh

Publication date 27-08-2021

Background: Non-echoplanar diffusion-weighted MRI (DWMRI) has a role in the surgical planning for cholesteatoma. Aims/Objectives: The aim of the study was to assess the use of DWMRI in the management of cholesteatoma across the UK, and measure clinicians’ confidence in the use of DWMRI.
Materials and Methods: Telephone survey in 139 Otolaryngology Departments in the United Kingdom between March 2017 and July 2017, and asking radiology delegates at the British Society of Head and Neck Imaging 2017 meeting.
Results: The response rate was 101 out of 139 Trusts (73%). Of those respondents who did have DWMRI available, 68/88 respondents (77%) use it for cholesteatoma. The mean confidence (±standard deviation) of the respondents with DWMRI in identifying cholesteatoma presence was 7.3 ± 2.1, in identifying volume of cholesteatoma was 6.8 ± 1.8, and in identifying subsites of cholesteatoma was 4.6 ± 2.1.
Conclusions and Significance: DWMRI has a well-defined role in the follow-up of patients after cholesteatoma surgery, and those primary cases of cholesteatoma where the diagnosis is in question. The use of DWMRI for cholesteatoma is variable across the UK, but there are certain clinical scenarios where there is not enough awareness regarding the benefits of imaging (such as petrous apex cases of cholesteatoma). ORL

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Sequential Bilateral Cochlear Implantation in a Child with Severe External, Middle, and Inner Ear Malformations: Surgical Considerations and Practical Aspects

D Zhang,Y Yuan,Y Su,G Wang,C Guo,Q Wang,S Gao,P Dai,X Gao

Publication date 25-08-2021

Cochlear implantation (CI) is a safe and beneficial surgery for children with congenital inner ear malformations, with the exception of cochlear nerve aplasia. The combination of microtia with middle and inner ear abnormalities is extremely uncommon and sufficiently severe to make a surgical approach to the cochlea difficult. We report herein the case of a 2-year-old girl who presented with profound bilateral sensorineural hearing loss, congenital aural atresia, microtia, and inner ear malformations. High-resolution computed tomography revealed poor development of the bilateral middle ear spaces, absence of the incus and stapes, aberrant courses of facial nerves, aplastic lateral semicircular canals, and covered round windows. With intraoperative imaging assistance, sequential bilateral CI was performed using a transmastoid approach with no complication. We propose that CI is feasible in patients with severe external and middle ear malformations. However, major malformations increase the risk of complications. As the facial nerve and cochlea are difficult to locate due to the lack of important anatomical landmarks, detailed planning and adequate preparation, including review of the preoperative imaging data, and the use of facial nerve monitoring and intraoperative imaging are very important. In addition, experienced surgeons should perform CI to ensure the success of the operation. ORL

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Comparison of Absorbable Packing versus No Packing in Wound Healing after Endoscopic Sinus Surgery: A Systematic Review and Pooled Analysis

Z Huang,B Zhou

Publication date 19-08-2021

Introduction: Nasal packing after endoscopic sinus surgery (ESS) is controversial. The aim of this systematic review was to compare absorbable packing versus no packing in wound healing after ESS for the treatment of chronic rhinosinusitis.
Data Source: English electronic databases, including Cochrane Library, EMBASE, MEDLINE, and Pub Med, were searched, and only randomized controlled trials were included.
Methods: The outcome measures were the presence of synechiae/adhesion formation, mucosal edema, crusting, granulation formation, and infection. The Mc Nemar’s test was used for pooled analysis.
Results: Four studies with 148 participants were included. The pooled analysis showed that absorbable packing may offer benefit in reducing adhesion at 6–8 weeks (odds ratio OR: 0.3864; 95% confidence interval CI: 0.2136–0.7235) and 12 weeks (OR: 0.2396, 95% CI: 0.08267–0.7709) postoperatively compared with no packing. There was no significant difference between the packed and the unpacked side at 2, 6–8, and 12 weeks after ESS in terms of presence of crusting, edema, and granulation formation.
Conclusion: There is insufficient evidence to suggest that absorbable packing after ESS does not increase mucosal edema, granulation formation, and infection. However, the absorbable packing may be more effective than no packing for the prevention of mucosal adhesion after ESS. The use of absorbable nasal packing after ESS is recommended when used to reduce postoperative mucosal adhesion. More research in this area is clearly needed. ORL

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Modified Arytenoid Adduction Operation for the Treatment of Unilateral Vocal Fold Paralysis

C Liu,Y Qiu,X Zhang,Y Liu,G Li,D Huang

Publication date 12-08-2021

Introduction: Unilateral vocal fold paralysis (UVFP) was a relative common glottic insufficiency disease; however, a completely satisfactory treatment of UVFP was elusive. This study was aimed to evaluate the surgical efficacy of modified arytenoid adduction with fenestration of the thyroid cartilage in the management of patients with UVFP, including voice and aspiration outcomes, and to summarize the postoperative complications.
Methods: A retrospective analysis was performed on a total of 21 patients who underwent modified arytenoid adduction operation with fenestration of the thyroid cartilage for UVFP from July 2012 to June 2017. The scores of Grade, Roughness, Breathiness, Asthenia, Strain scale (GRBAS), voice self-satisfaction, dynamic laryngoscopy and the voice acoustic data (fundamental frequency F0, fundamental frequency perturbation jitter, loudness, amplitude perturbation shimmer, and maximal phonatory time MPT, etc.) were statistically analyzed preoperatively and 3–6 months postoperatively. The occurrence of postoperative complications was also summarized.
Results: The voice subjective perception of 21 patients was significantly improved after operation. The rate of voice self-satisfaction was 90.5%. The mean values of voice acoustics parameters were significantly improved. The MPT was significantly longer (p #x3c; 0.001), and the ratings of postoperative aspiration were significantly decreased compared with the preoperation. Among the 21 patients, 15 cases had sense of laryngeal obstruction, 8 cases had of 1–2° laryngemphraxis (recovered after 10–15 days). There were 2 cases of laryngeal stridor, 1 case of incision infection, 1 case of pharyngeal fistula, and 1 case of falsetto (corrected by voice training). No patient had laryngeal hematoma, neck hematoma, or laryngospasm.
Conclusion: The modified arytenoid adduction operation with fenestration of the thyroid cartilage can significantly improve the vocal function of patients with UVFP and effectively reduce the aspiration, with fewer postoperative complications, less trauma, and more convenient advantages. ORL

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Hearing Impairment and Audiological Alterations in Euthyroid Hashimoto’s Thyroiditis

Publication date 11-08-2021

Introduction: Hearing loss may be associated with autoimmune diseases, but it was less studied in Hashimoto’s thyroiditis (HT). We aimed to evaluate hearing impairment and audiological alterations in adults with euthyroid HT.
Methods: Adult patients with euthyroid HT (normal thyroid functions, positive antithyroid peroxidase (anti-TPO)/anti-thyroglobulin, and sonographic findings) were compared with controls. We excluded pregnant or older patients (#x3e;40 years), those with a history of otological/audiological disease or surgery, otitis media, acoustic trauma, chronic illnesses, use of alcohol, cigarette, medications, rheumatoid factor, antinuclear, antimitochondrial, antiparietal, antineutrophil cytoplasmic, anti-smooth muscle, or antigliadin antibodies, abnormal biochemical or otological findings. Tympanometry which indicates tympanic peak pressure (TPP, da Pa), acoustic reflex testing (ART), pure-tone average (PTA), and transient evoked otoacoustic emission (TEOAE) were performed. We grouped the participants according to ART (positive/negative), TEOAE (normal/undetected), and PTA (≤20/#x3e;20 decibel).
Results: Air conduction thresholds on the right ear at 500, 4,000, 6,000, and 8,000 Hz, PTA, and the left ear at 250, 4,000, 6,000, and 8,000 Hz were higher in euthyroid HT (n = 36) than in controls (n = 40) (p #x3c; 0.05). We found less negative TPP and a higher ratio of negative ART in euthyroid HT (p #x3c; 0.05). Euthyroid HT predicted undetected TEOAE and increased hearing threshold on the right ear at 500 and 8,000 Hz (p #x3c; 0.001). TEOAE detected audiological abnormality at a higher rate. Anti-TPO was positively correlated with TPP and air conduction thresholds, except the right ear at 8,000 Hz. Discussion/Conclusion: Hearing and audiological tests may be impaired in euthyroid HT. We recommend close monitoring of audiological functions in these patients. TE­OAE more specifically indicates audiological abnormality. ORL

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Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents

CC Chiu,CY Huang,KM Chang,SC Lin,YH Liu,PH Liao,CJ Hung,CF Cho,JY Liao,YY She,BH Kang

Publication date 30-07-2021

Introduction: Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training.
Materials and Methods: The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital’s Emergency Department for UADT-FB during June 2013–August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients.
Results: Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2. Discussion/Conclusion: This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases. ORL

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A Cross-Sectional Evaluation of Outcomes of Pediatric Thyroglossal Duct Cyst Excision

J Mattioni,S Azari,T Hoover,D Weaver,SK Chennupati

Publication date 29-07-2021

Introduction: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cysts. They may become infected causing dysphagia or respiratory distress. Accordingly, the treatment is always surgical removal.
Objectives: The objectives of this article were to examine complications following TGDC excision by surgical specialty, demographics, and comorbid conditions.
Methods: A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2014 to November 1, 2015 with a current procedure terminology code of 60,280 (excision of TGDC or sinus) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities.
Results: Of the 867 cases that met inclusion criteria, the median age was 4 years. There were 448 males (52.3%) and 408 females (47.7%). Thirty-six patients (4.2%) experienced at least one 30-day complication. The most predominant complications were reoperation (19 patients, 2.2%), readmission (18 patients, 2.1%), and surgical site infection (16 patients, 1.9%). There was no statistically significant difference between complications and surgical specialty. In those experiencing a complication, there was a statistically significant difference between males (86.1%) and females (13.9%). Of patients with at least one comorbidity, 36.67% had a complication, while 17.22% did not have a complication. There was also a statistically significant difference in the percentage of patients with a past medical history of asthma between those with at least one complication (16.67%) compared to those without any complications (4.76%).
Conclusions: excision is a generally safe procedure across surgical specialties. There is a higher complication rate in males compared to females as well as those with a history of at least one medical comorbidity and those with asthma. The most common 30-day complications are reoperation, readmission, and surgical site infection. ORL

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