Journal of Laryngology and Otology

Journal of Laryngology and Otology

What does the future hold for otology?

17-09-2019 – Fishman, Jonathan,Fisher, Edward,Hussain, Musheer

Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery

19-08-2019 – Jones, L F,Farrar, E M,Roberts, D J H,Moor, J W

Journal Article

Background
The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.
Objective
To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.
Methods
A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.
Results
Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.
Conclusion
The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

The future of otology

29-08-2019 – Jackler, R K,Jan, T A

Journal Article

Background
The field of otology is increasingly at the forefront of innovation in science and medicine. The inner ear, one of the most challenging systems to study, has been rendered much more open to inquiry by recent developments in research methodology. Promising advances of potential clinical impact have occurred in recent years in biological fields such as auditory genetics, ototoxic chemoprevention and organ of Corti regeneration. The interface of the ear with digital technology to remediate hearing loss, or as a consumer device within an intelligent ecosystem of connected devices, is receiving enormous creative energy. Automation and artificial intelligence can enhance otological medical and surgical practice. Otology is poised to enter a new renaissance period, in which many previously untreatable ear diseases will yield to newly introduced therapies.
Objective
This paper speculates on the direction otology will take in the coming decades.
Conclusion
Making predictions about the future of otology is a risky endeavour. If the predictions are found wanting, it will likely be because of unforeseen revolutionary methods.

“Assessment of quality of life outcomes with the Glasgow Childrens Benefit Inventory following cochlear implantation in children”

22-08-2019 – Dev, A N,Adhikari, S,Lohith, U,Dutt, C S,Dutt, S N

Journal Article

Background
This study investigated health-related quality of life outcomes for children with cochlear implants in India using the Glasgow Childrens Benefit Inventory questionnaire. Cochlear implantation is associated with improved language outcomes. Some studies show this gives higher quality of life after implantation. Previous research demonstrates that India presents unique circumstances that impact perspectives regarding cochlear implantation.
Method
Children (aged under 18 years) who had undergone cochlear implantation were recruited from Vani Pradan Kendra, an organisation for individuals with hearing loss based in Bangalore, India. Demographic data including age, sex, duration of hearing loss and age at implant were collected, and the childrens parents or caregivers completed the Glasgow Childrens Benefit Inventory questionnaire.
Results
Sixty-nine children (mean age: 8.0 ± 3.89 years) were recruited, and all reported improved quality of life after cochlear implantation. There was no effect of age, gender or education on reported benefits. However, a younger age at implant and longer experience with an implant were associated with greater quality of life improvements.
Conclusion
Cochlear implantation leads to improved quality of life, with greater improvements associated with earlier implantation. This supports early intervention in children with profound hearing loss.

A study on modelling cochlear duct mid-scalar length based on high-resolution computed tomography, and its effect on peri-modiolar and mid-scalar implant selection

19-08-2019 – Pamuk, G,Pamuk, A E,Akgöz, A,Öztürk, E,Bajin, M D,Sennaroğlu, L

Journal Article

Objective
To determine cochlear duct mid-scalar length in normal cochleae and its role in selecting the correct peri-modiolar and mid-scalar implant length.
Methods
The study included 40 patients with chronic otitis media who underwent high-resolution computed tomography of the temporal bone. The length and height of the basal turn, mid-modiolar height of the cochlea, mid-scalar and lateral wall length of the cochlear duct, and the ‘X’ line (the largest distance from mid-point of the round window to the mid-scalar point of the cochlear canal) were measured.
Results
Cochlear duct lateral wall length (28.88 mm) was higher than cochlear duct mid-scalar length (20.08 mm) (p < 0.001). The simple linear regression equation for estimating complete cochlear duct length was: cochlear duct length = 0.2 + 2.85 × X line.
Conclusion
Using the mid-scalar point as the reference point (rather than the lateral wall) for measuring cochlear duct mid-scalar length, when deciding on the length of mid-scalar or peri-modiolar electrode, increases measurement accuracy. Mean cochlear duct mid-scalar length was compatible with peri-modiolar and mid-scalar implant lengths. The measurement method described herein may be useful for pre-operative peri-modiolar or mid-scalar implant selection.

Coblation tonsillectomy versus cold steel dissection tonsillectomy: a morphological study

22-08-2019 – Lieberg, N,Aunapuu, M,Arend, A

Journal Article

Objective
To compare the extent of tissue damage produced by conventional cold steel and coblation tonsillectomy.
Methods
Twenty patients underwent conventional and 18 underwent coblation tonsillectomy. The removed tonsils were histopathologically evaluated.
Results
Analgesic use was lower in the coblation group during the early post-operative period. Histological investigation of tonsils removed by the conventional method showed intensive haemorrhage and hyperaemia in the tonsillar capsules, which was not seen in the coblation group. Furthermore, in the coblation group, there was less mast cell degranulation (p = 0.0081) and a smaller amount of skeletal muscle tissue (p = 0.0043) in the tonsillar capsules, indicating less tissue damage.
Conclusion
Compared to the cold steel technique, coblation tonsillectomy is superior in terms of less early post-operative pain and less damage to surrounding tissues. Significantly lower mast cell degranulation in coblation tonsillectomy may contribute to the reduction of post-operative pain.

Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

19-08-2019 – Junaid, M,Sood, S,Walijee, H,Dorgham, J,De, S

Journal Article

Objective
This study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.
Methods
A prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.
Results
In total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.
Conclusion
Intracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

‘Urgent suspicion of cancer’ referrals to a head and neck clinic – what do patients expect?

23-08-2019 – Montgomery, J,Douglas, C M,Begbie, F,Hitchings, A,MacKenzie, K

Journal Article

Background
Public awareness of ‘red flag’ symptoms for head and neck cancer is low. There is a lack of evidence regarding patient concerns and expectations in consultations for cancer assessment.
Method
This prospective questionnaire study examined the symptoms, concerns and expectations of 250 consecutive patients attending an ‘urgent suspicion of cancer’ clinic at a tertiary referral centre.
Results
The patients’ most frequent responses regarding their concerns were ‘no concerns’ (n = 72, 29 per cent); ‘all symptoms’ were a cause for concern (n = 65, 26 per cent) and ‘neck lump’ was a symptom causing concern (n = 37, 17 per cent). The expectations of patients attending clinic were that they would find out what was wrong with them, followed by having no expectations at all. Overall patient knowledge of red flag symptoms was lacking and their expectations were low.
Conclusion
Patients with non-cancer symptoms are frequently referred with suspected cancer. Patients with red flag symptoms are not aware of their significance and they have low expectations of healthcare.

Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

22-08-2019 – Gouzos, M,Dale, O,Sethi, N,Foreman, A,Krishnan, S,Hodge, JC

Journal Article

Objectives
This study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.
Methods
A retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.
Results
Twenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.
Conclusion
In this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.

Primary laryngeal lymphoma in China: a retrospective study of the last 25 years

19-08-2019 – Zhao, P,Zhou, Y,Li, J

Journal Article

Objective
To retrospectively study the primary laryngeal lymphoma cases in China reported in Chinese-language literature.
Method
Chinese-language literature was searched for papers on primary laryngeal lymphoma published in the last 25 years.
Results
The selected papers comprised a total of 115 cases. The male-to-female ratio was 3.4:1. Non-Hodgkins lymphoma was the exclusive pathological type. The estimated 3-year, 5-year and 10-year survival rates were 70.9 ± 6.4 per cent, 63.4 ± 7.6 per cent and 56.4 ± 9.5 per cent respectively, as determined by Kaplan–Meier analysis. B-cell non-Hodgkins lymphoma patients had a better prognosis than T-cell non-Hodgkins lymphoma patients (p = 0.032). Patients with lymph node involvement at diagnosis had a poorer prognosis (p < 0.01).
Conclusion
Primary laryngeal lymphoma is a rare disease with no specific clinical features. More than one biopsy might be needed to obtain the correct diagnosis. Proper treatment could lead to promising outcomes. The T-cell subtype and lymph node involvement at diagnosis might indicate worse prognosis.

Paediatric hearing loss: a community-based survey in peri-urban Kumasi, Ghana

22-08-2019 – Larsen-Reindorf, R,Otupiri, E,Anomah, J E,Edwards, B M,Frimpong, B,Waller, B,Prince, M E,Basura, G J

Journal Article

Background
Paediatric hearing loss rates in Ghana are currently unknown.
Methods
A cross-sectional study was conducted in peri-urban Kumasi, Ghana; children (aged 3–15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable Shoe
Box audiometer. The Littl
Ears auditory questionnaire was also administered to caregivers and parents.
Results
Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 d
B. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the Little
Ears questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction.
Conclusion
Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.

Does surgical treatment of nasal airway obstruction improve sexual functions?

29-08-2019 – Cayir, S,Hizli, O,Gul, M

Journal Article

Objective
To investigate the effects of surgical treatment for nasal obstruction on sexual functions, regardless of the condition causing the nasal obstruction.
Methods
Of 238 patients identified with nasal obstruction, 57 complained of erectile dysfunction and were included in the analysis. Patients underwent septoplasty, functional endoscopic sinus surgery, concha bullosa excision or radiofrequency ablation of the inferior turbinates, depending on their obstruction-causing disease. Pre- and post-operative evaluation of perceived nasal obstruction was performed using the Nasal Obstruction Symptom Evaluation questionnaire. Pre- and post-operative assessment of sexual functions was performed using the International Index of Erectile Function.
Results
Mean post-operative scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction were significantly higher compared to the pre-operative scores (p = 0.022, p = 0.036, p = 0.033, p = 0.016 and p = 0.029, respectively).
Conclusion
Surgical treatment of nasal obstruction by septoplasty, endoscopic sinus surgery, concha bullosa excision or radiofrequency can significantly improve sexual performance.

“Evaluation of serum ischaemia-modified albumin levels in patients with Bells palsy”

22-08-2019 – Göker, A E,Alagöz, M H,Güntaş, G,Baskadem Yilmazer, A,Berkiten, G,Tutar, B,Ekincioglu, ME,Akgun, M F,Uyar, Y,Ozdemir, E

Journal Article

Objective
This prospective study aimed to evaluate the relationship between serum ischaemia-modified albumin levels and Bells palsy severity.
Methods
The study included 30 patients diagnosed with Bells palsy and 30 healthy individuals. The patients were separated into three disease severity groups (grades 2, 3 and 4) according to House–Brackmann classification. Blood samples were collected from all participants and the results compared between groups.
Results
Significant differences in serum ischaemia-modified albumin were found between the study and control groups (p < 0.001); values were significantly higher in the study group than in the control group.
Conclusion
The significantly higher levels of serum ischaemia-modified albumin in the study group suggest that Bells palsy pathogenesis is associated with oxidative stress.

Reduction of cicatricial stenosis after canalplasty for auditory exostoses

22-08-2019 – Rojas, X M,Bailón, M M,González, C F

Journal Article

Background
Canalplasty for auditory exostoses is reserved for symptomatic patients. This study reviewed the outcomes of our technique regarding cicatricial stenosis.
Method
A chart review was conducted on patients undergoing canalplasty for auditory exostoses between 2002 and 2017. The surgical technique is described.
Results
The study comprised 43 adults (50 operated ears). Exostoses were bilateral in 40 cases (94 per cent) and occlusive in 33 (66 per cent). After drilling, the external auditory meatus was covered with a graft in 34 cases (68 per cent) and a silicone sheet was used in 32 (64 per cent). Cicatricial stenosis appeared in eight cases (16 per cent). Skin grafts were not used in six of these eight cases (p < 0.04), and silicone sheets were used only in one of these eight (p < 0.01).
Conclusion
Canalplasty is challenging because of its potential complications. Our data showed that the use of skin grafts and silicone sheets to cover the bared external auditory meatus was associated with a lower rate of cicatricial stenosis.

Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?

22-08-2019 – Lou, Z-C

Journal Article

Objective
To review the origins of epistaxis in patients with unknown bleeding sites.
Methods
This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes.
Results
The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients.
Conclusion
Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.

Dizziness, driving, and the Driver and Vehicle Licensing Agency: audit of advice given to patients, and design of a patient information leaflet

23-08-2019 – Sinnott, J D,Mahoney, H,Wilkinson, A S,Broomfield, S J

Journal Article

Background
Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
Methods
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.

Endoscopic posterior nasal neurectomy

23-08-2019 – Ahilasamy, N,Rajendran Dinesh, K

English Abstract, Journal Article

Background
Surgical techniques for resistant chronic rhinitis (rhinorrhoea) vary, ranging from vidian neurectomy to post-nasal neurectomy. The techniques vary mainly on the basis of instrumentation, and the avoidance of post-operative epistaxis, transient hypoesthesia of the soft palate and dryness of the eye. Endoscopic visualisation, and cauterisation or resection of posterior nasal nerve branches, can prevent such complications.
Method
The technique and surgical steps of endoscopic posterior nasal neurectomy are presented.
Results
The critical steps include: bilateral sphenopalatine nerve blocks, transnasally or transorally via the greater palatine foramen; vertical incisions made behind the posterior fontanelle; and elevation of the mucoperiosteal flap. The sphenopalatine foramen and artery is identified. The posterior nasal nerve is located 4–5 mm inferior to the sphenopalatine artery, and is resected or cauterised. The flaps are repositioned back into place. No post-operative nasal packing is required. The same procedure is performed on the opposite side for effective results.
Conclusion
This technique provides consistent, robust results, with long-term relief of allergic and vasomotor rhinitis related nasal symptoms, without risk of complication.

Laryngology: Clinical Reference Guide J Ross, H Panossian, M J Hawkshaw, R T Sataloff Plural Publishing, 2019 ISBN 978 1 63550 140 7 pp 534 Price US$119.95

22-08-2019 – Flood, L M

Microsurgical Management of Middle Ear and Petrous Bone Cholesteatoma M Sanna, H Sunose, F Mancini, A Russo, A Taibah Thieme, 2019 ISBN 978 3 13200 005 6 eISBN 978 3 13200 006 3 pp 710 Price €199.99 US$239.99

22-08-2019 – Flood, L M

Laryngeal Function and Voice Disorders: Basic Science to Clinical Practice C R Watts, S N Awan Thieme, 2019 ISBN 978 1 62623 390 4 eISBN 978 1 62623 391 1 pp 323 Price €114.99 US$134.99 £102.50

03-06-2019 – Flood, L M

Skull Base Surgery: Strategies W C Jean Thieme, 2019 ISBN 978 1 62623 957 9 eISBN 978 1 62623 958 6 pp 455 Price €219.99 US$249.99 £191.50

20-06-2019 – Flood, L M

JLO volume 133 issue 9 Cover and Front matter

17-09-2019 –

JLO volume 133 issue 9 Cover and Back matter

17-09-2019 –