Journal of Laryngology and Otology

Journal of Laryngology and Otology

Imaging for vestibular schwannoma in the old: practice versus reason. Predictors of disease progression after endoscopic sinus surgery

22-08-2019 – Hussain, Musheer,Fishman, Jonathan,Fisher, Edward

Screening for vestibular schwannoma in the context of an ageing population

01-08-2019 – Basu, S,Youngs, R,Mitchell-Innes, A

Journal Article

Objective
To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.
Methods
A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.
Results
Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.
Conclusion
An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.

MicroRNAs in acquired sensorineural hearing loss

30-07-2019 – Chen, H H R,Wijesinghe, P,Nunez, D A

Journal Article

Objective
This review summarises the current literature on the role of micro
RNAs in presbyacusis (age-related hearing loss) and sudden sensorineural hearing loss.
Methods
Medline, PubMed, Web of Science and Embase databases were searched for primary English-language studies, published between 2000 and 2017, which investigated the role of micro
RNAs in the pathogenesis of presbyacusis or sudden sensorineural hearing loss. Quality of evidence was assessed using the National Institutes of Health quality assessment tool.
Results
Nine of 207 identified articles, 6 of good quality, satisfied the reviews inclusion criteria. In presbyacusis, micro
RNAs in pro-apoptotic and autophagy pathways are upregulated, while micro
RNAs in proliferative and differentiation pathways are downregulated. Evidence for micro
RNAs having an aetiological role in sudden hearing loss is limited.
Conclusion
A shift in micro
RNA expression, leading to reduced cellular activity and impaired inner-ear homeostasis, may contribute to the pathogenesis of presbyacusis.

Long-term outcomes of ossiculoplasty using bone cement

04-07-2019 – Demir, B,Binnetoglu, A,Sahin, A,Derinsu, U,Batman, Ç

Journal Article

Objective
This study aimed to evaluate the long-term results of ossiculoplasty using bone cement.
Method
Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9–54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air–bone gaps were calculated according to international guidelines.
Results
There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 d
B), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 d
B), and this result was significant (p < 0.0001). The pre-operative air–bone gap was 27.65 d
B and decreased to 19.65 d
B during follow-up (p = 0.0001). No adverse reactions or complications were observed.
Conclusion
Bone cement is reliable for the repair of incudostapedial-joint defects.

Long-term status of middle-ear aeration post canal wall down mastoidectomy

03-07-2019 – Ezulia, T,Goh, B S,Saim, L

Journal Article

Background
Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.
Objective
This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.
Methods
All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.
Results
Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.
Conclusion
After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

Benefits of pre-labyrinthectomy intratympanic gentamicin: contralateral vestibular responses

16-07-2019 – Amiraraghi, N,Gaggini, M,Crowther, J A,Locke, R,Taylor, W,Kontorinis, G

Journal Article

Objective
To determine the impact of pre-operative intratympanic gentamicin injection on the recovery of patients undergoing translabyrinthine resection of vestibular schwannomas.
Methods
This prospective, case–control pilot study included eight patients undergoing surgical labyrinthectomy, divided into two groups: four patients who received pre-operative intratympanic gentamicin and four patients who did not. The post-operative six-canal video head impulse test responses and length of in-patient stay were assessed.
Results
The average length of stay was shorter for patients who received intratympanic gentamicin (6.75 days; range, 6–7 days) than for those who did not (9.5 days; range, 8–11 days) (p = 0.0073). Additionally, the gentamicin group had normal post-operative video head impulse test responses in the contralateral ear, while the non-gentamicin group did not.
Conclusion
Pre-operative intratympanic gentamicin improves the recovery following vestibular schwannoma resection, eliminating, as per the video head impulse test, the impact of labyrinthectomy on the contralateral labyrinth.

Transnasal inferior meatal antrostomy with a mucosal flap for post-Caldwell–Luc mucoceles in the maxillary sinus

05-08-2019 – Suzuki, M,Matsumoto, T,Yokota, M,Toyoda, K,Nakamura, Y

Journal Article

Objective
Transnasal inferior meatal antrostomy is increasingly used for the treatment of post-Caldwell–Luc mucoceles in maxillary sinus. This study aimed to report the outcomes after inferior meatal antrostomy with a mucosal flap for recurrent mucoceles.
Method
The records of patients who had undergone transnasal inferior meatal antrostomy with or without a mucosal flap were reviewed.
Results
Transnasal endoscopic inferior meatal antrostomy with or without a mucosal flap was performed in 21 and 49 patients, respectively. No complications were observed. A closing of the antrostomy was found in 9 (18.4 per cent) of the 49 patients who underwent antrostomy without a mucosal flap. No closings were observed in the 21 patients who underwent antrostomy with a mucosal flap. There was a significant difference in the rate of closing for surgery with and without the mucosal flap.
Conclusion
Transnasal endoscopic inferior meatal antrostomy with a mucosal flap is a safe method for the treatment of post-Caldwell–Luc maxillary mucoceles that effectively prevents recurrence.

Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis

20-06-2019 – Tsuzuki, K,Hashimoto, K,Okazaki, K,Nishikawa, H,Sakagami, M

Journal Article

Objective
This study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.
Method
A total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n = 205) and non-eosinophilic chronic rhinosinusitis groups (n = 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses.
Results
The post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors.
Conclusion
Early, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.

Use of an image-guided navigation system for routine endonasal endoscopic dacryocystorhinostomy

24-07-2019 – Reichel, O,Taxeidis, M

Journal Article

Objective
This study aimed to evaluate the results of routine endonasal endoscopic dacryocystorhinostomy combined with computed tomography guided navigation in patients with nasolacrimal duct obstruction.
Method
This was a retrospective study of all patients with lacrimal drainage obstruction undergoing stereotactic endoscopic dacryocystorhinostomy between 1st January 2016 and 1st April 2018. Computed tomography dacryocystography was used for intra-operative navigation. Patients with a presaccal obstruction site location were excluded from the study.
Results
Endoscopic dacryocystorhinostomy with computed tomography guided navigation was successfully performed in all 17 cases without complications. Early post-operative dislocation of the inserted bicanalicular silicone stent occurred in two patients. Two other patients developed post-operative bacterial infection within the lacrimal sac. Otherwise, the silicone tube was removed three months after surgery, and after further follow up of 8 weeks, 94 per cent of the study population reported complete remission of epiphora.
Conclusion
The use of computed tomography guidance in routine endoscopic dacryocystorhinostomy enhanced safety for the patient and avoided unnecessary damage of bone and mucosa surrounding the lacrimal drainage system. Therefore, routine endoscopic dacryocystorhinostomy with additional stereotactic guidance by computed tomography navigation can contribute to high success rates with endoscopic dacryocystorhinostomy.

A novel prognostic biomarker for recurrent aphthous stomatitis: calprotectin

09-07-2019 – Kayabasi, S,Kuzucu, I

Journal Article

Objective
This study aims to investigate whether there is a correlation between serum calprotectin concentration and oral ulcer activity in patients with active recurrent aphthous stomatitis.
Method
This prospective, cross-sectional, historical cohort study included 52 patients (26 with active lesions and 26 with inactive lesions) with recurrent aphthous stomatitis and 27 healthy volunteers. The relationship between the groups was statistically evaluated in terms of serum calprotectin level and other inflammatory parameters.
Results
The median calprotectin value of the active lesion group (80.5 ng/ml) was significantly higher than that of the control group (55.4 ng/ml, p = 0.002). Furthermore, the median calprotectin value of the active lesion group was significantly higher than that of the inactive lesion group (72.5 ng/ml, p = 0.017).
Conclusion
In patients with recurrent aphthous stomatitis and active ulcer lesions, the serum calprotectin value can be used as a reliable and robust prognostic marker for inflammation.

The use of fluorescence lifetime technology in benign and malignant thyroid tissues

10-07-2019 – Nakache, G,Yahav, G,Siloni, G H,Barshack, I,Alon, E,Wolf, M,Fixler, D

Journal Article

Objective
To explore the use of fluorescence lifetime imaging microscopy in thyroid tissues, and to investigate how different thyroid lesions affect fluorescence lifetime.
Method
Fluorescence lifetime measurements were taken of fresh frozen thyroid surgical specimens stained with fluorescein isothiocyanate tagged anti-thyroglobulin monoclonal antibodies.
Results
The mean fluorescence lifetime measurements in 12 patients – 3 with multinodular goitre, 4 with follicular adenoma, 4 with papillary thyroid carcinoma and 1 with follicular carcinoma – were 3.16 ns (range, 2.66–3.52 ns), 3.75 ns (range, 2.99–4.57 ns), 2.97 ns (range, 2.57–3.21 ns) and 3.61 ns, respectively. The fluorescence lifetime of follicular adenoma patients was higher than that of papillary thyroid carcinoma patients by 26 per cent (p = 0.058). The fluorescence lifetime in the follicular carcinoma patient was similar to the follicular adenoma group, but higher than in the papillary thyroid carcinoma group by 22 per cent (p = 0.01).
Conclusion
Fluorescence lifetime measurements varied in different thyroid pathologies, possibly because of tissue-scale structural influences.

Simulation training in laser safety education: the use of technical and non-technical skills simulation in a comprehensive laser safety course

18-07-2019 – Hall, C,Okhovat, S,Milner, T D,Montgomery, J,Hitchings, A,Kunanandam, T,Clement, W A

Journal Article

Objective
The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation.
Methods
Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice.
Results
The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation.
Conclusion
The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors’ knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.

Two week wait referral criteria – heading in the right direction?

02-08-2019 – Gao, C,Qin, C,Freeman, S,Oskooee, N,Hughes, J

Journal Article

Objectives
The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses.
Methods
The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer.
Results
Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent.
Conclusion
The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10–15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.

Work-related musculoskeletal symptoms in otorhinolaryngology and their relationship with physical activity. A nationwide survey

18-07-2019 – Lobo, D,Gandarillas, M A,Sánchez-Gómez, S,Megía, R

Journal Article

Objective
The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort.
Method
A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists.
Results
Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found.
Conclusion
This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.

Paediatric Bonebridge: bilateral simultaneous asymmetrical implantation

26-06-2019 – Dusu, K,Walsh, M,Eze, N

Journal Article

Background
The Bonebridge is an active transcutaneous bone conduction implant recommended as a surgical option for adults and children (aged 5–18 years). Successful implantation of the Bonebridge is often restricted by an insufficient amount of temporal bone to house the transducer in the paediatric patient.
Method and results
In this unique paediatric case, bilateral Bonebridge devices were implanted simultaneously in the right sinodural angle and the left middle cranial fossa.
Conclusion
The simultaneous implantation of bilateral Bonebridge devices was well tolerated in this paediatric patient, with significant improvement in her hearing. The middle cranial fossa is a viable option for housing the transducer.

Fibro-muscular-periosteal flap and bilobed flap for post-auricular cutaneous mastoid fistula closure

06-06-2019 – Pendolino, A L,Pavone, C,Zanoletti, E

English Abstract, Journal Article

Background
A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon.
Objective
This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure.
Method and results
A case of a post-auricular cutaneous mastoid fistula developed after revision tympanoplasty for a cholesteatoma. The condition was successfully treated with the presented technique. Pre- and post-operative photographs are provided for demonstration.
Conclusion
The fibro-muscular-periosteal flap combined with a bilobed flap from the mastoid and lateral neck regions, in our view, can be considered a valid option for post-auricular cutaneous mastoid fistula closure.

Closure of tracheocutaneous fistula using prefabricated conchal bowl cartilage and a supraclavicular flap

09-07-2019 – Mundi, N,Patel, K B,Yeh, D H,Nichols, A C

Journal Article

Background
Tracheocutaneous fistula represents one of the most troublesome complications of prolonged tracheostomy. Simple closure of a fistula can be ineffective, particularly in the context of prior surgery and adjuvant radiation. As such, modes of repair have expanded to include locoregional flaps and even free tissue transfers.
Objective
This paper describes a case of persistent tracheocutaneous fistula in an irradiated patient who had undergone previous unsuccessful attempts at repair.
Method and results
The use of regional fasciocutaneous supraclavicular flap with prefabricated conchal bowl cartilage resulted in successful closure of the tracheocutaneous fistula.
Conclusion
This represents a novel technique for closure of such fistulas in patients for whom previous attempts have failed. This mode of repair should be added to the surgeons repertoire of reparative techniques.

The ancient practice of sutra neti leading to velopharyngeal stenosis: case report

07-06-2019 – Tiwana, H,Virk, R S,Gautam, V

Journal Article

Background
An ancient yoga technique called sutra neti, which is extensively used in India to keep the sinuses healthy, led to complete velopharyngeal stenosis in a 67-year-old male patient who presented with bilateral nasal obstruction, mouth breathing, anosmia and a change in voice.
Method
The patient was diagnosed by nasal endoscopy using a zero-degree Hopkins rod endoscope, and adhesions were released using coblation.
Results
The patient had post-operative alleviation of symptoms and a patent velopharyngeal inlet on examination.
Conclusion
Vigorous sutra neti can lead to velopharyngeal stenosis. Release of the stenosis is then required to cure the nasal blockade.

An introspection into the management of subglottic stenosis in pregnant women using advanced apnoeic ventilatory techniques by Damrose et al

12-07-2019 – Karim, H M R,Esquinas, A M

Journal Article

“Authors reply”

15-07-2019 – Damrose, E J,Manson, L,Nekhendzy, V,Collins, J,Campbell, R

Journal Article

Carcinoma of the Larynx and Hypopharynx S Bahadur, A Thakar, B K Mohanti (eds) Springer, 2019 ISBN 978 9 81133 109 1 pp 226 Price £88.75

24-05-2019 – Bradley, P J

Neck Dissection B C Stack Jr, M A Moreno Thieme, 2018 ISBN 978 1 62623 834 3 eISBN 978 1 62623 835 0 pp 317 Price €109.99 US$129.99 £98.00

01-08-2019 – Bradley, P J

Anatomical variation of the sphenoid sinus in paediatric patients and its association with age and chronic rhinosinusitis – ERRATUM

11-07-2019 – Odat, H,Almardeeni, D,Tanash, M,Al-Qudah, M

Journal Article

Safety standards for invasive procedures in out-patient departments, managing subglottic stenosis in pregnancy, a critical review on follow up of head and neck cancer patients, and a new classification for cochleovestibular malformations – ERRATUM

03-07-2019 – Hussain, Musheer,Fishman, Jonathan,Fisher, Edward

Journal Article

JLO volume 133 issue 8 Cover and Front matter

22-08-2019 –

JLO volume 133 issue 8 Cover and Back matter

22-08-2019 –