ORL

Hearing Improvement after Sudden Sensorineural Hearing Loss as a Predictor of Vestibular Schwannoma

18-12-2019 –

Introduction: Sudden sensorineural hearing loss (SSNHL) can be the presenting symptom of vestibular schwannoma (VS). Usually, steroidal treatment is given before magnetic resonance imaging (MRI) is performed. Objectives: The aim of this study was to investigate whether there is a different pattern of steroidal treatment response after SSNHL in patients with and without a VS, in order to determine whether rapid hearing improvement can serve as a predictor of the presence of VS. Methods: Charts of patients with SSNHLs were reviewed. Analysis of the presenting symptoms of patients with an SSNHL with and without a coexisting VS and comparison of the response to steroids of the two groups of patients was performed. Results: A total of 420 patients were treated for SSNHLs during the study period. Treatment consisted of intraoral prednisone 1 mg/kg/day. The male-to-female ratio was 1.00:1.17, and the median age at diagnosis was 38 years (range 18–82); neither parameter correlated with the presence of VS. MRI scans demonstrated a VS in 20 patients (4.76%). Audiometric testing 7 days after steroidal treatment initiation revealed that the pure-tone average of 240 patients (60%) without VS improved, and that of the 16 (80%) patients with VS improved by the same audiometric criteria (p = 0.0007). Conclusions:Improvement of hearing within 1 week after steroidal treatment initiation in patients with SSNHLs may suggest the presence of a VS.
ORL

Comparison of Different Slice Thicknesses in Computed Tomography for Labyrinthine Fistula Evaluation

18-12-2019 –

Objectives: The aim of the present study is to assess the impact of different slice thicknesses in computed tomography for labyrinthine fistula evaluation and to determine the appropriate slice thickness. Methods: A total of 258 patients who underwent mastoidectomy and tympanoplasty for chronic otitis media with cholesteatoma from 2010 to 2014 were reviewed. The radiological diagnoses were compared with intraoperative findings. Sensitivity and specificity of 2.0-, 1.5-, 1.0-, and 0.75-mm-thick computed tomographic (CT) images for the evaluation of labyrinthine fistulae were calculated. Cohen’s κ coefficient was also calculated. Results: The sensitivities of 2.0-, 1.5-, 1.0-, and 0.75-mm-thick CT images for the evaluation of labyrinthine fistulae were 76.9, 86.5, 90.4, and 93.3% (observer 1) and 67.3, 76.0, 79.8, and 87.5% (observer 2), respectively. The specificities of 2.0-, 1.5-, 1.0-, and 0.75-mm-thick CT images for labyrinthine fistula evaluation were 96.1, 94.8, 95.5, and 95.5% (observer 1) and 99.4, 97.4, 95.5, and 94.8% (observer 2), respectively. Cohen’s κ coefficients were 0.790, 0.788, 0.876, and 0.911 in 2.0-, 1.5-, 1.0-, and 0.75-mm-thick CT images, respectively. Conclusions: The sensitivity of CT for labyrinthine fistula evaluation increases with decreasing slice thickness, while the specificity does not improve.
ORL

IL-35 Inhibited Th17 Response in Children with Allergic Rhinitis

05-12-2019 – F Xie,Q Hu,Q Cai,R Yao,S Ouyang

Journal Article

Objective: Previous studies have proved that Th17 (T helper 17) cell subsets, a unique proinflammatory CD4+ T cell lineage, are deeply involved in the pathophysiology of allergic rhinitis (AR). IL-35, secreted mainly by natural Treg (n
Treg) and depending on the expression of Foxp3, can effectively alleviate allergen-induced specific airway inflammation. However, the regulation of IL-35 in AR is not clear. Methods: Twenty AR children and 20 healthy controls were enrolled. The expression of serum IL-35 protein was detected and the correlation with Th17 cytokines (IL-17, IL-23, IL-27) expression was analyzed by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells were prepared and stimulated by IL-35 to explore its effect on Th17 inflammation. Results: Serum IL-35 levels in AR were negatively correlated with serum IL-17 and IL-23 levels in AR. Recombinant IL-35 inhibits the Th17 response of PBMCs, which were mediated by the mitogen-activated protein kinase (MEK) and c-Jun N-terminal kinase (JNK) pathways. Conclusions: Our data demonstrate that IL-35 can inhibit Th17 response in AR through MEK and JNK pathways.
ORL

Contents Vol. 81, 2019

29-11-2019 –

ORL 2019;81:I–IV

Acknowledgement to Reviewers

29-11-2019 –

ORL 2019;81:354–355

Interleukin-33 Promotes Th2/Th17 Response in Eosinophilic and Non-Eosinophilic Nasal Polyps

28-11-2019 – X Luo,C Li,Y Wang,G Yang,Y Xu,G Li,F Liao,S Tan

Journal Article

Background: Interleukin-33 (IL-33) is reported to be involved in Th2-skewed eosinophilic inflammation. A recent study also found that IL-33 exerted opposite effects on Th17 response in different diseases. However, the role of IL-33 in chronic rhinosinusitis with nasal polyps (NPs) was not explored. Objectives: The purpose of this study was to investigate the expression and function of IL-33 in chronic rhinosinusitis with NPs. Materials and Methods: NP tissues from 60 NP patients and normal tissues of the inferior turbinate from 20 controls were sampled in operation. Immunochemistry was performed to identify eosinophilic or non-eosinophilic NPs. The expressions of IL-33 and Th1/2/17 cytokines were compared between different subtypes of NPs. The effect of IL-33 on Th response was detected in dispersed nasal polyp cells (DNPCs), and the signaling pathways involved in the process were detected using Western blot. Results: The concentration of IL-33 was significantly elevated in both eosinophilic and non-eosinophilic NPs compared with controls. By in vitro study, we found that IL-33 can induce IL-4 and IL-5 production from eosinophilic DNPCs through the PI3K/AKT pathway, whereas IL-33 can induce IL-17 production from non-eosinophilic DNPCs through the ERK1/2 pathway. Conclusion: IL-33 is involved in Th2/Th17 response in NPs. Our study suggests that different types of NPs need a different treatment target.
ORL

Epinephrine Use in Endoscopic Ear Surgery: Quantitative Safety Assessment

19-11-2019 – M Alicandri-Ciufelli,G Molinari,S Beckmann,M Caversaccio,L Presutti,L Anschuetz

Journal Article

Introduction: The management of bleeding in exclusive endoscopic ear surgery (EES) is largely dependent on epinephrine use. However, to date its suitability and safety have not been assessed. The aim of the present study would be to assess the safety profile of topical application and/or local infiltrationof diluted epinephrine during EES regarding the intra- and postoperative periods. We hypothesize that epinephrine may be safely used during EES. Methods: Retrospective analysis of 90 EES cases performed at the University Hospital of Modena, Italy. Patient’s charts and video recordings of the operations were assessed. Results: Epinephrine was used in all cases for hemostatic purposes as following: (1) diluted epinephrine (1:200,000) injection: mean 1.2 m
L (range: 0–3.5) corresponding to 0.006 mg (range 0–0.018), and (2) topical application (1:1,000) directly in the surgical field: mean 7 cottonoids (range: 0–18) corresponding to mean 0.56 mg (range: 0–1.44). No major cardiovascular adverse effects were assessed. Only 2 intraoperative hypertensive events were recorded. One sensorineural hearing loss was observed in a case of cholesteatoma involving the stapes; no facial palsy occurred during the study period. Conclusion: The combined use of local injection and topical epinephrine is a safe and effective strategy to control bleeding in exclusive EES, when used within the dilutions and quantities reported in this study.
ORL

Complications of Isolated Fungal Sphenoiditis: Patient Clinical Characteristics

19-11-2019 – C Promsopa,P Polwiang,S Chinpairoj,V Kirtsreesakul

Journal Article

Objective: To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis. Materials and Methods: The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected. Results: Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41–84) vs. 57.43 (36–81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis. Conclusion: This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.
ORL

Radiofrequency Coblation-Assisted Resection of Skull Base Neoplasms Using an Endoscopic Endonasal Approach

18-11-2019 – L Zhang,H Shi,D Li,H Ye,W Zhang,S Yin

Journal Article

Objectives: We describe our early experiences with resecting skull base tumors using a radiofrequency ablation-assisted endoscopic endonasal approach. Ninety-seven patients with skull base tumors who were admitted to the Otorhinolaryngology department at Shanghai Jiaotong University Affiliated Shanghai Sixth People’s Hospital between January 2014 and December 2016 were operated on using a radiofrequency ablation-assisted endoscopic endonasal approach. Complete resection was achieved in all patients. This paper describes the operative technique and presents the degree of resection, complications, and early clinical outcomes. Methods: We investigated the safety and feasibility of the technique and assessed preliminary treatment outcomes. Results: No patients experienced a new neurological deficit, cerebrospinal fluid leak, or meningitis after surgery. No deaths related to skull base tumors were observed during the follow-up period (14–50 months). The volume of intraoperative blood loss was 100–1,200 m
L (median 350 m
L), the duration of operation was 40–510 min (median 180 min), and the hospital stay was 6–65 days (median 18). Conclusions: Our limited experience indicates that this technique is feasible and safe for complete resection of some skull base tumors in selected cases and in the future will have an increasing role to play in endoscopic sinonasal and skull base tumor dissection.
ORL

Correlation between Type of Clefting and the Incidence of Otitis Media among Children with Lip and/or Palate Clefts

13-11-2019 – LRL Mangia,B Tramontina,R Tonocchi,JF Polanski

Journal Article

Introduction: Otitis media is a frequent condition among children with high morbidity. Orofacial clefts are undoubtedly one of the most well-established risk factors for otitis media during childhood. The clinical spectrum of disease in orofacial clefting is broad according to the subtype of malformation. This study aims to correlate the occurrence of otitis media among lip and/or palate cleft children with clinical and epidemiological parameters, in particular with the subtypes of malformation diagnosed. Methods: This is a clinical, retrospective, case-control type of study. Epidemiological and clinical data were obtained from medical records of children born between 2005 and 2008 and attending a multidisciplinary center for cleft patients. Results: 53% of the patients had registers of middle ear disorder during follow-up, and secretory otitis media was the most frequently diagnosed condition. Five children (1.39%) had chronic otitis media during the study period. Those patients with malformations including involvement of structures located posteriorly to the incisive foramen were more frequently diagnosed with otitis media than those with isolated pre-foramen cleft (p value #x3c; 0.001, odds ratio: 5.33). Gender and bilateral malformations did not correlate with increased occurrence of middle ear disease (p value #x3e; 0.05). Conclusion: Otitis media is frequent among lip and/or palate cleft children, although the grade of middle ear involvement seems to vary widely within this population. Post-foraminal malformations are clearly associated with increased incidence of otitis media, as well as with more severe diseases.
ORL 2019;81:338–347