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.

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.

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.

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.

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

The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery

07-11-2019 – T Rauchenwald,D Dejaco,EM Morandi,G Djedovic,D Wolfram,H Riechelmann,G Pierer

Journal Article

Background: Pectoralis major flap reconstruction is often associated with large unappealing scars in head-neck surgery. We recently established an alternative harvesting technique that improves aesthetic outcome. Objectives: The objective of this study was to demonstrate a modified surgical technique that harvests the pectoralis major muscle as an island flap and focuses on minimizing incision lines and applying a muscle-sparing approach. Methods: A retrospective analysis covering the period 2008–2018 was conducted. Patients who underwent pectoralis major island flap reconstruction for fistula prophylaxis after salvage laryngectomy at the Medical University of Innsbruck were included. Flap harvesting was performed subcutaneously using two small incision lines, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. Results: Twenty-three patients with squamous cell carcinoma of the larynx (n = 19) or pharynx (n = 4) underwent salvage laryngectomy and consecutive reconstruction using a pectoralis major island flap and our muscle-sparing technique. Mean overall operation time was 147 ± 48.6 min. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity as compared to traditional harvesting techniques. Six (26%) patients had major complications that required surgical revision. Three (13%) cases were complicated with fistulas. Conclusion: The pectoralis major island flap is shown to be reliable in otolaryngeal surgery. This surgical technique minimizes scarring and preserves thoracic wall architecture by taking a less invasive approach, thereby improving aesthetic outcome and reducing overall patient morbidity.
ORL 2019;81:327–337

Treatment of Laryngeal Contact Granuloma: Surgical Therapy or Conservative Treatment

06-11-2019 – W Chang,W Xu,L Cheng

Journal Article

Objective: Despite the fact that there are many treatment alternatives, laryngeal contact granuloma has a high tendency of persistence, spontaneous disappearance without treatment, and recurrence. A comparison of the effects of conservative treatment and surgical therapy on laryngeal contact granuloma was made in a retrospective review. Methods: A total of 124 patients with laryngeal contact granuloma were divided into 2 groups according to treatment: simple surgical excision (n = 36) and conservative treatment (n = 84). Additionally, the reflux finding score (RFS) and the reflux symptom index (RSI) were utilized to assess the disease. Results: A total of 124 patients, with a median age of 48.5 years, ranging from 9 to 74 years, were recruited (107 male, 17 female). According to the diagnostic criteria for laryngeal reflux (RSI #x3e;13 or RFS #x3e;7), there were 67 cases, accounting for 54.03% of the total. Surgery was effective in 15 patients (15/36, 41.67%), and conservative treatment was effective in 62 patients (62/84, 73.81%). The 2 groups had statistically significant differences. Conclusions: Conservative treatment, which is a comprehensive anti-reflux therapy, is better than surgical therapy and plays an important role in the treatment of laryngeal contact granuloma.
ORL 2019;81:348–353

Predictors of Occult Lymph Node Metastasis and Prognosis in Patients with cN0 T1–T2 Supraglottic Laryngeal Carcinoma: A Retrospective Study

22-10-2019 – SX Wang,WJ Ning,XW Zhang,PZ Tang,ZJ Li,WS Liu

Journal Article

Background: This work aimed to explore the predictors of lymph node metastasis (LNM) and analyze the prognosis of patients with clinically node-negative (c
N0) T1–T2 supraglottic laryngeal carcinoma (SGLC). Methods: Data for 130 patients with c
N0 T1–T2 SGLC who initially underwent surgery were retrospectively reviewed. Occult LNM incidence, relevant factors, and prognosis were analyzed. Results: Of the 130 patients with c
N0 T1–T2 SGLC, 21 (16.2%) had occult LNM. Based on univariate and multivariable regression analyses, male sex and poor tumor differentiation predicted the incidence of occult LNM. The incidence of occult LNM was 20.9% in males and 5.1% in females (p = 0.035). Patients with poorly differentiated tumors had a higher incidence of occult LNM (42.9%) than patients with well-differentiated (10.3%) and moderately differentiated tumors (14.3%; p #x3c; 0.05). Thirteen patients (10%) had cervical recurrence, and all had T2 tumors (p = 0.02). The 5-year disease-specific survival rates were 70 and 90% for patients with and without LNM, respectively (p = 0.000). Conclusions: Sex and tumor differentiation are potential predictors of occult nodal disease. Female patients with c
N0 T1–T2 SGLC are less likely than male patients to have neck metastasis. Poorly differentiated tumors are associated with the frequency of neck metastasis, and selective neck dissection is strongly recommended for these tumors.
ORL 2019;81:317–326