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Topical Corticosteroids Decrease IL-25 Expression by Immunohistochemistry

09-08-2019 –

Background: Interleukin-25 (IL-25) is an important contributing factor in the pathogenesis of allergic rhinitis. It leads to increasing peripheral and infiltrating eosinophilia as well as serum Ig
E, Ig
G, and Th2 cytokines (IL-4, IL-5, IL-13), which are responsible for the allergic symptoms. Intranasal steroids (INS) are effective in treating allergic rhinitis, but their effect on IL-25 release has not been studied. We aimed to study the link between IL-25 and the pathophysiology of allergic rhinitis as well as the effect of INS on its release. Methodology: This was a cohort, prospective, nonrandomized study that included 60 patients, 35 allergic rhinitis patients and 25 controls. We studied the effect of INS on IL-25 release. Results: Of allergic rhinitis patients 68.6% had strong cytoplasmic stain of IL-25 in the epithelial layer, while 25.7% had intermediate stain. INS caused significantly reduced IL-25 stain as only 14.3% of patients had intermediate stain and 85.7% had weak stain. Moreover, a correlation was found between nasal smear eosinophilia and the degree of IL-25 staining in the epithelial layer. Conclusion: Intranasal corticosteroids appear to be effective in the downregulation of IL-25, which may explain some of the utility of intranasal corticosteroid treatment in improving allergic rhinitis symptoms.
ORL

The Relationship between Age-Related Hearing Loss and Cognitive Disorder

07-08-2019 – SH Dong,JM Park,OE Kwon,SH Kim,SG Yeo

Journal Article

Background: Although the rates of occurrence of age-related diseases, including presbycusis and cognitive disorders, have increased with an increase in the geriatric population, the relationship between these two conditions remains unclear. Objective: To investigate the association between presbycusis and cognitive disorder. Subjects and Methods: A retrospective review of patient medical records was conducted at a single tertiary university hospital. This study enrolled 399 patients aged ≥65 years who were prescribed hearing aids for the chief complaint of hearing loss. For main outcomes and measures we used audiograms, the Korean Mini-Mental State Examination, and the Global Deterioration Scale (GDS). Results: Of the 399 patients who were prescribed hearing aids for presbycusis, 45 (11.3%) had dementia and 354 (88.7%) did not have dementia. When the cognitive disorder group was divided into mild (1–4) and severe (5–7) subgroups based on the GDS scores, the threshold of hearing loss was significantly higher in the severe group than in the mild group (p #x3c; 0.05). The prevalence of dementia was significantly higher in patients with hearing loss for ≥10 years than in patients with hearing loss for #x3c;10 years (p #x3c; 0.05). Conclusion: Presbycusis and cognitive disorder are correlated. More severe and prolonged hearing loss is associated with a higher prevalence of cognitive disorder.
ORL

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière’s Disease

07-08-2019 – E Kharkheli,S Japaridze,Z Kevanishvili,I Oz,LN Ozluoglu

Journal Article

Objective: To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière’s disease (MD). Methods: Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups. Results: Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD. Conclusion: VEMPs can be used for objective validation of the stage of MD.
ORL

Investigation of the Safety of Injection Laryngoplasty under Antithrombotic Therapy

26-07-2019 – T Sato,T Nito,R Ueha,T Goto,T Yamasoba

Journal Article

Background: Glottic insufficiency negatively affects phonation and swallowing function. Injection laryngoplasty is a convenient and minimally invasive treatment for glottic insufficiency. This study assessed whether injection laryngoplasty is safe under continued administration of antithrombotic drugs, and aimed to establish measurable laboratory values under which such a procedure can be safely performed. Method: This retrospective medical record review covered the period from November 2012 to June 2018. We examined 17 patients who underwent injection laryngoplasty (47 injections) under continued administration of antithrombotic drugs at the University of Tokyo Hospital. We analyzed clinical and demographic profiles, complications, and blood test values. Statistical analyses were performed regarding the risks of complications due to injection side, route of administration, and number of antithrombotic drugs. Results: No patients exhibited airway narrowing or dyspnea; however, bleeding after injection laryngoplasty was observed in 3 patients. All patients exhibited values within the optimal treatment range. There were no significant differences regarding the risks of complications due to injection side, route of administration, or number of antithrombotic drugs. Conclusions: When the platelet count, prothrombin time-international normalized ratio, and activated partial thromboplastin time were within the optimal range prior to treatment, injection laryngoplasty could safely be performed, regardless of the administration of antithrombotic drugs.
ORL

Allicin Protects against Cisplatin-Induced Stria Vascularis Damage: Possible Relation to Inhibition of Caspase-3 and PARP-1-AIF-Mediated Apoptotic Pathways

24-07-2019 – J Cai,X Wu,X Li,C Ma,L Xu,X Guo,J Li,H Wang,Y Han

Journal Article

Cisplatin is an anti-cancer drug that causes oxotoxic side effects such as impairment of inner ear function and hearing loss. We aimed to investigate the effects of allicin against cisplatin-induced stria vascularis damage in mice, and to clarify the mechanism underlying the protective effects of allicin against ototoxicity. Stria vascularis injury was induced in mice by intraperitoneal injection of cisplatin, which was significantly prevented by pretreatment with allicin. Allicin not only reduced cisplatin-activated expression of cleaved caspase-3 in marginal cells, PVM/Ms (perivascular resident macrophage-like melanocytes), and basal cells of the stria vascularis, but also decreased the expression of poly(ADP-ribose) polymerase-1 (PARP-1) and apoptosis-inducing factor (AIF) nuclear translocation in the stria vascularis cells. Our results demonstrate that allicin plays an effective role in protecting stria vascularis injury induced by cisplatin by inhibiting caspase-dependent, as well as caspase-independent PARP-1-AIF-mediated apoptotic pathways. Therefore, allicin may be useful in preventing cisplatin-induced ototoxicity.
ORL

Changes in Hearing Threshold and Tinnitus Severity after Stapes Surgery: Which Is More Important to the Patient’s Quality of Life?

17-07-2019 – B Dziendziel,H Skarzynski,E Gos,PH Skarzynski

Journal Article

Background: Stapes surgery is a common method of treatment of otosclerosis, and its effectiveness is reported based on audiometric hearing thresholds. Audiometric tests do not gauge the impact of tinnitus severity and auditory function on quality of life (QOL) after stapes surgery. Objective: To measure self-assessed QOL in otosclerosis patients after stapedotomy in terms of three major factors: change in audiometric hearing threshold, subjective hearing benefit, and tinnitus severity. Method: This prospective clinical study included 191 patients who underwent stapedotomy between April and October 2017 due to otosclerosis. All patients were tested by pure tone audiometry and filled in a questionnaire before surgery and 6 months afterwards. Subjective hearing was assessed with the Abbreviated Profile for Hearing Aid Benefit (APHAB); tinnitus severity was established using the Tinnitus Functional Index (TFI), and the QOL was measured by the Glasgow Benefit Inventory (GBI). Results: Statistical analysis showed that the average GBI total score (mean = 33.7; SD = 23.7) was statistically significantly higher than zero (t = 19.7; p #x3c; 0.001). Based on a regression model, all the three variables studied – audiometric hearing thresholds change, APHAB change, and TFI change – had a significant effect on QOL after stapedotomy. Interestingly, the highest beta value (b = 0.040; p #x3c; 0.001) was for TFI change, implying that TFI change had the greatest effect on QOL. Conclusion: Although the improvement of QOL after stapes surgery undoubtedly depended on improvement in both audiometric and self-reported hearing, the reduction of tinnitus severity had the greatest impact on increase in QOL.
ORL

Lemierre’s Syndrome Caused by Streptococcus anginosus Presenting as Postseptal Cellulitis in a Pediatric Patient

17-07-2019 – J Camacho-Cruz,H Preciado,N Beltrán,L Fierro,J Carrillo

Case Reports

Lemierre’s syndrome is an infrequent disease characterized by septic thrombosis of the internal jugular vein followed by pulmonary embolism generally occurring after upper respiratory and gastrointestinal tract infections. We present the case of a 15-year-old female patient with postseptal cellulitis and cervical abscess who developed pulmonary embolism and pleural effusion secondary to internal jugular vein thrombosis. Cultures were positive for Streptococcus anginosus, antibiotic treatment was established with satisfactory clinical outcome. High clinical suspicion is required for a diagnosis. The mainstay of treatment is a multidisciplinary approach based on two essential pillars: antibiotic therapy and surgical drainage. This is an important case because of the unusual presentation, the isolation of an infrequent pathogen, and the primary infection site (postseptal cellulitis), which are rare characteristics of this condition in the pediatric population.
ORL

The Smell and Taste Corner: The Human Chemical Senses Are Useless, Are They Not?

16-07-2019 – BN Landis,T Hummel

Editorial

ORL

Fast Screening of Olfactory Function Using the Q-Sticks Test

28-06-2019 – A Sorokowska,A Oleszkiewicz,A Minovi,CG Konnerth,T Hummel

Journal Article

Objectives: Classical, longer olfactory tests are associated with difficulties in everyday practice. The aim of this study was to investigate the clinical utility of the Q-Sticks test within the context of a multicenter study. Methods: A total of 333 subjects, aged between 12 and 88 years, completed a 3-item Q-Sticks test and a longer Sniffin’ Sticks identification test. We analyzed the sensitivity and specificity of the test results for different cutoffs for anosmia and hyposmia. Results: Our study showed that the test can be used on subjects aged 12 years and older, regardless of their sex. The data indicated a test sensitivity and specificity of 91.8 and 92%, respectively, with a score of 2 taken as a cutoff for olfactory dysfunction. Conversely, normal olfactory function can be declared with high probability with a score of 3 in the Q-Sticks test. Conclusion: We reconfirmed that the Q-Sticks test is a good screening tool for everyday medical practice and in laboratory settings, although it has to be kept in mind that the test can produce false-negative results at a score of 3. The test was relatively sensitive to anosmia and differences between normosmic and hyposmic/anosmic patients.
ORL

Refractory Oral Ulcer Responsive to Infliximab: A Case Report

28-06-2019 – K Ito,K Shikata,K Haba,T Ito

Case Reports

Purpose: Some oral ulcers are refractory to treatment. Recently, anti-tumor necrosis factor-alpha (anti-TNF-α) agents have been shown to induce relatively long remissions of refractory oral ulcers. Methods: A 69-year man presented with a sore throat caused by a pharyngeal ulcer in the soft palate and subsequently repeatedly developed oropharyngolaryngeal ulcers and an ulcer in the ileocecal region. Intestinal Behçet disease was suspected, but he did not meet the diagnostic criteria for this condition. Seven months after the initial presentation, he developed a lingual ulcer that did not resolve despite treatment with prednisolone. Given the suspicion of intestinal Behçet disease, 300 mg of infliximab was administered intravenously. Results: After the third dose of infliximab with prednisolone, the ulcer began to improve. He received infliximab every 8 weeks thereafter and developed no new oropharyngolaryngeal ulcers during the 17 months after the first infusion of infliximab. Conclusions: When a patient has refractory oral ulcers, attention must be paid to digestive symptoms and whether the patient has a systemic disease such as Behçet disease investigated. Furthermore, administration of infliximab to patients with refractory ulcers can be considered even when they do not fulfill the clinical criteria for a systemic disease.
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