Otosclerosis surgery under local anesthesia with sedation: Assessment of quality of life and stress

ObjectivesThe main study endpoint was tolerance of stapedotomy under local anesthesia with sedation and under general anesthesia using stress and quality of life assessment questionnaires. Secondary endpoints comprised operative time and functional results.Material and methodIn a consecutive series of stapedotomy patients operated on over a 12-month period, quality of life and perioperative stress were analysed by 3 questionnaires: the Glasgow Benefit Inventory, Cohen's perceived stress scale and the Post-traumatic stress disorder checklist scale. Questionnaire responses and audiometric data were compared between groups treated under local anesthesia with sedation and under general anesthesia.ResultsTwenty-two patients were included in the local anesthesia with sedation group and 6 in the general anesthesia group. There was no difference between the groups for quality of life, onset of post-traumatic stress, or perceived pre- and postoperative stress. There was also no difference in operative time. The audiometric data confirmed the reliability of stapedotomy. Stapedotomy under local anesthesia with sedation improved air conduction with ≤ 10 dB air-bone gap (ABG), comparable to results under general anesthesia. The rate of ABG ≤ 10 dB was 71.4%; no labyrinthisation was observed.ConclusionUnder local anesthesia with sedation, stapedotomy was well tolerated without increasing the stress associated with otosclerosis surgery. By correcting hearing loss, the procedure improves quality of life.     

Contribution of the Synkinesis Assessment Questionnaire and the Sunnybrook Facial Grading System to the evaluation of synkinesis after peripheral facial palsy: A STROBE observational study

ObjectivesThe main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients’ perceptions.MethodsThis retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software.ResultsPerceived synkinesis (total SAQ) matched objective grades (SFGS) (Z = 2.89; P = 0.004), especially for smiling (Z = 3.84; P < 0.001) and lip protrusion (Z = 3.79; P < 0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z = 2.96; P = 0.003). Duration (ρ = 0.5137; P < 0.001) and grade of PFP (Chi² = 13.82; P = 0.008) heightened the perception of synkinesis.ConclusionPatient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.     

Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement

ObjectivesTo analyze oncologic and functional outcomes after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in glottic carcinoma with anterior commissure (AC) involvement, to determine predictive factors, and to compare results with those reported for other therapeutic strategies.Material and methodsA retrospective analysis included all patients who underwent SCL-CHEP for glottic squamous cell carcinoma with anterior commissure involvement in our institution, between 2000 and 2014. Swallowing function was evaluated on the DOSS (Dysphagia Outcomes and Severity Scale).ResultsFifty-three patients were included. Three-year overall, cause-specific and recurrence-free survival rates were 86, 95 and 80%, respectively. There were 5 cases of local recurrence (9%), all treated by total laryngectomy. Smoking was the only predictive factor of recurrence-free survival (P = 0.02). Mean DOSS score was 5.5 ± 0.9. DOSS scores ≥ 6 (normal oral feeding) were recovered by 59% of patients. T-stage ≥ 2 was the only predictive factor for DOSS score (P = 0.04).ConclusionIn glottic carcinoma with anterior commissure involvement, SCL with CHEP provided a local control rate of more than 90%, which is higher than reported with endoscopic surgery or external radiotherapy. However, contrary to LSC, salvage of local recurrence can often be obtained by conservative treatments after endoscopic surgery. Therefore, total-laryngectomy-free survival rates after SCL-CHEP and endoscopic surgery are finally comparable.     

French adaptation and validation of the Stapesplasty Outcome Test (SPOT-25), following COSMIN guidelines

AimsOtosclerosis can severely impact quality of life, but no questionnaire is available in French. The present study aimed to adapt and validate a French version of the SPOT-25.Materials and methodsA controlled prospective study was conducted between September 2021 and April 2022. The translation used the “forward-backward” technique and statistical validation was performed in non-operated adult otosclerosis patients (cases) and a control group. Assessment Internal consistency, discrimination performance and test-retest reliability were assessed on global score, subscores and items.ResultsFifty-one cases and 58 control subjects filled out the test questionnaire and 35 of the 51 cases, also filled out the retest. Internal consistency on Cronbach alpha was 0.95 for the cases. Median total SPOT-25 score was 44 (range, 10–78) for cases and 2 (range, 0–33) for controls (p= P < 0.0001). Test-retest reliability on intraclass correlation coefficient was excellent (ICC = 0.92; [95% CI, 0.84–0.96]). Individual items all showed satisfactory performance.ConclusionThe French version of SPOT-25 was short and easy to use, with satisfactory performance in assessing quality of life in otosclerosis patients.     

Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa

GoalTo evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2.MethodRetrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R = 21) and without (NR = 24) robotic assistance, in the period 2006–2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P <  .005.ResultsThree- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P = .34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P = .81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P = .05) without significant impact on 5-year actuarial local control (P = 0.78).ConclusionRobotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.     

Rehabilitation following total laryngectomy: Oncologic,functional, socio-occupational and psychological aspects

GoalTo review rehabilitation following total laryngectomy by an analysis of epidemiological, oncologic and functional data.Materials and methodsThis retrospective observational study focused on patients having undergone total laryngectomy or pharyngolaryngectomy between January 1, 2005 and December 31, 2016. Oncologic data notably comprised survival and relapse and predictive factors. The impact of the procedure on quality of life and the voice was analyzed by self-administered questionnaires (EORTC QLQ-C30 and H&N35, VHI 30). A satisfaction questionnaire was also sent to patients.ResultsOne hundred and thirty three patients were included. Overall specific 5-year survival was 65%. The relapse rate was 32%. Factors influencing survival were WHO performance status ≥ 2 (P < 0.05), tumor location (P = 0.07), metastatic lymphadenopathy (P = 0.017) and positive resection margins (P = 0.01). Quality of life was moderately degraded (global EORTC QLQ-C30 status: 61.4 ± 23.9). Type of rehabilitation (P = 0.03), tube feeding (P = 0.03) and relapse (P < 0.01) influenced quality of life. There were no differences in voice quality according to rehabilitation method, and no predictive factors for failure of voice rehabilitation. More than 90% of patients were satisfied with their hospital stay; 43%, however, were not satisfied with community caregiver training for laryngectomy patients.ConclusionRehabilitation of laryngectomized patients is a current therapeutic challenge. A therapeutic education tool was designed to better meet patient expectations.     

Outcome for bilateral cochlear implantation in patients with congenital Cytomegalovirus infection

ObjectivesTo analyze the impact of bilateral cochlear implantation (CI) on perceptual and linguistic development in hearing-impaired children with congenital Cytomegalovirus (CMV) infection.Patients and methodA retrospective study was performed for the period 1991-2016 in a pediatric CI reference center. Closed Set Word (CSW) recognition scores, Categories of Auditory Performance (CAP) and linguistic level on the MT Lenormand scale (MTL) were compared between bilateral (Bi) and unilateral (Uni) groups 12, 24 and 36 months after first CI (CI-1).Results84 patients with congenital CMV infection who underwent CI were included, in 2 groups: sequential or simultaneous bilateral CI (Bi) (N = 20), and unilateral CI (Uni) (N = 64). Twelve, 24 and 36 months after CI-1, CSW scores were 35.56%, 64.52% and 82.93% in Uni and 60.3%, 85% (P = 0.0084*), and 100% (P = 0.00085*) in Bi. CAP scores 12, 24 and 36 months after CI-1 were 2.57, 3.85 and 4.3 in Uni and 3.91 (P = 0.0068*), 5.00 (p = 0.029*) and 5.50 (P = 0.051*) in Bi. MTL linguistic level scores at 12, 24 and 36 months were 0.72, 1.25 and 1.65 in Uni, and 1.72, 3 (P = 0.033) and 3.11 (P = 0.045) in Bi. These significantly better scores in Bi at 24 and 36 months after CI-1 were also found on analysis of subgroups with no associated neurologic disorder (P = 0.046* and P = 0.032*), no associated psychiatric pathology (P = 0.0055* and P = 0.0073*), and no other associated disorder (P = 0.0018* and P = 0.035*), and for all subgroups together (P = 0.0036 and P = 0.037).ConclusionBilateral CI is a faster way than unilateral CI for patients with congenital CMV infection to achieve structured fluent oral language. 50% of the series showed cerebral abnormalities on MRI, without difference between groups. This was not in itself predictive of poor progression of oral communication, unless associated with major neurologic disorder. Some children made little or no use of their CI in the medium term.     

Therapeutic effect of pregabalin on radiotherapy-induced trismus in nasopharyngeal carcinoma patients

AimsTo evaluate the effect of pregabalin on radiotherapy-induced trismus in patients with nasopharyngeal carcinoma, a hospital-based, clinical retrospective cohort study was conducted.Materials and methodsData were collected on patients diagnosed with radiotherapy-induced trismus from March 2014 and March 2016 in the department of neurology in our hospital. Patients in the treatment group were administrated pregabalin for 8 weeks combined with rehabilitation, while the control group only received rehabilitation. The clinical therapeutic effects were observed and evaluated by mandibular motion, severity of trismus measured by late effects of normal tissues/subjective and objective medical analysis (LENT/SOMA) scales, and quality of life (QOL) assessed using the World Health Organization QOL instrument (WHOQOL-BREF) at baseline, week 4 and week 8 during treatment in these two groups, respectively.ResultsIn the treatment group, the number of patients with improvement on maximal vertical dimension (MVD) was significantly more than controls at week 4 and week 8 (P = 0.013, P = 0.004, respectively). Moreover, at week 4 and week 8, the severity of trismus was both significantly improved on LENT/SOMA grade in treatment group (P = 0.047, P = 0.032, respectively). And at week 8, the physical health and the whole life domain of the WHOQOL-BREF score were significantly increased (P = 0.037, P = 0.034, respectively). In the treatment group, 11 patients (36.7%) presented dizziness, and 7 patients (23.3%) presented somnolence.ConclusionsAdministration of pregabalin, in adjunct to rehabilitation, might provide a better outcome in patients with radiotherapy-induced trismus.     

Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic

AimsTo assess the benefit of telemedicine consultation during the Covid-19 pandemic.Material and methodsA prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations. Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors. The significance threshold was set at P < 0.005. The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown. The secondary endpoint comprised predictive factors for overall satisfaction.ResultsOne hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire. Overall satisfaction was 87%. There were no clinically relevant predictive factors significantly associated with satisfaction. Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR = 3.40, P-value = 0.049; and OR = 3.79, P-value = 0.049). Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR = 0.30, P-value = 0.027).ConclusionTelemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients. It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals.     

The effects of music therapy in patients undergoing septorhinoplasty surgery under general anesthesia

IntroductionMusic has been used for several years as a relaxation method to reduce stress and anxiety. It is a painless, safe, inexpensive and practical nonpharmacologic therapeutic modality, widely used all over the world.ObjectivesWe aimed to evaluate the effect of music therapy on intraoperative awareness, patient satisfaction, awakening pain and waking quality in patients undergoing elective septorhinoplasty under general anesthesia.MethodsThis randomized, controlled, prospective study was conducted with 120 patients undergoing septorhinoplasty within a 2 months period. The patients were randomly selected and divided into two groups: group music (music during surgery) and control group (without music during surgery). All patients underwent standard general anesthesia. Patients aged 18–70 years who would undergo a planned surgery under general anesthesia were included. Patients who had emergency surgery, hearing or cognitive impairment, were excluded from the study.ResultsA total of 120 patients were enrolled, and separated into two groups. There were no statistically significant differences between the groups in terms of demographic characteristics, anesthesia and surgery durations (p > 0.05). In the music group, sedation agitation scores were lower than those in the control group at the postoperative period (3.76 ± 1.64 vs. 5.11 ± 2.13; p < 0.001). In addition; in patients of the music group, the pain level (2.73 ± 1.28 vs. 3.61 ± 1.40) was lower (p < 0.001), requiring less analgesic drugs intake.ConclusionMusic therapy, which is a nonpharmacologic intervention, is an effective method, without side effects, leading to positive effects in the awakening, hemodynamic parameters and analgesic requirements in the postoperative period. It is also effective in reducing the anxiety and intraoperative awareness episodes of surgical patients.     

Pepsin deteriorates prognosis of children with otitis media with effusion who undergo myringotomy or tympanostomy tube insertion

ObjectiveTo investigate the concentrations of pepsin and pepsinogen within the middle ear cavity and determine whether pepsin and pepsinogen affect the prognosis of children with otitis media with effusion (OME).MethodsAll middle-ear lavage fluid from patients with OME undergoing myringotomy (M subgroup) or tympanostomy tube insertion (T subgroup) was collected and pepsin and pepsinogen were detected using enzyme-linked immunosorbent assay. After close follow-up over 2 years, the effects of pepsin and pepsinogen on the prognosis of the patients with OME in the M and T subgroups were analyzed.ResultsThe average pepsin and pepsinogen concentrations were significantly lower in the M subgroup (n = 54; 24.38 ± 16.10 mg/mL and 286.49 ± 91.95 mg/mL, respectively) than in the T subgroup (n = 55; 45.56 ± 16.60 mg/mL and 664.92 ± 107.06 mg/mL; t = 2.484, P = 0.018 and t = 2.670, P = 0.011, respectively). In the M subgroup, the average time to tympanic membrane healing and tympanic pressure restoration to normal was much longer in pepsin(+) patients (17.0 ± 2.0 days and 26.0 ± 2.5 days, respectively) than in pepsin(−) patients (14.0 ± 1.1 days and 22.0 ± 1.0 days; t = 3.871, P = 0.001 and t = 5.734, P = 0.000, respectively), and the hearing level of pepsin(+) patients with OME ascended to 13.08 ± 1.19 dB, which was much lower than that of pepsin(−) patients (18.29 ± 1.27 dB; t = 11.001, P = 0.000). In the T subgroup, the complication rate including otorrhea and myringosclerosis was much higher in patients with high pepsin concentrations than in those with low pepsin concentrations (P < 0.05). Finally, in both subgroups, the recurrence rates of OME in pepsin(+) or patients with high pepsin concentrations (34.6% [9/26] and 28.6% [10/35]) were significantly higher than those in pepsin(−) or low pepsin concentrations (10.7% [3/28] and 5.0% [1/20]; χ² = 4.456, P = 0.035 and χ² = 4.420, P = 0.036). However, pepsinogen had no significant effect on OME prognosis or recurrence.ConclusionPepsin but not pepsinogen could postpone tympanic membrane healing and pressure restoration in children with OME undergoing myringotomy and increase the incidence of recurrence and complications including otorrhea and myringosclerosis for those undergoing tympanostomy tube insertion. Therefore, pepsin could be considered a poor prognostic factor for OME, further emphasizing the important role of pepsin in OME pathogenesis.     

Analysis of factors affecting postoperative functional outcome in patients with otosclerosis

ObjectiveThis study aimed to analyze the factors affecting postoperative hearing results of patients with otosclerosis.MethodsMedical records of 245 patients with clinical otosclerosis who underwent stapes surgery at our center from January 2009 to December 2018 were reviewed. The retrospectively collected data included patients’ demographics, clinical characteristics, pre- and postoperative audiometric data, size of preoperative air-bone gap (ABG) (small/large). The patients were categorized into two groups according to the postoperative functional outcome: Group 1 consisted of patients with a postoperative ABG of ≤10 dB and Group 2 comprised those with a postoperative ABG of >10 dB. Evaluation of factors affecting functional outcome were performed by logistic regression analysis. Receiver operating characteristics (ROC) curve was generated to obtain the cut-off points for preoperative ABG.ResultsThere were no statistically significant differences between the two groups in terms of age group (p = 0.393), gender (p = 0.670), operated side (p = 0.370), and laterality of disease (p = 0.607). There were 42 patients (31.6%) with a small ABG and 91 patients (68.4%) with a large ABG in group 1, and six (13.6%) and 38 patients (86.4%), respectively in group 2. There was a statistical significant difference between the groups in terms of the size of preoperative ABG (p = 0.020). In group 1, the mean preoperative air conduction (AC) threshold and preoperative ABG were significantly lower than in group 2 (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference between the groups in terms of the preoperative bone conduction (BC) threshold (p = 0.406). Preoperatively, the AC threshold and large ABG were found to be significantly poorer prognostic factors (p < 0.001; 95%CI: 1.031–1.210 and p = 0.037; 95%CI: 1.063–7.023, respectively). Preoperative ABG cut-off threshold for functional success was found to be 34.5 dB. The functional success rate was significantly higher in patients with a preoperative ABG of <34.5 than in patients with a preoperative ABG of ≥34.5 dB (p < 0.001).ConclusionThe preoperative AC threshold and large ABG were poor prognostic factors for postoperative hearing outcome in patients with otosclerosis. The functional outcomes were similar in patients with a preoperative small ABG and those with a preoperative ABG of <34.5 dB. A preoperative ABG cut-off value of <34.5 dB should be possibly considered as a parameter for predicting surgical success in otosclerosis and seems to be useful in clinical practice.     

Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013

ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P = 0.001), laryngeal recurrence (P = 0.026), rT1, rT2 or rT3 rather than rT4 tumor (P = 0.007), previous chemotherapy (P = 0.036), and neck dissection during salvage surgery (P = 0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (< T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.     

Resfriado-gripe: pérdida grave del olfato a largo plazo

IntroductionIn the general population, we can find 2-3% of lifelong olfactory disorders (from hyposmia to anosmia). Two of the most frequent aetiologies are the common cold and flu. The aim of this study was to show the degree of long-term olfactory dysfunction caused by a cold or flu.MethodsThis study was based on 240 patients, with olfactory loss caused only by flu or a cold. We excluded all patients with concomitant illness (66 patients), the rest of patients (n = 174) consisted of 51 men (29.3%) and 123 women (70.7%). They all underwent olfactometry study (i and v cranial nerve) and a nasal sinus computed tomography scan, as well as magnetic resonance imaging of the brain. Results were compared with a control group (n = 120).ResultsVery significant differences in levels of olfactory impairment for the olfactory nerve (P < .00001) and trigeminal nerve (P < .0001) were confirmed.ConclusionsPeople that suffer olfactory dysfunction for more than 6 months, from flu or a cold, present serious impairment of olfactory abilities.     

A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty

AimsThe surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty.Material and methodsOne hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n = 66) or septoplasty combined with turbinoplasty arm (n = 71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively.ResultsWith regard to the findings obtained from both scales, both interventions successfully relieved the patients’ complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P ˂ 0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P ˂ 0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study.ConclusionsA turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.     

Transoral-transcervical oropharyngectomy without mandibulotomy,associated to fasciocutaneous radial forearm free-flap reconstruction,for oropharyngeal cancer: Postoperative course,oncologic and functional results,and prognostic factors

ObjectiveTo analyze postoperative course, oncologic and functional results and prognostic factors of transoral-transcervical oropharyngeal cancer surgery without mandibulotomy, associated to radial forearm free-flap reconstruction.Material and methodsRetrospective analysis of computerized medical records of all patients who underwent this type of surgery in our institution between 2004 and 2014. Predictive factors of oncologic and functional results were investigated on univariate and multivariate analyses.ResultsForty-four patients (37 male, 7 female; mean age, 62.3 ± 9.3 years) were included. Three-year overall, disease-specific and recurrence-free survival was 90%, 92% and 79%, respectively. Functional scores were satisfactory (normal or slight impairment) for feeding, speech and oral opening functions in 86%, 93% and 100% of cases, respectively. ASA score ≥ III had significantly negative impact on overall survival (P = 0.005) and on feeding (P = 0.01) and speech (P = 0.01).ConclusionTransoral-transcervical oropharyngeal cancer surgery without mandibulotomy provided excellent oncologic and functional outcomes; it is an advantageous alternative to the conventional conservative transmandibular oropharyngectomy.     

Emotional prosody perception in presbycusis patients after auditory rehabilitation

ObjectivePerception of emotion plays a major role in social interaction. Studies have shown that hearing loss and aging degrade emotional recognition. The main aim of the present study was to evaluate the benefit of first-time hearing aids (HA) for emotional prosody perception in presbycusis patients. Secondary objectives comprised comparison with normal-hearing subjects, and assessment of the impact of demographic and audiologic factors.MethodsTo assess HA impact, 29 subjects with presbycusis were included. They were tested without HA and 1 month after starting to use HA. A test with emotional hearing stimuli (Montreal Affective Voice test: MAV) was performed at various intensities (50, 65 and 80 dB SPL). Patients’ experience was evaluated on the Profile of Emotional Competence questionnaire, before and after HA fitting. Results were compared with those of 29 normal-hearing subjects.ResultsAuditory rehabilitation did not significantly improve MAV results (P > 0.005), or subjective questionnaire results (P > 0.005). Scores remained lower than those of normal-hearing subjects (P < 0.001). MAV results, before and after HA, showed significant correlation with pure-tone average (r = ?0.88, P < 0.001) and age (r = 0.44, P = 0.018). The older the presbycusis patient and the more severe the hearing loss, the greater the difficulty in recognising emotional prosody.ConclusionDespite hearing rehabilitation, presbycusis patients’ results remained poorer than in normal-hearing subjects.     

Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery

ObjectivesTo assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings.MethodsThis study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management.ResultsHundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P = 0.005), surgeon experience (P < 0.0001) and previous sinus surgery (P = 0.041). Only 37% of the patients wished for same-day discharge; reasons for refusal were home-to-hospital distance and bleeding risk. Considering anesthesia contraindications, immediate complications and operating time, 107 patients were eligible for outpatient treatment, although only 13 patients underwent ambulatory surgery. Medical-economic savings with outpatient management would have been about €20,000 per year.ConclusionsBilateral radical ethmoidectomy, associated to septoplasty or not, could be performed on an outpatient basis in more than 60% of cases, without increased risk, and with cost savings of 28.4%.     

Colesteatoma: influencia de la técnica quirúrgica y el estadio EAONO/JOS en los resultados audiológicos

Introduction and objectiveThe treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient's hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study are to determine the influence of the surgical technique use and this classification on patient's hearing outcomes.MethodsA retrospective study that include patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 is carried out. Based on pre-surgical computed tomography (CT) images, disease is staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry are analysed according to the surgical technique used and according to the stage of the disease.Results143 patients with no statistically significant differences in hearing thresholds before surgery are included. One year after surgery, all the patients’ airbone pure tone average (PTA) and mean differential auditory threshold have improved significantly (P = .01 and P = .001). Those patients who undergo tympanoplasty with two-stage canal wall up mastoidectomy presente better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved airbone PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001 and P = .013). The mean differential auditory threshold is also better (P = .008) in the patients who undergo tympanoplasty with canal wall down mastoidectomy one year after the procedure.ConclusionsReconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement is significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.