The neutrophil-to-lymphocyte ratio in children with sudden sensorineural hearing loss: a retrospective study

Conclusion: The elevated neutrophil-to-lymphocyte ratio (NLR) value in children with sudden sensorineural hearing loss (SSNHL) would suggest the inflammatory etiology of pediatric SSNHL. The results of this study may suggest NLR value can be used as a useful indicator, which is associated with the disease severity in pediatric SSNHL.

Objectives: This study aimed to elucidate any clues of inflammatory etiology, which might be related with the development of pediatric SSNHL, using calculated NLR.

Methods: Forty-six patients aged younger than 19 years, who were admitted to the hospital with the diagnosis of SSNHL, were included in the study. Forty-six healthy children were matched as control group according to their propensity score. The complete blood cell count, calculated NLR, platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were compared. The relationship between NLR and the initial hearing level was also investigated.

Results: The mean NLR value was 2.86?±?2.58 in the SSNHL group, whereas the mean NLR value was 1.63?±?0.87 in the control group. The mean NLR value of the SSNHL children was significantly higher than that of the control group (p?=?.023). There was a positive correlation between the NLR value and initial hearing level (r?=?.312, p?=?.037).     

Vocal function after transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancer

Abstract

Conclusion: The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling.

Objectives: Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists.

Methods: Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified.

Results: Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0018) and neck dissection (p?=?.0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0021) was associated with post-operative voice impairment.     

The prognostic value of preoperative derived neutrophil-to-lymphocyte ratio in patients undergoing total laryngectomy with laryngeal carcinoma

Background: Emerging evidence indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors in laryngeal squamous cell carcinoma (LSCC).

Objective: To evaluate the prognostic significance of preoperative derived neutrophil-to-lymphocyte ratio (dNLR) in patients with total laryngectomy.

Methods: This was a retrospective analysis of 137 patients with LSCC who received total laryngectomy from January 2009 to December 2015. The preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and dNLR were calculated. Receiver-operating characteristic (ROC) curve was used to determine the cut-off values of these parameters. Univariate analysis and multivariate Cox regression model were used to evaluate the association between these parameters and recurrence-free survival (RFS) and overall survival (OS).

Results: The optimal critical value of dNLR was 1.85, by which cases were divided into high dNLR group (dNLR ≥ 1.85) and low dNLR group (dNLR?<?1.85). The elevated dNLR was significantly associated with decreased RFS (HR 2.72, 95% CI 1.56–4.75, p?=?.000) and remained significant in multivariate analysis (p?=?.034). However, we did not find any significant correlation between dNLR and OS.

Conclusions: An elevated preoperative dNLR may be an independent prognostic biomarker for RFS in patients undergoing total laryngectomy with LSCC.     

Pretreatment lymphocyte-to-monocyte ratio as an independent prognostic factor for hypopharyngeal squamous cell carcinoma

Objective: The aim of this work was to analyze the clinical characteristics and pretreatment peripheral blood cell counts of patients with hypopharyngeal squamous cell carcinoma (HPSCC) and determine their relationship with clinical outcomes.

Methods: One hundred ninety-seven patients were eligible for the study. The relationship between survival and pretreatment peripheral absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) were analyzed by one-way analysis of variance, t-test, and univariate and multivariate analysis.

Results: The median follow-up time was 30.95 months (range 1–82 months). The 3-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates for all patients were 40.8, 51.0, and 48.1%, respectively. The ANC, AMC, NLR, and LMR were significantly associated with tumor stage and clinical stage (p?p?=?.035, .047, and .045, respectively).

Conclusion: The pretreatment LMR should be considered as an independent prognostic factor for patients with HPSCC.     

外周血中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值评估声门型喉癌患者预后的价值

目的 探讨外周血中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与声门型喉鳞状细胞癌患者预后的关系。方法 收集115例有明确病理诊断的声门型喉鳞状细胞癌患者的临床病理及随访资料,通过建立受试者工作特征曲线（ROC曲线）,确定术前外周血NLR及PLR预测术后生存的最佳截点,以此将患者分为低NLR和高NLR组以及低PLR和高PLR组,分析NLR及PLR与患者的临床病理特征之间的关系,并通过单因素及多因素分析评估术前外周血NLR及PLR对患者术后生存的影响。结果 115例患者中获得随访107例,失访8例,随访率为93.0%。随访患者中27例死于喉鳞状细胞癌,80例生存。根据ROC曲线计算出PLR、NLR的临界值分别为139.79和2.83。107例声门型喉鳞状细胞癌患者的5年生存率为74.8%,其中低PLR组患者的5年生存率为82.7%;高PLR组患者的5年生存率为56.3%,差异具有统计学意义（P=0.004）。低NLR组患者的5年生存率为81.8%;高NLR组患者的5年生存率为56.7%,差异具有统计学意义（P=0.003）。单因素分析显示,声门型喉鳞状细胞癌患者的预后与患者的T分期、有无淋巴结转移、NLR水平和PLR水平有关（P均<0.05）。多因素分析显示,PLR水平以及NLR水平为影响声门型喉鳞状细胞癌患者预后的独立因素（P均<0.05）。结论 PLR和NLR可能是影响声门型喉鳞状细胞癌患者预后的独立因素。     

Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study

Abstract

Background: Few studies focused on the prognosis of sudden sensorineural hearing loss (ISSHL) of aged people.

Objectives: The aim of this study is to analyze the characteristics, treatment, and prognostic factors of ISSHL in aged people.

Material and methods: A total of 278 patients diagnosed of ISSHL in aged people from 2014 to 2019 were retrospectively analyzed. Univariates were analyzed by univariate and multivariate logistic analysis.

Results: Among the 13 univariates, the patients’ age was younger in the overall recovery group ORG (p?=?.018), while onset days was shorter in ORG (p?=?.000). The percentage of DM and HTN comorbidities were higher in ORG (p?=?.026 and .038). Meanwhile differences were significant in audiogram configurations (p?=?.037), the degree of hearing loss (p?=?.033), and types of lipid treatment (p?=?.020). Then these seven independent risk factors were included in the multivariate analysis, final results indicated that hypertension (p?=?.028), lipid control groups (p?=?.009), age (p?=?.000), and onset days (p?=?.001) were related to the treatment outcome of ISSHL.

Conclusions: The prognosis of ISSHL in aged patients was closely related to age, the onset days of treatment, and good control of complications such as hypertension and hyperlipidemia, so vascular factors were considered as the main causes of morbidity.     

Relationship between vertebral artery blood flow in different head positions and vertigo

Objective: To identify the vertebral artery blood flow in different head positions in patients with positional vertigo with no specific diagnosis.

Methods: Patients with history of vestibular symptoms associated with changes in head position were enrolled into the study. Healthy volunteers were evaluated as control group. Doppler ultrasonography examination of the cervical segment of the vertebral arteries was performed under three different head positions: (i) supine position, (ii) head hyperextended and rotated to the right side and (iii) head hyperextended and rotated to the left side.

Results: In the study group, right and left vertebral artery blood flow was significantly lower in the ipsilateral hyperextended position compared to standard supine position (respectively p?=?.014; p?=?.001), but did not differ significantly when compared between the standard supine and contralateral hyperextended positions (respectively?=?.959; p?=?.669). In the control group, left and right vertebral artery blood flow did not differ significantly when the head was hyperextended to the right or left sides compared to standard supine position (p?>?.05).

Conclusions: Our data demonstrated that the etiology of vestibular complaints in patients with undiagnosed positional vertigo might be related to impairment in vertebral artery blood flow according to head positions.     

Effect of uvulopalatopharyngoplasty (UPPP) on atherosclerosis and cardiac functioning in obstructive sleep apnea patients

Abstract

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular comorbidities including hypertension, arteriosclerosis, and heart failure. Uvulopalatopharyngoplasty (UPPP) is a frequently performed surgical treatment for OSA.

Aims/Objectives: To analyze if UPPP can improve cardiac parameters associated with atherosclerosis and reduce the cardiac burden in OSA patients.

Material and methods: A prospective cohort study was performed at a single tertiary care center where OSA patients undergoing UPPP were evaluated. Preoperative and 6-month postoperative cardiac parameters namely carotid artery intima-media thickness (CIMT), arterial stiffness parameters, echocardiography, and polysomnography (PSG) results were compared.

Results: Fifty three patients were included in the study. The success and response rate of UPPP was 60.4%. Following the surgery, significant reduction in arterial stiffness index (β) (12.4?±?4.1 vs. 11.2?±?4.0, p?=?.01), and elasticity modulus (Ep) (172.8?±?68.3 vs. 156.6?±?55.3, p?=?.05) was noticed. Additionally, echocardiographic parameters namely velocity across aortic valve (121.9?±?22.9 vs. 109.4?±?17.7, p?=?.01) and velocity across pulmonary valve (107.4?±?16.4 vs. 94.2?±?16.9, p?<?.01) significantly decreased following UPPP.

Conclusions and significance: UPPP significantly improves parameters related to carotid atherosclerosis and has the potential to reduce cardiac burden in OSA patients.     

Utilization of incus with bone cement for total ossicular reconstruction

Abstract

Background: Total ossicular chain reconstructions are performed to connect mobile stapes footplate and tympanic membrane. Data on the use of incus for total ossicular reconstruction is quite limited in the literature.

Objective: The main objective of this study is to describe a novel surgical method that utilizes incus with bone cement to stabilize the ossicular chain for total ossicular reconstruction.

Materials and methods: 16 patients who underwent total ossicular reconstruction using our method were included in this study. We evaluated hearing by comparing preoperative and postoperative air-bone gap (ABG), air conduction (AC) and bone conduction (BC). The percentage of patients achieving ABG ≤20?dB was determined.

Results: The mean preoperative ABG was 35.3?±?8.2 and postoperative ABG decreased significantly to 23.7?±?7.6 (p?<?.001). The mean preoperative AC (57.5?±?10) decreased significantly postoperatively to (46.5?±?13.3)(p?=?.014). There was not any difference between pre- and post-operative BC. We achieved successful hearing results (ABG ≤ 20dB) in 44% of patients.

Conclusion: The use of incus with bone cement stabilization for total ossicular reconstruction seems a feasible option. Good hearing outcomes, and low cost, complication, and extrusion rate may be the main reasons to prefer this method.     

Utilization patterns of systemic corticosteroid use for chronic rhinosinusitis

Objective: We sought to characterize the utilization pattern and factors associated with use of systemic corticosteroids for CRS.

Methods: This was a cross-sectional study of 236 participants with CRS who were prospectively recruited. Participants reported the number of CRS-related oral corticosteroid courses taken in the last year. Baseline CRS symptomatology was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and SNOT-22 sleep, nasal, otologic/facial pain and emotional subdomain scores. Clinical and demographic characteristics were also collected. Association was determined between patient characteristics and oral corticosteroid use in the last year for CRS.

Results: Sleep (p?=?.026), nasal (p?p?=?.022) SNOT-22 subdomain scores, and nasal polyps (p?=?.007) were associated with CRS-related oral corticosteroid use. In study participants without polyps, past CRS-related oral corticosteroid use was associated with sleep (adjusted OR?=?1.56, 95%CI: 1.01–2.40, p?=?.043), otologic/facial pain (adjusted OR?=?1.65, 95%CI: 1.09–2.51, p?=?.019) and nasal subdomain scores (adjusted OR?=?1.59, 95%CI: 1.01–2.51, p?=?.047). In study participants with polyps, past CRS-related oral corticosteroid use was only associated with the nasal subdomain score (adjusted OR?=?2.20, 95%CI: 1.40–3.45, p?=?.001).

Conclusions: Past CRS-related oral corticosteroid use was associated with increased baseline severity of specific symptoms, which were different depending on the presence of polyps.     

Efficacy of hypertonic (2.3%) sea water in patients with aspirin-induced chronic rhinosinusitis following endoscopic sinus surgery

Background: Aspirin-induced chronic rhinosinusitis (CRS) is a severe progressive persistent disease, usually associated with nasal polyps (NPs).

Aim/objective: To compare effect of hypertonic (2.3% NaCl) sea water and isotonic 0.9% NaCl on symptoms and endoscopic findings in those patients in the period of 1 month after endoscopic sinus surgery (ESS).

Material and methods: This prospective, randomized study included 30 patients with aspirin-induced CRS undergoing ESS. Patients were divided into two groups of 15 subjects and one of the two nasal irrigation solutions was administered in each group. Intensity of 5 symptoms (nasal obstruction, nasal discharge/postnasal drip, facial pain/pressure, headache and trouble sleeping) and endoscopic findings were assessed during the 1st, 7th, 14th, 21st and 28th days after the nasal packs removal.

Results: We found significantly lower total symptom score (TSS) during the 7th (p?=?.009), 14th (p?=?.003), 21st (p?<?.001) and the 28th day (p?=?.001), lower total endoscopic score (TES) on the 21st (p?=?.002) and 28th day (p?=?.001), lower nasal obstruction, facial pain/pressure, headache and trouble sleeping, and lower nasal mucosal edema, nasal secretion and nasal crusting in patients treated by hypertonic sea water.

Conclusion and significance: Hypertonic sea water should be recommended douching solution in the early postoperative care of patients with aspirin-induced CRS.     

Long term phonatory function following acoustic neuroma surgery: a cohort study

Abstract

Background: Acoustic neuroma (AN) is a well-recognized cause of neurological morbidity, peripheral facial paralysis being one of the most prevalent. Phonatory dysfunction in the late post-operative term has not been properly addressed so far.

Objective: The objective of this study is to describe the outcomes of phonatory function on the long-term follow-up of AN surgery and identify its prognostic factors.

Material and methods: This cohort study included patients submitted to AN surgery from 1999 to 2014, with a mean follow up of 6.4?±?4.5?years. To evaluate the phonatory function, we performed a combination of noninvasive acoustic and aerodynamic measurements including vocal intensity and stability, maximum declination rate of the glottal airflow (MDR) and transglottal pressure scale (TP).

Results: 101 patients were studied. 25 (24.7%) presented a deficit in phonatory function. Women comprised 56% and the mean age was 42.4?±?13.8 years (range19–80). 100% presented reduced expiratory airflow capacity with excessive manifestation of the laryngeal musculature (TP > 1,23s ;MDR/z/<MDR/s/). Dysphonic patients presented more neurofibromatosis II (NF II) (40% vs 12.7% p?=?.002), large tumors (3.8?±?1.1 p?=?.002) and needed less surgeries (≥256.7% vs 74.6%, p?=?.0073) in univariate analysis. NFII and tumor size were predictive of dysphonia according to multivariate analysis (NFII-OR 5.57, p?=?.006; tumor size-each 1?cm, OR1.68, p?=?.062).

Conclusion: The late postoperative prevalence of dysphonia corresponded to 24.7%. Dysphonia could be secondary to the hyperfunction of laryngeal musculature explained by the reduced expiratory airflow found in our patients. Tumor size and NF II were predictors for the occurrence of dysphonia in the present study.

• Highlights

• The comprise of phonation function can be a morbidity of AN surgery

• NF II and tumor size were predictive of dysphonia on late postoperative period

• Data of hypofunction secondary to the phonatory hyperfunction were unanimous in the dysphonic patients.

• The early diagnosis and treatment of phonation function could avoid alterations of pneumophono-articulatory coordination and projection deficiency.

     

Bipolar dissection technique in parotid gland surgery

Background: Parotid gland surgery (PGS) has to manage the balancing act between sufficient radicality and preservation of functional structures. While many studies evaluate post-therapeutic complication due to different extent of surgery, the current study introduces bipolar dissection (BP) being a fast and safe preparation technique.

Methods: Analysis of clinical parameters (age, sex, tumour entity, treatment modalities, facial nerve palsy, bleeding, saliva fistula and Frey’s syndrome) of 319 consecutively included patients who underwent extracapsular dissection and superficial/total/radical parotidectomy. Subgroup analysis was done according to the preparation technique (cold vs BP).

Results: Facial nerve palsy rate increased with the extent of PGS (p?p?=?.04), postoperative bleeding (p?=?.001) and salivary fistula (p?=?.045) when compared with cold preparation.

Conclusions: Ubiquitous available BP allows fast and safe PGS regardless its extent.     

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users

Abstract

Conclusions: The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development.

Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI).

Methods: Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10–16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n?=?14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.

Results: (1) GV in CG was lower in DT than with EN (p?=?.019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p?=?.006; DT, p?=?.0001; CI-OFF, p?=?.03). (3) CIU had slower GV walking with EN (p?=?.037) and with DT (p?=?.022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.     

Comparison of various bone cement ossiculoplasty techniques and functional results

Objective: In this study, functional results of different bone cement ossiculoplasty techniques are compared.

Methods: Retrospective case review at a tertiary referral center. Patients who underwent middle ear surgery and bone cement ossiculoplasty between 2006–2012 were included. A total of 52 patients, including 30 patients with ‘Incus to stapes’ (Group 1) and 13 patients with ‘malleus to stapes’ (Group 2), five patients with ‘incudoplasty?+?stapedotomy’ (Group 3), and four patients with ‘malleus to incus’ (Group 4) ossiculoplasty were enrolled in the study. Pre-operative and post-operative audiological findings of each group were evaluated.

Results: The mean hearing gain (the difference between pre-operative and post-operative air bone gap (ABG)) was 13?dB for Group 1, 30?dB for Group 2, 24?dB for Group 3, and 9?dB for Group 4. The pre-operative air pure tone averages (PTA) of groups 1, 2, and 3 improved significantly in the post-operative period (p?Conclusions: The results showed that glass ionomer cement is a simple and effective method for reconstruction of ossicular discontinuity in various ossicular chain pathologies and can be an alternative to conventional rebridging techniques such as sculpted incus interposition or partial ossicular replacement prosthesis (PORP).     

Prospective multi-center study on expansion sphincter pharyngoplasty

Background and objective: The aim of this study was to demonstrate the long-term effectiveness of Expansion Sphincter Pharyngoplasty (ESP) as a standalone surgical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) patients through a prospective multi-center study.

Material and methods: A prospective non-comparative multicenter study of patients suffering from OSHAS selected after drug-induced sleep endoscopy, with ESP as standing alone procedure was performed. Inclusion criteria were lateral collapse on oropharynx and preoperative AHI between 5 and 70. Minimum follow-up was >12 months. Outcome measures were Epworth sleepiness scale (ESS), AHI, success rate and CPAP need after surgery.

Results: A total of 75 ESP were performed. Mean patient age was 46.7?±?10.5 years. Mean pre-operative and post-operative AHI was 22.1?±?12.2 and 8.6?±?6.7, respectively (p?<?.001). Mean pre-operative and post-operative ESS score was 11.5?±?4.7 and 4.6?±?6.6, respectively (p?<?.001). AHI <5 was obtained in 25 patients (33.3%), and CPAP was not further needed after surgery in a total of 62 patients (82.6%).

Conclusions and significance: In this prospective multi-center study, patients undergoing ESP standing alone for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.     

Lower-pole intracapsular tonsillectomy in obstructive sleep apnea patients

Conclusion: Lower-pole intracapsular tonsillectomy (LPIT) is a valuable surgical technique capable of decreasing post-operative bleeding in obstructive sleep apnea (OSA) patients.

Objective: This study performed LPIT to simultaneously reduce post-operative bleeding of lower pole and prevent recurrent tonsillitis of upper pole and compared its effects to extracapsular tonsillectomy (ET).

Methods: ET was performed in the extracapsular plane, with complete monopolar dissection. In LPIT, the upper pole of palatine tonsil was removed by electrocautery with the extracapsular plane, followed by removal of the lower-pole by plasma ablation with the intracapsular plane. Post-operative bleeding incidence, bleeding site, and degree of pain were compared between the two groups.

Results: Three hundred and forty-seven patients diagnosed of OSA with polysomnography were enrolled. ET was performed in 152 patients and LPIT in 195 patients. There were no significant differences in post-operative pain between the two groups. The LPIT group showed significantly lower total bleeding incidence than the ET group (4.1% vs 9.2%; p?=?.05). In particular, lower-pole bleeding incidence was lower in the LPIT group than the ET group (1.0% vs 5.3%; p?=?.02).     

A comparison between systemic and intratympanic steroid therapies as initial therapy for idiopathic sudden sensorineural hearing loss: a meta-analysis

Conclusions: Intratympanic steroid (ITS) treatment groups exhibited better outcomes in PTA improvement and recovery rate than systemic steroid therapy (SST) groups. Whether initial hearing loss severity would influence the PTA improvement and recovery rate still requires further research.

Objective: This article was aimed at evaluating whether intratympanic steroid (ITS) treatment would provide benefits over systemic steroid therapy (SST) as initial therapy in patients with idiopathic sudden sensorineural hearing loss (ISSHL). A meta-analysis was carried out based on published RCTs that included the hearing outcomes of ITS treatment and SST in ISSHL as initial therapy. Both PTA differences and recovery rate were analyzed.

Methods: The literature search was based on the online database including Pubmed, Embase, and Cochrane trails, which completed in July 2016. This study extracted the relevant data following the selection criteria. Mean difference (MD) of PTA differences and Odds ratio (OR) of recovery rate were calculated within 95% confidence intervals.

Results: Six eligible articles were reviewed. The pooled MDs of PTA differences was 3.42 (95% CI?=?0.17–6.67, p?=?.04) and the pooled ORs of recovery rate was 2.05 (95% CI?=?1.38–3.03, p?=?.0003), which indicated that ITS treatment yielded better PTA improvement than SST. Sub-group analyses based on the initial hearing loss were also conducted; however, the difference was insignificant according to our analysis results (p?=?.82 for PTA improvement and p?=?.26 for recovery rate).     

Computed tomography and histopathological evaluation of osteitis in rabbit models with rhinosinusitis

Conclusions: There is clear correspondence between HU and histopathological evaluation of osteitis. It is feasible to evaluate bone remodeling in rabbit models with rhinosinusitis by measuring the HU.

Objective: The objective of this study was to determine whether the HUs of rabbit CRS models can be used to objectively evaluate the degree of osteitis.

Methods: Sixty rabbit models were inoculated with staphylococcus aureus. The rabbits were divided into three groups. Each group was divided into a medication administration team and a control team. The HU of the bone in each image was measured. All of the animals were executed after the CT exam. The samples for the mucous and bone changes using light microscope observation were scored. These scores and the HU measurements were compared to the actual bone remodeling over time to examine whether we could evaluate bone remodeling by measuring the HU.

Results: The average HU scores in Groups A, B, and C were significantly higher than those of normal rabbits (p?p?=?.042, 0.002). HU correlated with the mucous and bone scores in rabbit models with rhinosinusitis (coefficient r?=?.830, 0.641, 0.586, p?=?.000).     

Prognostic factors and importance of recognition of adult croup

Objectives: Croup, or laryngotracheobronchitis, is a common disease in childhood. On the other hand, to our knowledge, there are only 14 cases in six English literatures describing adult croup (AC). The clinical features of AC have not been well known.

Methods: We conducted a retrospective analysis of medical records of 18 patients with AC during the period from 2008 to 2016.

Results: None of the 18 patients required an urgent airway intervention. Univariate analysis indicated that the duration of symptoms was significantly longer in patients with cough (p?p?=?.037). The duration of subglottic edema was significantly longer in female (p?=?.035), patients with high levels of CRP (≥1?mg/dL, p?=?.049), and patients with cough symptom (p?=?.035).

Conclusions: Female, young age (<60 years), the symptom of cough, and high levels of CRP should be recognized as signs of prolonged AC. It is important to confirm the diagnosis of AC by laryngoscopic examination, which also help to avoid airway intervention.