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1.
Abd Elrheem Ahmed Singer Osama G. Abdel-Naby Awad Rafeek Mohamed Abd El-Kader Ahmed Rabeh Mohamed 《American journal of otolaryngology》2018,39(2):88-93
Purpose
Chronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings.Material and methods
This is a prospective study conducted from June 2016 to June 2017 in a tertiary referral hospital. 200 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The diseased ears were taken as study ears and normal ears as control ears in all patients. Detailed otologic history, clinical and audiometric findings were recorded and analyzed. Results were statistically compared in all patients for both study and control ears using different parameters.Results
Twenty patients had an average bone conduction threshold of all frequencies above 25 dB, which implies SNHL (10%). The incidence of SNHL was statistically significant at higher speech frequencies. The incidence increased with the presence of Diabetes Mellitus, smoking, duration of disease, presence of active discharge and the increase in size of perforation. However, it is not age dependent and there was no difference between males and females.Conclusion
Safe mucosal CSOM can cause SNHL with multiple predisposing factors. 相似文献2.
Ran Ren Shouqin Zhao Danni Wang Lin Yang Zhonglin Liu Ying Li Chenyi Wei 《American journal of otolaryngology》2017,38(2):121-126
Objectives
To facilitate the diagnosis, treatment and surgical options for congenital bony atresia of external auditory canal (EAC) with temporal-mandibular joint (TMJ) retroposition by analyzing its audiological features and the morphology of temporal bone on CT scan.Materials and methods
Two cohorts of patients with congenital EAC bony atresia with (n = 23) or without (n = 21) TMJ retroposition were recruited from September 2012 to July 2014 at Beijing Tongren Hospital, Capital Medical University. The patients with TMJ retroposition were set as the group A and those without as group B. Based on the degree of TMJ retroposition, group A was further divided into two sub-groups A1 (n = 13) and A2 (n = 10). The temporal bone CT scan, pure tone average (PTA) and air-bone gap (ABG) were obtained for the main outcome measurements. SPSS 17.0 was used for the statistics analysis with t and t test.Results
For group A, the average air conduction (AC) was 55.22 ± 12.53 dBHL, the average bone conduction (BC) was 7.07 ± 3.34 dBHL, and the average ABG was 50.69 ± 8.60 dBHL. For the sub-groups A1 and A2, the average AC was respectively 45.77 ± 8.43 dBHL and 59.50 ± 7.43 dBHL, BC 7.07 ± 3.34 dBHL and 6.89 ± 4.37 dBHL, and ABG 47.31 ± 7.92 dBHL and 53.00 ± 7.91 dBHL. For group B, the average AC was 70.24 ± 5.63 dBHL, BC 6.78 ± 4.37 dBHL, and ABG 60.19 ± 6.09 dBHL.Conclusions
The degree of TMJ retroposition is negatively related to the severity of hearing loss among patients with congenital EAC bony atresia, and those with TMJ have suffered less severe hearing loss than those without. Although TMJ retroposition might be a disadvantage for patients undergoing EAC plasty and tympanoplasty, it must be considered for its influence on hearing loss severity and auditory canal abnormality when planning the surgical treatment. Different from normal surgical protocol for congenital EAC bony atresia, we commend other hearing reconstruction methods such as BAHA and VSB, even without intervention. 相似文献3.
Anil Gungor 《American journal of otolaryngology》2017,38(1):77-81
Pediatric OSAS and craniofacial malformations present challenges that require innovative approaches and comprehensive treatment strategies. Synchronous airway lesions, craniofacial malformations, obstructive anomalies of the tongue base, nasal vault and choanae are commonly addressed by subspecialists from various clinical and surgical academic traditions who practice variable levels of required communication. This is not a mere social requirement but an important requisite for intelligent and effective airway management. Membership of dedicated airway, aero digestive or craniofacial teams are desirable but not required. I expect this clinical brief to help many brilliant clinicians in their pursuit of perfection. 相似文献
4.
Kuang-Hsuan Shen Yu-Hsuan Wang Ting-Wei Hsu Li-Chun Hsieh Fang-Ju Sun Ying-Piao Wang 《American journal of otolaryngology》2019,40(1):22-29
Purpose
The efficacy of postoperative oral corticosteroids on surgical outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients following endoscopic sinus surgery (ESS) remains controversial. This study evaluated the potential benefits of postoperative oral corticosteroids on surgical outcomes in CRSwNP patients and investigated the differential effects on eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (NECRSwNP).Materials and methods
Patients with bilateral CRSwNP who underwent ESS were enrolled and randomized to receive either oral prednisolone (30?mg/day) or placebo for 2?weeks after surgery. Visual analog scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22) scores were chosen as the subjective outcomes, evaluated at preoperative baseline and 1, 3, and 6?months postoperatively. Lund-Kennedy Endoscopic Scores (LKESs) were used as the objective outcome, evaluated at preoperative baseline and at 2?weeks and 2, 3, and 6?months postoperatively.Results
In total, 100 patients with bilateral CRSwNP were enrolled, of whom only 82 completed the 6-month follow-up. The subjective outcomes showed no significant difference at each follow-up points. Of the objective outcomes, the corticosteroid group reporting a trend of improvement in LKESs at 6?months postoperatively (p?=?0.05). After stratification by tissue eosinophils, only patients with NECRSwNP (<10 eosinophils/HPF) demonstrated a significant improvement in LKESs at 3?months postoperatively (p?=?0.03).Conclusions
Postoperative oral corticosteroids did not provide additional improvements in VAS and SNOT-22 scores; nevertheless, a trend of LKES improvement was noted at 6?months postoperatively. After stratification by tissue eosinophils, this effect was significant only among NECRSwNP patients at 3?months follow-up. 相似文献5.
Shay Schneider Joseph Kapelushnik Mordechai Kraus Sabri El Saied Itai Levi Daniel Michael Kaplan 《American journal of otolaryngology》2018,39(3):299-302
Purpose
Otogenic lateral sinus thrombosis (OLST) is an intracranial, potentially life-threatening complication of acute and chronic otitis media. Since congenital thrombophilic disorders are risk factors for cerebral venous thrombosis, OLST may be related to thrombophilia. The aim of our study was twofold: to evaluate whether patients who suffered from OLST in childhood also have thrombophilia, and whether these patients experienced thromboembolic episodes in future years.Study design
Retrospective case series.Methods
The medical charts of all children hospitalized for OLST at Soroka University Medical Center of Israel, a tertiary referral hospital, from January 1983 to September 2014 were reviewed. The patients were invited for a follow-up visit and comprehensive medical history was taken along with a physical examination and laboratory work-up for thrombophilia.Main findings
Seven patients were included in the study. Of these, 3 (43%) had results suggesting thrombophilic disorders manifested by elevated levels of factor IX and decreased levels of protein S activity (n?=?1), decreased levels of proteins C and S activity (n?=?1), and elevated levels of antibodies to cardiolipin (n?=?1). No patients experienced clear thrombophilic events; however, 2 patients (29%) with later proven thrombophilia suffered neurologic sequelae, possibly suggesting thrombophilic events.Conclusions
Pediatric OLST secondary to acute otitis media and mastoiditis may reflect an underlying thrombophilia. Laboratory work-up for thrombophilia should be performed, and anticoagulant treatment may be warranted in managing these patients. 相似文献6.
J.F. Thong D. Low A. Tham C. Liew T.Y. Tan H.W. Yuen 《American journal of otolaryngology》2017,38(2):218-221
Objective
Recent studies demonstrated the utility of high-resolution computed tomography (HRCT) scans in measuring basal cochlear length and cochlear insertion depths. These studies showed significant variations in the anatomy of the cochlea amongst humans. The aim of our study was to investigate for gender and racial variations in the basal turn length of the human cochlea in an Asian population.Method
HRCT temporal bone data from year 1997 till 2012 of patients with normally developed cochleae who reported with otologic disease was obtained. Reconstruction of the full basal turn was performed for both ears. The largest distance from the midpoint of the round window, through the midmodiolar axis, to the lateral wall was measured (distance A). Length of the lateral wall of the cochlea to the first turn (360°) was calculated and statistically analyzed.Results
HRCT temporal bone data from 161 patients was initially obtained. Four patients were subsequently excluded from the study as they were of various other racial groups. Study group therefore comprised of 157 patients (314 cochleae). Mean distance A was statistically different between the two sides of the ear (right 9.09 mm; left 9.06 mm; p = 0.0069). Significant gender and racial differences were also found. Mean distance A was 9.17 mm in males and 8.97 mm in females (p = 0.0016). The racial groups were Chinese (39%), Malay (38%) and Indian (22%). Between racial groups, mean distance A was 9.11 mm (Chinese), 9.11 mm (Malays) and 8.99 mm (Indians). The mean basal turn lengths ranged from 19.71 mm to 25.09 mm. With gender factored in, significant variation in mean basal turn lengths was found across all three racial groups (p = 0.04).Conclusion
The view of the basal turn of the cochlea from HRCT is simple to obtain and reproducible. This study found significant differences in basal cochlear length amongst male and female Asian patients, as well as amongst various racial groups. This has implications for cochlear electrode insertion as well as electrode array design. 相似文献7.
Objectives
Immune thrombocytopenia of childhood (platelet count < 100,000/μL) is the most common cause of thrombocytopenia in children. Patients typically present with bruising and bleeding in the setting of thrombocytopenia. Although it is usually short-lived, some cases persist and are unresponsive to treatment. This can lead to exposure to a variety of treatment regimens including immunosuppressants and splenectomy. The goal of this report is to present a case of chronic ITP of childhood that responded to tonsillectomy addressing the tonsils as a source of chronic infection and inflammation triggering ITP.Methods
A 4-year-old male with ITP of childhood presented with enlarged tonsils and obstructive sleep apnea. History and physical were consistent with chronic tonsillitis/adenoiditis including malaise, poor oral intake, congestion, rhinorrhea, tonsil hypertrophy, and lymphadenopathy persisting despite antibiotic therapy. Tonsillectomy and adenoidectomy were performed.Results
One, six, and eighteen weeks post-operatively the platelet count was 371, 215, and 205 respectively. Although at 12 months two relapses had occurred, during the observed period, he had decreased incidence and severity of disease.Conclusion
In around 60% of ITP there is a history of prior infection within the last month but no systemic symptoms at time of diagnosis. Additionally, chronic ITP is characterized by relapses coinciding with infection. This case is unique because the patient had chronic ITP and a clinical history and physical exam concerning for a subclinical, indolent inflammatory process that responded to surgical intervention. Given that chronic ITP exacerbation has been associated with recurrent acute infections it seems probable that chronic tonsillitis could serve as a trigger for relapse or contribute to a prolonged and/or more severe disease course. Therefore, tonsillectomy may result in earlier treatment and/or an altered disease course with avoidance of the expense and morbidity associated with frequent exacerbations and multiple treatment regimens. 相似文献8.
Introduction
Subcutaneous emphysema [SCE] can develop due to traumatic, infectious, and spontaneous causes and usually localizes to the periorbital space.Case
We present a case of an 18-year-old male with an 8-day history of migraine-like headaches followed by the acute onset of frontofacial swelling after vigorous sneezing. Radiologic and physical exam findings supported a diagnosis of frontofacial SCE in the setting of frontal sinusitis.Discussion
A sneeze, although usually benign, causes a significant increase in intranasal pressure. When coupled with a history significant for facial trauma or rhinosinusitis, this rise in pressure can be sufficient to cause fracturing of the bone overlying a paranasal sinus, leading to the formation of SCE. 相似文献9.
10.
Hemangiopericytomas are soft tissue tumors composed of pericytic cells that are characterized by their “staghorn” vascular branching and their variable clinical presentation. Fifteen to 25% of all HPC occur in the head and neck, with only 5% found in the nose or paranasal sinuses. Sinonasal hemangiopericytoma (SNHPC) is considered distinct from its soft tissue counterpart – the former showing a more uniform cellular organization, has convincing pericytic differentiation and is associated with a far better prognosis. With less than 200 cases of SNHPC reported in the literature, only limited assumptions can be made about this rare tumor. The purpose of this article is to add to the growing body of literature on this disease. We report two new cases of SNHCP – both in female patients who presented with epistaxis and anosmia. Pulsatile vascular masses were visualized with nasal endoscopy – one in the left middle meatus and the second one near the cribriform plate. CT and MRI studies show enhancing masses in the left nasal cavities with thinning and erosion of the skull base. Diagnoses were confirmed by pathology which reported spindle cell neoplasm staining positively for VEGF, NSE, factor XIIIa, S-100 protein, and CD34, and negative for actin, desmin, CD31, and pankeratin, consistent with hemangiopericytoma. In one patient, embolization of the sphenopalatine and labial artery as well as pre-operative radiation therapy was performed before complete endoscopic resection was undertaken. The second patient had a tumor invading the skull base, so a craniofacial resection was performed. Both patients remained free of disease two years after surgery. Review of the literature and treatment options are discussed. 相似文献
11.
Michael C. Topf David W. Hsu Douglas R. Adams Tingting Zhan Stanley Pelosi Thomas O. Willcox Brian McGettigan Kyle W. Fisher 《American journal of otolaryngology》2017,38(1):21-25
Purpose
To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection.Materials and methods
Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90 days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation.Results
One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18 days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5 days for perforation healing compared to 17.5 days with no prior history of radiation and this approached statistical significance (p = 0.078).Conclusions
The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation. 相似文献12.
Deguang Zhang Lei Xie Gaofei He Liang Fang Yuwen Miao Zhezhe Wang Li Gao 《American journal of otolaryngology》2017,38(2):115-120
Purpose
Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM.Materials and methods
Between May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness.Results
The mean follow-up period was 18.6 months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p = 0.0001) and mean age was lower (p = 0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p = 0.0003 and p < 0.0001, respectively).Conclusions
The safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM. 相似文献13.
14.
Seon-Lin Kim Sung-Dong Kim Han-Seul Na Jae-Wook Kim Keun-Ik Yi Sue-Jean Mun Kyu-Sup Cho 《Auris, nasus, larynx》2019,46(5):742-747
ObjectiveThe blocking of airflow into sinonasal cavity may decrease postoperative crusting and the development of adhesions. The purpose of this study was to investigate the efficacy of cotton ball packing in patients following endoscopic sinus surgery (ESS).MethodsThirty nine patients with chronic rhinosinusitis requiring the same extent of ESS were included. As a part of postoperative care, the patients were instructed to perform a nasal saline irrigation and apply a nasal spray in each nostril, and then informed to put a cotton ball in a one side of nostril, and the other side was kept to be empty as a control. Patients’ subjective symptoms, patients’ pain while receiving sinonasal cavity debridement, time required to perform debridement, and postoperative wound healing were evaluated.ResultsAlthough cotton ball packing resulted in less discomfort for postnasal drip, rhinorrhea, headache, and facial pain than no packing, there were no statistically significant differences between the groups. The cotton ball packing was associated with significantly less pain on while performing postoperative debridement, therefore less time was needed to perform debridement. The cotton ball packing appears to improve wound healing within the sinus cavities up to 1 month postoperatively.ConclusionThe use of the cotton ball packing after ESS results in significantly less formation of crusts and adhesions, leading to decreasing pain and time during postoperative debridement and promoting faster wound healing. 相似文献
15.
A.T. Day L. Tang U.A. Patel J.D. Richmon K.S. Emerick 《American journal of otolaryngology》2018,39(5):518-521
Objective
Despite the resurgence in regional flap use, otolaryngology resident regional flap experience has been incompletely studied. We sought to characterize United States (US) otolaryngology resident exposure to, and perceptions of, supraclavicular flaps (SCFs), submental flaps (SMFs), and other regional flaps.Methods
An online survey was disseminated every two weeks to 106 US otolaryngology residency program directors for distribution to residents within their programs between August and October 2016. 121 surveys were returned of which 106 were sufficiently completed and eligible for data analysis.Results
Among residents with adequate responses, 52 were postgraduate year (PGY) 1–3 (junior) residents and 54 were PGY 4–7 (senior) residents. Senior residents participated in more pectoralis major flaps (mean: 8.1, 95%-CI: 6.5–9.8) compared to SCFs (mean: 1.5, 95%-CI: 1.0–2.0, p?<?0.001) and SMFs (mean: 0.7; 95%-CI: 0.4–1.0, p?<?0.001). Among senior residents exposed to SCFs, SMFs and pectoralis flaps, more individuals judged pectoralis major flaps as successful or very successful (96.2%, 95%-CI: 91.1–100%), compared to SCFs (64.3%, 95%-CI: 46.5–82.0%; p?<?0.001) and SMFs (63.2%, 95%-CI: 41.5–84.8%; p?=?0.001).Conclusions
Senior otolaryngology residents were exposed to fewer SCFs and SMFs compared to pectoralis major flaps. Resident perception that SCFs and SMFs were not as successful as pectoralis major flaps should be investigated further. 相似文献16.
Barrett's esophagus is now thought to be an acquired condition rather than a congenital condition. It has a dangerous potential for malignancy; yet, aggressive medical management, antireflux procedures, and diligent follow-up may reduce the incidence of malignancy in this condition. 相似文献
17.
Cameron C. Wick Sharon J. Lin Heping Yu Cliff A. Megerian Qing Yin Zheng 《American journal of otolaryngology》2017,38(1):44-51
Hypothesis
Phosphorus and vitamin D (calcitriol) supplementation in the Phex mouse, a murine model for endolymphatic hydrops (ELH), will improve otic capsule mineralization and secondarily ameliorate the postnatal development of ELH and sensorineural hearing loss (SNHL).Background
Male Phex mice have X-linked hypophosphatemic rickets (XLH), which includes osteomalacia of the otic capsule. The treatment for XLH is supplementation with phosphorus and calcitriol. The effect of this treatment has never been studied on otic capsule bone and it is unclear if improving the otic capsule bone could impact the mice's postnatal development of ELH and SNHL.Methods
Four cohorts were studied: 1) wild-type control, 2) Phex control, 3) Phex prevention, and 4) Phex rescue. The control groups were not given any dietary supplementation. The Phex prevention group was supplemented with phosphorus added to its drinking water and intraperitoneal calcitriol from postnatal day (P) 7–P40. The Phex rescue group was also supplemented with phosphorus and calcium but only from P20 to P40. At P40, all mice underwent auditory brainstem response (ABR) testing, serum analysis, and temporal bone histologic analysis. Primary outcome was otic capsule mineralization. Secondary outcomes were degree of SNHL and presence ELH.Results
Both treatment groups had markedly improved otic capsule mineralization with less osteoid deposition. The improved otic capsule mineralized did not prevent the development of ELH or SNHL.Conclusion
Supplementation with phosphorus and calcitriol improves otic capsule bone morphology in the Phex male mouse but does not alter development of ELH or SNHL. 相似文献18.
Xuan Su Caiyun He Tao Tang Weichao Chen Zhaoqu Li Yong Chen Ankui Yang 《American journal of otolaryngology》2017,38(1):52-56
Objective
The value of additional use of cetuximab with the classical cisplatin, docetaxel and 5-fluorouracil regimen in larynx preservation remains unknown. This study was designed to resolve this issue and appraise its toxicity.Materials and methods
Thirteen untreated patients with stage III–IV larynx or hypopharynx squamous cell carcinoma were recruited and received two cycles of C + TPF regimen (cetuximab plus docetaxel, cisplatinand and 5-fluorouracil), followed by one more cycle of C + TPF and intensity-modulated radiotherapy (70 Gy). Primary endpoint was larynx preservation (LP) rate at 3 months. Secondary endpoints were larynx function preservation (LFP) and overall survival (OS) at 12, 36 and 60 months.Results
With a two-cycle induction treatment of C + TPF protocol, four (31%) and nine (69%) patients achieved complete and partial response, respectively. The top three toxicities were dermatitis (9 cases), nausea/vomiting (6 cases), and anemia (4 cases). After the full-course treatment, 12 out of 13 patients (92.3%) obtained LP at 3 months. This strategy demonstrated relatively high LFP rates of 92.3%, 69.2% and 54.5% and satisfactory OS rates of 100%, 84.6% and 54.5% at 12, 36 and 60 months, respectively.Conclusions
These preliminary results suggest induction treatment with C + TPF regimens, followed by intensity-modulated radiotherapy is well-tolerated, which warrants further evaluation. 相似文献19.