A facelift procedure for resection of a branchial cleft cysts

ObjectivesBranchial cleft cysts (BCCs) are common in daily practice, however, BCC patients suffer aesthetic problems due to postoperative scars on visible parts after surgery. To analyze the feasibility, surgical outcomes and possible risks and complications encountered during a facelift procedure for patients with BCC.MethodsThis retrospective analysis examined patients who had undergone surgery for branchial cleft cyst using a facelift procedure (n = 16) or conventional transcervical resection (n = 20) at our institutes between April 2015 and August 2021.ResultsThere was no significant difference between the groups that underwent the facelift procedure or conventional transcervical resection as to the average size of the cysts, operating time, bleeding, drain out, or recurrence. None of the patients needed to switch from the facelift procedure to conventional transcervical resection. In all the patients in the facelift procedure group, postoperative scars were fully concealed by the auricle and hair. However, four patients in the facelift procedure group experienced a transient auricular complication after surgery.ConclusionThe facelift procedure provides adequate visualization, workspace and excellent cosmetic results in suitably selected cases with BCC.     

Anatomo-radiological study supporting the use of ipsilateral nasoseptal flap for the transpterygoid management of temporo-sphenoidal meningoceles. A review of 21 cases

ObjectivesSurgical treatment of temporo-sphenoidal meningoceles involves the reduction of the meningocele, watertight closure and defect coverage with a nasoseptal flap (NSF). It can be performed contralaterally or ipsilaterally: in the latter situation, the pedicle of the flap must be dissected into the pterygopalatine fossa. The objective of this study was to evaluate the benefit of using an ipsilateral NSF in transpterygoid approaches for the management of temporo-sphenoidal meningoceles, compared to a contralateral NSF, based on a radiological study.Material and methodsRetrospective monocentric study of 21 cases, between 2002 and 2018. Measurement of the NSF lengths, and lengths needed to cover the defect were evaluated on the preoperative scanner. Early and later failure and complication rates were evaluated.ResultsSeventeen cases of temporo-sphenoidal meningoceles with available CT scan were identified. The mean duration of follow up was 27.9 months [1–147]. Theoretical lengths of the ipsi and contralateral NSF were comparable: 71.4 ± 7.8 mm vs. 78.8 ± 8 mm, P = 0.729. In 8 cases/18 (42%), the theoretical length of the contralateral NSF was not long enough to cover the defect beyond the V2 (mean lack of 8.87 ± 6.6 mm). In all cases, the theoretical length of the ipsilateral NSF was sufficient to cover the defect. In the case series, failure and complication rates were similar.ConclusionThe use of an ipsilateral NSF for the transpterygoid management of temporo-sphenoidal meningoceles, although more complex, allows a better coverage of the defect, compared to the contralateral NSF, which is not long enough in 42% of cases.     

Exhaled nitric oxide levels are associated with the severity of chronic epipharyngitis and decreased via epipharyngeal abrasion

ObjectiveThe author previously demonstrated that the levels of oral exhaled nitric oxide (NO) were reduced by repeated epipharyngeal abrasive therapy (EAT) for chronic epipharyngitis along with the patients’ symptoms, suggesting that exhaled NO may be a useful outcome parameter of repeated EAT. This study aimed to investigate whether the levels of oral exhaled NO indicate the severity of epipharyngitis and whether an epipharyngeal abrasion immediately influences the amount of exhaled NO.MethodsParticipants visited the author's clinic for the diagnosis and treatment of chronic epipharyngitis from November 2020 to March 2021. NO levels were measured orally before EAT, after nasal anesthesia and EAT without zinc chloride (ZnCl₂), and after EAT with ZnCl₂. The correlation between the endoscopic finding scores in conventional light and black spots and the cobblestone appearance with granular changes in band-limited light as well as the exhaled NO levels were determined.ResultsThe study included 102 patients (30 males, 72 females; median age, 45.7 years). NO levels were significantly lower (p < 0.01) in EAT without ZnCl₂ (17.0 [11.0–25.3]) and even lower with ZnCl₂ (12.0 [8.0–21.0]) than before EAT (21.5 [15.8–35.0]). NO was significantly higher (p <0.01) in chronic epipharyngitis with the cobblestone appearance with granular changes (23.5 [17.0–37.8]) than without it (19.0 [15.0–23.5]). The total number of endoscopic finding scores and the exhaled NO levels showed a positive correlation (r = 0.251; p = 0.015). Additionally, the cobblestone appearance with granular changes and exhaled NO levels showed a positive correlation (r = 0.256; p = 0.013).ConclusionEAT decreased immediately exhaled NO levels with or without ZnCl₂, suggesting that physical stimulation with a cotton swab without ZnCl₂ is therapeutic, and ZnCl₂ may increase this effect. The endoscopic scores were significantly associated with the exhaled NO levels, suggesting that the exhaled NO levels represent the severity of epipharyngitis. The cobblestone appearance with granular changes, which indicates that pathologic ciliated epithelium, was significantly correlated and increased exhaled NO levels, suggesting that NO may be exhaled from ciliated epithelia. These results indicated that exhaled NO levels may be useful as an objective parameter to express the severity of epipharyngitis as well as the outcomes of repeated EAT.     

Stapedius muscle: Don't mistake it for a branch of the facial nerve in images

ObjectiveThe relationship between the stapedius muscle and the vertical part of the facial nerve is important for surgery. The study aims to understand the spatial relationship between the stapedius muscle and the vertical part of the facial nerve in ultra-high-resolution computed tomography (U-HRCT) images.MethodsA total of 105 ears from the heads of 54 human cadavers were analyzed using U-HRCT. The location and direction of the stapedius muscle were evaluated with the facial nerve as the reference. The integrity of the bony septum between the two structures and the distance between the transverse sections were examined. Paired Student's t-test and the nonparametric Wilcoxon test were applied.ResultsThe lower end of the stapedius muscle emerged at the upper (45 ears), middle (40 ears), or lower (20 ears) level of the facial nerve and was positioned medial (32 ears), medial posterior (61 ears), posterior (11 ears), or lateral posterior (1 ear) to the facial nerve. The bony septum was not continuous in 99 ears. The distance between the midpoints of the two structures was 1.75 mm (IQR=1.55-2.16 mm).ConclusionThe spatial relationship between the stapedius muscle and the facial nerve was varied. They were close to each other and in most cases the bony septum was not intact. Preoperative familiarity with the relationship between the two structures is helpful for avoiding unwanted injury to the facial nerve in surgery.     

Transient decrease in sound tolerance levels following hearing deprivation in normal-hearing subjects

ObjectiveTo determine the circadian influence on sound sensitivity produced by temporal hearing deprivation in healthy normal human subjects.DesignParticipants underwent bilateral earplugging before completion of anthropometry, the author's developed questionnaire, the Hamilton Anxiety and Depression Inventory, pure tone audiometry (PTA), stapedial reflex thresholds (SRT), distortion products otoacoustic emissions input/output (DPOAE-I/O), and uncomfortable loudness levels (ULLs). Afterward, the participants were randomly divided into group A, starting at 8:00 a.m. and finishing at 8:00 p.m., and group B, starting at 4:00 p.m. and ending at 4:00 a.m. Serum cortisol levels and audiological test results were obtained at the beginning and end of the session and 24-h free urinary cortisol levels were measured.Study sampleThirty healthy volunteers.ResultsPTA was 2.68 and 3.33 dB HL in groups A and B, respectively, with no statistical difference between them. ULLs were significantly lower in group A compared to group B, with an average of 8.1 dB SPL in group A and 3.3 dB SPL in group B (p < 0.0001). A SRT shift was observed in group A, with no difference in group B, and a night shift in DPOAE-I/O in group B.ConclusionsReduced loudness tolerance is demonstrated during daytime hearing deprivation in contrast to nighttime; this may be due to increased central gain in the awake cortex.     

Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation

PurposeTo compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15).Methods50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up.ResultsThere was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group.ConclusionETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.     

Computer-assisted versus traditional technique in fibular free-flap mandibular reconstruction: A CT symmetry study

ObjectivesIn the past few years, virtual planning has been increasingly used for mandibular reconstruction. The objective of our study was to evaluate and compare symmetry and the accuracy of morphologic reconstruction in patients undergoing mandibular reconstruction by fibular free flap between traditional freehand technique and computer-aided surgical cutting guides.Material and methodsA single-center retrospective study included all cases of mandibular reconstruction using fibular free flap. In the three-dimensional (3D) group, virtual surgery planning with cut guides was used (Materialise ®), while the Control group underwent traditional freehand reconstruction. Morphometric comparisons were made to evaluate reconstruction accuracy between pre- and post-operative CT scans (mean deviations of 3 angles and 3 lengths). Mandible symmetry was calculated by comparing each angle and length in the affected and non-affected sides of the mandible.ResultsThirty-three patients treated between January 2015 and June 2018 were included: 25 patients in the 3D group and 8 in the control group. The average number of mandibular segments was 2.16 ± 0.55 in the 3D group and 1.75 ± 1.16 in the control group (p = 0.005). Mean deviations between pre- and post-operative values of the coronal mandibular angle (angle formed by the line through the two condyles and the ramus), mandibular body height and mandibular ramus length on the affected side were significantly lower in the 3D group than in the control group. Sagittal mandibular angle symmetry was better in the 3D group than, in the control group (ratios of affected over non-affected sides: 1.07 ± 0.04 vs 1.12 ± 0.1; p = 0.034).ConclusionVirtual surgical planning for fibula free-flap reconstruction helps to improve reconstruction accuracy and maintains a significantly greater symmetry than the traditional freehand technique, and should improve functional and esthetic outcome in mandibular reconstruction.     

Aging effect and test-retest reliability of the sinusoidal harmonic acceleration test and velocity step test using nanotorque rotatory chair

IntroductionRotatory chair testing has been used to evaluate horizontal canal function. Frequently used tests include sinusoidal harmonic acceleration test (SHAT) and velocity step test (VST).ObjectivesAssessment of age effect on the SHAT and VST and assessment of test-retest reliability of the parameters of those two tests.MethodsA prospective study was performed on 100 subjects with no ear or vestibular complaints and normal vestibular evaluation. They were divided into two groups; Group A: below 50 years of age and Group B: 50 years of age or above. SHAT was presented at frequencies 0.02, 0.04, 0.08, 0.16, 0.32, 0.64 Hz with a peak velocity of 60°/s. VST was performed using a maximum velocity of 100°/s with acceleration and deceleration of 200°/s^2. Thirty subjects were tested twice to assess reliability.ResultsStudy participants ranged in age from 20 to 67 years. Regarding group A, the mean age was 30.92 ± 7.31 and 55.36 ± 4.61 for group B. No significant differences were found in SHAT parameters between the two groups. As well, there was no significant difference in VST per-rotatory time constant, however, post-rotatory time constant was significantly longer for Group B (P value < 0.05). Intraclass correlation coefficient (ICC) values showed moderate to good reliability (ICC 0.580–0.818) for SHAT parameters for the lower frequencies and indicated moderate reliability for VST time constant (ICC 0.509–0.652).ConclusionsAge has no significant effect on the parameters of SHAT and VST. Test-retest reliability is generally good for both tests.     

The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

ObjectivesNecrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.MethodsRetrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0–19.5) months.ConclusionNEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.Level of evidenceLevel IV.     

Neck stiffness after transoral pharyngolaryngeal surgery for squamous cell carcinoma

IntroductionPyogenic spondylodiscitis is a rare, destructive intervertebral disc infection.Case summaryWe describe a case of C2-C3 pyogenic spondylodiscitis after transoral surgery of the posterior pharyngeal wall in a 64-year-old man with a history of oropharyngeal squamous cell carcinoma (SCC) treated by neck irradiation (45 Gy). Ten years after initial treatment, he underwent total laryngectomy for laryngeal SCC, together with transoral resection of carcinoma in situ (CIS) of the posterior pharyngeal wall followed by BioDesign® tissue repair graft. Five months later, C2-C3 spondylodiscitis was diagnosed with the formation of a fistula between the posterior pharyngeal wall and the intervertebral disc. Antibiotic therapy was administered for a total duration of 3 months (multi-susceptible Escherichia coli). Eight months after the diagnosis of spondylodiscitis, the patient died from carotid artery rupture following another course of radiotherapy for lymph node recurrence.DiscussionLarger-scale studies are necessary to evaluate the prevalence and risk factors of radiation-induced spondylodiscitis that currently remain poorly elucidated. The best treatment strategy (choice and duration of antibiotic therapy) and the optimal frequency of follow-up must be determined and the value of preventive measures (biomaterial, flap repair) needs to be evaluated.     

A multicenter study to investigate the positive rate of SARS-CoV-2 in middle ear and mastoid specimens from otologic surgery patients

ObjectiveSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab.MethodsWe conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery.ResultsThe median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutionsConclusionsOur results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.     

Treatment outcomes of sialendoscopy for submandibular gland sialolithiasis

ObjectiveSialendoscopy is a procedure used to remove salivary stones intraorally using a sialendoscope. In this study, we identified treatment outcomes of sialendoscopic surgery and identified predictive factors for successful stone removal by sialendoscopy alone.MethodsWe assembled the medical records of 144 patients who underwent sialendoscopic surgery for submandibular gland sialolithiasis at the Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, from October 2010 to November 2021, and collected patient backgrounds, medical condition, perioperative factors including operation method and complications, postoperative course, and stone constituents from a clinical laboratory testing company.ResultsSubmandibular gland stones were successfully removed using sialendoscopy in 58 patients (40%). In multivariate analysis, location, major axis, and mobility of the stones were independent factors for successful removal. In receiver operating characteristic analysis, <7.5 mm of a major axis may be used as a measuring standard for successful removal. Removal of parenchymal stones is prone to involve prolonged operation times, increased postoperative complications, and development of retained stones. The stones mainly consisted of calcium phosphate and protein, with content percentages ranging from 0 to 98% (median 37%) and from 0 to 100% (median 63%), respectively. The percentage of calcium phosphate was negatively correlated with the number of floating stones and successful stone removal.ConclusionSialendoscopy is an aesthetically attractive treatment for sialolithiasis that avoids cervical incisions. The present results showed not only known but also new predictive factors for the successful removal of stones (<7.5 mm) and percentage of calcium phosphate. Moreover, our results suggest that careful consideration is required regarding the indication of sialendoscopic surgery in patients with parenchymal stones.     

Silent sinus syndrome with interfrontal sinus retraction: A 3-case series using CARE methodology

IntroductionSilent sinus syndrome (SSS) is a rare entity, almost exclusively involving the maxillary sinus, frontal location being very rarely reported. The aim of the present study was to describe clinical and radiological characteristics and surgical treatment using the CARE methodology.ResultsOne woman and 2 men were referred for chronic unilateral frontal pain with imagery showing silent sinus syndrome. All showed partial or complete liquid opacification of the affected sinus associated with a thin interfrontal sinus (IFS) retracted toward the affected sinus. Functional endoscopic sinus surgery was performed in all cases, with good functional results.DiscussionWe describe 3 cases of SSS with IFS involvement. The frontal sinus wall seemed most vulnerable, probably most liable to be weakened by atelectasis. The study suggests that frontal SSS can be an etiology in chronic frontal sinusitis. Preoperative findings of IFS retraction are useful for surgical restoration of frontal sinus ventilation, relieving chronic pain and preventing complications.     

Complications and prognosis associated with intra-tympanic steroid injection to treat sudden sensorineural hearing impairment

PurposeThe purpose of this study was to measure the incidence of complications in sudden sensorineural hearing loss (SSNHL) patients treated with intra-tympanic steroid injection (ITSI) and compare hearing recovery rates.Materials and methods123 patients with unilateral SSNHL receiving ITSIs were included in this study. Post-ITSI complications were documented including otalgia, dysgeusia, vertigo (duration>1 h), and persistent eardrum perforation. The pain intensity was evaluated with visual analog scale (VAS). Hearing was measured before ITSI and at 1 month after the final ITSI. We compared our patients' hearing threshold between presence and absence of different complications.Results47.2% patients experienced post-injection otalgia with the average VAS score 3.2 (range 2–6). Five (4.1%) and six (4.9%) patients exhibited vertigo and persistent eardrum perforations, respectively. The patients were divided into three groups based on the absence of complications and the presence of vertigo and eardrum perforation. The hearing threshold improvements did not differ significantly among the three groups (p = 0.366). Although the difference was not significant (p = 0.664), the proportion of patients experiencing post-ITSI vertigo who were on contemporaneous oral steroids was lower than the proportion of non-vertigo patients on such steroids.ConclusionThe incidences of otalgia, vertigo, and persistent eardrum perforation in SSNHL patients treated with ITSI were 47.2%, 4.1% and 4.9%, respectively. We found no association between concurrent oral steroid use and the incidence of post-ITSI eardrum perforation or vertigo. Although statistical significance was lacking, patients who did not take contemporaneous oral steroids may have a higher rate of prolonged post-ITSI vertigo.     

Role of the periotic mesenchyme in the development of sensory cells in early mouse cochlea

ObjectiveTo investigate the role of the periotic mesenchyme (POM) in the development of sensory cells of developing auditory epithelium.MethodsDeveloping auditory epithelium with or without periotic mesenchyme was isolated from mice at embryonic days 11.5 (E11.5), E12.5 and E13.5, respectively, and cultured in vitro to an equivalent of E18.5’s epithelium in vivo. Then, the explants were co-stained with antibodies targeting myosin VIIA, Sox2 and BrdU.ResultsMore hair cells in E11.5 + 7 DIV, E12.5 + 6 DIV and E13.5 + 5 DIV auditory epithelia were found upon culture with POM (225.90 ± 62.44, 476.94 ± 100.81, and 1386.60 ± 202.38, respectively) compared with the non-POM group (68.17 ± 23.74, 205.00 ± 44.23, and 1266.80 ± 38.84, respectively). Moreover, regardless of developmental stage, the mesenchymal tissue increased the amount of cochlear sensory cells as well as the ratio of differentiated hair cells to total sensory cells.ConclusionsThe periotic mesenchyme promotes the development of cochlear sensory cells, and its effect depends on the developmental stage of the auditory epithelium.     

Application of UNETR for automatic cochlear segmentation in temporal bone CTs

ObjectiveTo investigate the feasibility of a deep learning method based on a UNETR model for fully automatic segmentation of the cochlea in temporal bone CT images.MethodsThe normal temporal bone CTs of 77 patients were used in 3D U-Net and UNETR model automatic cochlear segmentation. Tests were performed on two types of CT datasets and cochlear deformity datasets.ResultsThrough training the UNETR model, when batch_size=1, the Dice coefficient of the normal cochlear test set was 0.92, which was higher than that of the 3D U-Net model; on the GE 256 CT, SE-DS CT and Cochlear Deformity CT dataset tests, the Dice coefficients were 0.91, 0.93, 0 93, respectively.ConclusionAccording to the anatomical characteristics of the temporal bone, the use of the UNETR model can achieve fully automatic segmentation of the cochlea and obtain an accuracy close to manual segmentation. This method is feasible and has high accuracy.     

Scoping review of cochlear implantation in Susac’s syndrome

ObjectiveScoping review of published literature to establish clinical characteristics and audiologic outcomes in patients diagnosed with Susac’s Syndrome(SS) who have undergone cochlear implantation (CI).Data sourcesAll published studies of CI in SS and contribution of two of our own patients who have not been reported previously.MethodsA comprehensive search of MEDLINE (via PubMed) was carried out in March 2020 using the following keywords and related entry terms: Susac’s Syndrome, Cochlear Implantation.ResultsOur search identified a total of five case reports of CI in SS. With the addition of our two patients reported here, we analyzed characteristics and outcomes in seven patients. Mean age at implantation was 30 years old (range 19–46), with six women and one man implanted. Mean time from onset of hearing loss to implantation was 17 months (range three months to four years). Best reported postoperative speech understanding was reported via different metrics, with six of seven patients achieving open set speech scores of 90% or better, and one subject performing at 68%. Vestibular symptoms were present preoperatively in four of seven patients (57%), with vestibular testing reported in two patients, and showing vestibulopathy in one patient. No complications were reported following cochlear implantation.ConclusionCochlear implantation is a viable option for hearing rehabilitation in patients with SS, with levels of attainment of open set speech comparable to other populations of CI candidates.     

Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation

ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams.MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects.ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied.ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing.     

How to do and why perform the skull vibration-induced nystagmus test

The skull vibration-induced nystagmus test (SVINT) is a global vestibular test stimulating otoliths and semicircular canals at a frequency of 100 Hz, not modified by vestibular compensation, which may reveal vibration-induced nystagmus (VIN). Bone-conducted vibration applied to the mastoid processes and the vertex instantaneously induces predominantly low-velocity (∼10°/s) horizontal nystagmus, with rapid phases beating away from the affected side in patients with unilateral vestibular loss (UVL). VIN starts and stops immediately with stimulation, is continuous, reproducible, beats in the same direction irrespective of which mastoid process is stimulated, with no or little habituation. The SVINT acts like a vestibular Weber test. In peripheral UVL, the SVINT is a good marker of vestibular asymmetry and demonstrates pathological nystagmus beating towards the healthy side in 90% of cases of vestibular neuritis, 71% of cases of Menière's diseases and 44 to 78% of vestibular schwannomas. In superior semicircular canal dehiscence, VIN usually beats towards the affected side due to facilitation of bone conduction related to the presence of a third window. Stimulation of the vertex is more effective than in UVL patients, with sensitivity extending to higher frequencies, up to 700 Hz. Observation of vibration-induced nystagmus then reveals equally represented vertical, torsional, and horizontal components beating towards the affected ear, suggesting dominant, but not exclusive, stimulation of the dehiscent superior semicircular canal.     

Understanding the effects of structured self-assessment in directed,self-regulated simulation-based training of mastoidectomy: A mixed methods study

ObjectiveSelf-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance. This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.MethodsA prospective, educational cohort study of a novice training program consisting of directed, self-regulated learning with distributed practice (5x3 procedures) in a virtual reality temporal bone simulator. The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos. Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants. Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’ self-assessment scores.ResultsSix major themes were identified in the interviews: goal-directed behaviour, use of learning supports for scaffolding of the training, cognitive engagement, motivation from self-assessment, self-assessment bias, and feedback on self-assessment (validation). Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure. They scaffolded their learning through the available learning supports. Finally, structured self-assessment was reported to increase the participants’ cognitive engagement, which was further supported by a quantitative increase in cognitive load.ConclusionsStructured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.