Influencia de la existencia de una dehiscencia en un canal semicircular en el espesor óseo de los canales contralaterales

ObjectivesOur objective was to determine if the existence of dehiscence in the superior or posterior semicircular canal was associated with the thinning of the bone roof in the rest of the vertical canals (superior or posterior).MethodsThe thickness of the superior and posterior semicircular canals contralateral to a dehiscence was studied using computerized tomography and compared statistically.ResultsWhen a superior semicircular canal had a dehiscence, the contralateral canal showed a significant mean decrease in its thickness of 0.5 mm (SD: 0.3 mm). This was not the case if the dehiscence was in the posterior semicircular canal, where the thickness of 2.1 mm remained unchanged (SD: 1.2 mm; P=.49).When a posterior semicircular canal showed dehiscence, no significant thinning was shown in the superior semicircular (1 mm; SD: 0.4) or in the posterior contralateral (1.3 mm; SD: 0.3) canals.ConclusionThe existence of a dehiscence in the superior semicircular canal is associated with bone thinning in the canal on the opposite side, but not with the posterior semicircular canal. In contrast, if the dehiscence is in the posterior semicircular canal, contralateral and superior canal thickness is not modified.     

Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation

IntroductionVarious aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery.ObjectiveThe present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery.MethodsThirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification.ResultsWhen the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51–1.27 mm (mean of 0.69 ± 0.25 mm). Maximum width of round window ranged from 0.51 to 2.04 mm (mean of 1.16 ± 0.47 mm). Average minimum distance between round window and carotid canal was 3.71 ± 0.88 mm (range of 2.79–5.34 mm) and that between round window and jugular fossa was 2.47 ± 0.9 mm (range of 1.24–4.3 mm).ConclusionThe distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.     

Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches

IntroductionRadiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit.ObjectiveThe goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry.MethodsThis retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations.ResultsLamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88° and 9.6 mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm², 6.89 cm², 4.51 cm² and 12.46 cm² respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm³. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types.ConclusionPrecise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.     

Cephalometric evaluation of tongue position and airway remodelling in children treated with swallowing occlusal contact intercept appliance (S.O.C.I.A.)

IntroductionFacial growth changes the position of the jaws (in particular vertical position of the maxilla and antero-posterior position of the mandible) and may, in turn, modify the position of the tongue and the hyoid bone, thus, generating modifications of the upper airway space. In the present paper, effects on upper airway space and tongue position of a new functional appliance, the swallowing occlusal contact intercept appliance (SOCIA) have been investigated.Materials and methodsRetrospective cephaolmetric study of twenty-four children (mean age 9.46 ± 1.60) with hyperdivergent Class II malocclusion with mandibular retrusion and atypical deglutition, was performed on radiographs taken before and after 24 months treatment with “SOCIA” appliance. The variables considered in this study, and analysed by means of a Paired t-test with a 5% level of significance, included the distance between the base of epiglottis (EB) and the tip of the tongue (TT), the distance from the tongue dorsum to EB-TT (TGH), the distance between the posterior nasal spine PNS and EB (VAL), SPAS, MAS and IAS (i.e. superior, medium and inferior pharyngeal airspace width).ResultsOur findings showed a significant increase in tongue length (TT-EB) and tongue height (TGH); thus, confirming the reposition of the tongue from a lower posture to its physiological position onto the palatal spot. These modifications of the tongue posture had effects on the upper airway space. The most important modifications were observed in SPAS, with a significant 5.9 mm increase. Some increase was found also for MAS (0.83 mm) and IAS (1.1 mm) but without statistical significance. A significant increase (7.75 mm) was also found for VAL, probably as a result of the augmentation of posterior facial height.ConclusionsSOCIA appliance is capable to improve tongue position and the superior posterior airway space, and, consequently, to improve deglutition, phonation and respiratory function.     

Characterization of spontaneous otoacoustic emissions in full-term newborns

ObjectiveTo analyze the characteristics of spontaneous otoacoustic emissions (SOAEs) in full-term newborns.MethodsA total of 236 ears from 147 randomly selected full-term Chinese neonates (82 females and 65 males), who had passed the initial newborn hearing screening, were assessed for SOAEs using the Capella OAE equipment (Madsen, Denmark). The test was performed in a sound booth.Results(1) The overall prevalence of SOAE was 56.77% of the ears. The prevalence of SOAEs was significantly higher in females (69.23%) than in males (41.51%, p < 0.01), as well as in the right ears (64.17%) than in the left ears (49.14%, p < 0.05). (2) The overall mean level of SOAE was 11.78 ± 8.36 dB SPL, with no significant differences between males (11.73 ± 8.25 dB SPL) and females (11.81 ± 8.43 dB SPL) or between the left (11.97 ± 8.56 dB SPL) and the right ears (11.65 ± 8.22 dB SPL). (3) The 25th and 75th percentiles of SOAE frequencies were 2.31 and 4.36 kHz in females and 1.93 and 3.94 kHz in males, which were statistically significantly different (p < 0.01). In contrast, the SOAE frequency was not significantly different between ears (2.22–4.18 kHz in the left ears and 2.17–4.14 kHz in right ears). (4) The overall mean number of SOAEs was 3.70 ± 2.75, with no significant differences in females (3.62 ± 2.70) and males (3.86 ± 2.87) or in right (3.70 ± 2.55) and left ears (3.70 ± 3.02).ConclusionsThe prevalence rate of SOAE is significantly higher in females than in males and in the right ears than in the left ears in Chinese newborns. The frequencies of the SOAEs in newborns appeared to be higher than those reported in normal-hearing adults in the literature.     

Peripheral Th17/Treg cell-mediated immunity imbalance in allergic rhinitis patients,

IntroductionAllergic rhinitis (AR) is an IgE-mediated non-infectious disease of the nasal mucosa following contact with allergens.ObjectiveTo investigate the peripheral Th17 cells and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and the expression of cytokines in the serum of AR patients.MethodsThe peripheral blood of 14 patients with AR (AR group) and six healthy subjects (control group) was collected from March to May of 2012. Flow cytometry was performed to detect the Th17 cells and Treg cells, and enzyme-linked immunosorbent assay (ELISA) to measure the serum levels of IL-17 and TGF-&#946;1.ResultsThe proportion of Th17 cells in the AR group was markedly higher than that in the control group (p < 0.01). The proportion of Treg cells in the AR group was also dramatically reduced when compared with the control group (p < 0.01). In the AR group, serum IL-17 levels were markedly higher than those in the control group (p < 0.01). In the AR group, serum TGF-&#946;1 levels were significantly lower than those in the control group (p < 0.01).ConclusionThe imbalance of peripheral Th17/Treg cells plays an important role in the pathogenesis of AR.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by ElsevierEditora Ltda. All rights reserved.     

Scales of degree of facial paralysis: analysis of agreement

IntroductionIt has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics.ObjectiveTo analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use.MethodsCross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed.ResultsThere was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers’ point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale.ConclusionBoth scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales.     

Speech-in-noise perception ability can be related to auditory efferent pathway function: a comparative study in reading impaired and normal reading children

IntroductionDeficient auditory processing can cause problems with speech perception and affect the development and evolution of reading skills. The efferent auditory pathway has an important role in normal auditory system functions like speech-in-noise perception, but there is still no general agreement on this.ObjectiveTo study the performance of the efferent auditory system in a group of children with reading impairment in comparison with normal reading and evaluation of its relationship with speech-in-noise perception.MethodsA total of 53 children between the ages of 8–12 years were selected for the study of which 27 were with reading impairment and 26 were normal reading children. Transient evoked otoacoustic emissions suppression and auditory recognition of words-in-noise test were performed for all the children.ResultsThe average amplitude of transient evoked otoacoustic emissions suppression showed a significant difference between the two groups in the right (p = 0.004) and in the left ear (p = 0.028). Assessment of the relationship between transient evoked otoacoustic emissions suppression and monaural auditory recognition of words-in-noise scores showed a significant moderate negative relationship only in the right ear (p = 0.034, r = −0.41) of the normal reading children. Binaural auditory recognition of words-in-noise scores were significantly correlated with the amplitude of transient evoked otoacoustic emissions suppression in the right ear (p < 0.001, r = −0.75) and in the left ear (p < 0.001, r = −0.64) of normal reading children. In the reading impaired group, ?a weaker correlation was observed between binaural auditory recognition of words-in-noise scores and transient evoked otoacoustic emissions suppression in the right (p = 0.003, r = −0.55) and in the left ear (p = 0.012, r = −0.47).ConclusionsTransient evoked otoacoustic emissions suppression pattern in the reading impaired group was different compared with normal reading children, and this difference could be related to efferent system performance. Words-in-noise scores in children with impaired reading were lower than in normal reading children. In addition, a relationship was found between transient evoked otoacoustic emissions suppression and words-in-noise scores in both normal and impaired reading children.     

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity

IntroductionEarly carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps.ObjectiveThis study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity.MethodsA superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year.ResultsThe flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0–5 mm in 39 patients, 5–10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used.ConclusionThe study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.     

Masson tumor as a neck mass

IntroductionA Masson's tumor is a benign, intravascular tumor, typically located in the fingers. Histologically, a Masson's tumor is characterized by an intravascular endothelial papillary projection associated with thrombi, without atypia or necrosis. The CD 31 and CD 34 stains are the most efficient immunohistological markers to identify the vascular origin.Case summaryA 54-year-old man presented with a right lateral neck mass for 3 weeks. The CT scan of the neck showed an oval, well-circumscribed cystic mass, measuring 20 mm × 9 mm, situated over the right sternocleidomastoid muscle, with a peripheral vessel draining into the right anterior jugular vein. The mass was excised surgically, and a pathological report indicated a thrombosed material inside the lumen of a small vein with a differentiated papillary structure; neither nuclear atypia nor necrosis were seen. The patient had an uncomplicated recovery and completed 8 months of follow-up appointments without any evidence of recurrence.DiscussionIntravascular papillary endothelial hyperplasia (IPEH) can be differentiated from angiosarcoma by lack of extension to the perivascular tissue and absence of necrosis and atypia. The pathogenesis is still unknown; surgical excision is the method of treatment. This is an extremely rare presentation of Masson's tumor.     

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study

IntroductionThe cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities.ObjectiveThe main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries.MethodsA total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H₂O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20–30 cm H₂O at anytime, it was set to 25 cm H₂O again.ResultsThe intracuff pressure values were increased from 25 to 26.73 (25–28.61) cm H₂O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52–28.67) cm H₂O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02–36.94) and 34.55 (28.43–37.31) cm H₂O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033).ConclusionAccessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.     

OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure?

ObjectiveDrug-induced-sedation endoscopy (DISE) has proved superior to awake clinical examination for diagnosis of upper-airway obstruction sites and surgical planning. Our question is: does multilevel obstruction on DISE systematically entail failure for surgery limited to the upper pharynx?Material & methodsWe conducted a retrospective single-center study in patients with obstructive sleep apnea syndrome (OSAS) treated by single-level surgery of the upper pharynx (tonsillectomy with or without pharyngoplasty). Preoperative assessment included polysomnography (PSG) and DISE. Surgical efficacy was assessed on postoperative PSG. Treatment response was defined by postoperative apnea-hypopnea index (AHI) < 20 events/h with 50% reduction, and cure by AHI < 10 (patients with preoperative AHI ≤ 10 being excluded). Efficacy was compared between groups without (group A) and with basilingual or laryngeal collapsus on DISE (group B).ResultsWe analyzed 63 patients, with mean preoperative AHI 33.8 ± 17.9 events/h. The two groups (A, n = 36; B, n = 27) were clinically comparable. Postoperative PSG took place at a mean 8.5 ± 11.5 months. The success rate was 66.7% in group A (mean reduction in AHI, 57.3 ± 36.2%) and 59.3% in group B (mean reduction, 53.9 ± 39.2%). Cure rates were respectively 48.5% and 48.1%. There was no statistically significant difference between the two groups (P > 0.1).ConclusionsOropharyngeal surgery can alleviate associated obstructive sites found on DISE in the lower pharynx, and step-by-step treatment shows efficacy equal to that of single-step multilevel surgery.     

Endoscopic modified transseptal bi-nostril approach for pituitary tumors. Efficacy of complex preservation of every turbinate and olfaction: A STROBE analysis

AimsEndoscopic modified transseptal bi-nostril approach minimizes turbinate and olfactory mucosal invasion and ensures preservation of the turbinates and bilateral olfaction. The main objective of this study was to investigate the pre- and postoperative variations in olfactory function in patients using this approach, and the secondary objective was to investigate the complications associated with the surgical procedure.Material and methodsThis study is a single-center prospective cohort study using STROBE analysis. To completely protect the bilateral turbinates and olfactory epithelium, this procedure provided access to the sphenoid sinus by a transseptal approach via the left nasal cavity and by the olfactory cleft approach via the right nasal cavity without any turbinate resection. A T&T olfactometer was used to assess the mean recognition threshold of the left, right, and bilateral nasal passages before and after surgery, and complications associated with the surgical approach were investigated.ObjectivesWe included 27 patients who underwent endoscopic modified transseptal pituitary surgery with an olfactory and turbinate preservation approach at our hospital between April 2018 and December 2019.ResultsThe mean postoperative recognition threshold of the right, left, and bilateral nasal cavities did not worsen (P < 0.001 for all) relative to the preoperative values, and there was no difference in values between the right and left nasal cavities (P = 0.85). The nasal turbinates were preserved in all patients during the study period, and no recurrence was observed.ConclusionOur modified EETSA could be implemented as an approach for turbinate and olfaction preservation.     

Lateral pharyngeal flap with a double pedicle for repair of unilateral velopharyngeal insufficiency

ObjectivesConventional pharyngeal flap surgery, which closes the median portion of the velopharynx, has been performed for dysarthria patients with velopharyngeal insufficiency (VPI). However, for VPI due to unilateral pharyngeal paralysis, median closing disrupts pharyngeal contraction of the unaffected side and allows pharyngeal pressure to escape through the nose at the lateral portion of the affected side during speech and swallowing. The purpose of this study was to evaluate the effectiveness of lateral pharyngeal flap (LPF) surgery for unilateral VPI.MethodsSeven patients with unilateral VPI (five males and two females with an average age of 54 years) underwent LPF surgery combined with other transoral surgeries for dysphagia. The LPF surgical technique was as follows: after the laterocaudal-based pedicle flap of the soft palate and cranial-based pedicle flap of the posterior pharyngeal wall on the affected side were transorally elevated, each mucosal pedicle flap was sutured together. Functional oral intake scale (FOIS) scores and swallowing pressure before and after surgery were compared.ResultsUnilateral velopharyngeal closure preserved nasal breathing after LPF surgery in all patients. Rhinolalia aperta improved postoperatively in all patients except one. The mean FOIS scores were 2.3 preoperatively and 3.7, 5.3, and 5.9 at 2 weeks, 1 month, and 6 months postoperatively, respectively. The mean pressures significantly increased at the velopharynx (from 49 ± 30 mmHg to 92 ± 45 mmHg) and oropharynx (from 48 ± 18 mmHg to 66 ± 15 mmHg) six months after the surgery.ConclusionLPF surgery leaving the unaffected side intact can be an effective surgical procedure for patients with unilateral VPI.     

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.     

Azimuthal sound source localization of various sound stimuli under different conditions

AimTo evaluate azimuthal sound-source localization performance under different conditions, with a view to optimizing a routine sound localization protocol.Material and methodTwo groups of healthy, normal-hearing subjects were tested identically, except that one had to keep their head still while the other was allowed to turn it. Sound localization was tested without and then with a right ear plug (acute auditory asymmetry) for each of the following sound stimuli: pulsed narrow-band centered on 250 Hz, continuous narrowband centered on 2000 Hz, 4000 Hz and 8000 Hz, continuous 4000 Hz warble, pulsed white noise, and word (“lac” (lake)). Root mean square error was used to calculate sound-source localization accuracy.ResultsWith fixed head, localization was significantly disturbed by the earplug for all stimuli (P < 0.05). The most discriminating stimulus was continuous 4000 Hz narrow-band: area under the ROC curve (AUC), 0.99 [95% CI, 0.95–1.01] for screening and 0.85 [0.82–0.89] for diagnosis. With mobile head, localization was significantly better than with fixed head for 4000 and 8000 Hz stimuli (P < 0.05). The most discriminating stimulus was continuous 2000 Hz narrow-band: AUC, 0.90 [0.83–0.97] for screening and 0.75 [0.71–0.79] for diagnosis. In both conditions, pulsed noise (250 Hz narrow-band, white noise or word) was less difficult to localize than continuous noise.ConclusionThe test was more sensitive with the head immobile. Continuous narrow-band stimulation centered on 4000 Hz most effectively explored interaural level difference. Pulsed narrow-band stimulation centered on 250 Hz most effectively explored interaural time difference. Testing with mobile head, closer to real-life conditions, was most effective with continuous narrow-band stimulation centered on 2000 Hz.     

Keys for successful publication in Eur Ann Otorhinolaryngol Head Neck Dis: A STROBE analysis of peer reviews of articles submitted in 2020–2021

ObjectiveTo evaluate reviewing and editorial decision for articles submitted to the European Annals of Otorhinolaryngology Head & Neck Diseases.Materials and methodsA retrospective analysis was made of reviewers’ comments on 1,133 scientific articles (700 original articles, 96 literature reviews, and 337 case reports), originating from 69 countries, consecutively submitted on-line between January 1st, 2020 and December 31st, 2021. The main objective was to document the acceptance rate and decision time. Accessory objectives were to synthesize the main comments and to screen for correlations between acceptance and the main characteristics of first authors, articles and reviewers’ comments.ResultsIn total, 4.1% of submitted articles were accepted. Median decision time differed significantly (P < 0.0001), at 1 month in case of refusal and 4 months in case of acceptance. Reviewers mentioned failure to adhere to the journal's authors’ guide, to use the appropriate EQUATOR guidelines and to adopt the recommended P < 0.005 significance threshold in 94.8%, 54.2%, and 39.9% of cases, respectively. On multivariate analysis, 3 variables significantly impacted acceptance, which increased from 1.3% to 44.6% (P < 0.0001) when an appropriate EQUATOR guideline was used and from 0.3% to 57.4% (P < 0.0001) when the significance threshold was set at P < 0.005, and decreased from 10.5% to 1.1% (P = 0.0001) when the article did not originate from a French-speaking country (member of the Francophonie organization).ConclusionAdhesion to modern scientific medical writing rules increased acceptance rates for articles in the European Annals of Otorhinolaryngology Head & Neck Diseases. Teaching modern scientific medical writing needs to be enhanced in otorhinolaryngology.     

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.     

Hashimoto's thyroiditis – an independent risk factor for papillary carcinoma

IntroductionThe link between Hashimoto's thyroiditis and thyroid carcinoma has long been a topic of controversy.ObjectiveThe aim of our study was to determine the prevalence of thyroid carcinoma and Hashimoto's thyroiditis coexistence in histopathologic material of thyroidectomized patients.MethodsIn a retrospective study, the clinicohistopathologic data of 2117 patients (1738 females/379 males), who underwent total or partial thyroidectomy for thyroid gland disorder at a single institution from the 1st of January 2005 to the 31st of December 2014 were analyzed.ResultsThyroid carcinoma was detected in 318 cases (15%) and microcarcinoma (thyroid cancer ≤10 mm in diameter) was found in permanent sections in 169 cases (8%). Hashimoto's thyroiditis was detected in 318 (15%) patients. Hashimoto's thyroiditis was significantly more often associated with thyroid carcinoma and microcarcinoma compare to benign condition (p = 0.048, p = 0.00014, respectively). Coexistence of Hashimoto's thyroiditis and thyroid carcinoma/thyroid microcarcinoma did not affect tumor size (p = 0.251, p = 0.098, respectively), or tumor multifocality (p = 0.831, p = 0.957, respectively). Bilateral thyroid microcarcinoma was significantly more often detected when Hashimoto's thyroiditis was also diagnosed (p = 0.041), but presence of Hashimoto's thyroiditis did not affect bilateral occurrence of thyroid carcinoma (p = 0.731).ConclusionHashimoto's thyroiditis is associated with significantly increased risk of developing thyroid carcinoma, especially thyroid microcarcinoma.     

Assessment of pulmonary artery pressure and right ventricular function in children with adenotonsillar hypertrophy using different parameters

ObjectiveOur aim was comparison of preoperative and postoperative right ventricular functions of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction, using new echocardiographic parameters.MethodsForty-one children who have admitted to our hospital with symptoms suggestive of upper airway obstruction, whose history and physical examination findings suggest upper airway obstruction and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2 and 12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue Doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation.ResultsOf 41 children in study group, 26 (63.4%) had adenotonsillectomy and 15 (36.6%) had adenoidectomy. Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in preoperative group compared to control group (18.46 ± 1.67, 19.77 ± 1.62; p = 0.000, respectively). Myocardial performance index (MPI) was significantly higher in preoperative group than postoperative and control group (0.40 ± 0.07, 0.36 ± 0.06, 0.35 ± 0.07; p = 0.032, respectively). Tricuspid isovolumic acceleration (TIVA) was significantly lower in preoperative group than preoperative and control group (2.97 ± 0.8, 3.43 ± 0.7, 3.43 ± 0.9; p = 0.020, respectively). Disappearance of this difference was found between postoperative and control groups (p = 0.984). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control group (109.68 ± 18.03, 118.93 ± 17.46, 120.0 ± 14.07; p = 0.010, respectively). Mean pulmonary artery pressure (mPAP) was significantly higher in preoperative group than control group (29.64 ± 8.11, 24.95 ± 6.33; p = 0.010, respectively). In postoperative group mPAP was found to be similar to control group (25.48 ± 7.85, 24.95 ± 6.33; p = 0.740, respectively).ConclusionsTAPSE, PAcT, MPI and TIVA are useful markers for evaluation of preoperative and postoperative ventricular function in children with ATH who have findings of upper airway obstruction. We think that using these practical and easy-to perform parameters may be relevant for evaluation and postoperative follow-up of patients with ATH who have findings of upper airway obstruction. Besides adenotonsillectomy is a beneficial treatment option for these patients.