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.     

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.     

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.     

Hearing rehabilitation with osseointegrated hearing implant in bilateral congenital external auditory canal atresia

Introduction and objectivesCongenital atresia of the external auditory canal (EAC) is a congenital defect present in one in every 10,000–20,000 births. It causes conductive hearing loss, with an air-bone gap of 50–60 dB. Early amplification is essential in bilateral cases to ensure normal language development. The aim of this study is to present the osseointegrated hearing implant as a treatment for bilateral EAC atresia, reviewing the audiometric results and the rate of complications.Material and methodsRetrospective analysis of patients diagnosed with bilateral congenital EAC atresia under follow-up in the pediatric ENT clinic of the ENT and Head and Neck Surgery department of a Portuguese Tertiary Hospital, between 2003 and 2019. We reviewed the medical records and collected information on the assessment of the initial audiometric status. In the cases submitted for implantation with an osseointegrated hearing implant, we analyzed the details of follow-up, including immediate and long-term post-operative complications, as well as the audiometric results.ResultsWe present 8 pediatric patients, 6 girls and 2 boys, with a diagnosis of bilateral congenital EAC atresia. The audiometric assessment revealed moderate to severe bilateral conductive hearing loss with a mean speech recognition threshold (SRT) of 51 dB. Six patients underwent osseointegrated hearing implantation. All 6 patients showed good audiometric results, with an average SRT of 20 dB and closure of the air-bone gap.ConclusionsThe osseointegrated hearing implant was an effective treatment option in these patients, without significant morbidity or complications. Osseointegrated hearing implantation should be considered first line treatment for children with bilateral congenital EAC atresia, as it presents good functional results and a high level of patient satisfaction.     

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

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

Effect of different head impulse procedures on vestibulo-ocular reflex gain

Objectiveto study the effects on vestibulo-ocular reflex (VOR) gain using both video head impulse test (vHIT) and Suppression Head impulse test (SHIMP) either using the outward or the inwards head impulse.MethodsTwenty healthy subjects were enrolled in the study. They were examined using otometric vHIT and SHIMP test lateral plane using the lateral outwards head impulse ten impulses for each side and the inwards head impulse ten impulses for each side. The VOR gain resulting from the outwards versus inwards head impulse during the vHIT and SHIMP were statistically compared.ResultsTwenty healthy subjects, 10 Males and 10 females with a mean age 35 ± 11.7. Paired t- test showed no statistical significance difference in the mean VOR gain of right lateral semicircular canal (1.1 ± .12) using outwards versus (1.03 ± .22) inwards head impulses, nor for the left lateral semicircular canal mean VOR gain (1.1 ± .22) using outwards head impulse (1.1 ± .3) for inwards head impulse in vHIT. Paired t- test showed no statistical significance difference in the mean VOR gain of right lateral semicircular canal (0.96 ± 0.2)using outwards versus (1.04 ± 0.2) inwards head impulses, nor for the left lateral semicircular canal mean VOR gain (0.98 ± 0.25) using outwards head impulse (1.1 ± 0.28) for inwards head impulse in SHIMP test. No statistical significant difference was found between the VOR gain resulting from the right versus the left semicircular canal.ConclusionThe starting head position does not affect the VOR gain using both vHIT and SHIMP tests.     

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.     

A highly specific recurrent pleomorphic adenoma of the nasal septum

A 90-year-old woman presented with the sudden onset of visual loss. She previously underwent surgery to treat a right septal pleomorphic adenoma (PA) at 77 years old. She initially presented to our hospital with severe nasal obstruction at 83 years old. A large tumor occupied the bilateral nasal cavities and, thus, surgery was performed using midfacial degloving and an endoscopic endonasal combined approach. A 60×45×43 mm tumor was completely removed; however, a small area of the tumor capsule was damaged. Six years after surgery, PA recurred in the posterior midline portion of the nasal cavity. Imaging examinations revealed a 48×42×45 mm mass, which compressed the bilateral optic canal, thereby causing severe visual loss. The recurrent tumor was endoscopically removed, and vision recovered after surgery. The lack of malignant transformation was pathologically confirmed throughout this period. The present case had several highly specific features: she was very elderly, the tumor was very large, and visual dysfunction was caused by nasal PA. We described surgical procedures in detail and considered the specific findings of the present case. En bloc resection with a sufficient margin was considered to be important in the present case because recurrence may be caused by incomplete excision.     

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.     

Multifocal recurrence on the transaxillary robotic thyroidectomy incision

IntroductionRobotic thyroidectomy (RT) has been reported to achieve satisfactory results. However, its long-term oncological results have not been validated. The use of RT to treat thyroid cancer comprises specific risks that are not encountered with open thyroidectomy (OT).Case summaryWe report the case of a patient operated by two-stage RT for stage pT3a follicular carcinoma, followed by tumour seeding along the incision despite adjuvant Iodine-131 therapy and external beam radiotherapy.DiscussionThis case illustrates the limitations and insufficient perspective of RT for thyroid cancer, with the recent discovery of a risk of tumour seeding along the incision. Rigorous patient selection should help to avoid this risk of tumour seeding.     

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.     

Coblation versus microdebrider-assisted turbinoplasty for endoscopic inferior turbinates reduction

ObjectivePatients suffering from persistent inferior turbinates hypertrophy refractory to medical treatments require surgical intervention where the main aim is symptomatic relief without any complications. Extraturbinoplasty is one of the preferred procedures for turbinate reduction due to its efficacy in freeing up nasal space by removing the obstructing soft tissue and bone while preserving the turbinate mucosa. We sought to evaluate the effectiveness and safety of microdebrider assisted turbinoplasty (MAT) and coblation assisted turbinoplasty (CAT) performed as an extraturbinoplasty procedure.MethodsA prospective randomized comparative trial was conducted among patients with bilateral nasal blockage secondary to inferior turbinates hypertrophy. Patients were randomly assigned to MAT or CAT. An extraturbinal medial flap turbinoplasty was performed for both techniques. Symptom assessment was based on the visual analogue score for nasal obstruction, sneezing, rhinorrhea, headache and hyposmia. Turbinate size, edema and secretions were assessed by nasoendoscopic examination. The assessments were done preoperatively, at 1st postoperative week, 2nd and 3rd postoperative months. Postoperative morbidity like pain, bleeding, crusting and synechiae were documented. The clinical outcomes of both techniques were analyzed using repeated measures ANOVA.ResultsA total of 33 participants were recruited, 17 patients randomized for MAT and 16 patients for CAT. Nasal obstruction, discharge, sneezing, headache and hyposmia significantly reduced from 1st week until 3 months for both procedures. Similar significant reductions were seen for turbinate size, edema and secretions. However, there was no significant difference in symptoms and turbinate size reduction were seen between both groups at the first postoperative week, 2nd and 3rd postoperative months. There was significant longer operating time for CAT when compared to MAT (p = 0.001). The postoperative complications of bleeding, crusting and synechiae did not occur in both groups.ConclusionBoth MAT and CAT were equally effective in improving nasal symptoms and achieving turbinate size reduction in patients with inferior turbinate hypertrophy. Both MAT and CAT offer maximal relieve in patients experiencing inferior turbinates hypertrophy by removing the hypertrophied soft tissue together with the turbinate bone without any complications.     

Retrospective study of risk factors for tympanic membrane perforation in the early period after intratympanic steroid injection

ObjectiveIntratympanic steroid injection (ITSI) can be an effective treatment for sudden sensorineural hearing loss or Meniere's disease. Tympanic membrane (TM) perforation after ITSI is a major complication which needs additional treatment. The purpose of this study is to assess the factors associated with TM perforation after ITSI.MethodsWe obtained the clinical data of patients who underwent ITSI treatment at the Department of Otolaryngology JR Tokyo General Hospital from April 2013 to March 2021. The data included age, sex, treated side, number of injections, average interval between injections, TM anesthesia with Zentöl solution, which contains phenol, any history of diabetes and any concurrent use of oral or intravenous steroids. We evaluated the association between these variables and TM perforation after ITSI using the Student's t-test, the chi-squared test, univariate logistic regression analysis and multivariate logistic regression analysis. TM perforation was defined as a case in which perforation was observed at least once during outpatient visits.ResultsRecords of 205 ears in 190 patients were analyzed. The overall proportion of TM perforation in the early period after ITSI was 12.7% (26 out of 205 ears), which decreased to 9.3% (19 out of 205 ears) and 5.9% (12 out of 205 ears) at the 1- and 3-month follow-ups, respectively. The proportion of TM perforation in the early period after ITSI without TM anesthesia was 3.5% (5 ears out of 145 ears), which decreased to 1.4% (2 ears) or 0% at the 1- or 3- month follow-ups, respectively. The use of tympanic anesthetics which contain phenol was significantly associated with TM perforation in univariate logistic regression analysis (odds ratio: 15.08, 95% confidence interval: 5.34–42.56, p < 0.001) and in multivariate analysis (odds ratio: 20.76, 95% confidence interval: 6.31–68.3, p < 0.001). All TM perforation cases without TM anesthesia healed spontaneously or with paper tympanic closure treatment. TM perforation in 6 ears out of 21 ears with TM anesthesia did not heal during the follow-up.ConclusionThe overall proportion of TM perforations from the early period after ITSI was 12.7%, 9.3% at the 1-month post-ITSI outpatient follow-up, 5.9% at the 3-month post-ITSI outpatient follow-up. Tympanic anesthesia was significantly associated with TM perforation after ITSI, which indicated that TM anesthesia with solutions containing phenol is not recommended for ITSI.     

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.     

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.     

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty

IntroductionMechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent.ObjectiveThis study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms.MethodsThe research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients’ preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale.ResultsThe mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05).ConclusionThe data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).     

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.     

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.     

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.     

Changes in substance P levels of inferior turbinate in patients with mucosal contact headache

IntroductionMucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy.ObjectivesThis study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache.Methods28 patients who had contact headaches (study group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit.ResultsIn the study group average substance P levels were 2.65 ± 0.27 pg/mg tissue (range: 0.61–5.44) and in the control group it was 1.77 ± 0.27 pg/mg tissue (range: 0.11–4.35). The difference was statistically significant between the two groups (p = 0.0215). Average preoperative headache group visual analog scale scores was 5.93 ± 0.38 (2–9) and the turbinate volume was 6.56 ± 0.35 cm³ (3.50–10.30). The control group turbinate volume was 4.71 ± 0.39 cm³ (2.50–7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p = 0.001).ConclusionThis study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate.