Diagnostic significance of serum periostin in eosinophilic chronic sinusitis with nasal polyps

Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease. Eosinophilic CRSwNP (ENP) exhibits a strong tendency for recurrence after surgery. Given that the treatment strategy of ENP differs from that of non-eosinophilic CRSwNP (nENP), clinical diagnostic criteria that distinguish ENP from nENP are needed.

Methods: In total, 94 CRSwNP patients were enrolled in the cohort. Factors associated with ENP were determined with regression analysis, and optimal cutoff points of the predictors were determined by a receiver operating characteristic curve.

Results: Serum periostin levels, blood eosinophils and basophils counts significantly differed between ENP and nENP. A combination of the cut-off values for the three predictors, including absolute blood eosinophil and basophil counts, yielded a sensitivity of 79.2% and 70.8%, and a specificity of 84.8% and 73.9%, respectively. Serum periostin levels yielded a sensitivity of 72.9% and a specificity of 60.9% for the diagnosis of ENP. The predicted probability of periostin in combination with blood eosinophils and basophils counts (AUC, 0.872) exhibited moderate accuracy. In addition, patients with ENP displayed an increased prevalence of smoking.

Conclusions: Periostin in combination with blood eosinophils and basophils counts has the potential to better refine current CRSwNP phenotypes.     

Impact of nasal conditions on chronic otitis media: a cross-sectional study in Koreans

Objectives: We evaluated the relationship between pathological nasal conditions and pathological middle ear conditions on a large-scale epidemiological basis, conducted as a cross-sectional study at the population level using Korean National Health and Nutrition Examination Survey (KNHANES) data.

Study design: A cross-sectional study.

Methods: In a retrospective cohort study, we analyzed data from the KNHANES (2008–2012), which used a stratified, multi-stage, probability-cluster sampling method in a rolling sampling survey of South Korean citizens.

Results: The prevalences of nasal and middle ear pathologies were evaluated. Chronic postnasal drip, chronic hypertrophic rhinitis, and nasal polyps were correlated with the presence of middle ear pathologies; allergic rhinitis was negatively correlated. The prevalences of chronic otitis media and septal deviation showed no relationship. Only nasal polyps showed a tendency to be associated with cholesteatomatous otitis media in patients with COM.

Conclusions: Our results indicate the need for a nasal assessment when evaluating COM. Additionally, correction of nasal pathologies may be useful with the surgical treatment of COM to improve patient success rates and satisfaction.     

Plunging ranula – patient characteristics,treatment, and comparison between different populations

Objectives: To review our clinical experience and characteristics of Finnish patients with plunging ranula and compare our results with reports from other populations.

Design: A retrospective study from the electronic hospital records between 2005 and 2016.

Setting: The Department of Otorhinolaryngology and Head and Neck Surgery of Helsinki University Hospital, Finland.

Results: We describe the characteristics and treatment of 41 patients with MRI-confirmed plunging ranula. Most of our patients were young adults and 88% of them were male. Surgery and sclerotherapy were used for treatment.

Conclusions: The vast majority of Finnish plunging ranula patients in our cohort were male, suggesting significant population-related differences in plunging ranula gender distribution. Transoral surgery seemed to result in lowest recurrence rate and was the most common treatment in our clinic.     

Cochlear implantation under conscious sedation with local anesthesia; Safety,Efficacy, Costs,and Satisfaction

Objective: To evaluate the safety, efficiency, cost effectiveness, and satisfaction of patients undergoing cochlear implantation under conscious sedation versus general anesthesia.

Study design: Retrospective case review of 20 patients who underwent cochlear implantation under conscious sedation which was compared to 20 age-matched patients where surgery was performed under general anesthesia.

Methods: Perioperative times, length of stay, anesthesia drug costs, postoperative complications, and patient satisfaction were compared between the two groups.

Results: Conscious sedation was associated with decreased drug costs, surgery time, and anesthesia time. Length of stay was significantly longer for patients undergoing general anesthesia. Patient satisfaction was superior with conscious sedation. Perioperative morbidity was not significantly different between the two groups.

Conclusion: Conscious sedation for cochlear implantation is a safe, efficient, and cost-effective alternative to general anesthesia. The efficacy of conscious sedation for cochlear implant surgery may expand the treatment of profound hearing loss to the elderly who are deemed too sick for general anesthesia or are fearful of the cognitive or medical consequences of general anesthesia.     

Surgical complications and their management in cochlear implantees less than 5 years of age: The KEMH Pune experience

Objective: To evaluate the incidence of surgical complications of cochlear implantation and their management at K.E.M. hospital Pune.

Methods: It was a retrospective and prospective observational study conducted from February 2006 to December 2015 in the paediatric age group of 12 months to 5 years (213 cases). The complications were divided into major and minor groups based on the classification proposed by Cohen and Hoffman.

Results: The mean age of implantation was 3.03 years (ranged from 1 to 4.11 years). Sixteen patients had complications. The overall incidence of complications was 7.51% which comprised of major (2.34%) and minor (5.16%) complications. The commonest major complications were flap-related issues and the commonest minor complication was facial paresis.

Discussion: The results of our study were compared with similar studies conducted in the past. All surgical complications were treated conservatively or surgically with success.

Conclusions: Cochlear implantation is the safe procedure in children between the age group of 12 months and less than 5 years.     

Clinical analysis on surgical management of type III external auditory canal cholesteatoma: a report of 12 cases

Objective: To investigate surgical management of type III EACC with lesions involving the posterior external auditory canal and mastoid.

Methods: This retrospective case review was conducted in 12 patients with type III EACC who underwent intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone.

Results: During the follow-up, all patients obtained successful results on external auditory canal structures and hearing improvement, except for one patient who needed a revision operation for the fistula between the reconstructed wall and the mastoid.

Conclusion: Intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone was proved to be an effective and inexpensive choice for the patients with type III external auditory canal cholesteatoma (EACC) to achieve optimal outcomes.     

Will the presence of the patient at multidisciplinary meetings influence the decision in head and neck oncology management?

Objectives: Multidisciplinary team meetings (MTM) are essential in the choice of a therapeutic strategy in head and neck cancer. In many centres patients attend MTMs and are examined by the team. The aim of this study was to assess the influence of the patient’s presence on therapeutic decisions.

Study design: Prospective study of 119 consecutive patients.

Methods: Two therapeutic situations were compared: the therapeutic decision taken following discussion of the patient’s file in the MTM (D1) and the therapeutic decision taken after examination of the patient during MTMs (D2). Concordance between the two situations was measured.

Results: Concordance between D1 and D2 was 97%. No factors likely to decrease concordance were identified. Decisions taken during MTMs were acted upon for 97% of the patients.

Conclusion: The presence of the patient during MTMs is not essential if the files are thoroughly presented and discussed.     

The modified temporalis muscle flap in reconstruction of palate and temporal deformity

Purpose: The purpose of this article was to introduce a modified temporalis muscle flap (TMF) which was used to reconstruct palate and temporal deformity.

Patient and methods: This was a retrospective review of the use of the modified TMF in reconstruction of palate and temporal deformity. We evaluated the result which included operative time, bleeding, necrosis, infection, facial nerve deficit, and cosmetic deformity.

Results: All the 16 patients accepted the modified TMF surgery successfully. There were no complications. All of them were satisfied with the postoperative appearance.

Conclusions: The modified TMF was a reliable and safe flap that can be used to reconstruct the surgical defect of plate and fill the temporal fossa.     

Immunohistochemical analysis of EGFR and hyaluronan in tongue cancer and the development of regional recurrence in patients initially diagnosed N0

Objective: To investigate whether the extent of expression of hyaluronan (HA) and epidermal growth factor receptor (EGFR) in squamous cell carcinoma of the mobile tongue can predict the risk of cervical metastasis and survival.

Study design: Retrospective histopathologic study.

Methods: Surgical specimens from 64 patients who had undergone surgery for squamous cell carcinoma of the mobile tongue were assessed using immunohistochemistry to investigate the expression of HA and EGFR in the primary tumours, and the data were then correlated to cervical metastasis and survival.

Results: There was a significant correlation between the intensity of HA staining and patient survival (p .024), and a weak correlation between the staining proportion of EGFR and the risk for regional recurrence (AUC 66).

Conclusions: This study indicates that immunoscoring using HA could be used to provide prognostic tools for tongue cancer, and that it might be of interest to study the prognostic properties of EGFR further concerning the risk for regional recurrence after the primary treatment.     

The influence of the subarcuate artery in the superior semicircular canal dehiscence and its frequency on stillbirths: illustrative cases and systematic review

Literature describes that on the 25th gestational week the labyrinth is fully formed and with adult size. However, recent studies have shown that the cranial and labyrinth development continues until 3 years of age.

Objectives: To demonstrate through tomographic study the frequency of semicircular canal dehiscence on nine specimens of stillbirths between 32 and 40 weeks and, through literature review, present another possible etiology for its cause.

Methods: Tomographic study of the temporal bone of 9 specimens of stillbirths between 32 and 40 weeks.

Results: A frequency of 88.89% of alterations were found in our study, with 44% presenting bilateral alterations and 44% unilateral alteration; 11.11% had no dehiscence.

Conclusion: The tomographic study showed superior semicircular canal dehiscence (SSCD) in 88% of the specimens studied, protrusion of the superior semicircular canal (SSC) in all fetuses, and an enlarged SSC that may be caused by the expansion process provoked by the subarcuate artery entering the subarcuate canaliculus, leading to SSCD.     

Cochlear volume as a predictive factor for residual-hearing preservation after conventional cochlear implantation

Objective: The preservation of residual hearing after conventional cochlear implantation (CI) is frequently observed when atraumatic soft surgery is adopted. The purpose of this study was to elucidate the predictive factors for residual hearing preservation after atraumatic CI.

Patients: This study included 46 patients who underwent CI based on an atraumatic technique using a standard-length flexible electrode implant through a round window approach.

Main outcome measure: Cochlear volume was measured using magnetic resonance imaging (MRI). Cochlear duct length (CDL) was taken as the length of the scala media measured using computed tomography (CT). The association between residual hearing preservation and cochlear volume/CDL was then examined.

Result: Cochlear volume and CDL were significantly larger in patients with complete hearing preservation than in those with hearing loss. Multivariate logistic regression analysis revealed that cochlear volume was a significant predictive factor for residual hearing preservation.

Conclusion: Residual hearing preservation after conventional CI was observed in patients with a larger cochlear volume and longer CDL. Cochlear volume could be a predictive factor for residual hearing preservation after conventional CI.     

Comparison of the long term efficacy of radiofrequency ablation and surgical turbinoplasty in inferior turbinate hypertrophy: a randomized clinical study

Objective: To compare the long term effectiveness of radiofrequency thermal ablation with that of surgical turbinoplasty, a prospective, randomized, blinded clinical study was conducted.

Methods: Eighty six patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Forty four patients were operated by radiofrequency ablation, while 42 underwent surgical turbinoplasty. The outcomes of both techniques were compared in terms of symptoms using visual analogue score (VAS) and endoscopic scores.

Results: A statistically significant difference in the VAS scores existed between the two groups by the 3rd month in terms of nasal obstruction (p=.0002) and headache (p=.0001), by the 6th month in terms of nasal secretions (p=.007), by the end of 1 year in terms of sneezing (p=.023) and no statistically significant difference even till the end of year with respect to hyposmia.

Conclusions: Radiofrequency thermal ablation is more effective than surgical turbinoplasty in terms of treating nasal obstruction and equally effective in terms of managing sneezing. Radiofrequency ablation has the advantage of being a day care procedure and minimal complications.     

Psychiatric disorders in patients with intractable dizziness in the department of otolaryngology

Objective: Vertigo and dizziness are often not fully explained by organic illnesses, but instead may be related to psychiatric disorders. It is important to determine the types of psychiatric comorbidities that are frequent in cases of intractable dizziness.

Method: The study subjects were 90 patients who had experienced intractable dizziness for more than three months and were referred to a psychiatrist when their symptoms could not be fully explained based on their physical illness. The patients’ final diagnosis and questionnaire (DHI,SDS and STAI) scores were evaluated.

Results: Seventy percent (63/90) of patients with intractable dizziness had been diagnosed as having psychiatric conditions by the study psychiatrists. The most common diagnosis was unspecified depressive disorder.

Conclusions: Psychiatric comorbidities seem to be more prevalent in certain subgroups of organic dizziness. We found a higher rate of depressive disorders in the sequelae of sudden deafness and migraine-related dizziness.     

Auditory brain stem response and cortical evoked potentials in children with type 1 diabetes mellitus

Conclusions: Delay in ABR and CAEPs wave latencies in children with type 1DM indicates that there is abnormality in the neural conduction in DM patients. The duration of DM has greater effect on auditory function than the control of DM.

Background: Diabetes mellitus (DM) is a common endocrine and metabolic disorder. Evoked potentials offer the possibility to perform a functional evaluation of neural pathways in the central nervous system.

Objectives: To investigate the effect of type 1 diabetes mellitus (T1DM) on auditory brain stem response (ABR) and cortical evoked potentials (CAEPs).

Method: This study included two groups: a control group (GI), which consisted of 20 healthy children with normal peripheral hearing, and a study group (GII), which consisted of 30 children with type I DM. Basic audiological evaluation, ABR, and CAEPs were done in both groups.

Results: Delayed absolute latencies of ABR and CAEPs waves were found. Amplitudes showed no significant difference between both groups. Positive correlation was found between ABR wave latencies and duration of DM. No correlation was found between ABR, CAEPs, and glycated hemoglobin.     

Speech-evoked auditory brainstem response with ipsilateral noise in adults with unilateral hearing loss

Introduction: Subjects with unilateral hearing loss (UHL) report difficulties in speech understanding in noise. Speech-evoked auditory brainstem response (S-ABR) provides cues for temporal and spectral encoding of speech in the brainstem. S-ABR recording in noise increases its sensitivity in evaluating the auditory processing and related disorders.

Objectives: Study speech encoding at the level of brainstem when the auditory system relies on one ear and to study the effect of noise on this encoding.

Subjects and method: This study included two groups: control group consisted of 15 adults with normal hearing sensitivity and study group consisted of 30 adults with UHL. The study group was further subdivided into two subgroups: study subgroup A (SG A) consisted of 15 adults with right functioning ears and study subgroup B (SG B) consisted of 15 adults with left functioning ears. S-ABR in quiet and with ipsilateral noise was recorded in both the groups using complex ABR advanced auditory research module.

Results: In UHL, there was a statistically significant delay in the S-ABR onset and offset in noise compared to quiet. Moreover, quiet–noise (+5 SNR) correlation was significantly low compared to NH. Furthermore, pitch representation (F0 amplitude) was significantly degraded with noise. In addition, there was a statistically significant noise-induced phase shift in the transition region of speech syllable in these subjects.

Conclusion: In monaural processing, pitch representation (F0 amplitude) and cross-phaseogram were the main affected domains. Speech phonemes of transient origin can be confused in subjects with UHL.     

Intralesional bleomycin A5 injection for the treatment of nasal polyps through inducing apoptosis

Conclusion: An intralesional bleomycin A5 (BLE) injection might be used as an alternative therapy for eosinophilic-type nasal polyps (NPs). BLE-induced apoptosis might play an important role in shrinkage of NPs.

Objectives: The aim of this study is to determine the effect and explore the possible role of apoptosis in shrinkage of NPs.

Methods: Twenty-nine patients with eosinophilic-type NPs experienced repeated local injection of BLE. The recurrence rate of this group was obtained. The mechanism of BLE treatment was investigated through an in vitro experiment. Nasal polyp tissues were treated with BLE. The apoptotic activity was detected by the presence of DNA smear and test of terminal deoxynucleotidyl transferase dUTP nick end labeling. The caspase-8 and PARP were examined through immunohistochemistry and Western blotting.

Results: After several local injections of BLE, the nasal polyp tissues decreased and then disappeared. During follow-up of 3 years the recurrence rate of this group was significantly lower than another one treated with operation plus medicine treatment. Apoptosis in BLE-treated tissue was prominently detected in the infiltrating inflammatory cells. The expression of PARP and casp-8 were increased in BLE-treated nasal polyp tissue compared with PBS-treated tissue.     

Hearing loss and social support in urban and rural communities*

Objective: Perceived social support and hearing handicap were assessed in adults with and without hearing loss who lived in different geographical regions of Alabama.

Design: The Hearing Handicap Inventory for Adults (HHIA) assessed emotional and social consequences of hearing loss. The Medical Outcomes Study (MOS) Social Support Survey and the Social Functioning, Role Emotional and Mental Health scales of the SF-36 were administered.

Study sample: Data were collected from 71 study participants with hearing loss and from 45 adults without hearing loss.

Results: Degree of hearing loss and outcomes from the HHIA did not differ between adults who lived in rural or urban settings. Tangible support was poorer for adults with hearing loss who lived in rural settings compared to those who lived in urban settings. For adults without hearing loss, residency was not associated with tangible support. For these adults, income was associated with other types of social support (i.e. informational support, affection, positive social interaction).

Conclusions: Adults with hearing loss living in rural areas had poor perceived tangible support. The provision of support to address a hearing loss could be worse for these adults compared to adults who lived in urban settings.     

Effects of anesthesia with nitrous oxide on tympanoplasty outcomes: a randomized controlled trial

Objectives: To investigate effects of nitrous oxide (N₂O), as inhalational anesthetic agent, on tympanoplasty outcomes.

Methods: In this randomized controlled trial, patients were randomized into two groups: 39 patients who received N₂O as an inhalant anesthesia and 47 patients who did not receive. All were operated on with standard type of ear surgery. The protocol for the two groups was identical. Before surgery baseline audiometry was performed. Postoperative audiological controls were carried out at 3 months.

Results: There was no statistically significant difference between two groups regarding graft outcomes. No significant differences were found between the two groups regarding air-bone gap or bone conduction hearing level.

Conclusions: Nitrous oxide usage does not seem to have significant impact on graft or hearing outcome of patients undergoing surgical repair of tympanic membrane.     

Changes of video head impulse test results in lateral semicircular canal plane by different peak head velocities in patients with vestibular neuritis

Background: The peak head velocity influences on the video head impulse test (vHIT) results, but it has been not known how much the difference is.

Aims: To evaluate the clinical evidence for the superiority of high-velocity compared to low-velocity vHIT.

Material and methods: vHIT was performed in 30 patients with vestibular neuritis using two peak head velocities (mean 80 vs. 240°/s). vHIT gains and parameters of corrective saccades (CSs) were compared. A vHIT gain of ≤0.8 or a peak CS velocity of ≥100°/s was considered pathologic.

Results: The vHIT gains were significantly lower (mean 0.5 vs. 0.6), and GA was larger (35 vs. 25%) at high-velocity vHIT, compared to low-velocity vHIT. CSs were significantly more frequent (100 vs. 80%) and peak CS velocities were larger (252 vs. 112°/s) at high-velocity vHIT. The abnormal rates based on vHIT gains were higher (90% vs. 73%) and CSs occurred more frequently (100% vs. 80%) at high-velocity vHIT. The abnormal rates based on the peak CS velocity were significantly higher at high-velocity vHIT (100% vs. 57%).

Conclusion: High-velocity vHIT is superior to low-velocity vHIT with a difference of 17–20% based on pathologic vHIT gains and presence of CSs.     

The use of the Cochlear Mini Microphone (MM) as a personal radio system (FM) with young children who are deaf

Objectives: This paper describes the background, organization and findings of a project undertaken in 2016-2017, to examine the benefits and challenges of the use of the Cochlear Mini Microphone (MM) by the families of pre-school children with cochlear implants on the Nottingham Auditory Implant Programme.

Methods: The experiences and views of 25 families who used the equipment were obtained and analysed. The information informed subsequent advice, patient literature and professional training.

Results: The MM was viewed to be of benefit by just under half of the families. The attitudes and technical competence of families and local professionals, alongside the age and lifestyle of the children, were identified as the key factors affecting the amount of use.

Conclusion: The insights gained into the challenges and benefits of the MM for this population offered explanations for the limited take-up of the equipment and informed ways to encourage appropriate use

Discussion: Equipment issued to very young children works best alongside specific advice and training, targeted at both families and local professionals. Despite some technical limitations, the availability of a personal radio system was found to be of benefit by some families. It encouraged consideration by both families and professionals, of the potential benefits of early introduction of a personal radio system into pre-school group activities and educational settings.