Relative frequencies of symptoms and risk factors among patients with chronic rhinosinusitis with nasal polyps using a case-control study

Objectives: The aim of this study was to investigate the relative frequency of important symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), the link between CRSwNP and the lower airways and the importance of smoking in CRSwNP.

Method: Three hundred and sixty-eight patients with CRSwNP and 1349 controls were recruited to the study and underwent a structured interview about symptoms from the upper and lower airways, and about smoking habits. Furthermore, all participants were clinically examined using nasal endoscopy.

Results: Due to interactions between the outcome variables, a multiple logistic regression model was fitted to the data. Nasal secretions, nasal blockage and impaired sense of smell were symptoms associated with CRSwNP. Furthermore, male gender, increasing age and asthma were also associated with the disease. Current smoking was less frequent among patients with CRSwNP.

Conclusion: By comparing symptoms and risk factors of patients with CRSwNP with those of a large population-based control group and testing them in a multiple logistic regression model, we have been able to generate data that address key research interests in CRSwNP.     

Immunohistological analysis of eotaxin and RANTES in the model animal of eosinophilic otitis media

Background: The most crucial clinical problem of Eosinophilic Otitis Media (EOM) is sensorineural hearing loss. A previous report revealed that repeated antigen stimulation of middle ear causes eosinophilic inflammation not only in the middle ear but also in the inner ear.

Objective: The purpose of the present study was to elucidate the mechanism of eosinophil infiltration to the inner ear in the animal model of EOM.

Methods: Continuous OVA stimulation to the middle ear of guinea pigs was performed for 7 days, 14 days, and 28 days. Histological observation was made for eosinophil infiltration and morphological change of the inner ear. Immunostaining for eotaxin and RANTES was performed to study immunoreactivity of those chemokines.

Results: In the 7-day stimulation side, a few eosinophils were found in the scala tympani, without obvious morphological damage of the inner ear. Moreover, immunoreactivity of both eotaxin and RANTES was significantly higher in the OVA stimulation sides than control sides. For both eotaxin and RANTES, the number of immunopositive cells was significantly increased in the 14-day stimulation side over the 7-day stimulation side.

Conclusions: Eotaxin and RANTES seem to play some important roles for the eosinophil infiltration in the middle and inner ear of model animal of EOM.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Development of a multimedia educational programme for first-time hearing aid users: a participatory design

Objective: To develop content for a series of interactive video tutorials (or reusable learning objects, RLOs) for first-time adult hearing aid users, to enhance knowledge of hearing aids and communication.

Design: RLO content was based on an electronically-delivered Delphi review, workshops, and iterative peer-review and feedback using a mixed-methods participatory approach.

Study sample: An expert panel of 33 hearing healthcare professionals, and workshops involving 32 hearing aid users and 11 audiologists. This ensured that social, emotional and practical experiences of the end-user alongside clinical validity were captured.

Results: Content for evidence-based, self-contained RLOs based on pedagogical principles was developed for delivery via DVD for television, PC or internet. Content was developed based on Delphi review statements about essential information that reached consensus (≥90%), visual representations of relevant concepts relating to hearing aids and communication, and iterative peer-review and feedback of content.

Conclusions: This participatory approach recognises and involves key stakeholders in the design process to create content for a user-friendly multimedia educational intervention, to supplement the clinical management of first-time hearing aid users. We propose participatory methodologies are used in the development of content for e-learning interventions in hearing-related research and clinical practice.     

Effects of mechanical trauma to the human tympanic membrane: an experimental study using transmission electron microscopy

Hypothesis: To examine the cellular events following induced superficial lesions of the human tympanic membrane (TM). Such information could lead to enhanced appreciation of repair mechanisms and novel strategies to restore TM perforations.

Background: Persistent perforation of the TM in chronic otitis media is a major global health problem and frequently necessitates surgical intervention. Most TM perforations heal spontaneously and swiftly, but sometimes healing fails. The underlying mechanisms and the reason for incomplete repair are often elusive, although some mechanisms have been proposed.

Methods: Here, five healthy adult human TMs were sampled during vestibular schwannoma surgery. Three days before harvesting, three TMs were superficially lesioned, including the epithelial and sub-epithelial layers, using a needle and two TMs served as controls. Light and transmission electron microscopy were performed.

Results: Surrounding lesion showed distinct ultrastructural changes. This included a keratinocyte frontier with electron-dense cells with abundant ribosomes and nuclei metamorphosis. Beneath, were activated fibroblasts and invaded/transformed free cells and signs of increased transcellular activity of adjacent blood vessels.

Conclusions: The study describes dynamic morphological events of a human lesioned TM. The human model may be used for further investigations and understanding of TM healing mechanisms.     

Effects of artificial tracheal fixation on tracheal epithelial regeneration and prevention of tracheal stenosis

Conclusion: Tight fixation of the artificial trachea is important for epithelialization and tracheal stenosis.

Objective: The authors have developed an artificial trachea and have used it for tracheal reconstruction. Although various studies on tracheal reconstruction have been conducted, no studies have examined the effect of artificial tracheal fixation on tracheal stenosis and regeneration. Therefore, the purpose of the present study was to evaluate the effect of artificial tracheal fixation.

Study design: Preliminary animal experiment.

Methods: Artificial tracheae were implanted into rabbits with partial tracheal defects. Tracheal stenosis and regeneration of the tracheal epithelium on the artificial tracheae were evaluated by endoscopic examination, scanning electron microscopic analysis, and histological examination. The artificial tracheae fixed to the tracheal defects were classified into three groups (0-point, 4-point, and 8-point) by the number of fixation points.

Results: At 14 and 28 days post-implantation, the luminal surface of the implantation area was mostly covered with epithelium in all fixation groups. However, a small amount of granulation tissue was observed in the 0-point fixation group at 14 days post-implantation. Moreover, tracheal stenosis did not occur in the 8-point fixation group, but stenosis was detected in the other groups.     

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.     

Complications in translabyrinthine surgery of vestibular schwannoma

Objective: To evaluate the risk of complications associated with tumor size and patient’s age in translabyrinthine vestibular schwannoma surgery.

Methods: 700 patients with vestibular schwannoma primarily underwent translabyrinthine surgery between 1988 and 2014. Pre- and postoperative data were collected in a database and incidence of the postoperative complications cerebrospinal fluid leakage, meningitis, intracranial hemorrhage (ICH), facial nerve function and mortality were assessed and related to the tumor size and patient’s age and retrospectively evaluated.

Results: The tumor size significantly influenced the incidence of ICH and facial nerve dysfunction whereas age was correlated to facial nerve outcome.

Conclusions: The translabyrinthine approach is a safe surgical procedure with relatively low risks of complications. The tumor size was significantly associated with a higher risk of ICH and facial nerve dysfunction whereas age only influenced the facial nerve outcome.     

‘Compassionate use’ protocol for auditory brainstem implantation in neurofibromatosis type 2: Early House Ear Institute experience

Objective: To report the preliminary outcomes of auditory brainstem implantation (ABI) under a compassionate use protocol for two ABI devices that are not approved by the US Food and Drug Administration.

Methods: A retrospective review was performed of neurofibromatosis type 2 (NF2) patients who underwent microsurgery for vestibular schwannoma (VS) and placement of either the Cochlear ABI541 or Med-El Synchrony ABIs. Peri-operative and device- related complications were reviewed. Audiometric performance was also evaluated.

Results: Seven patients received either the Cochlear ABI541 (6) or the Med-El Synchrony ABI (1) after the resection of VS. No device or patient-related complications occurred to date. Surgical times and early audiological performance are similar to our previous experience with the Cochlear ABI24 device.

Conclusions: Early experience with the Cochlear ABI541 and Med-El Synchrony ABI devices under a compassionate use protocol suggest that both devices are safe with comparable utility to the Cochlear ABI24 device.     

Theoretical observation on diagnosis maneuver for benign paroxysmal positional vertigo

Conclusion: To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV.

Objective: Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver.

Materials and methods: This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model.

Results: The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.     

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.     

Cognitive skills affect outcome of CI in children: A systematic review

Objective: To systematically review previous literature to determine to what extent hearing- impaired children with cognitive disabilities benefit from cochlear implantation (CI). Ultimately, to recommend guidelines for preoperative cognitive testing of hearing- impaired children and for the postoperative rehabilitation programs.

Methods: Pubmed, Cinahl, Embase, and The Cochrane Library was searched systematically for studies reporting cognitive disabilities in CI children.

Results: Seven hundred and sixty-three studies were discovered by the search of which 15 fulfilled the inclusion- and exclusion criteria. An overall correlation was evident regarding cognitive abilities and benefit of CI in hearing, speech and language development, and speech perception.

Discussion: Many of the eligible studies were case series with evidence level four. Furthermore, heterogeneity of studies impeded comparison between the preoperative cognitive tests and the postoperative outcome tests. However, studies agree that cognitive abilities in hearing- impaired children can predict outcome after CI. International guidelines for preoperative cognitive tests in different age groups, along with international guidelines for postoperative outcome tests are necessary for better inter-study comparison.

Conclusion: The degree of preoperatively cognitive disabilities is associated with the outcome after CI, thereby emphasizing why accurate cognitive tests are an important part of the preoperative evaluation of CI and pre-requisite for shared decision making. Furthermore, individual postoperative rehabilitation programs must be created depending on the child's cognitive ability.