European Archives of Oto-Rhino-Laryngology最新文献

Purpose: The purpose of this study is to examine the influence of allergic rhinitis (AR) and asthma on the incidence of otitis media (OM), which in turn serves as a mediator for the need for tympanostomy tube placement (TTP).

Methods: A comprehensive logistic regression analysis was performed, incorporating multiple variables to assess the relationship between AR, asthma, and the likelihood of TTP. OM was considered the mediating variable in this relationship. The analysis adjusted for a range of demographic and health-related covariates to ascertain the independent effects of the allergic conditions. Mediation analysis was utilized to evaluate the extent to which otitis media influences the association between AR and asthma and the need for TTP. Additionally, sensitivity analyses were conducted to assess the robustness of the findings against potential missing data.

Results: The study revealed significant associations between AR and asthma with the prevalence of OM, which in turn significantly increased the odds of TTP. Specifically, the odds ratios (ORs) for AR were 2.46, 2.44, and 2.19 across models 1, 2, and 3, respectively, indicating a robust correlation with TTP. Asthma also showed a consistent positive relationship with TTP, with ORs of 1.95, 1.94, and 1.56 for the respective models. Mediation analysis provided evidence that OM significantly mediated the relationship between AR and TTP, with an Average Causal Mediation Effect (ACME) of 0.02219, translating to 2.22% of the total effect being mediated through OM. For asthma, the ACME was 0.01395, indicating a 1.4% mediation effect. The Average Direct Effects (ADE) for AR and asthma were 0.03151 and 0.02084, respectively, suggesting substantial direct and indirect effects on TTP. Sensitivity analyses, accounting for missing data, further substantiated the robustness of these associations, with adjusted ORs for AR and asthma remaining highly significant.

Conclusion: The study concludes that AR and asthma are key drivers of OM, which acts as a mediator for TTP. The significant mediation effects highlight the importance of managing these allergic conditions to potentially reduce the incidence of ear infections and the necessity for TT surgery. Further research is encouraged to explore the intricate links between allergic conditions and otological health, facilitating the development of more effective clinical interventions.

Objective: To evaluate the impact of the COVID-19 pandemic on acute otitis media (AOM) and acute mastoiditis (AM) by analyzing longitudinal changes in disease incidence, clinical presentations, complications, and microbial patterns across pre-pandemic, pandemic, and post-pandemic periods.

Methods: A retrospective cohort study examining pediatric AOM and AM cases (age ≤ 15 years) at a tertiary medical center between March 2015 and February 2024. Cases were categorized into three periods: pre-COVID (March 2015-February 2020), lockdown (March 2020-February 2021), and post-lockdown (March 2021-February 2024). We assessed disease incidence, microbiology, complications, and clinical outcomes.

Results: Among 6,673 patients (6,221 AOM, 452 AM), AOM cases significantly decreased during lockdown (301/year) vs. pre-COVID (658/year) (p = 0.041) but returned to baseline in post-lockdown (758/year). AM showed similar trends without statistical significance. Complications of AM per case were highest during lockdown (0.52) vs. pre-COVID (0.39), with increased mastoidectomy rates (28% vs. 18.4%). Positive culture rates increased post-COVID (52.7-73.7%), and mean hospitalization duration was longest during lockdown (8.56 days vs. 7.96 pre-COVID, p = 0.005).

Conclusions: The COVID-19 pandemic induced a significant temporary reduction in acute otitis media and acute mastoiditis cases, primarily during lockdown periods. Despite the initial decrease, disease incidence returned to pre-pandemic baseline levels post-lockdown. Notably, the lockdown period showed higher complication rates and longer hospitalization durations, suggesting potential delays in medical care, but overall disease patterns remained fundamentally unchanged.

Purpose: To evaluate the ototoxicity of povidone iodine (PVP-I) at concentrations of 5% and 10% during tympanoplasty by assessing frequency-specific audiometric outcomes and graft success rates in a large cohort of patients.

Methods: This prospective, triple-blinded, randomized clinical trial enrolled 542 patients undergoing primary tympanoplasty. After excluding patients for inadequate follow-up, 204 ears received 10% PVP-I and 199 ears received 5% PVP-I. Audiometric evaluations, including bone conduction (BC), air conduction (AC), air-bone gap (ABG), and speech reception threshold (SRT), were conducted preoperatively and 12 months postoperatively. The primary outcome was the incidence of sensorineural hearing loss (SNHL), defined as an increase in BC threshold of more than 10 dB. Secondary outcomes included graft success rate and audiometric gains.

Results: The overall incidence of SNHL was 1.5% in the 10% PVP-I group and 1.0% in the 5% PVP-I group, with no significant difference (P = 1.000). In ears with preoperative mixed hearing loss, SNHL at 0.25 kHz was significantly higher in the 10% PVP-I group (28.9%) compared to the 5% PVP-I group (6.7%) (P = 0.002). Graft success rates were 94.1% and 97.0% in the 10% and 5% PVP-I groups, respectively (P = 0.164). No clinically significant differences in audiometric gains were observed between the groups.

Conclusion: Both 5% and 10% PVP-I concentrations are safe for antiseptic preparation in tympanoplasty, as evidenced by low rates of SNHL and high graft success rates. These findings support the use of PVP-I in human otologic surgery without significant ototoxic risk.

Purpose: Tall cell papillary thyroid cancer (tcPTC) is traditionally considered to be an aggressive subtype of differentiated thyroid cancer, although its independent prognostic value is unclear. To investigate the independent prognostic value of tall cell morphology a tcPTC cohort was compared with a classical PTC (cPTC) cohort.

Methods: A retrospective longitudinal study was performed using a cohort of tcPTC patients treated at Royal North Shore Hospital and Westmead Hospital in Sydney, Australia, and a cohort of cPTC patients treated at Westmead Hospital. Clinicopathological tumour characteristics and treatment pathways were analysed. Thyroglobulin and thyroglobulin antibody levels and further neck surgeries in the two years post thyroidectomy were used as a surrogate marker for early disease recurrence.

Results: Presentation and treatment were analysed for 51 tcPTC patients and a comparator group of 365 cPTC patients. On univariate analysis, tcPTC was found to present at an older age (53.6 years v 46.4 years, p < 0.01), with greater rates of positive surgical margins (31.37% v 16.44%, p < 0.05), and greater rates of microscopic (47.06% v 22.74%, p < 0.001) and gross extrathyroidal extension (15.69% v 6.30%, p < 0.05). Longitudinal analysis was conducted for 236 patients (n = 24 for tcPTC, n = 212 for cPTC). Multivariate analysis found no difference in the odds of developing early recurrence between the tcPTC cohort and the cPTC cohort (OR = 0.65, p > 0.1).

Conclusion: tcPTC is associated with more aggressive features compared with cPTC. Tall cell morphology was not found to be an independent predictor of early recurrence.

Objective: Intraoperative systems for monitoring facial nerve function, in which temporal electrical stimulation is applied to the facial nerve through electrodes, are used in many surgeries requiring facial nerve preservation; however, continuous stimulation or quantitative evaluation of facial nerve function is difficult with this approach. We examined the usefulness of a continuous and quantitative facial nerve-monitoring system for temporal bone lesions by using our experience to modify the existing methods used for cases involving vestibular schwannomas.

Study design: Retrospective observational study.

Setting: Department of Otorhinolaryngology-Head and Neck Surgery at our hospital.

Methods: We modified the electrode placement and examined the usefulness of the modified system under several conditions. The study population consisted of patients who were operated on for temporal bone lesions at our department and underwent continuous nerve monitoring using the modified system. Case details, electrode-placement sites, and facial nerve function data before and after the surgery were obtained and retrospectively evaluated.

Results: Electrodes were placed safely during surgery in all cases. No obvious deterioration in facial nerve function was observed, except in one case.

Conclusion: The advantages of this system include its ability to perform quantitative intraoperative evaluations and prevent unexpected nerve damage in cases where the facial nerve shows complicated pathways. This monitoring system is useful, even in complex temporal bone surgeries.

Objective: This study aimed to translate the "Children with Cochlear Implant: Parental Perspectives (CCIPP)" scale into Turkish and evaluate its validity and reliability.

Material and methods: Parents of 378 children between the ages of 2 and 18, who had used cochlear implants for at least one year, filled out the Turkish version of the scale. The original scale was translated from English to Turkish. Explanatory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the scale construct validity. For the evaluation of the scale reliability, internal consistency and test-retest reliability measures were evaluated with Cronbach's alpha (α) and correlation, respectively.

Results: The reliability coefficients of the dimensions are between 0.237 and 0.678. The test-retest correlation coefficient of 0.875 was obtained. As a result of factor analysis, ten sub-dimensions were determined, corresponding to the original ten domains defined in the CCIPP scale. The Kaiser-Meyer-Olkin (KMO) sample adequacy coefficient calculated in the sub-factor analysis was determined to be 0.850. The dimensions obtained according to the result of the Bartlett test in which the significance of the factor structures was tested (test value: 9596.996, degrees of freedom (df): 2628, p < 0.001) are structurally significant. CFA confirmed the accuracy of the ten-dimensional structures (Comparative Fit Index (CFI) = 0.901; Incremental Fit Index (IFI) = 0.902; Root Mean Square Error of Approximation (RMSEA) = 0.054).

Conclusion: The Turkish version of the scale has good validity and reliability and can be used to examine parents' perspectives on cochlear implants.

Purpose: Pulmonary function assessment in laryngectomized patients is challenging due to technical difficulties in performing spirometry. Existing methods have limitations, including potential air leakage and patient discomfort. The purpose of this study was to develop a simple, comfortable extratracheal device for accurate pulmonary function assessment in laryngectomized patients.

Methods: We designed a silicone extratracheal device with a central connector for spirometer attachment and an adhesive layer for secure skin fixation. Ten laryngectomized patients underwent spirometry using the device. Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and FEV1/FVC ratio were measured and compared to predicted values.

Results: The extratracheal device was validated after performing successful spirometric tests in 10 laryngectomized patients, maintaining the necessary air seal to ensure the accuracy of the results, with no air leakage. Pulmonologists evaluating the device found it to be technically adequate for report generation.

Conclusion: The developed extratracheal device has proven to be reliable and effective for assessing pulmonary function in laryngectomized patients, potentially serving as a valuable tool for regular pulmonary function monitoring in this population.

Purpose: To assess whether increasing experience with implantation of a thin preformed electrode array for perimodiolar insertion reduces the incidence of tip fold-over (TFO).

Methods: The retrospective study included 100 patients who received a cochlear implant (CI) with the Slim Modiolar (SM) electrode array (Cochlear, Sydney, Australia) at a university CI centre between November 2015 and December 2022. Postoperative radiological imaging was performed to verify electrode position. Surgical reports and radiological images were reviewed and the incidence of TFO was analyzed for three experienced CI surgeons. In addition, the incidence of intraoperative measurements showing evidence of electrode malposition and the mean duration of surgery over time were documented.

Results: 129 SM implantations in 100 patients were included. In seven cases (5.4%) TFO was radiologically detected and successfully revised. In eight cases (6.2%), electrophysiological measurements indicated misplacement and the position was corrected during the same surgery. For one surgeon, five out of 67 implantations (7.5%) were affected by TFO, with the frequency of this complication decreasing over time. The average surgery time for all surgeons was 122.2 (± 44.2) minutes, with two surgeons showing a decrease over time.

Conclusion: The results show a tendency that the SM electrodes can be implanted with a lower complication rate and faster over time. Therefore, it can be assumed that the implantation of the SM electrode requires a certain amount of practice, even for experienced surgeons. As intraoperative electrophysiological measurements detected 71.4% of all radiologically confirmed TFOs, their use is highly recommended.

Objectives: To evaluate the effects of cochlear implantation on auditory-verbal and spatial-auditory abilities of hearing-impaired children.

Methods: A total of 406 hearing-impaired patients, ranging from 1 to 13 years, were categorized into six groups: 1-3 years (7), 3-5 years (34 ), 5-7 years (62), 7-9 years (94 ), 9-11 years (138 ), and 11-13 years (71 ) groups. Auditory-verbal ability and speech-space hearing quality were assessed using the Categories of Auditory Performance (CAP), the Speech Intelligibility Rating (SIR), and the Chinese version of the Speech, Spatial, and Other Qualities of Hearing Scale-Parental (SSQ-P). The auditory and speech abilities of cochlear implant patients at 1-3, 3-5, 5-7, 7-9, 9-11, and 11-13 years after start-up were compared.

Results: A longer duration of cochlear implant use within 1-9 years of start-up was associated with higher hearing ability and speech intelligibility scores of the hearing impaired patients (p < 0.001). The dimensions of speech perception and auditory quality in the SSQ-P questionnaire were also significantly improved (p < 0.001). Auditory ability, speech intelligibility, and speech-spatial hearing quality of hearing-impaired patients showed a decreasing trend within 9-13 years of start-up. Auditory ability affects speech perception and speech function affects 2 dimensions of speech perception and hearing quality.

Conclusions: Children with cochlear implants showed a significant improvement in auditory-verbal ability up to 9 years after start-up. Therefore, cochlear implantation has significantly improved auditory speech and spatial hearing abilities in children with hearing loss, and it is suggested that 9 years after implantation can be an important reference stage for whether to proceed with device renewal.

Objectives: We aimed to analyze auditory involvement in patients with Behcet's disease and its association with Optical Coherence Tomography Angiography findings and disease manifestations.

Methods: This study included 54 eyes and 68 ears of 34 adults with Behcet's disease in comparison to 30 eyes and 60 ears of healthy controls. Clinical, laboratory and ophthalmological evaluation including Optical Coherence Tomography Angiography was done. Audiological assessment included otoscopic examination, immitancemetry and pure tone and speech audiometry.

Results: Sensorineural hearing loss was observed in 32.35% of the studied cases. Behcet's disease patients showed significantly higher average hearing level and significant reduction of retinal vessel density compared to controls. Patients with sensorineural hearing loss demonstrated significantly lower central retinal capillary vessel density and higher neuro-Behcet's disease incidence in comparison to those without hearing loss (p-value = 0.039 and 0.024, respectively), which was confirmed by univariate regression analysis. After entering significant factors into the multivariate model, neuro-BD was identified as the most significant single predictor of sensorineural hearing loss in BD (p-value = 0.003).

Conclusions: The association between sensorineural hearing loss and central retinal vessel density reduction and neuro- Behcet's disease should be considered in Behcet's disease.