European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To evaluate the aesthetic outcomes of primary closure of auricle lacerations in the emergency department.

Methods: In this prospective case study in our tertiary referral center we included all patients with an auricular laceration without complete avulsion. Wound treatment involved thorough cleaning and primary closure. Photos of the auricle were taken at various stages for evaluation. To evaluate the achieved results after 3 months, a success classification system with four classes was developed: (1) full success, no irregularities, (2) partial success, only minor irregularities, (3a) unsuccessful, major irregularities or (3b) unsuccessful, (partial) necrosis.

Results: Most patients demonstrated successful outcomes (60.7% full success and 32.1% partial success), with helical involvement being associated with inferior results. The interobserver percent agreement of the classification system was 88%. The Fleiss' kappa coefficient was 0.570, p < 0.001.

Conclusion: Primary closure of ear lacerations results in a high success rate. We have introduced a revised classification system to qualify the success of treatment of the auricle laceration. Involvement of the helix is correlated with inferior surgical results three months after surgical closure. Trial registration number and date of registration: reference number W21_387 # 21.432, September 9, 2021.

Purpose: Recently, the indications for Cochlear Implant (CI) have also been extended to subjects with Single Sided Deafness (SSD) in order to restore binaural hearing. The primary objective of this study was to investigate the advantages of CI following one year of usage in SSD subjects. Secondarily we want to assess the long-term stability of the CI.

Methods: 57 participants performed speech audiometry in noise and localization test. For each was also evaluated subjective hearing profile (with Speech Spatial and Qualities_SSQ questionnaire) and the impact of tinnitus (with the Tinnitus Handicap Inventory_THI questionnaire).

Results: After one year of CI usage, we observed a significant improvement in speech in noise, in sound localization abilities, in the Speech (p-value 0.001) and Spatial (p-value 0.001) subscales of the SSQ questionnaire and in THI questionnaire (p-value 0.001). The improvements in speech in noise and localization abilities and the reduction of the SSQ and THI questionnaires scores were maintained over time. Only eight participants did not fully utilize the CI.

Conclusion: CI in SSD represents an effective method for improving speech recognition in noisy environments, restoring sound localization abilities, reducing tinnitus and improve subjective listening skills.

Purpose: The development of delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) injection has allowed the identification of endolymphatic hydrops (EH). We aimed to investigate the correlations between EH and auditory-vestibular clinical symptoms in patients with unilateral Ménière's disease (MD).

Methods: In this retrospective study, 91 patients with definite MD (DMD) and 20 patients with probable MD (PMD) underwent intratympanic injection Gd-enhanced MRI of the inner ear. Pure tone audiometry (PTA), speech discrimination score (SRS), electrocochleography (ECochG), and caloric tests were performed. Clinical features were analysed and compared between the DMD and PMD groups, and the relationships between EH and auditory-vestibular results were investigated.

Results: Cochlear endolymphatic hydrops (C-EH) and vestibular endolymphatic hydrops (V-EH) were more common and more severe in the DMD group than in the PMD group (P < 0.001). EH in both DMD and PMD patients was inconsistent with the results of auditory-vestibular tests. However, in the DMD group, the PTA average in the affected ear was significantly correlated with the severity of both C-EH (ρ = 0.376, P < 0.001) and V-EH (ρ = 0.404, P < 0.001). In the PMD group, C-EH was positively correlated with the 125 Hz PTA result (ρ = 0.449, P = 0.047). Furthermore, the severities of both C-EH (ρ = 0.210, P = 0.047) and V-EH (ρ = 0.266, P = 0.011) were significantly correlated with the disease course in the DMD group. In the PMD group, the severity of V-EH (ρ = -0.494, P = 0.027) was negatively correlated with the course of MD.

Conclusion: Gd-enhanced MRI of the inner ear is a clinically available and effective auxiliary examination that can provide a direct basis for the diagnosis of DMD and PMD.

Purpose: Eustachian tube dysfunction plays a crucial role in the pathophysiology of chronic otitis media and impacts surgical outcomes of tympanoplasty. We aimed to assess the outcomes of combined tympanoplasty with eustachian tuboplasty compared to tympanoplasty alone with respect totes graft success rate, hearing outcome, tympanometry measures, and improvement of eustachian tube function.

Methods: This review has been registered in the Prospective Register of Systematic Reviews. (CRD42024614970) and was conducted according to the PRISMA guidelines. Four major databases-PubMed, ScienceDirect, Web of Science, and Google Scholar-were used for the electronic search to identify relevant studies.

Results: Seven studies involving 386 patients were included; 195 (50.5%) and 191 patients (49.5%) were assigned to the tympanoplasty plus eustachian tuboplasty and tympanoplasty alone groups, respectively. The meta-analysis revealed significant improvements in graft success rates (Odds Ratio = 1.90, 95% CI: 1.02 to 3.54, p = 0.042), air-bone gap (MD = -2.07, 95% CI: -3.78 to -0.36, p = 0.018), and eustachian tube scores (Mean difference = 2.00, 95% CI: 0.02 to 3.98, p = 0.048) in the combined group compared to in the control group. Only minor complications were observed in some studies, such as mild tympanic membrane retraction, graft myringitis, and temporary patulous eustachian tubes.

Conclusion: Combining tuboplasty with tympanoplasty is an effective procedure with significant improvements in graft success rates, hearing outcomes, and eustachian tube function scores. Eustachian tuboplasty is a safe and successful procedure with very few potential complications.

Background: Adenotonsillar hypertrophy is the leading cause of obstructive sleep apnea (OSA) in children, with adenotonsillectomy (AT) being the most common surgical treatment. Although AT is widely performed, its efficacy in treating mild OSA remains uncertain. Current literature suggests that children with mild OSA might benefit from non-surgical management, but there is a lack of evidence ND studies evaluating the outcomes of AT specifically for mild OSA. The aim of this systematic review and meta-analysis is to provide conclusive insights into the effectiveness of adenotonsillectomy in improving health outcomes and quality of life for children with mild obstructive sleep apnea.

Methods: PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. We included original studies that evaluated the safety or effectiveness of AT in the management of mild OSA among pediatric patients. For quantitative analysis, data were synthesized using a random-effects model in R (version 4.3.3), and heterogeneity was assessed using statistical methods including the restricted maximum-likelihood estimator and the I2 statistic. We also conducted analyses of change scores and covariance to estimate the effect of AT on the severity of mild OSAS.

Results: Our review included 27 studies after screening 1851 citations. The meta-analysis demonstrated significant improvements with AT for mild OSA. The Pediatric Sleep Questionnaire scores improved with a mean difference (MD) of -0.32 (95% CI [-0.39; -0.25], p < 0.001). AHI decreased significantly with an MD of -1.45 (95% CI [-2.11; -0.80], p < 0.001). Comparison with watchful waiting revealed AT to be more effective: AHI showed an MD of -1.22 (95% CI [-1.92; -0.53], p < 0.001), and the arousal index had an MD of -1.73 (95% CI [-2.95; -0.51], p = 0.005). Safety data indicated that while AT is generally safe, it is associated with minor complications such as postoperative desaturation and occasional bleeding. Long-term serious adverse events were rare.

Conclusion: AT effectively improves symptoms in children with mild OSA, outperforming watchful waiting in several key metrics. This review supports AT as a viable option but underscores the importance of considering individual patient factors in treatment decisions.

Purpose: To investigate effectiveness of Virtual Reality (VR) on tinnitus burden in adult patients, and which improvements can be implemented. Literature review focuses on VR's usability as a tinnitus management tool, and on comparison with standard care.

Methods: Systematic search of PubMed and Google Scholar databases, covering articles from 2000 to 2024. We used MeSH terms "VR," "Virtual Reality," and "3D immersion" combined with "tinnitus," applying filters for clinical trials and randomized controlled trials. In Google Scholar, the advanced search function was used. Only English peer reviewed articles were included. Studies were selected based on PICOS (Patient Intervention Comparison Outcome Study) criteria, including adult patients receiving VR therapy with outcomes measured by questionnaires.

Results: Of the 17 initially identified articles, 10 remained after removing duplicates, and 2 studies were ultimately included for detailed review. Data extraction followed the PRISMA-ScR guidelines, with independent reviewers charting data. Primary outcomes included change in functional limitations, mood and distress. Results suggest beneficial findings of VR immersion equivalent to standard care. However, the clinical significance remains unclear due to small sample and effect sizes and short follow-up periods.

Conclusions: VR therapy shows promise as a potential tool for managing tinnitus, particularly due to its independence from therapists and shorter treatment duration, while being as effective as usual care. Further research with larger sample sizes, extended follow-up periods and incorporation of minimal clinically important differences (MCID) is necessary to validate effectiveness and scalability as an intervention for tinnitus resilience enhancement. Suggestions are given for content optimization.

Purpose: The gold standard diagnostic modality of Obstructive Sleep Apnea (OSA) is polysomnography (PSG), which is resource-intensive, requires specialized facilities, and may not be accessible to all patients. There is a growing body of research exploring the potential of artificial intelligence (AI) to offer more accessible, efficient, and cost-effective alternatives for the diagnosis of OSA.

Methods: We conducted a scoping review of studies applying AI techniques to diagnose and assess OSA in adult populations. A comprehensive search was performed in the Web of Science database using terms related to "obstructive sleep apnea," "artificial intelligence," "machine learning," and related approaches.

Results: A total of 344 articles met the inclusion criteria. The findings highlight various methodologies of disease evaluation, including binary classification distinguishing between OSA-positive and OSA-negative individuals in 118 articles, OSA event detection in 211 articles, severity evaluation in 38 articles, topographic diagnostic evaluation in 8 articles, and apnea-hypopnea index (AHI) estimation in 26 articles. 40 distinct types of data sources were identified. The three most prevalent data types were electrocardiography (ECG), used in 108 articles, photoplethysmography (PPG) in 62 articles, and respiratory effort and body movement in 44 articles. The AI techniques most frequently applied were convolutional neural networks (CNNs) in 104 articles, support vector machines (SVMs) in 91 articles, and K-Nearest Neighbors (KNN) in 57 articles. Of these studies, 229 used direct patient recruitment, and 115 utilized existing datasets.

Conclusion: While AI demonstrates substantial potential with high accuracy rates in certain studies, challenges remain such as model transparency, validation across diverse populations, and seamless integration into clinical practice. These challenges may stem from factors such as overfitting to specific datasets, limited generalizability, and the need for standardized protocols in clinical settings.

Objective: To discuss indications (unfavorable conditions), surgical steps, complications, and follow-up of subtotal petrosectomy (STP) in cochlear implantation based on our experience of 348 cases. Anatomical variations associated with or without cochlear malformations and differences between electrode insertions were included in our analysis.

Materials and methods: A retrospective case study was done in Gruppo Otologico (Piacenza, Italy), a quaternary referral center. Among 1002 cases that underwent subtotal petrosectomy, 348 were selected for cochlear implantation in the same setting. The study period was from 2004 to 2019. These patients' clinical and radiological follow-up ranged from 2 months to 180 months. Data were inspected, cleaned, and analyzed by SPSS software.

Results: The selected group's mean age was 57.236 years, including 178 male and 170 female patients. The follow-up period lasted up to 108.65 months. Out of 348 cases, 8 were children (under the age of 18 years old). Inclusion criteria to be eligible for cochlear implantation in the same setting of subtotal petrosectomy was a preoperative pure tone average (PTA) of more than 90 decibels associated with low speech discrimination ranging from 0% in most cases up to 50% in the minority. 329 patients had a complete electrode insertion intra-operatively. Minor complications were observed in 6 cases. These include one case of implant extrusion due to a middle ear infection leading to labyrinthitis, three cases of post-auricular fistula causing one device failure, one subcutaneous CSF collection, and one subcutaneous seroma collection.

Conclusion: Although in most cases, standardized trans mastoid facial recess technique for cochlear implantation is ideal as the surgical risks are minimal, in complicated cases such as concomitant chronic otitis media, prior canal wall-down cases, radical cavities, or inner ear abnormalities with high risk of cerebrospinal fluid leak subtotal petrosectomy should be the first choice of management with complete disease clearance. Close clinical and radiological follow-up is therefore mandatory. Single-stage implantation is preferred to staging the procedure unless one is unsure of disease clearance.

Purpose: To evaluate long-term hearing outcomes, healthcare utilization, and health-related quality of life (HRQoL) in adults with chronic otitis media (COM) who underwent primary tympanoplasty (PT) but were left with a significant air-bone gap (25-30 dB).

Methods: A retrospective medical chart review was conducted to assess the standard of care for COM patients across three European countries, analyzing hearing data, healthcare utilization, and demographics. Additionally, HRQoL and hearing disability were assessed prospectively using questionnaires. Sixty-nine adults diagnosed with COM who underwent PT between 2010 and 2016 were included.

Results: Average hearing outcomes showed minimal to no improvement, with a substantial number of patients experiencing moderate to severe hearing loss post-PT. Many continued to rely on rehabilitative technologies, with bone conduction hearing device (BCHD) users reporting higher consistent use compared to conventional hearing aid users. Participants required an average of 7.6 healthcare visits with a mean follow-up time of 7.64 years after PT, underscoring the ongoing burden on healthcare systems. Impaired hearing negatively impacted both general and disease-specific HRQoL.

Conclusion: Managing COM remains challenging due to the variability in surgical outcomes, particularly regarding hearing restoration. The high post-PT healthcare utilization and persistent HRQoL impairments caused by impaired hearing highlight the need for more effective rehabilitative strategies such as conventional hearing aids and BCHD.

Purpose: This study evaluates the role and effectiveness of indocyanine green (ICG) angiography in conventional thyroidectomy, comparing its outcomes with those of the naked-eye (NE) technique.

Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library databases through November 2024. Meta-analyses were performed on the selected studies. We compared the rates of parathyroid gland (PG) identification, autotransplantation, hypoparathyroidism, hypocalcemia, and postoperative levels of intact parathyroid hormone (iPTH) and calcium between the ICG and NE groups.

Results: We analyzed 29 studies involving 2,393 thyroidectomies. The PG identification rate was significantly higher in the ICG group at 84.7% (95% CI: 77.5-90.0%) than in the NE group (OR = 1.49, 95% CI: 1.26-1.79). Additionally, the rate of parathyroid autotransplantation was higher in the ICG group (OR = 2.18, 95% CI: 1.56-3.03). The transient hypoparathyroidism rate in the ICG group was 11.0% (95% CI: 5.3-21.5%), which was slightly lower than that in the NE group, although the difference was not statistically significant. Conversely, the transient hypocalcemia rate was significantly lower in the ICG group at 13.2% (95% CI: 8.6-19.6%) than in the NE group (OR = 0.50, 95% CI: 0.30-0.85). No significant differences were observed between the two groups in 1-day postoperative iPTH or calcium levels.

Conclusion: This meta-analysis demonstrates the superior efficacy of ICG angiography over the NE technique during thyroidectomy. ICG angiography resulted in a higher PG identification rate and significantly reduced postoperative transient hypocalcemia compared to those in the NE approach.