European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To integrate the results from multiple electrophysiological tests, which has the potential to significantly improve outcome predictions in patients with Bell's palsy.

Methods: This retrospective study analyzed 193 patients who were diagnosed with Bell's palsy at our Department of Physical Medicine & Rehabilitation, from January 2020 to December 2022. All patients were followed for at least 6 months, with a mean follow-up duration of 6.8 months (range: 6-9 months). Clinical data, including House-Brackmann (H-B) grade and electrophysiological data from five tests, were analyzed using multiple logistic regression analysis and decision tree analysis to predict outcome at 6 months. The five electrophysiological tests were: electroneurography degeneration index (ENoG DI), compound muscle action potential (CMAP) latency, blink reflex (BR), nerve excitability test (NET), and needle electromyography (nEMG).

Results: The decision tree model identified five key predictors of recovery: ENoG DI in the orbicularis oculi, initial H-B grade, interference pattern in orbicularis oculi, NET difference, and CMAP latency in the frontalis. Patients with an ENoG DI < 71.72% and initial H-B grade ≤ 3 had a high probability of complete recovery. For higher ENoG DI values, a NET difference ≥ 4.50 mA and CMAP latency > 3.80 ms predicted incomplete recovery. This analysis led to an overall accuracy of 86.01%.

Conclusion: This study demonstrated that the combined use of initial H-B grade with the results from multiple electrophysiological results provided reliable outcome predictions in patients with Bell's palsy.

Objective: To describe the baseline vestibular function in cochlear implant candidates and identify demographic and audiologic risk factors for vestibular dysfunction.

Study design: Retrospective cohort study (2012-2022) of the CI candidate population.

Setting: Neurotology practice at large academic hospital.

Methods: All patients evaluated for CI underwent routine preoperative vestibular evaluation, irrespective of symptoms. Preoperative audiologic data was also analyzed.

Results: Of a total of 180 preoperative VNGs obtained, 39.4% demonstrated preoperative vestibular weakness as determined on caloric testing. Of these, 26.8% had evidence of bilateral weakness, 60.5% unilateral weakness ipsilateral to the worse hearing ear and 12.7% contralateral weakness. Demographic variables such as age, gender, BMI and medical comorbidities including diabetes, hypertension, hyperlipidemia were not found to be associated with a higher risk of vestibular weakness. Patients with vestibular weakness had significantly poorer low tone hearing. Hearing loss at 250 Hz was the strongest prognostic factor for risk of vestibular weakness. Using a cutoff of 45dB at 250 Hz as an indicator for obtaining preoperative VNG was found to have a sensitivity of 92.9% and specificity of 37.9% for identifying vestibular weakness.

Conclusions: Traditional CI candidates have a high prevalence of preoperative vestibular weakness. Audiologic data and specifically severity of hearing loss in the low frequencies may be a useful indicator of vestibular weakness and thus help guide which patients should undergo preoperative VNG. We propose the cutoff point of 45dB at 250 Hz as an indicator of higher risk for vestibular weakness and recommend preoperative VNG testing for this population prior to surgery.

Background: Laryngotracheal stenosis (LTS) results from abnormal airway narrowing, primarily caused by iatrogenic injuries like prolonged intubation. It leads to respiratory distress and vocal complications, requiring interventions ranging from endoscopic procedures to open surgeries like laryngotracheal reconstruction (LTR) with autologous grafts. Pediatric patients pose unique challenges due to smaller airways but may have better healing outcomes. This review aims to synthesize evidence on the success and operative parameters of different grafts in pediatric LTR to guide clinical decision-making and improve patient outcomes.

Methods: We retrieved relevant articles from PubMed, Scopus, Web of Science, and the Cochrane Library up to August 2024. Two independent authors extracted data from eligible studies, including baseline information, success rate, need for extra procedures, time to stent removal, and time to decannulation. All analyses were undertaken using RevMan v5.4.

Results: We collected 1,201 records from four databases after excluding 788 duplicates. After screening titles and abstracts, 108 records were assessed for eligibility, resulting in 86 included articles. Of these, 64 had enough data for analysis. The overall success rate for LTR was 89% for costal grafts, 86% for thyroid grafts, and 85% for auricular grafts, with no significant differences between graft types. A third of cases required additional procedures. Time to stent removal averaged 7.85 days for single-stage LTR and 62.86 days for double-stage LTR. Decannulation took 198.29 days. Complications included respiratory issues like atelectasis and pneumonia, graft-related problems, infections, and wound complications. Donor site complications and deaths were rare but occurred due to respiratory arrest, pneumothorax, and tracheotomy tube obstruction.

Conclusion: Costal, thyroid, and auricular grafts are comparable and show similar success rates in pediatric LTR. Optimizing perioperative management is crucial for reducing complications. Future research should standardize postoperative care and address patient pathology heterogeneity to improve outcomes.

Purpose: Dizziness and vertigo are among the most frequently reported complaints among patients across various medical and healthcare specialties. Studies have revealed that they are associated with cognitive impairments, particularly in older adults. While vestibular rehabilitation therapy (VRT) alleviates physical symptoms, its effects on cognitive function remain underexplored. Hence, this study aims to assess the impact of VRT on the quality of life and cognitive performance of individuals with chronic dizziness or vertigo.

Methods: This was a randomized control trial in which 60 participants experienced chronic dizziness or vertigo. The participants were assigned to either the medication-only group receiving betahistine or the VRT + medication group receiving VRT combined with betahistine. Quality of life was measured via the Dizziness Handicap Inventory (DHI). Cognitive performance was assessed via a digit span test, task-switching test, and recording of P300 response.

Results: The VRT + Medication group showed significant improvements in cognitive performance, particularly in the digit span and task-switching tests, with reduced P300 response latency and increased amplitude. No significant cognitive changes were observed in the medication-only group. Both groups showed improvement in quality of life, with a greater reduction in DHI scores observed in the VRT + Medication group.

Conclusion: VRT combined with medication significantly improves cognitive function and quality of life in individuals with chronic dizziness or vertigo. These findings suggest that VRT not only addresses physical symptoms but also enhances cognitive performance, highlighting its potential as a comprehensive therapeutic approach.

Trial registration: The study protocol was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2020/03/023934).

Purpose: To investigate the efficacy of topical sucralfate on postoperative recovery following oropharyngeal surgery in adults using pain scales, analgesic use, and various self-reported measures.

Methods: CINAHL, Cochrane Library, PubMed, and SCOPUS databases were searched from inception through July 3, 2024. Randomized controlled trials related to topical sucralfate following oropharyngeal surgery in patients at least 18 years old were included. Study protocols for clinical trials, abstracts, and non-English language articles were excluded. Two authors extracted data, and disagreements were resolved with a third party if needed. Risk of bias was assessed according to Risk of Bias 2 (RoB 2) tool. Results of included studies and a narrative summary of our findings are presented through descriptive statistics (frequency (%) for categorical variables and mean (range) for continuous variables).

Results: Four studies (n = 185) pertaining to topical sucralfate and post-operative outcomes in an adult population were included. The sucralfate group had a mean age of 40.08 vs. 37.50 for the control group. The sucralfate group had a significantly higher reduction in pain scores than the control group. The sucralfate group also had statistically significant improvements in otalgia, strength, diet tolerance, and reduction in analgesic use compared to the control group in two of the four studies.

Conclusions: Oropharyngeal surgery is commonly performed in adults despite having a morbid recovery process. The literature shows promising results with the use of sucralfate in the reduction of post-operative pain in adults; however, further investigation is warranted given the limited scope of the literature.

Purpose: Trauma is a common cause of facial nerve palsy, accounting for 3% of all cases. While many facial palsies resolve with medical treatment, some require surgical intervention. This systematic review aimed to determine the best therapeutic strategy for traumatic facial palsy.

Methods: We reviewed eligible articles for patient demographics, pre-treatment assessment, parameters of selected treatment, type of treatment, outcomes, and post-treatment assessment.

Results: Among 135 unique citations, 32 studies were considered eligible, reporting treatment data for 2079 patients. Most studies (n = 30) were case series. The main proposed therapeutic strategies were medical, surgical, or a combination of both. For almost all the selected studies, the House-Brackmann (HB) scale was used to estimate the severity of facial palsy.

Conclusion: Based on the existing literature, a standardized guideline for the treatment of traumatic facial palsy is not well delineated, due to the extreme heterogeneity of available therapeutic choices and the lack of standardized patient stratification.

Objective: Fungal infection of the external auditory canal, otomycosis, is generally a superficial, but sometimes stubborn mycotic infection that rarely involves the middle ear. We designed a randomized, controlled cohort study to analyse the treatment effect of ear canal lavage on otomycosis.

Methods: The clinical patients were divided into two groups: an irrigation group and an irrigation + local drug treatment control group. The patients were followed up once a month for three months.

Results: From January 2022 to December 2023, a total of 102 patients treated for otomycosis were enrolled, and 98 of the patients were followed up for three months. 22 of the 98 patients (22.45%) had no or minor symptoms. Common symptoms such as pruritus, pain, hearing impairment, etc., presented solely or in combination. Our fungal culture results revealed that, in 83 patients (84.69%), the otomycotic pathogen was Aspergillus, in 3 patients (3.06%) it was Penicillium, in 2 patients (2.04%) it was Candida species, and in the remaining 13 patients (13.27%) it was negative. There were 3 patients (3.06%) with a mixture of fungal culture reports. In the lavage group, 48 (48/52, 92.30%) patients were cured with initial treatment after three months of follow-up, two (2/52, 3.85%) patients were cured after one month but were lost to follow-up after three months, and two (2/52, 3.85%) patients failed after initial treatment, received topical miconazole ointment treatment and were eventually cured. In the irrigation + local drug control group, 48 (48/50, 96.00%) subjects responded to initial treatment without recurrent disease after three months; 2 (2/50, 4.00%) subjects were lost to follow-up. According to Fisher's exact test, there was no significant difference in treatment efficiency between the two groups (P = 0.258).

Conclusion: This study demonstrated that the diagnosis of otomycosis requires vigilance from clinicians given its nonspecific or minor symptoms. Both ear canal rinses and local antifungal creams are effective, and sequential treatment via both methods is reasonable.

Purpose: This study aimed to systematically review various breathing training methods for patients with neurogenic dysphagia, and assess their clinical efficacy to improve swallowing function in individuals with neurological disorders such as stroke.

Methods: Relevant studies were retrieved from nine databases (PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CNKI, Wanfang, China Science and Technology Journal Database, and China Biomedical Literature Database). Articles included in the review were published from the date of establishment of each database up to January 2024. Eleven randomized control trials (RCTs) and five quasi-experimental studies that met the inclusion criteria were included in this systematic review. Data and information were extracted independently by two reviewers, with disagreements resolved through consensus with a third coauthor. The primary outcome assessed was swallow function occurrence. The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool and the JBI quality assessment tool.

Results: The meta-analysis results showed that expiratory muscle strength training can improve swallowing function (standard mean deviation = -0.89, 95% confidence interval [-1.23, -0.55], Z = 5.11, P < 0.01).

Conclusion: This paper categorized and summarized specific respiratory muscle groups targeted in different breathing training methods, providing guidance for clinicians in designing personalized regimens. The study showed that expiratory muscles strength training is the main method for improving respiratory strength and coordination between swallowing and breathing, reducing the risk of aspiration. More research is needed to assess the effectiveness of independent breathing training.

Objective: Acquired middle ear cholesteatomas (AMECs) is a pathological condition characterized by abnormal epithelial cell proliferation in the middle ear, often resulting from retraction pocket and epithelial migration theories. The aim of this study was to find the abnormal expressed circular RNAs (circ_RNAs) in AMECs and explore their role in the inflammatory response of AMECs.

Methods: Thirty-two AMECs patients and 32 healthy volunteers were recruited. Expression levels of circ_RNAs and inflammatory genes were quantified via reverse transcription quantitative polymerase chain reaction. Concentrations of inflammatory cytokines in human AMECs or normal post-auricular skin samples were measured using enzyme-linked immunosorbent assay.

Results: Results showed that circ_0006168 was higher expressed in AMECs. Receiver operating characteristic (ROC) curve analysis indicated that circ_0006168 might serve as a sensitive biomarker for diagnosing AMECs. Besides, AMECs samples showed increased inflammatory cytokines concentrations. Thirty-two AMECs patients were divided into the High (N = 17) and Low (N = 15) groups according to the expression of circ_0006168. The High group patients had more tinnitus and severe hearing loss than the Low group.

Conclusion: In summary, our findings suggested that circ_0006168 exacerbated inflammatory responses in AMECs, suggesting that circ_0006168 might be a potential biomarker in AMECs.

Purpose: The aim of this study was to evaluate the long-term outcome of Meniere's disease (MD) patients who had previously undergone sac and shunt operation using Hydrops MRI for assessment.

Methods: A total of 17 unilateral MD patients who had previously undergone sac and shunt operation underwent an inner ear test battery, followed by Hydrops MRI. The 34 ears were classified into two groups. Group A consisted of 17 operated ears, which were further subdivided into Group A1 (with endolymphatic hydrops, EH), and Group A2 (without EH). In contrast, Group B comprised 17 non-operated (opposite) ears including Group B1 (with EH) and Group B2 (without EH).

Results: More than 70% MD patients continued to experience the Meniere's triad of symptoms, even long-term (20 years) after surgery. A significantly decreasing sequence in the abnormality rates of the inner ear test battery was noted in Group A1 + B1, whereas no such declining trend was noted in Group A2 or B2. The prevalence of EH on operated ears demonstrated EH at the cochlea (65%), saccule (53%), and utricle (53%). Additionally, EH was also identified on non-operated ears, with a prevalence of 24% at the cochlea, and 12% at the saccule and utricle.

Conclusion: Using Hydrops MRI, this study found a 65% prevalence of cochlear EH on operated ears over a long-term period after surgery. This, coupled with a 70% prevalence of episodic vertigo, suggests that sac and shunt operation may not effectively alleviate EH.