European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Obstructive sleep apnea (OSA) is a prevalent disorder associated with severe comorbidities. Anatomical variations, including nasal diseases, have been identified as potential contributing factors. This study aimed to explore the relationship between nasal cross-sectional areas (CSAs) and OSA, using both acoustic rhinometry (AR) and computed tomography (CT).

Methods: A retrospective analysis was conducted on 355 individuals who underwent polysomnography (PSG), paranasal sinus CT, and AR. Clinical characteristics were compared among the non-OSA, mild OSA, moderate OSA, and severe OSA patients. Multiple logistic regression was used to determine the influence of nasal cross-sectional areas (CSAs) on the risk of developing moderate or severe OSA, with adjustments for sex, age, and body mass index.

Results: Significant associations between specific AR-measured CSA values of anterior nasal region and moderate-severe OSA were identified upon adjusting for confounders (p = 0.034, 0.010, and 0.025, respectively). The lower CSA measurements between the right and the left sides showed a stronger correlation with moderate-severe OSA than the summed values, suggesting the importance of the narrower nasal passage in OSA severity. No significant impact of CSA values on the development of severe OSA was observed.

Conclusion: Nasal CSA measured using AR appears to be a better method for verifying its association with OSA than CT. Nasal CSAs at the anterior region of the inferior turbinates play a crucial role in developing OSA, independent of other known risk factors.

Background: The prevalence, role, and clinical relevance of Helicobacter Pylori (HP) in sinonasal tissues of patients with chronic rhinosinusitis remain unclear.

Objective: To investigate the prevalence and clinical relevance of Helicobacter Pylori (HP) in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSSNP).

Methods: Three investigators conducted a PubMed, Scopus, and Cochrane Library systematic review of the prevalence and clinical relevance of HP infection in CRS patients through the PRISMA framework. A bias analysis was conducted to identify potential heterogeneity and biases across studies.

Results: Of the 42 identified studies, 20 met the inclusion criteria, accounting for 741 CRS patients and 368 controls. HP was detected in 37.1% (n = 127/342) of polyps of CRSwNP patients with the polymerase chain reaction (PCR) and 32.7% (n = 37/113) of polyp tissue with the immunohistochemistry (IHC). Controls reported a nasal PCR and IHC detection rates of 14.8% (n = 36/243) and 3.6% (n = 3/84), respectively. The HP rate did not differ between CRSwNP and CRSsNP. Among patients with CRS, the enzyme-linked immunosorbent assay testing detected blood HP antigens in 48.7% (n = 74/152) of CRS patients and 41.6% (n = 37/89) of controls. The detection of HP in polyps was associated with the severity of gastroesophageal reflux disease (GERD). There was an important heterogeneity between studies for the inclusion criteria, methods of HP detection, and reflux outcomes.

Conclusion: Helicobacter Pylori can be detected in one-third of sinonasal tissues from patients with CRS and can be considered a biomarker of GERD. The potential role of HP in the development of CRS remains unclear. The heterogeneity between studies limits the drawing of valid conclusions.

Background: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal multi-systemic vascular dysplasia caused by gene mutations that lead to recurrent epistaxis and other serious complications including mucocutaneous telangiectasias, gastrointestinal bleeding, and arteriovenous malformations. Treatment is limited to symptomatic relief with no approved standard therapy. Bevacizumab is a monoclonal antibody used primarily in treating metastatic malignancies and ophthalmology. Several studies have shown that bevacizumab is effective in the treatment of HHT-related epistaxis with a high safety profile.

Purpose: This systematic review and network meta-analysis aims to explore the efficacy and safety of bevacizumab in the treatment of HHT epistaxis.

Methods: A comprehensive literature search was done in many databases, including PubMed, Web of Science, Scopus, and the Cochrane Library. We conducted our network meta-analysis using R version 4.2.2 and R Studio version 2022.07.2. Dichotomous data was analyzed as risk ratio and 95% confidence interval and continuous data as mean difference and 95% confidence interval.

Results: We included four randomized clinical trials in our network meta-analysis. Different doses of bevacizumab failed to yield any statistically significant difference in reducing the epistaxis severity score, the number of epistaxis episodes, the duration of epistaxis, or improving hemoglobin levels compared to placebo or other comparators. The pooled effect sizes for all outcomes were homogenous.

Conclusion: Bevacizumab failed to show any significant difference compared to tranexamic acid, estriol, or placebo. These findings underscore the challenges in addressing HHT-related symptoms and highlight the ongoing need for innovative and more effective interventions.

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.

Purpose: Sigmoid sinus anomalies such as dehiscence or diverticula may present with pulsatile tinnitus (PT) and low-frequency hearing loss. Occasionally, these symptoms are severe, necessitating resurfacing of the affected area to restore a normal-appearing sinus wall. This study describes three cases wherein we managed PT attributed to sigmoid sinus anomalies using polymethylmethacrylate (PMMA) bone cement, a novel material.

Methods: Three patients with PT without any history of illnesses initially underwent cortical mastoidectomy to expose the affected area and resurface the sinus wall. Subsequently, PMMA bone cement was used to reconstruct any bony defects causing PT symptoms. Viscosity of the bone cement was altered based on specific characteristics and causes of the affected area. Additionally, we performed the water occlusion test (WOT), audiological assessment, the Tinnitus Handicap Inventory score (THI), and temporal computed tomography, both pre- and postoperatively, to assess the extent of PT.

Results: Preoperatively, all three patients had tinnitus that dissipated with pressure on the neck and the water occlusion test (WOT), with no reported vertigo, trauma, or ear infections. Moreover, all three cases had a severe handicap according to the THI. In contrast, all cases had reduced PT and a significantly decreased THI score postoperatively, as well as no recurrence or complications and no instances of increased intracranial hypertension at the 12-month follow-up.

Conclusion: All cases showed promising results, emphasizing the sustained benefits of this novel intervention for the management of PT.

Objective: To assess the opinion, practices, and challenges of international key opinion leaders about two minimal invasive surgical techniques in supraglottic laryngeal tumours: transoral laser microsurgery (TLM) and the transoral robotic surgery (TORS).

Methods: Design of a questionnaire composed of seven sections and fifty questions covering descriptive data of participants, practitioners experience procedural sequences, considerations related to airways, feeding, and voice, intraoperative haemorrhage, postoperative management, and a comparative analysis of TLM and TORS in treating supraglottic laryngeal cancer.

Results: A total of 27 head and neck surgeons replied to the survey. The experts had an average experience in laryngeal surgery of 20.0 ± 9.4 years, ranging from 5 to 36 years. We noted a significantly shorter installation time in TLM compared to TORS (19% of experts estimated the installation time of over 20 min with TLM vs 44% with TORS; p = 0.02). According to complications, the experts considered that bleeding was the major concern with supraglottic laryngeal surgery, especially intraoperative bleeding in TLM (52% in TLM vs 26% in TORS) (p = 0.09) and postoperative bleeding in TORS (56% in TORS vs 44% in TLM).

Conclusion: The experts did not identify a clear superiority of one technology (TLM) over the other (TORS). The two techniques seemed equivalent to the experts, except for the control of intraoperative haemostasis and visualisation of the surgical field, where TORS was perceived as superior to TLM.

Objectives: Draf III procedure is a challenging endoscopic technique, which has gradually gained an increasing popularity in treating frontal sinus pathologies. The main aim of this systematic review is to offer a comprehensive overview on clinical indications, pre-operative evaluation, surgical techniques, post-operative management and complications of the Draf III procedure. As a step forward, such issues have been comparatively evaluated as referred to patients who underwent primary Draf III procedure and revision DRAF III one). Finally, surgical outcomes related to mucosal flaps and stents to prevent re-stenosis are analyzed.

Methods: A systematic literature review has been performed following PRISMA 2020 checklist statement. An automated search has been carried out by applying an extensive set of queries on the Embase/PubMed, Scopus and Cochrane databases, relating to papers published from 2000 to 2021.

Results: Frontal chronic refractory sinusitis is the most frequent indication to Draf III procedure (72%), followed by mucoceles (11%) and skull base or paranasal tumors (10%). The success rate of primary and revision Draf III are 83.5% and 71%, respectively. The re-stenosis phenomenon seems to depend on allergic mechanism and polyposis). The use of mucosal flaps could improve the Draf III efficacy, better than the use of stents (87 vs 72% of neo-ostium patency).

Conclusion: Draf III is a safe and highly effective surgical technique. However, some limited clinical conditions require some careful technical features, such as the use of mucosal flap, in order to prevent re-stenosis.

Background: Global research has revealed inadequate levels of Auditory Processing Disorder (APD) awareness and knowledge among related professionals leading to neglect of this specific type of hearing impairment that is estimated to present in 50% of children with learning disabilities (dyslexia included) and more than 70% of adults with presbycusis or mild cognitive impairment.

Purpose: The aim of the current study was to record APD awareness and knowledge among professionals working in both Healthcare and Education sectors.

Methods: A 36-question questionnaire was developed and addressed to medical doctors of different specialties (ENTs and non-ENTs), therapists (speech & language therapists, occupational therapists, psychologists), and educators (of both typical and special education). The questionnaire was sent to Professional Societies of interest as well as a University Rectorate where authors are affiliated, requesting the spreading to all members, and was also posted to related private groups in social media. Data concerning APD-training and knowledge were gathered from 522 questionnaires. Level of knowledge was recorded both subjectively (self-rating) and objectively (pre-defined scoring of items).

Results: Analysis showed insufficient knowledge concerning APD among specialties. ENTs and/or therapists scored statistically significantly higher compared to other medical specialties and educators, while still lower than 50%. The current level of awareness on APD might negatively affect the way individuals with APD are addressed, all the way from referral to management. Levels of awareness and knowledge among professions which are related to APD either directly or indirectly can be further improved through formal education targeting bachelor, master and PhD programs of medical doctors, therapists and educators.

Conclusion: We are proposing the development of educational programs that target ENT doctors so that children and adults receive more elaborate services both diagnostically and from a rehabilitation point of view. This will improve quality of life and mental health.

Introduction: Penetrating middle ear trauma-induced pneumolabyrinth is an exceedingly rare finding in pediatric patients. This condition can lead to significant hearing and vestibular dysfunction. We present two pediatric cases, highlighting their clinical complexity.

Cases presentation: Case 1 presented a 9-year-old boy with hearing loss, vertigo, and vomiting following a penetrating trauma to the left ear. Surgical exploration revealed ossicular chain disruption and perilymphatic fistula, which were repaired. Despite initial recovery, he developed ossifying labyrinthitis and required cochlear implantation. Case 2 described a 15-year-old boy who had right-sided hearing loss and vertigo after right ear trauma. Conservative management resulted in improvement of vestibular symptoms, but the profound hearing loss remained. The family declined cochlear implantation, due to the patient's athletic activities.

Conclusions: Penetrating trauma-induced pneumolabyrinth in pediatric patients is extremely rare. These cases demonstrate the importance of tailored treatment approaches and vigilant follow-up to optimize auditory and vestibular outcomes.

Purpose: This review aims to explore the influences of tinnitus retraining therapy (TRT) on patients with tinnitus.

Methods: PubMed, MEDLINE, EMBASE, CINAHL, PEDro, SCOPUS, and Web of Science were screened for randomized controlled trials (RCTs) that explored the effects of TRT on patients with tinnitus from inception to June 30, 2024. The methodological quality of the included RCTs was evaluated using the physiotherapy evidence database (PEDro) scale.

Results: Fifteen studies met our eligibility criteria. A total of 2069 patients with tinnitus (mean age 52.93 years; 66% male) were involved in the present review. The quality of the selected studies ranged from 5 to 8 on the PEDro scale, with a median score of 7. TRT did not provide superior effects in treating patients with tinnitus compared to tinnitus masking (TM), tinnitus educational counselling (TED), TRT with open ear hearing aids, Tailor-made notched music training (TMNMT), partial TRT, usual care, and smart TRT.

Conclusions: TRT intervention is considered a treatment option for patients with tinnitus. Combining TRT with other interventions, such as cognitive-behavioral therapy, pharmacotherapy, or tDS, may show even greater efficacy. Additional studies are strongly required to recognize the long-term effects of TRT on tinnitus, determine who most likely would benefit from the intervention regarding tinnitus type and severity, and identify the optimal treatment protocol.