European Archives of Oto-Rhino-Laryngology最新文献

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.

Purpose: This article addresses the complex clinical scenario where patients present to otolaryngologists with symptoms typically ascribed to chronic rhinosinusitis (CRS) or migraines which may in fact stem from elevations in intracranial pressure. We aim to clarify the diagnostic challenges and emphasize the importance of considering elevated intracranial pressure (eICP) as its symptoms overlap with both CRS and migraines.

Methods: This narrative review synthesizes clinical experiences and literature to discuss the differential diagnoses involving CRS, facial pain/pressure, migraines, and eICP. Key discussion points include symptomatology of eICP and its management in otolaryngological practice.

Results: Patients presenting with symptoms of CRS or migraine may exhibit overlapping signs that makes diagnosis challenging. Patients with symptoms of facial pain and pressure, or other findings such as ear fullness, muffled hearing, and tinnitus, that do not resolve with conventional topical intranasal therapies or migraine management should be worked up for eICP.

Conclusion: The overlap in clinical presentations among patients with concern for CRS, migraines, and ICP elevations poses a diagnostic challenge. It is crucial for otolaryngologists and neurologists to collaborate closely to ensure accurate diagnoses and appropriate management. Enhanced awareness and understanding of the broader spectrum of symptoms associated with eICP can prevent misdiagnosis and promote better patient outcomes.

Purpose: To investigate whether the appearance of percutaneous bone conduction devices (perBCDs) or active transcutaneous bone conduction devices (atBCDs) is preferred by BCD-users and non-users. The second aim is to examine the degree to which the appearance of a device matters in comparison to other BCD traits, and whether certain participant characteristics predict this.

Methods: An online questionnaire was designed and administered to BCD-users and non-users (i.e., persons with no experience using a BCD). Pair-wise comparisons showing pictures of the latest generation perBCD and atBCD sound processors and implant sites were anonymously provided to participants, who could indicate their preference. Sum scores were calculated ranging from - 2 (strong preference for perBCD) to 2 (strong preference for atBCD). Means for the total score as well as sub scores of pictures showing either sound processor or implant site were calculated. Statements were presented in which the appearance of the device was weighed against other traits such as better hearing.

Results: The study population consisted of 102 BCD-users and 105 non-users. An overall preference for perBCD sound processors was observed (mean score - 0.50 (95% CI: -0.63, -0.37). BCD-users had no preference for implant sites whilst non-users preferred atBCDs (-0.03 (-0.27, 0.21) and 0.60 (0.40, 0.80) respectively, p < 0.01). Most participants found better hearing more important than having an appealing device (n = 150, 73.0%).

Conclusions: PerBCD sound processors were preferred over atBCD sound processors by both BCD-users and non-users. Functionality seems to be more important than the appearance of the device.

Purpose: Cochlear implant (CI) effectiveness in asymmetric hearing loss (AHL) is well established, but CI use over time and daily usage are rarely monitored by health care systems. Continued use of the CI after the first year could be considered an indirect indicator of subjective benefit. The objective of this study was to evaluate CI use with a follow-up period of 5 years.

Materials and methods: Sixty-four patients were included in this retrospective study. AHL candidates included patients with an aided speech perception score (SPS) < 50% at 60 dB in the ear to be implanted. The better ear had to have a non-fluctuating HL, and an aided SPS ≥ 60% for disyllabic words in quiet, with an interaural SPS gap ≥ 40%.

Results: Ninety-seven percent of patients still used their CI all day at 1-year and 93% at 5-years post-implantation. Only four patients discontinued use. The mean duration of daily use at 5-years assessed using data-logging was 12 ± 3.2 h. Aided SPS for the implanted ear improved at 1-year post-implantation, for both mono- and disyllabic words in quiet and sentences in noise (p < 0.0001), and remained stable at 5-years. Unaided and aided SPS of the acoustic ear decreased over time. However, SPS in bimodal conditions improved at 1-year for both mono- (p < 0.0001) and disyllabic words (p < 0.005) and sentences in noise (p < 0.0005) and the scores remained stable at 5-years.

Conclusion: The low percentage of non-users and the long duration of daily use at 5 years post-implantation are an additional strong argument to recommend cochlear implantation in patients with asymmetric hearing aid benefit.

Purpose: Comparison of dexamethasone phosphate (DXA) and triamcinolone acetonide (TCA) for intratympanic therapy (IT) in patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) to reveal a potential superiority regarding the efficiency to improve hearing function.

Methods: Retrospective, monocentric, two-armed cohort-study. Analysis of clinical and audiometric data of patients treated with IT for unilateral ISSNHL. 118 adults, who received IT with DXA (n = 67) or TCA (n = 51) were included. Main outcome parameters were hearing improvement in percent and decibel (dB) in relation to the healthy ear within a follow-up period of three months. Response to therapy was defined as an improvement of at least 10dB in affected frequencies.

Results: Median improvement was 24.6% and 6.2 dB in the DXA group, 31.4% and 10.0 dB in the TCA group. For the response analysis, 7 patients dropped out. Of the remaining 111 patients, 27 (43,5%; 95%CI 30,9-56,7) in the DXA and 26 (53,0%; 95%CI 38,2-67,4) in the TCA group showed response. Analysis of the outcome parameters showed no statistically remarkable difference (p < 0,05) between the two cohorts. The difference of initial pure tone average between the affected and healthy ear and the time between symptom onset and first IT, was confirmed as an influencing factor to the outcome.

Conclusion: For intratympanic treatment of ISSNHL dexamethasone phosphate and triamcinolone acetonide seem equivalent considering its ability to improve hearing function. A more severe hearing loss and a short duration between onset and therapy may favor the chance of hearing recovery.

Background: Bilateral sudden hearing loss (BSHL) is a rare otologic emergency, representing 1-2% of all sudden hearing loss cases. Autoimmune processes are considered one of the key contributors to BSHL, with immune responses targeting inner ear structures. The aim of our study is to identify the role of autoimmune and inflammatory markers in patients with BSHL and assess their prognostic significance.

Materials and methods: This retrospective study reviewed 30 BSHL patients out of 420 sudden hearing loss cases. Data including audiometric results, medical histories, autoimmune and inflammatory markers (ANA, RF, ESR, CRP, ACA, ANCA), and autoimmune diseases such as Ankylosing Spondylitis (AS), Hypothyroidism (HT), Rheumatoid Arthritis (RA), and Systemic Lupus Erythematosus (SLE) were analyzed. Audiometric recovery was assessed using Siegel's criteria, and the presence of autoimmune markers was evaluated for their impact on clinical outcomes and recovery.

Results: Autoimmune markers were detected in 60% of the patients with BSHL, with elevated levels of ANA, RF, ESR, and CRP observed most frequently. Patients who tested positive for autoimmune markers demonstrated significantly lower recovery rates compared to those without marker positivity. Specifically, 13% of patients with positive markers showed partial hearing recovery, while 100% of patients without markers exhibited partial recovery. The average hearing improvement across all frequencies was around 21.5 dB. These results suggest that autoimmune marker positivity is associated with poorer clinical outcomes and lower recovery rates following standard corticosteroid treatment.

Conclusion: Our study demonstrates that autoimmune and inflammatory markers play a significant role in the prognosis of BSHL. Patients with positive autoimmune markers exhibit poorer recovery rates, indicating the potential importance of these markers in predicting treatment outcomes for BSHL.