European Archives of Oto-Rhino-Laryngology最新文献

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.

Purpose: To identify probable triggers of delayed facial palsy (DFP) after middle ear surgery.

Methods: Retrospective single-center chart review of DFP cases between 2010 and 2021.

Results: Forty patients with DFP could be identified after 3,508 middle ear surgeries (1.14%). The occurrence of DFP was after tympanoplasty type 1 1.60%, after tympanoplasty type 3 without mastoidectomy 1.32%, after tympanoplasty type 3 with mastoidectomy 0.36%, and after all tympanomastoid surgery cases 0.35%. The anti-HSV-1 IgM was positive in three cases and borderline in two patients. The anti-VZV IgM was positive in three cases. Beside herpes virus reactivation, facial canal dehiscence (n = 8), bacterial infection, direct nerve microtrauma and intratympanal use of collagenous or oxidized cellulose sponges are presumed pathogenetic factors in our study.

Conclusion: The etiology of DFP is still not conclusively clarified, it has probably a heterogeneous pathogenesis and therefore requires further scientific research. Mastoidectomy may have a protecting effect against DFP. The risk may be reduced by avoiding possible promoting factors but this adverse event cannot be substantially eliminated yet. Nonetheless, we summarize practical considerations for the prevention, diagnosis, and therapy of DFP in the future.

Purpose: Given its unique anatomical position and the amalgamation of bony and soft tissues within the cochlea, exploring its intricacies poses persistent challenges. Histopathology remains the gold standard in research, but given its inherent limitations, there is a clear need for innovative alternatives. The integration of microCT technology with advanced volume rendering techniques emerges as a promising approach for overcoming the hurdles associated with anatomical investigations of the cochlea.

Methods: We seamlessly integrated high-resolution microCT cochlear images with medical imaging analysis software to create detailed 3D anatomical images of the human cochlea without the need of sample processing.

Results: Volume rendering allowed a multiplanar, non-destructive, detailed anatomical evaluation of the human cochlea, including its capillary system, as well as soft tissue visualization at single-micron resolution in 3D.

Conclusion: The use of volume rendering in cochlear anatomical studies is underexplored despite the prevalence of 3D reconstruction. This technique presents a promising avenue for scientific investigation, providing researchers with unprecedented insights that can potentially benefit patients with hearing disorders.

Purpose: Nasal breathing dysfunction resulting from uncontrolled decongestant use is an extremely urgent public health problem. This condition is referred to as rhinitis medicamentosa. Despite the high incidence of patients with this diagnosis, there is still no consensus on treatment tactics. The purpose of this study was to review the available literature on rhinitis medicamentosa treatment and summarize the findings reported in different approaches.

Methods and materials: We conducted a systematic review of PubMed (MEDLINE), The Cochrane Library, and Clinicaltrials.gov databases to identify studies that describe conservative and surgical treatments for rhinitis medicamentosa.

Results: Twelve studies, including 373 patients, met the search criteria. Out of these, seven studies used topical intranasal steroids like budesonide or fluticasone propionate sprays as a conservative treatment. One study used dexamethasone nasal drops. Five studies involved surgical treatment for patients; three of these studies used radiofrequency ablation to reduce the inferior turbinates, while the other two studies used diode laser and kinetic stimulation, respectively.

Conclusion: All studies included in this systematic review demonstrate the high efficacy of the separately presented treatment methods. However, the different design and evaluation methods do not allow us to systematize the data and develop a unified algorithm for treating rhinitis medicamentosa. We see the potential for conducting comparative evidence-based studies on a larger sample, along with the evaluation of long-term treatment results.

Objective: Bilateral vestibulopathy (BVP) is a rare condition which causes significant impairments in balance, spatial orientation, and gaze stability. The goal of this study was to assess the impact of BVP on several outcome domains related to daily life.

Study design: Cross-sectional survey.

Setting: Tertiary referral center for otology and neurotology.

Patients: Sixty-one patients treated for BVP at the Antwerp University Hospital.

Intervention: Questionnaire with items covering several outcome domains.

Main outcome measures: Impact of BVP on employment, mobility, activities of daily living, health outcomes, and finances.

Results: A total of 61 patients with BVP completed the questionnaire. Of these, 47.5% were retired, 26.2% were actively employed and 23% were unable to work due to their symptoms. 4.9% had to change work in the past, and 6.6% had to adjust their work situation. 8.1% had been absent from work for more than 4 weeks in the last year. Of those who had driven in the last year, 42.6% reported that their balance problems had affected their driving ability. 54.1% reported having fallen as a result of their BVP symptoms and 39.4% of these required a visit to their general practitioner or a hospital due to a fall. 14.8% reported that they had visited the emergency room and 21.3% reported that they had been admitted to the hospital in the last year. 13.1% reported that they had borne extra financial costs in the last year due to their condition, with a median burden of €1,000.

Conclusions: BVP has a significant impact on daily life as measured across several domains. These findings indicate that there is a significant disease burden associated with BVP. New treatment or management modalities are needed to reduce this burden.

Purpose: Otitis media with effusion (OME) is one of the most common childhood diseases. It is recommended to use tympanometry in addition to otoscopy and/or pneumatic otoscopy for the diagnosis and follow-up of OME. Clinitians are using Wideband absorbance (WBA), which is one of the methods of evaluating the middle ear in the diagnosis of OME, more widely.

Methods: The relationship between the changes in the examination findings obtained by otoscopy and pneumatic otoscopy and the findings of WBA in the monthly follow-ups performed during the three-month period of children diagnosed with OME, was examined. In the study, 48 ears of 26 individuals aged 24-71 month who were diagnosed with OME were evaluated. Otoscopy, pneumatic otoscopy, 226 Hz tympanometry and WBA measurements were performed at the initial, first, second and third month examinations. The relationship between the difference between consecutive measurements was examined because it was thought that consecutive measurements might be more significant in the relationship between measurements. The Spearman test was used to determine whether there was a relationship between WBA and otoscopic and pneumatic otoscopic examination results. For assessing parameters where there was a significant difference between the groups compared, the variables were assessed using Kruskal-Wallis analysis of variance. The Dunn test was used for post hoc testing.

Results: The change observed with both otoscopy and pneumatic otoscopy between the initial and first month control could not be adequately determined by 226 Hz tympanometry, but the change in the amount absorbance at 2520 Hz and 3175 Hz was moderately correlated with the examination findings. However, it was observed that the change between the first and the second follow-up examinations was significant at the frequency range of 226-630 Hz in WBA and the change between the second and third months was significant at the frequency range of 226-4000 Hz in WBA.

Conclusions: The findings obtained in the study show that, 226 Hz tympanometry may be insufficient to reflect the change in examination findings while WBA can provide more detailed information to support the examination findings during the follow-up period as well as the diagnosis of OME.