European Archives of Oto-Rhino-Laryngology最新文献

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.

Purpose: To translate and culturally adapt the SPOT-25 to the Dutch language and validate the Dutch SPOT-25 in a Dutch population of otosclerosis patients undergoing primary stapes surgery.

Methods: A multicenter prospective validation study was performed between November 2018 and May 2024. The translation into Dutch and validation process of the SPOT-25 was performed according to the COSMIN guidelines. Patients were asked to complete the SPOT-25 and Glasgow Health Status Questionnaire (GHSQ) preoperatively, the SPOT-25, GHSQ and Glasgow Benefit Inventory six to eight weeks postoperatively and the SPOT-25 eight to ten weeks postoperatively. Healthy controls were asked to complete the translated SPOT-25 once. Preoperative and postoperative audiometric results were also obtained. The evaluated measurement properties included construct validity, measurement invariance, discriminative validity, reliability and responsiveness of the translated SPOT-25.

Results: Hundred and fifteen patients and 50 healthy controls were analyzed. Analyses of the translated SPOT-25 showed adequate construct validity, discriminative validity, reliability and responsiveness. The SPOT-25 scores were strongly correlated with the GHSQ score. The internal consistency and test-retest reliability were good as Cronbach's alpha and intraclass correlation coefficients were higher than 0.70. The four-factor model fitted best in our population of otosclerosis patients; however the results indicated a mediocre fit between the model and the data.

Conclusion: The Dutch SPOT-25 showed good validity, reliability and responsiveness and can be implemented as an additional outcome measure to improve otosclerosis research and clinical practice.

Introduction: In otology consultations, patients with chronic otitis media (COM) often present as candidates for various hearing rehabilitation options. Selecting the most suitable approach requires careful consideration of patient preferences and expectations, the risk of disease progression, and the integrity of the bone conduction pathway. This study aims to evaluate and compare postoperative hearing outcomes in COM patients undergoing tympanoplasty (with or without passive middle ear implants), bone conduction systems (BCI), or active middle ear implants (AMEI). The objective is to assess the effectiveness of each surgical approach in hearing rehabilitation, considering the type and severity of hearing loss as well as the duration of the disease.

Methods: Retrospective data analysis in a tertiary referral center studying average PTA across six different frequencies, speech perception at 65 dB, influence of Eustachian tube dysfunction, reintervention rate and adverse effects, and the influence of disease duration on functional outcomes via linear regression analysis.

Results: 116 patients underwent surgery due to COM between 1998 and 2024. With a slight female predominance (54.31%). AMEIs and bone conduction devices provided the highest amplification in terms of PTA and speech discrimination, with a lower reintervention rate when comparing both groups with passive middle ear implants, OR in BCI group of 0.30 (0.10; 0.89, p = 0.030), OR in VSB group of 0.15 (0.04; 0.56, p = 0.005). It was also observed that a longer evolution time could be associated with greater auditory gain, with a p-value = 0.033.

Conclusions: The selection of each treatment option primarily depends on bone conduction thresholds, along with surgical risk, patient preferences, and MRI compatibility. In our study, AMEIs demonstrated the highest functional gain in terms of speech discrimination and frequency-specific amplification, followed by BCI. These findings support the use of implantable hearing solutions as effective alternatives for auditory rehabilitation in COM patients.

Propose: Osteogenesis imperfecta (OI) is a genetic connective tissue disorder primarily characterized by bone fragility. Hearing loss is an extra-skeletal manifestation of OI. This study aims to characterize the audiological findings of a sample of patients with OI in China.

Methods: A total of 76 patients (aged 4-77 years) were recruited and evaluated using audiometric evaluations, including pure tone audiometry (PTA), acoustic admittance measurements, and distortion-product otoacoustic emissions (DPOAEs). Patients were categorized into 2 age groups: adults (more than 18 years) and children (under 18 years), and classified by hearing type: normal hearing, conductive, sensorineural, or mixed hearing loss.

Results: Tympanometry (152 ears) showed 71.7% Type A tympanograms. There was a significant association between tympanogram type and hearing loss (p < 0.01). DPOAEs were predominantly abnormal in ears with sensorineural and mixed hearing loss (p < 0.01). PTA (146 ears) revealed hearing loss in 39.0%: 16.4% conductive, 15.1% sensorineural, and 7.5% mixed. Age correlated significantly with hearing loss type (p < 0.01). Adults' group exhibited higher pure-tone averages (11.3 dB vs. 8.8 dB, p < 0.01), average air-bone gap (2.5 dB vs.2.5 dB, p < 0.05), and bone conduction thresholds than children's group.

Conclusions: Hearing loss is common and progressive in Chinese OI patients, with a significant age-related increase in both the prevalence and severity of hearing loss. Establishing a hearing baseline and regular follow-up is essential for early intervention.

Objective: To analyze SLC26A4 gene mutations in children with large vestibular aqueduct syndrome (LVAS) with or without Mondini malformation, and to compare their hearing phenotypes, rehabilitation outcomes, and learning performance after cochlear implantation.

Methods: We used T7 Endonuclease I enzyme digestion to detect SLC26A4 mutations in 48 children with LVAS without Mondini malformation (EVA group), 29 children with LVAS and Mondini malformation (EVA + MD group). Negative results were confirmed by Sanger sequencing. Auditory performance (CAP) and speech intelligibility (SIR) scores assessed hearing and speech rehabilitation outcomes, while academic performance evaluated learning post-cochlear implantation.

Results: Electrophoresis showed that the positive detection rates of SLC26A4 mutations were 89.58% in the EVA group, 89.66% in the EVA + MD group, and 0% in the control group. In the EVA group, the most common mutations were in exons 7 + 8 (52.08%), 11 + 12 (22.92%), and 19 (18.75%). In the EVA + MD group, the predominant mutations were in exons 11 + 12 (51.72%), 4 (34.48%), 7 + 8 (27.59%), and 19 (24.14%). The EVA + MD group had higher detection rates for two-site (37.93%) and three-site compound heterozygous mutations (13.79%) compared to the EVA group (22.92% and 10.42%, respectively). The median diagnosis time for profound hearing loss was 6.62 months in the EVA + MD group versus 10.56 months in the EVA group. There were no significant differences in CAP and SIR scores between the groups, but the EVA group showed better learning performance.

Conclusion: This study reports, for the first time, multiple cases exhibiting a three-site compound heterozygous mutation in the SLC26A4 gene. The hotspot exons of the SLC26A4 gene differ between children with simple LVAS and those with LVAS accompanied by Mondini malformation. Children with both conditions show earlier onset of profound hearing loss and poorer learning performance compared to those with only LVAS.

Introduction: The incidence of otosclerosis appears to have been declining since the late 1970s. We conducted a retrospective nationwide study to assess the evolution of the annual number of stapes surgeries and to analyze the changes in technical practices, specifically comparing laser techniques to cold instruments.

Methods: We examined the French national dataset from the "Programme de Médicalisation des Systèmes d'Information" (PMSI). Within this national database, we collected data on the number of stapes surgical procedures performed using cold instruments and laser technology from 2013 to 2022 in France.

Results: The total number of stapes surgeries has decreased each year, dropping from 4,268 procedures in 2013 to 3,007 procedures in 2022, which represents a decline of 29.5% over a decade. On average, 162 fewer procedures were performed each year compared to the previous year. The use of laser technology increased from 42% of cases in 2013 to 61% of cases in 2022. Laser techniques were more commonly employed in university hospitals and private non-profit clinics than in general hospitals and private clinics.

Conclusion: The number of stapes surgeries is decreasing linearly and consistently, raising concerns regarding the training of young surgeons. Furthermore, laser techniques are gradually replacing cold instruments in clinical practice.