European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Posterior canal-type benign paroxysmal positional vertigo (pc-BPPV) is diagnosed when positional torsional nystagmus is induced by the Dix-Hallpike test (DHT). When the DHT is repeated, positional nystagmus disappears. This phenomenon is known as BPPV fatigue. In cases where positional nystagmus cannot be induced by the DHT because of BPPV fatigue occurring just before a medical examination, or where positional nystagmus is not observed during the first DHT, we cannot make a diagnosis of pc-BPPV because the DHT can no longer induce the positional nystagmus typical of pc-BPPV. Therefore, this study aimed to develop a new maneuver to rapidly restore positional nystagmus in cases of BPPV fatigue, thereby facilitating accurate diagnosis.

Methods: Twenty patients with pc-BPPV performed the DHT twice to induce BPPV fatigue, with the new maneuver being used, and then performed a third DHT to verify the restoration of positional nystagmus. The primary outcome measure (POM) was the ratio between the maximum slow-phase eye velocity of positional nystagmus during the third DHT and that during the first DHT. A higher ratio indicates a greater ability of the new maneuver to restore nystagmus.

Results: The 95% confidence interval for the POM was 0.712-1.026, exceeding the pre-defined lower limit of efficacy of 0.7 specified in the protocol.

Conclusion: The high values for the POM suggest that the new maneuver successfully restores positional nystagmus and demonstrates its potential applicability in clinical practice for diagnosing pc-BPPV in cases complicated by BPPV fatigue.

Purpose: The Karl Storz Company recently introduced a new exoscopic system equipped with new features and improvements compared to older counterparts. The endpoints of this study are to evaluate the new VITOM^® Eagle system and compare it to the older VITOM^® 3D for micro-laryngeal surgery, to analyze the new features of the latest Karl Storz's product and determine whether these upgrades provide a significant advantage to surgery of the laryngeal district.

Methods: Participants simulated CO₂ Transoral Laser Microsurgery (CO₂ TOLMS) procedures on 3D-printed laryngeal models firstly with both the VITOM^® 3D and VITOM^® Eagle. At the end of both sessions 2 questionnaires were administered: the first generic 3-item questionnaire comparing evaluating exoscopic and microscopic technology, the second questionnaire involved 8 items related to device quality.

Results: Overall the new VITOM^® Eagle resulted superior to the older VITOM^® 3D, there were statistically significant differences in scores evaluating the image quality (p = 0.002), magnification rate (p = 0.002), and luminance (p = 0.047). In addition, according to questionnaires results, senior Otolaryngologists appeared to be slightly less inclined to a complete transition to exoscopy when compared to young surgeons.

Conclusions: The results of this study demonstrate how the new VITOM^® Eagle significantly outperforms the older VITOM^® 3D. The upgrades discussed, have the potential of leading to better surgical outcomes by providing surgeons with better tools to navigate complex anatomical districts. Furthermore, results from this study highlighted how exoscopy is affecting the surgical training of young surgeons.

Background: Reconstructive surgery relies on microvascular flaps as the gold standard, however, for patients at high risk of extended procedures, a local flap may be preferable. In such cases, the platysma flap represents an effective option for the oral cavity, oropharynx, and small to medium-sized facial defects. Nevertheless, its use remains controversial, particularly regarding oncological radicality and safe neck dissection.

Method: This paper presents a step-by-step description and video of a clinical case from the Hospital of Bolzano, demonstrating a modified platysma flap technique.

Conclusion: The proposed variant, with its arterial supply from the facial artery, offers a more oncologically radical approach for local reconstruction.

Objective: To assess the incidence, risk factors, and outcomes of facial palsy following cochlear implantation using the transcanal technique, incorporating radiological predictors.

Methods: An ambispective observational study involving 978 patients who underwent cochlear implantation via the transcanal technique at three tertiary academic referral center from January 2014 to December 2024. Radiological parameters measured on preoperative computed tomography (CT) scans included facial nerve annulus distance (FAD), facial nerve-round window distance (FNRWD), facial recess width (FRW), alpha angle, and beta angle. Clinical data, including demographics, intraoperative details, and postoperative facial nerve function, were recorded.

Results: Facial palsy occurred in 7 out of 978 patients (0.71%), all were prelingually deaf children under five years old. Six out of seven had immediate onset facial palsy, with House-Brackmann grades IV-VI. In the non-facial palsy group (n = 971), mean radiological values were: FAD 7.12 mm (± 1.08), FRW 4.52 mm (± 0.67), and Alpha angle 51.2° (± 4.3°). In the facial palsy group (n = 7), values were 7.05 mm (± 1.15), 4.48 mm (± 0.73), and 50.1° (± 3.9°), with no significant differences between the groups.

Conclusion: Facial palsy following the transcanal technique is a rare complication, with an incidence of less than 1 in 100 patients. While reduced FRW and FAD were explored as potential contributors, no statistically significant risk factors could be established.

Purpose: (1) Study the preoperative predictive factors (such as duration of symptoms, tumor size, and cystic component) and their effects on the type of resection and facial nerve (FN) outcomes. (2) Analyze the intraoperative predictive factors, such as the extent of resection and intraoperative FN stimulation. (3) Compare our approaches (enlarged translabyrinthine approach, transotic and transcochlear approaches) to other approaches (retro sigmoid) and review the literature comparing different approaches. (4) To inquire if the surgical decision (total vs. non-total removal) and outcomes (complications and facial nerve function) of large and giant VS surgery have changed during 35 years at Gruppo Otologico.

Methods: A total of 567 cases out of 3707 were enrolled. The inclusion criteria were patients with tumors > 30 mm extrameatal diameter undergoing a translabyrinthine approach with a minimum follow-up of 12 months.

Results: The mean duration of symptoms was 35.9 months, pronounced more in the elderly (53.4 months) than in younger individuals (33.9 months). The mean tumor diameter was 36.6 mm, and 50.4% of them were cystic. Total resection (TR), near-total resection (NTR), subtotal resections (STR), and partial resection (PR) were achieved in 73.2%, 7.4%, 10.2%, and 9.1% of cases, respectively. Regrowth was observed only after STR and PR (20.7% and 44.2%, respectively). We excluded the sacrificed facial nerves (no.86) from the results of the FN outcomes. Postoperatively, FN outcomes were as follows: HB I-II 42.2%, HB III 46.9%, and HB IV-VI 10.8%. Younger individuals underwent TR in 403 (79.3%) cases, against 12 (20.3%) elderly individuals. Non-total resections (NTR/STR/PR) were performed in 47 (79.7%) cases in the elderly as against 105 (20.7%) in younger individuals. For experience effect, there were increased cases of NTR, STR, and PR (18.8% before 2004, 28.9% ≥ 2004), while the rate of complications decreased (24.8% before 2004, 13.1% ≥ 2004).

Conclusion: TR and NTR are good strategies for tumor control and FN outcomes. Preoperatively, longer symptom duration, profound deafness, and tumor diameter of ≥ 4 cm adversely influence facial nerve outcome after surgery. Conversely, cystic tumors may have a favorable influence. Additionally, intact FN responding to a stimulus after tumor resection anticipates good long-term FN (HB I-III) outcomes. With experience, operating time decreases and there may be an increase in poor outcomes of FN due to the high rate of operated giant tumors. Long-term follow-up is recommended.

Purpose: Vibrant Soundbridge (VSB) is an active middle ear implant that serves as a solution for people unable to use conventional hearing aids properly. Surgical techniques for VSB implantation have progressively advanced, improving its outcomes. Traditionally, VSB processor activation transpires around four weeks after the surgery to provide enough healing; however, contemporary practices in cochlear implant and bone-anchored hearing device activations indicate reduced waiting times. The purpose of this research is to explore the feasibility, safety, and advantages of early VSB activation.

Methods: This prospective study was conducted in two phases. In phase one, the patients only attempt using the device on the first business day after surgery and then return in 4 weeks for a complete and standard fitting and device use. In the second phase, participants had a thorough fitting and began using the device on a regular basis the first working day after surgery. Feasibility, safety, and audiological results were assessed throughout both phases.

Results: Early activation was successfully achieved in all patients in the early group without significant complications. When comparing the audiological examination and fitting parameters between the initial session the day after surgery and the one-month follow-up, there was no statistically significant change.

Conclusion: The study emphasizes the possibility for early VSB activation, which might minimize wait times and enhance patient satisfaction without compromising device function. Further study is required to validate these results in broader groups and investigate long-term consequences.

Purpose: Detection of complications during rehabilitation and postoperative follow-up after cochlear implantation is essential, especially in children and cognitively impaired patients. Electrode array migration can affect outcomes and must be detected early. Traditional radiographic methods, although effective, are costly and expose patients to radiation. This case report discusses the use of a previously published impedance-based model for cochlear implant array localization in a child with Aymé-Gripp syndrome.

Methods: Impedance telemetry data and X-ray images were collected at the time of initial surgery and before and after the required revision surgery. The impedance-based model was used to estimate the insertion depth of the most basal cochlear implant electrode within the cochlea. The resulting estimates were compared with the electrode positions from radiographs to assess the accuracy and applicability of the model.

Results: 20 months after implantation, the patient suddenly stopped tolerating the CI audio processor. Retrospectively, the impedance-based model revealed substantial electrode migration, which was confirmed by postoperative radiography.

Conclusion: The proposed model, which uses routine impedance telemetry data without radiation exposure, offers a cost-effective alternative to radiography. Early detection and intervention, particularly in complex cases, improves outcomes and reduces costs, highlighting the importance of objective monitoring.

Objective: Research on age and prognosis for oral cavity squamous cell carcinomas (OSCCs) has shown inconsistent results. We aimed to establish age as an independent prognostic factor and determine an age cutoff for staging in OSCC.

Methods: Electronic records were reviewed for all OSCC patients treated between 2000 and 2020.

Results: The study involved 250 patients, identifying a mortality cutoff age of 65 through Receiver Operating Characteristic curve analysis (sensitivity 77%, specificity 49%). Patients ≥ 65 had lower survival rates for early-stage (TNM I-II; 63.5% vs. 96%, p < 0.001) and advanced-stage (TNM III-IV; 37.5% vs. 62%, p = 0.011) diseases. A proposed age-based TNM staging system categorized ≥ 65 as Stage III/IV, with comparable survival rates confirmed in a revised analysis.

Conclusion: The study identifies age, with a 65-year cutoff, as an independent prognostic factor in OSCC and highlights its role in improving current staging systems.

Level of evidence: III.

Purpose: Cholesteatoma is characterized by the abnormal growth of keratinizing squamous epithelium in the middle ear. Although both pediatric and adult populations are affected, differences in the molecular mechanisms underlying cholesteatoma between these age groups are not fully understood. miRNA-21 and IL-6 have been implicated in various inflammatory and proliferative processes, and their roles in cholesteatoma pathogenesis among different age groups warrant detailed investigation. Research objective -Compare the expression levels of miRNA-21 and IL-6 genes in pediatric versus adult cholesteatoma tissues to elucidate potential age-related molecular differences.

Methods: Tissue samples were collected from 30 patients (15 in Pediatric group and 15 in Adult group) undergoing surgical treatment for cholesteatoma. Preoperative MERI scores and Quantitative real-time PCR (qRT-PCR) was employed to measure the expression levels of miRNA-21 and IL-6. Statistical analyses were conducted to compare the expression profiles between the two groups.

Results: The results revealed a significantly higher expression of miRNA-21 and IL-6 in pediatric cholesteatoma compared to adult cholesteatoma. These findings suggest distinct molecular pathways may be involved in the pathogenesis of cholesteatoma in different age groups.

Conclusion: The differential expression of miRNA-21 and IL-6 between pediatric and adult cholesteatoma underscores the potential for age-specific therapeutic targets. Increased miRNA-21 and IL-6 gene expression in pediatric cases may indicate a more pronounced role in tissue proliferation and inflammation. Further research is necessary to explore the clinical implications and potential for targeted treatments based on these molecular differences.

Level of evidence: 3:

Purpose: Obstructive sleep apnea syndrome is a common condition that can have serious consequences if left untreated. Many patients are intolerant of treatment by continuous positive airway pressure or a mandibular advancement splint. Tonsillopharyngeal surgery may be a viable therapeutic alternative. The objective of this study was to compare clinical assessments of tonsillar obstruction in awake patients with findings from drug-induced sleep endoscopy (DISE). A secondary objective was to evaluate its impact on therapeutic success.

Methods: A retrospective cohort study was conducted on 270 patients, of whom 128 were selected for the study. Patients were evaluated both clinically and via DISE.

Results: Significant differences were found between tonsillar obstruction pattern observed under sedation with those seen in awake patients. DISE led to the cancellation of surgeries planned in nearly half of the cases. Interestingly, size 2 tonsils, generally considered non-obstructive, were found to be obstructive in 58% of cases. Tonsillectomy and/or pharyngoplasty when performed on patients selected throught DISE was successful in 75% of cases.

Conclusion: DISE appears to be a valuable tool for assessing tonsillar obstructions and may allow more patients to benefit from appropriate surgical interventions.