European Archives of Oto-Rhino-Laryngology最新文献

Purpose: The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (Vicryl^TM, standard arm) with continuous self-locking, monofilament barbed suture (V-Loc^TM, experimental arm).

Methods: Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3 months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints.

Results: The median age was 61 years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30 min) and standard (7:01 ± 2.42 min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16).

Conclusion: For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results.

Trial registration information: The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 ( https://drks.de/search/de/trial/DRKS00025831 ).

Background: The introduction of endoscopy into middle ear has open up new opportunities for minimal invasive temporal bone surgery. The present study was planned to compare anatomical and functional outcome in patients who underwent endoscope assisted tympanoplasty using cartilage and temporalis fascia graft.

Methods: The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan, India from September 2020 to July 2021. Fifty patients of age group 18-60 years, with diagnosis of chronic otitis media having inactive mucosal disease were enrolled in the study and divided into two groups viz. cartilage (group I) and temporalis fascia group (group II). Each patient postoperatively underwent otoscopic examination of ear and pure tone audiometery at 8 weeks and 3rd month. Local wound condition, graft uptake and healing and hearing were assessed and compared.

Results: Graft uptake was 92% in cartilage group and 84% in temporalis fascia group. Air conduction and air-bone gap of patients in both the groups showed significant improvement after 3 months of surgery. (p˂0.05) Regarding bone conduction, both groups had shown non-significant changes. (p > 0.05) Hearing gain was comparable on both groups which was 6.71dB in cartilage group vs. 5.9 dB in other group.

Conclusions: The present study showed that graft placement time for temporalis fascia graft was less than cartilage graft, but the difference was insignificant. Hearing improvement, graft uptake and clinical improvement were found to be statistically insignificant between both groups.

Purpose: Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM.

Methods: Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected.

Results: Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air-bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery.

Conclusion: Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.

Office-based laryngology procedures evolved in the recent years with all the technology advances and have gained popularity among laryngologists. The indications enlarged, making it a valid surgical option for almost all voice disorders. This emerging technique raise the question of the place left for traditional phonosurgeries in the operating room under general anesthesia. We reviewed our surgical activity in our laryngology referral center from 2018 to 2023. Since we started the in-office procedures in 2018, the number of these interventions significantly increased, accompanying a significant increase in our total surgical activity. We noted no significant decrease in the number of interventions done in the operating room, which made us consider the office-based procedures as a complimentary and not a competitive option for traditional surgeries, helping us increase our total number of interventions, and thus offer patients more opportunities for a quicker medical care. Our register review showed also a change of treatment trends for unilateral vocal fold paralysis, with office-based interventions becoming the first-line treatment.

Purpose: Although dysphagia is a common symptom among patients with Spinal Muscular Atrophy Type 1 (SMA1), scant data exist on the application of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in this population. The aim was to analyze FEES feasibility, swallow safety and efficacy, dysphagia phenotype, and agreement with VideoFluoroscopic Swallow Study (VFSS) in children with symptomatic, medication-treated SMA1 and oral feeding.

Methods: 10 children with SMA1 underwent FEES. Six patients had also a VFSS. Two clinicians independently rated FEES and VFSS videos. Swallowing safety was assessed using the Penetration-Aspiration scale (PAS). Dysphagia phenotypes were defined according to the classification defined by Warnecke et al. Swallowing efficacy was evaluated with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in FEES, whereas pharyngeal residue was rated as present or absent in VFSS.

Results: FEES was performed in all children without complications. Four children tolerated bolus trials during FEES, in 4 children swallowing characteristics were inferred based on post-swallow residues, while 2 children refused to eat and only saliva management was assessed. The dysphagia phenotype of predominance of residue in the piriform sinuses was documented in 7/8 children. The PAS score was < 3 in 3 children and > 5 in one child. Swallowing efficacy was impaired in 8/8 children. VFSS showed complete agreement with FEES.

Conclusions: FEES is a feasible examination in children with SMA1. Swallowing safety and efficacy are impaired in nearly all patients with strong agreement between FEES and VFSS. Dysphagia is characterized by the predominance of residue in the piriform sinus.

Purpose: Smell ability is associated with nasopharyngeal obstruction. Herein, we evaluated the effect of nasopharyngeal obstruction by adenoid hypertrophy on the olfactory bulb (OB) volume and olfactory sulcus (OS) depth in children.

Methods: A total of 135 children who were candidates for brain magnetic resonance imagining scanning were enrolled in the study. The olfactory disorder-negative statements questionnaire was utilized to assess the patient-reported olfactory status. A validated sleep questionnaire was used to assess sleeping status. According to the adenoidal/nasopharyngeal (A/N) ratio, the children were divided into two groups: those with an A/N ratio ≤ 0.5 (n = 70) and those with an A/N ratio > 0.5 (n = 65). OB volume and OS depth measurements were performed on coronal T2-weighted images using planimetric manual contouring. The mean OB volumes and OS depths on the right and left sides were used for the evaluation.

Results: The mean OB volume of the group with an A/N ratio > 0.5 was significantly lower than that of the group with an A/N ratio ≤ 0.5 (P = 0.003), while there was no difference in the mean OS depth between groups (P = 0.061). In those with an A/N ratio > 0.5, the mean OB volume in older children (aged 9-12 years) was significantly lower than that in younger children (aged 5-8 years) (P = 0.012). In terms of laterality, the OS depth on the right side was significantly larger than that on the left side in both groups (P = 0.039 and P = 0.001). In the group with an A/N ratio ≤ 0.5, the OB volume on the right side was also significantly larger than that on the left side (P = 0.040); however, no such difference was observed in the group with an A/N ratio > 0.5 (P = 0.630). No sex-based differences were evident for any variable.

Conclusions: Children with nasopharyngeal obstruction greater than 50% have a significantly smaller OB volume. Our results suggest that morphological alterations in OB may contribute to the pathogenic mechanism of olfactory dysfunction related to nasopharyngeal obstruction.

Purpose: In patients with inner ear schwannomas (IES), reports on hearing rehabilitation with cochlear implants (CI) have increased over the past decade, most of which are case reports or small case series. The aim of this study is to systematically review the reported hearing results with CI in patients with IES considering the different audiologic outcome measures used in different countries.

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a search of published literature was conducted. We included patients with IES (primary or with secondary extension from the internal auditory canal (IAC) to the inner ear, sporadic or NF2 related) undergoing cochlear implantation with or without tumour removal. The audiological results were divided into the categories "monosyllables", "disyllables", "multisyllabic words or numbers", and "sentences".

Results: Predefined audiological outcome measures were available from 110 patients and 111 ears in 27 reports. The mean recognition scores for monosyllabic words with CI were 55% (SD: 24), for bisyllabic words 61% (SD: 36), for multisyllabic words and numbers 87% (SD: 25), and 71% (SD: 30) for sentences. Results from for multisyllabic words and numbers in general showed a tendency towards a ceiling effect. Possible risk factors for performance below average were higher complexity tumours (inner ear plus IAC/CPA), NF2, CI without tumour removal ("CI through tumour"), and sequential cochlear implantation after tumour removal (staged surgery).

Conclusion: Hearing loss in patients with inner ear schwannomas can be successfully rehabilitated with CI with above average speech performance in most cases. Cochlear implantation thus represents a valuable option for hearing rehabilitation also in patients with IES while at the same time maintaining the possibility of MRI follow-up. Further studies should investigate possible risk factors for poor performance. Audiological tests and outcome parameters should be reported in detail and ideally be harmonized to allow better comparison between languages.

Purpose: Different surgical techniques exist for treating cholesteatoma, such as microscopical or transcanal endoscopic ear surgery (TEES). This study aimed to compare these two techniques, focusing on quality of life.

Methods: This retrospective single-center study included 188 patients with cholesteatoma. The primary outcome was the assessment of health-related quality of life (HRQoL) using the Zurich Chronic Middle Ear Inventory (ZCMEI-21) preoperatively, 3 and 12 months postoperatively with regard to surgical technique and intraoperative staging of the cholesteatoma (ChOLE classification). Secondary outcomes included hearing pure tone average of 0.5, 1, 2 and 4 kHz (PTA₄), complications assessed 3 months postoperatively as well as recidivism within the follow-up time of 1 year postoperatively.

Results: A total of 28 patients underwent TEES and 160 microscopic ear surgery. The ZCMEI-21 total scores preoperatively were not significantly different between the two groups. An improvement in QoL one year postoperatively was observed in both groups to a comparable extent. The ZCMEI-21 decreased significantly (p < 0.01) in both groups. In the TEES group, the cholesteatoma tended to be smaller (lower ChOLE score), PTA₄ was better and complication rate comparable. The number of recidivisms was lower for the TEES group (1 [3.6%] vs. 31 [19.4%]).

Conclusion: TEES is a valuable alternative to the traditional microscopic technique, at least for small cholesteatoma, which leads to a comparable improvement in HRQoL as the microscopic technique. The better postoperative hearing and lower rate of recidivism in the TEES group may be related to the smaller extent of the cholesteatoma.

Objective: Primary stapes surgery is considered a challenging intervention in ear surgery. Despite an risk of deafness in 0.5-1 percent, this procedure has still a good benefit-risk ratio due to the improvement in hearing and quality of life that is usually achieved. However, revision after prior stapes surgery is considered even more challenging. Revisions after stapes surgery are very heterogeneous procedures, both in terms of the indication and the surgical strategy and are generally considered to be significantly more demanding. Reasons for complications after prior stapes surgery as well as strategies for successful revisions are not well described in the literature.

Methods: Retrospective cohort study, tertiary referral center. 124 cases of revisions after prior stapes surgery were identified between 2011-2022 and are analyzed based on biographic data, clinical, audiological, and intraoperative findings as well as the eventual therapy. Cases were analyzed regarding indication, intraoperative finding and the surgical strategy chosen.

Results: Acute, subacute, and long-term complications of the primary intervention as well as other incidental reasons such as progressive hearing loss can be identified as indication for revision surgery. Preoperative clinical findings were correlated to intraoperative findings and surgical strategies. Audiological results are discussed.

Conclusions: Different recommendations for the indication of a surgical revision can be derived depending on the individual preoperative case history and findings. In addition, there are patterns regarding the chances of success of a revision, especially in cases of persistent conductive hearing loss chances of hearing improvement seem possible in more than 80% of cases.

Background: Despites a tripling of recognised occupational sinonasal adenocarcinomas in the past three decades, no comprehensive publications of the epidemiological development and histological distribution of sinonasal malignancies exist in Germany. Therefore, this study aims to analyse population-related data and address gaps in the nationwide cancer registry.

Methodology: The German Center for Cancer Registry Data (ZfKD) provided a dataset covering the period from 2003 to 2015. 8332 cases were extracted, morphologically clustered and underwent descriptive analysis. Incidence and mortality rates were standardised, and overall survival (OS) probability was estimated.

Results: Standardised incidence rates increased, averaging 1.8 for men and 1.0 for women per 100,000 inhabitants. Sinonasal cancer manifested mostly in the nasal cavity with a 5-year OS of 63%. In contrast, malignancies in the frontal sinus had a less favourable survival probability (p < 0.001). Morphologically, the tumour entities comprised 55% squamous cell carcinomas, 18% adenocarcinomas, 8% mucosal melanomas, 4% esthesioneuroblastomas and 2% sinonasal undifferentiated carcinomas (SNUC). The highest 5-year OS rate was observed in esthesioneuroblastomas (59%), while SNUC (38%) and mucosal melanoma (29%) had the lowest (p < 0.001).

Conclusions: This study provides a comprehensive epidemiological analysis of sinonasal morphologies based on a unique dataset. Findings reveal a higher incidence and lower survival probability among men. The topographical distribution varies by sex and tumour entity. The mortality rate for patients with sinonasal cancer is moderate to high, particularly for SNUC and mucosal melanoma, with incidences of 8.4% and 2%, respectively. Hence, there is an urgent need for an optimised screening for early-stage malignancies.