European Archives of Oto-Rhino-Laryngology最新文献

Background: Global research has revealed inadequate levels of Auditory Processing Disorder (APD) awareness and knowledge among related professionals leading to neglect of this specific type of hearing impairment that is estimated to present in 50% of children with learning disabilities (dyslexia included) and more than 70% of adults with presbycusis or mild cognitive impairment.

Purpose: The aim of the current study was to record APD awareness and knowledge among professionals working in both Healthcare and Education sectors.

Methods: A 36-question questionnaire was developed and addressed to medical doctors of different specialties (ENTs and non-ENTs), therapists (speech & language therapists, occupational therapists, psychologists), and educators (of both typical and special education). The questionnaire was sent to Professional Societies of interest as well as a University Rectorate where authors are affiliated, requesting the spreading to all members, and was also posted to related private groups in social media. Data concerning APD-training and knowledge were gathered from 522 questionnaires. Level of knowledge was recorded both subjectively (self-rating) and objectively (pre-defined scoring of items).

Results: Analysis showed insufficient knowledge concerning APD among specialties. ENTs and/or therapists scored statistically significantly higher compared to other medical specialties and educators, while still lower than 50%. The current level of awareness on APD might negatively affect the way individuals with APD are addressed, all the way from referral to management. Levels of awareness and knowledge among professions which are related to APD either directly or indirectly can be further improved through formal education targeting bachelor, master and PhD programs of medical doctors, therapists and educators.

Conclusion: We are proposing the development of educational programs that target ENT doctors so that children and adults receive more elaborate services both diagnostically and from a rehabilitation point of view. This will improve quality of life and mental health.

Introduction: Penetrating middle ear trauma-induced pneumolabyrinth is an exceedingly rare finding in pediatric patients. This condition can lead to significant hearing and vestibular dysfunction. We present two pediatric cases, highlighting their clinical complexity.

Cases presentation: Case 1 presented a 9-year-old boy with hearing loss, vertigo, and vomiting following a penetrating trauma to the left ear. Surgical exploration revealed ossicular chain disruption and perilymphatic fistula, which were repaired. Despite initial recovery, he developed ossifying labyrinthitis and required cochlear implantation. Case 2 described a 15-year-old boy who had right-sided hearing loss and vertigo after right ear trauma. Conservative management resulted in improvement of vestibular symptoms, but the profound hearing loss remained. The family declined cochlear implantation, due to the patient's athletic activities.

Conclusions: Penetrating trauma-induced pneumolabyrinth in pediatric patients is extremely rare. These cases demonstrate the importance of tailored treatment approaches and vigilant follow-up to optimize auditory and vestibular outcomes.

Purpose: This review aims to explore the influences of tinnitus retraining therapy (TRT) on patients with tinnitus.

Methods: PubMed, MEDLINE, EMBASE, CINAHL, PEDro, SCOPUS, and Web of Science were screened for randomized controlled trials (RCTs) that explored the effects of TRT on patients with tinnitus from inception to June 30, 2024. The methodological quality of the included RCTs was evaluated using the physiotherapy evidence database (PEDro) scale.

Results: Fifteen studies met our eligibility criteria. A total of 2069 patients with tinnitus (mean age 52.93 years; 66% male) were involved in the present review. The quality of the selected studies ranged from 5 to 8 on the PEDro scale, with a median score of 7. TRT did not provide superior effects in treating patients with tinnitus compared to tinnitus masking (TM), tinnitus educational counselling (TED), TRT with open ear hearing aids, Tailor-made notched music training (TMNMT), partial TRT, usual care, and smart TRT.

Conclusions: TRT intervention is considered a treatment option for patients with tinnitus. Combining TRT with other interventions, such as cognitive-behavioral therapy, pharmacotherapy, or tDS, may show even greater efficacy. Additional studies are strongly required to recognize the long-term effects of TRT on tinnitus, determine who most likely would benefit from the intervention regarding tinnitus type and severity, and identify the optimal treatment protocol.

Introduction: Various factors, including an aging population and expanding eligibility criteria, may increase the demand for cochlear implants (CIs), potentially resulting in longer waiting times. In most Dutch CI centers, the time between referral and surgery exceeds 6 months. Clinical experience suggests that during the waiting period for cochlear implantation, hearing and communication difficulties increase. Simultaneously, there is an interest in outcomes more closely aligned with patient values and needs, which resulted in the SMILE (Societal Merit of Interventions on hearing Loss Evaluation) study. This paper presents results on observed changes in societal and participatory outcomes during waiting time in participants with a time to CI surgery exceeding 6 months.

Methods: SMILE is a prospective multi-center study including 232 individuals who were referred for unilateral CI. Continuous and nominal data from multiple questionnaires, sent immediately after referral and shortly before surgery, were analyzed by computing differences, Cohen's D, and odds ratios.

Results: Of the total 232 participants, 102 had a time between inclusion and surgery exceeding 6 months. Of these, 89 had (partially) filled out surveys at both time points. Of all the domain scores 55% did not show differences between timepoints. All Cohen's D estimates were relatively small, ranging from - 0.298 to 0.388 for those outcomes that showed noteworthy changes.

Conclusion: Waiting time from referral to surgery, even though exceeding 6 months, was observed to not seriously affect non-clinically-prioritized patients in an adverse way. Future investigations should identify subgroups on tolerable waiting times regarding short- and long-term outcomes.

Trial registration: Trial registration number at ClinicalTrials.gov: NCT05525221, 25-8-2022.

Purpose: The pathophysiology of COVID-19 remains unclear. Olfactory dysfunction is one of the neurological symptoms of the disease. There is no evidence to evaluate whether there is a morphometric change in the olfactory pathways. This study aimed to examine the effect of COVID-19 on olfactory center sections through morphometric measurements obtained from autopsy cases.

Methods: Our study was conducted on 63 autopsy cases (COVID-19 [n = 37], control (non-COVID) [n = 26]) between the ages of 18-80 years who came to Tokat Forensic Medicine Institute. The anatomical structures of the olfactory tracts were determined on the brains removed during routine autopsy. The dimensions of the structures belonging to the olfactory center sections were measured with a precision digital caliper, weights were measured with a precision digital scale, and volumes were measured with a 0.01 cm³ graduated cylinder. The Archimedes principle method was used for volume calculations.

Results: In the autopsy cases examined, it was found that there was a significant decrease in bilateral olfactory bulb (OB) and olfactory tract (OT) volumes in COVID-19 group (p < 0.001). In addition, OB and OT weights were lighter in COVID-19 group on both sides (p < 0.001). The length, width and depth measurements of the examined anatomical structures were found to be shorter in COVID-19 group (p < 0.01).

Conclusion: Autopsy findings showed damage in olfactory center sections in COVID-19 group. We believe that knowing the OB and OT morphology in particular will make significant contributions to both clinical approaches and future studies in the pathology of infectious diseases.

Purpose: The main objective of this study was to compare laryngeal dystonia (LD) and vocal tremor's (VT) response to botulinum toxin injection.

Methods: Retrospective study including every patient with LD or VT injected with botulinum toxin guided by electromyography, from January 1, 2010, to September 30, 2022, at a tertiary hospital centre. Improvement was assessed with the VHI-10, grade of dysphonia in a visual analogue scale (VAS; 0-10), GRBAS(I) scale (0-3) and maximum phonation time (MPT).

Results: A total of 77 patients were included, 44 patients with LD and 33 with VT. There were no differences between groups on pre-treatment VHI-10, grade of dysphonia in the VAS, MPT and G, R, B, A and I at diagnosis (p > 0.05). S was significantly higher in patients with LD (p < 0.001). After the first injection, both groups showed an increase in the grade of dysphonia on the VAS and a decrease in VHI-10, G, S and I (p < 0.05), with a higher variation in the VAS and S parameters in the LD group compared to VT (p < 0.05). In the 54 patients that performed two or more injections, G, S and I had a higher decrease in patients with LD when compared to patients with VT (p < 0.05).

Conclusion: BTX injection was successful in improving the VHI-10, grade of dysphonia on the VAS and G, S and I in the GRBAS-I scale for both DT and VT. LD seems to have a better response to BTX in comparison to VT.

Purpose: As a common pathogen of rhinosinusitis, the role of Staphylococcus aureus in modulating autophagy through STING activation and Th17 cell differentiation in CRSwNP remains unexplored. This study aims to investigate how S. aureus regulates Th17 cell differentiation and the occurrence and development of autophagy in CRS by inducing STING expression.

Methods: Immunoblotting and flow cytometry were employed to assess the expression levels of STING, RORγt, LC3B, and MUC5AC, as well as Th17 markers in cells. HNECs were co-cultured with S. aureus in vitro to explore its regulatory effects.

Results: STING expression was found to be decreased in CRSwNP tissues, while RORγt, LC3B, and MUC5AC levels were elevated. S. aureus was shown to induce Th17 differentiation via STING regulation. STING activators reduced Th17 inflammation, while autophagy activators increased autophagosomes and MUC5AC levels.

Conclusion: The STING system may play a protective role in the inflammatory response of nasal epithelial cells. S. aureus inhibits STING, not only by promoting the differentiation of pathogenic Th17 cells but also by increasing autophagy levels in nasal epithelial cells. Both mechanisms contribute to the enhanced expression of MUC5AC, facilitating the progression of CRSwNP.

Introduction: Mixed neuroendocrine and non-neuroendocrine neoplasms (MiNENs) refer to a heterogenous group of rare neoplasms which is usually composed of a neuroendocrine population which is either well differentiated and more frequently poorly differentiated along with a non-neuroendocrine component, each of the above accounting for at least 30% of the tumour population. It is most commonly seen in the gastro-entero-pancreatic tract. MiNENs have an aggressive behaviour due to its high grade neuroendocrine component and have poor prognosis. This is the first case reported in literature of a MiNEN in the oropharynx.

Case report: 69 year old male patient with no co morbidities presented to the outpatient department with complains of odynophagia for 1 month. He had history of neoadjuvant chemotherapy followed by transoral robotic surgery (TORS) with right selective neck dissection (SND) done in 2019 for carcinoma base of tongue. On flexible laryngoscopy, an ulcerative lesion was noted over the left base of tongue. Although PET scan done showed no significant abnormalities. Biopsy from the lesion showed features of poorly differentiated carcinoma along with morphological features of poorly differentiated neuroendocrine carcinoma (small cell carcinoma). He was planned for upfront surgery (TORS with left SND). Post operatively recovery was uneventful and patient was on ryles tube feed for 12 days. Final histopathology report showed features of mixed neuroendocrine non neuroendocrine neoplasm. He has been on follow up for 1 year with no features of recurrence.

Conclusion: MiNEN is an aggressive tumour which has poor prognosis and is most commonly located in the gastrointestinal tract. This is the first case reported in oropharynx who has been successfully treated and has been on follow up.