European Archives of Oto-Rhino-Laryngology最新文献

Purpose: The diagnosis of eosinophilic otitis media (EOM) remains a major challenge. Current diagnostic methods rely primarily on accurate samples of middle ear tissue or secretions, which can be complex. In this study, we sought to explore the diagnostic value of mastoid pneumatization combined with other temporal radiological features for EOM.

Methods: This study included 28 patients with EOM and 32 patients with ordinary OM. All participants underwent the temporal bone HRCT, and middle ear status was assessed using four sections: mesotympanum, attic, antrum, and mastoid air cells. Quantification of negative temporal bone pressure using three-dimensional analysis of mastoid volume images.

Results: The volumes of eosinophilic/non-eosinophilic mastoid air cells were approximately the same but were asymmetric. In contrast, in the normal OM group, there was a significant difference in the volume of mastoid air cells between the inflammatory and non-inflammatory sides. Statistically, the degree of opacification to the mesotympanum, attic, and mastoid air cells was more severe in patients with EOM than in patients with ordinary OM on the affected side. Furthermore, on the normal side, the opacification of the all four sites in the eosinophil group was basically worse than that in the control group.

Conclusion: Eosinophilic individuals have been found to be specific to the mastoid air cell system and middle ear status and are important factors to consider. Therefore, the potential imaging information of HRCT can help otologists diagnose EOM earlier and provide timely and effective treatment.

Background: Ceruminous adenomas (CA) are rare neoplasms of the external auditory canal (EAC), and their nonspecific symptoms frequently contribute to diagnostic challenges in clinical practice. By examining the clinical features, diagnostic considerations, and therapeutic approaches for these tumors, the findings aim to improve understanding of these tumors and improve clinical outcomes.

Case presentation: A retrospective analysis was conducted on six individuals diagnosed with CAs of the EAC at a single institution between January 2010 and January 2023. Clinical data, histopathological characteristics, and immunophenotypic findings were reviewed, along with a relevant literature analysis. Of the six cases, three involved simple CAs, one was associated with concurrent adenoid cystic carcinoma, and two exhibited localized areas of high mitotic activity, necessitating vigilant follow-up. No recurrences were observed during the follow-up period. Symptomatically, one patient reported occasional tinnitus, while another presented with ear discharge.

Conclusion: The diagnosis of ceruminous gland tumors requires a multidisciplinary approach, incorporating clinical evaluation, imaging studies, and histopathological examination. CAs of the EAC are uncommon, with reports in the literature indicating a risk of recurrence and potential for malignancy. Surgical management should involve wide excision with wound repair, followed by close postoperative monitoring to ensure early detection of any recurrence.

Purpose: This pilot study investigated the efficacy of a novel Tinnitus Retraining Therapy (TRT) device utilizing bone conduction white noise generation, in treating tinnitus in a normal hearing population.

Methods: This study was designed as a prospective, single-arm, observational trial in an outpatient clinic at a tertiary referral center, with 30 consecutive normal hearing patients with tinnitus. Tinnitus-specific questionnaires, namely the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI), translated and adapted to European Portuguese were administered. Patients were categorized into Group A (tinnitus characteristics within the device's maximum output performance) and Group B (outside the device's maximum output performance).

Results: 69% of the participants showed improvement in their TFI scores, with Group A exhibiting a significant mean reduction of 10 points (p = 0.0004). The device was well-tolerated, with no adverse effects reported.

Conclusion: The novel bone conduction tinnitus suppression device showed promise in reducing the impact of tinnitus, particularly in patients whose tinnitus profile is within the device maximum performance output. This improvement in TFI scores in the majority of the participants, observed after just a 30-day period, highlights the potential of specifically tailored sound therapy delivered via bone conduction in tinnitus management.

Introduction: Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary contractions of the facial muscles. Botulinum toxin (BTX-A) is an effective treatment, but its efficacy may vary across different geographical contexts. This multicentric study aims to compare the efficacy of BTX-A in treating HFS between centers in Morocco and France.

Methods: A retrospective study was conducted with 128 patients diagnosed with HFS, distributed between one center in Morocco and two centers in France. Parameters studied included age, sex, average treatment duration, dose administered, injection sites, injection frequency, and adverse effects. The results were analyzed separately for primary and secondary HFS. An HSF-8 score was used to evaluate treatment outcomes, assessing patients before treatment and two months after receiving BTX-A injections.

Results: This multicentric study assessed the efficacy of botulinum toxin (BTX-A) for treating hemifacial spasm (HFS) in centers in France and Morocco. Among the 128 patients included, 75% were women, with a mean age of 61.5 years. On average, patients had been receiving BTX-A injections for 6.49 ± 5.4 years, experiencing a mean self-reported improvement of 94.7% ± 2.3%. The treatment effect lasted approximately 3.15 ± 1.2 months per injection. Notable differences were observed between France and Morocco regarding the average dose per injection and injection frequency. Side effects were observed in 39.84% of patients in France compared to 10.94% in Morocco, but there was no significant difference. The most frequently reported side effects included ptosis, diplopia, and dry eyes. These effects are generally temporary and did not require discontinuation of treatment. The efficacy of BTX-A was objectively measured using the HFS-8 score, with significant improvements observed in both countries. Despite variations in therapeutic approaches, the overall efficacy of BTX-A remained comparable between the two countries, indicating consistent therapeutic outcomes across geographical contexts.

Conclusion: This multicentric study confirms the efficacy of botulinum toxin (BTX-A) in the treatment of HFS, with significant improvements and a well-tolerated side effect profile. While differences exist in treatment practices between Morocco and France, the overall efficacy of the treatment remains comparable, underscoring the reliability of BTX-A as an effective therapy across different geographical contexts.

Purpose: This study aims to analyze resectable T3-T4a glottic cancer patients treated with TOLM at a tertiary hospital, evaluating survival, function, and QoL in organ-preserved cases.

Methods: Patients with diagnosis of laryngeal glottic squamous cell carcinoma pT3-pT4a N < 3 M0 treated with primary curative intention TOLM from 2005 to 2021 were included. Statistical analysis was performed, including survival rates. Quality of life was evaluated using VHI-10, EORTC-QLQ-C30 and EORTC-QLQ-HN43.

Results: 82 patients were included in this study, predominantly male, with a mean age of 65.5 years old. Laryngeal preservation rate was 76.83%. 5-year overall survival was 68.3%, 5-year Disease Specific Survival was 80.9%, 5-year Local disease-free survival was 91.2%. Medium VHI-10 score was 9.20 (SD ± 5.90), with nearly two thirds (63.33%) having a normal score. On the QLQ-C30 questionnaire, five of the six functional scales were over 80. On the QLQ-HN43 all the scales (single and multi-item) scored less than 16.

Conclusion: TOLM achieved comparable survival rates to radical surgery and other organ-preserving methods for locally advanced glottic cancer, as well as good functional outcomes with minimal post-surgical symptoms and mild voice impairment.

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.