European Archives of Oto-Rhino-Laryngology最新文献

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.

Background: The sphenoid sinus features many anatomical variations between individuals from different populations in the world. The understanding of these variations is important for the surgeons to plan for surgeries which involve intervention through the nasal approach. The aim of the present systematic review was to perform a qualitative synthesis of available studies which assess the effect of sphenoid sinus (SS) anatomical variations on the outcomes of endoscopic endonasal transsphenoidal surgeries (ETSS).

Methods: The current review followed PRISMA 2020 guidelines. A systematic advanced electronic search was performed in four databases Medline (via PubMed), Scopus, Web of Science (WoS) and Lilacs in December 2023. Studies that assessed the anatomical variations of the SS that affect the outcomes of ETSS were eligible for inclusion. A qualitative synthesis of the methodology and results of the included studies was carried out. Quality assessment was performed using the National Institute of Health (NIH) quality assessment tool (last accessed on December 24, 2023).

Results: A total of 14 studies were included in the qualitative synthesis. Most of the studies included in the review found that the sellar pneumatization was the commonest followed by the postsellar type. Single intersphenoid sinus septum (ISS) was found to be the most common variation, which is more frequently found in males compared to females. There was sex difference seen in the attachment of the ISS to the carotid canal. It is more commonly attached to the posterolateral wall of the sinus in males compared to the females. Though complicated cases were less compared to uncomplicated ones, cerebrospinal fluid (CSF) leak was the leading post operative complication amongst the complicated cases and paranasal sinus (PNS) computed tomography (CT) scan showed ISS findings differed from intraoperative findings.

Conclusion: It is concluded that the ISS poses the commonest anatomical variations encountered during the ETSS. During planning for transsphenoidal endoscopic procedure, the ISS should thoroughly be assessed to minimize potential surgical complications.

Purpose: The effect of the inter-implant interval time on language and communication skills has been a subject of research for years in children with bilateral cochlear implants. This study aimed to investigate language and some attention and memory skills in children with bilateral sequential and simultaneous cochlear implants.

Method: The study included a total of 40 children aged between 6 and 8 years old, grouping bilateral simultaneous cochlear implanted children, sequential implanted children with 0-2 years interval, sequential implanted children with 2-4 years interval, and normal hearing peers. The language skills of the children were assessed using the Test of Language Development: Primary 4th edition, their selective attention and coping skills with disruptive effect were evaluated using the Stroop test, sustained attention and visual-motor synchronization skills were assessed using the Cancellation Test, and short-term memory skills were evaluated using the Visual Auditory Digit Span Test. The findings were analyzed using nonparametric statistical methods, with a significance level set at 0.05.

Results: Children with bilateral simultaneous cochlear implants demonstrated better performance in language skills and the attention-related subtests of the Stroop test (p < 0.05). On the other hand, children with simultaneous and sequential cochlear implants achieved similar scores in the Cancellation and the Visual Auditory Digit Span Test (p > 0.05).

Conclusions: Bilateral simultaneous cochlear implantation in children is beneficial for language, selective attention, and coping with the Stroop effect. However, these children may still lag behind their normal-hearing peers in terms of language, attention, and memory skills.

Purpose: While the scala tympani (ST) is usually the preferred site for electrode insertion in cochlear implantation, anatomical variations and cochlear ossification may require scala vestibuli (SV) insertion. This systematic review evaluates the feasibility, techniques, and clinical outcomes of SV insertions compared to ST insertions, focusing on their impact on auditory performance.

Methods: A systematic review was conducted using PRISMA guidelines. Studies on SV cochlear implantation were identified from databases like PubMed and EMBASE. The review included research articles reporting on anatomical feasibility, surgical methods, postoperative outcomes, and complications. Data extraction focused on demographic details, electrode types, insertion depths, and clinical outcomes of SV insertions. A two-stage selection process was applied, and 17 studies with 72 cases were included.

Results: The review covered 72 cases of SV insertions, with patients aged 18 months to 65 years. Bacterial meningitis was the leading cause of hearing loss (28%). Various electrode types were used, with insertion depths ranging from 12 to 31 mm. Approximately 75% of patients showed improved auditory performance. Complications, including vertigo and tinnitus, were reported in 10% of cases, with no significant difference between SV and ST insertions.

Conclusion: SV cochlear implantation is a feasible and effective alternative in cases where ST is inaccessible. Auditory outcomes are comparable to ST insertions, and the technique shows promise in challenging anatomical situations such as cochlear ossification. Further studies are required to optimize surgical approaches and confirm long-term outcomes.

Purpose: To conduct an updated meta-analysis evaluating the efficacy and safety of tranexamic acid (TXA) versus control during endoscopic sinus surgery.

Methods: Six databases were screened until July 7, 2024, and the quality of included randomized controlled trials (RCTs) was assessed. Endpoints were summarized as mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model.

Results: A total of 23 RCTs, including 29 arms and 1597 patients, were analyzed. The overall quality was rated as low-risk in 15 RCTs, high-risk in five RCTs, and of some concern in three RCTs. TXA significantly reduced intraoperative blood loss (n = 22 arms, MD = - 68.87 ml, 95% CI - 79.66, - 58.07) and operative time (n = 21 arms, MD = - 13.93 min, 95% CI - 17.49, - 10.37) compared to control. TXA also improved surgical field quality (measured on a 5-point Boezaart scale, n = 22 arms, MD = - 0.61, 95% CI - 0.88, - 0.34) and surgeon satisfaction scores (n = 9 arms, MD = 0.85, 95% CI 0.53, 1.17). No thromboembolic events were reported in either group. Leave-one-out sensitivity analyses confirmed the robustness of all endpoints, and no publication bias was detected. Subgroup analyses by route of administration (intravenous, topical, and oral) showed equal effectiveness. Additionally, analyses by sinus pathology demonstrated effectiveness in patients with severe chronic rhinosinusitis with nasal polyposis (CRSwNP). Trial sequential analysis showed conclusiveness for all outcomes.

Conclusion: Perioperative TXA, whether administered systemically or topically, correlates with decreased intraoperative blood loss, shortened operating times, and enhanced surgical visualization compared to control interventions. However, these findings are constrained by significant heterogeneity and varying reporting quality among studies.

Purpose: We evaluated the effects of two doses (186 µg and 372 µg) of exhalation delivery system with fluticasone (EDS-FLU) on chronic rhinosinusitis (CRS) with nasal polyp as a novel sinonasal delivery system.

Methods: We analyzed 5 studies retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to April 2024, focusing on subjective and objective scores, and adverse and beneficial effects (responder and complete responder rates, improvements in Patient Global Impression of Change [PGIC] scores, and surgical indication rates before and after EDS-FLU use.

Results: Over 3 months, EDS-FLU significantly reduced polyp (mean difference [MD] - 1.1605; 95% confidence interval [CI] [- 1.3277; -0.9934], I² = 61.4%) and 22-item Sinonasal Outcome Test (MD - 20.7561; 95% CI [- 22.3473; -19.1648], I² = 0.0%) scores compared to baseline. At 1 month, nasal congestion, facial pain, olfactory dysfunction, and rhinorrhea significantly improved compared to baseline. EDS-FLU significantly reduced the surgical indication rate (odds ratio 0.2594; 95% CI [0.1910; 0.3522], I² = 0.0%) and improved patient satisfaction, with 63.34% of patients reporting significant improvement in PGIC scores after 3 months. However, adverse effects, including epistaxis, headache, nasal congestion, and nasopharyngitis, were reported, with incidence rates ranging from 4.46 to 8.99%. There were no significant differences in beneficial or adverse effects between high and low fluticasone doses, but the high dose was associated with a higher percentage of complete responders.

Conclusion: Both doses of EDS-FLU significantly improved subjective and objective outcomes of CRS patients with nasal polyps. However, epistaxis and nasal septal erosive or ulcerative lesions were also considered.

Purpose: To compare the intersubject reliability of cortical auditory evoked potential (CAEP) elicited by acoustic and electrical stimulations in pediatric cochlear implant (CI) recipients.

Methods: Twenty-two MED-EL CI recipients (aged 13-93 months) participated in this study. The acoustic CAEP (aCAEP) waveforms were elicited using four speech stimuli (/ba/, /m/, /g/, and /t/) presented at 65 dB SPL in a free-field condition. The electrical CAEP (eCAEP) responses were obtained by presenting electrical pulses through apical, medial, and basal electrodes. The aCAEP and eCAEP data (n = 28 ears) were analyzed using coefficient of variation (CV) and other appropriate statistics.

Results: P1, N1, and P2 peaks were observed in most of the children (92.9% response rate). The CV values were smaller for the latency metric (13.6-34.2%) relative to the amplitude metric (51.3-92.4%), and the differences were statistically significant (p < 0.001). The aCAEP yielded smaller mean CV values than the eCAEP (for both latency and amplitude measures), and the mean CV value for the aCAEP (15.6%) was found to be statistically different from that of the eCAEP (31.0%) for the P1 latency (p = 0.001).

Conclusion: This study is the first to report the intersubject reliability of aCAEP and eCAEP in pediatric CI recipients. Overall, CAEP latencies were found to be more reliable than CAEP amplitudes, and the aCAEP testing demonstrated higher intersubject reliability compared to the eCAEP assessment. The present study's findings can be beneficial for researchers and clinicians in documenting CAEP in children who use CI.

Objective: This study extensively examined common complications related to anesthesia drugs and equipment on vocal cords. It also delved into factors such as smoking, anesthesia duration and anesthesia induction methods. Overall, the research aimed to pinpoint influential factors for creating a general anesthesia protocol with minimal post-operative complications.

Materials and methods: We searched PubMed, Scopus, Web of Science, and Google Scholar for studies concerning the impact of anesthesia drugs and equipment on the vocal cord, until May 2023. after screening and reviewing of full text, the characteristics of the study including sample size, age, dosage or size of anesthesia drugs and equipment, Duration of intervention, Adverse effects, and Maintenance of adverse effects, were extracted. The quality assessment was done using the Newcastle-Ottawa scale and the Jadad Scale.

Results: Our review included 39 studies from 1983 to 2023. The most frequent VCAEs were cough‎ (39.17%; CI = 9.84-68.51)‎, hoarseness (‎35.32%; CI = 25.04-45.60)‎, and erythema (35.09%; CI=-4.84-75.02). VC paralysis was relatively less frequent (‎4.16%; CI = 2.90-5.43)‎. Meta-regression showed no difference in the frequency of VCAEs with or without single-lung ventilation and smoking. However, the duration of procedure was shown to be affecting three outcomes; the duration shorter than 120 min is associated with lower rates of granuloma (2.74% vs. 44.30%; p < 0.05) and higher rates of cough (48.89% vs. 15.91%; p < 0.05) and VC paralysis (42.86% vs. 0.12%; p < 0.05). The overall outcomes were not affected.

Conclusions: The most common anesthesia-related VCAEs are cough, erythema, and dysphagia, while serious complications like vocal cord hematoma and paralysis are rare. Also surgery duration significantly influences VCAE occurrence.

Objective: The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of AI-assisted technologies, including endoscopy, voice analysis, and histopathology, for detecting and classifying laryngeal lesions.

Methods: A systematic search was conducted in PubMed, Embase, etc. for studies utilizing voice analysis, histopathology for laryngeal lesions, or AI-assisted endoscopy. The results of diagnostic accuracy, sensitivity and specificity were synthesized by a meta-analysis.

Results: 12 studies employing AI-assisted endoscopy, 2 studies for voice analysis, and 4 studies for histopathology were included in the meta-analysis. The combined sensitivity of AI-assisted endoscopy was 91% (95% CI 87-94%) for the classification of benign from malignant lesions and 91% (95% CI 90-93%) for lesion detection. The highest accuracy pooled in detecting lesions versus healthy tissue was the AI-aided endoscopy was 94% (95% CI 92-97%).

Conclusions: For laryngeal lesions, AI-assisted endoscopy shows excellent diagnosis accuracy. But more sizable prospective trials are needed to confirm the practical clinical value.

Background: This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery.

Methods: 62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters.

Results: The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study.

Conclusions: Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results.