European Archives of Oto-Rhino-Laryngology最新文献

Objective: To evaluate objective and subjective hearing outcomes in experienced cochlear implant users with single sided deafness (SSD CI) who used fitting maps created via anatomy-based fitting (ABF) and clinically-based fitting (CBF).

Participants: Twelve SSD CI users with postlingual hearing loss.

Intervention: OTOPLAN (Version 3. (MED-EL) was used to determine intracochlear electrode contact positions using post-operative high-resolution flat panel volume computed tomography. From these positions, the corresponding center frequencies and bandwidths were derived for each channel. These were implemented in the clinical fitting software MAESTRO to yield an ABF map individualized to each user.

Main outcome measures: ABF and CBF maps were compared. Objective speech perception in quiet and in noise, binaural effects, and self-perceived sound quality were evaluated.

Results: Significantly higher speech perception in noise scores were observed with the ABF map compared to the CBF map (mean SRT₅₀: -6.49 vs. -4.8 dB SNR for the S₀N_CI configuration and - 3.85 vs. -2.75 dB SNR for the S₀N₀ configuration). Summation and squelch effects were significantly increased with the ABF map (0.86 vs. 0.21 dB SNR for summation and 0.85 vs. -0.09 dB SNR for squelch). No improvement in speech perception in quiet or spatial release from masking were observed with the ABF map. A similar level of self-perceived sound quality was reported for each map. Upon the end of the study, all users opted to keep the ABF map. This preference was independent of the angular insertion depth of the electrode array.

Conclusions: Experienced SSD CI users preferred using the ABF map, which gave them significant improvements in binaural hearing and some aspects of speech perception.

Purpose: 'Illness perceptions' refers to the thoughts and ideas a person has about an illness. According to Leventhal's Self-Regulatory Model (SRM), changing the threatening illness perceptions of cochlear implant (CI) recipients can be a further step in optimizing hearing outcomes with the CI. The aims of the present study were to assess users' illness perceptions and to determine whether perceptions change during six months of CI rehabilitation.

Methods: One hundred and thirty-eight participants completed the Brief Illness Perception Questionnaire (Brief IPQ), assessing their illness perceptions on nine scales. Data were collected at a German CI center at first CI fitting and six-month follow-up. After first fitting, participants underwent intensive rehabilitation including auditory training, medical, audiological and psychological treatments.

Results: At both assessments, participants tended to view their hearing impairment as a severe threat. On the Brief IPQ, the 'consequences' assessment improved during CI rehabilitation, which can be explained by the CI-induced hearing improvement. However, 'understanding' and 'identity' assessments worsened. This could be because CI recipients only come to realize the full complexity of their hearing impairment during rehabilitation. The other scales and the total score remained unaffected.

Conclusions: Current practice in CI rehabilitation seems to be insufficient to improve threatening illness perceptions (except for perceived consequences). This may be because standard information often fails to reach the patients. The development and empirical validation of an intervention program to address individual illness perceptions in CI recipients could be helpful in this context. Further research will be needed to confirm the results.

Purpose

In cochlear implantation (CI) surgery, there are a wide variety of intraoperative tests available. However, no clear guide exists on which tests must be performed as the minimum intraoperative testing battery. Toward this end, we studied the usage patterns, recommendations, and attitudes of practitioners toward intraoperative testing.

Methods

This study is a multicentric international survey of tertiary referral CI centers. A survey was developed and administered to a group of CI practitioners (n = 34) including otologists, audiologists and biomedical engineers. Thirty six participants were invited to participate in this study based on a their scientific outputs to the literature on the intraoperative testing in CI field and based on their high load of CI surgeries. Thirty four, from 15 countries have accepted the invitation to participate. The participants were asked to indicate the usage trends, perceived value, influence on decision making and duration of each intraoperative test. They were also asked to indicate which tests they believe should be included in a minimum test battery for routine cases.

Results

Thirty-two (94%) experts provided responses. The most frequently recommended tests for a minimum battery were facial nerve monitoring, electrode impedance measurements, and measurements of electrically evoked compound action potentials (ECAPs). The perceived value and influence on surgical decision-making also varied, with high-resolution CT being rated the highest on both measures.

Conclusion

Facial nerve monitoring, electrode impedance measurements, and ECAP measurements are currently the core tests of the intraoperative test battery for CI surgery.

Purpose

The aim of this study is to describe the maximum exposure of the infraorbital region via the orbital floor using the transnasal prelacrimal recess approach (PLRA), and to provide an anatomical basis for treating lesions in the infraorbital region.

Methods

Ten freshly injected frozen heads were dissected using the PLRA. The orbital floor was removed along the border of the medial infraorbital quadrangle, and the periorbita was opened to expose the infraorbital region. The areas of the medial infraorbital quadrangles were measured and analyzed. The PLRA was applied separately on the left and right sides of each cadaver head, resulting in a total of 20 prelacrimal recess approaches.

Results

The PLRA enabled visualization of the optic nerve and the central retinal artery through the orbital floor. By integrating both medial and lateral approaches in relation to the inferior rectus muscle, all crucial anatomical structures within the infraorbital region could be clearly identified. The area of the medial infraorbital quadrangle was 420.65 ± 24.03 mm².

Conclusion

The PLRA provides access through the orbital floor to the maximum boundary of the infraorbital region, including the lateral orbital wall at the outermost level, the superior rectus muscle at the topmost level, and the medial orbital wall at the innermost level.

Objectives

Inner ear malformations (IEMs) may result in differences in outcomes of cochlear implant user. These differences could be observed in both behavioral and objective tests. eCAP is the most common used objective test in cochlear implants and have different presence rate in cochlear implant users with and without IEMs. This study aims to evaluate eCAP results from CI user with and without IEMs through different recoding methods; amplitude growth function, spreads of excitation and refractory recovery.

Methods

There were 42 CI users (20 IEM&22 normal) above five-years old and with at least one year experience. Three different eCAP measurement was conducted at several intracochlear electrodes. Presence rate, threshold levels and amplitude were compared between groups.

Results

For Amplitude growth function measurement, when the percentage of detected eCAP thresholds was analyzed between groups, there was a significant difference only for basal electrode and no significant difference for apical and middle electrodes. Similarly, the presence rate of RecF-eCAP for both groups were in a downward trend from apical to basal. However, there was no significant difference in AGF-eCAP and RecF-eCAP amplitudes between groups for the cochlea’s apical, middle and basal region. Although the presence rate of SOE-eCAP was lower for IEM group, there was no significant difference in ECAP amplitudes for all maskers.

Conclusions

It could be inferred that even though the observable eCAP rate differed between these two groups when the observable eCAP was recorded, the IEM group produced eCAP with similar amplitudes to normal cochlea group.

Purpose

Biologics represent a new therapeutic strategy for severe and recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). Usually, their actual therapeutic effectiveness is assessed by reduction in nasal polyps and/or improvement in nasal symptoms and quality of life. However, these measures do not consider nasal immunophlogosis, which can be evaluated through nasal cytology. The purpose of this study was to assess not only the clinical impact but also the cellular changes in the nasal inflammatory infiltrate observed through nasal cytology of CRSwNP patients treated with Dupilumab for 24 months.

Methods

Fifty-five CRSwNP patients treated with Dupilumab were collected. Patients were evaluated before starting treatment and at one, three, six, nine months, one year, one and a half years, and two years after the first drug administration. During follow–up visits patients underwent endoscopic evaluation, nasal symptoms and quality of life assessment, complete blood count and nasal cytology.

Results

During follow-up, significant improvement was found in Nasal Polyps Score (NPS), nasal patency, olfaction, Sino-Nasal Outcome Test (SNOT-22) score, and Visual Analogue Scale (VAS). Regarding nasal cytology, a reduction in eosinophils and mast cells in the cellular infiltrate was observed over the two-year follow-up period compared to baseline.

Conclusion

Dupilumab has demonstrated broad efficacy in the management of CRSwNP from both clinical and cytological findings. Further studies are needed to confirm our findings and evaluate the biologics’ impact on nasal mucosal inflammatory cells by nasal cytology with the aim of better identifying each patient’s endotype and predicting the response to biologics.

Purpose

It is aimed to evaluate the effect of maxillary sinus elevation with lateral antrostomy approach on mucociliary functions using the saccharin test.

Methods

The study was planned prospectively. 29 patients who underwent maxillary sinus elevation were included in the study. The age and gender information of the patients were noted. Saccharin test was performed in the nasal cavity on the operated side. Mucociliary functions were evaluated with the results of the saccharin test performed before the operation and the saccharin test results at the 1st week, 1st month, and 3rd month postoperatively. Comparisons were made with these values.

Results

The mean age of the patients was 42.10 ± 4.99 years. Of the patients, 14 (48.3%) were female and 15 (51.7%) were male. Preoperative saccharine test results were found to be significantly lower than the postoperative values. As the postoperative recovery period increased, a significant decrease was observed in the saccharin test results. However, preoperative values were within normal limits, while postoperative values were above the normal range.

Conclusions

In our study, it was observed that mucociliary functions improved as the postoperative period increased in patients who underwent maxillary sinus elevation, but were still above normal limits.

Background

This report analyzes traumatic anterior skull base CSF leaks following nasopharyngeal swab testing for detection of SARS-CoV-2 in the largest case series to date, combined with a systematic literature review.

Methods

Retrospective multi-institutional case-series of traumatic anterior skull base CSF leak with clear antecedent history of COVID-19 swab was completed. A comprehensive search of databases was performed for the systematic literature review.

Results

Thirty-four patients with traumatic CSF leak after COVID-19 nasopharyngeal swab testing were identified. Women were more than twice as likely to experience a CSF leak, as compared to men. The majority of patients (58.8%) had no reported predisposing factor in their clinical history. Common defect sites included the cribriform plate (52.9%), sphenoid sinus (29.4%), and ethmoid roof (17.6%). Four patients (11.8%) presented with meningitis. The median time between the traumatic COVID swab and the detection of CSF leak was 4 weeks (IQR 1–9). Patients with meningitis had a median leak duration of 12 weeks (IQR 8–18). The average leak duration was significantly longer in patients with meningitis compared to without meningitis (p = 0.029), with a moderate effect size (r = − 0.68). Most cases (92.9%) managed with endoscopic endonasal surgical repair were successful.

Conclusions

This report clarifies the presentation, risk factors, and management of CSF leaks attributable to diagnostic nasopharynx swabbing procedures in the COVID-19 era. Timely surgical repair is the recommended management option for such leaks.

Background

Vagal schwannomas are well-documented, but cervical sympathetic chain schwannomas (CSCS) are rare, with most knowledge from case reports. This study aims to identify radiological predictors of misdiagnosis and factors guiding surgical approaches based on tumor size and extent.

Methods

An ambispective analysis was conducted on 21 cases of CSCS, examining preoperative data, intraoperative findings and the questionnaire to identify the potential predictors. Tumors were classified into three types based on their relationship with the carotid sheath, and this classification was correlated with vessel ligation and postoperative neural outcomes.

Results

An excellent agreement was found between radiologist on new classification system(Kappa:0.89). Tumor classification revealed a diverse distribution, with 6 cases identified as Type 1, 6 as Type 2, 5 as Type 3, and 4 as Type 3S. The necessity of external carotid artery (ECA) ligation correlated with the tumor type. Type 3 tumors required ECA ligation in 50% of cases, while Type 1 and Type 2 tumors predominantly involved vascular preservation. Postoperative complications included vagal palsy in 28.5% of cases and first bite syndrome in 71.4%.

Conclusion

Accurate preoperative planning and a novel staging system can enhance surgical outcomes and reduce postoperative complications as validated by our study.