European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To minimize post-intubation laryngeal injury it is important to identify the factors that contribute to the development of these lesions. Previous literature has been inconsistent. This survey aims to investigate experts' opinions on the various factors associated with severe laryngeal injury following intubation in the pediatric population and to determine whether these opinions influence the treatment of patients with one or more of these factors.

Methods: A multiple-choice questionnaire with the possibility to provide open text answers was developed and sent by email, WhatsApp and Siilo to members of the scientific societies of anesthesiology, pediatric intensive care, emergency medicine and ear nose throat surgeons worldwide. Responses were analyzed thematically.

Results: A total of 363 physicians worldwide responded to the survey, mainly anesthesiologists (31%), intensivists (35%) and ENT surgeons (29%). The majority of the respondents (69%) had over 10 years of experience in pediatric airway management. Overall, factors with the highest agreement (> 80% of respondents) were 'traumatic intubation', 'multiple intubation attempts', 'the use of oversized tubes', 'skill level of the intubator', 'repeated intubations' and 'period of intubation', specifically in small (weight < 2 kg, age < 1 year) children. The factors 'use of muscle relaxants' and 'biological sex' were not considered relevant. In accordance with their daily practice, physicians from different specialties reported varying factors as being relevant. These assumptions influence their routine decisions regarding intubation and extubation procedures.

Conclusions: Although not extensively supported by literature, the majority of the experts indicate that factors such as 'traumatic intubation', 'multiple intubation attempts', 'oversized tubes', 'skill level of the intubator', 'repeated intubations' and 'period of intubation' are the most relevant factors in the development of post-intubation severe laryngeal injury in the pediatric population. Physicians from different specialisms also highlight specialism specific factors they consider most significant which influence their day-to-day clinical practice.

Purpose: To present the surgical outcomes and one-year audiological and quality of life results of implantation of the Osia^® 2 active piezoelectric bone conduction implant.

Methods: Twenty adults with mixed and conductive hearing loss were implanted with the Osia^® 2 system and followed up for at least one year. The surgical course, healing, and soft tissue condition were assessed. Audiometric tests included pure tone audiometry, speech audiometry and direct bone conduction measurements. Participants completed the APHAB and SSQ questionnaires.

Results: All surgeries were successful. No soft tissue problems were observed. Pure tone audiometry showed a mean functional gain of 47.4 ± 5.6 dB HL (p = 0.000089). The Polish Monosyllabic Word Test showed mean improvements for silent, medium and loud speech of 59.5 ± 1.8%, 46.5 ± 32.3% and 13.3 ± 20.9% in quiet and 38.5 ± 24.4%, 62.0 ± 9.1%, and 36.5 ± 34.4% in noise (all p < 0.05). The Polish Matrix Test indicated a mean SNR improvement of 8.78 ± 2.31 dB SPL (p = 0.000155). BC in situ measurements were significantly better post-implantation compared to preoperative levels with Baha^® 6 Max on the Softband. APHAB scores showed significant improvements in global, ease of communication, background noise and reverberation scores (all p < 0.001). SSQ scores improved significantly in speech, spatial and quality subscales (all p < 0.000001).

Conclusion: The Osia^® 2 implantation is an effective treatment for patients with mixed and conductive hearing loss. The surgery is relatively easy and safe, with no significant postoperative or magnet pressure-related complications. Osia^® 2 significantly improves speech understanding in noise and reduces communication problems.

Background: Total glossectomy is proven to be a superior treatment option for advanced tongue cancer. Despite its efficacy, the procedure is associated with profound morbidity, notably impacting Speech, swallowing, and overall quality of life. Limited therapeutic benefits and the potential for considerable morbidity render total glossectomy a subject of controversy.

Methods: We performed a multidimensional quality of life evaluation of long-term (more than 5 yrs.) total glossectomy survivors. In this study, we evaluated 25 total glossectomy survivors with comprehensive functional and quality of life outcomes using objective measures (London Speech Evaluation Scale, FOIS, 100 ml Water Challenge, FEES) and Patient-reported outcomes (SHI, PSS HN, EORTC QLQ 30 & HN35).

Results: EORTC QLQ 30 showed overall good global health status (M = 80 ± 20) and functional scale mean scores ranging from 87 to 91, despite issues in pain (M = 31.6 ± 31), swallowing (M = 23.3 ± 24), and Speech (26.1 ± 1). Speech outcomes revealed 80% with moderate to severe intelligibility impairment. Swallowing outcomes showed 84% requiring special food preparation, 24% exhibiting aspiration, and 72% having pharyngeal residue. Speech outcomes showed 88% having moderate-severe speech impairment, and Patient-reported speech outcomes indicated a mean SHI score of (M = 47.2 ± 42).

Conclusion: Patients undergoing total glossectomy report favourable long-term outcomes in global health-related quality of life despite moderate to severe impairments in objective speech and swallowing evaluations. These positive patient-reported outcomes support the consideration of total glossectomy as a viable treatment option if and when required, underscoring the importance of evaluating treatment outcomes through the patient-perceived quality of life.

Purpose: To investigate the prevalence and characteristics of bifurcation of the facial nerve (FN) in the mastoid segment using temporal bone CT scans.

Methods: A total of 970 cases (1931 ears) of temporal bone CT scans were reviewed, including 463 females and 498 males, aged 1 to 95 years (interquartile range: 20-69 years). CT imaging with multiplanar reconstruction (MPR) was used to identify and evaluate the bifurcation of the FN. Cases showing branching were confirmed by consensus among three physicians.

Results: We identified 10 cases (10 ears) with facial nerve branching in the vertical segment, yielding an incidence rate of 0.52% (10/1931 ears). Every cases were unilateral, predominantly on the left side. Age analysis revealed 1 case (0.22%) in individuals under 20 years and 9 cases (0.61%) in those over 20 years. Bifurcation generally occurred near the middle to lower vertical segment, with the closest proximity to the second genu observed in a 15-year-old patient.

Conclusions: Bifurcation of the FN in the mastoid segment, though rare, can be encountered in otologic surgery. Detailed preoperative imaging evaluations are crucial for surgical planning to minimize the risk of nerve damage. Our findings emphasize the importance of recognizing anatomical variations in the FN for improving surgical outcomes and patient safety.

Background: Perioperative intravenous lidocaine infusion can improve the quality of recovery (QoR) in patients undergoing functional endoscopic sinus surgery (FESS), but the effect of esmolol on recovery has been rarely studied. The aim of this study to compare the effects of esmolol and lidocaine on the QoR in patients with FESS.

Methods: A total of 60 patients were randomly divided into Group E: intravenous esmolol (0.5 mg/kg for 1 min, followed by 3.0 mg/kg/h); Group L: intravenous lidocaine (2.0 mg/ kg for 10 min, followed by 2 mg/kg/h). The quality of recovery-15 (QoR-15) score was compared. Other parameters compared were the numeric rating pain scale (NRS), haemodynamic data, Surgical field conditions, intraoperative drug dosages, number of cases of remedial analgesia, time to awakening and incidence of postoperative sore throat (POST) as well as postoperative nausea and vomiting (PONV).

Results: The mean difference in the QoR-15 score between Group E and Group L on postoperative day 1 (POD1) was - 1.37 (95% CI - 2.75 to 0.01; P < 0.001 for noninferiority), indicating the noninferiority of esmolol. Haemodynamic changes and intraoperative nitroglycerine dosages were significantly lower in Group E than in Group L (P < 0.05). The scores of surgical field quality (SSFQ) was higher in Group E than in Group L (P < 0.05).

Conclusion: Intravenous infusion of esmolol is not inferior to lidocaine in the quality of postoperative recovery in patients with FESS, and is more advantageous in terms of the quality of the surgical field, attenuation of intraoperative haemodynamic fluctuations, and postoperative awakening.

Objectives: Facial nerve palsy is one of the most important complications of vestibular schwannoma resection. When VII cranial nerve is damaged, ocular complications might appear, impacting patient´s quality of life. Therefore, standardized eye care must be a priority. This involves three key treatments: topical treatment, rehabilitation and oculoplastic surgery. The aim of this work is to review the results of oculoplastic surgery performed simultaneously with vestibular schwannoma resection in terms of vision-related quality of life, compared to deferred surgery.

Design: The study involved 177 patients who underwent vestibular schwannoma resection between 2015 and 2022. The incidence of facial palsy was registered. Of those patients who had the palsy, we selected 35 who also had oculoplastic surgery. 5 of them declined participating in the study. The final sample (n = 30) was divided in two groups depending on the timing of oculoplastic surgery: simultaneously- first group (n = 15) and deferred-second group (n = 15). The vision-related quality of life was measured using the NEI VFQ-25 test.

Results: 26.56% patients developed an immediate postoperative facial dysfunction, decreasing to 18.08% after one year of follow-up. Timing of oculoplastic surgery was associated with better results in quality of life; the first group of patients had a better quality of life (70.27/100) compared to the second group (53.73/100; p = 0.006). Moreover, worse results in quality of life were also associated with long-term postoperative facial palsy (p = 0.042). Current criteria for selecting patients were reliable, proving adequacy as we found worse long-term facial functions in patients who underwent simultaneous surgery (p = 0.01).

Conclusions: Our current criteria for selecting candidates for simultaneous oculoplastic surgery are effective. When long-term facial nerve dysfunction is expected during vestibular schwannoma resection, oculoplastic surgery should be performed simultaneously to preserve the q vision-related quality of life. Long-term severe facial palsy is associated with poor vision-related quality of life.

Objective: This study aimed to evaluate the impact of detailed cochlear dimensions, assessed using micro-CT (µCT) imaging, on insertion outcomes and associated trauma with a new slim, precurved electrode array.

Materials and methods: Eleven temporal bone specimens underwent implantation of a 22-electrode slim precurved array via the round window. High-resolution µCT scans post-implantation enabled visualization of cochlear structures and electrode positioning. Combination with subsequent scans taken after electrodes removal, we analyzed angular insertion depth (AID), insertion length, number of electrodes inserted, cochlear dimensions (specifically cochlear duct length (CDL), basal turn diameter, scala tympani dimension), and intracochlear trauma of fine structures. Statistical analyses were performed to correlate cochlear detailed dimensions and morphology with insertion outcomes and trauma.

Results: The mean AID was 351.82°, and the mean insertion length was 21.07 mm. CDL showed positive correlations with AID and insertion length. Basal turn diameter (value B) positively correlated with AID and insertion length, unlike value A. Middle-basal turn (M/B) relationships (angle and height) significantly influenced insertion depth. The cochleae with smaller M/B heights and specific angles were more susceptible to insertion trauma. Larger basal turn diameters correlated with increased trauma and electrode translocation into the scala vestibuli.

Conclusion: This study highlights the importance of precise cochlear measurements in predicting and optimizing cochlear implant outcomes. Specific cochlear dimensions and anatomical shapes were identified as critical factors affecting insertion depth, trauma risk, and electrode positioning. Utilizing micro-CT provided detailed insights into cochlear anatomy and insertion outcomes, offering valuable data for advancing cochlear implant technology and surgical practices.

Objectives: The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations.

Methods: This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared.

Results: Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported.

Conclusion: Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.

Purpose: An adult version of an app giving users the control over the level of the volume, microphone directionality and noise reduction was adapted for children. The main purpose of this study was to evaluate the effect of changes made to microphone directionality and noise reduction in the myPhonak Junior (the app) on Speech intelligibility in challenging listening environments in children and teens.

Methods: The randomized, non-blinded interventional study with a single group of subjects involved two study visits with a home trial in-between. In the final study session speech assessment in noise was conducted in three different, randomly assigned conditions: default mode (Autosense Sky OS), preffered (self-adjusted) and the extreme condition. Questionnaire based assessment was conducted to assess the subjective benefit of using the app in different daily situations.

Results: The best scores (speech results in noise) were achieved with the preferred setting and the default Autosense Sky OS setting was significantly better than the extreme setting. The self-reported benefit through the questionnaire indicates significantly better result when adjusting the hearing aids through the app.

Conclusion: The app is an easy-to-use way of controlling the level of noise reduction and the beam forming for children 11 years and older. It has the potential to help customizing the hearing aids beyond the default setting and helping to improve speech understanding in noise.