European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Unilateral vestibular dysfunction leads to significant asymmetry in the horizontal vestibulo-ocular reflex (VOR) during swift head movements. This reflex can be enhanced through rehabilitation exercises and visual-vestibular adaptation techniques. This systematic review aims to evaluate the current evidence on the effectiveness of unidirectional rotation treatments for improving symptoms and function in patients with vestibular disorders.

Methods: A systematic review was conducted following the PRISMA 2020 guidelines, using databases such as PubMed, Cochrane Library, EMBASE, and Scopus. Included were experimental studies, randomized controlled trials (RCTs), or pilot RCTs. Meta-analysis was performed based on the findings of these studies.

Results: Among 24 articles identified, three addressed the systematic review's question, two observational studies (one retrospective and one prospective) and a RCT. Studies included data from a total of 200 participants with vestibular disorders (n = 96; 48% males) for the meta-analysis. A meta-analysis, including a subgroup analysis, was conducted to assess the improvement in VOR asymmetry following vestibular rehabilitation. The analysis compared pre- and post-rehabilitation directional preponderance (DP) across three studies. Results showed a significant improvement in VOR asymmetry, with a mean difference of 18.72% in favour of rehabilitation.

Conclusion: Our findings substantiate the efficacy of unilateral vestibular stimulation in reducing asymmetry in the VOR among patients with vestibular dysfunction. This modality represents a promising rehabilitation strategy, significantly enhancing vestibular function and patient outcomes.

Purpose: Positional obstructive sleep apnea (POSA) is common among obstructive sleep apnea (OSA) patients and exhibits distinct clinical features. This study aimed to analyze the clinical characteristics and associated factors of POSA, as well as compare the outcomes between POSA and non-POSA (NPOSA).

Methods: OSA subjects aged over 40 years from the Sleep Heart Health Study were included in this study. OSA was classified into POSA and NPOSA according to the Cartwright criteria. Univariate and multivariable logistic regression analyses were conducted to identify predictors of POSA. The incidence of outcome events across the two groups was assessed using cumulative hazard curves and compared with the log-rank test.

Results: A total of 1,080 OSA subjects were included, with 412 in the NPOSA group and 668 in the POSA group. In the univariate analysis, body mass index, diabetes, apnea-hypopnea index (AHI), the percentage of sleep time with oxygen saturation below 90% (CT90) and arousal index were inversely associated with POSA, average oxygen saturation during sleep and minimum oxygen saturation during sleep were positively associated with POSA. In the multivariate analysis, AHI (OR 0.98, 95% CI 0.97 to 0.99, p = 0.006) and CT90 (OR 0.98, 95% CI 0.96 to 1.00, p = 0.027) remained significantly inversely associated with POSA after adjusting for other variables. There was no significant difference in the cumulative hazard of myocardial infarction, stroke, congestive heart failure, or all-cause mortality between the two groups during the mean follow-up period of 11 years.

Conclusions: This study identified AHI and CT90 as independent predictive factors for POSA. There was no significant difference in the incidence of myocardial infarction, stroke, congestive heart failure, or all-cause mortality between POSA and NPOSA.

Background: A new endoscopic tympanoplasty technique for large and medium-sized central perforations via a transcanal approach, without tympanomeatal flap elevation compared the preliminary postoperative graft success and hearing outcomes with other techniques in the literature.

Methods: The study involved 75 patients aged 12 to 44 who underwent tympanoplasty with the lateral malleolar flap technique from 2014 to 2017. Pre-operative otoscopy recorded perforation sizes, and pure tone averages were calculated at 500, 1000, 2000, and 4000 Hz. The procedure was performed under general anesthesia via a transcanal approach using tragal cartilage, without tympanomeatal flap elevation. A control otoscopy was conducted six months post-operation to assess reperforation and graft position. Pure tone averages were measured, and pre-operative and post-operative audiological values were compared.

Results: Post-operative six-month graft success rate was 94.6%. Reperforation was observed in one patient (1.3%), while another patient (1.3%) exhibited lateralization, and two patients (2.6%) demonstrated medialization. The pre-operative mean hearing level was recorded at 33.3 ± 7.0 dB, accompanied by an Air-Bone Gap (ABG) of 24.0 ± 6.6 dB. Post-operative measurements indicated an improvement in these values, with the mean hearing level decreasing to 18.0 ± 4.8 dB and the ABG reducing to 16.3 ± 5.3 dB (p < 0.05).

Conclusion: The endoscopic underlay cartilage tympanoplasty with lateral malleolar flap is a safe technique that avoids elevating the tympanomeatal flap. It offers shorter operation time, easier postoperative dressing, and high graft success rates similar to other tympanoplasty techniques.

Purpose: The persistent and recurring nature of Menière's Disease may pose psychological challenges for patients. The association between Menière's Disease and depression and anxiety remains inconclusive among pre-existing studies. This study seeks to review and synthesise existing evidence regarding the association between Menière's Disease and depression and anxiety.

Methods: Two authors independently searched PubMed, Embase and The Cochrane Library for observational or randomized studies investigating the association between Menière's Disease with depression or anxiety. Using a random-effects model, the prevalence of depression and anxiety among Menière's Disease patients were pooled using proportions, the standardized mean difference of depression and anxiety test scores between Menière's Disease patients and controls were compared, and maximally-adjusted risk ratios were pooled to determine the risk of depression and anxiety. Heterogeneity was assessed using the I² test. The bias of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the overall quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Results: We included 35 observational studies with 15,890 patients. The prevalence of depression and anxiety among Menière's Disease patients were 34% (95% CI 18%-54%) and 23% (95% CI 16%-32%) respectively. Patients with Menière's Disease exhibited significantly elevated scores in both depression (SMD: 0.73, 95% CI 0.22-1.25) and anxiety (SMD: 0.687, 95% CI 0.228-1.146) assessments in comparison to healthy controls. However, no significant correlation was observed between Menière's Disease and the long-term risk of developing depression or anxiety.

Conclusion: There may be an association between Menière's Disease and depression and anxiety, but further studies are required to confirm these findings.

Purpose: To evaluate the diameter of the facial nerve (FN) and facial canal (FC) at different segments in Bell's palsy (BP) patients and compare the facial nerve/facial canal width ratio (FN/FC) of the the affected and healthy sides to determine the entrapped sites.

Methods: This retrospective study enrolled 47 patients with BP that were referred to a tertiary referral hospital. From patients' records, initial House-Brackmann grades, cranial computurized tomography (CT) and contrast enhanced temporal magnetic resonance imaging (MRI) scans were revieved. FC and FN diameter measurements were performed at the midpoint of labyrinthine segment, geniculate ganglion and tympanic segment in the axial plane, and mastoid segment in the sagittal plane. Contrast-enhanced segments on MRI were evaluated.

Results: There was no statistically significant difference between the FC diameters of the affected and the healthy sides on CT at any measured segments. FN diameter was increased significantly for all segments except mastoid segment on the affected side compared to the healthy side. FN/FC ratio was significantly greater on the affected side than the healthy side in all measured segments. Evident contrast enhancement was observed in all affected FNs, with geniculate ganglion and labyrinthine segment being the most common sites with contrast enhancement on MRI.

Conclusion: Anatomical differences in FC may not be the main predisposing factor in BP. As the geniculate ganglion and labyrinthine segments had the highest FN/FC ratio and showed clear contrast enhancement on MRI, these findings may indicate a higher risk of inflammation and entrapment in these segments.

Background: Laryngeal cancer is one of the most common head and neck tumors, with 75% affecting the vocal cords. The 8th edition of the TNM staging system defines T1 glottic tumors as those limited to the vocal cords with preserved mobility. Since the publication of the third edition in 1998, this category has been divided into T1a (tumor limited to one vocal cord) and T1b (both vocal cords involved). However, these tumors can also involve the anterior commissure. The anterior commissure is considered a sublocation by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control, but it is not accounted for in the current T staging system. Although the anterior commissure is rarely the primary site of glottic tumors (1%), 20% of glottic tumors show involvement of the anterior commissure, with its impact on prognosis still controversial.

Methods: A global and specific survival analysis was performed using the Kaplan-Meier method, comparing survival curves with the Log Rank test. A Cox regression model was constructed, including confounding variables and examining possible interaction terms, evaluating the proportionality assumption through graphical methods. Confounding variables were controlled using the Propensity Score (PS), estimating the effect with different PS methods.

Results: The variable "Anterior Commissure" showed a significant effect on the recurrence of glottic cancer, consistent across the different propensity score adjustment methods. The Inverse Probability of Treatment Weighting (IPTW) method was particularly effective in adjusting for covariate differences between groups, maintaining the full sample size, and providing a robust and clinically relevant analysis.

Conclusions: The anterior commissure is a significant risk factor for the recurrence of glottic cancer. Integrating propensity score methods enhances the precision and validity of survival studies. It is recommended to continue exploring these methods in larger and more diverse cohorts.

Objective: Endoscopic ear surgery (EES) is engaged nearly in all otology procedures in this era. The widespread application is faced by raised drawbacks that EES can induce thermal injury to the inner ear structures.

Methods: This retrospective study investigates the effect of endoscopic tympanoplasty on the postoperative sensorineural element of hearing and other inner ear functions. Cases of endoscopic tympanoplasty admitted to the tertiary referral center in the period of the study were included. Important audiologic data were collected including the preoperative and postoperative bone conduction threshold and air bone gap. The total endoscopic usage time during surgery was collected. Appropriate statistical testing was performed using SPSS 20.

Results: The study included 51 patients who had endoscopic tympanoplasty. The mean age was (33.65 ± 10.840) years. The study showed no statistically significant difference between the preoperative and postoperative bone conduction threshold. In addition, Pearson correlation test showed no statistical association between the total endoscopic usage time and the postoperative bone conduction threshold. No significant vertigo nor facial nerve affection were observed in the postoperative period.

Conclusion: Endoscopic tympanoplasty as an example of EES does not affect the inner ear structures, clinically described as it does not affect the postoperative sensorineural hearing, facial nerve function nor the balance.

Objective: We aimed to compare the success rate of the inner-ear visualization and actual endolymphatic hydrops (EH) detection rate of gadolinium-enhanced MRI in ears with definite Meniere's disease (dMD) with intratympanic versus intravenous injection.

Methods: 122 ears with dMD were included and divided into the intratympanic (IT) administration and intravenous (IV) groups. 38 ears in the IT group were evaluated by 3D-real IR and 3D-FLAIR sequence scans 24 h after injection of 8-fold diluted gadolinium. 84 ears in IV group were evaluated by i3D-real IR sequence scans 4 h after intravenous gadolinium administration. The success rate and the detection rate of EH were evaluated and analysed.

Results: The i3D-real IR sequence in the IV group had a higher success rate (100%) than did the 3D-real IR (76.32%) and 3D-FLAIR (84.21%) sequences in the IT group. The actual EH detection rate in the IV group (98.81%) was significantly higher than that for the 3D-real IR (76.32%), 3D-FLAIR (78.95%) or 3D-real IR + 3D-FLAIR (84.21%) sequences in the IT group. The presence of EH could not accurately be assessed in 15.79% of ears in the IT group due to weak perilymph enhancement. After exclusion of these ears, the IT and IV groups showed similar EH detection rates.

Conclusion: The insufficient success rate of IT method reduced its actual EH detection rate. Using i3D-real IR, the IV method offers the higher success and actual EH detection rates, which provides a reference to the individualized choice of gadolinium-enhanced MRI.

Purpose: By synthesizing and analyzing existing research data, this study evaluates the clinical efficacy and safety of corticosteroids in the treatment of pediatric retropharyngeal abscess (RPA) and parapharyngeal abscess (PPA).

Data sources: Two authors independently searched PubMed, EMBASE, Cochrane Library, and Web of Science, for studies relating to corticosteroids-assisted antibiotic therapy for pediatric RPA and PPA.

Review methods: Literature was meticulously screened against predefined inclusion and exclusion criteria, and relevant data were extracted. Meta-analysis and systematic review methodologies were employed to synthesize and analyze existing research comprehensively, evaluating clinical efficacy and safety.

Results: Five studies were included (2 retrospective case series, 3 retrospective cohort studies), involving a total of 2560 subjects. The cohort studies demonstrated robust methodological quality. Meta-analysis results indicated significantly lower surgical drainage rates in the steroid group (OR = 0.28; 95% CI: 0.23-0.34; p < 0.01) and reduced hospitalization duration (OR=-0.14; 95% CI: -0.23 to -0.06; p < 0.01) compared to the non-steroid group. Systematic evaluation revealed lower hospitalization costs in the steroid group. Predominantly, studies favored intravenous dexamethasone (82.76%). No adverse reactions to corticosteroids were reported.

Conclusion: Current evidence suggests a beneficial role for corticosteroids in the treatment of pediatric RPA and PPA, emphasizing their importance in symptom improvement, decreased surgical intervention, shortened hospital stays, and reduced hospital costs. However, caution is warranted regarding potential side effects, particularly with long-term use. Future research should further elucidate specific dosages, durations, and optimal types of glucocorticoid therapy to better guide clinical practice.

Objective: Cochlear Implantation by classical Trans-mastoid Posterior tympanotomy approach for Round window insertion using microscope is often difficult due to limited visualization of Round window membrane niche. Our study aims to use Endoscope as an adjunct to classical microscopic technique to overcome this difficulty.

Methods: Our study is a Double blinded Randomised controlled trial with patients undergoing Cochlear implantation & having St Thomas Hospital classification IIb and III intraoperatively included in study. They were divided into two groups. Group A underwent Microscopic Cochlear Implantation while Group B underwent Endoscope assisted Cochlear Implantation. Based on visibility Round window niche structural visibility index (RSVI) score was recorded using both microscope and Endoscope.

Results: In Endoscope assisted group mean RSVI score was 8.44 ± 1.37 as compared to microscopic group was 5.47 ± 2.56 and it was Statistically significant with p < 0.05. Intraoperative mean electrically evoked compound action potentials(ECAP) for electrodes 1 to 8 was 187.9 ± 2.84 in microscopic group as compared to 179.44 ± 2.30 in Endoscopic group and the same for electrode 9 to 15 was 178.69 ± 3.16 & 175.3 ± 3.65 respectively but ECAP for electrode 16-22 was statistically insignificant between the groups considering p-value < 0.001. Endoscope assisted Cochlear Implantation was found to be associated with Statistically significant(p < 0.05) chances of Round window insertion with Chi square value of 15.45.

Conclusion: Microscope is the tool of choice for Cochlear Implantation but in cases with difficult visualization Endoscope can adjunct microscope in better visualization thus increasing chances of Round window insertion and promoting hearing preservation.