International Archives of Otorhinolaryngology最新文献

Introduction  Few studies have investigated the relationship between cytokines and dizziness in elderly individuals. Objective  To assess the levels of inflammatory biomarkers and their relationship with quality of life (QoL) among elderly individuals with dizziness. Methods  We conducted a cross-sectional study with 103 participants (90 women and 13 men) who were assessed through the Visual Analogue Scale (VAS) and the Dizziness Handicap Inventory (DHI). The plasma levels of cytokines were measured through the cytometric bead array (CBA) method. Cross-tabulations with the Chi-squared test were used to verify sample homogeneity, and parametric tests were used to analyze the data. Results  Out of the total sample of 103 individuals, dizziness was reported by 40 women and 5 men. A difference between the groups with and without dizziness was observed regarding the levels of interleukin 4 (IL-4; p  = 0.011): the group without dizziness presented a higher mean level (2.1 ± 2.8 pg/mL) when compared to the group that presented dizziness (1.0 ± 1.7 pg/mL). Another difference was found between the DHI classifications and the plasma levels of tumor necrosis factor alpha (TNF-α;) p  = 0.015): the groups without any losses in QoL presented lower TNF-α levels (1.4 pg/mL) compared to the group that presented moderate QoL loss (6.3 pg/mL). Conclusion  Dizziness affects the functional, physical and emotional dimensions of QoL and plays a role in the decrease in the levels of IL-4 and in the presence of fullness and tinnitus. Higher VAS scores are related to dizziness in the elderly. Moreover, the increased levels of TNF-α were associated to light-to-moderate losses in QoL among elderly patients with dizziness.

Introduction  Stapedotomy is the standard of care in the surgical management of clinical otosclerosis. It is a precise and technically demanding craft requiring impeccable surgical skills. Both conventional and laser-assisted procedures aim to achieve closure of the air-bone gap (ABG) with minimum collateral damage. Objective  To compare the postoperative outcomes of conventional stapes surgery and CO ₂ laser-assisted surgery. Methods  We conducted a retrospective analysis of the medical records of 74 adult patients who underwent stapedotomy at our center. The patients were divided into two groups for comparison: the "cold steel method" (CSM) group, which was composed of patients who had undergone conventional stapedotomy (manual microperforators/hand-held microdrill); and the "CO ₂ laser-assisted" (LA) group. The postoperative outcomes assessed at 3 and 6 months in both groups were analyzed and compared. The average operative time and complications of both groups were also compared. Results  The hearing outcomes presented statistically significant postoperative improvement in both groups. The LA group presented statistically significant better air conduction thresholds at 3 and 6 months ( p  < 0.05). The ABG and its degree of closure were statistically better at 3 months in the LA group; however, the difference became insignificant at 6 months. Transient vertigo was more common in the LA group ( p  < 0.01). There was no new sensorineural hearing loss in either group. The operative time was longer in the LA group. Conclusion  In experienced hands, both conventional and laser techniques can be used with equal ease and expectation of better outcomes. The CO ₂ laser is not an indispensable tool to achieve good surgical results on a routine basis.

Introduction  Mucoceles are benign expansile cystic lesions commonly seen in the frontoethmoidal region. Objective  To see if the distribution of frontal air cells predisposes to mucocele formation. Methods  Retrospective review of all cases of paranasal sinus mucocele from 2011 to 2021. Data on demographics, history of surgery or trauma, clinical features, radiological findings, and outcome were collected and analyzed. Results  Of the 28 cases, 19 (67.9%) were male and 9 (32.1%), female, with a mean age of 40.75 years. Mucocele was unilateral in 26 (92.9%) patients. Twenty patients (71.43%) presented with primary mucocele. The distribution of mucocele was frontal and frontoethmoidal in 8 (28.6%) patients each, maxillary in 6 (21.4%), and ethmoid and sphenoid sinus in 3 (10.7%) patients each. Sixteen (57.1%) patients had frontal sinus involvement. At presentation, 13 (46.4%) patients had nasal symptoms, 17 (60.7%) had orbital symptoms, while 16 (57.1%) had headache. Pain (12; 70.59%) was the predominant orbital symptom, followed by proptosis and diplopia (8; 47.06%). The most common sites of bony erosions were along the frontal sinus floor (14; 50%), followed by lamina papyracea (13; 46.43%), and frontal sinus anterior wall (10; 35.71%). The agger nasi and suprabullar cells were the most common frontal cells encountered in mucoceles involving the frontal sinus, with no significant difference in frontal cell distribution between involved and uninvolved sides. The frontal cell distribution was similar in mucoceles with and without frontal sinus involvement too. Conclusion  Though frontal and frontoethmoidal mucoceles were the most encountered, the type and distribution of frontal cells did not predispose to mucocele formation.

Introduction  Sickle cell anemia (SCA) is a genetic disorder with clinical manifestations due to circulatory changes, leading to adverse effects on the auditory system that might impact auditory processing, such as auditory discrimination and speech perception ability. This condition is associated with the severity level of anemia. Objective  The purpose of the present study was to investigate the influence of anemia severity on auditory discrimination ability and speech perception in noise among SCA patients with normal hearing sensitivity. Methods  A total of 52 normal-hearing adults diagnosed with SCA in the age range of 15 to 40 were grouped into mild, moderate, and severe, based on anemia severity. Auditory discrimination tests for frequency, intensity, and duration were evaluated at 500 and 4,000 Hz along with speech perception in noise (SPIN) at 0 dB SNR using the mlp toolbox in the MATLAB software, version 2014a (MathWorks, Natick, MA, USA). The IBM Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Results  The results revealed an increase in median and interquartile range among anemia groups with increasing severity. Additionally, the median scores were found to be poorer for the higher frequency in all auditory discrimination tests than for the lower one. A regression in performance with an increase in severity for the SPIN test was observed. Conclusion  The severity of anemia plays an important role in functional auditory processing deterioration. Circulatory changes secondary to SCA affected auditory discrimination processing and speech perception in noise. However, all auditory discrimination abilities are not necessarily affected equally.

Introduction  There are no clear guidelines for deciding between endoscopic sinus surgery and tooth extraction for the treatment of odontogenic sinusitis. Furthermore, tooth extraction does not necessarily improve sinusitis and eventually results in additional endoscopic sinus surgery. Objective  The present study aimed to retrospectively investigate negative predictive factors of tooth extraction for odontogenic sinusitis. Methods  In total, 22 patients with odontogenic sinusitis, who underwent tooth extraction between April 2017 and March 2021, were included. The patients were divided into the improved (n = 15) and non-improved (n = 7) groups. Subsequently, the two groups were compared. Results  A higher percentage of patients in the non-improved group had polyps in the middle nasal meatus ( p  = 0.0008), higher Lund-Mackay score (LMS) ( p  = 0.0008), and apical lesions penetrating the maxillary sinus ( p  = 0.113). Patients with middle nasal meatus polyps, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5, were less likely to see improvement in sinusitis with tooth extraction. Conclusion  Tooth extraction as the initial intervention for odontogenic sinusitis presents a higher risk of failure, particularly in cases in which polyps are present in the middle nasal meatus, with LMS ≥ 7, or with a combination of apical lesions penetrating the maxillary sinus and LMS ≥ 5.

Introduction  Otosclerosis leads to stapes fixation and consequent conductive hearing loss. Surgery is the mainstay of treatment, and it can be achieved through small fenestra stapedotomy or stapedectomy. Despite the first being favored by most, evidence supporting its superiority over the latter remains inconclusive. Objective  To assess the hearing outcomes and complications of stapes surgery performed in a series of patients with otosclerosis and compare the results of stapedotomy with stapedectomy. Methods  A retrospective study of 134 ears in 125 otosclerosis patients undergoing primary stapes surgery was conducted. Patients underwent either stapedotomy or stapedectomy, and outcomes were compared using pre- and postoperative audiometric data and complication rates. Results  Most cases (81%) underwent stapedotomy. Both techniques resulted in significant improvement in air-bone gap (ABG) and speech recognition threshold (SRT) postoperatively, with no significant difference between them. Complication rates were comparable between techniques, with no statistical difference in postoperative complications. Conclusion  Both stapedotomy and stapedectomy offer favorable hearing outcomes with low complication rates in otosclerosis patients. While stapedotomy remains the preferred technique, if the initial plan shifts to a stapedectomy, surgeons should remain composed and confident in a good hearing outcome.

Introduction  Drug-induced sleep endoscopy (DISE) is performed widely, and several studies have demonstrated its validity as it provides clinical information not available by routine clinical inspection alone. Objective  This study aims to evaluate the role of transoral drug-induced sleep endoscopy (DISE) in the evaluation of tongue-palate (TP) interaction and its impact on surgical outcomes. Methods  A total of 42 patients with known obstructive sleep apnea syndrome (OSAS) were classified into two groups according to TP interaction (the absence of space between tongue and palate with the visual impression that the tongue is pushing the soft palate) into +ve and -ve TP interaction. Snoring according to the visual analogue scale (VAS), the Epworth Sleepiness Scale (ESS), and sleep study data were recorded before and after the pharyngoplasty operation. Results  There was a statistically significant difference between studied groups postoperative regarding minimal oxygen saturation, snoring index, apnea-hypopnea index (AHI), the ESS, and visual analogue scale of snoring ( p  = 0.003*, p  < 0.001*, p  < 0.001*, p  = 0.004*, and p  = 0.003*, respectively). It displayed a marked higher average improvement among cases with -ve than in those with +ve TP interaction in terms of snoring index, AHI, and ESS. Conclusion  The Transoral DISE Has A Valuable Role In Evaluating And Assessing TP Interaction And Its Importance On Surgical Outcomes. Cases With Positive TP Interaction Show Poor Response To Isolated Palatopharyngeal Expansion And Need Further Analysis To Create A Better Treatment Plan And Improve Outcomes.

Introduction  The uncinate process (UP) is the most important and constant landmark in the ostiomeatal complex and the middle meatus. Objective  To identify the UP variations that have not been published before and establish a categorization using computed tomography (CT). Methods  The current study was carried out on 110 paranasal CT scans (220 sides). Axial images were acquired with multiplanar reformats to capture delicate details in other planes. Results  Out of 120 CT scans (220 sides), the UP was found to be of type 1 in 84.5%, type 2 in 12.3%, and type 3 in 3.2%, without significant diferences between genders, and it was found to be medialized in 81.9%, vertical in 16.3%, lateralized in 0.9%, and absent in 0.9%, without significant differences between genders. A total of 8.63% of the UPs were pneumatized. Conclusion  The present study improves surgeons' and radiologists' knowledge of the UP, while creating a standard classification and description to be used as a common language between otorhinolaryngologists and radiologists, which could also be used for training.

Introduction  In recent years, transcanal endoscopic ear surgery (TEES) has gained widespread recognition as an excellent surgical field for blind spots such as the sinus tympani (ST) when compared to microscopic ear surgery (MES). Objective  To investigate the postoperative hearing results for pars tensa cholesteatoma and the indications for utilizing endoscopy. Methods  The medical records of 16 patients (10 men and 6 women) with pars tensa cholesteatoma, who received initial surgical treatment between 2018 and 2022, were reviewed. We performed MES, TEES, or endoscopy-assisted MES (dual approach) depending on the pathological involvement in the mastoid cavity and ST. Results  The mean age of the patients was 45 years, and the surgical techniques utilized were MES in 2 cases, TEES in 7 cases, and dual approach in 7 cases. The preoperative pathological classification was stage I in 3 patients and stage II in 13 patients. The overall surgical success rates of postoperative hearing outcomes were 69% and 50% (1/2 patients) in the TEES group, 71% (5/7 patients) in the MES group, and 71% (5/7 patients) in the dual approach group. The successful cases (n = 11) were significantly younger and demonstrated better mastoid pneumatization than unsuccessful cases (n = 5). Conclusion  Endoscopy-assisted MES is appropriate for treating pars tensa cholesteatoma when pathological involvement is present at the deep bottom of the ST. Early surgical intervention and good eustachian tube function are crucial for improving hearing prognosis. Transcanal endoscopic ear surgery can be particularly useful in identifying and removing residual cholesteatoma within the ST.

Introduction  Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy. Objective  This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy. Methods  This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019. Multivariable logistic regression models were used to identify risk factors and associations of UTIs with postoperative morbidity and mortality. Results  In a cohort of 180,373 identified thyroidectomy patients, 0.28% contracted a UTI. Significant risk factors associated with UTIs included age > 60 years (adjusted odds ratio [OR] 2.187, 95% confidence interval [CI] 1.618-2.956), female gender (OR 1.767, 95% CI 1.372-2.278), American Society of Anesthesiologists (ASA) Classification 3 to 5 (OR 1.463, 95% CI 1.185-1.805), partially (OR 4.267, 95% CI 2.510-7.253) or totally dependent functional health status (OR 9.658, 95% CI 4.170-22.370), pulmonary disease (OR1.907, 95% CI 1.295-2.808), chronic steroid therapy (OR 1.649, 95% CI 1.076-2.527), inpatient procedure (OR 1.507, 95% CI 1.251-1.814), and operative time > 150 minutes (OR 1.449, 95% CI 1.027-2.044). Additionally, UTIs were independently associated with postoperative complications, including pulmonary, vascular, or cardiac complication; stroke; acute renal failure; infectious complications; sepsis; septic shock; pneumonia; prolonged length of stay; unplanned reoperation; and mortality. Conclusion  While UTIs are rare after thyroidectomy, they carry a significant burden on patient outcomes. Preoperative optimization of comorbidities and reducing operative times may help mitigate the risk of UTIs. Optimized care for postoperative UTI patients is also recommended to prevent complications and improve outcomes.