International Archives of Otorhinolaryngology最新文献

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  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.

Introduction  Obstructive salivary gland disease is a frequently encountered clinical entity that can present to various health practitioners. Obstructive sialadenitis can lead to recurrent infections and debilitating quality-of-life issues. Objective  There is a paucity of published data regarding obstructive salivary disorders among the multiracial Asian population. The present study aimed to determine the demographic pattern and risk factors of obstructive salivary gland disorders with the goal of better management of this condition. Methods  A retrospective cross-sectional study was conducted at a tertiary institution over a period of 5 years. Results  A total of 256 (9.84 for every 1,000) patients were found to have salivary disorders, 10% of who were diagnosed to have obstructive disorder. Among the obstructive salivary disorders, 76% had sialolithiasis, 19% had recurrent parotitis, and 1 patient had chronic sialadenitis. We observed a small female preponderance for obstructive salivary disorders. This study revealed that smoking is a significant risk factor ( p  = 0.041; prevalence ratio = 2.54, 95% confidence interval 1.12-5.78), and smokers were 2.5 times more likely to develop obstructive salivary disorders. There was no statistical correlation between the prevalence and other risk factors like infection, dehydration, intake of medications, history of diabetes mellitus, radiotherapy, and autoimmune disorders. Conclusion  Our study results demonstrated that the prevalence of obstructive salivary gland disorders was 0.1%. This study provided a better understanding of the prevalence and risk factors of obstructive salivary disorders, which facilitate timely management and improves quality of life.

Introduction  Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. Objective  The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. Methods  This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Results  Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm ² ). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3-13.2] cm ³ ) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8-5.2] cm ³ ). Tumor extension had a significant association with the residual tumor volume. Conclusion  According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension.

Introduction  Expansion sphincter pharyngoplasty has been shown to be a good alternative to continuous pressure devices in patients with moderate to severe obstructive sleep apnea. On the other hand, drug-induced sleep endoscopy provides information on the pattern of collapse in obstructive sleep apnea, although it is unclear whether this information improves the surgical outcomes. Objective  To evaluate the success rate obtained when performing expansion sphincter pharyngoplasty on a group of patients diagnosed with moderate to severe obstructive sleep apnea who were not previously selected by drug-induced sleep endoscopy. Methods  We present a series of patients with moderate to severe obstructive sleep apnea who underwent surgery. Pre- and postoperative home sleep apnea tests were performed. The success rate was calculated, and we assessed whether there were statistically significant pre- and postoperative differences in the apnea-hypopnea index and oximetry values. Results  In total, 20 patients were included, and the surgical success rate was of 80%. Statistically significant improvements were demonstrated in the mean apnea-hypopnea index (from 40.25 ± 15.18 events/hour to 13.14 ± 13.82 events/hour; p  < 0. 0001), the mean oximetric data (from 26.3 ± 12.97 desaturations/hour to 13.57 ± 15.02 desaturations/hour; p  = 0.034), and in the mean percentage of total sleep time in which the patient had less than 90% of saturation (from 8.64 ± 9.25% to 4.4 ± 7.76%; p  = 0.028). Conclusion  The results showed significant improvements in the apnea-hypopnea index and in the oximetric data, with a surgical success rate of 80%, despite the lack of prior drug-induced sleep endoscopy screening.

Introduction  Sudden sensorineural hearing loss (SSNHL) is defined as a rapid sensation of hearing impairment in one or both ears. Based on its personal impact on patients, the present study advances the analysis of new treatments for the prompt recognition and management of SSNHL, with higher chances of improvements in terms of hearing recovery and quality of life of the patients. Objective  To describe the intratympanic (IT) corticoid infiltration technique, to demonstrate the efficacy of betamethasone injection as a sequential treatment in patients whose initial systemic steroid treatment failed, as well as to compare its use in different treatment periods. Methods  The present clinical trial was conducted with 37 patients referred to our office with the diagnosis of SSNHL, from September 2019 to May 2022, who provided informed consent to participate. Results  Even dividing the analysis of increasing the pure tone average (PTA) or speech recognition threshold (SRT) between the difference into initiation of the salvage therapy in up to 15 days of the sudden deafness event, and between 15 days and 3 months of the event, we did not find any difference in hearing improvement. Conclusion  Intratympanic corticosteroid therapy is prescribed when conventional therapy fails or when there is a limitation to the use of corticosteroids due to the presence of systemic disorders. As such, new drugs, such as bethametasone, are studied and show promising results.