International Archives of Otorhinolaryngology最新文献

Introduction  Microtia and aural atresia present congenital ear anomalies that affect external ear and are associated with conductive hearing loss. Both anomalies result from exposure to various prenatal risk factors, most common during the first trimester of pregnancy. Objective  This study was aimed at epidemiological analysis of microtia/atresia and associated risk factors in the Kazakhstani population. Methods  A retrospective study in two stages. First, a cross-sectional analysis of microtia/ atresia frequencies from 2015 to 2019 on the basis of official statistics obtained from the Republican Centre for E-Health. Then, a case-control study was carried out to elucidate maternal risk factors associated with occurrence of microtia/atresia. We recruited patients presented in Almaty, Kazakhstan, between September 2021 and February 2022. Results  There was a substantial regional variation in the rates of both aural atresia and microtia/anotia. Mothers of children with microtia disclosed toxoplasmosis, other agents (including HIV, syphilis, varicella), rubella, cytomegalovirus, herpes simplex (TORCH) infections during pregnancy more often than those of healthy children (45.8 versus 7.3%; p  < 0.001). Exposure to different chemicals during pregnancy was mentioned more frequently by mothers of children with microtia when compared with the healthy controls (18.1 versus 8.1%; p  = 0.035). Self-reporting of alcohol consumption and intake of antibiotics was also significantly higher in mothers of children with microtia (31.9 and 36.1% respectively). Conclusion  Elucidation of microtia/atresia epidemiology is important due to their imposed social and economic burden, associated with treatment and rehabilitation costs.

Introduction  Adults with cochlear implants (CIs) need periodic programming of their speech processors to take advantage of alternative adjustments. However, this requires patients to attend the CI center in person. Objectives  To evaluate the feasibility of speech processor (SP) self-programming with remote assistance in CI users. To establish the characteristics of those who could benefit from self-programming. Methods  Adults with at least 1 year of experience with their CI, and whose SP was compatible with the use of the remote assistant fitting (RAF) were selected. Maps were created by the RAF from the neural response telemetry (NRT) results, evaluated in the same session with the audiologist. Patients were given 15-days to adjust to either the routine map or the NRT-based one. In the next session, the minimum and maximum stimulation levels (T- and C-levels) of all the maps were compared. Results  No statistical difference was found when comparing the T- and C-levels of the map in use, the map adjusted by RAF, and the NRT-based map created by the RAF and adjusted by the patient. Conclusion  Self-programming of the SP was safe and feasible in the studied sample of adults, since T- and C-levels were similar between the behavioral and RAF-adjusted maps. We consider it advisable to use the RAF for patients who have insertion of electrodes and at least one functioning; as well as those who do not have changes in anatomy, nor motor and cognitive conditions that prevent RAF usage.

Introduction  Platelet-rich plasma (PRP) contains high platelet concentration and growth factors that help in rapid wound healing, hemostasis, and decreased scarring. It has been used in various conditions to aid in healing, but its use in ear, nose, and throat (ENT) is not yet common. Objective  To compare the outcome of using PRP with myringoplasty with that of myringoplasty alone in the repair of tympanic membrane perforations. Methods  Sixty-eight patients in the 16-to-50 years age group with tympanic membrane perforation of 3 months duration, with dry ear for 6 weeks, and mild to-moderate conductive hearing loss were selected and divided by simple randomization into 2 equal groups. A thorough preoperative evaluation was done. In group A, patients underwent myringoplasty, and in group B, patients underwent myringoplasty with PRP. Patients were followed up for 3 months postsurgery. Results  At 6 weeks, 67.6 and 94.1% had graft uptake in groups A and B, respectively ( p -value 0.011). At 3 months, 85.3 and 97.1% had graft uptake in groups A and B, respectively ( p -value 0.197). The mean pure tone audiometry difference in group A was 8.35 ± 2.05, and 11.00 ± 2.28 in group B ( p  < 0.001). The mean air-bone gap difference for group A was 8.29 ± 2.14, and 10.76 ± 2.36 for group B ( p  < 0.001). Graft uptake rate at 6 weeks, pure tone audiometry, and air-bone gap difference were statistically significant. Conclusion The present study results showed that the use of PRP during myringoplasty aids healing of the tympanic membrane with better hearing improvement in the postoperative period when compared to myringoplasty alone.

Introduction  In the literature, there is divergence about the relationship between anatomical variations of the turbinates and nasal septum (NS) and alterations in the maxillary sinus (MS) mucosa. Objective  To determine, through cone-beam computed tomography (CBCT) images of Brazilian individuals, the prevalence and relationship of anatomical variations of the turbinates and NS with alterations in the mucosa of the MS, as well as to analyze the relationships of these variables with demographic data. Methods  The present cross-sectional study involved the analysis of 120 CBCT scans using the i-CAT Vision software, conducted by 2 calibrated examiners. The MS, lower and medium turbinates, and NS were evaluated. Data on gender, age, and the side affected by anatomical variation were also collected. The intra- and interexaminer agreements were assessed using Kappa indices. The association was analyzed using the Chi-squared or Fisher exact tests, and measured by the Phi, Cramer V, or Kendall Tau-C values. Results  Most patients presented partial opacification of the MS (89.2%), inferior turbinate hypertrophy (TH) (60.8%), and NS deviation (85%). There were no cases of inferior concha bullosa (CB), while the prevalence of middle CB was of 20%. Variation in the turbinates, CB, and NS were not significantly related to changes in the MS mucosa. Conclusion  We can conclude that, in the evaluated sample, there was no significant associations involving the studied variables.

Introduction  Minimally invasive Ponto surgery (MIPS) enables the installation of percutaneous bone-anchored hearing implants (BAHIs) with a drill guide through a hole punch incision. Despite being well established for adults, there is a lack of studies in the literature regarding its use in pediatric patients. Objective  The aim of the present study was to investigate the hearing performance and soft-tissue outcomes of the use of MIPS under local anesthesia in children with unilateral craniofacial malformation (UCM). Methods  The study used a retrospective cohort design. Nine subjects with UCM, aged between 6.5 and 17.1 (median = 12) years, who underwent the MIPS procedure under local anesthesia were included. Surgical procedure, intra, and postoperative complications were investigated. Speech recognition thresholds in quiet (SRTQ) and in noise (SRTN), daily use, satisfaction, and perceptual listening effort of the subjects were assessed after 4 months of postoperative follow-up. Results  It was possible to perform MIPS under local anesthesia in 8 of 9 subjects, with no intraoperative complications. One subject (11.11%) showed adverse skin reactions during a mean follow-up period of 11.4 months with MIPS. Speech recognition thresholds in quiet, SRTN, and subjective listening effort scores significantly decreased with the use of BAHI. The subjects were overall satisfied with the device and using it 8.2 hours/day, on average. Conclusion  Under local anesthesia, MIPS showed to be a viable option for BAHI installation in children with UCM. The hearing performance of the subjects improved, and they were globally satisfied with the device. Soft-tissue complications were minimal, and our results are comparable to those reported in the literature for adults.

Introduction  Bell palsy (BP) is an acquired, idiopathic facial palsy linked to lower motor neuron malfunction of the seventh cranial nerve. Several studies have identified BP as one of the many neuropathies that coronavirus disease 2019 (COVID-19) patients have developed, while other studies disagree. Objective  To study if there is an association between BP in pediatric patients and COVID-19, and to examine the pattern of recovery in all pediatric cases of BP during the COVID-19 pandemic. Methods  We performed a prospective cohort study on pediatric patients with acute onset unilateral facial weakness of unknown etiology (BP) during the pandemic period. All included patients were submitted to a reverse transcription-polymerase chain reaction (RT-PCR) test through nasopharyngeal and oropharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of the BP diagnosis. Results  No significant differences were found regarding COVID-19 infection and recovery from BP at the first, third, or sixth months of follow-up. According to the results, it seems that there is no association between COVID-19 infection and facial palsy; however, the patients infected with COVID-19 in the sample experienced a rapid, early recovery from BP. The mean incidence of BP in 5 years (2017-2021) was of 1.73/100 thousand individuals, with a statistically insignificant change throughout the years. Conclusion  We were not able to show any association between BP and COVID-19. The patients underwent follow-up for up to 6 months, and we studied their patterns of recovery from BP, which were like those observed before the pandemic.

Introduction  Mucormycosis is an aggressive, lethal fungal infection affecting the nasal and paranasal territory in immunocompromised patients. Orbital involvement is not uncommon and may require orbital exenteration. Objectives  The management of orbital involvement in invasive fungal sinusitis is challenging, ranging from conservative retrobulbar amphotericin B injection in the early stages to orbital exenteration in late stages. Endoscopic endonasal debridement is a minimally invasive technique used to manage orbital fungal involvement in the late stages. Methods  Endoscopic endonasal orbital clearance was performed to manage late-stage orbital invasive fungal infection (≥ stage 3c) or after failure of retrobulbar amphotericin B injection with no light perception. Removal of the lamina papyracea (LP) and incision of the periorbita were done to expose all the necrotic intraorbital content in the extra and intraconal spaces. A microdebrider was utilized to debride necrotic fungal infected tissue until a healthy vascularized plane was reached. Gelfoam (Pfizer Inc., New York, NY, United States) soaked in amphotericin B was applied as an adjunctive step to deliver antifungal medication to the orbital content. Results  Fourteen patients were included in the study, 9 of whom were male and 5 female, with a mean age of 58.5 years. Eleven patients showed no evidence of disease progression (complete recovery and cessation of medical treatment). Two patients died 15 days after the surgery. The last patient developed frontal lobe abscess but has been treated with double antifungal medication. Conclusion  Endoscopic endonasal orbital debridement could be an effective method to treat late-stage orbital fungal infection without jeopardizing the patient's life. Level of Evidence : 4.

Introduction  Supracricoid partial laryngectomy is a surgical treatment for advanced laryngeal cancer which is implemented to preserve organ function, but it may cause obstructive sleep apnea syndrome (OSAS) due to anatomical changes after surgery that may be neglected by clinicians. Although the gold standard for the diagnosis of OSAS is polysomnography, respiratory polygraphy is an alternative valid method with a high level of diagnostic sensitivity and specificity; since the equipment is portable, it can be used at home, with no need for hospitalization. Objective  To describe the polygraphy result of patients submitted to supracricoid partial laryngectomy. Methods  The present study included 13 patients, and we collected data on age, date of the surgery, body mass index, cardiovascular risk factors, Epworth score, and apnea-hypopnea index (AHI). Results  The 13 patients were all male, with a mean age of 62 years. As for the AHI, one patient was classified as severe, six, as moderate, and three patients, as mild; moreover, 3 patients were simple snorers. While 77% of the sample presented OSAS, only 23% presented symptoms of drowsiness. Conclusion  The study group, who underwent supracricoid partial laryngectomy, did not present self-reported symptoms of OSAS. Nevertheless, polygraphy was a useful tool in this group, and we recommend its systematic use after decannulation to avoid leaving OSAS undiagnosed. Level of evidence  4; case series study.

Introduction  The Nijmegen cochlear implant questionnaire (NCIQ) is a quantifiable self-assessment health-related quality of life (HRQoL) tool used internationally to determine quality of life (QoL) in cochlear implant (CI) users and to evaluate the implant's subjective benefits. Objective  This study aimed to validate the Danish version of the questionnaire (DA-NCIQ) with a test-retest including 60 participants (30 CI users and 30 CI candidates). Methods  The intraclass correlation coefficients (ICC) were calculated to evaluate the temporal stability of the participants' answers and the internal consistency of the questionnaire domains was determined using the Cronbach alpha in order to compare these results with the NCIQ's other language versions. Results  The DA-NCIQ was found to have Cronbach alpha coefficients between 0.7 and 0.91, as well as test-retest reliability with ICC values between 0.7 and 0.92. These findings were similar to the original and other language versions of this questionnaire. The Cronbach alpha coefficients varied between 0.73 and 0.89, while the ICC test-retest reliability varied between 0.64 and 0.85. Furthermore, the present study found that participants with CIs had an improved HRQoL in all subdomains, except for the advanced sound perception one, when compared to the CI candidates. Conclusion The results supported the DA-NCIQ as a reliable instrument to measure the subjective benefits of CIs in postlingually deafened/hearing-impaired adults.