Journal of Laryngology and Otology最新文献

Objectives: To localise bleeding points identified in patients with intractable epistaxis.

Methods: We reviewed all patients with intractable epistaxis who underwent endoscopic nasal examination under anaesthesia between 1989 and 2024 in a tertiary otolaryngology unit in Ireland.

Results: In total, 194 patients were included. Bleeding points were identified in 85 per cent of patients (165 cases). In addition, 89 patients (46 per cent) had bleeding from the septum, 70 (36 per cent) of which were high on the anterosuperior septum above the axilla of the middle turbinate. It was also found that 77 patients (40 per cent) had bleeding from the lateral nasal wall: 44 (23 per cent) at the posterior end of the middle meatus and 33 (17 per cent) at the posterior end of the inferior meatus.

Conclusion: This study describes remarkably consistent bleeding point localisation in epistaxis failing first-line measures. We recommend detailed endoscopic examination as a first-line intervention in such instances. Direct cauterisation is the simplest method for controlling epistaxis, avoiding complex procedures such as arterial ligation or embolisation.

Objectives: The objective of the study was to determine the effect of tranexamic acid in ear surgeries on duration of surgery, intra-operative blood loss, visibility and mean arterial pressure (MAP).

Methods: A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. Five databases were used (PubMed, Cochrane, Scopus, Web of Science and Embase). A search yielded 73 articles: 31 were duplicates and 42 were screened for by two authors. A standardised mean difference (SMD) was calculated to measure the effect size across studies.

Results: The search yielded five final studies with ear procedures including tympanoplasty, atticotomy, mastoidectomy, ossiculoplasty, stapedotomy, tympanotomy and microscopic modified radical mastoidectomy. Tranexamic acid reduced duration of surgery (standardised mean difference = -3.82; p = 0.38), intra-operative blood loss (standardised mean difference = -19.64; p < 0.05) and mean arterial pressure (standardised mean difference = -2.88; p < 0.05).

Conclusion: This meta-analysis demonstrated that tranexamic acid reduced bleeding and mean arterial pressure that were both statistically significant, while the reduction in duration of surgery was statistically insignificant. All studies reported better visibility.

Objectives: Severe laryngeal dysfunction following (chemo)radiotherapy for head and neck cancer may be managed with functional salvage total laryngectomy (FSTL). We investigated communication and swallowing outcomes following FSTL at our tertiary centre.

Methods: All patients treated with FSTL from 2009-2023 were included. Functional Oral Intake Scale score and primary mode of communication were recorded at pre-surgical baseline, point of discharge from inpatient admission, six and 12 months post-surgery.

Results: Ten patients were identified. Pre-surgery all patients were nil by mouth due to severe dysphagia, and 70 per cent were communicating verbally. By 12 months post-surgery, 70 per cent were tolerating full oral intake and 40 per cent were using surgical voice restoration as the primary mode of communication.

Conclusion: Variability in functional outcome must be explained to patients who are offered surgical management of non-functioning larynx, and further work is needed to identify factors that may influence outcome.

Objectives: To compare between two methods of radiofrequency (coblation and radiofrequency volume reduction) in turbinate volume reduction under local anaesthesia regarding efficacy, pain, and crust formation.

Methods: In a prospective randomised double-blinded trial, 90 patients were randomised into two groups in a 1:1 ratio where group (I) underwent submucosal turbinate reduction using coblation radiofrequency while group (II) underwent turbinate reduction using conventional radiofrequency using radiofrequency volume reduction technique. Patients were assessed by Nasal Obstruction Symptom Evaluation for technique efficacy, pain visual analogue scale score, Endoscopic Turbinate Grading scale, and crust formation 1, 6, and 12 months post-operative.

Results: Nasal Obstruction Symptom Evaluation score showed significant difference between patients in the same group compared to baseline (p < 0.001), pain visual analogue scale was significantly higher in radiofrequency group (p < 0.001) and there was no significant statistical difference regarding crust formation.

Conclusion: Both techniques are tolerable, effective, and safe for turbinate reduction under local anaesthesia in patients with mainly soft-tissue component turbinate hypertrophy.

Background: Temporal bone computed tomography delivers a relatively high radiation dose. Cone beam computed tomography could be a promising alternative, offering good performance with reduced radiation exposure. This study aimed to compare the irradiation during temporal bone imaging using computed tomography versus cone beam computed tomography.

Materials and methods: We conducted a single-centre prospective study evaluating dosimetric data collected from patients undergoing temporal bone imaging via computed tomography or cone beam computed tomography. Absorbed doses (milligrays) were measured using mini-dosimeters placed on key anatomical sites: eyes, ears, lower neck and pubic region, and compared between the two imaging modalities.

Results: CBCT significantly reduced radiation, with absorbed doses being two to six times lower than those observed with conventional computed tomography, depending on the measured sites.

Conclusion: Our findings align with existing literature, confirming the reduced irradiation with cone beam computed tomography in ear imaging. Further studies are warranted to evaluate image quality relative to radiation dose between the two techniques.

Objective: Emerging reports show that personal listening device usage causes vestibular impairment. This study aims to investigate the effect of personal listening device usage on vestibular impairment.

Methods: Subjects between 13 and 25 years were recruited. Each subject underwent a personal listening device usage questionnaire and quantification of sound exposure level, followed by a series of vestibular tests. Statistical analyses were performed to identify the association between personal listening device characteristics, sound exposure level and vestibular function.

Results: A total of 131 participants were recruited, with a mean age of 20 ± 2.55 years. The mean duration of personal listening device usage per day was 5.53 ± 2.76 hours. Noise exposure from personal listening device usage was noted to cause more saccular damage in adolescents. A correlation was found between the preferred listening level, the 40-hour equivalent continuous exposure level (r = 0.406, p = 0.029) and the latency right p13 among adolescents.

Conclusion: Sound exposure levels among adolescents are higher than among young adults. Personal listening device usage resulted in saccular damage among adolescents.

Objectives: This study aimed to review the incidence, outcomes and treatment of delayed facial nerve palsy (DFP) following otological surgery.

Methods: MEDLINE, Pubmed, Embase and The Cochrane Central Register of Controlled Trials were searched up to 10 May 2024. A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of studies reporting on DFP following otological surgery. The risk of bias was assessed using the JBI critical appraisal tools.

Results: Forty-nine articles were included with 201 instances of DFP following 24,917 operations from 1967 to 2021. The mean day of onset post-operatively was 8.4. 93 per cent of episodes fully recovered, with most cases taking between eight days and one month to recover.

Conclusion: Many theories of the pathogenesis of DFP exist. It is rare and has an excellent prognosis following treatment with corticosteroids with or without anti-viral therapy.

Objectives: This study aimed to compare the outcome of the standard trans-cervical approach and modified trans-cervical approach regarding cosmesis and complications outcomes in a tertiary hospital in Nigeria.

Methods: In this study, 25 patients with submandibular salivary gland lesions adjudged not to be malignant neoplasia were included. They were randomised into the two groups by balloting method.

Results: Twelve (48 per cent) patients had the traditional transcervical approach while 13 (52per cent) had the modified approach. There was no statistically significant difference between the groups in terms of general complication, transient paresthesia and wound infection (p > 0.05). The presence of a non-visible scar was reported in almost 85 per cent of patients in the modified trans-cervical approach group compared to 50 per cent in the standard trans-cervical approach group.

Conclusions: Though by observation the modified trans-cervical approach was superior to the standard trans-cervical approach, the differences were statistically insignificant.

Introduction: An aspirated foreign body in a child can represent a potentially life-threatening emergency.

Methods: This retrospective study, carried out from 2014 to 2024, compares the estimated effective radiation dose children received during ultra-low dose computed tomography (CT) scans with that received with traditional cumulative radiographic investigations.

Results: Of the 44 patients included in the study, 32 were in the radiograph group and 12 were in the CT group. There was a statistically significant reduction in the length of stay and cost in the CT group when compared with the radiograph group (p < 0.01). There was a statistically significant reduction in the cumulative estimated effective radiation dose in the radiograph compared to the estimated effective dose received in the CT group (p < 0.01). No patients required sedation for CT imaging.

Conclusion: Ultra-low dose CT is a safe, cost-effective first-line investigation in stable patients with suspected foreign body aspiration.

Objective: Investigate the impact of surgical method on hearing outcomes and complication rates after otosclerosis surgery.

Methods: Records of patients more than 18 years old who underwent otosclerosis surgery were reviewed to identify prosthesis type, surgical approach, post-operative dizziness, overnight admissions and hearing outcomes.

Results: A total of 132 stapedotomies were performed with McGee pistons and 144 stapedectomies were performed using ribbon loops. No sensorineural hearing loss was noted with both techniques. Stapedotomy patients had a statistically larger improvement in speech reception thresholds, but there was no significant difference in air-bone gap closure between the two methods. 3.7 per cent of stapedotomy patients experienced post-operative dizziness, which was not significantly different the 7.6 per cent dizzy after stapedectomy (p = 0.2037). Diazepam was prescribed for dizziness in 90.9 per cent (10/11) of dizzy patients with ribbon loops and 0 per cent of those (0/5) with McGee pistons (p = 0.0018).

Conclusion: Both approaches yielded similarly good air-bone gap closure and were found to be safe and effective with low post-operative dizziness.