Pub Date : 2022-02-01DOI: 10.1017/S0022215122000512
E. Fisher, J. Fishman
Dementia in all its forms constitutes a major public health, economic and societal problem globally as age demographics change, with an estimated 130 million sufferers worldwide predicted by 2050. Associations with olfactory impairment have been established in the past, and age-associated hearing loss and dementia have been under discussion in recent years. This issue of The Journal of Laryngology & Otology’s ‘article of the month’ is from Sheffield, and draws together evidence regarding hearing impairment and dementia. The evidence is mounting of an association between early cognitive impairment and age-associated hearing loss. Association does not necessarily mean causation, as hearing loss may simply reflect the general degradation of brain processing power that is produced by the pathological processes in underlying causes of dementia. More work is required to clarify whether hearing loss is a truly independent variable and whether it has a role in assisting cognitive decline. If auditory input can have a beneficial effect on the progression of some forms of dementia, this encourages everyone involved in interventions to improve hearing in the elderly in the hope that this may delay dementia progression. Benign obstructive salivary gland pathologies were discussed in an article in last month’s issue of The Journal, and this month includes a paper by Leopard and colleagues from South Wales regarding the epidemiology of salivary carcinomas. In Wales, 356 carcinomas arose over 27 years, as established by national databases. This work was hampered by the comparative rarity of these tumours, but analysis tantalisingly demonstrated an interesting link between various histological subtypes of cancer and background radiation (radon), smoking, and obesity. An association with prior radiotherapy was already established, and many different types of cancer have been associated with radon levels in epidemiological studies. A recent series of parotid carcinomas from Japan, published in The Journal, managed to accumulate 108 cases over 32 years, favouring adjuvant radiotherapy, and emphasised the difficulty in studying epidemiology and outcomes for conditions with inherently low numbers. Vestibular neuronitis (or ‘neuritis’) is a common cause of acute vertigo, with an interesting history, which was well reviewed back in 1973 in The Journal by Wilmot from Omagh, Northern Ireland, in relation to vestibular function test findings and terminology. This has been updated in this month’s article by Manzari and colleagues from Italy, which focuses particularly on the two different aspects of otolith function in patients with vestibular neuronitis, dissecting the different otolith functions by the use of a variety of vestibular assessments. The authors remind us that ‘In the labyrinth, the utricular and saccular macula with their afferents form two complementary otolithic systems: the sustained system concerned with signalling low frequency linear accelerations and
{"title":"Hearing loss and dementia, vestibular neuronitis, salivary carcinoma, and the history of tympanic membrane anatomy","authors":"E. Fisher, J. Fishman","doi":"10.1017/S0022215122000512","DOIUrl":"https://doi.org/10.1017/S0022215122000512","url":null,"abstract":"Dementia in all its forms constitutes a major public health, economic and societal problem globally as age demographics change, with an estimated 130 million sufferers worldwide predicted by 2050. Associations with olfactory impairment have been established in the past, and age-associated hearing loss and dementia have been under discussion in recent years. This issue of The Journal of Laryngology & Otology’s ‘article of the month’ is from Sheffield, and draws together evidence regarding hearing impairment and dementia. The evidence is mounting of an association between early cognitive impairment and age-associated hearing loss. Association does not necessarily mean causation, as hearing loss may simply reflect the general degradation of brain processing power that is produced by the pathological processes in underlying causes of dementia. More work is required to clarify whether hearing loss is a truly independent variable and whether it has a role in assisting cognitive decline. If auditory input can have a beneficial effect on the progression of some forms of dementia, this encourages everyone involved in interventions to improve hearing in the elderly in the hope that this may delay dementia progression. Benign obstructive salivary gland pathologies were discussed in an article in last month’s issue of The Journal, and this month includes a paper by Leopard and colleagues from South Wales regarding the epidemiology of salivary carcinomas. In Wales, 356 carcinomas arose over 27 years, as established by national databases. This work was hampered by the comparative rarity of these tumours, but analysis tantalisingly demonstrated an interesting link between various histological subtypes of cancer and background radiation (radon), smoking, and obesity. An association with prior radiotherapy was already established, and many different types of cancer have been associated with radon levels in epidemiological studies. A recent series of parotid carcinomas from Japan, published in The Journal, managed to accumulate 108 cases over 32 years, favouring adjuvant radiotherapy, and emphasised the difficulty in studying epidemiology and outcomes for conditions with inherently low numbers. Vestibular neuronitis (or ‘neuritis’) is a common cause of acute vertigo, with an interesting history, which was well reviewed back in 1973 in The Journal by Wilmot from Omagh, Northern Ireland, in relation to vestibular function test findings and terminology. This has been updated in this month’s article by Manzari and colleagues from Italy, which focuses particularly on the two different aspects of otolith function in patients with vestibular neuronitis, dissecting the different otolith functions by the use of a variety of vestibular assessments. The authors remind us that ‘In the labyrinth, the utricular and saccular macula with their afferents form two complementary otolithic systems: the sustained system concerned with signalling low frequency linear accelerations and ","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"8 1","pages":"95 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87183845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-10DOI: 10.1017/S0022215121004278
M. Reddy Y, Anjali Lepcha, A. Augustine, Mary John, Ajay Philip
Abstract Objective Cochlear implant is the standard treatment of choice for children and adults with severe to profound sensorineural hearing loss. The main objective of this study was to assess the knowledge, attitude and practices regarding cochlear implant among doctors other than otolaryngologists in a tertiary care academic institution. Method A 24-item knowledge, attitude and practices questionnaire was developed based on an extensive literature review and expert opinion and was administered to 100 non-otolaryngologists in a tertiary care academic institution to be completed in about 15 minutes. The data obtained was analysed to assess knowledge, attitude and practices regarding cochlear implant in this group. Results The results showed that awareness regarding the option of cochlear implants for elderly and unilateral deafness was deficient. Surgeons and doctors in higher specialties did better when it came to practice related to cochlear implant. The age and experience of doctors also improved knowledge and practice with regards to cochlear implant. Conclusion Improving awareness about cochlear implants and their benefits among non-otolaryngology colleagues can ensure that more people who could potentially benefit from cochlear implants will receive appropriate counselling and referral.
{"title":"Knowledge, attitude and practices regarding cochlear implants among medical doctors other than otolaryngologists: a prospective cross-sectional study","authors":"M. Reddy Y, Anjali Lepcha, A. Augustine, Mary John, Ajay Philip","doi":"10.1017/S0022215121004278","DOIUrl":"https://doi.org/10.1017/S0022215121004278","url":null,"abstract":"Abstract Objective Cochlear implant is the standard treatment of choice for children and adults with severe to profound sensorineural hearing loss. The main objective of this study was to assess the knowledge, attitude and practices regarding cochlear implant among doctors other than otolaryngologists in a tertiary care academic institution. Method A 24-item knowledge, attitude and practices questionnaire was developed based on an extensive literature review and expert opinion and was administered to 100 non-otolaryngologists in a tertiary care academic institution to be completed in about 15 minutes. The data obtained was analysed to assess knowledge, attitude and practices regarding cochlear implant in this group. Results The results showed that awareness regarding the option of cochlear implants for elderly and unilateral deafness was deficient. Surgeons and doctors in higher specialties did better when it came to practice related to cochlear implant. The age and experience of doctors also improved knowledge and practice with regards to cochlear implant. Conclusion Improving awareness about cochlear implants and their benefits among non-otolaryngology colleagues can ensure that more people who could potentially benefit from cochlear implants will receive appropriate counselling and referral.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"513 1","pages":"492 - 499"},"PeriodicalIF":0.0,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85604153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-10DOI: 10.1017/S0022215121004722
C-C Lin, Y. Wang, Chung-Hsin Chiu, Y-K Sun, Mei-Wei Lin, I. Tzeng
Abstract Objective This study aimed to elucidate whether molecular signalling involved in upper airway remodelling is enhanced in patients with obstructive sleep apnoea. Method Twenty patients with mild obstructive sleep apnoea (control group) and 40 patients with moderate to severe obstructive sleep apnoea (obstructive sleep apnoea group) who desired uvulopalatopharyngoplasty were recruited for the study. After uvulopalatopharyngoplasty, surgical specimens of the uvula were subjected to haematoxylin and eosin, Masson's trichrome and immunohistochemical staining. Western blot and reverse transcriptase-polymerase chain reaction were used to evaluate the protein and messenger RNA expressions. Results The obstructive sleep apnoea group showed more severe inflammation, increased collagen deposition and higher immunohistochemical staining intensity for TGF-ß and MMP-9 as well as higher protein and messenger RNA expression of MMP-9, VEGF, TGF-ß, p38 MAPK, SMAD 2/3, AKT and JNK in the uvula than control group. Conclusion Patients with obstructive sleep apnoea demonstrated more severe inflammation, increased airway remodelling, and increased protein and messenger RNA expression of pro-inflammatory and pro-fibrotic cytokines in the uvula than control participants.
{"title":"Molecular signalling involved in upper airway remodelling is enhanced in patients with obstructive sleep apnoea","authors":"C-C Lin, Y. Wang, Chung-Hsin Chiu, Y-K Sun, Mei-Wei Lin, I. Tzeng","doi":"10.1017/S0022215121004722","DOIUrl":"https://doi.org/10.1017/S0022215121004722","url":null,"abstract":"Abstract Objective This study aimed to elucidate whether molecular signalling involved in upper airway remodelling is enhanced in patients with obstructive sleep apnoea. Method Twenty patients with mild obstructive sleep apnoea (control group) and 40 patients with moderate to severe obstructive sleep apnoea (obstructive sleep apnoea group) who desired uvulopalatopharyngoplasty were recruited for the study. After uvulopalatopharyngoplasty, surgical specimens of the uvula were subjected to haematoxylin and eosin, Masson's trichrome and immunohistochemical staining. Western blot and reverse transcriptase-polymerase chain reaction were used to evaluate the protein and messenger RNA expressions. Results The obstructive sleep apnoea group showed more severe inflammation, increased collagen deposition and higher immunohistochemical staining intensity for TGF-ß and MMP-9 as well as higher protein and messenger RNA expression of MMP-9, VEGF, TGF-ß, p38 MAPK, SMAD 2/3, AKT and JNK in the uvula than control group. Conclusion Patients with obstructive sleep apnoea demonstrated more severe inflammation, increased airway remodelling, and increased protein and messenger RNA expression of pro-inflammatory and pro-fibrotic cytokines in the uvula than control participants.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"7 1","pages":"1096 - 1104"},"PeriodicalIF":0.0,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77154837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-10DOI: 10.1017/S0022215121004242
Catherine Haighton, R. Watson, Janet A. Wilson, Steven Powell
Abstract Objective There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children. Method The study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically. Results General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed. Conclusion Guidelines for the management of paediatric sleep-disordered breathing are needed.
{"title":"Perspectives on paediatric sleep-disordered breathing in the UK: a qualitative study","authors":"Catherine Haighton, R. Watson, Janet A. Wilson, Steven Powell","doi":"10.1017/S0022215121004242","DOIUrl":"https://doi.org/10.1017/S0022215121004242","url":null,"abstract":"Abstract Objective There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children. Method The study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically. Results General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed. Conclusion Guidelines for the management of paediatric sleep-disordered breathing are needed.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"13 1","pages":"520 - 526"},"PeriodicalIF":0.0,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82454954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.1017/S0022215121003650
N. Mehta, E. Arram, M. Rouhani, L. Dimitrov, H. Ubhi, S. Khalil, S. R. Saeed
Abstract Background Superior semi-circular canal dehiscence syndrome is a disorder characterised by auditory and vestibular symptoms that can significantly impact quality of life, and yet it has no disease-specific quality of life instrument. Method Thirty-six patients who underwent transmastoid superior semicircular canal resurfacing and plugging were included from an initial cohort of 60 surgically managed patients. A sub-cohort of 19 consecutive patients completed validated symptom and quality of life questionnaires before and after surgery. Of the 36 patients, 31 participated in a telephone semi-structured interview post-operatively. Results Following surgery, there was a statistically significant improvement in autophony index score (p = 0.02), symptom severity score (p < 0.001) and sound hypersensitivity (p = 0.01). Thematic analysis of telephone interviews suggested three main symptom themes: auditory hypersensitivity, dysequilibrium, headache and concentration difficulties. Dysequilibrium was found to persist post-operatively. Conclusion Surgery improves overall symptoms and quality of life. However, important symptom themes may be overlooked using the outcome measures that are currently available. A unified disease-specific outcome measure is urgently required to better understand the impact of symptoms and measure treatment effects.
{"title":"Superior semi-circular canal dehiscence syndrome: quantifying the effectiveness of treatment from the patient's perspective","authors":"N. Mehta, E. Arram, M. Rouhani, L. Dimitrov, H. Ubhi, S. Khalil, S. R. Saeed","doi":"10.1017/S0022215121003650","DOIUrl":"https://doi.org/10.1017/S0022215121003650","url":null,"abstract":"Abstract Background Superior semi-circular canal dehiscence syndrome is a disorder characterised by auditory and vestibular symptoms that can significantly impact quality of life, and yet it has no disease-specific quality of life instrument. Method Thirty-six patients who underwent transmastoid superior semicircular canal resurfacing and plugging were included from an initial cohort of 60 surgically managed patients. A sub-cohort of 19 consecutive patients completed validated symptom and quality of life questionnaires before and after surgery. Of the 36 patients, 31 participated in a telephone semi-structured interview post-operatively. Results Following surgery, there was a statistically significant improvement in autophony index score (p = 0.02), symptom severity score (p < 0.001) and sound hypersensitivity (p = 0.01). Thematic analysis of telephone interviews suggested three main symptom themes: auditory hypersensitivity, dysequilibrium, headache and concentration difficulties. Dysequilibrium was found to persist post-operatively. Conclusion Surgery improves overall symptoms and quality of life. However, important symptom themes may be overlooked using the outcome measures that are currently available. A unified disease-specific outcome measure is urgently required to better understand the impact of symptoms and measure treatment effects.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"1 1","pages":"809 - 822"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81885870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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