European Annals of Otorhinolaryngology-Head and Neck Diseases最新文献

Introduction: Cochlear implantation (CI) is an option for severe to profound hearing loss when hearing aids are ineffective. This study aimed to evaluate its relevance in individuals over 80 by assessing long-term CI use and audiological outcomes.

Methods: We conducted a retrospective, single-center study including 29 patients over 80years old who received their first CI between January 2012 and December 2021 with data recorded until December 2024. Annual rates of users and non-users, audiometric test results, and pre- and postoperative complications were recorded.

Results: The mean age at implantation was 82.8, and the mean duration of CI usage was 4.9years. The percentage of patients still using their implant was 100%, 93%, 83%%, 76% and 75% at 1, 2, 3, 4 and 5years respectively. This number dropped to 33% 8years after the surgery. The main reasons for discontinuation were loss of autonomy and lack of benefit. Audiometric results showed improvement in mean pure-tone audiometry thresholds and free-field speech audiometry. Minor complications occurred in 24% of cases, while severe complications occurred in 13%.

Conclusion: CI is a viable option for patients over 80years old with severe to profound hearing loss. However, given the progressive decline of usage after implantation in this age group, a detailed cost-benefit analysis could provide valuable insight into its indication for this population.

Objectives: This study aimed to measure and compare nasal mucus cystatin SN levels in patients with controlled and uncontrolled chronic rhinosinusitis, and to evaluate its diagnostic performance in distinguishing between these disease states.

Material and methods: A total of 98 CRS patients were prospectively enrolled and evaluated for disease control based on the EPOS criteria. Specimens of nasal mucus and tissue from patients with CRS and 15 healthy controls undergoing surgery for the deviated septum were obtained to measure cystatin SN levels. Disease severity was evaluated using the 22-item Sinonasal Outcome Test (SNOT-22), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) score, Lund-Kennedy score, Lund-Mackay score, olfactory cleft endoscopy scale (OCES), and olfactory cleft computed tomography (CT) score. Multivariable logistic regression analysis was used to determine the risk factors associated with uncontrolled CRS.

Results: Among the patients with CRS, 42.86% were uncontrolled. Cystatin SN expression in the nasal epithelium was significantly increased among patients with uncontrolled CRS compared to those with controlled CRS and healthy controls (both P<0.001). Furthermore, the uncontrolled CRS exhibited significantly higher blood eosinophil counts (BEC) (P=0.001), SNOT-22 score (P=0.001), QOD-NS score (P=0.004), Lund-Mackay score (P=0.022), OCES (P=0.004), and olfactory cleft CT score (P=0.012) than controlled CRS. Additionally, mucus cystatin SN levels showed a positive correlation with BEC (R=0.126, P=0.012) in patients with CRS. Multivariable logistic regression analysis showed that nasal mucus cystatin SN was identified as an independent predictor of uncontrolled CRS (OR=1.011, P=0.028). Mucus cystatin SN levels with a cutoff point greater than 106.050pg/mL had a superior predictive value for uncontrolled CRS compared to BEC (area under the curve, 0.886 vs. 0.782, P<0.001).

Conclusion: Mucus cystatin SN levels were highly associated with disease severity in patients with uncontrolled CRS.

Aim: To determine factors affecting pain on a numeric rating scale (NRS) during office-based voice prothesis exchange. And, secondarily, to review voice prothesis replacement techniques in France.

Material and method: A multicenter prospective observational study was conducted by the Head and Neck Tumor Study Group (GETTEC) between November 2022 and November 2024. A survey questionnaire was filled out by the practitioner after informed consent was obtained from the patient. All laryngectomized patients presenting in consultation for voice prothesis exchange were included. Pain was assessed on a unidimensional 0-10 numeric rating scale.

Results: Three hundred and nine questionnaires were collected. Mean pain rating was 2±2.8. Three factors were associated with significantly lower pain intensity: procedure duration <5minutes (P<0.001), a single attempt (P<0.001), and the status of the practitioner performing the replacement (P=0.002); 2 factors were associated with suggestively lower pain intensity: male gender (P=0.030), and use of a capsule (P=0.011). Pain intensity was not significantly associated with local anesthesia (P=0.4) or the extraction technique (P=0.2). Sixty seven percent of replacements were in emergency contexts, particularly for intra-prosthetic leakage (68%). Local anesthesia was used in 87% of cases. Extraction was by pushing the implant into the esophagus in 52% of cases, and by pulling it out in 48%. Most replacements (75%) required only 1 attempt, and 77% required less than 5minutes (77%). Capsules were used in 23% of cases.

Conclusion: We found a wide range of techniques for replacing a voice prothesis. The procedure is quick and relatively painless. For replacement that is as painless as possible, it is advisable for it to be carried out quickly, using a capsule.

Objectives: To compare early results in isolated ossiculoplasty under potentialized local anesthesia and general anesthesia.

Material and method: A single-center retrospective observational study included 123 consecutive patients treated by isolated ossiculoplasty between September 1, 2019 and March 1, 2021 in a French private hospital. The main aim was to compare the management pathway (operating room time, hospital stay, outpatient management rate, "by-pass" rate of direct return to the outpatient department without passing through the recovery room) according to potentialized local anesthesia versus general anesthesia. Secondary endpoints comprised audiometric results and post- and intraoperative complications (nausea and vomiting, pain, dizziness, crossover). The significance threshold was set at P<0.005. The STROBE guideline was followed.

Results: In total, 123 patients were included: 41 with local and 82 with general anesthesia. The two groups were comparable except for type of surgeon. The rate of outpatient treatment was significantly greater with local anesthesia (93% vs. 55%). Operating time and operating room, recovery room and outpatient room occupancy times were shorter with local anesthesia. Postoperative dizziness was significantly more frequent with general anesthesia. Audiometric results did not differ.

Conclusion: Potentialized local anesthesia can improve organizational management and outpatient rates in ossicular surgery, without impairing the quality of results.