Annals of Otology Rhinology and Laryngology最新文献

Objective: To evaluate the efficacy of a smartphone-based application providing tinnitus-specific cognitive behavioral therapy and customized sound therapy for tinnitus.

Methods: In a prospective randomized controlled trial, the treatment group participated in daily sound therapy and weekly interactive CBT modules, and the control group did not receive the program (waitlisted). Outcome measures after 8 weeks included the Tinnitus Functional Index (TFI), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI).

Results: Ninety-two patients (mean age = 57.2 ± 11.9 years) were included. The treatment (n = 47) and control (n = 45) cohorts had similar TFI, PHQ-9, GAD-7, PSS, and PSQI scores at presentation (all P > .05). Treatment-group patients had significantly higher improvements than controlled patients in their TFI (16.7 ± 14.9 vs 1.9 ± 10.8, P < .001), PHQ-9 (1.9 ± 4.2 vs -0.7 ± 3.4, P = .002), GAD-7 (1.1 ± 3.6 vs -0.9 ± 3.3, P = .009), and PSQI scores (2.5 ± 3.2 vs -1.1 ± 2.1, P < .001). Treatment-group subjects also significantly improved in 7 of the 8 TFI domains (all P < .05). TFI improvements of ≥20 occurred in 18 (38.3%) treatment subjects. Of the 9 treatment-group patients presenting with moderate-severe depression, 4 (44.4%) improved to minimal depression. Of the 4 treatment-group patients with moderate-severe anxiety, 2 (50.0%) improved to minimal anxiety. Of the 17 treatment-group patients with moderate-severe sleep difficulties, 10 (55.6%) had considerable sleep improvement.

Conclusion: This novel smartphone application providing cognitive behavioral therapy and customized sound therapy was effective in reducing symptom severity and improving anxiety, sleep, and mood for tinnitus patients.

Objectives: Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants.

Methods: A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups.

Results: Twenty-one patients were included in each cohort. The AFRS group was younger in age (P = .015) and had a significantly longer AEA-SB length (P = .014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group.

Conclusions: AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS.

Objective: Gestational diabetes mellitus (GDM) is associated with several adverse health conditions in newborns such as preterm birth, hyperbilirubinemia, macrosomia, respiratory distress. However, the effect of GDM on the hearing sensitivity of newborns is still unclear. The study aimed to explore the effect of GDM on newborn hearing. The study aimed to explore the effect of GDM on newborn hearing.

Method: A systematic search was conducted using PubMed, Scopus, and CHINAL databases. Keywords like "gestational diabetes," "diabetic pregnancies," "hearing loss," "hearing impairment," and "hearing disorder" were used to form a search string. The Rayyan software was used for screening procedure. The full-length articles were shortlisted, extracted, and appraised.

Results: The 7 articles were included in the review. Findings suggest that hearing loss is more prevalent in newborns with GDM pregnancies than in non-GDM pregnancies. In addition, OAE findings were "referred during the first hearing screening of newborns with GDM pregnancies." The refer rate of the first bilateral hearing screening was higher for newborns with GDM pregnancies. Furthermore, children of diabetic pregnancies were found to be at risk of bilateral hearing loss, particularly sensorineural in nature.

Conclusion: The present systematic review suggests an association between GDM and a higher refer rate in hearing screening. A multidisciplinary collaboration between gynecologists, pediatricians, and audiologists can smoothen the early detection of hearing loss in newborns with GDM pregnancies, leading to early intervention and better clinical outcomes to improve the quality of life of affected newborns.

Objectives: Hypoglossal nerve stimulation (HNS) is a treatment option for patients with moderate-to-severe obstructive sleep apnea. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to improve apnea hypopnea index (AHI) reduction and/or patient comfort. This study describes response patterns to HNS after AEAP as well as patient-specific patterns in our patient population.

Methods: Retrospective evaluation of 17 consecutive patients who underwent AEAP between June 2019 and December 2022. Post-AEAP AHIs were used to create 2 response groups, which facilitated analysis of patient-based characteristics. AHI reporting, deemed non-titration AHI (NT-AHI), is the whole-night AHI resulting from non-titration studies. Chi-squared, Pearson correlation coefficient, and independent samples t-test were used to determine significance deemed as P < .05.

Results: Fifteen of 17 patients (88.2%) presented for failed NT-AHI reduction, and 2/17 (11.8%) presented for comfort measures. Eleven patients (65%) showed an improvement in post-AEAP NT-AHI; 6 (35%) patients failed to improve. Four patients with either lateral wall collapse or concentric wall collapse at the tongue base failed to improve NT-AHI compared to a single patient who showed an improved NT-AHI (P = .017). Of the 2 patients who presented with discomfort, patient 1/2 demonstrated improvement in device usage, and patient 2/2 reported improved comfort while maintaining average device usage.

Conclusion: AEAP is a powerful tool that offers the ability to identify settings conducive to increased therapy efficacy and improved treatment tolerability. Airway phenotypes are closely correlated with treatment efficacy, and as such, careful anatomical consideration of the upper airway must be performed when titrating therapy.

Lay summary: Amongst the different treatment options for obstructive sleep apnea, hypoglossal nerve stimulation has been shown to be effective in positive-airway-pressure intolerant patients. This article explores response patterns to AEAP and highlights the importance of careful anatomical considerations of the upper airway.

Level of evidence: Level 3.

Objectives: Intraoperative parathyroid hormone (IOPTH) monitoring has become routine in parathyroid surgery to facilitate less invasive techniques to treat hyperparathyroidism. Despite this, little is known about in vivo IOPTH kinetics, which can greatly affect the reliability of its interpretation.

Methods: A prospective cohort of patients undergoing routine parathyroidectomy was studied. During each case, IOPTH was measured frequently, during all key perioperative events. Qualitative, univariate, and multivariate analysis was performed to better understand the patterns of in vivo IOPTH kinetics.

Results: The IOPTH increased from preoperative baseline in every case, but some patients had a rapid spike after gland manipulation while others had a more gradual increase. The IOPTH peak occurred prior to excision in almost every case. The IOPTH began to fall prior to excision, typically returning to preoperative baseline levels just before excision. The average in vivo half-life of parathyroid hormone (PTH) was 5.2 minutes.

Conclusion: There is substantial variation in the in vivo IOPTH kinetics and more research is needed to understand predictors of kinetic patterns and PTH half-life during parathyroidectomy.

Objective: This article seeks to systematically review existing literature on the use of acupuncture in treating olfactory dysfunction in order to better understand the methodology and efficacy of this alternative treatment modality.

Methods: A comprehensive search of PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar was conducted. The review was conducted by 2 independent reviewers that authored this article. Inclusion criteria included all studies analyzing the efficacy of acupuncture for treatment of olfactory dysfunction. Articles were excluded if they were duplicates, opinion or review papers, incomplete or unavailable papers, or if they were in a language other than English.

Results: The review found 10 articles matching the inclusion criteria that overall showed a positive improvement in olfactory dysfunction after acupuncture intervention in multiple settings. Challenges highlighted in this review include variability in acupuncture protocols, such as differences in point selection, session frequency, and overall treatment duration, as well as the lack of standardized outcome measures for assessing olfactory function.

Conclusion: This systematic review suggests acupuncture may have therapeutic effect on improvement of olfactory function across various types of olfactory disorders, most notably seen in post-viral anosmia. Given the variability in acupuncture protocols and lack of standardized outcome measures, there is a need for further research with standardized methods and larger sample sizes. Olfactory dysfunction is fundamentally a quality-of-life issue; advancing research could solidify acupuncture as a valuable and cost-effective addition to treatment plans, optimizing patient well-being.

Objective: Otoscopy is a key clinical examination used by multiple healthcare providers but training and testing of otoscopy skills remain largely uninvestigated. Simulator-based assessment of otoscopy skills exists, but evidence on its validity is scarce. In this study, we explored automated assessment and performance metrics of an otoscopy simulator through collection of validity evidence according to Messick's framework.

Methods: Novices and experienced otoscopists completed a test program on the Earsi otoscopy simulator. Automated assessment of diagnostic ability and performance were compared with manual ratings of technical skills. Reliability of assessment was evaluated using Generalizability theory. Linear mixed models and correlation analysis were used to compare automated and manual assessments. Finally, we used the contrasting groups method to define a pass/fail level for the automated score.

Results: A total of 12 novices and 12 experienced otoscopists completed the study. We found an overall G-coefficient of .69 for automated assessment. The experienced otoscopists achieved a significantly higher mean automated score than the novices (59.9% (95% CI [57.3%-62.6%]) vs. 44.6% (95% CI [41.9%-47.2%]), P < .001). For the manual assessment of technical skills, there was no significant difference, nor did the automated score correlate with the manually rated score (Pearson's r = .20, P = .601). We established a pass/fail standard for the simulator's automated score of 49.3%.

Conclusion: We explored validity evidence supporting an otoscopy simulator's automated score, demonstrating that this score mainly reflects cognitive skills. Manual assessment therefore still seems necessary at this point and external video-recording is necessary for valid assessment. To improve the reliability, the test course should include more cases to achieve a higher G-coefficient and a higher pass/fail standard should be used.

Objectives: We aimed to estimate the global prevalence of hearing loss among adults and to explore its associated factors.

Methods: Our systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). We retrieved corresponding documents published up to Sep 24, 2021 in PubMed and Web of Science. Random-effects models were used to calculate the pooled prevalence of hearing loss. Subgroup analyses were conducted to explore potential heterogeneity.

Results: The pooled prevalence of any hearing loss across 100 studies was 31.0% (95% CI: 26.9-35.1, P < .001, I² = 99.9%), and the pooled prevalence of disabling hearing loss across 34 studies was 15.9% (95% CI: 11.1-20.7, P < .001, I² = 99.9%). The prevalence of hearing loss was higher in the year range of 2000 to 2009, among the elder (≥70) or males, in studies using either ear side of hearing loss definition or in the region of the Americas. Ear disease or surgery, job noise exposure, current smoking, off-work noise exposure, males, cardiovascular disease, past drinking, diabetes mellitus, hypertension, older age, and past smoking are risk factors of hearing loss while education level surpasses high school acts as a protect factor for hearing.

Conclusion: Our results demonstrate high prevalence of hearing loss among adults worldwide and verify several related factors of the disease. Prevention and intervention measures should be implemented.

Objectives: Rosuvastatin is an antihyperlipidemic statin group pharmacological agent with antioxidant, neuroprotective, and anti-inflammatory effects. In this study, we aimed to examine the functional, electrophysiological, and histopathological effects of rosuvastatin or in combination with corticosteroids on facial nerve regeneration in rats with traumatic peripheral facial paralysis (PFP).

Methods: PFP was induced in 28 female Sprague Dawley rats that we divided into 4 groups: group 1, control group; group 2, methylprednisolone group; group 3, rosuvastatin group; group 4, rosuvastatin and methylprednisolone group. Electrophysiological, functional, and histopathological examinations were performed before and after the medications.

Results: Electrophysiological threshold values of group 3 and group 4 were found to be significantly lower than the control group on day 21 after treatment (P = .002, P = .001; P < .01).In the histopathological evaluation, axonal degeneration, macrovacuolization, and vascular congestion levels were compared between the groups, and a statistically significant difference was observed in group 4 compared to the control group. The recovery time of the eye corneal reflex was found to be significantly higher in the control group than in groups 3 and 4 when comparing postoperative day 1 to day 7 and postoperative day 1 to day 14.

Conclusion: Rosuvastatin, especially when combined with methylprednisolone was found to significantly increase the facial nerve electrophysiological, functional, and histopathological recovery in injury-induced traumatic PFP.