Ent-Ear Nose & Throat Journal最新文献

Objective: The objective of this study was to assess the graft and functional outcomes of inlay butterfly cartilage-perichondrium graft myringoplasty in an office setting. Material and Methods: Adult patients with chronic perforations underwent inlay butterfly cartilage-perichondrium graft myringoplasty under local and topical anesthesia. The graft and functional outcomes, intraoperative pain score, and complications were evaluated at 6 months postoperatively. Results: A total of 39 patients (39 ears) were included in this study. All patients completed 6 months of follow-up. The mean operation time was 26.5 ± 3.2 (ranged from 21 to 32) minutes. The intraoperative mean pain score was 0.61 ± 0.28. The graft success rate was 97.4% (38/39) at 6 months postoperatively. The mean preoperative air-bone gap (ABG) was 19.18 ± 4.01 dB, while the mean postoperative ABG at 6 months was 10.56 ± 2.27 dB (P < .05; Paired-Samples T Test). The functional success rate was 100.0% (38/38). Endoscopic examination showed that the transplanted perichondrium graft gradually atrophied, flattened, and became indistinguishable from the surrounding tympanic membrane 2 to 3 months following surgery, the superficial layer of perichondrium graft formed the crust and migrated into the external auditory canal at 3 to 6 months postoperatively. Conclusions: Perichondrium-cartilage inlay butterfly myringoplasty is a highly successful and minimally invasive procedure well tolerated by adults for closure of small- and medium-sized perforations in an office setting.

Objective: Perform a pilot feasibility study to demonstrate viability, quality, and safety advantages of light-emitting diode (LED) illumination when performing tonsillectomy. Study Design: Prospective cohort. Setting: Children's Hospital and Community Multispecialty Hospital. Methods: We tested a commercially available LED light, held in position with a minimally modified mouth gag, for off-label use in a "cavernous wound." We assessed surgeons', residents', and nurses' perceptions of function, safety, as well as preferences compared to headlights. Results: The light was used in 30 cases. Noted advantages over traditional lighting methods included superior brightness, stability and consistency of illumination, and the ability for others to assist more quickly. The inability to adjust brightness and/or the angle of light was an observed disadvantage. A small oral cavity or large tonsillar pillars creating a shadow required the temporary addition of a headlight. However, LED light use was not discontinued. Surgeons and residents reported a preference for not wearing a headlight, and nurses expressed concerns about headlight cleanliness. Conclusion: LED lighting technology demonstrated utility for teaching surgeons, residents, and nurses, and was perceived as safe. Additional specifications may make the light applicable to a wider variety of cases and could potentially mitigate headlight use during procedures of the oral cavity and oropharynx. Level of Evidence: 4.

Background: As mental health comorbidities can impact patient perception of symptoms, understanding a potential association of anxiety and depression with patients' perception of their cough may provide insight into preferred treatment plans. Methods: A retrospective cohort study of patients presenting with chronic cough was completed. Demographics, anxiety and depression diagnoses, and patient-reported outcome measures were collected. Patient-reported outcomes between the four groups of patients-anxiety only, depression only, anxiety and depression, and none of these conditions-were compared using Kruskal-Wallis and Mann-Whitney U tests that were used for post-hoc analysis. Results: Cough Severity Index scores were higher in those with both anxiety and depression as compared to neither, with a median score of 26 (range: 5-39) versus 19 (range: 1-38), respectively (P = .041). These results were persistent also after controlling for sex and smoking status in the robust regression analysis. Conclusions: Patients with prior diagnoses of anxiety and depression self-reported more severe symptoms for chronic cough. Adequately understanding the association of mental health with perceived cough severity may help for more individualized, successful treatment plans.

Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays (P < .001), higher C-reactive protein levels (P = .021), higher blood sugar levels (P = .012), and a higher likelihood of diabetes mellitus (P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway (P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.

Objective: To investigate the technique and efficacy of fully endoscope resection of intralabyrinthine schwannomas (ILS) by transcanal transpromontorial endoscopic approach (TTEA). Study Design: Retrospective case review. Setting: Hospital. Patients: All patients who were affected by ILS, without extension to the internal auditory canal and underwent surgery with TTEA in our hospital in 2020. Intervention(s): Therapeutic. Main Outcome Measure(s): Recovery status, postoperative complications and remaining symptoms after surgery. Results: Three patients were included, all of which underwent gross total resections. The follow-up period was from 10 months to 2 years. No intraoperative and postoperative major complications were observed. There was no facial paralysis or cerebrospinal fluid leakage postoperatively. The hospitalization time of TTEA was 5 days. Three patients' vertigo was relieved after 1 week without receiving vestibular therapy. Only 1 patient complained of transient episodes of vertigo when climbing or holding heavy objects. Conclusions: TTEA has the advantages of clear vision to identify the anatomical structure, enabling complete tumor resection, reduced operation time, and faster postoperative recovery. Level of Evidence: IV.

Objective: To compare the graft success rate and hearing outcomes of endoscopic cartilage reinforcement perichondrium-cartilage composite graft and push-through techniques for the treatment of large marginal perforations. Study Design: Randomized controlled trial. Materials and Methods: A total of 57 large marginal perforations were prospectively randomized to cartilage reinforcement (n = 29) and cartilage push-through technique (n = 28) groups. The graft success rate, audiometric outcomes, and complications were compared between the 2 groups at 6 months. Results: All patients completed 6 months of follow-up. The graft success rate in the cartilage reinforcement group was significantly higher compared to that in the push-through group (100.0% vs 78.6%, P < .01). Residual perforation was observed in 5 (17.9%) patients, and re-perforation in 1 (3.6%) patient, in the push-through group. The preoperative air-bone gap (ABG) was 17.6 ± 3.5 dB in the cartilage reinforcement group and 16.8 ± 8.4 dB in the push-through group (P > .05). Postoperatively, although the postoperative ABG in the cartilage reinforcement group was higher than that in the push-through group, no significant difference was observed (11.8 ± 4.3 dB vs 8.9 ± 2.5 dB, P > .05). Additionally, no significant difference was found in ABG closure between the 2 groups (6.6 ± 1.9 dB vs 7.9 ± 4.7 dB, P > .05). Conclusion: Cartilage reinforcement myringoplasty is a simpler and more useful technique to achieve graft success compared to cartilage-perichondrium push-through for the treatment of large marginal perforations, and it does not affect hearing levels.

ObjectiveThe assessment of bone conduction thresholds in patients with conductive hearing loss is not a full measure of the function of the inner ear due to the weakening of the influence of middle ear components on bone conduction. This relationship has been called the 'Carhart effect'.MethodsThe retrospective analysis covered 977 patients diagnosed and treated for middle ear diseases from 2010 to 2020. The Carhart effect was considered to be an increase in the bone conduction threshold by a minimum of 10 dB relative to adjacent frequencies. The study was performed with the aim of assessing the presence of the Carhart effect in the course of middle ear diseases in pretreatment analysis.ResultsThe Carhart effect was observed in 532 cases, most often in patients with chronic otitis media and otosclerosis. It was least often observed in patients with otitis media with effusion. In otitis media with effusion, the Carhart effect was more often noted for the frequency of 4000 Hz, in otosclerosis for the frequency of 2000 Hz. In patients with chronic otitis media, this effect for the frequency of 4000 Hz was correlated with the location of inflammatory changes in the attic area. The presence of inflammatory lesions in the oval window area was associated with the presence of the Carhart effect for the frequency of 2000 Hz.Conclusions1. The frequency of the Carhart effect observed in diseases of the middle ear does not depend on the disease entity but on the type and location of abnormalities in the middle ear. 2. The Carhart effect observed for the frequency of 4000 Hz coexists with the localization of lesions in the range of the malleus and incus, and for the frequency of 2000 Hz, it is partially associated with abnormalities in the range of stapes and oval window.