Journal of International Advanced Otology最新文献

Background: Postoperative adhesion is an important complication after middle-ear surgeries. Although many materials have been tried to prevent this complication, the use of Poly (dl-lactide ε-caprolactone) as an anti-adhesive material after middle-ear surgery has not yet been reported. The aim of this study was to evaluate the anti-adhesive effect of poly (dl-lactide ε-caprolactone) on the ears of rats with middle-ear mucosa damage.

Methods: In our study, 14 Wistar albino rats and 28 ears in total were used. The rats were randomly divided into 4 groups. Middle ear mucosa damage was performed in all groups with a transcanal approach under otomicroscopy in sterile conditions. The effects of poly (dl-lactide ε-caprolactone), silicone sheet, and absorbable gelatin sponge were compared histologically with the secondary healing group. In addition, hearing evaluation was performed before the procedure and on the 28th postoperative day.

Results: No significant difference was observed in transient otoacoustic emission and distortion product otoacoustic emissions tests performed before and after the surgical procedure when the groups were compared. While adhesion was observed in the tympanic membrane in the absorbable gelatin sponge group, no adhesion was observed in the other groups. In the absorbable gelatin sponge group, increased fibroblastic activity, inflammation, and neovascularization were observed in the middle-ear mucosa. No significant difference was observed in silicone sheet, poly (dl-lactide ε-caprolactone), and control groups in terms of fibroblastic activity, inflammation, and neovascularization.

Conclusion: It can be concluded that absorbable poly (dl-lactide ε-caprolactone) is nonototoxic and biocompatible with the rat's middle ear cavity by short-term evaluation.

Objective: The aim of the study was to present the indications for facial nerve decompression in malignant external otitis, to analyze the results of such treatment, and to describe own experience in that field.

Methods: A search in the PubMed and Google Scholar databases for English language articles published between 1968 and May 2022 was performed. We focused on papers describing patients with malignant external otitis and facial nerve palsy treated by decompression. Moreover, retrospective analysis of 24 consecutive patients with malignant external otitis hospitalized in our department in the past 10 years was performed.

Results: In the literature, 48 cases with malignant external otitis and facial nerve paresis treated by decompression were identified. In total, 41 patients recovered (85.42%), 4 died (1 due to exacerbation of the disease, 2 for pneumonia, and 1 for heart failure), and in 3 cases the final outcome was not presented. In most cases (24; 50%), facial nerve function did not improve after decompression, in 8 patients (16.67%) partial recovery was observed, in 11 cases (22.92%) full improvement was observed, and data were not given for 5 patients. In only one case, the spread of infection and deterioration of local and general patient states were noted. In our material, we identified 13 patients with malignant external otitis and facial nerve palsy. Two of them were treated surgically, of which only one had facial nerve decompression. Partial improvement of facial nerve function was observed after 6 months of rehabilitation.

Conclusion: The management of malignant external otitis is still difficult and not well defined. Facial nerve decompression seems justified in selected cases of malignant external otitis not responding to conservative treatment.

Background: This study aimed to examine the roles of miR-10a-5p and phosphatidylinositol-4,5-bisphosphonate 3-kinase catalytic subunit α in the pathogenesis of middle ear cholesteatoma.

Methods: We enrolled 27 patients with middle ear cholesteatoma and collected samples of intraoperative cholesteatoma and normal posterior ear skin tissues. The mRNA expression levels of miR-10a-5p and PIK3CA were detected using real-time quantitative polymerase chain reaction. PIK3CA protein expression was measured by immunohistochemistry and western blotting.

Results: Middle ear cholesteatoma tissues showed significantly lower miR-10a-5p expression levels and significantly higher PIK3CA expression levels than normal posterior ear skin tissues (both P < .05). Furthermore, the miR-10a-5p and PIK3CA expression levels were significantly negatively correlated in middle ear cholesteatoma tissues (r = -0.926, P < .001).

Conclusion: Low miR-10a-5p expression levels in middle ear cholesteatoma tissues may inhibit the growth and proliferation of cholesteatoma, whereas high PIK3CA expression level may promote its growth and proliferation. In addition, miR-10a-5p may affect the proliferation and differentiation of cholesteatoma by negatively regulating its target gene, PIK3CA.

Waardenburg syndrome is an autosomal dominant inherited syndromic hereditary hearing loss characterized by varying combinations of sensorineural hearing loss and abnormal pigmentation of the hair, skin, and inner ear. The aim of this study was to analyze the clinical phenotypes and genetic variants of a Chinese boy with Waardenburg syndrome type 2 and to explore the possible molecular pathogenesis of Waardenburg syndrome type 2. Clinical, audiological, and ophthalmologic evaluations were performed on the proband. Clinical data from the principal members in the proband's family were collected through questionnaires. Genetic analysis was conducted, including targeted next-generation sequencing of 144 known deafness genes, Sanger sequencing, and bioinformatic analysis. Waardenburg syndrome type 2was diagnosed in a 4-year-old boy according to the Waardenburg Syndrome Consortium Criteria. The novel missense mutation c.426G>T (p.Trp142Cys) was identified in SOX10 in the proband but was absent in his parents and the controls. A de novo missense mutation in SOX10 was the genetic cause of Waardenburg syndrome type 2 in the proband, which was useful for the molecular diagnosis of Waardenburg syndrome type 2.

Background: Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder and is currently treated by many types of repositioning maneuvers. A simplification of this procedure would be desirable. A new, anatomically realistic, 3-dimensional computational simulator of the human labyrinth provides a novel insight to evaluate the viability of any new maneuver. The purpose of this study is to propose a single maneuver with potential to treat canalolithiasis-type benign paroxysmal positional vertigo of any individual canal, or even multiple canals on the same side, based on a 3-dimensional model.

Methods: The benign paroxysmal positional vertigo Viewer, a 3-dimensional model of the human labyrinth, was used to analyze a "Universal Repositioning Maneuver."

Result: Through the gravity vector, the expected position of the otoliths was demonstrated by moving the model through a single sequence of head positions, successfully promoting otolith migration from the three semicircular canals to the utricular cavity, either individually or together.

Conclusion: The analysis with the 3-dimensional model predicts the effectiveness of the Universal Repositioning Maneuver for the resolution of each single canal or multiple-canal benign paroxysmal positional vertigo canalolithiasis, making treatment much more straightforward.

Background: Pneumatization of the mastoid process is variable and of significance to the operative surgeon. Surgical approaches to the temporal bone require an understanding of pneumatization and its implications for surgical access. This study aims to determine the feasibility of using deep learning convolutional neural network algorithms to classify pneumatization of the mastoid process.

Methods: De-identified petrous temporal bone images were acquired from a tertiary hospital radiology picture archiving and communication system. A binary classification mode in the pretrained convolutional neural network was used to investigate the utility of convolutional neural networks in temporal bone imaging. False positive and negative images were reanalyzed by the investigators and qualitatively assessed to consider reasons for inaccuracy.

Results: The overall accuracy of the model was 0.954. At a probability threshold of 65%, the sensitivity of the model was 0.860 (95% CI 0.783-0.934) and the specificity was 0.989 (95% CI 0.960-0.999). The positive predictive value was 0.973 (95% CI 0.904-0.993) and the negative predictive value was 0.935 (95% CI 0.901-0.965). The false positive rate was 0.006. The F1 number was 0.926 demonstrating a high accuracy for the model.

Conclusion: The temporal bone is a complex anatomical region of interest to otolaryngologists. Surgical planning requires high-resolution computed tomography scans, the interpretation of which can be augmented with machine learning. This initial study demonstrates the feasibility of utilizing machine learning algorithms to discriminate anatomical variation with a high degree of accuracy. It is hoped this will lead to further investigation regarding more complex anatomical structures in the temporal bone.

The aim of our study was to report rates of facial nerve palsy and residual tumor following surgical intervention and subsequent tumor recurrence in patients with endolymphatic sac tumors. A systematic literature review of preoperative assessment and surgical management is also included. Studies including patient/s affected by sporadic or von Hippel-Lindau disease related endolymphatic sac tumors, reporting levels of facial nerve function, residual and recurrence pathology following a surgical procedure, were considered. Data were combined for proportional meta-analysis, and the selected studies' methodological quality was also evaluated. Overall 34 papers, including 202 subjects (209 cases of endolymphatic sac tumors) were analyzed. Pooled proportion rate (95% CI) of overall facial nerve palsy was 39.7% (28.2-51.9) and residual tumor was 16.5% (10.3-23.7) after surgical procedure. Pooled proportion rate (95% CI) of tumor recurrence was 14.0% (9.7-19.3) during a mean follow-up period of 49.7 months (8-136). Our results showed that preoperative facial nerve function is impaired in almost 30% of patients with endolymphatic sac tumors. Surgical management of endolymphatic sac tumor may cause a worsening of facial nerve function in a low percentage of treated subjects. Residual and/or recurrence of endolymphatic sac tumors are not rare events, and follow-up strategies should be designed accordingly.

Bilateral vestibular schwannomas are commonly diagnosed in patients affected by neurofibromatosis type 2, a genetic disease caused by a heterozygous mutation in the gene region encoding neurofibromin-2. Sporadic bilateral vestibular schwannomas are very rare entities affecting almost exclusively elderly people. We present the case of a senior woman who was followed up with the "wait-and-scan" strategy for a unilateral vestibular schwannoma that later developed as a contralateral tumor, compatible with vestibular schwannoma, raising questions about its nature and risk of having been transmitted in offspring. Genetic testing excluded mutations of the neurofibromatosis type 2 gene. The presence of bilateral vestibular schwannomas is often considered pathognomonic of neurofibromatosis type 2, but the estimated probability of sporadic bilateral tumors in the absence of other neurofibromatosis type 2 features is 50% over 70 years of age. Therefore, the NF2 gene assessment is in any case recommended in these patients not only for an evaluation of the risk of being transmitted. The treatment strategy should be carefully personalized for each patient, considering the size of the tumors, symptoms, and hearing function together with the patient's age.

Background: The aim of this study is to evaluate the indications and efficacy of facial nerve decompression through an endoscopic transcanal approach for patients with traumatic facial paralysis.

Methods: This single-center retrospective study included 11 patients with traumatic facial paralysis from February 2018 to April 2019. We compared the facial nerve and auditory function before and after operation so as to reveal the feasibility and effect of the surgical approach.

Results: All 11 patients have successfully received facial nerve decompression through endoscopic transcanal approach. Facial nerve function was objectively evaluated by electroneurography test and House-Brackmann facial nerve grading system. All patients were graded HB-VI with electroneurography ≥ 95% before surgery. The recovery of facial nerve function was good (HB-I or II) (90.9%) a year after surgery with only one case (9.1%) for HB-III. Preoperative high-resolution computed tomography showed that 1 patient had ossicular chain interruption, which was confirmed during operation. Meanwhile, 2 patients with air-bone gap >35 dBHL and whose computed tomography failed to diagnose were found with ossicular chain interruption during operation. The air-bone gap of patients with normal ossicular chain connection was all <30 dBHL. The average air-bone gap was reduced from 27.5 ± 10.1 dBHL to 7.8 ± 3.3 dBHL after operation.

Conclusion: Preoperative high-resolution computed tomography combined with localization test can accurately estimate the location of facial nerve injury. Facial nerve decompression through endoscopic transcanal approach can decompress the geniculate ganglion to pyramidal segment of facial nerve, which is suitable for patients with traumatic facial paralysis of this segment. In addition, air-bone gap >35 dBHL may indicate the ossicular chain interruption when it is difficult to be completely judged by high-resolution computed tomography.