Journal of International Advanced Otology最新文献

Background: The objective of this study was to evaluate the utility of a caprine model in endoscopic ear surgical education using the index procedures of tympanoplasty and ossiculoplasty. Specifically, this study assessed the face and content validity of the caprine model, and the potential impact of anatomical differences on trainee understanding of human middle ear anatomy.

Methods: Twelve otolaryngology trainees attended a 3-hour endoscopic ear surgery course utilizing the caprine model in which they completed canalplasty, tympanoplasty, and ossiculoplasty. Prior to the course, the trainees completed a self-reported needs assessment and knowledge assessment of human middle ear anatomy. Following the course, the trainees repeated the knowledge assessment and completed evaluation and validation questionnaires. Five-point Likert scores were used for the needs assessment and validation questionnaire.

Results: Of the 12 trainees, 9 participated in the study. All domains of the learner needs assessment showed an average improvement of 1 point on the post-course evaluation with 6 of 9 domains being significantly improved using the Wilcoxon signed-rank test (P< .05). The model achieved validation in the domains of face, content, and global content validity with an average Likert score > 4. Knowledge assessment scores increased by 7% (P=.23) after the course compared to before.

Conclusion: The caprine model offers an effective surgical simulation model for endoscopic ear surgery training with good face and content validity. We find it to be readily available and affordable. We currently use it routinely to give otolaryngology residents the experience of endoscopic ear surgery before operating on patients.

Background: Bilateral hearing aids are desirable to restore hearing in the most effective and natural way. The aim of the present study was to identify which type of hearing rehabilitation was preferred by our patients and which factors drove their choice.

Methods: One hundred eight patients with moderate-to-severe asymmetrical hearing loss before and after a 1-month trial with bilateral hearing aids were considered.

Results: As high as 58.3% of patients decided to continue with bilateral hearing aids (group BI), while 41.7% chose unilateral hearing aid (UNI group) in the best ear. Patients in the UNI group were significantly older than those in the BI group (P=.04); age > 77 years was an independent prognostic factor of unilateral hearing aid choice (odds ratio=6.26; P=.04). Matrix test scored significantly worse with a single hearing aid than with 2 hearing aids in both groups (UNI P=.03; BI P=.01).

Conclusion: Patients with asymmetric hearing loss often prefer unilateral hearing aid, almost half in our experience. Nonetheless, bilateral hearing aids are desirable as unilateral hearing aid was associated with significantly poorer performance at a speech in noise hearing tests. Age at fitting could play a relevant role and is thus important in early diagnosis. Further studies are needed to confirm our results and investigate strategies to promote bilateral rehabilitation.

Background: The incidence of tinnitus has been increasing together with its patient impact and societal costs. Much research has been conducted in the field of tinnitus, especially on treatment modalities because there still is no cure. This study aims to analyze the evolutions and developments in the scientific output relating to tinnitus.

Methods: We analyzed the Science Citation Index Expanded featured articles in the Web of Science Core Collection relating to tinnitus from 1980 to 2020. The publications were analyzed by characteristics such as the countries and institutions, journals, the most cited articles and references, and the most frequently used words in the abstracts and keywords.

Results: In total, 8282 articles relating to tinnitus were identified in the Web of Science. The number of publications has been significantly increasing after the 1990s. Of the 8282 articles, a major part originated from the American and European institutions. Most articles originated from high-impact journals, which consequently also covered the most cited papers. A major interest was seen in areas about treatment and pathogenic mechanisms.

Conclusion: This bibliometric analysis here indicated an increasing trend in tinnitus research from 1980 to 2020, particularly with the increase in tinnitus burden and the societal costs by it. Specific interest has been seen in the specific tinnitus pathophysiological mechanisms and treatment. Individual researchers and institutions will gain a new perspective on their future studies based on the bibliometric data in our paper.

Background: It is known that there is a relationship between hearing loss, which is an important cause of disability, psychological symptoms, and low quality of life. The aim of this study is to evaluate the anxiety, depression levels, and quality of life analysis of adults with postlingual hearing loss and who have undergone cochlear implants and to compare them with the data of subjects who have never had a hearing loss.

Methods: The prospective controlled clinical study included 53 subjects who had cochlear implants and 52 healthy controls in terms of hearing. Hospital Anxiety and Depression Scale and Short Form 36 were filled by all subjects to investigate their depression, anxiety, and quality of life levels.

Results: The mean age of subjects was 42.88 ± 18.04, and 44% (23) were women. There was no significant difference between the study and control groups in terms of Hospital Anxiety and Depression Scale scores. Short Form 36 physical role (P = .018) and SF-36 general health (P = .014) in quality of life assessment sub-scores were statistically significantly higher in the study group than in the control group. When the correlation between the time elapsed after surgery and Hospital Anxiety and Depression Scale scores and Short Form 36 scores was evaluated, no significance was observed.

Conclusion: The fact that the patients evaluated after cochlear implant surgery had similar depression and anxiety levels and quality of life as the controls, and even physical role and being significantly better in general health compared to the controls reveal the importance of regaining the hearing ability.

Background: Mastoidectomy is a complex procedure which can be trained on human cadaveric temporal bones or simulation models. The number of repetitions offered in most training curricula is considerably less than what is normally required for motor skills acquisition in crafts or sports. Directed, self-regulated virtual reality simulation training may provide unlimited repetitions but the effect on learning of extended but unsupervised training is unknown. This study recorded extended learning curves of novices in virtual reality simulation mastoidectomy training.

Methods: Six medical students used the visible ear temporal bone simulator at home for 100 repetitions. Virtual temporal bones were later assessed by 2 blinded experts on a 26-point modified Welling Scale.

Results: Four participants completed 100 procedures each and 2 participants completed 50 procedures. Learning curves and plots of time demonstrated great variation: one participant improved gradually during the first 50 procedures and sustained a high performance; another participant achieved only 16 points after 50 procedures; a third participant demonstrated mediocre performances between 10 and 15 points but only used about 5 minutes per procedure. The remaining 3 participants achieved high but fluctuating scores with very limited time use per procedure. Their score per time exceeds the performance of experienced otosurgeons and suggests the use of save/restore gaming strategies to inflate their performance.

Conclusion: Deliberate learners may reach proficiency in virtual reality simulation of mastoidectomy after 50 repetitions. However, even 100 repetitions cannot guarantee proficiency if motivation fails. Creative "gaming" behavior must be considered and opposed by motivation, supervision, testing, and certification.

Background: In the surgical development of cholesteatoma, in order to reduce the recurrence of cholesteatoma, 2 kinds of surgeries were carried out: removal of Cog and Korner's septum to ventilate supratubal recess (supratubal recess opened) and obliteration of the mastoid and attic space (bony obliteration tympanoplasty) were invented, respectively. Their purpose is the same but the theoretical basis is different, and the comparison of these 2 methods is not reported in the current literature. This study aims to evaluate the rates of recurrent and residual cholesteatoma with the simple canal wall up and canal wall up-supratubal recess opened and canal wall up-bony obliteration tympanoplasty mastoidectomy in a large cohort of patients. The secondary objectives were to assess the 3 techniques' infection rates and hearing outcomes.

Methods: Overall, 352 patients with middle ear cholesteatoma preoperatively underwent temporal bone ultrahigh-resolution computed tomography scan. The shape of the Eustachian tube and the supratubal recess were analyzed, and superior and posterior tympanic recesses, including the supratubal recess, were opened in different surgical groups.

Results: After 5 years of follow-up, the results show that the lowest recurrence rate was 6.6% (7/106) for canal wall up-supratubal recess opened, 10.9% (12/101) for canal wall up-bony obliteration tympanoplasty, and canal wall up had the highest recurrence rate of 19.31% (28/145). The postoperative infection rate was 5.7% in the canal wall up-supratubal recess opened group, 10.89% in the canal wall up-bony obliteration tympanoplasty group, and 7.59% in the simple canal wall up group. The postoperative median air conduction was increased 8 dB in the canal wall up-supratubal recess opened group, 1 dB in the canal wall up-bony obliteration tympanoplasty, and 6 dB in the simple canal wall up group.

Conclusion: Opening the supratubal recess to ensure the patency of the attic facilitates the gas exchange between the mastoid process and the middle ear and reduces the possibility of cholesteatoma recurrence.

Background: Invasive fungal otitis media is clinically rare. The clinical features are often atypical in the early stages of the disease, and delayed treatment results in poor outcomes.

Methods: In this study, we report 2 patients with invasive fungal otitis media with diabetes. The early diagnosis was confirmed by comprehensive methods such as laboratory tests and imaging examinations, and the condition was significantly improved by antifungal drugs and surgical treatment.

Results: By reviewing the literature, we found that invasive fungal infections confined to the middle ear and mastoid were rarely reported, and the diagnosis and treatment were still controversial.

Conclusion: In this article, we summarized and evaluated the different diagnoses and treatment methods so as to better diagnose and improve the cure rate in the early stage of invasive fungal infection of the middle ear.

Background: The aim of the study was to measure the distance of the tympanic nerve to the oval window and round window niche in adult cadavers for evaluating its usability as an anatomical landmark during middle ear-related surgeries, including stapedotomy and cochleostomy, and for preventing its iatrogenic damage during surgical practices such as otosclerosis surgery and cochlear implantation.

Methods: The middle ears of 10 adult cadavers aged 74.70 ± 14.56 years were bilaterally dissected with the help of an endoscope and microscope to measure the distance of tympanic nerve to round window niche and oval window.

Results: Tympanic nerve was found as 1.60 ± 0.86 mm (range, 0-3.11 mm) and 1.55 ± 0.38 mm (range, 1.04-2.20 mm) away from round window niche and oval window, respectively. In relation to the quantitative values of these 2 distances, neither right-left nor male-female significant differences were determined (P > .05). Tympanic nerve was observed in all temporal bones. In terms of the shape and twigs of tympanic nerve, extreme variations among cadaveric temporal bones were determined. Tympanic nerve-round window niche distance between 0-1 mm was defined as type 1 (20%), between 1 and 2 mm as type 2 (45%), between 2 and 3 mm as type 3 (30%), and between 3 and 4 mm as type 4 (5%).

Conclusion: Tympanic nerve may be vulnerable at round window niche- or oval window-related surgeries (e.g., cochleostomy).

Vestibular schwannomas often present with unilateral hearing loss, tinnitus, or dizziness. Imaging is commonly pursued in individuals with unexplained unilateral sensorineural hearing loss, deterioration in word recognition scores, or persistent tinnitus. We present the case of a 76-year-old male with cough-induced vertigo as his primary presenting symptom. Vestibular testing suggested a right vestibular hypofunction, and a small right-sided vestibular schwannoma was discovered using magnetic resonance imaging. Cough-induced vertigo and associated nystagmus may be a presenting feature of vestibular schwannoma.