Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: Considerations regarding reconstruction of the temporomandibular junction (TMJ) following ablation have been underreported in head and neck surgery literature. Here, we discuss the complexity of reconstructing this unique joint and highlight the benefits and drawbacks of free tissue transfer. Additionally, we address the growing role of customized alloplastic implants and virtual surgical planning technologies in TMJ reconstruction.

Recent findings: Technological advances in computerized manufacturing, 3D printing, and virtual reality have led to a recent burgeoning in patient-specific customization that may become the method of choice in these complex reconstruction cases.

Summary: Since trauma and malignancy rarely compromise the entire TMJ, guidelines currently do not exist regarding how to best reconstruct the region in these unique cases. The methods that work in ankylosis and other intrinsic joint diseases are likely less appropriate in this patient population. Recent literature has reported improved patient outcomes and reduced operative times with virtual surgical planning techniques that may optimize autogenous graft approaches.

Purpose of review: This article provides a comprehensive review of the computed tomography (CT) and magnetic resonance (MR) imaging findings of invasive fungal sinusitis with an emphasis on pattern recognition and approach to interpretation.

Recent findings: Fungal sinusitis is categorized into invasive (acute, chronic, and granulomatous) and noninvasive forms (allergic fungal sinusitis and mycetoma). CT is superior for detecting bony erosion and hyperdense fungal elements, while MRI excels in evaluating soft tissue and mucosal involvement. Key radiologic signs such as bone destruction, sinus wall thickening, and 'black turbinate sign' aid in early diagnosis, especially in invasive cases. Early imaging signs can be subtle. Early detection is necessary, particularly in immunocompromised patients with acute invasive fungal sinusitis, where rapid intervention is critical.

Summary: Pattern recognition and adequate interpretation of fungal sinusitis are possible using CT and MRI. Imaging can also help identify complications, aiding with reliable diagnosis and prompt intervention.

Purpose of review: Here we explore the current literature on cochlear implantation of pediatric patients under the age of 5 years with single-sided deafness (SSD).

Recent findings: Single-sided deafness has been noted to cause developmental delays in speech, language, and cognition because of loss of binaural hearing. Currently, cochlear implantation is the only intervention capable of restoring binaural hearing for pediatric patients with SSD. Young children have been shown to have the greatest neuroplasticity of the auditory cortex before 4 years of age. Currently, only children over the age of 5 years are approved by the United States Food and Drug Administration (FDA) to undergo cochlear implantation for SSD. Cochlear implantation for SSD in patients under the age of 5 years has been performed on a limited basis and has been shown to have excellent results.

Summary: Cochlear implantation is a well tolerated and effective treatment for pediatric patients under the age of 5 years with SSD. Receiving cochlear implantation under the age of 5 years is critical for child development as neuroplasticity decreases after this age.

Purpose of review: Balloon dilation of the cartilaginous portion of the Eustachian tube has increasingly gained acceptance among otolaryngologists in the treatment of obstructive Eustachian tube dysfunction. There is however little data on the procedure performed in children. The purpose of this study is to review the recent developments regarding balloon dilation in pediatric patients.

Recent findings: Balloon dilation of the Eustachian tube is safe in pediatric patients. The effects of the procedure are durable during long term follow-up. Diagnosing obstructive dysfunction remains challenging. There is no single test or questionnaire for diagnosing the condition; instead a series of appropriate tests should be used. The pediatric Eustachian tube is very responsive to the effects of balloon dilation. While the treatment is effective, overtreatment can have unwanted results such as patulous symptoms. Reducing the time of dilation should therefore be considered.

Summary: Otolaryngologists performing the procedure should be familiar with the effects of balloon dilation on the pediatric Eustachian tube and consider altering the duration of dilation accordingly. Further studies are needed especially regarding patient selection, optimal age for dilation and balloon parameters for pediatrics (e.g. dimensions, inflation duration, inflation pressure).

Purpose of review: This review addresses the pressing need for an updated understanding of high-definition 3D exoscope role in contemporary otologic and neurotologic practice. With technological advancements driving innovations in surgical visualization, it is crucial to evaluate the efficacy of exoscope-assisted surgery compared to traditional microscopic approaches. By synthesizing recent literature, this review offers insights into the current state of exoscopic ear and lateral skull base surgery and its implications for clinical practice and research.

Recent findings: Recent literature has focused on several key themes. Firstly, studies have demonstrated the feasibility and safety of exoscopic approaches for various otologic and neurotologic procedures. Secondly, comparative studies have highlighted similar outcomes with exoscopic techniques compared to conventional microscopic surgery, particularly in terms of operative time and complication rates. Thirdly, the exoscope can be a valuable tool for the education and training of surgeons.

Summary: The findings from recent literature underscore the growing significance of exoscope-assisted surgery in otology and lateral skull base practice. However, challenges such as high magnification image quality and learning curve must be addressed to optimize its widespread adoption. Overall, this review highlights the importance of continued research and innovation in this rapidly evolving field.

Purpose of review: Oscillopsia and unsteadiness are common and highly debilitating symptoms in individuals with bilateral vestibulopathy. A lack of adequate treatment options encouraged the investigation of vestibular implants, which aim to restore vestibular function with motion-modulated electrical stimulation. This review aims to outline the ocular and postural responses that can be evoked with electrical prosthetic stimulation of the semicircular canals and discuss potential approaches to further optimize evoked responses. Particular focus is given to the stimulation paradigm.

Recent findings: Feasibility studies in animals paved the way for vestibular implantation in human patients with bilateral vestibulopathy. Recent human trials demonstrated prosthetic electrical stimulation to partially restore vestibular reflexes, enhance dynamic visual acuity, and generate controlled postural responses. To further optimize prosthetic performance, studies predominantly targeted eye responses elicited by the vestibulo-ocular reflex, aiming to minimize misalignments and asymmetries while maximizing the response. Changes of stimulation parameters are shown to hold promise to increase prosthetic efficacy, together with surgical refinements and neuroplastic effects.

Summary: Optimization of the stimulation paradigm, in combination with a more precise electrode placement, holds great potential to enhance the clinical benefit of vestibular implants.

Purpose of review: Children experiencing dizziness frequently go unevaluated or experience delays in correct diagnosis due to systemic and inherent barriers. While most causes of pediatric dizziness do not involve the peripheral vestibular system, otolaryngologists are frequently consulted for expert opinion. This study offers a broad overview of the leading causes of pediatric dizziness and imbalance to assist otolaryngologists with evaluating and managing this challenging population.

Recent findings: Evaluation of children with dizziness should exclude serious central nervous system conditions. Approximately 70% of nonhazardous cases of pediatric dizziness are caused by migraine-related conditions, concussion, or functional disorders. Etiologies for peripheral vestibular dysfunction include inner ear malformations and vestibular disorders more commonly seen in adults. Audiometric and vestibular testing can provide helpful information, although correct diagnosis depends on a detailed history.

Summary: Otolaryngologists should be familiar with the conditions that cause dizziness in children. While most underlying causes are outside their scope of practice, understanding possible etiologies can facilitate correct diagnosis and appropriate management.

Purpose of review: To summarize indications, methods, and diagnostic yields for genetic testing for pediatric hearing loss.

Recent findings: Genetic testing has become a cornerstone of clinical care for children with sensorineural hearing loss. Recent studies have shown the efficacy of gene panels and exome sequencing for any child with sensorineural hearing loss. Recent findings have underscored the importance of a diagnosis in clinical care. Clinical trials for gene therapy for hearing loss have begun.

Summary: Genetic testing has become critical for personalized care for children with hearing loss. Recent studies have shown a 43% overall diagnostic yield for genetic testing for pediatric hearing loss, though the diagnostic yield may range from 10 to 60% depending on clinical features. Syndromic diagnoses comprise 25% of positive genetic tests for pediatric sensorineural hearing loss. While diagnostic yield is lower for children with unilateral or asymmetric sensorineural hearing loss, the likelihood of syndromic hearing loss finding is higher. An early and accurate genetic diagnosis is required for participating in clinical trials for gene therapy for hearing loss.

Purpose of review: The purpose of this review is to summarize the very recent literature surrounding hearing outcomes of children with congenital cytomegalovirus (cCMV) detected through systematic screening programs.

Recent findings: There are several different approaches to cCMV screening including forms of targeted vs. universal screening of newborns as well as maternally-derived prenatal testing. However, many studies fail to document hearing-related outcomes both in the newborn period and further into childhood when late-onset sensorineural hearing loss (SNHL) can occur. This systematic review included studies of neonates screened for cCMV reporting hearing outcomes for at least one point in time. Hearing targeted screening appeared the most widely reported for detection of unilateral and bilateral SNHL in those with cCMV. A few studies examined these clinical findings in relation to antiviral treatment.

Summary: Congenital CMV is an important and common cause of childhood hearing loss. Newborn screening programs may expand opportunities for early diagnosis and treatment of the infection and its sequelae.