Acta Oto-Laryngologica最新文献

Background: Noise-induced cochlear synaptopathy has recently emerged as a focus in hearing research.

Purpose: This study aimed to examine the impact of repeated noise exposure on the quantification and mRNA expression levels of cochlear synapses.

Methods: Measurements were conducted at baseline, 1 day, and 14 days post-exposure to 88 or 97 dB SPL noise (2 h/day for 7 days, frequency range 2-20 kHz). Auditory brainstem responses (ABRs), immunofluorescence and quantitative real-time PCR (qRT-PCR) were used to examine the results.

Results: 1. Exposure to 88 dB SPL caused minimal changes in ABRs, ribbon morphology and medial olivocochlear (MOC) efferent synapses; elevation of synaptophysin(SYP) and α9α10 nAchR mRNA levels were observed. 2. Exposure to 97 dB SPL caused threshold shift and synaptopathy of ribbon and MOC; downregulation of α10nAchR, SYP and ctbp2 mRNA levels were observed.

Conclusion: Noise-induced cochlear synaptic degeneration involves both afferent and efferent synaptopathy.

Background: Normative clinical values for wideband acoustic immittance (WAI) are not well-established.

Aims: This study aims to define the normative contour plot characteristics of WAI and evaluate its diagnostic value in detecting tympanic effusion.

Materials and methods: Data were collected from subjects with normal hearing (76 ears) and type C tympanograms on 226-Hz tympanometry (130 ears). Matlab was used to process and analyze the data. The maximum absorbance of WAI was used as the primary indicator, and the receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value. WAI contour plots were compared to 226-Hz tympanometry and otoendoscopy, the latter being the gold standard.

Results: Mean WAI plots in the normal group showed single peaks (absorbance, >70%) and a nearly symmetrical distribution of the peak area around the 0 daPa pressure line. The ROC curve indicated an AUC value of 0.910, with 78% as the optimal cut-off value of maximum absorbance for detecting effusion. WAI demonstrated better diagnostic performance (sensitivity: 82.26%, specificity: 86.76%, kappa: 0.691) than 226-Hz tympanometry (sensitivity: 61.29%, specificity: 61.76%, kappa: 0.230).

Conclusions and significance: Normative WAI values were established, and WAI proved more accurate than 226-Hz tympanometry for identifying tympanic effusion, offering valuable guidance for selecting treatment options.

Background: Anti-IL-4 receptor α antibody (dupilumab) has demonstrated favorable sinonasal outcomes for chronic rhinosinusitis with nasal polyps (CRSwNP), which is mainly caused by type 2 inflammation. Although increased blood eosinophil levels and injection site symptoms are frequently observed as acute adverse events (AEs) of dupilumab, limited knowledge is available regarding the late AEs of dupilumab for CRSwNP.

Objectives: We investigated the late AEs following the initiation of dupilumab treatment for CRSwNP.

Material and methods: Fifty-one patients with CRSwNP treated with dupilumab for > 3 months were enrolled, and their clinical data were collected from their medical records.

Results: Six (11.8%) patients experienced late AEs. One case of eczema with pruritus, one case of psoriasis-like dermatitis, two cases of severe rash, one case of malignant lymphoma, and one case of alopecia areata were observed. Skin disorders were the most common late AEs in this study. It is a Th1-inflammatory disease, and its mechanism is thought to be due to the immune imbalance caused by dupilumab. We could not confirm whether malignant lymphoma in our case was caused by dupilumab use.

Conclusions and significance: Skin disorders are often late AEs associated with dupilumab; therefore, careful monitoring after dupilumab initiation should be considered.

Background: Facial paralysis patients with normal hearing often require ossicular chain dislocation throughout the entire process of facial nerve decompression surgery, and their hearing tends to be slightly impaired after surgery. There is not detailed explanation of hearing changes after facial nerve decompression with preserving intact ossicular chain.

Purpose: This study aimed to determine the efficacy and hearing outcomes of facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway in Bell's palsy.

Methods: A retrospective study comparing the pre- and post-operative facial nerve HB functional grades and hearing results of 12 patients with Bell's palsy who underwent facial nerve decompression.

Results: Preoperative and postoperative mean House-Brackmann (HB) scores respectively were 4.41 ± 0.67 and 1.58 ± 0.79 grades; The recovery rate to HB grade I, II was 100% or to grade III or lower was 83.3% (10/12). The pre- and post-operative mean PTAs (0.125, 0.25, 0.5, 1, 2, 4, 8KHz) were 19.1 ± 1.9 dB and 36.8 ± 4.1 dB; The pre- and postoperative low frequencies (0.125, 0.25KHz) were 18.5 ± 2.3 dB and 26 ± 3.8 dB; The pre- and postoperative speech frequencies (0.5, 1, 2KHz) mean PTAs were 18.5 ± 1.9 dB and 21.5 ± 2.9 dB; Comparison of pre- and post-operative hearing outcomes at all frequencies, low frequencies, and speech frequencies showed no statistically significant differences (p < 0.05); The pre- and postoperative high frequencies (4, 8KHz) were 20.6 ± 4.7 dB and 70.4 ± 11.6 dB and the hearing outcomes were statistically significant (p >0.05).

Conclusion: Subtotal facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway does not cause the verbal frequency hearing loss of Bell's palsy, but it has high frequency sensorineural hearing loss, which tend to be unavoidable and independent of the skill of the surgical operator.

Background: While cochlear implantation (CI) and electric acoustic stimulation (EAS) have a positive outcome in most cases, their effectiveness varies depending on the etiology of the hearing loss. Among the various etiologies, genetic factors are the leading cause of hearing loss and may impact CI and EAS outcomes.

Aims/objectives: To reveal the genetic background of the hearing loss in CI/EAS patients in each ethnic population, we undertook a multi-center study involving the genetic testing of hearing loss in CI/EAS patients from 10 centers.

Material and methods: Saliva samples and clinical information for the patients and their family members were obtained and next-generation sequencing analysis using a panel carrying 63 deafness genes was then performed.

Results: Genetic testing successfully identified the causative gene variants in 54.5% (48/88) of patients with pre-lingual onset hearing loss (onset under 6 years) and in 12% (12/95) of those with late-onset hearing loss (onset at 6 years or more).

Conclusions and significance: We clearly indicated that genetic factors are the most common cause of hearing loss regardless of ethnic background. Saliva-based genetic testing is a useful tool for multi-center studies seeking to clarify the genetic causes of hearing loss in CI or EAS patients between countries separated by distance.

Background: Studies have shown that carotid artery reconstruction results in the best overall survival (OS) in Advanced Head and Neck Squamous Cell Carcinoma involving the Carotid Artery (AHNSCC-CA).

Aims: The purpose of this study was to evaluate the efficacy of covered stent implantation combined with radical tumor resection and to compare and analyze the historical literature on conventional carotid artery resection and reconstruction.

Materials and methods: A total of 68 patients with AHNSCC-CA were included in this study. This study compared the survival, local recurrence, surgical complications, and neurologic complications between the two groups.

Results: The OS rate at 12 months in the experimental group was 58.5% (median survival time: 15 months, 95% CI: 7.61-22.40). The OS rate at 12 months in the control group was 34.3% (median survival time: 8 months, 95% CI: 3.94-12.06, p = .371). In addition, the differences in the rates of local recurrence, surgical complications and neurological complications between the two groups were statistically insignificant (p = .677, p = .197 and p = .617).

Conclusions and significance: Compared with conventional carotid artery resection and reconstruction, covered stent implantation combined with radical tumor resection yields similar survival outcomes, but with significantly lower surgical risk and difficulty, and faster postoperative recovery.

Background: Immune checkpoint inhibitors (ICIs) occasionally cause immune-related adverse events (irAEs) in various organs. However, predictors of irAEs remain unidentified.

Objectives: We evaluated the predictors of irAEs and compared the outcomes of ICIs with and without irAEs in patients with recurrent/metastatic head and neck cancers (R/M HNCs).

Materials and methods: We retrospectively analyzed 157 patients with R/M HNCs who were administered an anti-PD-1 antibody between September 2014 and December 2022. We examined whether various pretreatment factors were associated with irAEs. The overall survival (OS) and progression-free survival (PFS) in patients with and without irAEs were analyzed.

Results: Overall, 44 patients (28.0%) developed irAEs. The survival curve estimated for patients with and without irAEs showed a significant difference in PFS (p = 0.018), but not in OS (p = 0.208). Multivariate analysis revealed significant differences in relative eosinophil counts (p < 0.001), TP (p = 0.014), and NLR (p = 0.002), which may be independent predictors of irAEs.

Conclusion: IrAEs may be associated with higher efficacy of ICIs and longer PFS. The relative eosinophil count may be predictors of irAEs and useful in routine medical practice. Using these biomarkers to predict irAEs will help predict ICI effects and manage irAEs.