Acta Oto-Laryngologica最新文献

Background: Transoral robotic surgery (TORS) has emerged as a minimally invasive technique for managing head and neck pathologies, offering reduced morbidity and improved surgical precision. Despite its growing popularity, institutional experiences with TORS remain limited.

Objectives: This study aimed to evaluate the outcomes of TORS for oncological and obstructive sleep apnoea syndrome (OSAS) cases, focusing on efficacy, safety and complications.

Materials and methods: A retrospective analysis was conducted on 61 patients who underwent TORS at a single institution between 2018 and 2024. Demographic, surgical and postoperative data were collected, including histopathological findings, complications and hospitalization duration. Statistical analyses were performed using SPSS software (SPSS, Chicago, IL, USA), with significance set at p < .05.

Results: Of the 61 patients, 67.2% were male, with a mean age of 57.25 years. TORS was performed for oncological purposes in 72.1% of cases and OSAS in 27.9%. The most common surgical procedure was base-of-tongue resection (42.6%). Postoperative bleeding occurred in 11.4% of cases, all oncological, with two mortalities due to haemorrhage. Hospital readmission within 30 days occurred in 13.1% of patients. OSAS cases demonstrated shorter hospital stays and lower complication rates than oncological cases.

Conclusions: TORS is a safe and effective technique for both oncological and OSAS cases, offering significant benefits in reducing morbidity. However, complications, particularly bleeding in oncological cases, remain a challenge, highlighting the need for careful patient selection and perioperative management.

Background: Pediatric cochlear implant (CI) recipients with cochlear malformations face challenges due to variable speech recognition outcomes.

Aims/objectives: This study assesses the predictive value of intraoperative electrically evoked compound action potential (eCAP) thresholds, residual hearing, age at implantation, Intelligent Quotient (IQ), and malformation type for speech recognition outcomes.

Material and methods: A prospective cohort of 52 children (aged 1-4 years) with cochlear malformations who underwent CI between 2016 and 2024 was analyzed. Intraoperative eCAP thresholds were recorded, and disyllable word recognition scores (WRS) were evaluated 24 months postoperatively.

Results: Patients included incomplete partition (IP-II, 46.2%), cochlear hypoplasia (30.8%), IP-I (13.5%), and common cavity (9.6%). IP-II cases had higher mean eCAP thresholds (18.85 µV) compared to cochlear hypoplasia and common cavity cases. Higher eCAP thresholds correlated with better WRS outcomes (p < 0.001). Logistic regression revealed eCAP thresholds, residual hearing, age, IQ, and malformation type as significant predictors, with an AUC of 0.92.

Conclusions and significance: Intraoperative eCAP thresholds and residual hearing strongly predict auditory outcomes in children with cochlear malformations. Tailored CI strategies based on individual profiles can optimize speech recognition outcomes.

Background: The incidence of spontaneous CSF otorrhea is increasing and knowledge about treatment management is growing.

Objectives: To analyse the cases operated via the middle cranial fossa approach (MCFA) for spontaneous CSF otorrhea in our clinic and to evaluate the long-term surgical results in the light of the literature.

Methods: Demographic data, presenting complaints, complications, hearing outcomes, recurrence rates and long-term success of patients operated with MCFA between 2012 and 2022 in our tertiary care centre were evaluated.

Results: The mean age of the 12 patients who met the inclusion criteria was 58.3 ± 13.4 years. Hearing loss and ear fullness in five patients and persistent otorrhea after ventilation tube insertion in three patients were the most common symptoms. The mean body mass index (BMI) was 35.03 ± 3.39. More than one defect was detected in seven patients. No perioperative or postoperative complications were observed in any patient. The mean airway hearing threshold (ASH)±SD was 40.6 ± 13 preoperatively and 24.4 ± 6.3 postoperatively, a statistically significant decrease (p = 0.003). The mean follow-up period was 80.8 ± 32.5 months and no recurrence was observed in any patient.

Conclusion: Our experience and results support the use of MCFA in the repair of spontaneous CSF otorrhea as safe, highly successful, and beneficial.

Background: Meniere's disease (MD) affects 0.2% to 0.5% of the global population, with regional variations. Standard diagnostic methods, including the glycerol test and EcochG, show variable sensitivity and specificity, highlighting the need for more reliable diagnostic approaches.

Objective: This study aims to investigate latency differences in wave V of the Auditory Brainstem Response (ABR) by comparing waveforms for rarefaction and condensation clicks to identify MD.

Materials and methods: The study analyzed latency differences in wave V of the ABR using condensation and rarefaction clicks in 15 ears diagnosed with MD. The control groups included 10 ears with sensorineural hearing loss (SNHL) [non-MD ears] and 20 ears with normal hearing sensitivity.

Results: MD patients exhibited a significant wave V latency shift between rarefaction and condensation stimuli, suggesting altered cochlear dynamics due to endolymphatic hydrops. No such shift was observed in normal hearing or SNHL ears. Patients with definite MD showed a greater latency difference than those with probable MD, possibly reflecting varying endolymphatic pressure.

Discussion: These findings suggest that ABR testing with opposite polarity stimuli could serve as an adjunctive diagnostic tool for MD, particularly in differentiating the severity of the condition but further research is needed to validate these preliminary.

Background: Vestibular migraine (VM) and Menière's disease (MD) have numerous overlapping symptoms. Distinguishing the two common recurrent vestibulopathies was challenging.

Objectives: To assess the characteristics of hearing loss and the horizontal semicircular canal function in VM and MD.

Materials and methods: Various frequency horizontal semicircular canal function tests, including caloric test, video head impulse test (vHIT), and rotatory chair test, as well as multifrequency audiological test with pure-tone average (PTA), were carried out.

Results: The hearing threshold of all frequencies in VM is lower than that of MD (p < .05). The phase shift at 0.01 Hz, 0.02 Hz, 0.04 Hz, 0.08 Hz and 0.64 Hz was significantly different in VM and MD patients. The gain at 0.01 Hz differed between VM and MD (p < .05); the time constant (RTc) in VM patients was longer than that of MD patients (p < .05). The incidence of caloric test abnormality was 40% in VM patients and 68.3% in MD patients. The abnormal rate of horizontal semicircular canal vHIT was 3.2% in VM and 5.8% in the MD, and the rates of overt/cover saccades were 9.7% and 17.6%, respectively.

Conclusions: The degree and type of hearing loss were conducive to distinguishing between VM and MD, and the rotatory chair test was a necessary supplement.

Background: Superior canal dehiscence syndrome (Minor's syndrome) is a condition characterized by a bony defect in the superior semicircular canal (SSCC), with treatment primarily being surgical, notably through plugging of SSCC.

Aims/objectives: To examine the clinical outcome and postoperative VHIT findings after transmastoid plugging of the SSCC.

Materials and methods: Patients having a superior semicircular canal dehiscence (SSCCD) syndrome with debilitating symptoms who underwent a plugging of the SSCC via a transmastoid approach were included. Through a retrospective chart review and literature review, postop video head impulse test (VHIT) findings, pre and post-operative audiological/vestibular symptoms and audiograms were analyzed in a tertiary care university hospital.

Results: All patients operated by plugging of the SSCC through a transmastoid approach had a significative post-operative VHIT deficit in the function of the SSCC (range 0.34-0.70, median gain function 0.41, mean gain function 0.46, standard deviation of 0.15, p = 0.0391) Almost all patients had improvement of their preoperative symptoms. No surgical complication was noted. The literature review also highlighted safety and effectiveness of this surgical technique.

Conclusion and significance: Post-operative VHIT findings showed an elective deficit of the SSCC function thus confirming the surgical SSCC plugging through a trans mastoid approach.

Background: Noise-induced hearing loss (NIHL) is a kind of acquired sensorineural hearing loss and has shown an increasing incidence in recent years. Hence, elucidating the exact pathophysiological mechanisms and proposing effective treatment and prevention methods become the top priority. Though a great number of researches have been carried out on NIHL, few of them were focused on metabolites.

Aims/objectives: To reveal the metabolomic changes in cochlear fluid after noise injury and search for underlying inner ear biomarkers of NIHL.

Material and methods: In this study, cochlea fluid extracted from guinea pigs after impulse noise exposure were subjected to GC-MS and LC-MS untargeted metabolomics analysis.

Results: After impulse noise exposure, 62 significantly changed metabolites in guinea pig cochlea fluid were screened out and deoxyribose 1-phosphate was selected as the key metabolite and underlying biomarker for NIHL. KEGG pathway analysis showed that oxidative phosphorylation, glycerophospholipid metabolism, pyrimidine metabolism and pentose phosphate pathway were significantly changed at all observed time points after noise.

Conclusions and significance: This study effectively promoted the application of metabolomics in hearing research. The pathophysiology process of NIHL in the inner ear was closely connected with oxidative phosphorylation, glycerophospholipid metabolism, pyrimidine metabolism and pentose phosphate pathway and deoxyribose 1-phosphate could be the biomarker for NIHL.

Background: The Canalith Repositioning Maneuver (CRM) is often ineffective for persistent geotropic direction-changing positional nystagmus (DCPN). In these cases, determining the lesion side can be challenging, as the null plane side and the side with stronger nystagmus on the roll test are frequently opposite.

Objectives: This study investigates whether the low therapeutic efficacy of CRM in persistent DCPN could be attributed to incorrect determination of the lesion side.

Material and methods: This prospective randomized trial involved two groups of patients with persistent geotropic DCPN, categorized based on the method used to determine the lesion side: the null plane side and the side with stronger nystagmus on the head roll test. We assessed the therapeutic efficacy of CRM on the null plane side (null plane group) and the side with stronger nystagmus on the head roll test (stronger nystagmus group).

Results: Both groups showed minimal or no immediate therapeutic effect of CRM, with a low short-term effect observed in both as well. No significant differences were found in the immediate and short-term therapeutic effects of CRM between the two groups.

Conclusions and significance: The limited therapeutic effect of CRM in persistent geotropic DCPN does not appear to result from incorrect determination of the lesion side.

Background: Myringoplasty is one of the treatments used for perforated tympanic membrane.

Aim/objective: We aimed to evaluate the long-term anatomical and functional outcomes of patients who underwent endoscopic inlay butterfly cartilage myringoplasty.

Material and methods: We retrospectively analyzed 74 patients who had undergone endoscopic butterfly cartilage myringoplasty were followed for at least five years. The evaluation included age, sex, duration of follow-up, perforation location, size, preoperative and postoperative pure tone audiometry thresholds (years 2 and 5), air-bone gap, follow-up complications, and postoperative graft and tympanic membrane status.

Results: The study included 74 patients with a mean follow-up duration of 76.7 months (range: 60-125 months). The graft success rates were 89.1% at two years and 82.4% at five years postoperatively. There was a significant improvement in air conduction thresholds when comparing preoperative levels to those at two and five years postoperatively (p = 0.003). The air-bone gap showed a significant reduction from preoperative levels to those observed at two and five years postoperatively (p < 0.0001).

Conclusion and significance: Our study demonstrates that endoscopic butterfly cartilage myringoplasty is safe and effective for achieving long-term anatomical and functional success. We recommend extending the follow-up period to five years with additional annual assessments thereafter.

Background: Large palatine tonsils cause a variety of symptoms including obstructive sleep apnea and snoring. In adults, the prevalence of tonsillar hypertrophy remains uncertain.

Aims: We estimated the incidence of tonsillectomy for adult palatine tonsillar hypertrophy using population data and retrospective patient charts.

Material and methods: Patient data were retrospectively collected between 2004 and 2018 in the Hospital District of Southwest Finland. Adult patients with tonsil hypertrophy, obstructive sleep apnea or mouth breathing/snoring as an indication for surgery were included. Data were verified from patient charts. To determine in adults the incidence of tonsillectomy for tonsillar hypertrophy, the number of surgeries was compared to population data.

Results: The incidence of tonsillectomy for adult tonsillar hypertrophy was 8.49 per 100000 person-years. In our hospital district, 9.5% of adults who underwent tonsil surgery had tonsillar hypertrophy. The incidence rate reduced with age. The most common indication for surgery of hypertrophic tonsils was snoring (30.8%). In this study, 12.7% of patients with asymmetric tonsils had malignancy with the most common being lymphoma.

Conclusions and significance: Symptomatic adult tonsil hypertrophy remains rare. In adults, tonsil asymmetry should invoke a suspicion of lymphoma. Even during adulthood, as age increases, tonsillar hypertrophy becomes less common.