Acta Oto-Laryngologica最新文献

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.

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: Recent advances in artificial intelligence have facilitated the automatic diagnosis of middle ear diseases using endoscopic tympanic membrane imaging.

Aim: We aimed to develop an automated diagnostic system for middle ear diseases by applying deep learning techniques to tympanic membrane images obtained during routine clinical practice.

Material and methods: To augment the training dataset, we explored the use of generative adversarial networks (GANs) to produce high-quality synthetic tympanic images that were subsequently added to the training data. Between 2016 and 2021, we collected 472 endoscopic images representing four tympanic membrane conditions: normal, acute otitis media, otitis media with effusion, and chronic suppurative otitis media. These images were utilized for machine learning based on the InceptionV3 model, which was pretrained on ImageNet. Additionally, 200 synthetic images generated using StyleGAN3 and considered appropriate for each disease category were incorporated for retraining.

Results: The inclusion of synthetic images alongside real endoscopic images did not significantly improve the diagnostic accuracy compared to training solely with real images. However, when trained solely on synthetic images, the model achieved a diagnostic accuracy of approximately 70%.

Conclusions and significance: Synthetic images generated by GANs have potential utility in the development of machine-learning models for medical diagnosis.

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: Frontal sinus fractures are rare. Although they can manifest as isolated fractures, they mostly occur as a part of larger panfacial injuries of the facial bones.

Objective: Considering the relative rarity of this type of fracture, we decided to perform a retrospective analysis of patients with this type of injury at our institution, focusing on post-injury complications.

Material and methods: We retrospectively evaluated 26 patients with frontal sinus fracture (isolated or as a part of a complex injury to the facial skeleton) treated and subsequently followed up at our institution between 2016 and 2022.

Results: The most common complication was trigeminal nerve hypersensitivity, occurring in 7 patients (47% of patients with any complication). All patients with this complication were treated conservatively. Four patients developed cerebrospinal fluid leak, of which three were treated conservatively and one surgically. Four more patients developed a deformity, of which 3 patients underwent surgery and one was treated conservatively.

Conclusion and significance: The therapeutic goal is to restore the conditions of the mucosa and to preserve the drainage of the frontal sinus.

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: The Vibrant Soundbridge Implant provides multiple options for coupling the Floating Mass Transducer (FMT) to the ossicles. A parametric evaluation in clinical trials is difficult.

Aims/objectives: We studied the vibratory output of the FMT with three couplers-short process, former long process, and current long process-in an acoustic-mechanical middle ear model (AMEM) under simulated impaired coupling conditions.

Materials and methods: The AMEM, with life-sized ossicles, was tested via acoustic and electrical (FMT-) stimulation. Simulated impairments included accidental bone-contact, cable tension, and insufficient connection. Stapedial footplate vibrations were measured using Laser Doppler.

Results: Acoustic stimulation generally fulfilled the ASTM standard. With normal coupling, SP- and LP-couplers performed comparable to temporal bone data. Impaired coupling led to various effects: bone-contact reduced the transmission up to 20 dB, cable tension minimally affected SP and current LP couplers but reduced the sound transmission for the former LP coupler. Connecting the SP-coupler with only two of four titanium legs caused a single frequency dip without affecting overall magnitude, whereas off-axis LP fixation reduced the output by 15-20 dB around 1000 Hz.

Conclusions and significance: The AMEM generated reproducible, ASTM-compliant measurements. SP and current LP couplers showed resilience to potential FMT implantation impairments in most frequencies.

Background: Endoscopic transcanal butterfly cartilage myringoplasty is a prominent procedure because surgeons can perform this operation without elevating the transmeatal flap.

Objective: To evaluate factors that affect endoscopic butterfly cartilage myringoplasty regarding graft success and hearing improvement and determine long-term outcomes.

Materials and methods: This study included 86 patients who underwent surgery. The rates of graft success and hearing improvement were investigated, together with the effects of sex, age, operated side, and size and location of the perforation.

Results: The overall graft success was 83.7%. There was a statistically significant difference between pre- and post-operation in terms of hearing improvements at 0.5, 1, and 2 kHz (p < 0.001). Sex, age, operative side, and perforation size did not significantly affect graft success or hearing improvement (p > 0.05). The perforation location was significantly associated with graft success (p < 0.05). However, the location of the perforation did not significantly affect hearing improvement (p > 0.05).

Conclusions: Endoscopic transcanal butterfly cartilage myringoplasty can be performed with a high graft success rate and improved hearing. However, surgeons should be more careful when treating patients with posterior perforations.

Significance: The location of the perforation is significantly related to graft success.

Background: The Glasgow Benefit Inventory (GBI) is a widely used patient-reported outcome measure in otorhinolaryngology. A Danish version would serve as a validated tool for assessing quality of life among Danish patients after otorhinolaryngological interventions, enabling both cross-intervention, cross-country and cross-cultural comparisons.

Aims/objectives: This study aimed to translate, culturally adapt and linguistically validate the GBI into Danish.

Materials and methods: We followed the guidelines of the Quality of Life Special Interest Group - Translation and Cultural Adaptation Group established by ISPOR, to ensure a rigorous adaptation process.

Results: A Danish version of the GBI was developed in accordance with the guidelines. Minor adjustments were made to enhance clarity, consistency, and ease of use for Danish respondents. These modifications were carefully considered to preserve the original concepts and intent of the original questionnaire.

Conclusions and significance: The GBI has been successfully translated, culturally adapted, and linguistically validated for use in Danish. This version provides a valuable tool for evaluating the impact of otorhinolaryngological operations/treatments by measuring the patient-reported outcomes in Danish otorhinolaryngology patients.