Acta Oto-Laryngologica最新文献

Background: In some rare cases of congenital aplasia of the oval window (OW), malformed facial nerve (FN) locations covering the most or entire OW present a challenge to hearing reconstruction, there is no a highly effective surgical hearing reconstruction methods.

Aims/objectives: To update a Scala tympani drill-out technique (SDT) for abnormal FN course covering the OW.

Material and methods: All patients of congenital atresia of the OW was recruited between August 2014 and July 2023 in a tertiary-care center. When it's inability to perform the vestibulotomy with FN covering the OW, The SDT surgery was made with a titanium TORP between the tympanic membrane and scala tympani fenestration for hearing reconstruction. Air conduction (AC) thresholds, bone conduction (BC) thresholds, and air-bone gap (ABG) at 0.5, 1, 2, 4 kHz pure tone frequencies were compared before and 3 months after surgery.

Results: A total of 11 patients underwent SDT surgery during the study period. All cases showed no bone conduction (BC) hearing loss, facial paralysis, tinnitus, or dizziness. The ABG has decreased by 21.2 ± 10.8 dB 3 month after operation. In the long term, three cases had the same hearing as pre-operative, three cases felt their hearing gradually decreased but better than pre-operative.

Conclusions and significance: As a new and optional method, our results suggest an effective way to reconstruct hearing for middle ear deformities with FN occlusion, the short-term effect can be confirmed, while the long-term effect is mixed, and a large amount of clinical research is still needed.

Background: Caffeic acid phenethyl ester (CAPE), an active component of honey bee propolis, has been demonstrated in animal models and studies to have anti-inflammatory, antioxidant, immunomodulatory, neuroprotective, and cytoprotective properties.

Objective: We investigated the efficacy of CAPE, which we believe may be therapeutically useful in facial nerve restoration due to its neuroprotective and antioxidant properties.

Material and methods: 20 Sprague Dawley rats were divided randomly into 4 primary and 2 secondary groups and assigned as control, methylprednisolone, CAPE, CAPE+methylprednisolone groups and the sham and the trauma groups. Except for the sham group, all groups had the left facial nerve crushed. Three weeks after surgery, prospective functional, electrophysiologic, and histologic recovery was assessed.

Results: The CAPE and CAPE+methylprednisolone group had similar and more significant recovery at Nerve Excitability Thresholds and achieved a significantly faster improvement in histopathological evaluation at the end of three weeks.

Conclusions and significance: The combination of CAPE and methylprednisolone was found to be efficient in nerve regeneration in an experimental rat facial nerve crush model. Given the strong systemic adverse effects of methylprednisolone, the combination of CAPE may be a good alternative for lowering the dose of methylprednisolone and thereby reducing its negative effects.

Background: Gait instability and falls significantly impact life quality and morbi-mortality in elderly populations. Early diagnosis of gait disorders is one of the most effective approaches to minimize severe injuries.

Objective: To find a gait instability pattern in older adults through an image representation of data collected by a single sensor.

Methods: A sample of 13 older adults (71-85 years old) with instability by vestibular hypofunction is compared to a sample of 19 adults (21-75 years old) without instability and normal vestibular function. Image representations of the gait signals acquired on a specific walk path were generated using a continuous wavelet transform and analyzed as a texture using grey level co-occurrence matrix metrics as features. A support vector machine (SVM) algorithm was used to discriminate subjects.

Results: First results show a good classification performance. According to analysis of extracted features, most information relevant to instability is concentrated in the medio-lateral acceleration (X axis) and the frontal plane angular rotation (Z axis gyroscope). Performing a ten-fold cross-validation through the first ten seconds of the sample dataset, the algorithm achieves a 92,3 F1 score corresponding to 12 true-positives, 1 false positive and 1 false negative.

Discussion: This preliminary report suggests that the method has potential use in assessing gait disorders in controlled and non-controlled environments. It suggests that deep learning methods could be explored given the availability of a larger population and data samples.

Background: The intraoperative measurements are essential steps in cochlear implant (CI) surgery for confirming correct electrode placement.

Objectives: To examine the intraoperative impedance and electrically evoked action potential (ECAP) measurement results of cochlear implant (CI) users with normal cochlear anatomy (NCA) and to compare them with CI users with inner ear malformations (IEM).

Material and methods: This retrospective study included intraoperative data of 300 ears from 258 individuals using Medel^® and Cochlear (Nucleus^®) CI devices.

Results: Impedance values differed through all regions, and that differences in ECAPs results mainly stemmed from the basal region in Cochlear users, when comparing the impedance values and ECAPs recording prevalence between the NCA and IEM groups, it was observed that there was no significant difference in the impedance values across the intracochlear regions of the groups (apical; p = .26, middle; p = .12, basal; p = .99). However, it was found that the prevalence of measurable ECAPs in all intracochlear regions of the NCA group was higher than the IEM group (p = .000).

Conclusion and significance: The robustness of cochlear structures is a crucial factor in the recording of ECAPs. Furthermore, findings in the IEM group demonstrated that proper placement of intracochlear electrodes did not guarantee effective auditory nerve stimulation.

Background: Sudden sensorineural hearing loss (SSNHL) typically affects one ear and is often linked to various underlying causes. However, bilateral SSNHL (BSSHL), where both ears are affected, is much rarer and presents a more severe clinical challenge.

Aims/objectives: To report the clinical features and short-term outcomes of patients with BSSHL.

Material and methods: The clinical features and outcomes of cases with BSSHL treated in between January 2016 and November 2024 were retrospectively analyzed.

Results: A total of 1212 cases with SSNHL were collected, and only 24 cases showed BSSHL (2.0%). The average hearing thresholds before treatment in the simultaneous onset group were significantly higher than that of the sequential onset group (p < .05). After prednisolone therapy, the effective rate of cases treated within 7 days was 18.2%, significantly higher than that of cases (0%) treated after 7 days (p < .05).

Conclusions and significance: BSSHL is more common in females and may be related to viral infection. Simultaneous BSSHL is more common than sequential BSSHL. Hearing loss in patients with simultaneous onset of BSSHL is more severe than those with sequential onset. Prednisolone treatment for BSSHL within 7 days is critical for recovery.

Background: Neuroendocrine tumors are rare malignancies of the head and neck, especially in the larynx. Variations in the location and morphology of laryngeal neuroendocrine tumors result in a lack of standardized clinical treatment.

Objective: This study aimed to examine the treatment and prognosis of laryngeal neuroendocrine tumors in the G2 stage.

Material and methods: Data from eight patients diagnosed with G2 stage laryngeal neuroendocrine tumors, this collection of common clinical cases was analyzed retrospectively to examine the disease's clinical characteristics, treatment, and prognosis affecting the larynx.

Results: Seven cases were supraglottic type and one was a glottic type. These cases were treated with open surgery and CO₂ laser resection with support laryngoscopy, respectively. After surgery, six patients survived, one passed away due to pulmonary metastasis, and one case was lost to follow-up. OS and DSF rates at 1, 3, 5 years were 87.50%, 65.63% and 65.60%, respectively.

Conclusion and significance: The clinical manifestations of G2 stage laryngeal neuroendocrine tumors varied across different locations. Surgical resection of the lesion is the standard treatment. Selection between open neck surgery and support laryngoscope CO₂ laser surgery depends on the tumor's size and location. Following radical surgery, the tumor demonstrates a favorable prognosis.

Background: US guided sampling is a validated diagnostic approach for non-thyroid deep head and neck masses.

Aim: To describe the setting of a clinician-driven Lump Clinic and analyze a monoinstitutional 7-year database of 849 patients undergoing US-guided sampling.

Methods: FNA with Rapid OnSite Evalutation (ROSE) was the first diagnostic step. In the last years in selected cases, upon ROSE and discussion between clinician and histopathologist, a core biopsy was performed, usually in the same access. If cytology is non-diagnostic, and core biopsy have not been obtained, all available clinical and diagnostic data were re-examined by surgeons and cytopathologists to establish a multiparametric diagnosis (MD).

Results: Cytology and MD showed a sensitivity of 91.8% and 95.3% respectively and a specificity of 95.7% in diagnosing malignancy. Complication rate of US guided sampling was 0,12% (considering the number of patients: 1/849), without any serious adverse event.

Conclusions and significance: Present data confirm the great safety and utility of US guided procedures in the management of head and neck non-thryoid deep masses, while demonstrating the added value of a lump clinic built on the close cooperation between the head and neck surgeon and the histopathologists.

Background: There is conflicting literature regarding whether cochlear implants (CI) electrode array (EA) selection impacts audiologic outcomes.

Objective: To compare outcomes for the two EA designs, precurved and straight.

Methods: A systematic search of CINAHL, Cochrane Library, PubMed, and SCOPUS was conducted according to PRISMA guidelines. Included studies reported word recognition scores, sentence recognition scores in quiet or noise, or hearing preservation (HP) rates for patients with post-lingual hearing loss who underwent CI with either EA type. Primary outcome measures included mean difference (baseline vs. post-surgery) and proportions (%) with 95% confidence intervals (CI).

Results: Of 4134 unique abstracts screened, 92 studies (N = 5365 patients, 5658 ears) were included. Mean improvement of overall word recognition scores for patients with precurved EAs (46.5%, 95% CI: 43.13-49.88%) was significantly (p = 0.0009) superior to that of patients with straight EAs (36.33%; 95% CI, 31.4-41.27%). There was no significant difference between mean improvement of Azbio Quiet scores, mean improvement of overall sentences in noise scores, or HP or pure-tone averages between patients with precurved EAs and those with straight EAs.

Conclusions: Precurved EAs were superior in mean word recognition score improvement, but there was no superior EA design regarding sentence recognition or hearing preservation.

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: 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.