Acta Oto-Laryngologica最新文献

Background: Patients with smaller vestibular schwannoma (VS) with preserved hearing can be subjected to hearing preservation surgery using the Middle Cranial Fossa (MCF) approach.

Aims/objectives: We aimed to evaluate hearing outcome postoperatively and more than 10 years after MCF surgery.

Materials and methods: Eighty-four patients with sporadic unilateral VS treated with MCF surgery between 1998 and 2020 at a single tertiary centre, were retrospectively studied. Pure tone audiometry and word recognition scores (WRS) preoperatively, postoperatively, and after > 10 years of follow-up, were analysed.

Results: Sixty (71%) patients had preserved hearing function after MCF surgery. Twenty-three of the 60 patients were followed up for >10 years after surgery. Hearing outcomes of the tumour ear after >10 years of follow up were as follows: median pure tone average (PTA): 61 decibel hearing level (dB HL) (range 6-94 dB HL), and median WRS 71% (range: 0-98%). The age-related decline in pure tone audiometry thresholds was not significantly different between the tumour and contralateral ears.

Conclusions and significance: MCF surgery offers the possibility of retaining hearing function even after >10 years of surgery in patients with preserved hearing. Additional hearing loss at the long-term follow-up was bilateral and symmetrical.

Objective: To investigate the prevalence and clinical relevance of endolymphatic hydrops in the contralateral ear of patients with unilateral Meniere's disease.

Material and methods: We analyzed 66 patients with definite unilateral MD. Participants underwent audiological examinations and clinical assessments, including the Tinnitus Handicap Inventory (THI), Dizziness Handicap Inventory (DHI), disease duration, and vertigo characteristics. Besides, bilateral intratympanic gadolinium-enhanced 3D-Real IR magnetic resonance imaging (MRI) was performed.

Results: EH was detected in 24.2% of contralateral ears, predominantly presenting as isolated vestibular or cochlear hydrops. Cochlear hydrops in the contralateral ear showed a positive correlation with hearing loss severity (χ²= 3.95, p < 0.05) and disease duration (t = 3.5, p < 0.001). Conversely, vestibular hydrops in the contralateral ear exhibited no significant associations with hearing loss or disease duration (p > 0.05). Furthermore, no correlations were found between contralateral EH and THI, DHI, or vertigo duration.

Conclusion and significance: Our study confirms that contralateral EH is a prevalent imaging finding in unilateral MD, highlighting the disease's potential for subclinical bilateral involvement.

Background: Radical surgery with free-flap reconstruction for advanced head and neck squamous cell carcinoma (HNSCC) carries a high risk of postoperative complications.

Aims/objectives: To identify the complication most strongly associated with poor oncologic outcomes.

Materials and methods: We retrospectively evaluated 346 patients who underwent free-flap reconstruction between January 2013 and December 2022. Postoperative complications were classified using Clavien-Dindo (CD) grading. Overall survival (OS), recurrence-free survival (RFS), hospital stay, and the surgery-to-postoperative radiotherapy (S-PORT) interval were evaluated.

Results: Surgical site infection (SSI) was the most common complication (n = 56). Patients with CD grade ≥ IIIa SSI showed significantly worse 5-year OS (hazard ratio [HR], 3.075; 95% confidence interval [CI], 1.605-5.892; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.135-3.866; p = 0.018). Multivariate analysis confirmed CD grade ≥ IIIa SSI as an independent prognostic factor for OS (HR, 3.539; 95% CI, 1.786-7.012; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.155-4.053; p = 0.016). These patients had significantly longer hospital stays, whereas S-PORT intervals showed no difference.

Conclusions and significance: CD grade ≥ IIIa SSI independently predicts poor survival after free-flap reconstruction in HNSCC. Preventing and promptly managing SSIs are crucial to improving long-term outcomes.

Background: Nasal vestibular cyst is a common disease in otolaryngology. Traditional surgery via the labiogingival groove approach is invasive, while the rapid development of endoscopic minimally invasive technology may be significant for the improvement of nasal vestibular cyst surgery.

Objectives: To compare the clinical efficacy of endoscopic uncapping surgery and traditional sublabial approach resection in treating nasal vestibular cysts, providing evidence for clinical practice selection.

Methods: A retrospective analysis was performed on 47 patients with nasal vestibular cysts admitted to the Department of Otorhinolaryngology-Head and Neck Surgery from March 2019 to October 2024. They were divided into an endoscopic group (24 cases, undergoing endoscopic uncapping surgery) and a control group (23 cases, receiving traditional sublabial resection). Surgical indicators (operation time, intraoperative blood loss), postoperative recovery indicators (facial compression need, VAS scores at 24/48h, hospital stay), complication incidence, and cyst recurrence during follow-up were compared.

Results: The endoscopic group showed significantly shorter operation time [(20.13 ± 3.15) vs (59.13 ± 13.45) min], less intraoperative blood loss [(5.34 ± 0.67) vs (15.64 ± 2.63) ml], no need for facial compression (vs all controls needing it), lower VAS scores (24h: 2.13 ± 0.52 vs 4.87 ± 0.76; 48h: 1.56 ± 0.41 vs 3.92 ± 0.63), shorter hospital stay [(1.25 ± 0.31) vs (3.76 ± 0.84) days], and lower complication incidence (4.17% vs 13.04%) (all p < 0.05). No recurrence was found in either group during 12-month follow-up.

Conclusion: Endoscopic uncapping surgery for nasal vestibular cysts has advantages of short operation time, less bleeding, mild postoperative pain, rapid recovery, few complications, and low recurrence rate, with significant clinical effect worthy of wide promotion.

Background: Video exergame training shows promise in balance rehabilitation for children, effectively addressing the challenge of poor compliance. However, its application is limited by the need for specialized equipment.

Aims/objectives: To evaluate the effect and safety of smartphone-based video exergame training in children.

Materials and methods: Children with unilateral cochlear implants from the Gansu Hearing-Speech Rehabilitation Centre were recruited. All participants completed exergame training using the ihuman AI Sports app during the school term. Vestibular and balance functions were assessed before and after training, using the Cervical Vestibular Evoked Myogenic Potential (cVEMP) and the balance subset of Bruininks-Oseretsky Test of Motor Proficiency-II (BOT-2).

Results: A total of 37 children aged 4-7 years with balance deficit (BD) were recruited and divided into two groups based on adherence to the exercise. In Group I, one task of BOT-2 showed significant improvement after 9 weeks exercise. In Group II, total scores and 2 tasks improved significantly after 13 weeks training (p < 0.001).

Conclusions and significance: Smartphone-based video exergame training showed significant improvements in postural stability among children with BD. It is effective and safe, suggesting its potential as a valuable tool for balance rehabilitation in young children at home.

Background: Ferritin, a key iron-storage and antioxidant protein, is integral to iron metabolism. Its association with hearing loss remains unclear.

Objectives: This study aimed to investigate the association between serum ferritin levels and hearing loss in U.S. adults and explore potential causal relationships using Mendelian Randomization (MR).

Methods: We analyzed 2,971 participants from NHANES 1999-2002 using weighted multivariable logistic regression to assess associations between serum ferritin levels (high, normal, and low) and different frequencies of hearing loss. Stratified analyses were conducted. Bidirectional MR was performed using GWAS summary statistics to infer causal associations for sensorineural/conductive hearing loss.

Results: After full adjustment, high serum ferritin was associated with a significantly lower risk of high-frequency hearing loss (HFHL) (OR = 0.600 [0.390, 0.922]), especially in younger participants (20-44 years) and males. MR analysis supported a causal protective role of ferritin against sensorineural hearing loss (OR = 0.860 [0.765, 0.968]).

Conclusions: Higher serum ferritin levels are observationally associated with a reduced risk of HFHL. Genetic analyses further suggest a protective causal relationship between ferritin and sensorineural hearing loss.

Significance: These findings suggest ferritin may be a biomarker or potential intervention target for hearing preservation. Further prospective and experimental validation of these associations is warranted.

Background: Parotidectomy for benign salivary gland tumours may result in postoperative sequelae affecting health-related quality of life. No validated Swedish disease-specific instrument for postoperative symptom burden after parotid surgery has been previously available.

Aims/objectives: To translate and validate the Parotidectomy Outcome Inventory-8 for Swedish-speaking patients (SwPOI-8).

Material and methods: A total of 108 adults who had undergone parotidectomy for benign disease at least six months previously were included. The SwPOI-8 was developed using forward-backward translation. Psychometric evaluation included internal consistency, test-retest reliability and construct validity assessed against the established patient-reported outcome measures.

Results: All SwPOI-8 items were completed by all respondents. The mean total score was 6.4 ± 5.2 (range 0-31). Internal consistency was acceptable (Cronbach's α = 0.75). Test-retest reliability was good, assessed using the intraclass correlation coefficient (ICC = 0.87), with substantial agreement for the total score based on weighted kappa (κ = 0.74). Moderate correlation was observed with the Postoperative Global Impairment Scale, while correlations with general patient-reported outcome measures were weak.

Conclusions and significance: The SwPOI-8 demonstrates satisfactory reliability and validity as a disease-specific measure of postoperative symptom burden after benign parotid surgery, supporting its use in clinical follow-up, research and quality assessment.

Background: Speech reception thresholds (SRTs) can be estimated with speech in noise tests using adaptive procedures. Since these tests are time-consuming, it is preferable to use as few trials as possible to identify reliable results.

Aims/objectives: To estimate the impact of early test termination in a German matrix speech test in noise (Oldenburger Satztest) on SRT estimation after 20 instead of after 30 sentences and to identify groups of subjects, for who such a tradeoff between measurement time and accuracy might be useful and acceptable.

Material and methods: Retrospective analysis of 789 tests from cochlear implant users and from simulated tests in 10000 virtual subjects.

Results: Early test termination results in increased estimation errors of the SRT in both real, and simulated listeners. Average test time is reduced from 5.0 to 3.6 min. For estimated SRT's above approximately +2 dB after 20 test sentences, the expected average difference to the result after 30 trials becomes higher than 0.5 dB.

Conclusions and significance: If adaptive speech in noise tests are terminated already after 20 sentences, time can be saved, but it should be considered only in listeners with relatively favourable SRT-estimates after 20 trials, preferably below +2 dB.

Background: Benign paroxysmal positional vertigo (BPPV) has a characteristic, called BPPV fatigue, in which positional nystagmus (PN) and dizziness symptoms disappear when the patient repeatedly assumes a head position that causes dizziness.

Aims/objectives: We previously developed a new maneuver to restore PN that had disappeared because of BPPV fatigue in posterior-canal-type BPPV (pc-BPPV). This study aimed to demonstrate that the maneuver restores PN from BPPV fatigue to a level sufficient for diagnosing BPPV by macroscopic observation of PN.

Material and methods: Thirty patients with pc-BPPV underwent the Dix-Hallpike test (DHT) three times, and video recordings of PN were made during the DHTs. Twenty patients underwent the maneuver before the third DHT. The videos were shown to six examiners, who judged whether PN had been restored from BPPV fatigue to a level that allowed diagnosis, including on the affected side.

Results: PN was restored from BPPV fatigue in 18 of the 20 patients who underwent the maneuver, although PN was not restored in all 10 patients who did not undergo the maneuver.

Conclusions and significance: When BPPV fatigue occurs, the maneuver can induce sufficiently strong PN to diagnose pc-BPPV by macroscopic observation, including on the affected side, with 90% probability.

Background: Tympanic membrane perforation (TMP) is the result of recurrent or chronic otitis media, iatrogenic or traumatic events. It may sometimes require a surgical repair, known as myringoplasty, with the purpose of rebuilding a barrier between the external and middle ear, and restoring a good hearing level.

Objective: The aim of this study is to identify the prognostic factors that may affect the outcomes of myringoplasty.

Material and methods: A retrospective chart review was carried out by including all patients who had undergone myringoplasty for TMP in our Institution in the period between January 2017 and December 2021. All the potential prognostic factors were evaluated.

Results: A global success rate of 90.1% was found, with a satisfying hearing recovery in 71.5% of cases. Reperforation was demonstrated to be more frequent in children, in patients with a poor educational level, in the presence of tympanosclerosis and involvement of the anterior half of the membrane.

Conclusions and significance: Our data show that knowing the prognostic factors may help adapting the techniques and indications to every single case, thus improving the outcomes of myringoplasty.