Acta Oto-Laryngologica最新文献

Background: Laser fenestration in stapedotomy has thermal effect to the vestibule.

Aims/objectives: To evaluate the role of energy density (fluence) in the severity of postoperative vestibular symptoms.

Materials and methods: The retrospective chart-review study included 84 patients with otosclerosis that underwent primary laser stapedotomy. Surgical outcomes, including nystagmus, and subjective vestibular symptoms during one-month follow-up, were compared between potassium titanyl phosphate (KTP) and CO₂ laser. According to this study and literature, we assessed the relationship between laser parameters and the incidence of persistent vestibular symptoms lasting more than one week after surgery.

Results: The KTP and CO₂ laser group included 48 and 36 patients, respectively. Fluence was different between the KTP (637 J/cm²) and CO₂ (141 J/cm²) laser (p < .001). The KTP group showed gradual decrease in dizziness during one-month observation period, while the CO₂ group exhibited a steep recovery curve in the first postoperative week (9 and 4 d of duration, respectively). The incidence of persistent vestibular symptoms was correlated with both fluence (r = 0.80, p = .01) and spot size (r = -0.74, p = .01).

Conclusions and significance: Appropriate setting of parameters with lower fluence is desirable for the efficiency and safety of laser stapedotomy.Abbreviations: ABG: air-bone gap; SD: standard deviation.

Background: There are two types of speech processors used in CI devices: behind-the-ear (BTE) and off-the-ear (OTE).

Objectives: This study aimed to investigate the characteristics of patients and revision cases in relation to the type of speech processors.

Materials and methods: A retrospective review of 452 ears that underwent CI was performed.

Results: Children with severe inner ear anomalies (91.7%) more frequently preferred BTE speech processors than those without severe inner ear anomalies (p = .000). The magnet strength used in OTE speech processor users was significantly higher than in BTE speech processor users (p = .002). In cochlear implantees who underwent surgery before 12 months of age, the magnet strength in the revision group was greater than in the non-revision group (p = .025).

Conclusions and significance: Overall, our findings suggest factors to consider when choosing the type of speech processor and modifying the magnet strength of the implant device. The choice between BTE and OTE speech processors led to different required magnet strengths, contributing to the occurrence of skin flap inflammation.

Background: Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) can result in prolonged dizziness.

Objectives: This study aimed to compare the video head impulse test (vHIT) of patients with SHLV and VN.

Methods: Fifteen patients with SHLV and 21 patients with VN who visited the Vertigo/Dizziness Center of our hospital between December 2016 and February 2023 were included. vHIT was performed at the time of admission, and the VOR gain and catch up saccade (CUS) in the three types of semicircular canals (SCCs) were analyzed.

Results: Pathologic vHIT results were observed most frequently in the posterior SCC (73%), followed by lateral (53%) and anterior (13%) SCCs in the SHLV group. In contrast, pathologic vHIT results were observed most frequently in the lateral SCC (100%), followed by the anterior (43%) and posterior SCC (24%) SCCs in the VN group. Pathological vHIT results in the lateral and posterior SCC showed significant differences between the two groups, but for anterior SCC, no significant differences were found.

Conclusions and significance: Comparison of the two vHIT results revealed differences in the SCC dysfunction patterns. This may be due to the different pathophysiological mechanisms of the two vestibular disorders, which may result in prolonged vertigo.

Background: Water homeostasis is essential for inner ear function. Several aquaporins (AQPs), which are water transport proteins in the cell or plasma membrane, have been reported in the lateral wall of the rat inner ear (cochlea). However, the presence of AQP-10, -11 and -12 has not been reported in the rat stria vascularis (SV) to date.

Aims/objectives: We have aimed to clarify the expression of AQP-10, -11 and -12 in the cochlea lateral wall.

Materials and methods: Using Wistar rats, we examined the expression of AQP-10, -11 and -12 in the cochlea lateral wall using molecular approaches and immunohistochemistry.

Results: AQP-11 was molecular biologically expressed, but the expression of AQP-10 and -12 was not observed. Immunohistochemically, AQP-11 was diffusely localized in the basal cells and marginal cells of the rat SV but was not expressed at the apical site of marginal cells with double staining. The expression of AQP-10 and -12 was not observed.

Conclusions and significance: Only AQP-11 was expressed in the basal cells and marginal cells, but it was not expressed at the apical site of marginal cells. Based on this study, AQP-11 may not have an important role in water flux between the perilymph and endolymph.

Background: Posterior expansion of the utricular endolymphatic space (ES) is a finding occasionally observed, and often occurs in bilateral ears. The clinical significance of posterior expansion of the utricular ES is not clear.

Objectives: To investigate the clinical significance of posterior expansion of the utricular ES detected on magnetic resonance imaging (MRI).

Materials and methods: Among 957 patients who underwent contrast-enhanced MRI to investigate the presence of endolymphatic hydrops (EH), clinical findings in cases with posterior expansion of the utricular ES were evaluated and the significance of their existence is considered.

Results: Posterior expansion of the utricular ES was detected in 30 ears from 20 cases (7 males, 13 females; mean age 48.7 years). The ears with posterior expansion had a significantly lower incidence of vestibular EH than those without, and this tendency was more prominent in cases in bilateral ears. Some cases with posterior expansion had vestibular symptoms and were diagnosed with Ménière's disease, although EH was not detected in their vestibules.

Conclusion and significance: Posterior expansion of the utricular ES was associated with Ménière's disease without vestibular EH. Posterior expansion of the utricular ES might not be associated with the formation of EH but may occur independently.

Background: The effect of wearing masks on olfaction remains unclear.

Objectives: This study aimed to clarify the differences between the effects of no masks, surgical masks, and N95 respirator masks by conducting both identification and threshold olfaction tests.

Methods: Young, healthy volunteers aged ≥ 18 years and < 30 years without awareness of apparent olfactory disorder were included. All participants filled out a questionnaire on olfaction and completed an acuity smell identification test (Open Essence test) and an olfactory threshold test (T&T olfactometry) while wearing no masks, surgical masks, or N95 respirator masks.

Results: In the Open Essence tests, the no-mask group score was significantly higher than those of the surgical- and N95-mask groups. Using T&T olfactometry, the median-detection threshold of the no-mask group was significantly lower than that of the surgical-mask group, and the surgical-mask group threshold was significantly lower than that of the N95-mask group. Similar patterns were observed for the median-recognition threshold.

Conclusions: Wearing masks, especially an N95 mask, reduces the ability to detect and identify odors. This disadvantage should be considered by professionals such as healthcare workers, who require proper olfaction to perform appropriate tasks.

Background: The mortality rates of laryngeal squamous cell carcinoma cancer (LSCC) have not significantly decreased in the last decades.Objectives: We primarily aimed to compare the predictive performance of DeepTables with the state-of-the-art machine learning (ML) algorithms (Voting ensemble, Stack ensemble, and XGBoost) to stratify patients with LSCC into chance of overall survival (OS). In addition, we complemented the developed model by providing interpretability using both global and local model-agnostic techniques.Methods: A total of 2792 patients in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with LSCC were reviewed. The global model-agnostic interpretability was examined using SHapley Additive exPlanations (SHAP) technique. Likewise, individual interpretation of the prediction was made using Local Interpretable Model Agnostic Explanations (LIME).Results: The state-of-the-art ML ensemble algorithms outperformed DeepTables. Specifically, the examined ensemble algorithms showed comparable weighted area under receiving curve of 76.9, 76.8, and 76.1 with an accuracy of 71.2%, 70.2%, and 71.8%, respectively. The global methods of interpretability (SHAP) demonstrated that the age of the patient at diagnosis, N-stage, T-stage, tumor grade, and marital status are among the prominent parameters.Conclusions: A ML model for OS prediction may serve as an ancillary tool for treatment planning of LSCC patients.

Background: There is a lack of effective treatment for idiopathic unilateral vocal fold paralysis (IUVFP). A better phonation was reported by patients after laryngeal nerve stimulation during our clinical examination.

Objectives: This study aims to investigate immediate effect of recurrent laryngeal nerve (RLN) stimulation on phonation in patients with IUVFP.

Material and methods: Sixty-two patients with clinically identified IUVFP underwent RLN stimulation with needle electrodes. Laryngoscopy, acoustic analysis, and voice perception assessment were performed for quantitative comparison of vocal function and voice quality before and after the intervention.

Results: Laryngoscopic images showed a larger motion range of the paralyzed vocal fold (p < .01) and better glottal closure (p < .01) after RLN stimulation. Acoustic analysis revealed that the dysphonia severity index increased significantly (p < .01) while the jitter and shimmer decreased after the intervention (p < .05). According to perceptual evaluation, RLN stimulation significantly increased RBH grades in patients with IUVFP (p < .01). Furthermore, the improvement in voice perception had a moderate positive correlation with the decrease in the glottal closure.

Conclusions and significance: This study shows a short-term improvement of phonation in IUVFP patients after RLN stimulation, which provides proof-of-concept for trialing a controlled delivery of RLN stimulation and assessing durability of any observed responses.

Background: Obstructive sleep apnea (OSA) is a sleeping disorder that can cause multiple complications.

Aims/objective: Our aim is to build an automatic deep learning model for OSA event detection using combined signals from the electrocardiogram (ECG) and thoracic movement signals.

Materials and methods: We retrospectively obtained 420 cases of PSG data and extracted the signals of ECG, as well as the thoracic movement signal. A deep learning algorithm named ResNeSt34 was used to construct the model using ECG with or without thoracic movement signal. The model performance was assessed by parameters such as accuracy, precision, recall, F1-score, receiver operating characteristic (ROC), and area under the ROC curve (AUC).

Results: The model using combined signals of ECG and thoracic movement signal performed much better than the model using ECG alone. The former had accuracy, precision, recall, F1-score, and AUC values of 89.0%, 88.8%, 89.0%, 88.2%, and 92.9%, respectively, while the latter had values of 84.1%, 83.1%, 84.1%, 83.3%, and 82.8%, respectively.

Conclusions and significance: The automatic OSA event detection model using combined signals of ECG and thoracic movement signal with the ResNeSt34 algorithm is reliable and can be used for OSA screening.

Background: Age-related hearing loss (ARHL) is a major cause of chronic disability among the elderly. Individuals with ARHL not only have trouble hearing sounds, but also with speech perception. As the perception of auditory information is reliant on integration between widespread brain networks to interpret auditory stimuli, both auditory and extra-auditory systems which mainly include visual, motor and attention systems, play an important role in compensating for ARHL.

Objectives: To better understand the compensatory mechanism of ARHL and inspire better interventions that may alleviate ARHL.

Methods: We mainly focus on the existing information on ARHL-related central compensation. The compensatory effects of hearing aids (HAs) and cochlear implants (CIs) on ARHL were also discussed.

Results: Studies have shown that ARHL can induce cochlear hair cell damage or loss and cochlear synaptopathy, which could induce central compensation including compensation of auditory and extra-auditory neural networks. The use of HAs and CIs can improve bottom-up processing by enabling 'better' input to the auditory pathways and then to the cortex by enhancing the diminished auditory signal.

Conclusions: The central compensation of ARHL and its possible correlation with HAs and CIs are current hotspots in the field and should be given focus in future research.