Acta otorrinolaringologica espanola最新文献

Background

Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant.

Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.

Patients and methods

Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.

Results

AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3–30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.

Conclusions

Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1–4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.

Objective

The effect of hypoxia on the functioning of the outer hair cells of the cochlea, which are responsible for the response to otoemissions used in neonatal hearing screening, is well known.

The aim of this study is to determine the influence of mild to moderate variations in umbilical cord pH at birth on the outcome of hearing screening with otoemissions in healthy newborns without hearing risk factors.

Results

The sample is composed of 4536 healthy infants. The results show no significant differences in the hearing screening outcome between the asphyctic (<7.20) and normal pH group. Nor is a figure below 7.20 detected in the sample that is related to an alteration in the screening.

When broken down into subgroups with known factors of variation in the screening result, such as gender or lactation, no significant differences in response were detected.

Apgar ≤ 7 is significantly related to pH < 7.20.

Conclusions

In conclusion, mild-moderate asphyxia associated with delivery of healthy newborns, without auditory risk factors, does not alter the outcome of otoemission screening.

Background

The altered cellular metabolism is one of the hallmarks of the cancer cells, favoring the process of aerobic glycolysis, known as the Warburg effect. The pyruvate dehydrogenase (PDH) complex is one of the elements involved in this metabolic process. The present study aims to evaluate the relationship between the transcriptional expression of PDHB and the risk of local recurrence in patients with oral cavity carcinomas.

Methods

We determined the transcriptional expression of PDHB in biopsies from 41 patients with oral cavity carcinomas treated with surgery. The PDHB expression was categorized according to the local control of the disease with a recursive partitioning analysis.

Results

During the follow-up period 13 patients (31.7%) had a local recurrence of the tumor. Considering local disease control as the dependent variable, the recursive partitioning analysis classified the patients in two categories according to high (n = 16, 39.0%) or low (n = 25, 61.0%) PDHB expression. Five-year local recurrence-free survival for patients with high PDHB expression was 84.8% (95% CI: 65.2-100%), and for patients with low expression it was 54.3% (95% CI: 34.3–74.2 %) (P = 0.034). The results of multivariate analysis showed that patients with a low PDHB expression had a 4.90 times higher risk of local recurrence of the tumor (95% CI: 1.02–22.68, P = 0.042).

Conclusion

There is a relationship between the metabolic characteristics of the tumor and its aggressiveness. According to our results, patients with oral cavity carcinomas with low transcriptional expression levels of PDHB have a significantly higher risk of local tumor recurrence.

Objective

Patients with head and neck squamous cell carcinoma (HNSCC) have an increased risk of second esophageal neoplasms. The aim of the present study is to evaluate the incidence, risk factors and prognosis of second esophageal neoplasms in patients with HNSCC.

Material and methods

A retrospective study of 4,711 patients with index tumor in the oral cavity, oropharynx, hypopharynx or larynx between 1985 and 2020 was conducted.

Results

During the period analyzed 149 patients (3.2%) had a second esophageal neoplasm. The incidence of second esophageal neoplasia was 0.42% per year and remained nearly constant throughout the follow-up period. According to the results of a multivariate study, the risk factors related to the appearance of second esophageal neoplasms were a history of high alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx. The 5-year disease-specific survival rate in patients with a second esophageal neoplasm, calculated from the diagnosis of this second neoplasm, was 10.5%.

Conclusions

Patients with a HNSCC have an increased risk of developing of a second esophageal neoplasm. The risk factors associated with the appearance of a second esophageal neoplasm were severe alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx.

Objective

To analyze the predictive capacity at the primary location of the tumor of the FAT1 transcriptional expression in patients with head and neck squamous cell carcinoma treated with radiotherapy.

Material and methods

We conducted a retrospective study from biopsies of the primary location of the tumor in 82 patients with head and neck squamous cell carcinoma treated with radiotherapy. The transcriptional expression of FAT1 was determined by RT-PCR. The level of FAT1 transcriptional expression was categorized according to the local control after radiotherapy using a recursive partitioning analysis.

Results

Elevated FAT1 transcriptional expression was associated with an increased risk of local recurrence after radiotherapy. Patients with a high expression level of FAT1 (n = 18; 22.0%) had a 5-year local recurrence-free survival of 42.1% (95% CI: 18.6–65.6%), whereas for patients with a low expression (n = 64; 78.0%) it was 72.4% (95% CI: 61.5%–83.3%) (P = 0.002). According to the result of a multivariate analysis, patients with a high FAT1 expression category had a 2.3-fold increased risk of local recurrence (95% CI: 1.0–5.2; P = 0.043).

Conclusions

Elevated FAT1 transcriptional expression was associated with a significantly increased risk of local recurrence in patients with head and neck squamous cell carcinoma treated with radiotherapy.

Background and objectives

Evidence has shown a cause-and-effect relationship between type 1 diabetes mellitus and auditory and cognitive dysfunctions. This study aimed to investigate the effect of type 1 diabetes mellitus (T1DM) on central auditory and cognitive functions in school-age children and adolescents.

Methods

The study sample consisted of 101 children and adolescents, 50 with T1DM, of both sexes, aged between 7 and 18 years. All participants were selected for a structured interview on hearing, behavioral, and cognitive health and assessment of brainstem auditory evoked potentials (BAEP) and event-related potentials (P300).

Results

Significant differences were observed in memory (p = 0.002) and attention (p = 0.021) complaints between participants with and without T1DM. In the BAEP responses, there were differences between wave III latencies in the right (p = 0.017) and left (p = 0.019) ears and in wave V latencies in the left ear (p = 0.001) between the evaluated groups. In addition, there was an association between BAEP findings and metabolic control in the T1DM group in the left ear in waves III (p = 0.006) and V (p = 0.005) and in the right ear in wave V (p = 0.026). No differences were observed in the latencies of P300 between the evaluated groups.

Conclusion

This study demonstrated the existence of a subclinical finding in the central auditory pathway, offering an increased risk for retrocollear alterations, which may be a consequence of poor metabolic control.

Introduction

In newborns, hearing loss secondary to congenital cytomegalovirus (CMVc) infection, despite its low prevalence, can cause a serious problem in the personal development and social integration of patients. Therefore, it is important to include the determination of CMV DNA as a neonatal screening tool.

Materials and methods

We have carried out a 5-year retrospective study, by describing the CMVc in the Autonomous Community of the Basque Country (Spain) in newborns who did not pass the hearing screening in the early hearing loss detection program. The times of detection, confirmation (incidence) and intervention (treatment) are described.

Results

Of 18,782 subjects studied, 58 (3 per 1,000 live births) presented hearing loss. Of these, CMVc is guaranteed in 4 patients (one woman and 3 men). The mean time to hearing screening was 6.5 days (SD: ±3.69) and to detect CMV by polymerase chain reaction in urine and saliva was 4.2 days (SD: ±3.94). Time to confirm hearing loss by BAEP and audiological intervention 2.2 (SD: ±0.957) and 5 months (SD: ±3.741), respectively. Four hearing aid adaptations and one cochlear implant were performed.

Discussion and conclusion

Neonatal hearing screening has established itself as a good public health program. The determination of viral DNA allows an early, specific and interdisciplinary diagnosis and treatment, in which otorhinolaryngology plays a fundamental role. Our study highlights the importance of including CMV polymerase chain reaction as a universal screening tool.