Ear, nose, & throat journal最新文献

Background: Vitamin B12 is an essential nutrient crucial for overall health, and deficiencies can lead to hearing loss. Objective: The aim of the systematic review was to explore the intricate connection between vitamin B12 deficiency and hearing loss using a systematic literature review. Methods: A systematic literature search was carried out to identify the articles exploring the connection between vitamin B12 deficiency and hearing loss. Electronic databases such as PubMed, Scopus, and Cochrane databases were used to identify the relevant studies. Results: A total of 612 studies were identified from 3 databases, and after stepwise screening, 9 articles were found eligible for the data extraction and inclusion in the review. Most of the studies had observed statistically-significant differences in the hearing thresholds with low vitamin B12 levels. However, few studies found hearing loss in the low frequencies (250 and 500 Hz), and others have found elevated thresholds above 4 KHz. Factors such as age, gender, and treatment for vitamin B12 did not show any significant changes in the hearing thresholds. Conclusion: The systematic review revealed that individuals with lower vitamin B12 levels tended to have a higher prevalence of hearing impairment than those with normal or elevated levels. Vitamin B12 deficiency, coupled with high homocysteine levels and low folate concentrations, may contribute to different degrees of hearing loss, particularly in the elderly. Lower serum levels of vitamin B12 have been associated with slight to mild hearing loss, while cochlear dysfunction and poorer hearing thresholds have also been observed in individuals with vitamin B12 deficiency. These findings highlight the importance of maintaining optimal levels of vitamin B12 for preserving hearing health and warrant further investigation into potential interventions.

Objective: The purpose of this study was to evaluate and clarify the effects of menopause on voice by comparing postmenopausal female participants who did not receive hormone therapy (HT) to premenopausal female participants.

Methods: The study included 50 postmenopausal women who had not undergone HT, as well as 50 premenopausal women. The acoustic voice analysis considered fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio (HNR), and noise-to-harmonic ratio (NHR). Jitter is variations of F0, and shimmer is of peak amplitude. Experts completed the Grade, Roughness, Breathiness, Asthenia, Strain scale for perceptual assessment, while participants self-evaluated their voice using the Voice Handicap Index-10 (VHI-10).

Results: Postmenopausal women had lower acoustic parameters (F0 [P = .01], G [P = .037], R [P = .011], and S [P = .031]) scores. Age had a link with G (r = 0.303, P = .002), R (r = 0.417, P < .001), A (r = 0.297, P = .003), and S (r = 0.370, P = .001) and the F0 (r = -0.455, P = .001). There was no significant difference in the VHI-10 (P = .526), jitter (P = .216), shimmer (P = .920), HNR (P = .261), and NHR (P = .301) values.

Conclusion: Postmenopausal women's voice have lower frequency, and perceptually-lower grade, roughness, and strain than premenopausal women; however, these changes do not affect their quality of life.

Objectives: Laimer's diverticulum (LD) is a very rare clinical entity originating between the cricopharyngeus muscle (CPM) and circular muscular fibers of the esophagus. Its diagnosis and management remain to be elucidated. This article summarizes our experience in its diagnosis and open surgical management.Methods: A retrospective review of LD cases treated at our tertiary medical institution was conducted between July 2018 and May 2023. The clinical and demographic data were retrieved from case notes.Results: Three cases were included in this review. There were 2 male patients and 1 female patient. The average and median ages were 47.3 and 54 years, respectively. Presenting symptoms included hoarseness, pharyngeal foreign body sensation, and neck mass. All 3 diverticula were on the left side, with the first 2 cases discovered accidentally on gastric endoscopic or cervical MRI examinations. After evaluating esophageal swallowing with barium sulfate or urografin contrast media, all the patients consented to undergo an open surgical procedure. During surgical exploration, the diverticula were found to be on the posterior part of the cervical esophagus, below CPM, and away from the recurrent laryngeal nerve, and only then, could the diagnosis of LD be established. Then, diverticulectomy and manual suturing of the esophagus was performed. Recovery of all 3 patients was uneventful. Nasogastric tube feeding lasted 7 to 12 days until esophageal examinations demonstrated no leak, and then, oral liquid feeding resumed. The median duration of follow-up was 50 months. No recurrence of symptoms or diverticulum was observed, and the swallowing function of all 3 patients was excellent.Conclusions: An open surgical approach is not only important for the diagnosis of LD, but can also be utilized as a safe and effective treatment.

Objective: Brachial plexus schwannoma (BPS) is a rare clinical entity that poses a significant challenge for head and neck surgeons due to its neuroanatomical complexity and potential severe complications, such as major motor or sensory neurological deficits or pain of the corresponding upper extremity. This article summarizes our experience in its diagnosis and intracapsular enucleation with intraoperative neuromonitoring (INM).

Methods: A retrospective review of BPS cases treated at our tertiary medical institution was conducted between April 2020 and May 2023. The clinical and demographic data were retrieved from case notes.

Results: Totally, 3 cases were included. All 3 patients were male, aged 43 to 54 years (median age = 52). The presenting symptom was a palpable supraclavicular mass in all these cases (2 on the left side and 1 on the right side). Neuromonitoring was performed with a 4-channel nerve integrity monitor, with the electrodes placed in the upper arm and forearm muscles, as demonstrated in the literature. After exposing the mass and identifying its origin from the brachial plexus, a unipolar stimulating probe was used to stimulate the tumor surface or the nerves with a 1.0-mA current, and a longitudinal incision into the tumor capsule was made along a carefully mapped line with no INM response. Then the mass was carefully exposed and meticulously dissected from its capsule to achieve an intact enucleation. Immediate postoperative neurological deficit was documented in Case 1 as a mild grasping weakness. The recovery of the other 2 patients was uneventful. The follow-up duration was 7 to 38 months (median = 8 months). The minor motor deficit of Case 1 recovered completely 1 month after surgery. No recurrence of BPS was observed.

Conclusions: Intracapsular enucleation with INM could result in complete removal of BPS and minimal postoperative neurological deficit, whose recovery was quick and satisfactory.

Background: Congenital cholesteatoma is defined as a white mass behind an intact eardrum without a history of otitis media or previous otologic procedures. Congenital cholesteatoma is a relatively rare disease that accounts for about 2% to 5% of all cholesteatomas. However, the actual incidence rate of congenital cholesteatoma may be underestimated. Conductive hearing loss is the most common presenting symptom. The current study aims to describe the clinical characteristics and management of patients with congenital cholesteatoma and promote awareness of the disease in unilateral or asymmetric conductive hearing loss patients. Methods: In this study, we report a case series of 3 patients including 1 child, 1 adolescent, and 1 young adult, managed in our department between June and August 2023, and present a summary of the literature. Results: Congenital cholesteatoma is primarily a pediatric disease, but it has also been reported in adults. Two cases presented with unilateral secretory otitis media, and 1 case presented with asymmetric unilateral conductive hearing loss. Two patients of Potsic stage III congenital middle ear cholesteatomas underwent transcanal endoscopic ear surgery, and 1 patient of Potsic stage IV underwent conventional microscopic approach canal wall-up mastoidectomy combined with endoscopy. Conclusions: In children or young adults with persistent unilateral or asymmetric conductive hearing loss, congenital middle ear cholesteatoma should be considered. Congenital cholesteatoma cannot be ruled out in children with unilateral secretory otitis media.

A man in his late 60s, with a history of psoriatic arthritis, presented with a 10-year history of hoarseness and exertional dyspnea. Flexible laryngostroboscopy demonstrated bilateral true vocal cord immobility resting in paramedian positions with glottic airway space reduction at ~5 to 10 mm on respiration. A contrast-enhanced computed tomography scan of the neck was performed to assess for a lesion along the course of the recurrent laryngeal nerves (RLNs), and it confirmed the findings of vocal cord immobility, evidenced by enlarged pyriform sinus and laryngeal ventricle, medialization and thickening of the aryepiglottic folds, and anteromedial deviation of the arytenoid cartilage, but no lesions along the RLNs. In the absence of structural, neurologic, or malignant causes, the findings were suggestive of cricoarytenoid joint fixation secondary to psoriatic arthritis. While cricoarytenoid arthritis is associated with other rheumatologic conditions, its association with psoriatic arthritis is exceedingly rare, with only 1 previously documented case. Our case highlights the importance of considering psoriatic arthritis in the workup of bilateral vocal cord immobility, particularly in patients with no other identifiable cause.

Objectives: To examine the success and limitations of office removal of nasal foreign bodies (FBs) in a pediatric population.

Methods: Children presenting to an academic pediatric outpatient department were identified from a computerized collection of office notes. FB removal was performed via: (1) preprocedure discussion with shared decision-making, (2) topical anesthesia and vasoconstriction of the nose, (3) restraint in supine position with a trained second person holding the head, and (4) FB removal using an operative microscope with instrumentation. Removal was considered a failure if subsequent removal under general anesthesia was required.

Results: Among 547 consecutive children presenting with head and neck FBs during a 22 year period, exactly 100 had nasal FBs. Forty-four percent had previous attempts at FB removal in an emergency department or pediatricians' office. Ninety-six percent of FBs were successfully extracted in the office. Four percent required removal in the operating room. No complications were reported. Children with neurodevelopmental disorders were no more likely to experience failed removal ([0/4] vs [6/96], P = .61). The most common FBs were beads (19%), plastic (12%), and foam rubber (10%).Concluearsion:This protocol resulted in a high rate of successful nasal FB removal, even in children with prior failed attempts with no significant nasal injuries. This approach should be considered by otolaryngologists who care for children.

Level of evidence: 3 - retrospective review.

Objectives: To investigate and identify the most reliable method for assessing Eustachian tube function (ETF) in pediatric patients with otitis media with effusion (OME).

Methods: A total of 49 ears from pediatric patients diagnosed with OME and 32 healthy control ears were included. The assessment methods for ETF included acoustic immittance measurement (AIM), tubomanometry (TMM), Eustachian tube score (ETS), sonotubometry (STM), and tubo-tympano-aerodynamic-graphy (TTAG).

Results: AIM was used as the standard, and the consistency of TMM, ETS, STM, and TTAG was tested with sensitivities of 75.6%, 60.0%, 82.05%, and 53.85%, specificities of 94.4%, 97.2%, 66.67%, and 83.33%, and Youden indices of 0.700, 0.572, 0.487, and 0.372, respectively. ROC analysis revealed an optimal diagnostic threshold for TMM values of 4.5. Significant differences in AIM results were observed between groups stratified by this TMM-based diagnostic threshold (χ² = 36.690, P = .000). When the TMM values were <4.5, the rate of normal Eustachian tube opening was 5.55%, which increased to 75.56% for values ≥4.5.

Conclusion: TMM demonstrates superior diagnostic performance compared to ETS, STM, and TTAG. The combination of AIM and TMM is recommended for the evaluation of ETF in pediatric patients with OME.