The journal of international advanced otology最新文献

BACKGROUND: Inside attendant personnel (IAP) working in hyperbaric oxygen therapy (HBO2) chambers face unique risks due to their exposure to pressurized environments, similar to those encountered by divers. During sessions, IAP breathe only compressed air, making them susceptible to potential adverse effects on hearing function. Previous studies have almost exclusively focused on divers, leaving a gap in understanding how these conditions might affect the hearing function of IAP. METHODS: A retrospective analysis was conducted on the audiometry results of 15 IAP who worked at the Akyurt HBO2 Center between 2012 and 2023. Hearing function was assessed through pure tone audiometry at frequencies ranging from 0.5 to 6 kHz. The data were analyzed by comparing baseline and final audiometry results, with subgroup analyses based on age, number of sessions, and working duration. RESULTS: The study comprised a sample of 15 IAP, corresponding to 30 ears, who participated in a total of 2446 HBO2 sessions. The analysis revealed no significant changes in hearing function, and no clinically significant hearing loss was detected. Three participants experienced mild middle ear barotrauma, and no cases of decompression sickness (DCS) were reported. Percent change values were computed to show the change more clearly; however, no clinically significant or consistent changes were identified in any subgroup analyses. CONCLUSION: The findings suggest that with proper precautions, the risks associated with barotrauma and DCS do not pose significant threats to the hearing function of IAP. In this occupational setting, ongoing health screenings and preventive strategies appear to be beneficial for main-taining auditory health.

BACKGROUND: There is a general idea that the external auditory canal (EAC) is wide in patients with otosclerosis. However, as far as we know, there is no objective measurement of the EAC of patients with otosclerosis. In this study, we aimed to measure objectively the dimensions of the osseous EAC (OEAC) in otosclerosis, using high-resolution computed tomography (HRCT). METHODS: High-resolution CT images of cranial bones were obtained from 66 patients with otosclerosis and 48 control individuals using a 256- slice CT scanner with a thickness of 0.67 mm. The dimensions and shape of the OEAC from the end of the cartilaginous portion of the EAC to the annulus of the middle ear were then measured. RESULTS: A total of 228 ears were analyzed using CT images. The osseous external ear canal was most commonly conical in both groups. The width of OEAC was not significantly different in the otosclerosis group. The length of the osseous external ear canal was 6.69 ± 1.49 mm in the control group, and 5.96 ± 1.07 mm in the otosclerosis group. It was significantly shorter in the otosclerosis group (P=.001). CONCLUSION: We measured the OEAC in otosclerosis using an objective method. Contrary to what is known, the OEAC tends to be short bilaterally in the ears of patients with otosclerosis, rather than wider.

BACKGROUND: To characterize alterations in white matter microstructure in cases with idiopathic sudden sensorineural hearing loss (SSNHL) through tract-based spatial statistics applied to diffusion tensor imaging (DTI), elucidating both early-stage and chronic neuroanatomical alterations. METHODS: All cases underwent high-resolution conventional magnetic resonance imaging and DTI. Diffusion data preprocessing was performed using the FMRIB Software Library, including corrections for eddy currents and head motion, brain extraction, and normalization to standard space. Tract-based spatial statistics was employed to undertake voxel-wise whole-brain analysis of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity across 3 groups: left-sided idiopathic SSNHL, chronic left-sided sensorineural hearing loss (SNHL), and healthy control (HC). Additionally, in the SNHL group, correlation analysis of regional DTI metrics with clinical variables was implemented, involving disease duration, interaural latency difference, and auditory brainstem response thresholds. RESULTS: Relative to the HC group, the left SNHL group exhibited remarkably diminished FA values in the bilateral internal capsules, superior corona radiata, and left external capsule. Concurrently, elevated MD values were noteworthy in the body of the corpus callosum, left external capsule, bilateral internal capsules, and corona radiata. Radial diffusivity values were escalated in the corpus callosum body, bilateral superior corona radiata, and left external capsule, suggesting compromised microstructural integrity. CONCLUSION: Both idiopathic SSNHL and chronic SNHL cases demonstrated discernible white matter abnormalities, implicating a disruption in major commissural and projection fiber tracts. Notably, cases with prolonged auditory deprivation exceeding 2 years exhibited microstructural signatures consistent with axonal degeneration and progressive demyelination.

BACKGROUND: The aim is to quantify the electrode insertion trauma-induced hearing loss (EITHL), its risk factors, and its impact on speech outcomes in prelingually deafened children undergoing cochlear implantation. METHODS: This was a prospective, observational study conducted at a single center between 2021 and 2024. Forty children aged 1-5 years with severe-to-profound sensorineural hearing loss underwent cochlear implantation using either the cochleostomy or round-window (RW) techniques. Auditory steady-state response (ASSR) thresholds were utilized to assess hearing preservation levels. Speech outcomes were evaluated by measuring word recognition scores (WRS) at 6, 12, and 24 months. The correlation between electrode insertion depth, hearing preservation, and speech outcomes was analyzed. RESULTS: All participants achieved Grade 1 hearing preservation (>75%). The mean hearing preservation rates at 3, 6, 9, and 12 months were 93.2%, 92.3%, 92.9%, and 92.1%, respectively. Although the RWT demonstrated better hearing preservation than the CS technique, the difference was not statistically significant. A significant increase in low-frequency hearing thresholds was observed over time, with 12-month values of 84.9 ± 3.5 dB (250 Hz), 90.2 ± 3.7 dB (500 Hz), and 92.4 ± 4.0 dB (1000 Hz). A negative correlation was found between the depth of electrode insertion and hearing preservation (r=-0.45, P=.03). Word recognition scores improved over time, with bilateral implant recipients showing significantly higher scores (P < .00). CONCLUSION: Cochlear implantation via both CS and RW approaches preserves residual hearing in prelingually deafened children, with RW insertion demonstrating superior preservation. Deeper electrode insertion is associated with poorer hearing preservation, while better hearing preservation correlates with improved speech outcomes.

We present the case of a 42-year-old female who experienced gradually worsening pain in the left ear, accompanied by hearing impairment and occasional ear discharge. These lesions rarely occur in the temporal bone. Computed tomography and magnetic resonance scans identified a mass of soft tissue located in the left mastoid, with intracranial invasion and mastoid erosion. Initial treatment involved surgery followed by histo- pathology, which confirmed the diagnosis of a plasma cell granuloma, also known as an inflammatory pseudotumor. After surgery, the pseudo- tumor invaded the ipsilateral parapharyngeal space and became surgically inaccessible. Steroid therapy and radiotherapy were proceeded with. When feasible, aggressive surgical intervention is advised as the primary treatment, supplemented by steroids and radiation therapy for persis- tent or recurrent conditions. At the last follow-up, the patient was not completely free of disease but symptom-free and in good general health.

Ludwig's angina is a cellulitis involving multiple spaces in the floor of the mouth. It is mainly associated with odontogenic infections and head or facial trauma, which may result in death by asphyxiation due to sudden airway obstruction. By presenting a case of Ludwig's pharyngitis second- ary to middle ear cholesteatoma, it was aimed to alert otolaryngologists to the potential risks and management of this disorder. The patient was a 49-year-old woman with a 40-year history of middle ear cholesteatoma. Ten days prior to her admission, she sustained an ipsilateral punch injury to the tempo-lateral region, which was followed by postauricular erythematous swelling, pain, and postauricular subperiosteal abscess forma- tion. Sudden mandibular swelling was found during postoperative extubation from middle ear cholesteatoma surgery. In order to prevent the occurrence of sudden acute asphyxia in the postoperative period, an immediate prophylactic tracheotomy was carried out to establish an artifi- cial airway. The patient was subsequently treated with antibiotics and had an uneventful recovery. Prompt diagnosis and aggressive therapeutic interventions are essential for successfully managing Ludwig's angina.

BACKGROUND: This study examines low-dose botulinum toxin at acupuncture points for its effects on vestibular symptoms, headaches, depression, anxiety, and stress in vestibular migraine patients. METHODS: This prospective study included patients with vestibular migraine per Barany Society criteria. Fifty units of Onabotulinum toxin were injected using a 31-gauge needle at 5 units/0.1 mL, diluted from 100 units with 2 mL of 0.9% sodium chloride. The injections were given at predetermined acupuncture points: Yintang (EX-HN3), Taiyang (EX-HN5), Baihui (GV20), Shuaigu (GB8), Fengchi (GB20), and Tianzhu (BL10). Six-month follow-up assessments included assessments using the Migraine Disability Assessment Scale (MIDAS), Dizziness Handicap Inventory-Screening Form (DHI-S), Vertigo Symptom Scale-Short Form (VSS-SF), Depression Anxiety Stress Scale (DASS-21), and Allodynia Symptom Checklist (ASC-12). RESULTS: Statistically significant improvements were observed in MIDAS, VSS-SF, DHI-S, and DASS-21 scores at both 3 and 6 months (P < .05). CONCLUSION: Application of Onabotulinum toxin A (BoNT-A) to acupuncture points alleviated headache, vestibular symptoms, and anxiety, with benefits persisting for up to 6 months.

Pulsatile tinnitus (PT) is a symptom consisting of the perception of sound without an external stimulus, synchronized with the patient's heartbeat.It accounts for 4% of all tinnitus cases. The most common etiologies are vascular, including carotid stenosis, idiopathic intracranial hypertension, sinus stenosis, aneurysms, and arteriovenous malformations. The diagnostic approach involves a complete history and clinical examination to determine if PT is of arterial or venous origin and to guide imaging studies. Treatment ranges from lifestyle modifications and pharmacological therapy to minimally invasive procedures like endovascular interventions and surgery. Minimally invasive endovascular procedures offer promising outcomes. This narrative review analyzes the etiologies, diagnostic approaches, and management strategies of PT, providing updated information to guide its approach. Most patients with PT have a treatable cause; however, despite a thorough diagnostic approach, a specific etiology is not found in approximately 30% of cases. Although most etiologies of PT are not life-threatening, it affects the patient's quality of life as it provokes psychological disturbances.

BACKGROUND: The aim of this study is to investigate factors associated with computed tomography (CT) scan prescription and surgical intervention in pediatric patients with acute mastoiditis (AM). METHODS: Children with AM admitted to Modena University Hospital over a 10-year period were retrospectively divided into 3 groups: those who did not undergo a CT scan nor surgery (Group A); those who underwent a CT scan but not surgery (Group B); and those who underwent CT scan and surgery (Group C). A multivariate analysis was performed to determine possible differences among groups in terms of clinical and laboratory variables. RESULTS: In total, 80 patients were included (57 Group A, 22 Group B, 13 Group C). Factors independently associated with CT scan prescription and surgical intervention were WBC count (P = .015 and .041, respectively), CRP (P = .001 and .003, respectively), and at-home antibiotic adminis-tration (P= .008 and .039, respectively). CONCLUSION: Laboratory parameters may be helpful in guiding pediatric AM management. Antibiotic treatment prior to admission is associated with a worse clinical picture.