The journal of international advanced otology最新文献

Background: Acute mastoiditis (AM), a complication of acute otitis media, remains a concern despite medical advancements and often leads to severe complications such as cerebral sinus vein thrombosis (CSVT). This study aimed to characterize the clinical, microbiological, and hematological aspects of CSVT secondary to AM in children while assessing the necessity of thrombophilia evaluation in these patients.

Methods: A retrospective analysis was conducted on pediatric patients with CSVT secondary to AM between January 2015 and December 2022. This study examined clinical data, laboratory and microbiological results, imaging studies, treatment approaches, and patient outcomes.

Results: Seventeen pediatric patients with a mean age of 3 years were included in this study. Most patients were female (76.5%) and of Jewish ethnicity (82.4%). Group A Streptococcus is the primary pathogen responsible for this condition. The treatment plan involved the administration of intravenous antibiotics and surgical intervention, including cortical mastoidectomy and ventilation tube insertion. Additionally, anticoagulation therapy with Clexane® was initiated and continued for at least 3 months post event. Follow-up imaging revealed recanalization in most cases within an average of 3 months. Hematologic follow-up revealed no recurrent thrombotic events and low thrombophilia incidence.

Conclusion: Cerebral sinus vein thrombosis following AM is a provoked thrombotic event effectively managed with Clexane®. Thrombophilia evaluation may be reserved for patients with a high suspicion of underlying hematological conditions. Follow-up imaging within 3 months post event may be premature.

Background: Primary ciliary dyskinesia (PCD) is a rare genetic disorder that affects the respiratory and auditory systems. This study aims to assess the prevalence, type, and severity of bilateral hearing loss (HL) in PCD and Kartagener syndrome (KS) patients, examining age-related differences and chronic impacts of otologic pathologies.

Methods: A total of 19 patients (38 ears), including 6 children and 13 adults, were evaluated from June to September 2021. Comprehensive clinical examinations included otoscopy, tympanometry, and pure tone audiometry (PTA) for air and bone conduction. Tympanometry findings were compared with otoscopic results. Statistical analyses were conducted using SPSS v16.0 (SPSS Inc.; Chicago, IL, USA), with a significance threshold of P ≤ .05.

Results: Hearing loss was identified in 42.1% of patients, with conductive HL predominant in children (3 out of 4), while mixed HL was more common in adults (3 out of 4). Tympanometry results showed 57.9% type A and 42.1% type B findings, correlating with otoscopic observations. Chronic otitis media with effusion (OME) and tympanosclerosis (TS) were the primary pathologies contributing to middle ear damage. Age was significantly correlated with HL severity (P= .005). Mild HL was most common (62.5%), followed by moderate HL (25%) and moderately severe HL (12.5%).

Conclusion: This study identifies distinct age-related patterns in the type and severity of HL among PCD patients, with sensorineural components observed in adults due to progressive middle ear damage. Audiological evaluations are essential for identifying these complications. Further research is needed to optimize treatment approaches and understand the progression of HL in PCD/KS patients.

Background: Debates and research about otosclerosis and stapes surgery have continued since the time it was described, and there is still no consensus on many issues. The aim of this article is to report the controversies in the etiology, pathophysiology, diagnosis, imaging, treatment, and management of otosclerosis and address the points of consensus of experts.

Methods: In the last session of the Fifth International Otosclerosis and Stapes Surgery Symposium held in Brussels, a round table meeting was held where controversial issues in otosclerosis and stapes surgery were discussed, and a survey was administered to all participants. Nine experienced panelists were interviewed by the moderator on stage, and 166 participants provided their answers interactively through the online voting system.

Results: All of the panelists were experts in their field who had performed more than 1000 cases, and if we take into account the more experienced participants, the results are based on at least 16 968 stapes surgery experiences. While full consensus was reached by the expert panelists on 14 questions, agreement was reached by participants on only 2. The most striking difference between the panelists and attendees was regarding reparative granuloma.

Conclusion: Even if a consensus was reached on some issues, controversies, especially the surgical technique, medical equipment and prostheses used are subjects to both discussion and development. Even the experts who come to present and share knowledge do not always agree. It is strongly recommended that clinicians follow all developments, compare their results with those of others, and use the techniques and materials with which they feel most comfortable for their patients.

Background: Endoscopes play an important role in otologic surgery. Baby shampoos, known for their hypoallergenic, anti-irritant, and antifogging properties, are increasingly being used. The purpose of this study was to evaluate the safety and ototoxic effects of baby shampoo in an animal model using both electrophysiological and histological methods.

Methods: Twenty-eight male Sprague-Dawley rats were divided into 4 groups: 7 control (group 1), 7 saline (group 2), 7 isopropyl alcohol (70%) + chlorhexidine (2%) antiseptic (group 3), and 7 baby shampoo (group 4). Baseline hearing was assessed by auditory brainstem response (ABR). All groups except the control received 3 doses of their respective substances by intratympanic injection. Auditory brainstem response measurements were performed on day 7 and day 21, after which the temporal bones were dissected. Histological evaluation of the cochlea and vascular endothelial growth factor (VEGF) immunoreactivity studies were performed.

Results: Baseline hearing thresholds were similar and within normal limits. On days 7 and 21, hearing thresholds were significantly impaired at all frequencies in the experimental groups. In particular, groups 3 and 4 had higher thresholds than the other groups. Baby shampoo caused significant damage to outer hair cells and sustentacular cells and decreased VEGF immunoreactivity in the stria vascularis, spiral ligament, and organ of Corti.

Conclusion: Baby shampoo was found to progressively impair hearing over time, indicating its potential to cause long-term ototoxicity.

Background: The aim of this study is to compare patients who develop facial nerve stimulation (FNS) after cochlear implantation (CI) and are managed with a triphasic stimulation pulse pattern (TPP) to those who do not develop FNS regarding the behavioral mapping parameters including the most comfortable loudness level (MCL) charge and amplitude, and the threshold level (THR), as well as the electrophysiological mapping parameters including phase duration (PD) and impedance level.

Methods: A retrospective chart review of the patients who developed FNS at any point after device activation and were managed with TPP was carried out. Electrophysiological and behavioral mapping parameters were retrieved from the programming software database at 3 time points: the time of implantation, the time of shift to TPP, and the last programming session. A control group with no FNS was matched randomly to evaluate any difference in the mapping parameters that could be attributed to FNS.

Results: Sixteen ears with FNS were found to be eligible for inclusion in this study. These cases were matched to 16 ears in the control group. The programming was changed from biphasic pulse pattern (BPP) to TPP (time point -1) after a period of 22.37 ± 14.62 months. Resolution of FNS was achieved in 14 ears (87.5%) by using TPP alone.

Conclusion: The TPP mapping strategy, in addition to decreased phase duration, showed successful results in managing facial nerve stimulation while allowing an increase in the hearing level in the form of increased MCL amplitude.

A port-wine stain (PWS) or nevus flammeus is a congenital capillary malformation that often affects the skin of the head and neck region. Little is known about neuro-otological manifestations associated with this birthmark. We describe 2 patients with a hemifacial PWS and sensorineural hearing loss, caused by involvement of the internal auditory canal (IAC) and inner ear structures. Case one had a history of sudden vestibular hypofunction, followed by high-frequency sensorineural hearing loss 2 years later. In the second case, the exact onset of the high-frequency hearing loss could not be determined. In both patients, magnetic resonance imaging (MRI) showed dural enhancement of the IAC and a loss of T2 signal intensity of the ipsilateral labyrinth. This report shows that a PWS of the head and neck region may be associated with dural thickening within the IAC and secondary inner ear dysfunction. In patients with this capillary malformation suffering from hearing impairment or balance problems, MRI is warranted to detect involvement of the ipsilateral dura and labyrinth.

Background: Vestibular schwannoma (VS) management decisions are made within multidisciplinary meetings (MDMs). The improved accuracy of volumetric compared to linear tumor measurements is well-recognized, but current volumetric evaluation methods are too time-intensive. The aim was to determine if the availability of fully automated volumetric tumor measures during MDM preparation resulted in different radiological outcomes compared to a standard approach with linear dimensions, and whether this impacted the clinical management decisions.

Methods: A prospective cohort study evaluated 50 adult patients (mean age 64.6, SD 12.8; 24 male, 26 female) with unilateral sporadic VS. Two simulated MDMs were convened using different methods to measure tumor size during radiology preparation: MDM-mlm used linear tumor dimensions, while MDM-avm was provided with fully automated deep learning-based volume measurements. Interval changes in VS size from the index to final and penultimate to final magnetic resonance imaging (MRI) studies defined the radiological outcomes. The subsequent clinical MDM outcomes were classified. Wilcoxon signed rank tests compared the radiological classification of VS size change and the management outcomes between the MDM-mlm and the MDM-avm.

Results: The 57 interval MRI comparisons in 33 patients showed a significant difference in the classification of VS size change between the MDM-mlm and MDM-avm for all intervals (z=2.49, P=.01). However, there was no significant difference in the resulting management decisions between the 2 MDMs (z=0.30, P= .76).

Conclusion: Provision of fully automated VS volume measurements to "real-world" MDM preparation significantly impacted the radiological classification of VS size change but did not influence management decisions.

Background: External auditory canal (EAC) squamous cell carcinoma (SCC) is classified as a rare cancer and has a poor prognosis at advanced stages. Mechanical stress has been implicated in external auditory canal squamous cell carcinoma (EACSCC), but the molecular mechanism has not been elucidated. Mechanotransduction is well-known for Yes-associated protein (YAP) signaling. When YAP is translocated to the nucleus, the L1 cell adhesion molecule (L1CAM) is activated as an effector of mechanotransduction. Core fucosylation of L1CAM by Fucosyltransferase 8 (FUT8) has been implicated in the degree of tumor malignancy, modulating cleavage of the extracellular domain of L1CAM. Methods: In this study, an expression analysis of YAP, L1CAM, and FUT8 was performed by stretch assay in vitro. Immunohistochemistry was also performed in human EACSCC and normal skin specimens. Results: The labeling index of FUT8-positive cells exhibited YAP nuclear translocation under stretch stress was significantly higher in a human SCC cell line (HSC1) than in a human keratinocyte cell line. Stretch stress significantly increased the expression levels of full-length L1CAM in HSC1 cells. Moreover, colocalization of FUT8 and L1CAM was demonstrated immunohistochemically in advanced human EACSCC tissues. Conclusion: These results suggested that L1CAM expression is increased under mechanotransduction and may possibly avoid L1CAM cleavage by FUT8 modulation.