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Δευτέρα 16 Δεκεμβρίου 2019

American Journal of Otolaryngology


  1. Research articleAbstract only

    Complications of bone-conduction hearing implants implantation surgery

    Timothy Shun Man Chu, Michael Mather, Anirvan Banerjee
    In Press, Journal Pre-proof, Available online 16 December 2019
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    Abstract
    Purpose
    Bone-conduction Hearing Implants (BCHIs) are surgically implanted hearing devices. As the implantation surgery involves soft tissue dissection through periosteum and drilling of skull, complications related to the skin and soft tissue remain common despite several modifications of surgical techniques over the years. This study aims to evaluate a single centre's BCHI implantation complication rates over time, identify the effects of surgical modifications, and compare these to data from the literature.
    Materials and methods
    A retrospective case review was performed on all patients who received BCHI implantation from 2013 to 2018. 11 complication rates over time were recorded. Changes to practice occurring during the study period were also recorded and their effects on complication rates were identified. A literature search was performed to identify the complication rates reported in the literature and compared with that of our cohort.
    Results
    162 BCHI implantations were performed over the 5 years. 23 articles were included in the study after the literature review process. In our cohort, complications related to skin and soft tissue were most common, which was in line with that reported in the literature. Complication rates have overall decreased following the introduction of innovative practices, including adoption of minimally-invasive single stage procedures and the training of specialist nurses.
    Conclusions
    In this study we have highlighted the changes in complication rates of BCHI implantation over time at a single centre with reference to changes in clinical practice. Continued review of practice and on-going technological developments will facilitate continued reductions in complications of BCHI surgery.
  2. Research articleAbstract only

    Pediatric tracheostomies in patients less than 2 years of age: Analysis of complications and long-term follow-up

    Brandon I. Esianor, Zi Yang Jiang, Pauleatha Diggs, Sancak Yuksel, ... Zhen Huang
    In Press, Corrected Proof, Available online 14 December 2019
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    Abstract
    Purpose
    Identify variables that are predictive of morbidity and mortality in children under the age of two undergoing tracheostomy and to provide longitudinal data on this patient population.
    Methods
    Patients were retrospectively identified using Current Procedural Terminology codes 31600, 31601, 31610 from 2009 to 2016.
    Results
    Median age at time of tracheostomy was 0.43 years (interquartile range, 0.27–0.61). Patients were followed for a median of 1.39 years (range 0.03–4.25). Overall mortality rate in this cohort was 23.5% with the majority (81.3%) of deaths occurring >30 days following tracheostomy. The most frequently encountered major complication was cardiopulmonary arrest (10.29%) in the short-term follow up period (<30 days) and accidental decannulation (32.81%) during long-term follow up (>30 days). Peristomal skin breakdown was less likely to develop in patients who did not receive paralytics following tracheostomy. Most patients (54.4%) were discharged to home following initial admission and experienced a mean of 2.10 readmissions for any reason during the follow-up period. 64.4% of patients underwent surveillance direct laryngoscopy and bronchoscopy during the follow-up period and suprastomal granuloma formation was detected in 31.2% of these patients. 9 patients underwent decannulation at a median of 2 years from original tracheostomy placement.
    Conclusion
    Pediatric patients under the age of 2 undergoing tracheostomy exhibit high morbidity during both the initial hospital admission and the subsequent months following discharge. However, major complications were low and mortality was not directly related to tracheostomy status in any case.
  3. Review articleAbstract only

    Hyaluronic acid in otology: Its uses, advantages and drawbacks - A review

    Christophe Abi Zeid Daou, Marc Bassim
    In Press, Journal Pre-proof, Available online 13 December 2019
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    Abstract
    Objectives
    Review of the literature for studies involving the use of hyaluronic acid (HA) in otology.
    Methods
    Pubmed and OvidMedline were searched using a combination of the following words in different variations: hyaluronic acid, hyaluronate, otolaryngology, otology, ear, tympanic membrane, perforation, tympanostomy, tympanoplasty, myringoplasty, packing, middle ear, cochlea, gene delivery, gene therapy, cochlear implant, hearing loss, meniere, vertigo, otitis and cholesteatoma.
    Results
    The papers relevant for this review were triaged based on abstracts and titles and were then categorized based on topic/disease entity/procedure. The papers were read and summarized in order to use their findings in this review.
    Conclusions
    HA is being recently used as adjuvant therapy for multiple inflammatory conditions and in tissue repair. These immunomodulatory properties and biocompatibility have interested researchers specially in the field of otology for repair, gene delivery, immunomodulation etc. Recent data in the field show optimistic results for the use of HA in several conditions especially tympanic membrane perforations and gene delivery. It also establishes the role of HA as ancillary treatment in many other otologic pathologies. This review presents the most recent findings on the use of HA in otology. The results could be used to guide clinical practice and incite further research based on the presented results of the literature.
  4. Research articleAbstract only

    Hearing handicap in Asian patients with dementia

    Bibek Gyanwali, Saima Hilal, Narayanaswamy Venketasubramanian, Christopher Chen, Jenny Hooi Yin Loo
    In Press, Journal Pre-proof, Available online 12 December 2019
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    Abstract
    Background
    Hearing loss and hearing handicap may contribute to cognitive impairment and dementia. The purpose of this study was to analyze the association between hearing loss and hearing handicap with dementia in an Asian memory clinic parents.
    Methods
    This study includes the data obtained from patients with mild dementia who attended the National University hospital memory clinic and non-demented healthy subjects among spouses and caregivers who are non-genetically related to our patients. All participants underwent comprehensive physical, medical, neuropsychological and audiological assessments (i.e. pure tone audiometry - PTA). Disabling hearing loss was defined as a hearing loss of >40 dB in the better ear on PTA. Amsterdam Inventory for Auditory Disability and Handicap (AIADH) questionnaire was administered through the verbal interview to measure their hearing handicap score. Linear regression models were used to investigate the association between hearing loss and hearing handicap with dementia. Mean differences (β) with 95% confidence intervals (CI) were calculated.
    Results
    91 participants (65–90 years old) were recruited for this study; 39 of them were patients with dementia and 52 were non-demented healthy controls. 48.7% of the patients with dementia had disabling hearing loss, which is higher than the non-demented controls (25.0%) (p = 0.019). The significant association between hearing handicap (as measured by AIADH) and dementia was observed, which was independent of demographic factors and audiology related history and PTA average (β = −6.40; 95% CI = −0.11.99, −0.81, p = 0.025). There was no independent association between hearing loss and dementia (p > 0.05).
    Conclusion
    A significant association between hearing handicap and dementia was found. The mechanism of this association requires further research and may involve higher order central processing disorder.
  5. Research articleAbstract only

    Short-term postoperative CPAP may improve the outcomes of velopharyngeal surgery for obstructive sleep apnea

    Guoping Yin, Mu He, Jinkun Xu, Xin Cao, ... Jingying Ye
    In Press, Journal Pre-proof, Available online 11 December 2019
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    Abstract
    Purpose
    To evaluate the effects of short-term postoperative continuous positive airway pressure (CPAP) on the outcomes of velopharyngeal surgery for obstructive sleep apnea (OSA).
    Materials and methods
    This study included 119 OSA patients who underwent velopharyngeal surgery. Based on the results of postoperative pulse oximetry, the patients were divided into 3 groups: intervention, control, and observation. Patients with oxygen desaturation index (ODI) > 10 and lowest SpO2 < 90% were randomly assigned to the CPAP intervention group and non-CPAP control. Patients with ODI ≤10 or lowest SpO2 ≥ 90% were assigned to the non-CPAP observation group. Patients in the intervention group completed at least 3 months of CPAP treatment. Postoperative polysomnography data were compared to assess the difference of prognosis between the three groups.
    Results
    Baseline data showed no significant differences between the three groups except the observational group showed a significantly larger tonsil size relative to the intervention and control groups. However, there was no significant difference in terms of tonsil size between the control and intervention groups. The surgical success rate of the intervention group was 80.65%, whereas it was 55.17% in the control group, with significant difference. The success rate of the observation group was 85.71% which was significantly different from that of the control group, but not the intervention group.
    Conclusion
    Short-term postoperative CPAP treatment may improve the outcomes of velopharyngeal surgery for OSA in patients who have respiratory events related hypoxia after surgery. Further studies are necessary for the underlying mechanisms.
  6. Research articleAbstract only

    Early discharge after free-tissue transfer does not increase adverse events

    Andrea Hanick, Joseph B. Meleca, Michael A. Fritz
    In Press, Journal Pre-proof, Available online 10 December 2019
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    Abstract
    Introduction
    Demonstrate that carefully selected free flap patients may be discharged early after surgery without increasing the rates of postoperative complications or readmissions.
    Methods
    Based on a published article in Laryngoscope 2016 of 51 free-tissue transfers, a retrospective chart review was performed on an expanded cohort who underwent free-tissue transfer for head and neck reconstruction between February 2010 and May 2018 and discharged by postoperative day 3.
    Results
    101 patients who underwent 104 free flaps with average age of 56 (3–84) years old were reviewed. Free flap indications included orbital and maxillary defects (n = 22), palatal defects (n = 16), nasal and septal defects (n = 16), cranioplasty and scalp defects (n = 16), mandibular defects due to osteoradionecrosis (n = 14), facial contouring and parotid defects (n = 12), and complex postsurgical and radiotherapy wounds or fistula closure (n = 8). Free flaps performed were anterolateral thigh (n = 97), radial forearm (n = 2), serratus (n = 2), latissimus (n = 1), fibula (n = 1) and supraclavicular (n = 1). The recipient vessels used via minimal access approaches were facial (n = 43), superficial temporal (n = 29), angular (n = 20) and others. There were 3 flap failures (2.9%) recognized in follow-up. No flap failures or perioperative complications were associated with early discharge. There were only 2 patients readmitted and 1 watched in observation within 30 days postoperatively.
    Conclusion
    An updated review of our institutional experience with more than double the cohort size substantiates previous conclusions that early discharge after free-tissue transfer is a safe option in select patients. Moreover, earlier discharge is a critical management choice that reduces cost and decreases hospital-related adverse events.
  7. Research articleAbstract only

    Impact of cochlear abnormalities on hearing outcomes for children with cochlear implants

    Evette Ronner, Razan Basonbul, Rupal Bhakta, Leila Mankarious, ... Michael S. Cohen
    In Press, Journal Pre-proof, Available online 10 December 2019
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    Abstract
    Objective
    Evaluate the impact of cochlear anomalies on hearing outcomes for pediatric patients with cochlear implants.
    Study design
    Retrospective chart review.
    Setting
    Tertiary care center.
    Subjects and methods
    Charts were retrospectively reviewed for cases where pediatric cochlear implant surgery was performed between 2002 and 2018 at a single, tertiary care institution. Patients were divided into groups based on the presence or absence of radiological cochlear abnormalities, which were further classified as low or high risk anomalies. Hearing outcomes were evaluated by measuring pure tone averages and word recognition scores preoperatively, 3 and 12 months postoperatively, in addition to the most recent test results.
    Results
    There were 154 ears implanted in our cohort of 100 patients. 107 ears had normal cochlear anatomy, 31 had low risk, and 16 had high risk abnormalities. The most common modality of preoperative imaging was CT scan. Postoperative mean pure tone average (PTA) was significantly higher in patients with inner ear anomalies compared to those with normal anatomy. No significant difference in PTA was noted between low versus high risk patients. <50% of patients had word recognition scores available within the first year following surgery.
    Conclusion
    Abnormalities of the inner ear significantly influenced hearing outcomes over time following cochlear implant surgery when compared to pediatric patients with normal anatomy. Obtaining hearing testing can be difficult in very young children and therefore future studies are warranted to further investigate the impact that cochlear abnormalities may have on hearing outcomes following cochlear implant surgery.
  8. Research articleAbstract only

    Retrospective study of Langerhans cell histiocytosis in ear, nose and neck

    Yan Guo, Fei Ning, Guojian Wang, Xiaohong Li, ... Pu Dai
    In Press, Journal Pre-proof, Available online 6 December 2019
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    Abstract
    Objective
    Langerhans cell histiocytosis (LCH) is a rare clinical disorder. We retrospectively analysed the clinical manifestations, treatments and prognoses of LCH cases involving the ear, nose, and neck.
    Materials and methods
    28 cases with confirmed LCH in ear, nose or neck were reviewed. We recorded patient age, sex, chief complaints, accompanying symptoms, lesional sites, radiological data, treatments and pathologies. Whole-exome sequencing was performed on the patient diagnosed with LCH and Treacher-Collins syndrome (TCS).
    Results
    The mean age was 14.86 years. Most LCH was in the ear (93%), usually in the mastoid. The most common symptoms were an ear mass and a purulent discharge. Imaging was not very useful. Treatments included surgery, chemotherapy, and radioactive particle implantation. Some cases exhibited multisystem involvement. Most patients enjoyed good prognoses. One patient was diagnosed with both temporal LCH and TCS. Whole-exome sequencing revealed a heterozygous c.261_272delAGGTACCCTTCC(p.87_91delRGTLPinsR) mutation in exon 2 of the POLR1D gene (NM_015972).
    Conclusion
    LCH mostly occurs in children. In head and neck it affects principally the mastoid part of the temporal bone. Treatments include surgery, chemotherapy, and irradiation. Most patients enjoy good prognoses. LCH accompanied by TCS is rare and increases the difficulty of diagnosis; molecular data aid in TCS identification.
  9. Research articleAbstract only

    Objective and subjective changes in voice after endoscopic sinus surgeries in patients with and without nasal polyps

    Eugene Hung Chih Wong, Aun Wee Chong
    In Press, Corrected Proof, Available online 5 December 2019
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    Abstract
    Background
    Many studies have looked at the effect of functional endoscopic sinus surgeries (FESS) on nasalance, nasal consonant and nasalized vowels. Only two studies investigated the effect of FESS on vocal sound quality and have not found statistically significant changes before and after operations. The aim of this study was to examine the short-term and long-term objective and subjective changes in the vocal quality of patients after FESS, comparing patients with and without nasal polyps.
    Methods
    Sixteen patients were recruited for voice analysis during pre-operative, within two weeks and at least three months post-operatively. Subjective questionnaire was used to assess perception of voice changes.
    Results
    There were no statistically significant changes in the acoustic parameters of patients with nasal polyposis. In patients with CRS without polyps, there was a statistically significant increase in fundamental frequency (F0) in nasal sound during early follow up. The changes in soft phonation index (SPI) values between the two groups were statistically significant during early follow-ups. Only patients with nasal polyposis perceived a subjective change in their voice post-operatively.
    Conclusions
    Clinicians should inform all patients, especially voice professionals about the possible effects of endoscopic sinus surgeries on their voice quality.
  10. Research articleAbstract only

    Cochlear implantation in adults with auditory deprivation: What do we know about it?

    Flavia Sorrentino, Flavia Gheller, Giuseppe Lunardi, Davide Brotto, ... Roberto Bovo
    In Press, Corrected Proof, Available online 2 December 2019
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    Abstract
    Introduction
    In the ENT community, auditory deprivation is frequently considered as a negative prognostic factor for a good hearing outcome of cochlear implantation (CI), even if a growing literature suggests that this is not completely true. The purpose of this study is to evaluate the results of CI in patients with hearing deprivation, to compare them to results from non-deprived patients and then estimate how time of deprivation impacts on CI outcome and how a bilateral deprivation can affect the outcome compared to a unilateral deprivation.
    Methods
    Seventy-eight adults with severe to profound post-verbal hearing loss, with and without auditory deprivation history, received CI; audiological results obtained at 3–6–12–24 months follow up post CI were analyzed.
    Results
    No differences were founded between patients with unilateral deprivation and patients with no deprivation. Patients with bilateral deprivation seem to have a worse hearing outcome compared to that of those patients with unilateral deprivation or no deprivation at all. Long time deprivation (>15 years) seems to have a negative influence on the hearing outcome but results with CI remain excellent.
    Conclusions
    Auditory deprivation should not be considered a contraindication to CI. The duration of auditory deprivation in the implanted ear seems to be a negative prognostic factor only for ears deprived from more of 15 years.
  11. Research articleAbstract only

    Relationship between progression of type 2 diabetes mellitus and olfactory function

    Kerem Sami Kaya, Emrah Erkan Mazı, Semra Tiryaki Demir, Fatih Tetik, ... Suat Turgut
    In Press, Corrected Proof, Available online 29 November 2019
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    Abstract
    Objectives
    In the literature, diabetes mellitus was mentioned as one of the etiologic factors of olfactory disorder. However, association between olfactory dysfunction and complications of type 2 diabetes mellitus is unclear. The aim of this study was to determine if there is any correlation between olfactory dysfunction and complications of diabetes mellitus.
    Methods
    The study population included eighty-five (85) patients with type 2 diabetes mellitus (56 females and 29 males, mean age 55.4 ± 9.4 years). The routine laboratory and ophthalmoscope examinations were used in the study. The Connecticut Chemosensory Clinical Research Center odor test was performed to all patients. Patients were grouped (normal, anosmia, mild hyposmia, moderate hyposmia, severe hyposmia) in respect to olfactory function.
    Result
    Distribution of the patients was 34.1% male (29) and 65.9% female (56). Mean Hemoglobin A1c value was 9.0 ± 2.7. The distribution of complications was 38.8% nephropathy, 25.9% retinopathy, 24.7% microalbuminuria. In Odor Test classification, statistically significant difference was not detected in nephropathy, retinopathy and microalbuminuria ratios (p = 0.523, p = 0.057, p = 0.993).
    Conclusions
    This study revealed that in odor test classification, statistically significant difference was not detected between the patients with complications (nephropathy, retinopathy, and microalbuminuria) and the patients without complications.
  12. Research articleAbstract only

    Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery

    Lei Lei, Daling Zhong, Jian Zou, Haiyang Wang, ... Fumei Wu
    In Press, Journal Pre-proof, Available online 28 November 2019
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    Abstract
    Materials and methods
    The records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed.
    Results
    A total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC–). The mortality rates were 18.1% and 3.7% in the AC+ and AC– groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC– group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%.
    Purpose
    This study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM).
    Conclusion
    AC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.
  13. Research articleAbstract only

    Efficacy of the additional effect of hyperbaric oxygen therapy in combination of systemic steroid and prostaglandin E1 for idiopathic sudden sensorineural hearing loss

    Satoshi Hara, Takeshi Kusunoki, Hirotomo Honma, Yoshinobu Kidokoro, Katsuhisa Ikeda
    In Press, Corrected Proof, Available online 27 November 2019
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    Abstract
    Purpose
    The efficacies of hyperbaric oxygen therapy (HBO), systemic steroid, prostaglandin E1, or the combination of any two modalities have been reported in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). However, little is known about the combined efficacy of HBO, systemic steroid, and prostaglandin E1 for this disorder. We aimed to investigate the efficacy of HBO combined with systemic steroids and prostaglandin E1 as triple therapy in patients with ISSNHL.
    Materials and methods
    We retrospectively evaluated the records of 67 patients with ISSNHL who were treated with systemic steroid and prostaglandin E1, with (n = 38) or without (n = 29) HBO. The inclusion criteria included a diagnosis of ISSNHL within 14 days of symptom onset, age ≥15 years, treatment according to the protocol, and clinical follow-up of at least 1 month. The patients' hearing levels were evaluated 1 month after hearing loss onset. The primary outcome was hearing improvement on pure tone audiometry. We also evaluated the demographic profiles of patients.
    Results
    Patients treated with triple therapy showed significantly greater hearing improvement (p < 0.01) than those treated without HBO, despite some differences between the two treatment groups. Multivariate logistic regression analysis revealed a significant positive correlation between pure tone audiometry improvement and hyperbaric oxygen therapy, after adjustment for confounding factors (odds ratio = 7.42; 95% and confidence interval = 2.37–23.3; p = 0.001).
    Conclusion
    HBO with systemic steroid and prostaglandin E1 administration conferred significant therapeutic benefits for ISSNHL. Therefore, routine use of triple therapy is recommended for patients with ISSNHL.
  14. Research articleAbstract only

    The anesthesia airway evaluation: Correlation with sleep endoscopy findings

    Michael Eggerstedt, Matthew J. Urban, Emily Chi, Ethan M. Ritz, Phillip Losavio
    In Press, Corrected Proof, Available online 23 November 2019
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    Abstract
    Purpose
    Drug-induced sleep endoscopy (DISE) is a cost-effective, safe, and reliable tool to evaluate obstructive sleep apnea (OSA) patients by revealing upper airway sites, patterns, and severity of obstruction. DISE provides valuable data because reliable evaluation of the OSA airway while awake has remained elusive. Few studies (with mixed results) have analyzed the correlation between pre-operation, awake airway assessments routinely performed by anesthesia and DISE results.
    Methods
    Preoperative anesthesia evaluation records and subsequent DISE reports were obtained for 99 adult patients undergoing DISE between 2016 and 2018. All patients carried the diagnosis of OSA, based on polysomnography. Anesthesia-collected variables were compared with DISE findings in an effort to determine if commonly-utilized physical exam findings correlated to patterns of upper airway collapse observed on sleep endoscopy.
    Results
    Most anesthesia preoperative evaluation variables were not found to be predictive of any identifiable patterns of collapse on DISE, including Mallampati score, ability to prognath, and overall airway assessment score. Obesity did not correlate with circumferential collapse at the velopharynx, or to multi-level collapse. Thyromental distance <6.5 cm was found to be statistically correlated to total epiglottic collapse (E = 2+). Friedman tongue position scores were found to be correlated to velopharyngeal collapse (p < 0.05).
    Conclusions
    Anesthesia airway assessment algorithms and physical exam findings do not correlate well with findings on sleep endoscopy. DISE remains the gold standard for evaluating levels of collapse and operative planning in the OSA population.
  15. DiscussionAbstract only

    Endolymphatic hydrops evaluation on MRI: Practical considerations

    Rafael Maffei Loureiro, Daniel Vaccaro Sumi, Hugo Luis de Vasconcelos Chambi Tames, Carolina Ribeiro Soares, ... Mauro Miguel Daniel
    In Press, Corrected Proof, Available online 23 November 2019
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    Abstract
    Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Ménière's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space.
    In patients with a unilateral clinical presentation of Ménière's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Ménière's disease tends to undergo bilateral evolution over time.
  16. Research articleAbstract only

    Relationship between inflammation and the severity of Recurrent Respiratory Papillomatosis

    Vivian Narana Ribeiro El Achkar, Andressa Duarte, Román Carlos, Jorge Esquiche León, ... Estela Kaminagakura
    In Press, Corrected Proof, Available online 18 November 2019
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    Abstract
    Objective
    To characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale.
    Materials and methods
    The data and biopsies from 36 patients with Juvenile (JRRP) and 56 patients with Adult (ARRP) were collected and analyzed under light microscopy. The patients were separated into groups according to the Derkay index: ≥20 for the most severe and < 20 for the less severe cases. Immunohistochemical analysis using CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 antibodies was performed, and the inflammatory cells were quantified. All the clinicopathological characteristics and the results of the immunohistochemical analysis were compared among the groups proposed using the Chi-Square test and correlated through the Spearman correlation test.
    Results
    The ARRP showed significantly higher quantities of CD3+, CD8+ and MUM1+ cells (p < .05) than the JRRP samples. The presence of CD15+ cells showed positive correlation with the Derkay index (p < .05), while the MUM-1+ cells showed an inverse correlation (p = .01).
    Conclusion
    There are differences between the inflammatory cells population in the juvenile and adult groups and it can be related to disease severity.
  17. Research articleAbstract only

    Investigation of vitamin D levels in patients with Sudden Sensory-Neural Hearing Loss and its effect on treatment

    Hossein Ghazavi, Amir-Abbas Kargoshaie, Mohammad Jamshidi-koohsari
    In Press, Corrected Proof, Available online 12 November 2019
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    Abstract
    Background
    Due to high prevalence of vitamin D deficiency and the possible association with Sudden Sensory-Neural Hearing Loss (SSNHL) finding the main causes and appropriate treatments are highly essential. This study aimed to investigate vitamin D levels in patients suffering SSNHL and its effect on response to treatment.
    Materials and methods
    This cross-sectional study was performed on two groups of case (34 SSNHL patients) and control (34 healthy subjects without risk of hearing loss). All patient information such as age, sex, audiogram illustration of hearing frequency and the level of vitamin D were recorded at baseline. Patients with SSNHL received routine treatments such as 10 days of 1 mg/kg/day steroid and the response or lack of complete response to treatment was recorded and analyzed according to the audiometry.
    Results
    Vitamin D level in SSNHL group with a mean of 19.28 ± 9.56 ng/ml was significantly less than the control group (25.71 ± 11.21 ng/ml; P value < 0.001). After treatment, 76.5% were completely recovered and 23.5% did not recover completely. Factors such as age, sex and level of initial hearing loss did not have a significant effect on the response to treatment, but the level of vitamin D in these patients had a significant relationship with the response to treatment (P value = 0.004); so that all patients with sufficient vitamin D level had completely recovered, versus 87.5% of patients with vitamin D deficiency and 12.5% of insufficient vitamin D had no response to treatment.
    Conclusion
    According to the results of the present study, the prevalence of vitamin D deficiency in patients with SSNHL was more than healthy people. SSNHL patients with deficient vitamin D had the highest percentage of no response to treatment.
  18. CorrespondenceNo access

    Osteoradionecrosis of the mandible: Why not to be more aggressive in earlier stage?

    Nidal F. AL Deek
    In Press, Corrected Proof, Available online 12 November 2019
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  19. Research articleAbstract only

    Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in children

    Osama G. Abdel-Naby Awad
    In Press, Journal Pre-proof, Available online 12 November 2019
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    Abstract
    Purpose
    Recurrent tonsillitis in children is a common disease affecting children quality of life and extends to their families. The aim of this study was to assess the effect of combined use of oral Azithromycin (AZT) plus Echinacea compared to exclusive use of AZT in children with recurrent tonsillitis.
    Material and methods
    A prospective comparative study including three groups of children with recurrent tonsillitis. Group 1: (100 patients) had no prophylactic treatment. Group 2 (100 patients) received [60 mg/kg] prophylactic dose of AZT divided as (10 mg/kg/day) over 6 consecutive days every month for 6 consecutive months. Group 3 (100 patients) received AZT as in group 2 plus commercially available Echinacea in a dose of 5 ml oral suspension; 3 times daily for 10 consecutive days every month for 6 consecutive months. Number of tonsillitis attacks and severity of tonsillitis symptoms were assessed and compared in different groups.
    Results
    Group 2 and group 3 had significant less number of tonsillitis attacks and severity of assessed symptoms during 6 months of prophylactic treatment with significant better results in group 3 (i.e. AZT plus Echinacea) compared to group 2 (I.e. AZT alone). However; there was no significant difference in patients with any prophylaxis.
    Conclusion
    The combined use of Echinacea with Azithromycin produced favorable outcome than Azithromycin alone in pediatric patients with recurrent tonsillitis.
  20. Research articleAbstract only

    Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomy

    Thomas H. Fitzpatrick, Benjamin D. Lovin, Marcus J. Magister, Joshua D. Waltonen, ... Christopher A. Sullivan
    In Press, Corrected Proof, Available online 12 November 2019
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    Abstract
    Eagle Syndrome (ES) is a rare disorder that can present with symptoms ranging from globus sensation to otalgia that is attributed to an elongated styloid process and/or calcified stylohyoid ligament. No standardized treatment algorithm exists, and although various surgical approaches have been described, data on the use of transoral robotic surgery (TORS) in this population is limited. To investigate the utility of TORS in the treatment of ES, a retrospective review in 19 ES patients was carried out at a single academic, tertiary medical center between 2000 and 2017. Nineteen patients underwent twenty-one styloid resections: 6 performed via TORS and 15 via transcervical approach. Across all patients, 90% reported some degree of lasting improvement in symptoms while 55% reported significant improvement. When TORS was compared to transcervical resection, there was no difference in the subjective rate of “meaningful” (83 vs. 57%) versus rate of “non-meaningful” symptom improvement (17 vs. 43%) (p = 0.35). There was a trend towards less estimated blood loss (EBL), operative time, and post-operative length of stay (LOS) with TORS versus transcervical cases (9.2 mL vs. 30.0 mL, 98 vs. 156 min, and 0.7 vs. 1.2 days); however, these did not reach statistical significance (p = .11, 0.13, and 0.42, respectively). Three patients experienced complications associated with an open approach, as compared to none with TORS. In select patients, TORS styloidectomy is a reasonable surgical alternative to traditional transoral and transcervical techniques as it provides similar symptom improvement, and reduced length of stay, blood loss, and operative time.









  1. Research articleAbstract only

    Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgery

    Michael J. Eliason
    In Press, Corrected Proof, Available online 11 November 2019
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    Abstract
    Purpose
    Endoscopic sinus surgery (ESS) is the mainstay for chronic inflammatory and neoplastic sinonasal process and as a result many modalities have been studied to minimize blood loss and patient morbidity and to maximize intraoperative visualization. However, often conclusions of actual blood loss are based on surgeons' estimations without ever actually assessing the accuracy of these estimations. The objective of this study was to determine the accuracy of intraoperative blood loss estimates by attending otolaryngology surgeons among patients undergoing ESS.
    Materials and methods
    After obtaining institutional review board approval, data were collected on six surgeons performing ESS at a military academic medical center for 21 surgical cases. Specifically, both hourly and end-of-case total “estimated” (EBL) and “calculated actual” (ABL) blood loss values were recorded and compared statistically. Surgeons were blinded to the results until after all data were collected.
    Results
    The difference between mean EBL and ABL was 62.5 ml and was statistically significant (p = .007, Power 86.2%). EBL lagged ABL for both hourly intervals during a surgical case and the total end-of-surgery values.
    Conclusion
    The surgeons studied had EBL that were statistically significantly less than ABL both at hourly intervals during the surgery and at the conclusion of the case. As a result there exists potential for adverse consequences in clinical care and in efforts in medical research/advancement.
  2. Research articleAbstract only

    Cerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infection

    Shoude Zhang, Mao Jin, Guojin Zhou, Yuejiao Zhang
    In Press, Corrected Proof, Available online 7 November 2019
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    Abstract
    Objective
    This study investigated the exact composition and tried to be helpful in explaining the etiologic mechanism of cerumen impaction in the external auditory canal (EAC).
    Methods
    A hundred impacted cerumen samples and 15 normal cerumen samples were collected by manual removal and divided into 2 groups. All samples were examined via microbial culture, hematoxylin–eosin staining, periodic acid–Schiff staining, and fungal fluorescent staining.
    Results
    Eighty-eight patients in group 1 were in the habit of using cotton buds. Forty-seven impacted cerumen samples tested positive for microbes, while only 1 sample of normal cerumen tested positive for microbes (p < .05). The most commonly isolated bacterium and fungus was Staphylococcus aureus and Aspergillus terreus respectively. All cerumen samples were composed of exfoliated keratinocytes and microorganisms assessed via pathologic examination. However, unlike normal cerumen, impacted cerumen contained nucleated keratinocytes and infiltrated neutrophils. Recurrent impaction was found only among patients who tested mold culture-positive.
    Conclusion
    Impacted cerumen is composed of abnormal exfoliated keratinocytes that was correlated with microbial-induced neutrophil-mediated inflammation. Mold infection is highly correlated with recurrent cerumen impaction. Microbial culture of removed impacted cerumen is strongly recommended. Ear cleaning with cotton buds, particularly when the EAC is wet might be one of the important causes of cerumen impaction which is need further studied.
    Level of evidence
    2b.
  3. Research articleAbstract only

    Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting

    Danny Jandali, Sarah Shearer, Richard Byrne, Peter Papagiannopoulos, ... Pete S. Batra
    In Press, Corrected Proof, Available online 29 October 2019
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    Abstract
    Introduction
    Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction.
    Methods
    Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.
    Results
    83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.
    Conclusion
    Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.
  4. Research articleAbstract only

    Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation

    J. Eric Lupo, Allison Biever, David C. Kelsall
    In Press, Corrected Proof, Available online 11 September 2019
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    Abstract
    Purpose
    To comprehensively assess and describe functional auditory performance in a group of adults with bilateral, moderate sloping to profound sensorineural hearing loss who were dissatisfied users of well-fit bilateral hearing aids and presented for Cochlear implant evaluation. Participants were evaluated with bilateral hearing aids and after six months of bimodal (Cochlear implant and a contralateral hearing aid) hearing experience with a Cochlear implant and contralateral hearing aid.
    Methods
    Study participants were assessed using pure tone audiometry, aided speech understanding in quiet (CNC words) and in noise (AzBio sentences at +10 and +5 dB SNR) in the sound field with unilateral and bilateral hearing aids fit to target. Participants completed subjective scales of quality of life, (Health Utilities Index Mark 3), hearing disability, (Speech, Spatial and Qualities of Hearing Scale) and a device use satisfaction scale. Participants ≥55 years were administered the Montreal Cognitive Assessment screening tool. One-hundred enrolled individuals completed baseline evaluations.
    Results
    Aided bilateral mean speech understanding scores were 28% for CNC words and 31%, and 17% for AzBio sentences at a +10 dB, and +5 dB SNR, respectively. Mean scale ratings were 0.46 for overall quality of life and 3.19 for functional hearing ability. Ninety percent of participants reported dissatisfaction with overall hearing performance.
    Conclusions
    Evaluation results, including functional performance metrics quantifying the deleterious effects of hearing loss for overall wellbeing, underscore that bilateral hearing aids are not an effective treatment for individuals with bilateral, moderate sloping to profound sensorineural hearing loss. Individuals with this degree of hearing impairment, who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life, require timely referral to a Cochlear implant clinic for further evaluation.
  5. Research articleAbstract only

    Olfaction in juvenile nasopharyngeal angiofibroma: The first study

    Anupam Mishra, Pankaj Pandey, Subhash Chandra Mishra
    In Press, Journal Pre-proof, Available online 10 September 2019
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    Abstract
    Background
    To study the pattern of olfactory dysfunction/recovery in juvenile nasopharyngeal angiofibroma (JNA).
    Methods
    Olfactory assessment was undertaken in 30 patients (category1) both pre- & post-operatively and in another 18 (category 2) only postoperative. All patients underwent transpalatal excision and variables of interest included age, radiological stage/parameters & tumor size.
    Results
    Objective olfactory dysfunction was seen in 60% while involvement of olfactory strip was suggested in 50%. Despite some marginal trends only noted between size/age with change of olfaction, Pearson's correlation test did not reveal any significance amongst multiple variables. However a better recovery of olfaction following surgery was evident in Category-2 where Chi-Square test (p < 0.05) significantly revealed this to be a function of postoperative duration. This regenerative course in JNA suggests an optimum period of 4 years for full recovery after surgery.
    Conclusion
    In this first study of olfaction in JNA many new trends have been appreciated. In general, deteriorations of olfaction were seen due to ‘vascular-concussion’ effect in early postoperative phase where post-surgical clearance of airway showed minimal effect in terms of improvement. The hypervascularity of olfactory epithelium with possible hormonal effects may be responsible for the unique pattern of olfactory function and recovery in JNA.
  6. Research articleAbstract only

    Quality of life outcomes after transmastoid plugging of superior semicircular canal dehiscence

    Tristan Allsopp, Alexandrea H. Kim, Alexa M. Robbins, Joshua C. Page, John L. Dornhoffer
    In Press, Corrected Proof, Available online 9 September 2019
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    Abstract
    Purpose
    This study was performed to evaluate the effectiveness and impact on quality of life in patients undergoing plugging of superior semicircular canal dehiscence using the transmastoid approach.
    Materials and methods
    Retrospective chart review with prospective outcomes assessment, using validated quantitative scoring systems, was performed on 10 patients (23–76 years) who underwent transmastoid plugging of superior semicircular canal dehiscence between February 2014 and February 2018 at a tertiary referral center. Pre-operative and post-operative autophony and vertigo were measured by The Autophony Index and the Dizziness Handicap Index. Overall quality of life following intervention was measured by the Glasgow Benefit Inventory. Subjective improvement, audiological changes, and subjective quality of life changes were also recorded.
    Results
    A significant reduction in the total Dizziness Handicap Index was seen following transmastoid repair of superior semicircular canal dehiscence (p = 0.0078). This was also evident when subgroup analysis of the Dizziness Handicap Index was performed, as physical (p = 0.0273), emotional (p = 0.0078), and functional subgroups were all significantly reduced (p = 0.0117). Autophony was also significantly reduced following intervention (p = 0.0312). Overall quality of life was seen to be improved following surgery as measured by the Glasgow Benefit Inventory (p = 0.0345).
    Conclusion
    Our data suggest that transmastoid plugging of a dehiscence in the superior semicircular canal is a safe and effective means of improving autophony, dizziness and overall quality of life in these patients. We believe that these results should be taken into consideration in discussions regarding surgical approach for patients who are contemplating this procedure.
  7. Research articleAbstract only

    Utility of videolaryngoscopy for diagnostic and therapeutic interventions in head and neck surgery

    Jared A. Shenson, Stephen Marcott, Karuna Dewan, Yu-Jin Lee, ... Davud B. Sirjani
    In Press, Journal Pre-proof, Available online 4 September 2019
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    Abstract
    Background
    Videolaryngoscopy is commonly used by anesthesiologists to manage difficult airways. Recently otolaryngologists have reported use in select procedures; to date there is limited evaluation in head and neck surgery.
    Materials and methods
    Patients who underwent direct laryngoscopy (DL) with use of GlideScope videolaryngoscopy (GVL) were retrospectively identified from a tertiary care Veterans Affairs hospital. GVL was used to assist or replace traditional laryngoscopes for diagnostic and therapeutic procedures.
    Results
    Nineteen patients (48–83 years old) underwent 21 procedures. Difficult endotracheal intubation was reported in 53% of patients. GVL replaced traditional DL in 76% of cases, assisted evaluation prior to traditional DL in 10%, and rescued failed traditional DL in 14%. No complications occurred. Three indications for GVL were identified.
    Discussion
    GVL was safe in our experience and provides unique benefits in selected scenarios in head and neck surgery. Otolaryngologists can consider videolaryngoscopy as a complement to traditional DL.
  8. Research articleAbstract only

    3D printed temporal bone as a tool for otologic surgery simulation

    Dominick J. Gadaleta, Denis Huang, Nicholas Rankin, Victor Hsue, ... Bon Ku
    In Press, Journal Pre-proof, Available online 2 August 2019
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    Abstract
    Purpose
    In this face validity study, we discuss the fabrication and utility of an affordable, computed tomography (CT)–based, anatomy-accurate, 3-dimensional (3D) printed temporal bone models for junior otolaryngology resident training.
    Materials and methods
    After IRB exemption, patient CT scans were anonymized and downloaded as Digital Imaging and Communications in Medicine (DICOM) files to prepare for conversion. These files were converted to stereolithography format for 3D printing. Important soft tissue structures were identified and labeled to be printed in a separate color than bone. Models were printed using a desktop 3D printer (Ultimaker 3 Extended, Ultimaker BV, Netherlands) and polylactic acid (PLA) filament. 10 junior residents with no previous drilling experience participated in the study. Each resident was asked to drill a simple mastoidectomy on both a cadaveric and 3D printed temporal bone. Following their experience, they were asked to complete a Likert questionnaire.
    Results
    The final result was an anatomically accurate (XYZ accuracy = 12.5, 12.5, 5 μm) 3D model of a temporal bone that was deemed to be appropriate in tactile feedback using the surgical drill. The total cost of the material required to fabricate the model was approximately $1.50. Participants found the 3D models overall to be similar to cadaveric temporal bones, particularly in overall value and safety.
    Conclusions
    3D printed temporal bone models can be used as an affordable and inexhaustible alternative, or supplement, to traditional cadaveric surgical simulation.
  9. Research articleNo access

    Incidental Thyroid cancer in patients undergoing surgery for hyperthyroidism

    Yogesh More, Aly Bernard Khalil, Huda Mustafa, Manjiri Gupte, ... Shaik Irfan Basha
    In Press, Corrected Proof, Available online 11 March 2019
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  10. Research articleAbstract only

    Pediatric ear foreign body retrieval: A comparison across specialties

    Katie Mingo, David Eleff, Samantha Anne, Kyra Osborne
    In Press, Corrected Proof, Available online 15 February 2019
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    Abstract
    Objectives
    To analyze what characteristics of patients and/or ear foreign bodies should prompt referral to otolaryngology with the goal to maximize successful removal and minimize complications.
    Methods
    This was a retrospective chart review of pediatric patients who presented for ear foreign body removal from January to December 2016 at a tertiary hospital center. Data collection included successful removal, major or minor complications, use of general or conscious sedation, use of otic or oral antibiotics, age of patient, comorbid behavioral disorders, and foreign body characteristics. Major complications included tympanic membrane perforation or ossicular damage. Minor complications included injury of the canal wall. Patients with retained or extruded tympanostomy tubes were excluded.
    Results
    Of 275 patients aged 1–18 years, 16% presented initially to otolaryngology (ENT), 48.4% presented to the emergency department (ED), 21.8% presented to a pediatrician, and 13.8% presented to ENT after prior attempts at removal. Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). Retrieval by ENT after prior failed attempts had the highest rate of minor complications (26.3% vs 2.3–6.0%). There were two tympanic membrane perforations that were noted by ENT after prior failed attempts. Rate of operative intervention was significantly higher in patients who presented to ENT after prior attempts compared to patients who presented initially to ENT (34.2 vs 4.6%, p = 0.001). Of the patients who presented to ENT after previous failed attempts, there was a higher rate of complications and operative intervention if the patient was age 5 or under or the foreign body was difficult to grasp.
    Conclusions
    Pediatric ear foreign body presentation is common. Repeated attempts at removal are associated with higher rates of minor complications and operative intervention. Early consultation to otolaryngology should be considered if the foreign body is deemed difficult to grasp such as a bead or stone, especially if the patient is age five or younger.
  11. Research articleAbstract only

    Impact of allergic rhinitis on quality of life after powered intracapsular tonsillectomy and adenoidectomy

    Su Jin Kim, Ho Yun Lee, Jung Wook Kang, Oh. Eun Kwon, Kun Hee Lee
    In Press, Corrected Proof, Available online 22 January 2019
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    Abstract
    Background
    Allergic rhinitis (AR) has been reported to worsen quality of life (QoL) after adenotonsillectomy. Although powered intracapsular tonsillectomy and adenoidectomy (PITA) has been widely performed, it is not clear whether comorbid AR may worsen QoL in patients who undergo PITA.
    Purpose
    To evaluate QoL after PITA in relation to AR.
    Methods
    Children undergoing PITA for sleep-disordered breathing were enrolled and divided into AR and non-AR groups. QoL was evaluated using serial applications of the Obstructive Sleep Apnea-18 (OSA-18) questionnaire and compared between the two groups.
    Results
    Of 151 enrolled patients, 73 were categorized into the AR and 78 into non-AR groups. After surgery, patients exhibited marked improvement in OSA-18 scores in both groups, with similar results at each follow-up. The degree of improvement in OSA-18 scores was less in the AR group 3 months after surgery; however, this difference was not significant 6 months after surgery.
    Conclusions
    Although comorbid AR may initially appear to impede improvement in QoL after PITA, QoL was improved similarly 6 months after PITA, irrespective of AR status. In children with comorbid AR, PITA could be safely performed to treat sleep-disordered breathing without concerns regarding worsening of QoL.



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