select article Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic reviewReview articleAbstract only
Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review
Margherita Tofanelli, Vincenzo Capriotti, Carmelo Saraniti, Alberto Vito Marcuzzo, ... Giancarlo TirelliIn Press, Journal Pre-proof, Available online 4 February 2020Purchase PDF
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Abstract
Abstract
Background
Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system.
Methods
The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type.
Results
Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automated endoscope reprocessing (AER) and safe for patients and health-care workers. TTWS represented cheaper system than AER or sheaths in low- and medium-volume centers.
Conclusion
TTWS could be a valid, safe and fast HLD method for nasopharyngoscopes, with reasonable costs for medium-low reprocessing volumes.
select article Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigoResearch articleAbstract only
Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo
Yue Lou, Miao Cai, Liangguo Xu, Yanwen Wang, ... Xiaoli LiuIn Press, Journal Pre-proof, Available online 4 February 2020Purchase PDF
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Abstract
Abstract
Objectives
To evaluate the efficacy of automatic benign paroxysmal positional vertigo (BPPV) diagnosis and treatment system for BPPV compared with the manual repositioning group.
Methods
Two hundred thirty patients diagnosed as idiopathic BPPV who were admitted from August 2018 to July 2019 in Zhejiang Hospital were included. Among them, 150 patients of posterior semicircular canal BPPV(pc-BPPV), 53 patients of horizontal semicircular canal BPPV(hc-BPPV), and 27 patients of horizontal semicircular canal calculus (hc-BPPV-cu) were randomly treated with BPPV diagnosis and treatment system(the experimental group) or manual repositioning (the control group). Resolution of vertigo and nystagmus on the Dix-Hallpike and Roll test on day 3,day 7,day 14 and day 28 follow-up after first treatment was the main outcome measure to assess the efficacy of treatment.
Results
At 3-day and 7-day follow-up after treatment with BPPV diagnosis and treatment system, 79%, 91%had complete resolution of vertigo and nystagmus, the effective rate in the experimental group were significantly higher than those in the control group, the differences were statistically significant(P < .05). On day 14, the effective rate in the experimental group (96%) was slightly higher than that in the control group(91%), but there was no significant difference between the two groups. And at 28-day after the first treatment, the effective rate was 100% in the experimental group and the control group. The repositioning efficiency of pc-BPPV (the first, second, third treatment), hc-BPPV (the first, second, third treatment), hc-BPPV-cu(the first, second treatment) in the experimental group were higher than the control group, and the secondary reposition of pc-BPPV in the experimental group was significantly higher than the control group(96%vs.84%; P < .05). While for the hc-BPPV-cu patients, the effective rate of the third treatment in the experimental group was slightly lower than that of the control group, but the differences were not statistically significant.
Conclusions
BPPV diagnosis and treatment system is effective for the treatment of BPPV, with a better effective rate than those treated with manual maneuver, and is safe and easy to perform on patients.
select article Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective non-randomized studyResearch articleAbstract only
Identifying early postoperative serum parathyroid hormone levels as predictors of hypocalcaemia after total thyroidectomy: A prospective non-randomized study
Andro Košec, Filip Hergešić, Filip Matovinović, Ivan Rašić, ... Vladimir BedekovićIn Press, Journal Pre-proof, Available online 4 February 2020Purchase PDF
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Abstract
Abstract
Objective
There is no clear cut-off value of serum parathyroid hormone (PTH) or calcium in which patients are at risk for hypocalcemia after total thyroidectomy. We evaluated the usefulness of serum calcium and PTH concentration measurements after total thyroidectomy in predicting late-occurring hypocalcemia.
Design
A prospective, single-center, non-randomized longitudinal cohort study of 143 patients undergoing thyroidectomy between August 2019 and December 2019 with serum calcium and PTH levels sampled 1 h after surgery and on the first and fifth postoperative day. Hypocalcemia was defined as serum calcium levels < 2.14 mmol/L regardless of clinical symptoms. Normal PTH range was 1.6–6.9 pmol/L.
Measurements
The primary outcome measure was presence of hypocalcemia on the first and fifth postoperative day, analyzed by a logistic regression model. The PTH cut-off value for prediction of hypocalcemia was identified using a ROC curve comparing all three time points using the Youden J index.
Results
Out of 143 patients, 52 (36.4%) had hypocalcemia on the fifth postoperative day. Advanced age, concomitant neck dissection and serum PTH levels < 2.9 pmol/L 1 h after surgery and on the first postoperative surgery day were associated with a high risk of hypocalcemia on the first and fifth postoperative day and need for higher doses of calcium supplements (P < 0.0001, AUC 0.748, 95% CI 0.669–0.817, with 76.92% sensitivity and 71.43% specificity).
Conclusion
Serum PTH level measured immediately postoperatively and on the first postoperative day is a reliable predictor of postoperative hypocalcemia with important clinical implications.
select article Ludwig's angina and steroid use: A narrative reviewReview articleAbstract only
Ludwig's angina and steroid use: A narrative review
Abigail Tami, Sammy Othman, Architha Sudhakar, Brian J. McKinnonIn Press, Journal Pre-proof, Available online 1 February 2020Purchase PDF
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Abstract
Abstract
Background
Ludwig's angina, a rapidly progressive cellulitis causing airway obstruction, has traditionally been managed with antibiotics and surgical intervention. More controversial is the use of steroids in the management of patients with this condition. This article summarizes the literature of steroid use in the management of Ludwig's angina.
Methods
The study used a narrative review method alongside the PRISMA guidelines for systematic reviews. PubMed, Ovid Medline, Cochrane, and Web of Science were searched for cases of Ludwig's angina with documented steroid use in patient management. Inclusion criteria were articles in the English language with direct patient outcomes. There were 17 articles selected with 31 patient cases.
Results
Most reports of steroid use in Ludwig's angina in the literature are case reports, with one retrospective review, and one letter to the editor. Dexamethasone was the steroid of choice in most cases reviewed. All patient cases reported used antibiotics alongside their steroid use, and 27 out of 31 patient cases required surgery. Most patients recovered with no further sequelae or complications. Three (9.68%) patients suffered mortality due to unrelated causes.
Conclusions
Primary literature reporting the use of steroids in the management of Ludwig's angina includes few cases. While the role steroids have in these cases remains uncertain, the articles summarized do not suggest an adverse influence, and may suggest a benefit.
select article Effect of posterior nasal neurectomy on the suppression of allergic rhinitisResearch articleAbstract only
Effect of posterior nasal neurectomy on the suppression of allergic rhinitis
Lusha Wang, Manman Chen, Ming XuIn Press, Journal Pre-proof, Available online 27 January 2020Purchase PDF
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Abstract
Abstract
Objectives
Recent guidelines have revealed that allergic rhinitis (AR) impairs quality of life. Neuropeptides play a central role in AR. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of AR and for the suppression of neuropeptides and type 2 cytokine expression.
Methods
In total, 77 patients undergoing PNN were recruited. Subjective symptoms, including sneezing and rhinorrhea, were elicited with a questionnaire using a 10 cm visual analogue scale (VAS). Nasal lavage fluid taken from a random sample of 17 patients both preoperatively and 1 year postoperatively was screened with enzyme-linked immunosorbent assays.
Results
Postoperative rhinorrhea (6.03 ± 1.31vs 2.12 ± 1.40, P < 0.001) and sneezing (5.53 ± 1.25vs 2.04 ± 1.29, P < 0.001) were significantly improved relative to the preoperative levels; the mean SP and NPY concentrations in the nasal lavage fluid were 91.6 ± 20.9 pg/ml and 71.5 ± 10.5 pg/ml, which decreased significantly to 52.9 ± 16.7 pg/ml and 31.8 ± 8.2 pg/ml, respectively, and the mean periostin and IL-5 concentrations were 215.2 ± 87.7 pg/ml and 984.5 ± 181.8 pg/ml, which decreased significantly to 146.1 ± 70.1 pg/ml and 281.6 ± 74.0 pg/ml, respectively.
Conclusions
PNN was safe and well tolerated, and the symptom (sneezing and rhinorrhea) scores were significantly decreased by 1 year postoperatively.
select article Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey studyResearch articleAbstract only
Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study
Anita Sulibhavi, Samuel J. Rubin, Jong Park, Sean Hashemi, ... J. Pieter NoordzijIn Press, Corrected Proof, Available online 25 January 2020Purchase PDF
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Abstract
Abstract
Objective
To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy.
Methods
All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia.
Results
A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist.
Conclusions
Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.
select article Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safetyResearch articleAbstract only
Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety
George Stavrou, Vassilios Grosomanidis, Anastasia Sarafidou, Gavriil Tsiropoulos, ... Katerina KotzampassiIn Press, Corrected Proof, Available online 23 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Percutaneous endoscopic gastrostomy [PEG] by the pull-technique is easy and safe to perform through the oral cavity. However, the presence of a cervical esophageal fistula, either due to tumor invasion or simply inflammation and tissue necrosis after previous intervention or radiotherapy, in the anterior cervical region is of crucial importance when passing the endoscope and the PEG catheter from the mouth downwards.
Methods
We describe a modification of the standard peroral PEG, which is to insert the endoscope from the cervical esophageal opening instead of the oral cavity, and we support the use of this “stoma” as a way to protect it and avoid possible forceful dilatation/expansion when advancing the endoscope and the gastrostomy catheter through the mouth.
Results
The performance of PEG through the cervical esophageal opening was applied in 8 cases of esophageal fistula of different primary etiology but where the oro-pharyngeal passage was easily accessible. The procedure was technically successful in all patients, and no bleeding or tearing of the friable esophageal wall was evident.
Conclusion
The use of the esophageal fistula at the anterior cervical region as a route for PEG insertion is a safe and practical alternative, highly to be recommended.
select article Comparative cost of transoral robotic surgery and radiotherapy (IMRT) in early stage tonsil cancerResearch articleAbstract only
Comparative cost of transoral robotic surgery and radiotherapy (IMRT) in early stage tonsil cancer
Joseph Spellman, Michael Coulter, Aniket Kawatkar, Gabriel CalzadaIn Press, Journal Pre-proof, Available online 23 January 2020Purchase PDF
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Abstract
Abstract
Purpose
To compare treatment costs and cost-effectiveness for transoral robotic surgery (TORS) and definitive intensity-modulated radiotherapy (IMRT) in managing early stage tonsil cancer.
Materials and methods
Direct treatment costs for surgery and IMRT were calculated from SEER-Medicare data for a cohort with clinically early stage (cT1/2N0) p16+ tonsillar squamous cell carcinoma from Kaiser Permanente Southern California Health Plan between 2012 and 2017. A Markov decision tree model with a 5-year time horizon was then applied to the cohort which incorporated costs associated with treatment, surveillance, and recurrence.
Results
IMRT cost up to $19,000 more (35%) than TORS in direct treatment costs. When input into the Markov model, TORS dominated IMRT with lower cost and better effectiveness over a range of values.
Conclusion
TORS is a more cost-effective treatment method than IMRT in early stage (cT1/2N0) tonsil cancer.
select article Pediatric button battery ingestion: Publication trends in the literatureReview articleAbstract only
Pediatric button battery ingestion: Publication trends in the literature
Narmien Haddad, J. David Wilson, Darian Fard, Jessica R. LeviIn Press, Corrected Proof, Available online 22 January 2020Purchase PDF
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Abstract
Abstract
Objective
Examine literature for evidence of changes in button battery (BB) research over time including: amount and rate of literature output, levels of evidence, and the location of the research.
Methods
Literature review of all peer-reviewed button battery literature available online through Pubmed and Embase was performed. Inclusion criteria were applied to ensure relevance. Publications were grouped into 4 time periods. Various study characteristics were compared between groups.
Results
A total of 255 original research studies were reviewed. A significant increase in study number was found with a 664% increase comparing 2009–2018 and 1977–1988 (p < 0.001) and a 187% increase comparing 2009–2018 and all previous years. Average author number significantly increased over the study period (range: 2.8 to 4.4; p < 0.001). Case report or case series were consistently the most common type of study design (range: 56.5% to 84.0%). Level of evidence has remained at 4–5 for the majority of studies (range: 87% to 92.1%). First author specialty remained stable over time, with non-otolaryngologist surgeons being the most common authors, followed by pediatricians and otolaryngologists (28.8%, 18.9%, 18.5%, respectively). Location of research has diversified, with US publications falling from 50% to 29.5% of all studies when comparing 1977–1988 to 2009–2018 time periods.
Conclusions
Button battery ingestion in the pediatric population has been an important topic of discussion among various medical specialties due to a rise in morbidity and mortality surrounding these ingestions. Despite the increase in number of studies and authors, the strength of these studies has remained largely unchanged.
select article Management of invasive intralabyrinthine cholesteatoma: Can one realistically preserve hearing when disease is medial to the otic capsule?Research articleAbstract only
Management of invasive intralabyrinthine cholesteatoma: Can one realistically preserve hearing when disease is medial to the otic capsule?
Khalid Al Zaabi, Fatemeh Hassannia, Michael J. Bergin, John Alexander RutkaIn Press, Corrected Proof, Available online 21 January 2020Purchase PDF
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Abstract
Abstract
Purpose
To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma.
Material and methods
The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated.
Results
10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results.
Conclusion
We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
select article In response to: Gelfoam, bactroban ointment and ofloxacin drops facilitate the eardrum healingDiscussionNo access
In response to: Gelfoam, bactroban ointment and ofloxacin drops facilitate the eardrum healing
Samantha Anne, Janki Shah, Blake Smith, Elizabeth O. ShayIn Press, Corrected Proof, Available online 21 January 2020Purchase PDF
select article Gelfoam, bactroban ointment and ofloxacin drops facilitate the eardrum healingCorrespondenceNo access
Gelfoam, bactroban ointment and ofloxacin drops facilitate the eardrum healing
Zhengcai LouIn Press, Corrected Proof, Available online 20 January 2020Purchase PDF
select article Tongue symptoms, suspension force and duration during operative laryngoscopyResearch articleAbstract only
Tongue symptoms, suspension force and duration during operative laryngoscopy
T. Logan Lindemann, Brandon Kamrava, David Sarcu, Ahmed M.S. SolimanIn Press, Corrected Proof, Available online 17 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity.
Materials and methods
A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded.
Results
120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor.
Conclusions
Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.
select article Tourniquet use and factors associated with hematoma formation in free tissue transferResearch articleAbstract only
Tourniquet use and factors associated with hematoma formation in free tissue transfer
Christopher J. Britt, Michelle S. Hwang, Peter M. Vila, Rajan P. Dang, ... Shaun C. DesaiIn Press, Corrected Proof, Available online 17 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Our objective was to understand which variables are associated with hematoma formation at both the donor and recipient sites in head and neck free tissue transfer and if hematoma rates are affected by tourniquet use.
Methods
Patients were identified who underwent free tissue transfer at three institutions, specifically either a radial forearm free flap (RFFF) or a fibula free flap (FFF), between 2007 and 2017. Variables including use of tourniquet, anticoagulation, treatment factors, demographics, and post-operative factors were examined to see if they influenced hematoma formation at either the free tissue donor or recipient site.
Results
1410 patients at three institutions were included in the analysis. There were 692 (49.1%) RFFF and 718 (50.9%) FFF. Tourniquets were used in 764 (54.1%) cases. There were 121 (8.5%) hematomas. Heparin drips (p < .001) and DVT prophylaxis (p = .03) were significantly associated with hematoma formation (OR 95% CI 12.23 (4.98–30.07), 3.46 (1.15–10.44) respectively) on multivariable analysis.
Conclusions
Heparin Drips and DVT prophylaxis significantly increased hematoma rates in free flap patients while tourniquets did not affect rates of hematoma.
select article Narrow band imaging might contribute to the diagnosis of laryngopharyngeal refluxResearch articleAbstract only
Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux
Dipanpan Wu, Xinhua Cui, Ying Guo, Bo Geng, ... Hui LiangIn Press, Corrected Proof, Available online 17 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Laryngopharyngeal reflux (LPR) accounts for 4–10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis.
Materials and methods
We recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated.
Results
Fifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P < 0.05), and has poor consistency with the RSI (P < 0.05). Fifty-three LPR patients underwent posttreatment laryngoscopy. The positivity rate decreased to 17.0% (P < 0.05).
Conclusion
NBI has good value for LPR diagnosis.
select article Commentary to “Epidermal growth factor on the healing of human subacute tympanic membrane perforation”DiscussionNo access
Commentary to “Epidermal growth factor on the healing of human subacute tympanic membrane perforation”
Zhengcai LouIn Press, Corrected Proof, Available online 10 January 2020Purchase PDF
select article Epidermal growth factor on the healing of human subacute tympanic membrane perforationCorrespondenceNo access
Epidermal growth factor on the healing of human subacute tympanic membrane perforation
Yachao LiuIn Press, Corrected Proof, Available online 10 January 2020Purchase PDF
select article The effect of passive smoking on the etiology of serous otitis media in childrenResearch articleAbstract only
The effect of passive smoking on the etiology of serous otitis media in children
Yosunkaya M. TarhunIn Press, Corrected Proof, Available online 10 January 2020Purchase PDF
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Abstract
Abstract
Serous otitis media (SOM) is a disease mostly seen in the pediatric age group and characterized by serous effusion in the middle ear. The disease which is mostly silent can cause permanent hearing loss if it is not diagnosed and treated early. Passive smoking is one of the environmental factors in the etiopathology of the disease and risk factors for SOM formation in children. In our study, smoking habits of family members of 75 children with SOM and 50 healthy controls were investigated. At the end of the study, the correlation between SOM and passive smoke exposed was statistically significant in children (p < 0.01). In this study, the effect of passive smoking, which is a preventable and controllable risk factor in the etiology of the SOM in children is emphasized.
select article Laser ablation of posterior nasal nerves for rhinitisResearch articleAbstract only
Laser ablation of posterior nasal nerves for rhinitis
Yosef P. Krespi, Karen A. Wilson, Victor KizhnerIn Press, Corrected Proof, Available online 9 January 2020Purchase PDF
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Abstract
Abstract
Background
Posterior nasal nerve (PNN) surgery, Radiofrequency (RF), and cryoablation have been described as alternative treatments for allergic and vasomotor rhinitis. We hypothesize that endoscopic (diode) laser ablation (ELA) is effective and less invasive than previously described methods.
Methods
An IRB approved prospective study was performed. Thirty-two patients with chronic rhinitis and nasal congestion resistant to medical management were recruited. Total Nasal Symptom Score (TNSS) measurements were used to assess symptom severity and treatment outcomes. ELA was performed bilaterally in the clinic with a 940 nm diode laser with CW 5 W output, under topical/local anesthesia in 21 patients, while the remaining 11 were treated under sedation in the operating room. The 400-micron uninitiated diode laser fiber tip with a malleable protective shaft was specially designed for PNN ablation. The fiber was pre-shaped according to the intranasal anatomy and endoscopically advanced toward the posterior middle meatus. Patients were followed up for the first 90 days after treatment.
Results
ELA was successfully completed in 97% of patients. No crusting, epistaxis, or other complications were observed. One patient could not be treated in the office due to limited endoscopic access. TNSS was reduced significantly after30 and 90 days (mean ± SD: 6.0 ± 0.7 prior to ablation, 2.3 ± 0.4 at 90 days, p < .001). Rhinitis and congestion scores decreased at 30 and 90 days after treatment compared to the baseline (p < .001).
Conclusion
ELA of the PNN region is safe and well tolerated both in the office and ambulatory settings. Symptom scores were significantly decreased after 30 and 90 days. This new minimally invasive method appears to be a promising treatment method.
select article Bilateral same-day endoscopic tympanoplastyResearch articleAbstract only
Bilateral same-day endoscopic tympanoplasty
Engin Dursun, Emine Demir, Suat Terzi, Zerrin Özergin Coşkun, ... Özlem Çelebi ErdivanlıIn Press, Journal Pre-proof, Available online 9 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Although bilateral same-day tympanoplasty is a faster and more comfortable procedure for patients, it is rarely performed due to its theoretical risks. The present study aims to evaluate the results of patients who underwent bilateral same-day endoscopic tympanoplasty.
Materials and methods
In this study, 26 patients and 52 ears were evaluated. Postoperative anatomic success rate, pre- and postoperative hearing test results, hearing gains and postoperative complications were recorded.
Results
Postoperative anatomic success rate was 92.3% (48/52). Audiological tests revealed the preoperative air-bone gap (ABG) as 19.1 ± 8.8 (7–35) dB and postoperative ABG as 9.8 ± 5.7 (5–25) dB. Postoperative ABG decreased significantly (p: <0.001) and 9.2 ± 4.6 (2−23) dB hearing gain was obtained. We did not observe any significant complications.
Conclusion
Bilateral same-day endoscopic tympanoplasty is a feasible surgical procedure with good anatomic and functional outcomes, low complication rate and good postoperative patient comfort.
select article Which element plays important role for the effect of myringoplasty between platelet rich plasma, hyaluronic acid and fat graft?Research articleNo access
Which element plays important role for the effect of myringoplasty between platelet rich plasma, hyaluronic acid and fat graft?
Yachao LiuIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
select article Evaluation of emergence agitation after general anaesthesia in rhinoplasty patients: Inhalation anaesthesia versus total intravenous anaesthesiaResearch articleAbstract only
Evaluation of emergence agitation after general anaesthesia in rhinoplasty patients: Inhalation anaesthesia versus total intravenous anaesthesia
Gamze Talih, Ahmet Yüksek, Ender ŞahinIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
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Abstract
Abstract
Background
Emergence agitation (EA) is a clinical condition that occurs early in recovery from general anaesthesia, and reduces patient comfort. The aim of this study was to compare the effects of low-flow sevoflurane anaesthesia and total intravenous anaesthesia (TIVA) on agitation in rhinoplasty patients, and to determine the frequency of EA in low flow sevoflurane anaesthesia after rhinoplasty.
Material and methods
A total of 90 rhinoplasty patients, under general anaesthesia were included in this prospective randomised study. After induction of anaesthesia, propofol infusion was initiated in the TIVA group (n = 45), and sevoflurane was administered in the SEVO group with a fresh gas flow of 1 l/min and MAC (minimum alveolar concentration) 1–1.1 (n = 45). Early emergence times, Richmond agitation-sedation scale (RASS), Boezaart scale, Likert scale and incidences of nausea/vomiting were recorded at the end of surgery.
Results
Early emergence time was significantly shorter in the TIVA group, than in the SEVO group (p < 0.001). İntraoperative bleeding was significantly lower in the TIVA group, than in the SEVO group (p = 0.005), and surgical field image quality and surgeon satisfaction were better in the TIVA group (p = 0.016, p < 0.001). The ratio of patients with RASS > +1 for all patients was 35.6% at 0 min, postoperatively. This rate was 12.2% (n = 11) in the TIVA group, and 23.3% (n = 21) in the SEVO group (p = 0.028).
Conclusions
In rhinoplasty, TIVA caused shorter early emergence times, less bleeding, high surgeon satisfaction, and lower EA scores when compared with low flow sevoflurane anaesthesia.
select article Transoral robotic surgery: Differences between online information and academic literatureResearch articleAbstract only
Transoral robotic surgery: Differences between online information and academic literature
Kunal Ramanand Shetty, Kevin Wong, Sean Hashemi, Anisha Shetty, Jessica R. LeviIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
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Abstract
Abstract
Objectives
Evaluate the authorship, content, quality, and readability of information on Transoral Robotic Surgery (TORS) available to patients online.
Methods
The technical search term “TORS Surgery” and layperson's term “robotic surgery of the mouth” were utilized to conduct a search of the top 50 websites on Google, Bing, and Yahoo. Websites were evaluated according to the HONcode evaluation of content and quality, and readability was assessed using the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level Formula, SMOG readability formula, Coleman Liau Index formula, and Gunning Fog Index. Statistical analysis was conducted using the Fisher Freeman- Halton test to compare differences in authorship, quality, and content between the three search engines and the Fisher exact test was used to determine if there was a difference in these variables between the two search terms.
Results
Overall, websites were predominantly from academic institutions with 97% mentioning benefits of TORS with 24% mentioning risks. 45% of TORS websites had no description of the TORS procedure, while 62% allowed individuals to make appointments. There was a significant difference in authorship with the layperson's terms yielding more news sources, but there were no significant differences in quality and content of information elicited through the technical and layperson search terms. The mean readability scores were Flesch Kincaid Grade Level 13.81(±3.32), Gunning-Fog Index 16.51(±3.39), SMOG 12.53(±2.40), and Automated Readability Index 14.05 (±4.17).
Conclusions
Current online information on TORS surgery may not provide balanced information for patients to make informed healthcare decisions. The current readability of online information regarding TORS far exceeds the average literacy level of average American adults.
select article Characteristics and considerations for children with ankyloglossia undergoing frenulectomy for dysphagia and aspirationResearch articleAbstract only
Characteristics and considerations for children with ankyloglossia undergoing frenulectomy for dysphagia and aspiration
Lauren S. Buck, Hudson Frey, Morgan Davis, Michael Robbins, ... Jeffrey D. CarronIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
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Abstract
Abstract
Objective
The purpose of this study is to analyze the basic demographics of patients who underwent frenulectomy at our institution as well as additional considerations regarding age, location of procedure, and possible effects on aspiration.
Methods
A retrospective chart review was performed based on CPT codes for frenulectomy and basic demographic data was collected. Other information such as presenting symptoms, type of ankyloglossia, location of the procedure, and modified barium swallow study (MBSS) information were also obtained.
Results
A total of 226 (66.4% male) patients underwent frenulectomy in the study time frame. Younger patients underwent frenulectomy for feeding symptoms (average age 6.5 months) and older children typically presented with speech related symptoms (average age 3.8 years). Of patients who had MBSS before and after the procedure, 5/11 (43%) had improvement of their aspiration after frenulectomy.
Conclusions
Symptomatic ankyloglossia is more common in boys. Two age groups typically present for frenulectomy, infants for feeding difficulties and toddlers/preschoolers for speech related difficulties. Children with aspiration may benefit from frenulectomy, though aspiration is unlikely to resolve if other comorbidities are present. Proper evaluation and documentation of anatomy and functional tongue movement is important for future studies and decision-making regarding frenulectomy.
select article Identification of MMP1 and MMP2 by RNA-seq analysis in laryngeal squamous cell carcinomaResearch articleAbstract only
Identification of MMP1 and MMP2 by RNA-seq analysis in laryngeal squamous cell carcinoma
Weijun Fang, Jun ShenIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
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Abstract
Abstract
Background
Laryngeal squamous cell carcinoma (LSCC) is the most common histologic subtype of laryngeal cancer characterized by a poor prognosis. Determining gene expression changes in LSCC should improve our understanding of putative risk factors and provide potential targets for therapy.
Objectives
To assess differential gene expression between LSCC tissue and paired normal laryngeal tissue, and to provide gene targets for future studies of this type of laryngeal cancer.
Materials and methods
Three paired-sample groups (tumor and normal tissue) from patients with laryngeal squamous cell carcinoma were analyzed by RNA sequencing (RNA-seq).
Results
The six cDNA libraries generated raw reads ranging from 15,195,586 to 21,443,488 counts. Changes in gene expression levels were determined in 40,205 of these counts, with 18,466 deferentially expressed genes in all three groups. Compared to normal tissue, the expression levels of MMP1 and MMP2 increased significantly in tumor tissue of patients with laryngeal squamous cell carcinoma.
Conclusions
Whole transcriptome sequencing revealed that MMP1 and MMP2 are highly expressed in LSCC. These genes may be useful both as biomarkers for LSCC diagnosis and as targets for therapy, as well as for increasing our understanding of LSCC tumorigenesis.
select article Differences in self-reported symptoms in patients with chronic odontogenic and non-odontogenic rhinosinusitisResearch articleAbstract only
Differences in self-reported symptoms in patients with chronic odontogenic and non-odontogenic rhinosinusitis
Ivan Oreški, Tomislav Gregurić, Petar Gulin, Natalija Prica Oreški, ... Davor VagićIn Press, Corrected Proof, Available online 7 January 2020Purchase PDF
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Abstract
Abstract
Purpose
To evaluate the possible differences in self-reported symptoms between patients with chronic odontogenic rhinosinusitis (CORS) and patients with chronic non-odontogenic rhinosinusitis (CnORS).
Materials and methods
The study included 64 patients diagnosed with chronic rhinosinusitis according to EPOS guidelines. 32 patients had CORS, and the control group were 32 patients with CnORS. Patients were matched according to gender and age. All the patients underwent a CT scan evaluated by a radiologist, and were evaluated by an oral surgeon and otorhinolaryngologist before being assigned to one of the groups. The severity of the symptoms was assessed through questioners SNOT-22 (sino-nasal outcome test) and VAS (visual analogue scale) symptom score. Kolmogorov-Smirnov's, Fisher's and Mann-Whitney U test were used in the statistical analysis of the data.
Results
People with CORS show similar symptomatology on SNOT-22 score to patients with CnORS, with no significant statistical difference between any of the SNOT-22 symptoms. VAS symptom score showed that odontogenic group had a significantly higher score for fever (p = .004) and halitosis (p = .003).
Conclusion
Halitosis and fever might be the most important symptoms in differentiating between CORS and CnORS symptomatology. Better diagnostic tools, such as VAS symptom score might help medical professionals to be quicker at recognizing CORS specific symptomatology, and help them treat the disease as early and adequately as possible.
select article Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysisResearch articleAbstract only
Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis
Su Jin Kim, Dong Sik Chang, Myoung Su Choi, Ho Yun Lee, Jung-Soo PyoIn Press, Journal Pre-proof, Available online 3 January 2020Purchase PDF
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Abstract
Abstract
Background
The efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty.
Methods
PubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case–control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs).
Results
Thirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024–0.056) than in the no splint group (0.087, 95% CI 0.055–0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups.
Conclusions
These findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.
select article The effect of fibromyalgia treatment on tinnitusResearch articleAbstract only
The effect of fibromyalgia treatment on tinnitus
Ö. Çaglar Cil, C. Zateri, O. Güçlü, S. Oymak, E. TezcanIn Press, Corrected Proof, Available online 3 January 2020Purchase PDF
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Abstract
Abstract
Objectives
We investigated the frequency of tinnitus in fibromyalgia patients and the effect of drugs used for routine fibromyalgia on tinnitus.
Methods
We included 101 diagnosed fibromyalgia patients. After detailed ear nose throat examination, audiometric tests and tinnitus handicap index (THI) were performed. After the tests, routine treatment for fibromyalgia was started by the physical therapy and rehabilitation department. Two months after the beginning of the treatment, THI were repeated again and the results were statistically evaluated.
Results
All patients included in the study were women. 74.3% of the patients had tinnitus. Pregabalin and selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant-treated patients were evaluated; In both groups, there was a statistically significant difference between pre- and post-treatment tinnitus levels (p < .001). However, there was no statistically significant difference between pregabalin group and diloxetine group according to treatment results.
Conclusions
The incidence of tinnitus is high in fibromyalgia patients. That pregabalin and duloxetine agents routinely used in fibromyalgia require further experimental and human studies in order to be able to use in tinnitus.
select article Predictive factors for prolonged operative time in head and neck patients undergoing free flap reconstructionResearch articleAbstract only
Predictive factors for prolonged operative time in head and neck patients undergoing free flap reconstruction
Michael M. Lindeborg, Sidharth V. Puram, Rosh K.V. Sethi, Nicholas Abt, ... Daniel G. DeschlerIn Press, Corrected Proof, Available online 3 January 2020Purchase PDF
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Abstract
Abstract
Purpose
Defining the predictive factors associated with prolonged operative time may reduce post-operative complications, improve patient outcomes, and decrease cost of care. The aims of this study are to 1) analyze risk factors associated with prolonged operative time in head and neck free flap patients and 2) determine the impact of lengthier operative time on surgical outcomes.
Methods
This retrospective cohort study evaluated 282 head and neck free flap reconstruction patients between 2011 and 2013 at a tertiary care center. Perioperative factors investigated by multivariate analyses included gender, age, American Society of Anesthesiologists class, tumor subsite, stage, flap type, preoperative comorbidities, and perioperative hematocrit nadir. Association was explored between operative times and complications including flap take back, flap survival, transfusion requirement, flap site hematoma, and surgical site infection.
Results
Mean operative time was 418.2 ± 88.4 (185–670) minutes. Multivariate analyses identified that ASA class III (beta coefficient + 24.5, p = .043), stage IV tumors (+34.8, p = .013), fibular free flaps (−44.8, p = .033 for RFFF vs. FFF and − 67.7, p = .023 for ALT vs FFF) and COPD (+36.0, p = .041) were associated with prolonged operative time. History of CAD (−43.5, p = .010) was associated with shorter operative time. There was no statistically significant association between longer operative time and adverse flap outcomes or complications.
Conclusion
As expected, patients who were medically complex, had advanced cancer, or underwent complex flap reconstruction had longer operative times. Surgical planning should pay special attention to certain co-morbidities such as COPD, and explore innovative ways to minimize operative time. Future research is needed to evaluate how these factors can help guide planning algorithms for head and neck patients.
select article Quality improvement in tracheostomy care: A multidisciplinary approach to standardizing tracheostomy care to reduce complicationsResearch articleAbstract only
Quality improvement in tracheostomy care: A multidisciplinary approach to standardizing tracheostomy care to reduce complications
Samuel J. Rubin, Stefanie S. Saunders, Jacob Kuperstock, Dominick Gadaleta, ... Michael P. PlattIn Press, Corrected Proof, Available online 24 December 2019Purchase PDF
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Abstract
Abstract
Purpose
Develop a model for quality improvement in tracheostomy care and decrease tracheostomy-related complications.
Methods
This study was a prospective quality improvement project at an academic tertiary care hospital. A multidisciplinary team was assembled to create institutional guidelines for clinical care during the pre-operative, intra-operative, and post-operative periods. Baseline data was compiled by retrospective chart review of 160 patients, and prospective tracking of select points over 8 months in 73 patients allowed for analysis of complications and clinical parameters.
Results
Implementation of a quality improvement team was successful in creating guidelines, setting baseline parameters, and tracking data with run charts. Comparison of pre- and post-guideline data showed a trend toward decreased rate of major complications from 4.38% to 2.74% (p = 0.096). Variables including time to tracheotomy for prolonged intubation, surgical technique, day of first tracheostomy tube change, and specialty performing surgery did not show increased risk of complications. There were increased tracheostomy-related complications in cold months (p = 0.04).
Conclusions
An interdisciplinary quality improvement team can improve tracheostomy care by identifying system factors, standardizing care among specialties, and providing continuous monitoring of select data points.
select article Network meta-analysis of surgical treatment for secondary hyperparathyroidismReview articleAbstract only
Network meta-analysis of surgical treatment for secondary hyperparathyroidism
Jianzhong Hou, Haojie Shan, Yingchao Zhang, Xianzhao Deng, ... Youben FanIn Press, Corrected Proof, Available online 21 December 2019Purchase PDF
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Abstract
Abstract
Background
Main surgical treatments for secondary hyperparathyroidism (SHPT) include subtotal parathyroidectomy (sPTX), total parathyroidectomy with autotransplantation (tPTX+AT), and total parathyroidectomy (tPTX); however, determining the best treatment is debatable. We conducted a network meta-analysis (NMA) comparing three treatments in terms of postoperative hypocalcemia (or hypoparathyroidism), postoperative recurrence, and reoperation.
Methods
We searched PubMed, Medline, the Cochrane Library, and Embase for relevant research from inception to July 30, 2019. We performed our Bayesian NMA using R 3.51 software to assess odds ratios (OR) and 95% confidence intervals (CI). Network and forest plots displayed study outputs. Potential publication bias was assessed with funnel plots using software Stata/MP 13.0.
Results
Twenty-six articles comprising 5063 patients were included in our NMA, which showed that postoperative hypocalcemia (or hypoparathyroidism) occurred more frequently in tPTX than in sPTX (OR = 3.50, 95% CI 1.10–11.0) or tPTX+AT patients (OR = 1.80, 95% CI 0.66–5.20). Regarding postoperative hypocalcemia (or hypoparathyroidism), there was no significant difference between sPTX and tPTX+AT (OR = 0.53, 95% CI 0.24–1.10). As for recurrence rates, statistically significant differences were observed between sPTX and tPTX (OR = 25.0, 95% CI 5.1–260), tPTX+AT and tPTX (OR = 20.0, 95% CI 4.2–200), and sPTX and tPTX+AT (OR = 1.30, 95% CI 0.65–2.50). Regarding reoperation rates, sPTX experienced higher incidence compared with tPTX+AT (OR = 1.20, 95% CI 0.53–2.70) or tPTX patients (OR = 2.70, 95% CI 1.20–14.00).
Conclusions
TPTX+AT is recommended as the most efficient and safe surgical SHPT treatment with minimal adverse effects. Large-scale randomized controlled trials are recommended to confirm the NMA results.
select article Comparison of sonotubometry, impedance, tubo-tympano-aerography, and tubomanometry to test eustachian tube functionResearch articleAbstract only
Comparison of sonotubometry, impedance, tubo-tympano-aerography, and tubomanometry to test eustachian tube function
Kaian Ruan, Jingyu Li, Songhua Tan, Lei Liu, Anzhou TangIn Press, Corrected Proof, Available online 21 December 2019Purchase PDF
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Abstract
Abstract
Purpose
There is currently no gold standard for the diagnosis of eustachian tube (ET) dysfunction. To provide an objective basis for the clinical diagnosis of ET dysfunction, we explored the characteristics of sonotubometry, impedance, tubo-tympano-aerography (TTAG), and tubomanometry (TMM) in volunteers with healthy ETs.
Materials and methods
Sonotubometry, impedance, TTAG, and TMM tests were performed in 110 healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed.
Results
The ET opening rate was compared between sonotubometry with dry swallowing, impedance with the Valsalva maneuver, TTAG with the Valsalva maneuver, and TMM with a nasopharyngeal pressure of 50 mbar in 100 (90.9%), 102 (92.7%), 99 (90.0%), and 104 (94.5%) ears, respectively; there was no significant difference among the four methods (P = 0.575). In sonotubometry, both dry swallowing and the Valsalva maneuver were superior to wet swallowing in terms of detecting ET opening (P = 0.000). In TMM, both the opening rate and the external auditory canal pressure were positively correlated with the nasopharyngeal pressure. Specifically, the opening rate and external auditory canal pressure increased with an increase in the nasopharyngeal pressure (r = 0.271, P = 0.000; r = 0.315, P = 0.000, respectively).
Conclusions
Sonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical practice, the appropriate ET function test should be chosen on the basis of the patient's specific condition.
select article The anatomical basis and rational for the transoral approach during the surgical excision of the sublingual salivary gland for the management of plunging ranulaResearch articleAbstract only
The anatomical basis and rational for the transoral approach during the surgical excision of the sublingual salivary gland for the management of plunging ranula
Kabunda Syebele, Thifhelimbilu I. MunzheleleIn Press, Corrected Proof, Available online 20 December 2019Purchase PDF
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Abstract
Abstract
Purpose
The aim of this study was to illustrate and confirm that the complete intraoral excision of the sublingual gland alone, is anatomically the most rational approach, for the management of plunging ranula.
Material and methods
We retrospectively reviewed clinical charts of diagnosed HIV-infected patients presenting with plunging ranula. The intraoral approach was used for the complete excision of the sublingual gland with evacuation of the pseudocystic content only. Neither extra oral approach, nor ranula dissection / drainage was performed. The surgical procedure was performed using local anesthesia.
Pre- and postoperative MRI-scan investigations were recorded. Histological reports were documented to confirm the diagnosis of oral mucocele. Patients were clinically monitored.
Results
We identified 90 adults presenting with oral mucocele, type ranula. Seventy (77%) of them were diagnosed with HIV infection. Plunging ranula was recorded in 35 (50%) patients from the latter group. The study enrolled 11 operated patients whose files contained useable data, including an acceptable follow-up period. The postoperative follow-up period ranged from three to 15 months. The clinical and postoperative MRI-scans of operated patients demonstrated satisfactory results. There were neither postoperative complications nor recurrence of ranula reported.
Conclusion
The location of the sublingual gland in the floor of the mouth coupled with the physio-pathogenesis of the plunging ranula, makes the transoral complete excision of the offending gland, with the intraoral evacuation of the pseudocyst, anatomically the most rational approach for plunging ranula management. There is no need for cervical approach, ranula dissection and/or postoperative placement of drainage.
select article Experience with cholesteatoma behind an intact tympanic membrane in childrenResearch articleAbstract only
Experience with cholesteatoma behind an intact tympanic membrane in children
Milan Urík, Andrea Kaliariková, Josef Machač, Michal JurajdaIn Press, Corrected Proof, Available online 19 December 2019Purchase PDF
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Abstract
Abstract
Introduction
To systematically investigate all surgeries for cholesteatoma behind an intact tympanic membrane at our department. To identify predictive factors that can help the surgeon to plan surgery, surgical techniques, and follow-up treatment.
Material and methods
This retrospective study evaluates 21 child patients, who were operated in the period 2007–2017 on for cholesteatoma behind an intact tympanic membrane.
Results
A total of 202 primary operations were performed for cholesteatoma. In 21 cases (10,4%) there was a cholesteatoma behind an intact tympanic membrane and in 11 (5,45%) cases of it there was the congenital cholesteatoma. The most frequently affected area was the anterior-superior quadrant. The preoperative hearing loss increased significantly with disease severity (I–IV by Potsic).
Conclusions
The classification system according to Potsic is sufficient and fully corresponds to the surgeon's needs. It has been clearly shown that a higher CC stage is associated with worse postoperative hearing results.
select article Complications of bone-conduction hearing implants (BCHI) implantation surgeryResearch articleAbstract only
Complications of bone-conduction hearing implants (BCHI) implantation surgery
Timothy Shun Man Chu, Michael Mather, Anirvan BanerjeeIn Press, Corrected Proof, Available online 16 December 2019Purchase PDF
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Abstract
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.
select article Pediatric tracheostomies in patients less than 2 years of age: Analysis of complications and long-term follow-upResearch 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 HuangIn Press, Corrected Proof, Available online 14 December 2019Purchase PDF
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Abstract
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.
select article Hyaluronic acid in otology: Its uses, advantages and drawbacks - A reviewReview articleAbstract only
Hyaluronic acid in otology: Its uses, advantages and drawbacks - A review
Christophe Abi Zeid Daou, Marc BassimIn Press, Corrected Proof, Available online 13 December 2019Purchase PDF
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Abstract
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.
select article Hearing handicap in Asian patients with dementiaResearch articleAbstract only
Hearing handicap in Asian patients with dementia
Bibek Gyanwali, Saima Hilal, Narayanaswamy Venketasubramanian, Christopher Chen, Jenny Hooi Yin LooIn Press, Corrected Proof, Available online 12 December 2019Purchase PDF
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Abstract
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.
select article Short-term postoperative CPAP may improve the outcomes of velopharyngeal surgery for obstructive sleep apneaResearch 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 YeIn Press, Corrected Proof, Available online 11 December 2019Purchase PDF
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Abstract
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.
select article Early discharge after free-tissue transfer does not increase adverse eventsResearch articleAbstract only
Early discharge after free-tissue transfer does not increase adverse events
Andrea Hanick, Joseph B. Meleca, Michael A. FritzIn Press, Corrected Proof, Available online 10 December 2019Purchase PDF
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Abstract
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.
select article Impact of cochlear abnormalities on hearing outcomes for children with cochlear implantsResearch articleAbstract only
Impact of cochlear abnormalities on hearing outcomes for children with cochlear implants
Evette Ronner, Razan Basonbul, Rupal Bhakta, Leila Mankarious, ... Michael S. CohenIn Press, Corrected Proof, Available online 10 December 2019Purchase PDF
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Abstract
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.
select article Retrospective study of Langerhans cell histiocytosis in ear, nose and neckResearch articleAbstract only
Retrospective study of Langerhans cell histiocytosis in ear, nose and neck
Yan Guo, Fei Ning, Guojian Wang, Xiaohong Li, ... Pu DaiIn Press, Corrected Proof, Available online 6 December 2019Purchase PDF
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Abstract
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.
select article Objective and subjective changes in voice after endoscopic sinus surgeries in patients with and without nasal polypsResearch 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 ChongIn Press, Corrected Proof, Available online 5 December 2019Purchase PDF
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Abstract
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.
select article Cochlear implantation in adults with auditory deprivation: What do we know about it?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 BovoIn Press, Corrected Proof, Available online 2 December 2019Purchase PDF
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Abstract
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.
select article Relationship between progression of type 2 diabetes mellitus and olfactory functionResearch 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 TurgutIn Press, Corrected Proof, Available online 29 November 2019Purchase PDF
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Abstract
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.
select article Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgeryResearch 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 WuIn Press, Corrected Proof, Available online 28 November 2019Purchase PDF
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Abstract
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.
select article Efficacy of the additional effect of hyperbaric oxygen therapy in combination of systemic steroid and prostaglandin E<sub>1</sub> for idiopathic sudden sensorineural hearing lossResearch 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 IkedaIn Press, Corrected Proof, Available online 27 November 2019Purchase PDF
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Abstract
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.
select article The anesthesia airway evaluation: Correlation with sleep endoscopy findingsResearch articleAbstract only
The anesthesia airway evaluation: Correlation with sleep endoscopy findings
Michael Eggerstedt, Matthew J. Urban, Emily Chi, Ethan M. Ritz, Phillip LosavioIn Press, Corrected Proof, Available online 23 November 2019Purchase PDF
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Abstract
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.
select article Endolymphatic hydrops evaluation on MRI: Practical considerationsDiscussionAbstract 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 DanielIn Press, Corrected Proof, Available online 23 November 2019Purchase PDF
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Abstract
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.
select article Relationship between inflammation and the severity of Recurrent Respiratory PapillomatosisResearch 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 KaminagakuraIn Press, Corrected Proof, Available online 18 November 2019Purchase PDF
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Abstract
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.
select article Investigation of vitamin D levels in patients with Sudden Sensory-Neural Hearing Loss and its effect on treatmentResearch 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-koohsariIn Press, Corrected Proof, Available online 12 November 2019Purchase PDF
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Abstract
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.
select article Osteoradionecrosis of the mandible: Why not to be more aggressive in earlier stage?CorrespondenceNo access
Osteoradionecrosis of the mandible: Why not to be more aggressive in earlier stage?
Nidal F. AL DeekIn Press, Corrected Proof, Available online 12 November 2019Purchase PDF
select article Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in childrenResearch articleAbstract only
Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in children
Osama G. Abdel-Naby AwadIn Press, Journal Pre-proof, Available online 12 November 2019Purchase PDF
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Abstract
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.
select article Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomyResearch 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. SullivanIn Press, Corrected Proof, Available online 12 November 2019Purchase PDF
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Abstract
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.
select article Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgeryResearch articleAbstract only
Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgery
Michael J. EliasonIn Press, Corrected Proof, Available online 11 November 2019Purchase PDF
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Abstract
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.
select article Cerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infectionResearch articleAbstract only
Cerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infection
Shoude Zhang, Mao Jin, Guojin Zhou, Yuejiao ZhangIn Press, Corrected Proof, Available online 7 November 2019Purchase PDF
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Abstract
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.
select article Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar graftingResearch 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. BatraIn Press, Corrected Proof, Available online 29 October 2019Purchase PDF
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Abstract
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.
select article Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluationResearch 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. KelsallIn Press, Corrected Proof, Available online 11 September 2019Purchase PDF
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Abstract
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.
select article Olfaction in juvenile nasopharyngeal angiofibroma: The first studyResearch articleAbstract only
Olfaction in juvenile nasopharyngeal angiofibroma: The first study
Anupam Mishra, Pankaj Pandey, Subhash Chandra MishraIn Press, Journal Pre-proof, Available online 10 September 2019Purchase PDF
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Abstract
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.
select article Quality of life outcomes after transmastoid plugging of superior semicircular canal dehiscenceResearch 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. DornhofferIn Press, Corrected Proof, Available online 9 September 2019Purchase PDF
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Abstract
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.
select article Utility of videolaryngoscopy for diagnostic and therapeutic interventions in head and neck surgeryResearch 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. SirjaniIn Press, Journal Pre-proof, Available online 4 September 2019Purchase PDF
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Abstract
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.
select article 3D printed temporal bone as a tool for otologic surgery simulationResearch articleAbstract only
3D printed temporal bone as a tool for otologic surgery simulation
Dominick J. Gadaleta, Denis Huang, Nicholas Rankin, Victor Hsue, ... Bon KuIn Press, Journal Pre-proof, Available online 2 August 2019Purchase PDF
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Abstract
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.
select article Incidental Thyroid cancer in patients undergoing surgery for hyperthyroidismResearch articleNo access
Incidental Thyroid cancer in patients undergoing surgery for hyperthyroidism
Yogesh More, Aly Bernard Khalil, Huda Mustafa, Manjiri Gupte, ... Shaik Irfan BashaIn Press, Corrected Proof, Available online 11 March 2019Purchase PDF
select article Pediatric ear foreign body retrieval: A comparison across specialtiesResearch articleAbstract only
Pediatric ear foreign body retrieval: A comparison across specialties
Katie Mingo, David Eleff, Samantha Anne, Kyra OsborneIn Press, Corrected Proof, Available online 15 February 2019Purchase PDF
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Abstract
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.
select article Impact of allergic rhinitis on quality of life after powered intracapsular tonsillectomy and adenoidectomyResearch 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 LeeIn Press, Corrected Proof, Available online 22 January 2019Purchase PDF
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Abstract
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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