Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Κυριακή 12 Φεβρουαρίου 2023

Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses

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imageObjectives To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome. Methods A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days. Results The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25–0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26–0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I2 = 52.1%). The OR was 0.31 (95% CI, 0.21–0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I2 = 0.0%). Conclusion Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome. Level of Evidence Level I.
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Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration

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imageObjective The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients? Data Sources PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched. Study Selection Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study. Data Extraction Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted. Data Synthesis Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables. Conclusions The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.
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Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients

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imageObjective Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes. Methods Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map. Results Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = −20 to 50 dB, Z = −2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = −4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = −20% to 90%, Z = −4.412, p
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Roid Rage: Historical Perspective on the Emergence of Oral Steroids as a Treatment of Idiopathic Sudden Sensorineural Hearing Loss

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imageObjectives To review the historical circumstances that led to the emergence of corticosteroid therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) and to discuss how this history has influenced current perspectives on the condition. Methods PubMed and Google scholar were used to identify articles of ISSNHL and oral corticoid steroid use. Historical articles accessed through our institutional medical library were also reviewed. Results The use oral corticosteroids as a treatment for ISSNHL was seemingly influenced by three key historical circumstances that, together, provided the substrate for the treatment's use in ISSNHL. First, ISSNHL was a frustrating condition with uncertainty regarding its etiology and few reliable treatment options. Second, the discovery of corticosteroids was awarded the Nobel Prize in 1950, which led to widespread application of this therapy. Third historical circumstance was the evolution and emergence of more rigorous methodological study designs in clinical research. In 1980, these events culminated in a double-blind study evaluating the effectiveness of oral steroids for treatment of ISSNHL. Interestingly, this study is often misrepresented as a randomized controlled trial, which ultimately contributed to adoption of a new standard for treatment in ISSNHL. Research subsequent to these historical events has challenged the notion of corticosteroids as a gold standard but has not altere d the historically established paradigm of corticosteroid treatment. Conclusions The use of steroids as a treatment for ISSNHL evolved from our specialty's need to address a complex condition, a novel therapeutic discovery, and a landmark study that met emerging methodological standards. Despite these strong historical foundations, ISSNHL remains a condition with an unknown etiology and the therapeutic value of corticosteroids remains unpredictable despite their gold standard label.
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Recurrent Benign Paroxysmal Positional Vertigo in DFNB16 Patients with Biallelic STRC Gene Deletions

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imageObjective Deletions of STRC gene (DFNB16) account for 12% of isolated congenital mild to moderate hearing loss (HL). In mice, the stereocilin protein, encoded by STRC, is present in the vestibular kinocilium embedded in the otoconial membrane of the utricular macula. Despite this, effects on vestibular function have not been widely investigated. The aim of this study was to investigate the prevalence of benign paroxysmal positional vertigo (BPPV) in a cohort of DFNB16 patients. Study Design Observational descriptive epidemiological study. Setting Single-center study, in a tertiary referral center. Patients Older than 5 years, with a genetic diagnosis of HL related to biallelic STRC gene deletions, diagnosed between 2015 and 2021 Intervention Patients or their parents were interviewed to determine whether they had experienced vertigo or episodes of BPPV. Main Outcome Measure Criteria were at least five acute episodes of rotatory vertigo, each lasting less than 1 minute, episodes triggered by changes in specific head position, and an absence of neurological symptoms. Results Sixty-four patients having mild (33%) to moderate (66%) HL were included. Median age was 15 years (range, 6–48 yr). Prevalence of BPPV was 39% (25 of 64). Median age of first onset was 13 years (range, 3–18 yr). Conclusions This study showed recurrent BPPV and early age of onset in patients with biallelic STRC gene deletions. BPPV may be associated with the HL phenotype in patients with STRC gene deletions. It is important to inform patients and families of this potential risk such that appropriate management can be proposed.
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Impedance Change as an Indicator of Cochlear Implant Failure

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imageObjective In February 2020, Advanced Bionics initiated a field action notice to remove the MS Ultra (V1) implant from circulation. In this study, we quantify a single site's incidence with device failure and examine the relationship between impedance change and declining speech perception. Study Design Retrospective/cohort study. Setting Tertiary healthcare center. Patients Forty-nine adult patients (52 devices) were implanted between October 2017 and December 2019, with the following exclusion criteria: 15%. Device failures were confirmed through analyses completed by the manufacturer. Results To date, 21% (11/52) of devices have met all three criteria for a confirmed failure with an average decline in speech perception of 27.7 ± 22%. The average length of time for detection of device failure was 21.9 ± 5 months postimplantation. An additional 7 devices (13%) are currently being monitored for failure but have not yet met full criteria. There was no predictive relationship between degree of impedance change and speech perception scores. Electrodes along the entire array (channels 1–16) can be affected. Conclusions Impedance values can be used as a reliable indicator of device malfunction, thus facilitating patient counseling and early intervention. No correlation was identified between impedance changes and speech perception scores.
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Temporomandibular joint meniscopexy using the juggerknot ®soft anchor system. technical note

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Anterior disk displacement is one of the most frequent temporomandibular joint (TMJ) disorders. Disc displacement can incite inflammatory changes that cause osteoarthritis and progressive degenerative joint disease1. (Source: The British Journal of Oral and Maxillofacial Surgery)
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Growth Rates of Pulmonary Carcinoid Tumors and Hamartomas

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imageBackground Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas. Methods A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400–600 days; and more than 600 days. Results Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas (P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days. Conclusions Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
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Investigation of the Value of T2 Mapping in the Prediction of Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

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imageObjectives Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eosCRSwNP) usually have more extensive sinus disease, severe symptoms, and poorer disease control compared with patients with non-eosCRSwNP. Separating these entities will be crucial for patient management. The purpose of this study is to investigate T1, T2, and apparent diffusion coefficient (ADC) values of the nasal polyps in patients with CRSwNP and evaluate the usefulness of these parameters for differentiating these diseases. Methods Sinonasal magnetic resonance imaging was performed in 36 patients with eosCRSwNP and 20 patients with non-eosCRSwNP (including T1 mapping, T2 mapping, and diffusion-weighted imaging) before surgery. The T1, T2, and ADC values were calculated and correlated with pathologically assessed inflammatory cells of nasal polyps. Results Significant higher T2 value, higher eosinophil count, and lower lymphocyte count of the nasal polyps were observed in eosCRSwNP than those in non-eosCRSwNP. There was no significant difference in T1 or ADC values between the 2 groups. T2 value was correlated with eosinophil count and lymphocyte count in CRSwNP. The area under the curve of T2 value for predicting eosCRSwNP was 0.78 with 89.9% sensitivity and 60.0% specificity. Conclusion T2 value is a promising imaging biomarker for predicting eosCRSwNP. It can help to distinguish eosCRSwNP from non-eosCRSwNP.
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Safety of different surgical modalities for recurrent respiratory papillomatosis resection: A systematic review and meta‐analysis

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Abstract

Background

Currently, the most common surgical modalities used for recurrent respiratory papillomatosis (RRP) resection are microdebrider, carbon dioxide (CO2) laser and potassium-titanyl-phosphate (KTP) laser. However, complication rates vary among different surgical modalities and have been controversial in different studies.

Objective of Review

This study systematically reviews the available studies which reported intra-operative and post-operative complications, aiming to compare the safety of microdebrider, CO2 laser and KTP laser.

Type of Review

Meta-analysis.

Search Strategy

Seven electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane Library and Web of Science) were searched from inception through 28 April 2022. Randomised controlled, prospective or retrospective observational studies that recorded the complications of three different surgical modalities for RRP resection were included in the meta-analysis.

Evaluation Method

Outcomes of interest were intra-operative and post-operative complications, and complication rate was calculated to evaluate the safety of surgical methods.

Results

Twenty different studies were included in quantitative synthesis. Only one study compared outcomes of those three kinds of treatment modalities simultaneously, two studies compared microdebrider and CO2 laser, and the remaining studies focussed on only one of three treatments. The weighted average complication rate for microdebrider was 0.03 (95% confidence interval [CI] 0.00–0.21), n = 6, for CO2 laser treatment was 0.16 (95% CI 0.09–0.25), n = 14 and for KTP laser treatment was 0.04 (95% CI 0.00–0.14), n = 4.

Conclusion

The limited evidence demonstrated that CO2 lasers in the surgical treatment of RRP may lead to more surgical complications, and microdebrider and KTP lasers may be safer. However, the heterogeneous data limit any strong comparison of outcomes of different treatment of laryngeal papillomas. Future randomised controlled trials that directly compare the safety of different surgical modalities are needed.
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