Tuesday, September 28, 2021

Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

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Front Surg. 2021 Sep 10;8:729736. doi: 10.3389/fsurg.2021.729736. eCollection 2021.

ABSTRACT

Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot. Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot (RobOtol®, Collin, Bagneux, France) with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250-500-750 Hz, 500-1,000-2,000-3,000 Hz, and 3,000-4,000-8,000 Hz for low, mid, and high frequencies, respectively. Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies (p < 0.0001; Adjusted R 2 = 0.64, polynomial non-linear regression). Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion (p = 0.018; Fisher's exact test). Conclusion: The restoration of high-frequency thresholds (3,000-4,000-8,000 Hz) by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced afte r a robot-assisted insertion.

PMID:34568420 | PMC:PMC8461256 | DOI:10.3389/fsurg.2021.729736

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The correlation between neonatal parameters and late‐onset inner ear disorders in congenital cytomegalovirus infection: an 10‐year population‐based cohort study

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Abstract

Objective

To evaluate the correlation of neonatal parameters with late-onset sensorineural hearing loss (SNHL) and vestibular dysfunction in individuals with congenital cytomegalovirus (cCMV) infection using the National Health Insurance Research Database (NHIRD) in Taiwan.

Design

Retrospective cohort study.

Setting

The whole Taiwanese population.

Participants

Patients with related diagnostic codes and examinations in their records were regarded as having cCMV infection. Each subject in that group was matched to 10 control individuals with noncongenital CMV infection on the basis of several neonatal parameters, including low gestational age, low birth weight, low Apgar score, maternal history of CMV infection and prolonged cCMV infection. A total of 5,893 and 58,930 participants were enrolled in the study and control groups, respectively.

Main outcome measures

The main outcomes were the development of SNHL and the development of vestibular dysfunction within one year after birth as reflected by diagnostic codes and specific examinations. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (HR) and 95% confidence interval (CI) of each primary outcome between the two groups.

Results

Overall, 109 and 397 episodes of SNHL developed in the study group and the control group, respectively, and the study group demonstrated a significantly higher incidence of SNHL (adjusted HR: 2.56; 95% CI: 2.07–3.18). In addition, similar incidence rates of vestibular dysfunction were found in the study group and the control group, with 7 and 90 events, respectively (adjusted HR: 0.77; 95% CI: 0.36–1.67). In subgroup analyses, a higher incidence of SNHL was correlated with lower gestational age (GA) (adjusted HR: 2.09; 95% CI: 1.29–3.39), lower birth weight (BW) (adjusted HR: 2.05; 95% CI: 1.28–3.30), and prolonged cCMV infection (adjusted HR: 3.92; 95% CI: 1.95–7.88).

Conclusions

Low GA, low BW and a long disease course are significantly correlated with late-onset SNHL in cCMV infection.

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Morphological Changes in Nasal Mucosa in Patients with Sarcoidosis

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Abstract

•Changes in the microvascular network of the nasal mucosa may be accompanied by changes in olfaction.

•Contact endoscopic changes in the microvascular network of the nasal mucosa may be used as a marker of sinonasal sarcoidosis.

•A modified version of the Negoro's classification, in use for the tongue mucosa, may be used for the classification of contact endoscopic microvascular patterns of the nasal mucosa in patients with sarcoidosis

•The validation of the use of the vascular patterns of nasal mucosa on contact endoscopy as a marker of nasal disease activity is a major future research challenge

•Contact endoscopy emerges as a promising technique for on-site diagnosis of early, advanced or late inflammatory mucosal spots or generalized mucosal affection in sarcoidosis.

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Cord Medialization in Unilateral Vocal fold paralysis improves forced vital capacity

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Abstract

Objective

The lateralized vocal fold of unilateral vocal fold paralysis (ULVFP) is unphysiological for expiration wherein vocal folds normally adduct to increase expiratory resistance and prevent small airway collapse. ULVFP may therefore impair ventilatory function and ventilatory volume. This study seeks to test if vocal fold medialization improves forced vital capacity (FVC).

Design

Prospective inception cohort intervention study.

Setting

Academic Tertiary Care Institution.

Participants

Twenty-five patients of ULVFP with a phonatory gap ranging from 2-6 mm.

Main outcome measures

Vocal fold medialization undertaken with autologous fat injection. Forced Vital Capacity (FVC) assessments by spirometry undertaken pre-treatment and 1month post-treatment.

Results

Improvement in FVC noted in all patients with the quantum of improvement ranging from 0.1 to 0.6 liters. Mean FVC improved from 3.10 liters pre-injection to 3.45 liters post-injection. (p<0.001). A moderate correlation was noted between the degree of medialization and improvement in FVC (r=0.33, Pearson's Correlation Coefficient)

Conclusion

Objective improvement in FVC is consistently noted post vocal fold medialization for ULVFP, and is probably mediated by increased glottic expiratory resistance and consequent improvement in intrinsic PEEP.

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Suspension Laryngoscopy Experiences in a Tertiary Airway Service: a Prospective Study of 150 Procedures

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Abstract

Objectives

In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates.

Design

Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed pre-operatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery.

Setting

Tertiary adult airway service for predominantly benign pathology.

Results

Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r=0.22, p=0.008;) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r=-0.20, p=0.014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r=-0.19, p=0.023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r=0.45, p=1.611x10-8).

Conclusion

In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms.

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Cochlear Implantation in Goldenhar Syndrome

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Abstract

Goldenhar syndrome is a rare genetic condition characterized by hemifacial microsomia, mandibular hypoplasia, auricular malformations, and epibulbar dermoids. The syndrome has both sporadic and familial occurrence. Incidence of congenital hearing loss in these patients is 1:1000 in children with a male to female ratio of 3:2. In our case study we report a case of Goldenhar Syndrome who underwent cochlear implantation. The patient had right side microtia, right hemifacial microsomia and right side torticollis, pterygium in her right eye, right hypoplastic thumb and unilateral right side kidney. Radiologically, there was narrow duplicated internal auditory canal on right side with absent right cochlear nerve with normal anatomy on left side and the left side showed malformed facial nerve at tympani segment and second genu. Therefore, the patient was planned for left side cochlear implantation. Intraoperatively, there were malformed ossicles with anomalous facial nerve covering whole of oval window and partially the round window. Thus, a separate cochleostomy was done. Impedance was < 5 Hertz in all electrodes and electrically evoked action potential (ECAP) thresholds were obtained on all electrodes.

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Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with COVID 19 infection

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Abstract

The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable because of the limited human understanding of the virus with the current literature. In this study, we have tried to correlate the various predisposing factors influencing the clinical profile and treatment outcomes in patients with covid associated mucormycosis (CAM). It is a retrospective analysis of cases of CAM during the second wave of COVID 19 infection, which was managed in the department of Otorhinolaryngology from Dec 1, 2020, to June 10, 2021. The detailed clinical, radiological and management of patients with CAM were collected, recorded, evaluated and correlated with the predisposing factors. Of the total, 46 patients, 44(95.65%) were diabetic and 41 patients had a previous history of steroid intake. When clinical parameters were compared between blood sugar < 200 mg/dl and > 200 mg/dl, the old and newly diagnosed diabetes mellitus in patients with CAM, there was no significant differences in any of the above clinical parameters (p > 0.05), except the hospital stay (p = 0,004). Steroid intake in patients with coexisting DM associated with CAM is considered the most important factor for the development of the CAM. There was are no significant difference in any of the clinical/treatment outcomes in patients with CAM with respect to the initial blood sugar, except for the hospital stay. A large sample size with a long-term follow-up period may be needed for a better understanding of common predisposing factors for the development of CAM.

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Radioactive Particle Implantation Combined with Chemotherapy for Treatment of Pancreatic Adenocarcinoma

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Radiol Imaging Cancer. 2021 Sep;3(5):e219020. doi: 10.1148/rycan.2021219020.

NO ABSTRACT

PMID:34533374 | DOI:10.1148/ryca n.2021219020

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Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments

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Abstract

Background

To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery.

Methods

Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated.

Results

The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085–0.979]) and anterior (HR = 0.278 [0.128–0.605]) and posterior (HR = 0.269 [0.115–0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537–8.495]) and posterior (HR = 5.195 [2.167–12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS.

Conclusions

Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.

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Identification of enhancer RNAs for the prognosis of head and neck squamous cell carcinoma

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Abstract

Background

Enhancer RNAs (eRNAs) play an important role in carcinogenesis. The landscape of eRNAs in head and neck squamous cell carcinoma (HNSCC) remains largely unknown.

Methods

The eRNA expression matrix was obtained from the enhancer RNA in the cancer database. Functional enrichment analyses were performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG). Prognostic eRNAs were identified using Cox regression analysis, and a prognostic prediction model was constructed based on coefficients.

Results

KEGG analysis showed that eRNA-related transcription factors were mainly enriched in herpes simplex virus 1 (HSV1) infection. The zinc finger (ZNF) family may play an essential role in HNSCC. ENSR00000188847, ENSR00000250663, ENSR00000313345, ENSR00000317887, and ENSR00000336429 were identified. The prediction model was robust.

Conclusions

We constructed a robust 5-eRNA prognostic prediction model, and these eRNAs are potential biomarkers for HNSCC prognosis.

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Impact of Masks on Speech Recognition in Adult Patients with and without Hearing Loss

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Introduction: The coronavirus 2019 pandemic has altered how modern healthcare is delivered to patients. Concerns have been raised that masks may hinder effective communication, particularly in patients with hearing loss. The purpose of this study is to determine the effect of masks on speech recognition in adult patients with and without self-reported hearing loss in a clinical setting. Methods: Adult patients presenting to an otolaryngology clinic were recruited. A digital recording of 36 spondaic words was presented to each participant in a standard clinical exam room. Each word was recorded in 1 of 3 conditions: no mask, surgical mask, or N95 mask. Participants were instructed to repeat back the word. The word recognition score was determined by the percent correctly repeated. Results: A total of 45 participants were included in this study. Overall, the mean word recognition score was 87% without a mask, 78% with a surgical mask, and 61% with an N95 mask. Among the 23 subjects (51.1%) with self-reported hearing loss, the average word recognition score was 46% with an N95 mask compared to 79% in patients who reported normal hearing (p #x3c; 0.001). Conclusion: Our results suggest that masks significantly decrease word recognition, and this effect is exacerbated with N95 masks, particularly in patients with hearing loss. As masks are essential to allow for safe patient-physician interactions, it is imperati ve that clinicians are aware they may create a barrier to effective communication.
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A comprehensive analysis of the correction of alar retraction in rhinoplasty: A systematic review

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J Plast Reconstr Aesthet Surg. 2021 Sep 6:S1748-6815(21)00387-9. doi: 10.1016/j.bjps.2021.08.008. Online ahead of print.

ABSTRACT

BACKGROUND: Alar retraction, as a type of alar deformity, seriously affects the esthetic perception of the nose in patients. Despite the rapid development of rhinoplasty in recent years, the treatment of alar retraction is still a challenge work in plastic surgery. This systematic review highlights the etiology, treatment, and prevention of alar retraction to further guide practitioners.

METHODS: A systematic review was conducted from 1975 to 2020 through PubMed, Embase, Web of Science, and Cochrane database with the key words "alar retraction" and "rhinoplasty" or "Rhinoplasties" to investigate the surgical treatment of alar retraction. The inclusion and exclusion criteria were set to screen the literature.

RESULTS: A total of 163 literatures were obtained through database retrieval. After remov ing the duplicate literature, reading the title and abstract, and reviewing the full text finally, 34 articles were included in the final study. Most of the articles have summarized the surgical methods to correct alar retraction by retrospective study.

CONCLUSIONS: Alar retraction should be analyzed from the etiology, pathogenesis, and treatment. The diversity of surgical methods provides more options for the clinic. However, the plastic surgeons need to develop sharp analytical skills, improve clinical operational capability, and look for appropriate methods to achieve in good result.

PMID:34580056 | DOI:10.1 016/j.bjps.2021.08.008

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