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American Journal of Otolaryngology 2024
Topics: Humans; Otosclerosis; Semicircular Canal Dehiscence; Tomography, X-Ray Computed; Male; Female; Middle Aged; Semicircular Canals; Stapes Surgery
PubMed: 38640814
DOI: 10.1016/j.amjoto.2024.104295 -
International Archives of... Apr 2024Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different...
Facial nerve stimulation (FNS) is a complication in cochlear implant (CI) when the electrical current escapes from the cochlea to the nearby facial nerve. Different management to reduce its effects are available, although changes might result in a less-than-ideal fitting for the CI user, eventually reducing speech perception. To verify the etiologies that cause FNS, to identify strategies in managing FNS, and to evaluate speech recognition in patients who present FNS. Retrospective study approved by the Ethical Board of the Institution. From the files of a CI group, patients who were identified with FNS either during surgery or at any time postoperatively were selected. Data collection included: CI manufacturer, electrode array type, age at implantation, etiology of hearing loss, FNS identification date, number of electrodes that generated FNS, FNS management actions, and speech recognition in quiet and in noise. Data were collected from 7 children and 25 adults. Etiologies that cause FNS were cochlear malformation, head trauma, meningitis, and otosclerosis; the main actions included decrease in the stimulation levels followed by the deactivation of electrodes. Average speech recognition in quiet before FNS was 86% and 80% after in patients who were able to accomplish the test. However, there was great variability, ranging from 0% in quiet to 90% of speech recognition in noise. Etiologies that cause FNS are related to cochlear morphology alterations. Facial nerve stimulation can be solved using speech processor programming parameters; however, it is not possible to predict outcomes, since results depend on other variables.
PubMed: 38618606
DOI: 10.1055/s-0043-1775809 -
International Archives of... Apr 2024The early geneticist and psychiatrist Ernst Rüdin (1874-1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi...
The early geneticist and psychiatrist Ernst Rüdin (1874-1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi era. His connections in the international eugenics network have played an important role in the history of eugenics. To discuss the connections between Ernst Rüdin's scientific group in Munich and Otmar von Verschuer's group in Frankfurt during the Nazi era. Otorhinolaryngological materials from Ernst Rüdin's former private library are presented, and they show Rüdin's deep involvement in the international eugenics network. These materials provide insights into early medical genetics in otorhinolaryngology. One result of the present study is that eugenics groups from Munich, Frankfurt, and New York certainly influenced one another in the field of otorhinolaryngology. Karlheinz Idelberger and Josef Mengele were two scientists who performed hereditary research on orofacial clefts. Later, Mengele became deeply involved in Nazi medical crimes. His former work on orofacial clefts clearly had, to some extent, an influence on subsequent studies. An international eugenics network already existed before 1933. However, it becomes clear that the weaknesses of many early genetic studies did not enable its authors to draw firm scientific conclusions, suggesting that scientists lacked an accurate concept of the genetic causes of most illnesses.
PubMed: 38618601
DOI: 10.1055/s-0043-1776701 -
International Journal of Audiology Apr 2024The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for...
OBJECTIVE
The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for Alternative Interventions (IOI-AI) in the context of ear surgery (IOI-AI) and to test the psychometric properties.
DESIGN
The validated Swedish questionnaire IOI-HA was adapted to the IOI-AI by omitting the question about hearing aid use and changing the term "hearing aid" to "surgery" in the remaining items. The validity, component structure and reliability of the IOI-AI were assessed.
STUDY SAMPLE
Subjects diagnosed with otosclerosis and undergoing stapedotomy were included in the study (n = 162).
RESULTS
High mean scores were noted for all items. Ceiling effects were noted, most pronounced for the satisfaction item. Principal component analysis (PCA) yielded a two-component structure explaining 77.5% of the variance. The test-retest reliability measured by intra class correlation coefficient was >0.9, and the internal consistency coefficient measured by Cronbach's alfa was >0.8.
CONCLUSION
The IOI-AI showed good psychometric properties. However, ceiling effects were observed. The two-component solution was in line with previous factor analyses of the IOI-HA and the IOI-AI. The comprehensive IOI-AI is recommended as a useful tool to evaluate patient perspectives after ear surgery.
PubMed: 38587069
DOI: 10.1080/14992027.2024.2332774 -
International Journal of Pediatric... Apr 2024Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR...
INTRODUCTION
Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term.
METHODS
Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration.
RESULTS
Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term.
DISCUSSION
Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.
Topics: Adult; Humans; Male; Child; Female; Titanium; Ossicular Replacement; Ossicular Prosthesis; Prosthesis Implantation; Ear, Middle; Retrospective Studies; Treatment Outcome
PubMed: 38579403
DOI: 10.1016/j.ijporl.2024.111938 -
Acta Oto-laryngologica Feb 2024Laser fenestration in stapedotomy has thermal effect to the vestibule.
BACKGROUND
Laser fenestration in stapedotomy has thermal effect to the vestibule.
AIMS/OBJECTIVES
To evaluate the role of energy density (fluence) in the severity of postoperative vestibular symptoms.
MATERIALS AND METHODS
The retrospective chart-review study included 84 patients with otosclerosis that underwent primary laser stapedotomy. Surgical outcomes, including nystagmus, and subjective vestibular symptoms during one-month follow-up, were compared between potassium titanyl phosphate (KTP) and CO laser. According to this study and literature, we assessed the relationship between laser parameters and the incidence of persistent vestibular symptoms lasting more than one week after surgery.
RESULTS
The KTP and CO laser group included 48 and 36 patients, respectively. Fluence was different between the KTP (637 J/cm) and CO (141 J/cm) laser ( < .001). The KTP group showed gradual decrease in dizziness during one-month observation period, while the CO group exhibited a steep recovery curve in the first postoperative week (9 and 4 d of duration, respectively). The incidence of persistent vestibular symptoms was correlated with both fluence ( = 0.80, = .01) and spot size ( = -0.74, = .01).
CONCLUSIONS AND SIGNIFICANCE
Appropriate setting of parameters with lower fluence is desirable for the efficiency and safety of laser stapedotomy.Abbreviations: ABG: air-bone gap; SD: standard deviation.
Topics: Humans; Stapes Surgery; Male; Female; Retrospective Studies; Middle Aged; Otosclerosis; Adult; Dizziness; Lasers, Gas; Lasers, Solid-State; Postoperative Complications; Laser Therapy; Aged
PubMed: 38546378
DOI: 10.1080/00016489.2024.2329287 -
European Archives of... Mar 2024Otosclerosis is a primary osteodystrophy of the otic capsule that causes stapedo-vestibular ankylosis. Its diagnosis is suspected on the basis of clinical and...
BACKGROUND
Otosclerosis is a primary osteodystrophy of the otic capsule that causes stapedo-vestibular ankylosis. Its diagnosis is suspected on the basis of clinical and audiometric elements, basically in the presence of conductive hearing loss with a normal eardrum. The CT-scan is an essential examination for the preoperative evaluation of otosclerosis. The aim of our study was to evaluate the use of CT-scanning in predicting the functional outcome of otosclerosis surgery by correlating postoperative audiometric results and preoperative CT findings.
METHODS
We conducted a retrospective study at the ENT Department in association with the Medical Imaging Department of our hospital, over a period of 8 years, from January 2014 to December 2022 and involving 90 patients (104 ears).
RESULTS
The average age of our patients was 40 years with extremes ranging from 22 to 61 years. We noted a sex ratio of 0.38. The preoperative CT-scan showed signs of otosclerosis in 87% of the cases and infra-radiological forms in 13% of the cases. Veillon stage II was the most frequent radiological stage encountered with a percentage of 48%. A good audiometric evolution, defined by a closure of postoperative Air Bone Gap (ABG ≤ 20 dB) and by an improvement of Bone Conduction (BC gain ≥ 0), was recorded in 86 cases (82.7%) for ABG and in 84 cases (80.8%) for BC gain. Scanographic predictive factors of poor postoperative outcome for ABG and BC gain were: advanced stages (Veillon stage III and IV), endosteal effraction, and round window involvement. According to multivariate analysis, only the extent of otosclerotic foci was directly and independently associated with the postoperative audiometric outcome.
CONCLUSION
The CT-scan is an essential examination in the preoperative evaluation of otosclerosis. It allows a positive diagnosis to be made and evaluate the extension of otosclerosis. Moreover, thanks to the analysis of the extent of the otosclerosis foci, mainly by the Veillon classification, the CT-scan allows to predict the postoperative audiometric prognosis.
PubMed: 38530462
DOI: 10.1007/s00405-024-08585-1 -
Otology & Neurotology : Official... Jun 2024Microdrill and diode laser are two different methods used in endoscopic stapedotomy for otosclerosis. These two methods have not been compared in endoscopic stapedotomy. (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Microdrill and diode laser are two different methods used in endoscopic stapedotomy for otosclerosis. These two methods have not been compared in endoscopic stapedotomy.
AIMS/OBJECTIVES
To analyze the differences between microdrill and diode laser in endoscopic stapedotomy for otosclerosis.
MATERIALS AND METHODS
This is a randomized clinical trial; patients with otosclerosis were randomly divided into microdrill group (group A: n = 69) and diode laser group (group B: n = 62). Differences between the two groups were then compared.
RESULTS
The preoperative air-bone gap (ABG) was 25.40 ± 10.88 dBHL in group A and 24.84 ± 12.23 dBHL in group B, with no significant between-group difference ( p > 0.05). The postoperative ABG in group A was 13.27 ± 9.91 dBHL versus 11.79 ± 10.82 dBHL in group B, and there was no significant difference between the groups ( p > 0.05). The surgical time in group B (64 ± 31.23 minutes) was significantly longer than that in group A (48 ± 25.62 minutes) ( p = 0.02). There were no significant between-group differences in basic patient-related data, preoperative air conduction (AC), preoperative bone conduction (BC), postoperative AC, distribution of postoperative ABG, preoperative ABG at different frequencies, and postoperative ABG at different frequencies. There was also no significant between-group difference in the average bleeding volume or number of patients with postoperative dizziness.
CONCLUSION AND SIGNIFICANCE
The postoperative improvement in hearing level in the two group was equivalent, but group A had the advantage of a shorter operation time.
LEVEL OF EVIDENCE
4.
Topics: Humans; Stapes Surgery; Otosclerosis; Female; Male; Adult; Middle Aged; Lasers, Semiconductor; Endoscopy; Treatment Outcome; Bone Conduction; Laser Therapy; Operative Time
PubMed: 38530360
DOI: 10.1097/MAO.0000000000004177 -
Otology & Neurotology : Official... Jun 2024To assess the location/number of otic capsule demineralization and hearing outcomes of stapes surgery (SS) for osteogenesis imperfecta (OI) compared with otosclerosis... (Comparative Study)
Comparative Study
OBJECTIVE
To assess the location/number of otic capsule demineralization and hearing outcomes of stapes surgery (SS) for osteogenesis imperfecta (OI) compared with otosclerosis (OS).
PATIENTS
This study included 11 and 181 consecutive ears from 6 and 152 patients with OI and OS, respectively.
INTERVENTIONS
Demineralization loci observed as hypodense area of the otic capsule were examined using high-resolution computed tomography. All patients underwent SS.
MAIN OUTCOME MEASURES
Locations of the hypodense areas were classified into the anterior oval window, anterior internal auditory canal, and pericochlear area. The location/number of hypodense areas and preoperative/postoperative hearing parameters were correlated. Postoperative hearing outcome was evaluated 12 months after surgery.
RESULTS
Hypodense area was more frequently observed in OI (9 of 11 ears [81.8%]) than in OS (96 of 181 ears [53.0%]), with significant differences. Multiple sites were involved in 81.8% OI and 18.8% OS patients, showing significant differences. Preoperative air conduction (AC), bone conduction, and air-bone gap (ABG) were 48.9 ± 17.8, 28.0 ± 11.3, and 20.7 ± 8.4 dB, respectively, in OI and 56.2 ± 13.5, 30.5 ± 9.9, and 26.4 ± 9.7 dB, respectively, in OS, demonstrating greater AC and ABG in OS than in OI. Postoperative AC (31.3 ± 20.5 dB), ABG (10.6 ± 10.0 dB), and closure of ABG (12.1 ± 4.7 dB), that is, preoperative ABG minus postoperative ABG of OI, were comparable to those of OS (AC, 30.9 ± 13.3 dB; ABG, 7.0 ± 7.4 dB; closure of ABG, 20.1 ± 11.6 dB).
CONCLUSION
OI ears showed more severe demineralization of otic capsule than OS ears. However, favorable hearing outcomes could be obtained through SS for OI and OS ears.
Topics: Humans; Otosclerosis; Stapes Surgery; Osteogenesis Imperfecta; Female; Male; Adult; Treatment Outcome; Middle Aged; Adolescent; Bone Conduction; Hearing; Young Adult; Tomography, X-Ray Computed; Aged
PubMed: 38518766
DOI: 10.1097/MAO.0000000000004166 -
Otology & Neurotology Open Mar 2023Proteins enriched in the perilymph proteome of Meńier̀e disease (MD) patients may identify affected cell types. Utilizing single-cell transcriptome datasets from the...
HYPOTHESIS
Proteins enriched in the perilymph proteome of Meńier̀e disease (MD) patients may identify affected cell types. Utilizing single-cell transcriptome datasets from the mammalian cochlea, we hypothesize that these enriched perilymph proteins can be localized to specific cochlear cell types.
BACKGROUND
The limited understanding of human inner ear pathologies and their associated biomolecular variations hinder efforts to develop disease-specific diagnostics and therapeutics. Perilymph sampling and analysis is now enabling further characterization of the cochlear microenvironment. Recently, enriched inner ear protein expression has been demonstrated in patients with MD compared to patients with other inner ear diseases. Localizing expression of these proteins to cochlear cell types can further our knowledge of potential disease pathways and subsequent development of targeted therapeutics.
METHODS
We compiled previously published data regarding differential perilymph proteome profiles amongst patients with MD, otosclerosis, enlarged vestibular aqueduct, sudden hearing loss, and hearing loss of undefined etiology (controls). Enriched proteins in MD were cross-referenced against published single-cell/single-nucleus RNA-sequencing datasets to localize gene expression to specific cochlear cell types.
RESULTS
In silico analysis of single-cell transcriptomic datasets demonstrates enrichment of a unique group of perilymph proteins associated with MD in a variety of intracochlear cells, and some exogeneous hematologic and immune effector cells. This suggests that these cell types may play an important role in the pathology associated with late MD, suggesting potential future areas of investigation for MD pathophysiology and treatment.
CONCLUSIONS
Perilymph proteins enriched in MD are expressed by specific cochlear cell types based on in silico localization, potentially facilitating development of disease-specific diagnostic markers and therapeutics.
PubMed: 38516320
DOI: 10.1097/ONO.0000000000000027