Single-sided deafness (SSD) and asymmetric hearing loss (AHL) have recently been proposed as a new indication for cochlear implantation. There is still no recommended treatment for these hearing deficits, and most options considered rely on the transfer of sound from the poor ear to the better ear, using Contralateral Routing of the Signal (CROS) hearing aids or bone conduction (BC) devices. In contrast, cochlear implantation allows the poor ear to be stimulated and binaural hearing abilities to be partially restored. Indeed, most recently published studies have reported an improvement in the spatial localisation of an incoming sound and better speech recognition in noisy environments after cochlear implantation in SSD/AHL subjects. It also provides consistent relief of tinnitus when associated. These encouraging hearing outcomes raise the question of the cost-utility of this expensive treatment in an extended indication.
Background The sinuses, nasal cavity, and middle ear represent a rarer location of head and neck malignancy than more common sites such as the larynx and oral cavity. Population-based studies are a useful tool to study the demographic and treatment factors affecting survival in these malignancies. Methods Population-based database search of the Survival, Epidemiology, and End Results (SEER) database from 1973 to 2015 for malignancies involving the nasal cavity, paranasal sinuses, and middle ear. Data were analyzed for demographics, treatment type, stage, primary site and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival. Results A total of 13,992 cases of sinonasal or middle ear malignancy were identified and analyzed. The majority of patients were between ages 50 and 80 at the time of diagnosis. Overall 5-, 10-, and 20-year survival was 45.7%, 32.2%, and 16.4%, respectively. Lymph node metastasis was reported in 4.4% of patients, while distant metastasis was present in 1.5% of cases. On univariate analysis surgical vs. nonsurgical treatment, sex, race, age at diagnosis, T stage, N stage, M stage, AJCC overall stage, primary site, tumor grade, and histopathologic subtype significantly affected survival. On multivariate analysis age, race, sex, primary site, overall AJCC stage, surgical vs. nonsurgical treatment, and T, N, and M stage remained significant predictors of overall survival. Conclusions Malignancies of the nasal cavity, paranasal sinuses, and middle ear account for a minority of overall head and neck cancers. The overall 5-, 10-, and 20-year survival for these malignancies is relatively low. Higher T, N, M, and overall stage and higher tumor grade is associated with lower survival. Patients treated with surgery as part of the treatment regimen had higher overall survival. Demographics and primary site also significantly affect survival. Certain histopathologic subtypes were associated with poorer survival.
Background: Quality control after phonosurgery is important and may be time consuming. Often questionnaires focusing on quality of life are applied. We aimed at investigating the use of organ specific symptoms, such as hoarseness and voice failure with the use of self-reported visual analogue scales (VAS) and Likert-scales. Methods: A vocal surgical questionnaire using VAS and Likert-scales for hoarseness, voice failure and factors that could influence voice quality was given twice consecutively to a group of healthy volunteers (n = 57, 45 female) and a group of voice patients (n = 34, 21 females) for a test/re-test study. Secondly, a group of patients undergoing surgery (n = 90, 61females) answered the questionnaire preoperatively and postoperatively. The difference between test/retest, healthy volunteers and patients, and between pre- and postoperative results were compared. Results: There was no significant difference in the test/retest results in healthy volunteers nor in the patient group. There was statistically significant difference between the healthy volunteers and patients, and between the preoperative and postoperative results after phonosurgery. Conclusion: This short and organ specific questionnaire clearly demonstrates the effect of phonosurgery, making it an easy and relevant tool in quality control and potentially reducing the need of postoperative controls in the outpatient clinic.
Worldwide, the burden of chronic rhinosinusitis (CRS) is variable, but not known in Uganda. CRS has significant negative impact on quality of life (QOL) and as such QOL scores should guide adjustments in treatment strategies. However, most of these studies have been done in the west. Our hypothesis was that QOL scores of the majority of CRS patients in low- to- middle income countries are poorer than those among patients without CRS. The aim of this study was to determine the burden of CRS among patients re-attending the Otolaryngology clinic and whether CRS is related to poor QOL.
Background Adenoid cystic carcinoma (ACC), a rare tumor of epithelial cell origin, commonly arises from the major salivary glands. Uncommonly it may be found outside the salivary glands and it's especially rare in the nasal cavity. Case presentation A 71-year female had complaints of swelling at the base of nose, Fine needle aspiration (FNA) from the swelling revealed features of adenoid cystic carcinoma; cell block & IHC for CD-117 was positive. Conclusions Sino-nasal ACC (SNACC) continues to pose diagnostic and therapeutic challenges to clinicians. Due to its rarity & vague presentation, early diagnosis requires a high index of suspicion. FNA can be used as an invaluable diagnostic tool in the evaluation of these lesions. Since it’s incidence in sinonasal region is rare; our attempt to report this case will heighten the physician’s awareness of this disease, helping further treatment.
Background Mitochondrial maternally inherited hearing impairment (HI) appears to be increasing in frequency. The incidence of mitochondrial defects causing HI is estimated to be between 6 and 33% of all hearing deficiencies. Mitochondrial m.1555A > G mutation is the first mtDNA mutation associated with non-syndromic sensorineural deafness and also with aminoglycoside induced HI. Its prevalence varied geographically between different populations. Methods We carried out PCR, restriction enzyme based screening, and sequencing of 337 subjects (including 132 patients diagnosed clinically with hereditary deafness) from 54 families from Syria for m.1555A > G mitochondrial mutation. Results Mitochondrial m.1555A > G mutation was detected in one of fifty-four families (1.85%), six out of the 132 (4.5%) of all patients with NSHI and one propositus of the 205 individuals with normal hearing (0.48%). Conclusion This is the first study to report prelingual deafness causative gene mutations identified by sequencing technology in Syrian families. It is obvious from the results that the testing for the m.1555A > G mutation is useful for diagnosis of hearing loss in Syrian patients and should also be considered prior to treatment with aminoglycosides in predisposed individuals.
Background Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope. Methods A prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant. Results Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age ( p = 0.031), rural residence ( p = 0.005), previous history of health care visit and treatment ( p = 0.000), upper respiratory tract infection ( p = 0.018) and presence of cigarette smoker in the house ( p = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials. Conclusions Majority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment.
Background Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectrum with poorer surgical outcomes. We performed a microbial genome-wide association study (mGWAS) to investigate whether S. aureus isolates from CRS patients have particular genetic markers associated with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). Methods Whole genome sequencing was performed on S. aureus isolates collected from 28 CRSsNP and 30 CRSwNP patients. A mGWAS approach was employed using large-scale comparative genomics to identify genetic variation within our dataset. Results Considerable genetic variation was observed, with > 90,000 single nucleotide polymorphisms (SNPs) sites identified. There was little correlation with CRS subtype based on SNPs and Insertion/Delection (Indels). One indel was found to significantly correlate with CRSwNP and occurred in the promoter region of a bacitracin transport system ATP-binding protein. Additionally, two variants of the highly variable superantigen-like (SSL) proteins were found to significantly correlate with each CRS phenotype. No significant association with other virulence or antibiotic resistance genes were observed, consistent with previous studies. Conclusion To our knowledge this study is the first to use mGWAS to investigate the contribution of microbial genetic variation to CRS presentations. Utilising the most comprehensive genome-wide analysis methods available, our results suggest that CRS phenotype may be influenced by genetic factors other than specific virulence mechanisms within the S. aureus genome.
Background: While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death. Methods: A PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher's exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity. Results: A total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1). Conclusions: Necrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.
Epithelial-myoepithelial carcinoma is an uncommon malignant neoplasm seen most frequently in the salivary glands, representing approximately 1 to 2% of salivary gland tumors. Less than 600 cases have been reported in the literature since its initial description in 1972. The aim of this study was to examine demographic, site, stage, and survival factors in patients with epithelial-myoepithelial carcinoma.
The purpose of this study was to examine whether allergic rhinitis is associated with periodontal disease in a representative sample of elderly Korean people that was adjusted for socio-demographic factors, oral and general health behaviors, and systemic health status.
The orbital floor is a reliable and useful surgical landmark in endoscopic endonasal surgery. In revision cases or advanced disease, the normal landmarks can be distorted or absent and the orbital floor serves as a reference point for surgeons to avoid any unintentional injury to the skull base, the internal carotid artery and other critical structures.
Otitis media is inflammation of the middle ear and tympanic membrane, which often occurs after an acute upper respiratory tract infection. It is the most common episode of infection in children and the second most important cause of hearing loss affecting 1.23 billion people, thus ranked fifth global burden of disease with a higher incidence in sub-Saharan Africa. Thus, the aim of this study was to determine the isolation rate of bacterial pathogens from pediatric patients with otitis media.
BACKGROUND:The purpose of this study was to investigate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on the timing of laryngeal vestibule closure during the pharyngeal stage of swallowing in healthy adults. The theoretical framework proposed that NMES applied to these muscles would present a perturbation to laryngeal vestibular closure reaction time (the amount of time for the laryngeal vestibule to close once the swallowing reflex has been triggered) by providing an antagonistic force to the direction of vestibule closure.METHODS:Nine healthy adults (2 males, 7 females) received ten consecutive stimulations applied to the submandibular hyolaryngeal muscles while performing dry swallows. Laryngeal vestibule closure reaction time (LVCrt) and the laryngeal vestibule closure duration (LVCd) were measured from videoflouroscopic images pre-stimulation and post-stimulation.RESULTS:Results indicated a significant effect of stimulation on LVCrt but not LVCd. LVCrt was significantly reduced (timing was faster) during swallows immediately after stimulation compared to pre-stimulation.CONCLUSIONS:Findings from this study support the supposition that laryngeal muscles respond to perturbations via adaptation learning, which might be used for rehabilitation of neuromuscular swallowing impairment. This pilot study supports the need for further research.
BACKGROUND:Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.METHODS:Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.RESULTS:A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.CONCLUSIONS:Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.
Background The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery. Methods All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups. Results Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 (p < 0.01) and group-3 which reported more problems in the ear/facial--subset of SNOT-20 and in the general-mental-health-domain of SF-36 than group-1 (p < 0.01) . Postoperatively all patient groups reported improved symptom scores of nasal obstruction, nasal discharge, snoring, oral breathing and reduced general health (p < 0.01), and better HQOL (p < 0.05). Patients in group-2 had less symptoms of nasal obstruction than group-3 (p < 0.05) . Postoperative symptom score for nasal obstruction was 29.1 (SD67.6) in group-1, 27.5 (SD22.5) in group-2 and 37.2 (SD24.8) in group-3. Revision cases reported more nasal obstruction postoperatively; 41.3 (SD27) than non revision cases; 28.6 (SD24) (p < 0.01). The HQOL after surgery was about the same in all three patient groups, but we found that patients with comorbidities as sleep apnea and asthma reported worse HQOL than other patients (p < 0.01). Conclusion Surgical treatment of nasal obstruction led to less symptoms and better HQOL for all three patient groups. Comparing the postoperative scores between the patient groups we find that all groups reached the same level of HQOL. Regarding symptoms, the patients who underwent septoplasty combined with RFIT reported postoperatively less nasal obstruction than patients who underwent RFIT alone which may indicate that a combined procedure of septoplasty and RFIT is better than RFIT alone to treat nasal obstruction. Furthermore, revision cases, patients with sleep apnea and asthma patients seem to have poorer outcome after surgery than other patients. Both disease specific and general QOL instruments add valuable information for identifying factors influencing outcome.
Background: To the best of our knowledge, no empirically based consensus has been reached as to if, and to what extent, persons with hearing loss (HL) have reduced generic Quality of life (QoL). There seems to be limited knowledge regarding to what extent a hearing aid (HA) would improve QoL. The main aim of the present study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL. Methods: Literature databases (Cinahl, Pub Med and Web of Science) were searched to identify relevant journal articles published in the period from January 2000 to March 17, 2016. We performed a primary search pertaining to the relationship between HL, HA and QoL (search number one) followed by a supporting search pertaining to the relationship between distress/mood/anxiety and HL (search number two). After checking for duplications and screening the titles of the papers, we read the abstracts of the remaining papers. The most relevant papers were read thoroughly, leaving us with the journal articles that met the inclusion criteria. Results: Twenty journal articles were included in the present review: 13 were found in the primary search (HL and QoL), and seven in the supporting search (HL and distress). The literature yields equivocal findings regarding the association between generic QoL and HL. A strong association between distress and HL was shown, where distressed persons tend to have a lowered generic QoL. It is suggested that QoL is lowered among HL patients. Some studies suggest an increased generic QoL following the use of HA, especially during the first few months after initiation of treatment. Other studies suggest that HA use is one of several possible factors that contribute to improve generic QoL. Conclusions: The majority of the studies suggest that HL is associated with reduced generic QoL. Using hearing aids seem to improve general QoL at follow-up within the first year. HL is a risk factor for distress. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.
Background Lateral sphenoid encephaloceles present a surgical challenge. These encephaloceles may be difficult to access given their lateral location and proximity to the neural and vascular structures of the sphenoid floor, pterygopalatine fossa, and lateral and superior sphenoid walls. Additionally, many patients have idiopathic intracranial hypertension, increasing the risk of recurrence. When untreated or undiscovered, these encephaloceles increase the risk of meningitis. Methods All consecutive endoscopic repairs of lateral sphenoid encephaloceles by a single surgeon from 2012 to 2017 were analyzed for method of repair, complications, and recurrence rate. Odds ratio for recurrence of CSF leak for Alloderm inlay/abdominal fat sphenoid obliteration/nasoseptal flap with multilayer repair vs. other method (Alloderm onlay/contralateral nasoseptal flap or free mucosal graft) was compared, and Fischer’s exact test was used to calculate the two-sided p -value for the two repair methods. Results The success rate (no recurrence of cerebrospinal fluid rhinorrhea) for Alloderm inlay/abdominal fat onlay/nasoseptal flap onlay was 100% while for Alloderm onlay/contralateral nasoseptal flap + free mucosal graft the success rate was 0%. For any nasoseptal flap repair vs. free mucosal graft the success rates were 83.3% and 16.7% respectively. The success rate for Alloderm inlay/abdominal fat onlay/nasoseptal flap onlay vs. Alloderm onlay/contralateral nasoseptal flap + free mucosal graft was statistically significant ( p = 0.048), but the success rate for any nasoseptal flap repair vs. free mucosal graft was not significant ( p = 0.29). The success rate for patients without post-op lumbar drain vs. with post-op lumbar drain was also nonsignificant ( p = 0.29). Conclusions In the author’s hands Alloderm inlay/abdominal fat onlay/nasoseptal flap onlay was superior to other repair methods (Alloderm onlay/contralateral nasoseptal flap or free middle turbinate mucosa onlay graft). The complication rate was low. Post-operative lumbar drainage did not affect the success rate.
