JOURNAL OF OTOLOGY
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Chinese Journal of Otology
JOURNAL OF OTOLOGY
Journal of Otology
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Department of Otolaryngology, Head & Neck Surgery, Chinese PLA General Hospital
Chinese PLA General Hospital
2019, 14(2) Published: 15 June 2019
Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review
Pauline Vanneste, Cyril Page
JOURNAL OF OTOLOGY, 2019, 14(2): 33-39
Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases)tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.
Autoinflammatory characteristics and short-term effects of delivering high-dose steroids to the surface of the intact endolymphatic sac and incus in refractory Meniere’s disease
JOURNAL OF OTOLOGY, 2019, 14(2): 40-50
Objective: To investigate immune-related genetic background in intractable Meniere’s disease (MD) and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac (ES) and incus in a sustainable manner.
Case report and methods: Candidate genes involved in immune regulation were sequenced using a nextgeneration sequencing method in a patient with intractable MD. Mutations were confirmed using the Sanger sequencing method. The ES was exposed, and gelatin sponge particles were immersed in highdose methylprednisolone solution and placed onto the surface of ES. “L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES. Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.
Results: Autoinflammation in the refractory MD case was indicated by genotype, including novel heterozygous mutations of PRF1, UNC13D, SLC29A3, ITCH, and JAK3, as well as phenotype. The vertigo was fully relieved immediately after operation. Tinnitus and aural fullness were resolved 3 weeks after operation, whereas hearing improved in 2 mon postoperation. No recurrence was noted during the 5 months follow up, and the final MRI supported the novel therapeutic hypothesis.
Conclusion: Autoinflammation was involved in a refractory MD. This novel therapy, which involves the delivery of steroids to the surface of the intact ES and incus, is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.
The cardiovascular aspects of a Meniere’s disease population A pilot study
Angela Reis Rego, David Dias, Ana Pinto, Sandra Sousa e Castro, Telma Feliciano, Cecília Almeida e Sousa
JOURNAL OF OTOLOGY, 2019, 14(2): 51-56
Introduction: MD is considered a rare disease. An adequate model that explains MD's pathophysiology is not well established. Recently, the vascular theory of the disease has been revived.
Objectives: To characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course.
Methods: In this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Barany Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors).
Results: 31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p ¼ 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors.
Conclusions: Treatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.
Assessment of outcomes of hearing and speech rehabilitation in children with cochlear implantation
Shaofeng Liu a, Fang Wang b, Peipei Chen a, Na Zuo a, Cheng Wu a, Jun Ma a, Jingjiang Huang a, Chuanxi Wang a
JOURNAL OF OTOLOGY, 2019, 14(2): 57-62
Objectives: This study aimed to assess the effect of hearing and speech rehabilitation in patients with Nurotron® cochlear implants.
Design: Ninety-eight paediatric patients with bilateral severe-to-profound sensorineural deafness who received cochlear implantation were divided into three groups according to age: group A (3 years), group B (4 to 7 years), and group C (8 to 16 years). All patients were followed up for one year for hearing and speech performance after the surgery. The comprehensive Auditory Perception Assessment, MAIS, CAP and SIR hearing and speech assessments and rating materials were used for assessment before the surgery and at 3, 6, and 12 months after implant activation.
Results: The scores of patients in the open-set speech assessment, Chinese Auditory Perception Assessment, MAIS, CAP and SIR significantly improved after cochlear implantation in all age groups. The younger the age at implantation, the better the results. Moreover, the hearing and speech performance of cochlear implant recipients gradually improved with the extension of rehabilitation time.
Conclusions: Nurotron® Venus™ cochlear implantation can improve the hearing and speech performance of patients with bilateral severe-to-profound sensorineural deafness.
A retrospective review of 14 cases of malignant otitis externa
Saldanha Marina, M.K. Goutham, A. Rajeshwary, Bhat Vadisha, T. Devika
JOURNAL OF OTOLOGY, 2019, 14(2): 63-66
Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients.We reviewed cases of malignant otitis externa in our setup to document the epidemiology and outcome of management.
Methods: This is a retrospective case review observational study from January 2013eDecember 2017. Fourteen patients diagnosed with malignant otitis externa in our tertiary referral centre were included in the study. Based on hospital protocol, empiric treatment was started. After discharge, the patients follow up visits to the hospital were also documented.
Results: Otalgia was the most common symptom. Edema and congestion of the external auditory canal were observed in most cases. Diabetes was present in all patients. Three cases had associated facial palsy, and one patient had involvement of 7th, 9th, 10th, 11th and 12th cranial nerve. Two patients with facial palsy recovered. Pseudomonas aeuroginosa was the most common organism isolated (50%).
Conclusions: In our series, malignant otitis externa invariably presented with severe otalgia. Lower cranial palsies were also seen. Methods to evaluate complete eradication of disease should be centered on clinical symptoms and signs, but the measurement of erythrocyte sedimentation rate or radiological
imaging may be used as a useful adjunct when there is uncertainty.
Sudden sensorineural hearing loss (SSHL) following a local anesthetic dental procedure
Yi Wang a, Jun-Kai Cao a, Hui-Xin Yang a, Jin Feng a, Qi-you Zhou b, Fei Ji b, c, d
JOURNAL OF OTOLOGY, 2019, 14(2): 67-72
Acute sensorineural hearing loss is an uncommon phenomenon in dentistry. We describe the case of a 79-year-old male who presented with acute sensorineural hearing loss occurring 2 days after a tooth extraction procedure under local anesthesia. Possible mechanisms are discussed. He was treated with vasodilators (Ginaton and Alprostadil Injection) and Mecobalamin injection with benefit. High dose oral steroids (1 mg/kg) and low molecular weight dextran were used.
New low-cost magnifying device for temporal bone laboratory
Vittorio Rinaldi a, c, Manuele Casale a, Antonio Moffa b, Giovanni Mancini c, Daniela Carioli d, Didier Portmann e, Michele Cassano b, Lorenzo Pignataro d
JOURNAL OF OTOLOGY, 2019, 14(2): 73-75
Temporal bone dissection has important role in educating and training oto and skull base surgeons. Mounting of a temporal bone laboratory is expensive. A dedicated magnifying system, such as a surgical microscope or an endoscopic equipment, represents one of the most significant costs. The aim of this study is to test and demonstrate the utility of a commercial USB as a low-cost solution to equip the laboratory with a good magnifying system and illumination.
JOURNAL OF OTOLOGY
12th Conference of the Asian Society of Mitochondrial Research and Medicine
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