Auris Nasus Larynx

Effects of cochlear implants on otolith function as evaluated by vestibulo-ocular reflex and vestibular evoked myogenic potentials Publication date: Available online 19 April 2019 Source: Auris Nasus Larynx Author(s): Takao Imai, Tomoko Okumura, Yumi Ohta, Kazuo Oshima, Takashi Sato, Takefumi Kamakura, Hidenori Inohara Abstract Objective The aim of this study was to investigate whether the insertion of an implant into the cochlea is accompanied by a deterioration in otolith function. Cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) and linear vestibulo-ocular reflex (lVOR) during eccentric rotation were assessed before and after cochlear implantation (CI) to evaluate otolith function. Methods Twelve patients with bilateral severe sensorineural hearing loss who had undergone CI surgery in our hospital between May 2016 and November 2017 were included in this study. cVEMP and oVEMP were assessed using the asymmetry ratio (AR), calculated with the following formula: [(peak-to-peak amplitude calculated as the sum of the p13 and n23 amplitudes in the non-operated side) − (that in the operated side)]/[(that in the non-operated side) + (that in the operated side)]. The ratio of VOR gain during eccentric rotation against VOR gain during center rotation was used to assess lVOR. For eccentric rotation, patients were rotated while displaced from the axis of rotation. At the same time, linear acceleration stimulated the utricle and induced lVOR. All patients underwent cVEMP and oVEMP tests and center and eccentric rotation tests before and about 30 days after CI surgery. Results Three patients with absent cVEMP responses before surgery were excluded, leaving pre-surgery cVEMP results for 9/12 patients. In five of these patients, the AR of cVEMP increased after CI, indicating that saccular function, as evaluated by cVEMP, did not deteriorate significantly postoperatively. One patient with an absent oVEMP response before CI was excluded, leaving pre-surgery oVEMP results for 11/12 patients. In 10 of these patients, the AR of oVEMP increased after CI surgery, indicating that utricular function, as evaluated by oVEMP, deteriorated significantly postoperatively. However, because the ratio of VOR gain during eccentric rotation against VOR gain during center rotation did not become worse after CI, utricular function, as evaluated by lVOR, did not deteriorate significantly postoperatively. Symptoms of vertigo became worse after CI in two of the 12 patients. Conclusion CI does not cause a deterioration in saccular function, as evaluated by cVEMP. Although CI does cause a deterioration in utricular function in oVEMP tests, this is not consistent in lVOR tests. These results indicate that CI causes a slight deterioration in utricular function that is insufficient to cause vertigo or deterioration of lVOR.

Results of stapedotomy in otosurgical treatment of adult patients with osteogenesis imperfecta Publication date: Available online 18 April 2019 Source: Auris Nasus Larynx Author(s): Henryk Skarżyński, Kamila Kordowska, Piotr H. Skarżyński, Elżbieta Gos Abstract Objective This is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center. Methods This study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003–16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and >12 months). Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed. Results In short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p < 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p < 0.05). Conclusion Stapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses.

Application of Ambulatory Phonation Monitoring (APM) in the measurement of daily speaking-time and voice intensity before and after cochlear implant in deaf adult patients Publication date: Available online 18 April 2019 Source: Auris Nasus Larynx Author(s): Francesco Mozzanica, Antonio Schindler, Elisabetta Iacona, Francesco Ottaviani Abstract Objective to evaluate the changes in daily voice production, analysed through the Ambulatory Phonation Monitoring (APM), and their relationship with Quality of Life (QOL) measurements in a group of profound deaf patients treated with Cochlear Implant (CI). Methods A total of 12 consecutive post-lingual deaf patients (8 females and 4 males) treated with CI for bilateral severe-to-profound hearing loss were enrolled. Each patient was evaluated before and after 6 months of CI use. In particular, the daily voice production evaluation was performed using the APM, while QOL information were gathered from the Italian version of the Nijmegen Cochlear Implant Questionnaire (I-NCIQ). Results Significant differences in the APM results obtained before and after CI were found. In particular, a significant decrease of the mean amplitude and a significant increase of the daily phonation time and percentage of phonation time were demonstrated after CI use in all the patients. A significant improvement in the I-NCIQ scores was demonstrated after CI use and significant correlations among I-NCIQ scores and the APM parameters were found. Conclusions The APM could be useful in the evaluation of the benefits of cochlear implantation and may represents an indicator of deaf patient participation. In addition, the daily voice production's modifications after CI and their significant relations with the changes in QOL measurements could be useful in treatment planning as well as during pre- and post-operative counselling.

Visual changes after transnasal endoscopic versus transcaruncular medial orbital wall decompression for dysthyroid optic neuropathy Publication date: Available online 9 April 2019 Source: Auris Nasus Larynx Author(s): Kunihiro Nishimura, Yasuhiro Takahashi, Nobuyuki Katahira, Yasue Uchida, Hiromi Ueda, Tetsuya Ogawa Abstract Objective To compare postoperative changes in visual acuity between the transnasal endoscopic approach and the transcaruncular approach when comparison of preoperative values used for medial orbital wall decompression in patients with dysthyroid optic neuropathy. Methods We included 14 patients (23 sides) and divided them into a transnasal group (11 sides, 8 patients) and a transcaruncular group (12 sides, 6 patients). Visual acuity was examined preoperatively, on postoperative days 1, 3, and 7, and at a final follow-up visit. The differences in postoperative improvement of the logarithm of the minimum angle of resolution (logMAR) visual acuity and critical flicker frequency (CFF) between the two surgical groups at each time point were analyzed using the Mann–Whitney U test. Results Postoperative improvement in logMAR visual acuity on postoperative days 1 and 3 and that in CFF on postoperative day 1 were greater in the endonasal group than in the transcaruncular group (P < 0.050). Vision was improved or maintained in all patients in the transnasal group at the final follow-up. One patient in the transcaruncular group had loss of vision on one side and decreased vision on the other side after surgery. Conclusion Medial orbital decompression appears to provide better postoperative vision when performed by the transnasal approach than by the transcaruncular approach in patients with dysthyroid optic neuropathy.

Squamous cell carcinoma at sites of old maxillary fractures Publication date: Available online 5 April 2019 Source: Auris Nasus Larynx Author(s): Masaki Kawabata, Hiromi Nagano, Hiroyuki Iuchi, Mizuo Umakoshi, Junichiro Ohori, Yuichi Kurono Abstract Malignancies have been reported to occasionally arise in scar tissue following injury. One hypothesis involves prolonged overactivation of tissue repair systems due to chronic inflammation and irritation, although the pathogenesis of cancers occurring in scars is not fully understood. We describe here two cases with a history of maxillary fracture at the site where squamous cell carcinoma (SCC) subsequently developed. The first patient developed SCC 7 years after right maxillary fractures resulting from a traffic accident. He underwent chemoradiotherapy (70 Gy in 35 fractions) and maintained complete response (CR) for 10 months. The second patient developed SCC 3 years after sustaining right maxillary fractures in an ice hockey game. Radiotherapy and total maxillectomy were performed, but local recurrence arose and he has since been receiving chemotherapy.

Direct approach to the anterior and lateral part of the maxillary sinus with an endoscope Publication date: Available online 4 April 2019 Source: Auris Nasus Larynx Author(s): Kazuhiro Omura, Kazuhiro Nomura, Satoshi Aoki, Nobuyoshi Otori, Yasuhiro Tanaka Abstract Objective The Caldwell-Luc (CL) approach with a sublabial incision is used to manipulate the anterior wall of the maxillary sinus. Paresthesia is one of the major complications associated with the CL approach. We developed a new method, "direct approach to the anterior and lateral part of the maxillary sinus with an endoscope" (DALMA), that negates the need for a sublabial incision and minimizes dental paresthesia by reducing the risk of anterior superior alveolar nerve injury. This study aimed to describe how to perform the DALMA technique, and to review its effectiveness and associated complications. Methods We retrospectively reviewed 10 patients who had received DALMA. Results Ten patients underwent DALMA. The anterior superior alveolar nerve was identified in all patients. Access to the lateral side beyond the infraorbital canal and anterior wall of the maxillary sinus was achieved. Conclusions DALMA is a simple, effective, and minimally invasive technique that can be used as an alternative to CL with sublabial incision.

Simultaneous metastasized primary unknown signet ring cell carcinoma of the cervical lymph node and mucoepidermoid carcinoma of the parotid gland as double cancers Publication date: Available online 4 April 2019 Source: Auris Nasus Larynx Author(s): Keitaro Miyake, Takahito Kondo, Nobuyuki Koyama, Hiroshi Hirano, Midori Wakiya, Atsuo Takeda, Takashi Iwasawa, Naiue Kikawada, Kenji Hanyu, Yasuo Ogawa, Kiyoaki Tsukahara Abstract Lymph node metastasis from signet ring cellcarcinoma (SRCC) primary unknown is extremely rare. We here report a case of primary-unknown SRCC that metastasized to the cervical lymph nodes, co-existing with mucoepidermoid carcinoma (MEC) of the parotid gland as a simultaneous double cancer. A 68-year-old female patient with right swollen cervical lymph nodes consulted our medical center. A diagnosis of bilateral cervical lymph node metastasis and a right parotid tumor was made. After bilateral neck dissection and right parotidectomy, the pathological diagnosis was SRCC of primary unknown with metastasis to the cervical lymph node and MEC of the parotid gland. Examination of the CRTC1/3-MAML2 fusion gene showed no relation between SRCC of primary unknown with metastasis to the cervical lymph node and MEC of the parotid gland. Ten months after the first treatment, there was recurrence in the left neck lymph node, and left neck dissection was performed. Fourteen months after the first treatment, the patient is alive and cancer-free. This case is the fourth report of SRCC with lymph node metastasis, and highlights the value of fusion gene detection to determine relatedness between simultaneous cancers. Moreover, such cases should be closely monitored for the subsequent appearance of distant metastases.

Mucosal melanoma of the cranio-facial region: Surgical challenges and therapeutic options Publication date: April 2019 Source: Auris Nasus Larynx, Volume 46, Issue 2 Author(s): Julia Thierauf, Anna-Maria Glück, Peter Plinkert, Johannes A. Veit, Thomas K. Hoffmann, Andreas Körber, Christoph Bergmann Abstract Objective Although current therapeutic options for cutaneous melanoma (CM) are constantly improving survival, mucosal melanoma (MM) remains a rare tumor disease with a poor clinical outcome. While radical surgery is the gold standard, clear margin resections in the head and neck area are particularly critical due to high density of vulnerable structures. Adjuvant therapeutic options increases local control and data on the effect of systemic agents is sparse. The aim of this study was to elucidate surgical challenges in the craniofacial area and to evaluate the effect of local and systemic therapy in Head and Neck Mucosal Melanoma (HNMM). Methods In total, 21 patients with nasal mucosal malignant melanoma were included in this study over the course of 20 years in two German tertiary referral centers. Patient characteristics and conducted therapy as well as clinical outcomes were analyzed retrospectively. Results By performing survival analysis for multimodal therapies, we observed a superiority effect of interferon therapy compared to surgery with radiation and surgery alone in the first therapeutic approach. However, patients treated with surgery alone in a recurrent setting showed the best outcome. Conclusion Both, Interferon and radiation as adjuvant therapies, demonstrated survival benefits in initial treatment compared to surgery alone. Analysis after recurrence, however, revealed salvage surgery as a reliable and powerful tool to prolong post-recurrence survival without exposing palliative patients to the risk of severe adverse events from systemic therapies.

Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters Publication date: April 2019 Source: Auris Nasus Larynx, Volume 46, Issue 2 Author(s): Maria Doulaptsi, Alexandros Karatzanis, Emmanuel Prokopakis, Stylianos Velegrakis, Alexia Loutsidi, Athina Trachalaki, George Velegrakis Abstract Objective Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity. Methods and materials A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed. Results Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%. Conclusion Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.

Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy Publication date: April 2019 Source: Auris Nasus Larynx, Volume 46, Issue 2 Author(s): Yaxuan Liu, Yangyang Ying, Jaffar S. Pandu, Yan Wang, Shuang Dou, Yanzhong Li, Dedong Ma Abstract Objective We have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy. Methods 40 healthy volunteers were enrolled to measure the end-tidal carbon dioxide pressure (PETCO2) while being treated by EPAP mask. 40 symptomatic moderate or severe OSAHS patients (AHI ≥ 15/h) recruited were equally divided into two groups randomly and treated with CPAP or mask for a week respectively. After a week of washing out, the patients were applied with exchanged therapeutic methods for another week. The PSG was performed at the end of each week of treatment with device-on. Results There were no significant differences of PETCO2 under different exhaled positive pressure level between CPAP, EPAP therapies and non-therapy for the healthy volunteers (P > 0.05). After being treated, among the OSAHS patients in the two groups, the ESS scores and AHI decreased, and minimum SaO2 and mean SaO2 increased significantly (all P > 0.05). There was no significant differences of the efficacy between EPAP and CPAP therapy. Conclusions EPAP mask therapy was safe and reliable with significant efficacy for selected OSAHS patients. However, the compliance needs further improvement.