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Τρίτη 26 Οκτωβρίου 2021

Otology

EDITORIAL

The limitations of pure-tone audiometry (as the gold standard test of hearing) that are worthy of consideration [pg. 1]
Mohd Normani Zakaria
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ORIGINAL ARTICLES

Inner ear malformations in cochlear implant recipients [pg. 3]
Luan Viet Tran, Vu Anh Duong, Saim Lokman
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Anatomical variations of round window in different age groups and surgical difficulties associated with them during cochlear implantation [pg. 7]
Rabindra Bhakta Pradhananga, Bigyan Raj Gyawali, Pabina Rayamajhi, Bebek Bhattarai
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Validity of modified whisper test as hearing screening method in presbycusis patients [pg. 11]
Rizki Najoan, Nyilo Purnami
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Detection of two pathogenesis previously unreported myosin xva pathogenic variants in two large Iranian pedigrees with autosomal recessive nonsyndromic hearing loss [pg. 14]
Fatemeh Azadegan-Dehkordi, Korosh Ashrafi, Gholam Reza Mobini, Nasrin Yazdanpanahi, Maryam Shirzad, Effat Farrokhi, Morteza Hashemzadeh-Chaleshtori
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Chronic suppurative otitis media and microbial flora: Adult versus pediatric population [pg. 22]
Ashish Chandra Agarwal, Anitya Srivastava, Manodeep Sen
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Risk of hepatic toxicity and drug response in patients with chronic suppurative otitis media [pg. 26]
S M Tariq Rafi, Shafaque Mehboob, Mejabeen , Naila Tariq, Hurithmina Khan, Moona Mehboob
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Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception [pg. 30]
Himanshu Chaurasiya
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Effectiveness of intratympanic dexamethasone as salvage therapy in treating sudden sensorineural hearing loss [pg. 36]
Bigyan Raj Gyawali, Rabindra Bhakta Pradhanaga, Pabina Rayamajhi
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Prospective study of use of Island of tragal cartilage in revision tympanoplasty [pg. 40]
Bhavika Verma, Naresh Dawat, Yogesh G Dabholkar, Sachin J Patil
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Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria [pg. 44]
Solomon Joseph Hassan, Yikawe Stephen Semen, Dabit Othniel Josep, Ekuma Otu Gabriel, Osisi Kingsley, Solomon Ndudiri Calista
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Conducting Fukuda stepping test in a noisy clinic and the effects of sound [pg. 47]
Carren Sui Lin Teh, Erica Anak Gima, Hani Binti Mamat, Meng Hon Lye, Sobani Bin Din, Narayanan Prepageran
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Cortical auditory-evoked potential as a biomarker of central auditory maturation in term and preterm infants during the first 3 months

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Clinics (Sao Paulo). 2021 Oct 18;76:e2944. doi: 10.6061/clinics/2021/e2944. eCollection 2021.

ABSTRACT

OBJECTIVES: To analyze central auditory maturation in term and preterm infants during the first 3 months of life by comparing the latency and amplitude of cortical auditory-evoked potential at different frequencies.

METHODS: In this study, 17 term and 18 preterm infants were examined; all had tested positive on the neonatal hearing screening test. Cortical auditory potential was investigated during the first and third months of life. The response of the cortical auditory-evoked potential was investigated at frequencies of 500, 1000, 2000, and 4000 Hz. The latency and amplitude of the cortical response were automatically detected and manually analyzed by three researchers with experience in electrophysiology. The results were compared using analysis of variance and the Bonferroni test. A significance level of 5% was used for all analyse s.

RESULTS: Latency values of cortical auditory-evoked potential in the first month of birth were significantly higher than those in the third month, and latency values of the preterm group were higher than those of the term group, regardless of the frequency and time of evaluation. In general, the latency of the cortical auditory-evoked potential was higher at high frequencies. Amplitude values in the third month of life were significantly higher than those in the first month for term and preterm infants.

CONCLUSION: Central auditory maturation was observed in both groups but with different results between those born at term and preterm, with latencies of cortical auditory-evoked potential higher for the preterm group and at high frequencies.

PMID:34669874 | PMC:PMC8491591 | DOI:10.6061/clinics/2021/e2944

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Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception

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Himanshu Chaurasiya

Indian Journal of Otology 2021 27(1):30-35

Background: Pathological and physiological disabilities of human auditory receptors reduce speech intelligibility under hearing loss (HL) at high frequencies. Objectives: The objective of the study is to investigate the speech-intelligibility-enhancement (SIE) in elderly with high-frequency HL (HFHL) through visual-speech-perception (VSP). The hypothesis is that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. Also; to decide the statistical relevance of the precise significant difference in speech discrimination (SD) with VSP on the subjected ear. Methods: Observational and descriptive studies of SIE with VSP on 12 elderly listeners (24 clear ears; without wax impaction) with progressive and bilateral HFHL were examined. The entire experimental records were checked for distribution with normal (Gaussian) using the Shapiro–Wilk's and paired Student's t-test (parametric test) had the 5% (0.05) signific ance level (α). Results: We analyzed, improved, and better performance in SIE with HFHL through VSP. The statistical P (probability) measure was calculated nothing, i.e., 0 (P < 0.05). Therefore, investigators strongly and carefully discarded the null hypothesis consideration. There was some significant value of statistical variation also exists with VSP. Moreover, with the help of the confidence-interval analysis, the same conclusion was achieved. Conclusions: In this study, it is concluded that the elderly-individuals of this experiment, whose mother tongue and official language is Hindi and English, respectively, they demonstrate the SIE with HFHL through VSP. This investigation also helps to improve the hearing sensitivity to some extent with VSP.
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Inner ear malformations in cochlear implant recipients

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Luan Viet Tran, Vu Anh Duong, Saim Lokman

Indian Journal of Otology 2021 27(1):3-6

Objective: The aim of this study is to determine the prevalence of the inner ear malformations (IEMs) in cochlear implant recipients according to Sennaroglu's classification, and to document the intraoperative difficulties and complications in those cases. Methods: This was a descriptive cross-sectional study performed at our hospital between January 2016 and October 2019. IEMs on temporal bone computed tomography scans were identified in all patients who received cochlear implants during the study. Intraoperative difficulties and complications relating to these malformations were described. Results: Twelve patients with IEMs were identified from a total of 212 cochlear implant recipients, representing a prevalence of 5.7%. Among them, one patient with incomplete partition (IP) Type I (8.3%), seven patients with IP Type II (58.3%), one patient with IP Type III (8.3%), one patient with cochlear hypoplasia (CH) Type I (8.3%), and two patients with CH Type III (16.7%) were identified. A ssociated enlarged vestibular aqueduct was found in four cases with IP Type II (33.3%). Round windows were not identified intraoperatively in 3 cases with CH (25%). Three cases (25%) had cerebrospinal fluid gusher (one patient in each of the following anomalies: IP-I, IP-II, and IP-III). The mean categories of auditory performance score was 6, which was collected within 23.3 months after the surgery. Conclusion: This study documents the prevalence of IEMs in cochlear implant recipients (classified by Sennaroglu in 2017). The identification of such anomalies will significantly aid surgeons in making decisions regarding cochlear implant candidacy and surgical strategy when cochlear implantation is contemplated to obtain optimal outcomes.
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Sensitivity of treatment-free survival to subgroup analyses in patients with advanced melanoma treated with immune checkpoint inhibitors

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Patients with advanced melanoma treated with immune checkpoint inhibitors can experience ongoing disease control after treatment discontinuation without subsequent systemic anticancer therapy. We previously defined a novel outcome, treatment-free survival (TFS), as the time between protocol therapy cessation and sub sequent therapy initiation/death. We assessed the effect of established prognostic variables [lactate dehydrogenase (LDH), programmed death ligand 1 status, BRAF mutation status, performance status, and sex] on TFS in different treatment scenarios: treatment until toxicity/progression with frequent early cessation (nivolumab plus ipilimumab), treatment until toxicity/progression with a well-tolerated regimen (nivolumab), and treatment for a short fixed duration (ipilimumab). Data were pooled from 1077 patients with advanced melanoma treated in the CheckMate 069 and 067 trials. TFS was defined as the area between the Kaplan–Meier curves for time to therapy cessation and time to subsequent therapy initiation/death. TFS was estimated by restricted mean (r-mean) survival time at 36 months since randomization. Clinically meaningful TFS (r-mean TFS 3.7–12.7 months) was observed across all patient subgroups. TFS was longest in patients treated with nivolumab plus ipilimumab. The la rgest differences in r-mean TFS were observed with LDH in the nivolumab plus ipilimumab and ipilimumab treatment groups (TFS difference 4.7 and 4.9 months, respectively). In the nivolumab group, there was little difference in TFS across subgroups (r-mean TFS 3.7–5.5 months). TFS was sensitive to prognostic subgroup differences; however, duration of treatment affected the sensitivity of TFS. These results provide further support for TFS as a clinical outcome measure. Received 8 February 2021 Accepted 29 September 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Correspondence to Meredith M. Regan, ScD, Division of Biostatistics, Dana-Farber Cancer Institute, Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA, Tel: +617 632 2471; e-mail: mregan@jimmy.harvard.edu This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Ponatinib-induced eruptive nevi and melanocytic proliferation

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Ponatinib, an oral third-generation tyrosine kinase inhibitor, is indicated for the treatment of imatinib-resistant leukemia. We experienced a case of ponatinib-induced eruptive nevi, and the biologic effects of ponatinib on melanocytes were investigated. Treatment with ponatinib significantly increased the proliferat ion of normal human melanocyte or melanoma cells through the upregulation of the extracellular signal-regulated kinase and protein kinase B signaling pathways. The downstream molecules of cyclin B1 and D1 were significantly increased in ponatinib-treated melanocytes. These results demonstrate the capacity of ponatinib to induce the proliferation and tumorigenesis of melanocytes. Received 23 July 2021 Accepted 21 September 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Correspondence to Hee Young Kang, MD, PhD, Department of Dermatology, Ajou University School of Medicine, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea, Tel: +82 31 219 5190; fax: +82 31 219 5189; e-mail: hykang@ajou.ac.kr Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Long-term outcomes and prognostic factors in papillary thyroid microcarcinoma patients with distant metastases

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Endocrine. 2021 Oct 26. doi: 10.1007/s12020-021-02906-8. Online ahead of print.

ABSTRACT

PURPOSES: Distant metastasis from papillary thyroid microcarcinoma (PTMC) is extremely rare and the long-term outcomes and independent prognostic factors remain unclear. The present study aimed to investigate clinicopathological characteristics and evaluate the long-term outcomes and prognostic factors of PTMC patients with distant metastases (DM) who underwent surgery and radioactive iodine (< sup>131I) treatment.

METHODS: We retrospectively reviewed the medical records of 13,441 patients with thyroid cancer (including 1697 cases with PTMC) who underwent 131I treatment at our institution between January 2008 and December 2019. PTMC patients with distant metastases with sufficient clinical follow-up data were enrolled in this cohort study. The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan-Meier method and the prognostic factors were assessed by Cox proportional hazards.

RESULTS: Thirty-three PTMC patients with DM were enrolled in this study. The median follow-up was 75 months (range: 5-151 months). The 5-year and 10-year OS rates were 96.97 and 81.41%, respectively, and the 5-year and 10-year PFS rates were 90.46 and 69.68%, respectively. Multivariate analysis showed that male sex (P = 0.005), radioactive iodine refractory PTMC (P = 0.033), and symptomatic DM (P = 0.022) were significantly associated with worse 10-year PFS in PTMC patients with DM. No independent predictor related to poor 10-year OS was found in the present study.

CONCLUSIONS: The prognosis of PTMC patients becomes worse after the development of DM. Male sex, radioactive iodine refractory PTMC, and symptomatic DM were identified as independent factors associated with PFS.

PMID:34699028 | DOI:10.1007/s12020-021-02906-8

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Serum immunoglobulin G4 has limited diagnostic value in immunoglobulin G4-related chronic rhinosinusitis

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Eur Arch Otorhinolaryngol. 2021 Oct 21. doi: 10.1007/s00405-021-07083-y. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the profiles and factors influencing serum IgG4 levels and evaluate the diagnostic value of serum IgG4 in IgG4-related CRS.

METHODS: This was a prospective study analyzing data from 288 hospitalized CRS patients who had undergone endoscopic sinus surgery from July 1, 2017 to August 31, 2018. Data were analyzed for correlations between elevated serum IgG4 concentrations (> 135 mg/dL) and clinical symptoms (nasal congestion, rhinorrhea, loss of smell, headache and/or facial pain), endoscopic presentation (Lund-Kennedy scores), allergic status (total and allergen-specific IgE), and pathological features (IgG4+ and IgG+ cells).

RESULTS: Overall, 43/288 (14.9%) CRS patients had elevated serum IgG4 levels > 135 mg/dL. Comparison of the clinical parameters between patients with elevated and normal serum IgG4 levels demonstrated serum total IgE levels to be significantly different (P = 0.003) between the two groups; and significantly correlated with serum IgG4 level in CRS subjects (P = 0.000; r = 0.232), particularly CRS patients with nasal polyps (P = 0.000; r = 0.259). In contrast, the ratio of plasmocyte/inflammatory cells and IgG4+ cells/IgG+ plasmocytes, and IgG4+ plasma cells/HPF in sinus mucosa were not significantly different between the groups and no patient with elevated serum IgG4 demonstrated ratio of IgG4+ /IgG+ cells > 40% or > 10 IgG4+ plasma cells/HPF.

CONCLUSION: Serum IgG4 concentration is not related to the clinical phenotype of CRS and is likely to be of limited value when used alone in the diagnosis of IgG4-related CRS.

PMID:34673994 | DOI:10.1007/s00405-021-07083-y

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Ramsay Hunt syndrome with multiple cranial neuropathy: a literature review

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Eur Arch Otorhinolaryngol. 2021 Oct 23. doi: 10.1007/s00405-021-07136-2. Online ahead of print.

ABSTRACT

BACKGROUND: Ramsay Hunt Syndrome (RHS) is a neurotological disorder involving the reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve (Sweeney and Gilden in J Neurol Neurosurg Psychiatry 71:149-154, 2001). The characteristic presentation involves ipsilateral lower motor neuron type facial paresis, auricular pain with or without hearing impairment, and vesicular lesions of the external auditory canal and outer ear. Involvement of the facial and vestibulocochlear nerve is typical in RHS, whilst multiple cranial neuropathies are rare and associated with poorer prognosis and systemic complications (Arya et al. in Am J Case Rep 19:68-71, 2017; Shinha and Krishna in IDCases 2:47-48, 2015; Shim et al. in Acta Otolaryngol 131:210-215, 2011; Coleman et al. in J Voice 26:e27-e28, 2012; Morelli et al . in Neurol Sci 29:497-498, 2008;). Likely mechanisms involved in the pathogenesis of cranial polyneuropathy include direct peri-neural and trans-axonal spread of viral inflammation between contiguous cranial nerves and haematogenous dissemination between nerves with shared blood supply. Impairments in speech, swallowing, hearing, and oculo-protection can contribute to morbidity and requires a multidisciplinary approach to patient care.

METHODS: We present a rare case of RHS with multiple cranial neuropathies followed by a comprehensive review of current literature with regard to the pathophysiology, diagnostic workup, and the management strategies employed in these patients.

CONCLUSION: RHSs with multiple cranial neuropathies are important to recognise as they are associated with significant morbidity and poor prognosis. A multidisciplinary approach to patient management is required to address the several complications that can arise from cranial nerve deficits, especia lly in regard to speech and swallow.

PMID:34687339 | DOI:10.1007/s00405-021-07136-2

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Denosumab-related osteonecrosis of the external auditory canal-benefit of the early surgical management

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Ear Nose Throat J. 2021 Oct 21:1455613211053389. doi: 10.1177/01455613211053389. Online ahead of print.

ABSTRACT

Background: Antiresorptive drugs are widely used to reduce bone mineral loss in patients with osteoporosis and to prevent skeletal-related events in patients with metastatic cancers and multiple myeloma (MM). Both the bisphosphonates (BP) and denosumab typically used in this indication were shown to be effective and relatively safe. Obviously, this medicatio n could have some adverse effects; one of them is osteonecrosis of the external auditory canal. Only sporadic cases of external auditory canal osteonecrosis have been published yet. Here, we provide a case of denosumab-related osteonecrosis of the external auditory canal successfully treated surgically in the early stage of the disease.Case report: A 68-year-old patient with breast cancer underwent comprehensive oncological treatment, including denosumab administration. She was diagnosed with osteonecroses in the jaw and ear canal. The necrotic bones in both regions were resected with primary wound closure. Both affected sites healed well with no signs of necrosis recurrence.Conclusions: Osteonecrosis of the external auditory canal is a rare but probably underdiagnosed complication of antiresorptive medication. It has a negative impact on patient quality of life if left untreated. Early surgical treatment appears to be effective. The authors highlight several similarit ies with medication-related osteonecrosis of the jaw. Therefore, an analogous disease staging and treatment rationale is suggested.

PMID:34672841 | DOI:10.1177/01455613211053389

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