To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implanta...To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implantation.The intraoperative assessment did not reveal any major red flags of electrode array misplacement.He did not display any vestibular symptoms postoperatively but showed poor speech performance,even though the aided tone audiometry revealed good sound detection thresholds.High-resolution computed tomography(HRCT)showed that the entire perimodiolar electrode array was situated within the vestibule,and a revision surgery was conducted.Retrospective analysis of the neural response telemetry(NRT)revealed subtle differences in responses between the misplaced and correctly placed electrode arrays.Unlike previously reported cases,the patient did not display vestibular symptoms despite the misplacement of the electrode in the vestibule due to existing weakness in otolithic function.Further investigation is warranted when a motivated patient with normal inner ear anatomy does not show benefit with the cochlear implant post-operatively.展开更多
BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy w...BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.展开更多
BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy ...BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.展开更多
Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preser...Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.展开更多
Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different ...Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms,hearing problems,psychosocial impact,and the need for care.The optimal length of the recall period has not been studied.For these reasons,a new survey is needed that would cover most chronic ear diseases.Methods A preliminary 24-item survey(EOS-24)was created.Untreated adult patients(included n=186)with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument.The recruiting otologists evaluated the severity of the disease and the disability caused by it.A control group was recruited.Based on the patients’responses in different diagnosis groups,the items were reduced according to pre-defined criteria.The resulting survey was validated using a thorough statistical analysis.Results The relevance and necessity of the original 24 items were thoroughly investigated,leading to the exclusion of 8 items and the modification of 1.The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups,thus constituting the final instrument,EOS-16.The most suitable recall period was three months.Conclusions EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population.The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.展开更多
Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympa...Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympano metric parameters between asymptomatic and symptomatic contralateral ears.Design:Prospective analytical clinical study Setting:Specialized(Ear,Nose,and Throat)clinic of a tertiary health institution.Participants:Patients with UPN ear trauma who presented within the first week of the incident.Main outcome measures:Otologic symptoms in the contralateral ear in UPN ear trauma Results:Eighteen out of 53 patients(34.0%)experienced symptoms in the contralateral ear.The symptoms were tinnitus in 77.8%(14/18),hearing loss in 66.7%(12/18),and ear blockage in 27.8%(5/18).There was hearing loss in 38/53(71.7%)of contralateral ears.Hearing loss type and PTAv at the low frequencies were not significantly different(p=0.142),but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears(p<0.05 in all).Type C tympanogram was more prominent in the symptomatic contralateral ear.There was a statistically-significant difference in the type of tympanogram between the two categories of patients(p=0.018).There was no difference in acoustic reflex between the two categories of patients(p=0.095).Conclusions:The contralateral ear may be affected in up to one-third of patients with UPN ear trauma,and experience otologic symptoms similar to those of the traumatized ears.Audiologic and audiometric parameters were abnormal in most of the contralateral ears.The two ears must be assessed thoroughly in cases of UPN ear trauma.展开更多
Background: Self-cleaning of ears with different objects is a common practice among school children with scanty report in literature. Aim: The aim of this study was to determine the prevalence and profile of self-ear ...Background: Self-cleaning of ears with different objects is a common practice among school children with scanty report in literature. Aim: The aim of this study was to determine the prevalence and profile of self-ear cleaning among school children. Methods: It was a cross-sectional institutional-based study which was carried out among school children in Ekiti, south western Nigeria from January 2017, to March 2017. Results: A total of 174 students participated in this study. Their age ranged between 13 and 17 years. The highest number of participant was found at the age of 15 years. One hundred and eighteen (67.8%) of them had carried out self ear cleaning. Personal hygiene was the commonest reason for self ear cleaning in 28.8% of the students. Cotton buds were mostly used by the respondents in 51.7% of them. Injury to the external auditory canal (EAC) was the most recorded complications. Conclusion: The outcome of this study shows that self-ear cleaning practices were common among school children with a prevalence of 67.8%. Cotton buds were the commonest objects used. Avoidable complications were reported among respondents. There is a need to intensify efforts on public enlightenment programme and the establishment of school health programme in our various schools.展开更多
Nasal bone fracture is one of the most common face bone injuries and the third most frequent of all body fractures.[1]Clinical examination is considered to be the gold standard to confirm the diagnosis of a nasal frac...Nasal bone fracture is one of the most common face bone injuries and the third most frequent of all body fractures.[1]Clinical examination is considered to be the gold standard to confirm the diagnosis of a nasal fracture.However,diagnosis may be challenging in case of haematoma and oedema of adjacent tissues,this leading to the use of X-rays to confirm or infirm the hypothesis.[2]Radiographic explorations for midface traumas can also be indicated for forensic purposes.[3]展开更多
BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess ...BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.展开更多
Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and female...Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and females, possibly true for SCA due to gender-specific disease pathophysiological changes. Objective: To investigate gender differences in psychoacoustical abilities, and speech perception in noise in SCA individuals and further compare with normal healthy(NH) population. Methods: 80 SCA and 80 NH normal-hearing participants aged 15-40 years were included and further grouped based on gender. Auditory discrimination for frequency, intensity, and duration at 500Hz and 4000Hz;temporal processing(Gap detection threshold & Modulation Detection Threshold) and Speech Perception In Noise(SPIN) at 0d BSNR tests were evaluated and compared between males and females of SCA and NH population. Results: SCA performed poorer compared to NH for all experimental measures. In the NH population, males performed poorer than females in psychoacoustical measures whereas within the SCA population, the reverse was true. Female participants performed better in the SPIN test in both populations. Conclusions: The adverse impact of SCA on the auditory system due to circulatory changes might cause poorer performance in SCA. Poorer performance by Female SCA is possibly due to the contrary impact of lower Hb level overlying Sickle disease.Estrogen levels and gender preference in auditory processing might lead to better performance by females within the NH population. SPIN performance depends on different attentional demands and sensorimotor processing strategies in noise beyond psychoacoustical processing may lead to better female performance in both populations.展开更多
BACKGROUND To summarize the clinical characteristics of acute cerebral infarction(ACI)in patients with sudden deafness(SD)as the first symptom,improve the awareness of the disease,and help diagnosis and treatment.CASE...BACKGROUND To summarize the clinical characteristics of acute cerebral infarction(ACI)in patients with sudden deafness(SD)as the first symptom,improve the awareness of the disease,and help diagnosis and treatment.CASE SUMMARY From 2019 to 2020,three patients with ACI with SD as the first symptom were admitted to our hospital.Pure tone audiometry,head magnetic resonance imaging(MRI),vertebral artery and carotid artery B-ultrasound,head and neck computed tomography angiography,and other examinations were performed.Following the treatment of SD,hearing and dizziness were not significantly improved.Then,the patients developed symptoms of related cranial nerve injury,and brain MRI showed cerebral infarction in the cerebellopontine angle area.All three cases were transferred to the neurology department for relevant conservative treatment.CONCLUSION Patients with ACI with SD as the first symptom usually attend the otolaryngology clinic.Here a diagnosis of SD,which is based on an audiological examination,is made and the corresponding treatment is administered.To reduce the misdiagnosis of this disease,close attention should be paid to the changes in the patient's clinical symptoms and related auxiliary examinations should be performed,such as brain MRI and cerebrovascular imaging.Otolaryngologists should pay attention to the type and severity of hearing loss,the accompanying symptoms,age,high-risk factors for cerebral infarction,and related cranial nerve symptoms in patients with SD.If the patient's early brain MRI does not show abnormalities,monitoring remains essential.The head MRI should be analyzed quickly based on the changes in the symptoms of the patient,to make an accurate diagnosis and provide the timely and correct treatment for the patients.展开更多
BACKGROUND Since 2017,the number of magnet ingestion cases has increased year over year in our hospital.Almost all of the ingested magnetic foreign bodies were magnetic beads,and most of the patients experienced intes...BACKGROUND Since 2017,the number of magnet ingestion cases has increased year over year in our hospital.Almost all of the ingested magnetic foreign bodies were magnetic beads,and most of the patients experienced intestinal perforations,causing substantial damage.AIM To summarize our experience with surgical treatment of multiple magnet ingestion in children.METHODS The data for general surgeries were collected from January 2010 to April 2020,and the clinical characteristics,treatment methods,and outcomes were summarized and analyzed.Several typical cases were selected and discussed.RESULTS Fifty-six cases of ingested magnetic foreign bodies were collected,of which 47 were magnetic beads.The average patient age was 4.7±3.0 years old.The number of ingested magnetic foreign bodies ranged from 2 to 73.There were 26 cases with symptoms at the time of admission,including two cases of shock.Thirteen patients were discharged successfully following conservative treatment and 43 were treated by surgery.Laparotomy was the main method of operation.Laparoscopy was used in four cases,of which three were converted to open surgery,and one was treated successfully using surgery through the navel.Postoperative complications occurred in seven cases,incision infections were observed in six,and adhesive ileus was observed in one.CONCLUSION Clinicians need to summarize their experiences with treating magnetic foreign body ingestions in detail and carry out clinical research to reduce the damage to children.展开更多
Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in...Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups.Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l(SD: 20.8) compared to 47.5 nmoL/l(SD: 27.4) on the control group(p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l(SD: 0.7) for SSCD compared to2.41 mmoL/l(SD: 0.11) for controls(p = 0.01), being within normal limits for both the SSCD and the control group.Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.展开更多
Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this p...Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this paper the authors report the nonsurgical treatment of a case of infratentorial subdural empyema. The patient with left recurrent otitis was hospitalized with symptoms of headache and fever of 3 weeks duration. Examination revealed that the patient had Glasgow Coma Scale score of 15, fever, mild cerebellar signs, no focal deficit, and abundant suppuration from the left ear. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that mimicked a subdural empyema. Routine hematological investigation revealed polymorphic leukocytosis and elevated erythrocyte sedimentation rate. After the left mastoidectomy and antibiotic treatment, the patient recovered with complete resolution of the subdural empyema on CT scan.展开更多
Allergic rhinitis (AR) is the inflammation of nasal mucosa due to the type 1 hypersensitivity reactions mediated by immunoglobulin E (IgE) and triggered by certain allergens. The latest concept in allergic disease is ...Allergic rhinitis (AR) is the inflammation of nasal mucosa due to the type 1 hypersensitivity reactions mediated by immunoglobulin E (IgE) and triggered by certain allergens. The latest concept in allergic disease is the role of regulatory T cells (Treg). Interleukin-2 enhances the function and survival of Treg to perform its function as a controller of effector for forming a tolerant system by suppressing and regulating the homeostasis system. Treg has a transcription factor FoxP3 which plays a role in developing major function of Treg and progression to produce IL-10 and TGF-?. The atopic diseases are caused by a deficiency of Treg. The new perspective is low-dose IL-2 therapy towards autoimmune disease and allergic inflammation. Low-dose IL-2 therapy requires further clinical studies to optimize the dose, time, and the schedule of the IL-2 treatment. FoxP3 has the potential to assist in evaluating the active process of immunological process, which cannot be evaluated by Th1 and Th2 markers, and FoxP3 can be a successful immunotherapy marker.展开更多
Objective To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.Methods From August 2002 to January 2008,16 cases with facial nevi had been treated in our w...Objective To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.Methods From August 2002 to January 2008,16 cases with facial nevi had been treated in our wards with the selected approaches.Surgical approaches including serial excision or one-time radical excision,free skin graft,and expanded flap were adopted in accordance with the individual size and location of the facial nevi.Results All cases experienced complete excision and had satisfactory cosmetic appearance in the end.Conclusion The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.展开更多
Otoacariasis is the presence of ticks and mites in the auditory canal.A 50-year-old Iranian man was subjected at the an ear,nose,and throat clinic at Rouhani Hospital in Babol with complaint of left ear pain.Otoscopic...Otoacariasis is the presence of ticks and mites in the auditory canal.A 50-year-old Iranian man was subjected at the an ear,nose,and throat clinic at Rouhani Hospital in Babol with complaint of left ear pain.Otoscopic examination showed mite infestation in the left auditory canal.The infestation was eradicated with the 2% H2O2 solution.Treatment began by applying oral ciprofloxacin (500 mg/day) twice daily for 7 d.We report the rare case of an ear canal infestation with the Rhizoglyphus and their eradication with 2% H2O2 solution.展开更多
Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. ...Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. Diagnosis: Fluconazole-induced Stevens-Johnson syndrome with fungal infection in ear. Intervention: Surgical and systemic antibiotic therapy. Outcomes: The patient recovered and resumed her normal life. Lessons: The prescription of fluconazole for patients with underlying conditions should be done with caution.展开更多
Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to...Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.展开更多
Neurogenic tumor is the name given to any tumor that arises from the nerve tissue or its coverings. Neurogenic tumors of Sino-nasal cavity are a very rare entity. The most common types are Schwannomas and Neurofibroma...Neurogenic tumor is the name given to any tumor that arises from the nerve tissue or its coverings. Neurogenic tumors of Sino-nasal cavity are a very rare entity. The most common types are Schwannomas and Neurofibromas and the plexiform subtype is one form of these neuroendocrine tumors. We report the case series of two such cases of a plexiform neurofibroma of the nasal tip, which were excised via an open rhinoplasty approach.展开更多
文摘To report a case of cochlear implantation with a misplaced electrode array in the vestibule and the causes for the delay in identification.A 23-year-old male with left single-sided deafness underwent cochlear implantation.The intraoperative assessment did not reveal any major red flags of electrode array misplacement.He did not display any vestibular symptoms postoperatively but showed poor speech performance,even though the aided tone audiometry revealed good sound detection thresholds.High-resolution computed tomography(HRCT)showed that the entire perimodiolar electrode array was situated within the vestibule,and a revision surgery was conducted.Retrospective analysis of the neural response telemetry(NRT)revealed subtle differences in responses between the misplaced and correctly placed electrode arrays.Unlike previously reported cases,the patient did not display vestibular symptoms despite the misplacement of the electrode in the vestibule due to existing weakness in otolithic function.Further investigation is warranted when a motivated patient with normal inner ear anatomy does not show benefit with the cochlear implant post-operatively.
文摘BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.
文摘BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.
文摘Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.
文摘Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms,hearing problems,psychosocial impact,and the need for care.The optimal length of the recall period has not been studied.For these reasons,a new survey is needed that would cover most chronic ear diseases.Methods A preliminary 24-item survey(EOS-24)was created.Untreated adult patients(included n=186)with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument.The recruiting otologists evaluated the severity of the disease and the disability caused by it.A control group was recruited.Based on the patients’responses in different diagnosis groups,the items were reduced according to pre-defined criteria.The resulting survey was validated using a thorough statistical analysis.Results The relevance and necessity of the original 24 items were thoroughly investigated,leading to the exclusion of 8 items and the modification of 1.The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups,thus constituting the final instrument,EOS-16.The most suitable recall period was three months.Conclusions EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population.The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.
文摘Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympano metric parameters between asymptomatic and symptomatic contralateral ears.Design:Prospective analytical clinical study Setting:Specialized(Ear,Nose,and Throat)clinic of a tertiary health institution.Participants:Patients with UPN ear trauma who presented within the first week of the incident.Main outcome measures:Otologic symptoms in the contralateral ear in UPN ear trauma Results:Eighteen out of 53 patients(34.0%)experienced symptoms in the contralateral ear.The symptoms were tinnitus in 77.8%(14/18),hearing loss in 66.7%(12/18),and ear blockage in 27.8%(5/18).There was hearing loss in 38/53(71.7%)of contralateral ears.Hearing loss type and PTAv at the low frequencies were not significantly different(p=0.142),but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears(p<0.05 in all).Type C tympanogram was more prominent in the symptomatic contralateral ear.There was a statistically-significant difference in the type of tympanogram between the two categories of patients(p=0.018).There was no difference in acoustic reflex between the two categories of patients(p=0.095).Conclusions:The contralateral ear may be affected in up to one-third of patients with UPN ear trauma,and experience otologic symptoms similar to those of the traumatized ears.Audiologic and audiometric parameters were abnormal in most of the contralateral ears.The two ears must be assessed thoroughly in cases of UPN ear trauma.
文摘Background: Self-cleaning of ears with different objects is a common practice among school children with scanty report in literature. Aim: The aim of this study was to determine the prevalence and profile of self-ear cleaning among school children. Methods: It was a cross-sectional institutional-based study which was carried out among school children in Ekiti, south western Nigeria from January 2017, to March 2017. Results: A total of 174 students participated in this study. Their age ranged between 13 and 17 years. The highest number of participant was found at the age of 15 years. One hundred and eighteen (67.8%) of them had carried out self ear cleaning. Personal hygiene was the commonest reason for self ear cleaning in 28.8% of the students. Cotton buds were mostly used by the respondents in 51.7% of them. Injury to the external auditory canal (EAC) was the most recorded complications. Conclusion: The outcome of this study shows that self-ear cleaning practices were common among school children with a prevalence of 67.8%. Cotton buds were the commonest objects used. Avoidable complications were reported among respondents. There is a need to intensify efforts on public enlightenment programme and the establishment of school health programme in our various schools.
基金This research received no specific grant from any funding agency in the public,commercial,or not-for-profit sectors.
文摘Nasal bone fracture is one of the most common face bone injuries and the third most frequent of all body fractures.[1]Clinical examination is considered to be the gold standard to confirm the diagnosis of a nasal fracture.However,diagnosis may be challenging in case of haematoma and oedema of adjacent tissues,this leading to the use of X-rays to confirm or infirm the hypothesis.[2]Radiographic explorations for midface traumas can also be indicated for forensic purposes.[3]
文摘BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.
文摘Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and females, possibly true for SCA due to gender-specific disease pathophysiological changes. Objective: To investigate gender differences in psychoacoustical abilities, and speech perception in noise in SCA individuals and further compare with normal healthy(NH) population. Methods: 80 SCA and 80 NH normal-hearing participants aged 15-40 years were included and further grouped based on gender. Auditory discrimination for frequency, intensity, and duration at 500Hz and 4000Hz;temporal processing(Gap detection threshold & Modulation Detection Threshold) and Speech Perception In Noise(SPIN) at 0d BSNR tests were evaluated and compared between males and females of SCA and NH population. Results: SCA performed poorer compared to NH for all experimental measures. In the NH population, males performed poorer than females in psychoacoustical measures whereas within the SCA population, the reverse was true. Female participants performed better in the SPIN test in both populations. Conclusions: The adverse impact of SCA on the auditory system due to circulatory changes might cause poorer performance in SCA. Poorer performance by Female SCA is possibly due to the contrary impact of lower Hb level overlying Sickle disease.Estrogen levels and gender preference in auditory processing might lead to better performance by females within the NH population. SPIN performance depends on different attentional demands and sensorimotor processing strategies in noise beyond psychoacoustical processing may lead to better female performance in both populations.
文摘BACKGROUND To summarize the clinical characteristics of acute cerebral infarction(ACI)in patients with sudden deafness(SD)as the first symptom,improve the awareness of the disease,and help diagnosis and treatment.CASE SUMMARY From 2019 to 2020,three patients with ACI with SD as the first symptom were admitted to our hospital.Pure tone audiometry,head magnetic resonance imaging(MRI),vertebral artery and carotid artery B-ultrasound,head and neck computed tomography angiography,and other examinations were performed.Following the treatment of SD,hearing and dizziness were not significantly improved.Then,the patients developed symptoms of related cranial nerve injury,and brain MRI showed cerebral infarction in the cerebellopontine angle area.All three cases were transferred to the neurology department for relevant conservative treatment.CONCLUSION Patients with ACI with SD as the first symptom usually attend the otolaryngology clinic.Here a diagnosis of SD,which is based on an audiological examination,is made and the corresponding treatment is administered.To reduce the misdiagnosis of this disease,close attention should be paid to the changes in the patient's clinical symptoms and related auxiliary examinations should be performed,such as brain MRI and cerebrovascular imaging.Otolaryngologists should pay attention to the type and severity of hearing loss,the accompanying symptoms,age,high-risk factors for cerebral infarction,and related cranial nerve symptoms in patients with SD.If the patient's early brain MRI does not show abnormalities,monitoring remains essential.The head MRI should be analyzed quickly based on the changes in the symptoms of the patient,to make an accurate diagnosis and provide the timely and correct treatment for the patients.
文摘BACKGROUND Since 2017,the number of magnet ingestion cases has increased year over year in our hospital.Almost all of the ingested magnetic foreign bodies were magnetic beads,and most of the patients experienced intestinal perforations,causing substantial damage.AIM To summarize our experience with surgical treatment of multiple magnet ingestion in children.METHODS The data for general surgeries were collected from January 2010 to April 2020,and the clinical characteristics,treatment methods,and outcomes were summarized and analyzed.Several typical cases were selected and discussed.RESULTS Fifty-six cases of ingested magnetic foreign bodies were collected,of which 47 were magnetic beads.The average patient age was 4.7±3.0 years old.The number of ingested magnetic foreign bodies ranged from 2 to 73.There were 26 cases with symptoms at the time of admission,including two cases of shock.Thirteen patients were discharged successfully following conservative treatment and 43 were treated by surgery.Laparotomy was the main method of operation.Laparoscopy was used in four cases,of which three were converted to open surgery,and one was treated successfully using surgery through the navel.Postoperative complications occurred in seven cases,incision infections were observed in six,and adhesive ileus was observed in one.CONCLUSION Clinicians need to summarize their experiences with treating magnetic foreign body ingestions in detail and carry out clinical research to reduce the damage to children.
文摘Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups.Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l(SD: 20.8) compared to 47.5 nmoL/l(SD: 27.4) on the control group(p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l(SD: 0.7) for SSCD compared to2.41 mmoL/l(SD: 0.11) for controls(p = 0.01), being within normal limits for both the SSCD and the control group.Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.
文摘Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this paper the authors report the nonsurgical treatment of a case of infratentorial subdural empyema. The patient with left recurrent otitis was hospitalized with symptoms of headache and fever of 3 weeks duration. Examination revealed that the patient had Glasgow Coma Scale score of 15, fever, mild cerebellar signs, no focal deficit, and abundant suppuration from the left ear. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that mimicked a subdural empyema. Routine hematological investigation revealed polymorphic leukocytosis and elevated erythrocyte sedimentation rate. After the left mastoidectomy and antibiotic treatment, the patient recovered with complete resolution of the subdural empyema on CT scan.
文摘Allergic rhinitis (AR) is the inflammation of nasal mucosa due to the type 1 hypersensitivity reactions mediated by immunoglobulin E (IgE) and triggered by certain allergens. The latest concept in allergic disease is the role of regulatory T cells (Treg). Interleukin-2 enhances the function and survival of Treg to perform its function as a controller of effector for forming a tolerant system by suppressing and regulating the homeostasis system. Treg has a transcription factor FoxP3 which plays a role in developing major function of Treg and progression to produce IL-10 and TGF-?. The atopic diseases are caused by a deficiency of Treg. The new perspective is low-dose IL-2 therapy towards autoimmune disease and allergic inflammation. Low-dose IL-2 therapy requires further clinical studies to optimize the dose, time, and the schedule of the IL-2 treatment. FoxP3 has the potential to assist in evaluating the active process of immunological process, which cannot be evaluated by Th1 and Th2 markers, and FoxP3 can be a successful immunotherapy marker.
文摘Objective To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.Methods From August 2002 to January 2008,16 cases with facial nevi had been treated in our wards with the selected approaches.Surgical approaches including serial excision or one-time radical excision,free skin graft,and expanded flap were adopted in accordance with the individual size and location of the facial nevi.Results All cases experienced complete excision and had satisfactory cosmetic appearance in the end.Conclusion The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.
文摘Otoacariasis is the presence of ticks and mites in the auditory canal.A 50-year-old Iranian man was subjected at the an ear,nose,and throat clinic at Rouhani Hospital in Babol with complaint of left ear pain.Otoscopic examination showed mite infestation in the left auditory canal.The infestation was eradicated with the 2% H2O2 solution.Treatment began by applying oral ciprofloxacin (500 mg/day) twice daily for 7 d.We report the rare case of an ear canal infestation with the Rhizoglyphus and their eradication with 2% H2O2 solution.
文摘Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. Diagnosis: Fluconazole-induced Stevens-Johnson syndrome with fungal infection in ear. Intervention: Surgical and systemic antibiotic therapy. Outcomes: The patient recovered and resumed her normal life. Lessons: The prescription of fluconazole for patients with underlying conditions should be done with caution.
文摘Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.
文摘Neurogenic tumor is the name given to any tumor that arises from the nerve tissue or its coverings. Neurogenic tumors of Sino-nasal cavity are a very rare entity. The most common types are Schwannomas and Neurofibromas and the plexiform subtype is one form of these neuroendocrine tumors. We report the case series of two such cases of a plexiform neurofibroma of the nasal tip, which were excised via an open rhinoplasty approach.
