A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results.

BACKGROUND: Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. METHODS: Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients' clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. RESULTS: In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. CONCLUSIONS: Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.

Differential Diagnostic Value of Machine Learning-Based Models for Embolic Stroke.

Cancer-associated thrombosis (CAT) and atrial fibrillation (AF)-related stroke are two subtypes of acute embolic stroke with distinct lesion patterns on diffusion weighted imaging (DWI). This pilot study aimed to evaluate the feasibility and performance of DWI-based machine learning models for differentiating between CAT and AF-related stroke. Patients with CAT and AF-related stroke were enrolled. In this pilot study with a small sample size, DWI images were augmented by flipping and/or contrast shifting to build convolutional neural network (CNN) predicative models. DWI images from 29 patients, including 9 patients with CAT and 20 with AF-related stroke, were analyzed. Training and testing accuracies of the DWI-based CNN model were 87.1% and 78.6%, respectively. Training and testing accuracies were 95.2% and 85.7%, respectively, for the second CNN model that combined DWI images with demographic/clinical characteristics. There were no significant differences in sensitivity, specificity, accuracy, and AUC between two CNN models (all P = n.s.).The DWI-based CNN model using data augmentation may be useful for differentiating CAT from AF-related stroke.

Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study.

Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays (P < .001), higher C-reactive protein levels (P = .021), higher blood sugar levels (P = .012), and a higher likelihood of diabetes mellitus (P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway (P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.

Assessment of Factors Associated With Long-Term Hospitalization in Patients With a Deep Neck Infection.

BACKGROUND: Deep neck infection (DNI) is a severe infectious disorder of deep neck spaces that can cause serious complications. Long-term hospitalization is when a patient spends more time in the hospital than originally expected for a disease. There are few studies assessing the risk factors associated with long-term hospitalization for a DNI. This study investigated the factors causing DNI patients to experience long-term hospitalization. METHODS: Long-term hospitalization is defined as a length of hospital stay exceeding 28 days (> 4 weeks) in this research. A total of 362 subjects with a DNI between October 2017 and November 2022 were recruited. Among these patients, 20 required long-term hospitalization. The relevant clinical variables were assessed. RESULTS: In a univariate analysis, C-reactive protein (odds ratio [OR] = 1.003, 95% CI: 1.000-1.007, P = .044), involvement of ≥3 deep neck spaces (OR = 2.836, 95% CI: 1.140-7.050, P = .024), and mediastinitis (OR = 8.102, 95% CI: 3.041-21.58, P < .001) were significant risk factors for long-term hospitalization in DNI patients. In a multivariate analysis, mediastinitis (OR = 6.018, 95% CI: 2.058-17.59, P = .001) was a significant independent risk factor for long-term hospitalization for a DNI. There were no significant differences in pathogens between the patients with and without long-term hospitalization (all P > .05). However, the rates of no growth of specific pathogens were significantly different between patients with and without long-term hospitalization, and those with long-term hospitalization had greater rates of growth of specific pathogens (P = .032). The rate of tracheostomy in patients with long-term hospitalization was higher than for those without (P < .001). Nevertheless, the rates of surgical incision and drainage between patients with and without long-term hospitalization did not achieve statistical significance (P = .069). CONCLUSIONS: Deep neck infection (DNI) is a critical, life-threatening disease that could lead to long-term hospitalization. The higher CRP and involvement of ≥3 deep neck spaces were significant risk factors in univariate analysis, while concurrent mediastinitis was an independent risk factor associated with long-term hospitalization. We suggest intensive care and prompt airway protection for DNI patients with concurrent mediastinitis.

Postpartum Spinal Cord Infarction: A Case Report and Review of the Literature.

Background: Postpartum spinal cord infarction is a very rare disease. Only two cases have been reported in the English literature. Methods: We reported a 26 year old female who received second doses of the mRNA-1273 vaccine 52 days before delivery. She presented as sudden onset of paraplegia, sensory level, and sphincter incontinence at postpartum period. No history of heparin exposure was noted. Imaging findings confirmed the T10-11 level infarction and her anti-human heparin platelet factor 4 (anti-PF4) antibody was positive. After 7 days of dexamethasone therapy, her paraplegia and urinary incontinence gradually improved. Results: The CT angiography (CTA) of the artery of Adamkiewicz (Aka) showed tandem narrowing, most conspicuous at the T10-11 level, which was presumably due to partial occlusion of the arteriolar lumen. The thoracolumbar spine magnetic resonance imaging with contrast medium showed owl's eyes sign at the T10 and T11 levels. We compared our case with two other case reports from the literature. Conclusions: Post-partum spinal cord infarction with positive anti-PF4 antibody and relatively thrombocytopenia are the characteristics of our case.

Deep Learning Artificial Intelligence to Predict the Need for Tracheostomy in Patients of Deep Neck Infection Based on Clinical and Computed Tomography Findings-Preliminary Data and a Pilot Study.

Background: Deep neck infection (DNI) can lead to airway obstruction. Rather than intubation, some patients need tracheostomy to secure the airway. However, no study has used deep learning (DL) artificial intelligence (AI) to predict the need for tracheostomy in DNI patients. Thus, the purpose of this study was to develop a DL framework to predict the need for tracheostomy in DNI patients. Methods: 392 patients with DNI were enrolled in this study between August 2016 and April 2022; 80% of the patients (n = 317) were randomly assigned to a training group for model validation, and the remaining 20% (n = 75) were assigned to the test group to determine model accuracy. The k-nearest neighbor method was applied to analyze the clinical and computed tomography (CT) data of the patients. The predictions of the model with regard to the need for tracheostomy were compared with actual decisions made by clinical experts. Results: No significant differences were observed in clinical or CT parameters between the training group and test groups. The DL model yielded a prediction accuracy of 78.66% (59/75 cases). The sensitivity and specificity values were 62.50% and 80.60%, respectively. Conclusions: We demonstrated a DL framework to predict the need for tracheostomy in DNI patients based on clinical and CT data. The model has potential for clinical application; in particular, it may assist less experienced clinicians to determine whether tracheostomy is necessary in cases of DNI.

Effects of oral N-acetylcysteine combined with oral prednisolone on idiopathic sudden sensorineural hearing loss.

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an acute condition that presents with sudden hearing loss, for which steroids remain the main treatment. N-acetylcysteine (NAC), as a precursor of glutathione, can reduce the production of reactive oxygen species to protect hair cells in the inner ear from damage. However, data regarding the therapeutic outcomes of oral steroid combined with oral NAC for ISSNHL are still limited. This study was performed to investigate this issue. METHODS: Between June 2016 and October 2021, 219 patients (219 ears) diagnosed with ISSNHL and treated with oral prednisolone were enrolled in this retrospective study. Oral NAC was prescribed to 94 of these patients (NAC group) but not to the remaining 125 patients (non-NAC group). The clinical and audiological findings were assessed. RESULTS: The NAC group showed a mean hearing level gain of 29.5 ± 21.8 dB, speech reception threshold (SRT) gain of 26.2 ± 34.4 dB, and speech discrimination score (SDS) gain of 25.5 ± 30.4%. Although the NAC group had better mean hearing level, SRT, and SDS gains than the non-NAC group, the differences were not statistically significant (all P > .05). The only significant difference between the NAC and non-NAC groups was the posttreatment pure tone audiometry (PTA) thresholds at 8 kHz, which were 54.2 ± 24.4 and 60.9 ± 34.1 dB, respectively (P = .046). CONCLUSIONS: This study demonstrated the effect of oral steroid combined with oral NAC for ISSNHL. Both the NAC and non-NAC groups showed obvious improvement in all PTA thresholds, as well as mean hearing level, SRT, and SDS gains. The NAC group showed significantly better PTA performance at a high frequency (8 kHz) than the non-NAC group. Therefore, for oral treatment of ISSNHL, we advocate concurrent use of oral prednisolone and oral NAC.

Prognostic factors in elderly patients after an intra-tympanic steroid injection for idiopathic sudden sensorineural hearing loss.

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) presents with emergent hearing impairment and is mainly treated with steroids. However, limited data exist regarding the prognostic factors among elderly patients (>65 years old) who receive an intra-tympanic steroid injection (ITSI). Therefore, we investigated the prognostic factors in these patients. METHODS: Between July 2016 and March 2022, we retrospectively enrolled 105 elderly patients (>65 years old) with unilateral ISSNHL who were treated with an ITSI, and recorded their clinical and audiological variables. RESULTS: The patients had a mean age of 72.03 ± 6.33 years and mean hearing level gain of 22.86 ± 21.84 dB, speech reception threshold (SRT) gain of 15.77 ± 35.27 dB, and speech discrimination score (SDS) gain of 19.54 ± 27.81 %. According to Siegel's criteria, 5 (4.76 %), 44 (41.91 %), 46 (43.81 %), and 10 (9.52 %) patients had complete recovery, partial recovery, slight improvement, and no improvement, respectively. In the univariate analysis, vertigo (odds ratio [OR] = 0.290, 95 % confidence interval [CI]: 0.130-0.651, p = 0.002) and profound hearing loss on pure tone audiometry (PTA; OR = 0.233, 95 % CI: 0.101-0.536, p = 0.004) were negative prognostic factors among elderly ISSNHL patients. In the multivariate analysis, vertigo (OR = 0.300, 95 % CI: 0.128-0.705, p = 0.005) and profound pure tone audiometry (OR = 0.240, 95 % CI: 0.101-0.570, p = 0.001) were independent adverse prognostic factors among elderly ISSNHL patients. CONCLUSIONS: We demonstrated the treatment outcomes of 105 elderly ISSNHL patients after an ITSI. Vertigo and profound PTA are independent adverse risk factors among elderly ISSNHL patients, and patients with these risk factors require active treatment.

Factors affecting perforation of the esophagus in patients with deep neck infection.

BACKGROUND: Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors. METHODS: Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed. RESULTS: In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603-18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98-855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05). CONCLUSION: Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.

Acute Fulminant Myocarditis After ChAdOx1 nCoV-19 Vaccine: A Case Report and Literature Review.

According to recent literatures, myocarditis is an uncommon side effect of mRNA vaccines against COVID-19. On the other hand, myocarditis after adenovirus based vaccine is rarely reported. Here we report a middle-aged healthy female who had acute fulminant perimyocarditis onset 2 days after the first dose of ChAdOx1 vaccine (AstraZeneca) without any other identified etiology. Detailed clinical presentation, serial ECGs, cardiac MRI, and laboratory data were included in the report. Possible mechanisms of acute myocarditis after adenoviral vaccine was reviewed and discussed. To our knowledge, a few cases of myocarditis after Ad26.COV2.S vaccine were reported, and this is the first case report after ChAdOx1 vaccine.

Factors Affecting Patients with Concurrent Deep Neck Infection and Lemierre's Syndrome.

Deep neck infection (DNI) is a severe disease affecting the deep neck spaces, and is associated with an increased risk of airway obstruction. Lemierre's syndrome (LS) refers to septic thrombophlebitis of the internal jugular vein after pharyngeal infection, and is linked with high morbidity and mortality. Both diseases begin with an oropharyngeal infection, and concurrence is possible. However, no studies have examined the risk factors associated with co-existence of LS and DNI. Accordingly, this study examined a patient population to investigate the risk factors associated with concurrent DNI and LS. We examined data from a total of 592 patients with DNI who were hospitalized between May 2016 and January 2022. Among these patients, 14 had concurrent DNI and LS. The relevant clinical variables were assessed. In a univariate analysis, C-reactive protein (odds ratio (OR) = 1.004, 95% CI: 1.000−1.009, p = 0.045), involvement of multiple spaces (OR = 23.12, 95% CI: 3.003−178.7, p = 0.002), involvement of the carotid space (OR = 179.6, 95% CI: 22.90−1409, p < 0.001), involvement of the posterior cervical space (OR = 42.60, 95% CI: 12.45−145.6, p < 0.001) and Fusobacterium necrophorum (F. necrophorum, OR = 288.0, 95% CI: 50.58−1639, p < 0.001) were significant risk factors for concurrent DNI and LS. In a multivariate analysis, involvement of the carotid space (OR = 94.37, 95% CI: 9.578−929.9, p < 0.001), that of the posterior cervical space (OR = 24.99, 95% CI: 2.888−216.3, p = 0.003), and F. necrophorum (OR = 156.6, 95% CI: 7.072−3469, p = 0.001) were significant independent risk factors for concurrent LS in patients with DNI. The length of hospitalization in patients with concurrent LS and DNI (27.57 ± 14.94 days) was significantly longer than that in patients with DNI alone (10.01 ± 8.26 days; p < 0.001), and the only pathogen found in significantly different levels between the two groups was F. necrophorum (p < 0.001). Involvement of the carotid space, that of the posterior cervical space and F. necrophorum were independent risk factors for the concurrence of DNI and LS. Patients with concurrent LS and DNI had longer hospitalization periods than patients with DNI alone. Furthermore, F. necrophorum was the only pathogen found in significantly different levels in DNI patients with versus those without LS.

Factors Creating a Need for Repeated Drainage of Deep Neck Infections.

Deep neck infection (DNI) is associated with morbidity and mortality. Surgical incision and drainage (I&D) of DNI abscesses are essential. Refractory abscesses require repeat I&D. Few studies have assessed the risk factors associated with repeat I&D; here, we investigated such factors. In total, 605 patients with DNI were enrolled between July 2016 and February 2022. Of these patients, 107 underwent repeat I&D. Clinical variables were assessed. On univariate analysis, a high blood sugar level (odds ratio (OR) = 1.006, p < 0.001), the involvement of at least four neck spaces (OR = 15.44, p < 0.001), and mediastinitis (OR = 1.787, p = 0.040) were significant risk factors for repeat I&D. On multivariate analysis, a high blood sugar level (OR = 1.005, p < 0.001) and the involvement of at least four neck spaces (OR = 14.79, p < 0.001) were significant independent risk factors for repeat I&D. Patients who required repeat I&D had longer hospital stays and a higher tracheostomy rate than did other patients (both p < 0.05). The pathogens did not differ between patients who did and did not require repeat surgical I&D (all p > 0.05), but the rates of pathogen non-growth from blood cultures were 19.47% (97/498) in the group without a need for repeat I&D and 0.93% (1/107) in the group with such a need (p < 0.001). DNI can be fatal; a higher blood sugar level and the involvement of at least four neck spaces were independent risk factors for repeat surgical I&D. If at least four neck spaces are involved, we recommend controlling the blood sugar level after admission. We found significant differences in the length of hospital stay and the need for tracheostomy between groups who did and did not require repeat surgical I&D. Although the pathogens did not differ between the groups, pathogen non-growth from blood cultures was less common in the group with for repeat surgical I&D than in the group without such a need.

Factors affecting patients with concurrent deep neck infection and aspiration pneumonia.

BACKGROUND: Deep neck infection (DNI) is a life-threatening condition of the deep neck spaces with potential to obstruct the airway. Aspiration pneumonia (AP), which results from aspiration of colonized oropharyngeal or upper gastrointestinal contents, is a respiratory infection that affects the lungs, wherein the air sacs are filled with purulent fluid. The cooccurrence of these two diseases can cause severe damage to the respiratory system, leading to morbidity and mortality. However, the risk factors for concurrent DNI and AP have not yet been investigated. This study aimed to address this issue. METHODS: A total of 561 DNI patients were enrolled in this study between June 2016 and December 2021. Among these patients, 26 had concurrent DNI and AP at the time of diagnosis. Relevant clinical variables were assessed. RESULTS: In the univariate analysis, age > 60 years (OR = 3.593, 95% CI: 1.534-8.414, p = 0.002), C-reactive protein (OR = 1.005, 95% CI: 1.001-1.008, p = 0.003), involvement of ≥3 spaces (OR = 4.969, 95% CI: 2.051-12.03, p < 0.001), and retropharyngeal space involvement (OR = 4.546, 95% CI: 1.878-11.00, p < 0.001) were significant risk factors for concurrent DNI and AP. In the multivariate analysis, age > 60 years (OR = 2.766, 95% CI: 1.142-6.696, p = 0.024) and retropharyngeal space involvement (OR = 3.006, 95% CI: 1.175-7.693, p = 0.021) were independent risk factors for concurrent DNI and AP. The group with concurrent DNI and AP had longer hospital stays (p < 0.001) and lower rates of incision and drainage (I&D) open surgery (p = 0.020) than the group with DNI alone. There were no significant differences in pathogens (p > 0.05) between the groups. CONCLUSIONS: Both DNI and AP can independently compromise the airway, and the concurrence of these two conditions makes airway protection more difficult. Age > 60 years and retropharyngeal space involvement were independent risk factors for the concurrence of DNI and AP. The group with concurrent DNI and AP had longer hospital stays and lower rates of I&D open surgery than the group with DNI alone. There were no differences in DNI pathogens according to concurrent AP status.

Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis.

Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p < 0.001), blood sugar (OR = 1.007, p < 0.001), and diabetes mellitus (DM, OR = 4.017, p < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p < 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.

Management of Descending Necrotizing Mediastinitis, a Severe Complication of Deep Neck Infection, Based on Multidisciplinary Approaches and Departmental Co-Ordination.

OBJECTIVES: Descending necrotizing mediastinitis (DNM) developing after deep neck infection (DNI) is a potentially lethal disease of the mediastinum with a mortality rate as high as 40% prior to the 1990s. No standard treatment protocol is available. Here, we present the outcomes of our multidisciplinary approaches for treating DNM originating from a DNI. METHODS: Between June 2016 and July 2021, there were 390 patients with DNIs admitting to our tertiary hospital. A total 21 patients with DNIs complicated with DNM were enrolled. The multidisciplinary approaches included establishment of airway security, appropriate surgery and antibiotics, extracorporeal membrane oxygenation, and intensive care unit management. The clinical variables were analyzed. RESULTS: Two patients died and 19 survived (mortality 9.5%). The patients who died had a higher mean C-reactive protein (CRP) level than did those who survived (420.0 ± 110.3 vs 221.8 ± 100.6 mg/L) (P = .038). The most common pathogens were Streptococcus constellatus and Streptococcus anginosus. From 2001 to 2021, the average mortality rate of studies enrolling more than 10 patients was 16.1%. CONCLUSION: Multidisciplinary approaches, early comprehensive medical treatment, and co-ordination among departments significantly reduce mortality. Patients with severe inflammation and high CRP levels require intensive and aggressive interventions.

The necessity and effect of prophylactic quinolone ear drops after ventilation tube insertion for otitis media with effusion.

BACKGROUND: Otitis media with effusion (OME) is a condition where non-infective fluid builds up in the middle ear. Long-term OME can cause damage to the middle ear and hearing impairment. Ventilation tube insertion (VTI) is an efficient procedure to drain persistent OME. However, the effect of prophylactic ear drops after VTI remains controversial because no infection is present. This study investigated the need for and effect of quinolone ear drops in patients with OME after VTI. METHODS: Between July 2018 and July 2021, 272 patients (436 ears with OME) who underwent VTI were enrolled. Prophylactic quinolone ear drops (ofloxacin) were used in 271 OME ears and not used in 165. The clinical findings and effect of the ear drops were assessed. RESULTS: The group with postoperative ofloxacin had less postoperative otorrhea (p < 0.001). In univariate analysis, age ≥ 13 years (odds ratio [OR] = 1.499, 95% confidence interval [CI]: 1.003-2.238, p = 0.046) was significantly associated with recovery to normal middle ear functioning (type A on postoperative tympanometry). No adenoid hypertrophy (OR = 1.692, 95% CI: 1.108-2.585, p = 0.014) and no postoperative otorrhea (OR = 2.816, 95% CI: 1.869-4.237, p < 0.001) were significant independent factors associated with middle ear recovery in both univariate and multivariate analysis. After VTI, 65% of tympanic membranes in the group with postoperative ofloxacin recovered to normal, while in 67% of tympanic membranes in the group without ofloxacin scarring remained. CONCLUSIONS: Patients who received prophylactic postoperative ofloxacin had less postoperative otorrhea. No adenoid hypertrophy and no postoperative otorrhea were significant independent predictors of middle ear recovery to normal function in both univariate analysis and multivariate analysis. However, prophylactic ofloxacin was not an independent predictor of normal middle ear functioning after VTI. After VTI, most OME patients who had used ofloxacin postoperatively had eardrums that were in better condition than those of patients who had not used ofloxacin. In this study, we confirmed the advantages and limitations of OME after VTI with prophylactic ofloxacin, thus providing clinicians with some guidance regarding the decision to administer prophylactic ofloxacin.

Characteristics and outcome differences in male and female oral cavity cancer patients in Taiwan.

ABSTRACT: Oral cavity squamous cell carcinoma (OSCC) is a leading cause of death in Taiwan. Most of the patients in the literature are male. The risk factors, cancer characteristics, and treatment outcomes were investigated in female patients and compared with male patients in this study.This retrospective study recruited 2046 OSCC patients between 1995 and 2019. The age, tumor subsites, and survival were reviewed and recorded. Overall survival and disease-free survival were the main outcomes.Female patients represented 6.7% of the entire study cohort. Females were diagnosed at an older age and an earlier local stage than male patients (P < .001). Female patients were less exposed to cigarettes, alcohol, and betel-quid (all P < .001). The tongue (55.1%) was the most frequent subsite in females, while the buccal cavity (38.4%) and the tongue (35.3%) were more likely (P < .001) to be associated with the male gender. Female patients in the tongue cancer subgroup presented less frequently with extra-nodal extension compared with male patients (P = .040). No significant differences in recurrence or overall deaths were observed between the genders during the follow-up period.The OSCC male to female ratio in Taiwan was 14:1. Female OSCC occurred more frequently on the tongue, and was diagnosed at an older age and at an earlier tumor stage than in male patients. No survival difference was found between female and male OSCC patients.

Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis.

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905-158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961-4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187-175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131-5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

Early strategy of scepter XC balloon angioplasty and simultaneous Nimodipine infusion for vasospasm following ruptured aneurysm.

BACKGROUND: Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish a protocol for the management of vasospasm and demonstrate our experience of angioplasty using the Scepter XC balloon catheter. METHODS: In this retrospective study, a computed tomography angiography and perfusion image was arranged if early symptoms occurred or on the 7th day following aneurysmal SAH. In patients with clear consciousness, balloon angioplasties were performed for symptomatic vasospasms, which were not improved within 6-12 h after maximal medical treatments. In unconscious patients, balloon angioplasties were performed for all patients with angiographic vasospasms. RESULTS: Fifty patients underwent Scepter XC balloon angioplasty among 396 consecutive patients who accepted endovascular or surgical treatments for ruptured aneurysms. All angioplasty procedures were successful without complications. 100% angiographic improvement and 94% clinical improvement were reached immediately after the angioplasties. A favorable functional outcome (modified Rankin Score of ≤2) could be achieved in 82% of patients. Even in patients with poor clinical grading (Hunt-Hess grade 4-5), a clinical improvement rate of 87.5% and favorable outcome rate was 70.8% could be achieved. CONCLUSION: Balloon angioplasty with Scepter XC balloon catheter is safe and effective for post-SAH vasospasm. This device's extra-compliant characteristics could considerably improve the quality of angioplasty procedures. For all patients, even those with poor neurological status, early treatment with combined protocol of nimodipine and angioplasty can have good clinical outcomes.