The Impact of Cardiovascular Risk Factors on the Incidence, Severity, and Prognosis of Sudden Sensorineural Hearing Loss (SSHL): A Systematic Review.

Sudden sensorineural hearing loss (SSHL) is believed to be mainly idiopathic since the cause is not usually identified. Several recent studies have examined the role of cardiovascular risk factors in this disease. The aim of this systematic literature review is to investigate the possible association between acquired and inherited cardiovascular risk factors and the incidence, severity, and prognosis of SSHL. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the PubMed database for the period between February 2010 and January 2023 was performed in order to retrieve eligible articles. The analytic cohort included 24 studies. Overall, this systematic review includes a total of 61,060 patients that were encompassed in these studies. According to most studies, the prevalence of dyslipidaemia, diabetes, and ultrasound indices of atherosclerosis was significantly higher in SSHL patients compared to controls. On the other hand, obesity, hypertension, and smoking did not seem to influence the risk of SSHL. Most studies suggest the presence of a correlation between a high cardiovascular risk profile and the risk of developing SSHL. The theory of microvascular impairment in the development of SSHL is indirectly supported by the findings of this review.

Surgical Excision of a Laimer's Diverticulum: A Case Report and Review of the Literature.

A pharyngoesophageal diverticulum (PED) is a rare clinical entity. This paper reports on a 79-year-old male patient with PED and symptoms of dysphagia, regurgitation and chronic cough. The diverticulum was located on the dorsal side of the cervical esophagus, midline, inferior to the cricopharyngeal muscle. These findings were consistent with Laimer's diverticulum (LD), the rarest type of PED. This case proposes a surgical treatment of LD via an external transcervical approach.

The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial.

PURPOSE: Chronic rhinosinusitis (CRS) is a prevalent chronic disease observed on a global scale. The utilization of endoscopic sinus surgery (ESS) has gained significant recognition as an effective intervention for individuals with CRS and nasal polyps who have not responded to conventional treatments. The need (or not) for revision surgery frequently relies on the promotion of optimal wound healing. The impact of platelet-rich plasma (PRP) on tissue healing has been extensively examined in various surgical fields. METHODS: The present prospective study involved 30 patients suffering with nasal polyposis who underwent endoscopic sinus surgery. 15 patients were assigned to the PRP group, and 15 patients to the control group. The clinical follow-up of the patients took place at specific intervals, at weeks 1, 2, 3, 4, 8, and 12 after the surgical procedure. The evaluator identified the existence of adhesions, crusting, bleeding, granulation and infection using a visual analogue scale score. The patients also completed the SNOT 22 questionnaire prior to surgery and at each postoperative visit. RESULTS: The present study observed a lower incidence of adhesion, infection, hemorrhage and granulation in the PRP group. Furthermore, a statistically significant difference was detected between the groups. CONCLUSION: Based on the findings of the present investigation, it seems that platelet-rich plasma (PRP) is beneficial on wound healing during the early stages following the surgical procedure. The technique is characterized by its limited invasiveness, which contributes to its low risk profile and the achievement of clinically good outcomes.

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus.

OBJECTIVE: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1614-1624, 2024.

Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society.

PURPOSE: Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible-even unethical-to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. METHODS: A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above. RESULTS: Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. CONCLUSION: Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies.

A "Terrible" Headache in a HIV Patient.

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

CO2 laser or dissection tonsillectomy: A systematic review and meta-analysis of clinical outcomes.

OBJECTIVE: Recent evidence has suggested that performing a tonsillectomy with CO2 laser results in favorable intraoperative and postoperative outcomes. This study aimed to compare the clinical outcomes of CO2 and dissection tonsillectomy. METHODS: We conducted a systematic search in PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of September 2021 for completed studies comparing intraoperative and postoperative outcomes of CO2 laser and dissection tonsillectomy. Primary outcomes were operative time, intraoperative blood loss, and postoperative pain. Secondary outcomes included postoperative hemorrhage and tonsillar fossa healing. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was performed. A subgroup analysis considering the randomization of trials was carried out, and sensitivity analyses linked to the quality of included papers or the age of patients were executed. Quality assessment was appraised with the Cochrane risk of bias and ROBINS-I tools for randomized and non-randomized trials, respectively. RESULTS: Eight trials with 632 cases contributed data to this review. For operative time, a significant difference in favor of CO2 laser tonsillectomy was documented (SMD = -1.32; 95% CI = -2.24 to -0.40; p < 0.005). This was also the case for intraoperative blood loss (SMD = -3.94; 95% CI = -5.62 to -2.26; p < 0.00001). For postoperative pain, no significant differences were detected on day one and seven between the intervention groups (SMD = -0.24; 95% CI = -1.11 to 0.63; p = 0.59 and SMD = 1.31; 95% CI = -0.14 to 2.75; p = 0.08, respectively). CO2 laser tonsillectomy was not superior to conventional dissection tonsillectomy regarding postoperative bleeding rates (OR = 0.50; 95% CI = 0.10 to 2.53; p = 0.40). CONCLUSION: This study demonstrates that CO2 laser tonsillectomy is more likely to result in a clinically meaningful decrease in operative time and blood loss compared to the conventional dissection technique in both pediatric and adult patients. We found no significant difference in postoperative pain and bleeding. Performing further level-1 trials on this topic with a standardized and validated outcome measurement method will enable more robust conclusions to be drawn.

A Prospective Controlled Study Investigating Odor Identification in Laryngopharyngeal Reflux.

OBJECTIVE: To psychophysically evaluate olfaction in patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Prospective controlled study. SETTING: Tertiary medical center. METHODS: From January 2021 to January 2022, patients with LPR diagnosed with hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring underwent psychophysical evaluation of the sense of smell. Reflux symptoms and findings were assessed with the Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA). Nasal symptoms were assessed through the Sino-Nasal Outcome Test 22 (SNOT-22). From pre- to posttreatment, patients underwent identification Sniffin' Sticks test and olfactory cleft examination. Clinical outcomes were compared between LPR patients and healthy individuals. RESULTS: In total, 107 patients and 76 healthy individuals completed the evaluations. LPR patients reported significant higher RSS, RSA, and SNOT-22 scores. Psychophysical olfactory evaluations were significantly lower in reflux patients compared with controls, while there were no significant differences in olfactory cleft score. RSS and RSA significantly improved from baseline to 3 months posttreatment. SNOT-22, olfactory cleft endoscopy scale, and psychophysical olfactory evaluations did not change throughout treatment. Patients with higher number of acid pharyngeal reflux events reported lower psychophysical olfactory scores (P = .025). CONCLUSION: LPR disease was associated with low odor identification results in patients without olfactory cleft abnormalities. The sense of smell did not improve after 3-month therapy. Future controlled studies using threshold, discrimination, and identification testing are needed.

Platelet-Rich Fibrin in Otorhinolaryngology.

Background: Platelet-rich fibrin is a second-generation platelet concentrate. It is rich in platelets, cytokines, growth factors and leukocytes. Compared to platelet-rich plasma, it releases growth factors for a more extended amount of time. Methods:A literature review was conducted on the applications of platelet-rich fibrin in otolaryngology. Only articles written in English were further considered for the study; all others were excluded. Also, articles relating to oral and maxillofacial surgery were removed. Results: Twenty-five studies were deemed appropriate for inclusion in the present review. Conclusion:Based on the current data, platelet-rich fibrin appears to be a safe, healing-promoting material. It is a cost-effective, autologous material with enormous therapeutic application potential in the future. However, further clinical research is required before conclusive conclusions can be drawn about its usefulness.

Gracilis free flap in head and neck reconstruction beyond facial palsy reanimation.

INTRODUCTION: The gracilis muscle free flap has gained popularity in head and neck reconstruction due to minimal donor-site morbidity, reliable vascular pedicle, strong muscular component, and possibility to perform nerve coaptation. However, almost all the existing evidence in the literature is related to its use for facial palsy reanimation. The aim of this study was therefore to review and provide a comprehensive summary of all the possible indications and outcomes of this versatile free flap in head neck reconstructive surgery. MATERIALS AND METHODS: A systematic review of the literature was conducted including articles from 1970 to 2019. All articles were examined and described. RESULTS: Twenty-seven papers published between 1994 and 2019 were identified for analysis. The evidence highlights the use of the gracilis muscle free flap for parotid, forehead and midface defects, oral tongue, oral sphincter, lower and upper lip, cheek, and oral commissure defects, among others, as the most common defects reconstructed. CONCLUSION: This flap represents an easy to harvest and versatile free flap with low donor-site morbidity and multiple proven uses in head & neck reconstruction. We therefore encourage reconstructive surgeons to include this flap in their armoury, either as a first or as a second-line option.

Laryngopharyngeal Reflux and Olfaction Disorders. Is There Any Connection? A Scoping Review.

Objectives: To review the evidence regarding olfaction in patients with laryngopharyngeal reflux. Methods:Conducting a scoping review of studies evaluating olfactory sense in patients with laryngopharyngeal reflux. Online databases were searched and studies evaluating laryngopharyngeal reflux impact on other nasal functions were excluded. Other exclusion criteria were the presence of severe nasal anatomical issues, rhinosinusitis, allergic rhinitis and nasal polyps in the study group. Results:Seven studies, between 2016 and 2019, met our inclusion criteria. Olfaction threshold was significantly lower in patients with laryngopharyngeal reflux than controls in three studies and in two of these studies, all three assessed parameters, including threshold, identification and discrimination, were significantly affected in the laryngopharyngeal reflux group. In three other studies, where the Connecticut Chemosensory Clinical Research Center test had been used, smell test scores were also statistically significantly lower in the reflux group. Finally, in a survey-based study evaluating olfaction, olfactory anomalies were positively related to gastroesophageal reflux disease and gastroparesis symptom severity. Conclusions:There is scarce evidence regarding the effect of laryngopharyngeal reflux on olfaction, but preliminary evidence shows that laryngopharyngeal reflux may cause olfactory abnormalities. Thus, olfactory abnormalities can be an additional reflux manifestation. Gastroparesis, gastroesophageal reflux disease, laryngopharyngeal reflux and Helicobacter pylori infection are factors that can potentially cause olfactory sensory disturbance.

Laryngopharyngeal Reflux: The Last Decade.

Laryngopharyngeal reflux (LPR) and its consequences for the upper aerodigestive tract have been an issue of debate and controversy for more than three decades [...].

Silent sinus syndrome: Reduction of surgical invasiveness in an underdiagnosed clinical entity.

OBJECTIVE: The aim of this study was to investigate our experience in the management of silent sinus syndrome. MATERIAL AND METHODS: The records of all patients treated for silent sinus syndrome between 2011 and 2021 were evaluated retrospectively. Data were collected on epidemiological parameters (age, gender), referral specialty, imaging findings, surgical approach, and management. RESULTS: In total, nine cases made up our final study sample (5 men, 4 women; male-female ratio 1:0.8). Their mean age was 39 years (range: 19-71 years). Besides the typical imaging findings (orbital floor depression, maxillary sinus atelectasis with ostium occlusion), lateralization of the uncinate process could be seen in seven cases (77.8 %) and ipsilateral septal deviation in six cases (66.6 %). Four cases were managed by means of middle meatal antrostomy and five with additional reconstruction of the orbital floor (transconjuctival approach in two cases, endonasal endoscopic approach in three cases). Enopthalmus recovered in all cases; diplopia (3 cases) recovered completely in two cases and partly in one case. CONCLUSION: Reduced surgical invasiveness in silent sinus syndrome, with management of the cause (maxillary sinus hypoventilation) and the sequel (orbital floor depression) using the same endoscopic approach, is associated with an acceptable clinical outcome.

Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis.

INTRODUCTION: Pharyngocutaneous fistula (PCF) remains the most frequent complication following total laryngectomy (TL). Pharyngeal closure with a surgical stapler (SAPC) has been proposed as an effective closure technique that decreases the rate of PCF, reduces surgical time, decreases the length of hospital stay, and shortens the time required before safely initiating oral feeding. METHODS: This study involved a systematic review and meta-analysis of patients with laryngeal cancer who underwent TL and with subsequent stapler pharyngeal closure, in order to analyse the current literature regarding the role of SAPC after TL. RESULTS: The incidence of PCF in the stapler-assisted suture group (SASG) was 9.5% (95% CI 8.2-15.9%), with a mean absolute deviation of 1.12, while in the hand-suture group (HSG) group the incidence was 23.4% (95% CI 23-26.1%), with a mean absolute deviation of 5.71 (p = 0.01). CONCLUSIONS: SAPC may decrease the risk of PCF in patients following TL. Based on the current data, SAPC appears to shorten the surgical time and the length of hospital stay. Nevertheless, prospective randomized trials are required to validate these findings.

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis.

OBJECTIVES: Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. METHODS: The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. RESULTS: Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively). CONCLUSIONS: This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review.

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere's disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series.

BACKGROUND: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. METHODS: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. RESULTS: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. CONCLUSION: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

Impact of subspecialty training on management of laryngopharyngeal reflux: results of a worldwide survey.

OBJECTIVE: To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees. METHODS: A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment. RESULTS: Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management. CONCLUSIONS: LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.