Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment / Perda auditiva súbita bilateral idiopática simultânea - características e resposta ao tratamento

Abstract Introduction The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. Objective The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. Methods This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. Results The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p < 0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1 dB for unilateral sudden hearing loss and 63.3 dB for the left ears and 67.6 dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0 dB and 55.4 dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p < 0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p < 0.001). Tinnitus scores decreased significantly in both groups of patients (p < 0.001) in spite of there was no significant difference between the groups of patients. Conclusion Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Resumo Introdução A etiologia da perda auditiva súbita ainda não está bem definida; contudo, presume-se que as etiologias infecciosas, vasculares e neoplásicas sejam as responsáveis. Além disso, a etiologia da perda auditiva súbita bilateral também é desconhecida. Objetivo O objetivo desse estudo foi identificar as características e a resposta ao tratamento de perda auditiva súbita bilateral simultânea. Método Este é um estudo de caso-controle realizado em um centro de atenção terciária. Foram incluídos 132 pacientes com Perda Auditiva Neurossensorial Súbita (PANS) que foram tratados com esteroides sistêmicos e oxigênio hiperbárico. 26 pacientes tiveram PANS bilateral e 106 pacientes tiveram PANS unilateral. Os pacientes foram avaliados com exames clínicos, audiológicos, radiológicos e exames laboratoriais. Os achados e a resposta ao tratamento dos pacientes foram comparados. Resultados As idades médias dos pacientes com PANS unilateral e bilateral foram 42,0 anos e 24,5 anos, respectivamente, com diferença estatisticamente significante (p < 0,001). Os marcadores de resposta imune foram mais prevalentes na PANS bilateral. Os limiares audiológicos pré-tratamento foram 69,1 dB para PANS unilateral e 63,3 dB para a orelha esquerda e 67,6 dB para a orelha direita para PANS bilateral, sem diferença significativa. O limiar médio de audição pós-tratamento em PANS unilateral foi de 47,0 dB e 55,4 dB para a orelha esquerda e 59,0 para a orelha direita em PANS bilateral. A melhora auditiva média no grupo com PANS unilateral foi significativa (p < 0,001), apesar de não ser significativa no grupo com PANS bilateral para ambas as orelhas. Houve diferença significativa entre os grupos na melhora auditiva favorecendo a PANS unilateral (p < 0,001). Os escores de zumbido diminuíram significativamente em ambos os grupos de pacientes (p < 0,001), apesar de não ter havido diferença significativa entre os grupos de pacientes. Conclusão Os pacientes com PANS bilateral eram mais jovens, tinham pior prognóstico e maior taxa de marcadores de resposta imunológica positiva. Os fatores de risco cardiovasculares parecem ter um papel importante na etiologia dos casos unilaterais, ao passo que essa importância não estava presente nos casos bilaterais.

Effect of Spreader Graft on Nasal Functions in Septorhinoplasty Surgery.

OBJECTIVE: The authors aimed to investigate the effect of spreader grafts on nasal function in septorhinoplasty (SRP). METHODS: A prospective randomized double-blind study was conducted. Thirty patients who underwent SRP operation between October 2011 and January 2013 were divided into 2 equal groups randomly. Fifteen patients underwent SRP surgery without spreader graft technique (Group I) and 15 patients underwent SRP surgery with spreader grafts (Group II). Preoperative and postoperative evaluation included visual analog score (VAS) and acoustic rhinometry test. RESULTS: Visual analog scores and acoustic rhinometry measurements of Group I and Group II patients were compared. Statistically significant difference was found for VAS scores of both the sides of the nasal cavity (both before and after topical decongestion) (P < 0.05), except for the VAS on the right side of the nasal cavity before decongestion (P > 0.05). On acoustic rhinometry test the difference was statistically significant for minimal cross-sectional area (MCA) and volumetric values (VOL)-MCA1, MCA2, VOL1, VOL2 values on the left side of the nasal cavity (both before and after topical decongestion) (P < 0.05) but not on the right side of the nasal cavity (P > 0.05). CONCLUSIONS: Performing spreader graft technique in SRP surgery can prevent the narrowing of the internal nasal valve area after surgery and maintain adequate airway for respiration.

Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment.

INTRODUCTION: The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. OBJECTIVE: The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. METHODS: This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. RESULTS: The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p<0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1dB for unilateral sudden hearing loss and 63.3dB for the left ears and 67.6dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0dB and 55.4dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p<0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p<0.001). Tinnitus scores decreased significantly in both groups of patients (p<0.001) in spite of there was no significant difference between the groups of patients. CONCLUSION: Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Acute ischemia of the parotid gland and auricle following embolization for epistaxis.

We report a case of ischemia of the auricle and acute parotitis that developed following embolization for epistaxis. A 53-year-old male was previously conservatively treated for epistaxis with bilateral posterior nasal packing due to hypertension. As the bleeding, continued the patient underwent bilateral embolization of the internal maxillary arteries. The bleeding was controlled but the patient developed acute ischemia of the ipsilateral parotid gland and the auricle that regressed with medical treatment.

Primary marginal zone B-cell lymphoma of the larynx.

Extranodal non-Hodgkin lymphomas limited to the larynx are rare, accounting for less than 1% of all laryngeal neoplasms. The most common site of development of primary laryngeal lymphomas is the supraglottic region. In most cases, the presenting symptoms are hoarseness, dysphagia, dyspnea, and cervical lymphadenopathy. In these cases, larynx lymphoma was the mucosa-associated lymphoid tissue type and located in the supraglottic area.

Epidermal inclusion cyst of the larynx.

Epidermal inclusion cyst (EIC) is a benign cyst filled with keratin fibers, which can develop in any part of the body. It is commonly seen in the skin, especially on the face, scalp, neck, and trunk, and has the tendency to slowly grow toward deeper epidermis parts and to cause cystic expansion. Epidermal inclusion cysts are not common in mucosal sites such as the larynx; however, these can arise owing to squamous metaplasia of the glands. We present a 52-year-old man with a laryngeal EIC. This is a very rare case in the literature of EIC in the larynx.

High-grade mucoepidermoid carcinoma of the larynx.

Laryngeal mucoepidermoid carcinoma is rare. Approximately 85 cases have been reported in the literature. There is no standardized treatment because of the rarity of the disease. A case of a 55-year-old man with laryngeal mucoepidermoid carcinoma, who was treated with total laryngectomy and postoperative radiotherapy, is presented, and current literature is reviewed.