Association Between Hearing Loss and Cardiovascular Disease: A Meta-analysis.

OBJECTIVE: Hearing loss (HL) has been postulated to be linked to cardiovascular diseases (CVDs) via vascular mechanisms, but epidemiological associations remain unclear. The study aims to clarify the association between HL and stroke, coronary artery disease (CAD), and any CVD. DATA SOURCES: PubMed, Embase, and SCOPUS from inception until April 27, 2022. REVIEW METHODS: Three blinded reviewers selected observational studies reporting stroke, CAD, and any CVD in patients with HL, compared to individuals without HL. We extracted data, evaluated study bias using the Newcastle-Ottawa scale, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and a PROSPERO-registered protocol (CRD42022348648). We used random-effects inverse variance meta-analyses to pool the odds ratios (ORs) for the association of HL with stroke, CAD, and any CVD. RESULTS: We included 4 cohort studies (N = 940,771) and 6 cross-sectional studies (N = 680,349). Stroke, CAD, and any CVD were all strongly associated with HL. The overall pooled OR of the association between HL and stroke was 1.26 (95% confidence interval [CI] = 1.16-1.37, I2 = 78%), and was 1.33 (95% CI = 1.12-1.58) and 1.29 (95% CI = 1.14-1.45) for low- and high-frequency HL, respectively. Minimal publication bias was observed, with minimal change to pooled effect size following trim and fill. Similarly, the pooled OR of the association between HL and CAD was 1.36 (95% CI = 1.13-1.64, I2 = 96%), while that between HL and any CVD was 1.38 (95% CI = 1.07-1.77, I2 = 99%). CONCLUSION: Our findings suggest that HL and CVD are closely related. Physicians treating patients with HL should be cognizant of this association and view HL in the broader context of general health and aging.

Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis.

Importance: Hearing loss is associated with cognitive decline. However, it is unclear if hearing restorative devices may have a beneficial effect on cognition. Objective: To evaluate the associations of hearing aids and cochlear implants with cognitive decline and dementia. Data Sources: PubMed, Embase, and Cochrane databases for studies published from inception to July 23, 2021. Study Selection: Randomized clinical trials or observational studies published as full-length articles in peer-reviewed journals relating to the effect of hearing interventions on cognitive function, cognitive decline, cognitive impairment, and dementia in patients with hearing loss. Data Extraction and Synthesis: The review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) reporting guidelines. Two authors independently searched the PubMed, Embase, and Cochrane databases for studies relating to the effect of hearing interventions on cognitive decline and dementia in patients with hearing loss. Main Outcomes and Measures: Maximally adjusted hazard ratios (HRs) were used for dichotomous outcomes and ratio of means for continuous outcomes. Sources of heterogeneity were investigated using sensitivity and subgroup analyses, and publication bias was assessed using visual inspection, the Egger test, and trim and fill. Results: A total of 3243 studies were screened; 31 studies (25 observational studies, 6 trials) with 137 484 participants were included, of which 19 (15 observational studies, 4 trials) were included in quantitative analyses. Meta-analysis of 8 studies, which had 126 903 participants, had a follow-up duration ranging from 2 to 25 years, and studied long-term associations between hearing aid use and cognitive decline, showed significantly lower hazards of any cognitive decline among hearing aid users compared with participants with uncorrected hearing loss (HR, 0.81; 95% CI, 0.76-0.87; I2 = 0%). Additionally, meta-analysis of 11 studies with 568 participants studying the association between hearing restoration and short-term cognitive test score changes revealed a 3% improvement in short-term cognitive test scores after the use of hearing aids (ratio of means, 1.03; 95% CI, 1.02-1.04, I2 = 0%). Conclusions and Relevance: In this meta-analysis, the usage of hearing restorative devices by participants with hearing loss was associated with a 19% decrease in hazards of long-term cognitive decline. Furthermore, usage of these devices was significantly associated with a 3% improvement in cognitive test scores that assessed general cognition in the short term. A cognitive benefit of hearing restorative devices should be further investigated in randomized trials.

Associations of Hearing Loss and Dual Sensory Loss With Mortality: A Systematic Review, Meta-analysis, and Meta-regression of 26 Observational Studies With 1 213 756 Participants.

IMPORTANCE: Hearing loss (HL) and dual sensory loss (DSL) are prevalent, disabling, and associated with numerous age-related health conditions, including dementia and frailty. To date, no evidence-based summary of their mortality risk is available. OBJECTIVE: To clarify the epidemiological associations between HL/DSL and mortality. DATA SOURCES: PubMed, Embase, and Cochrane Library, from inception until June 18, 2021. STUDY SELECTION: Two blinded reviewers selected observational or interventional studies, published as full-length English articles in peer-reviewed journals, that reported the presence or severity of HL or DSL (ie, comorbid HL and vision loss), whether objectively measured or self-reported, in association with any mortality estimate, among adults 18 years and older. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data and evaluated study bias using the Newcastle-Ottawa Scale, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and a PROSPERO-registered protocol. The analysis pooled maximally adjusted estimates using mixed-effects models, measured heterogeneity using I2, investigated sources of heterogeneity using meta-regression and subgroup meta-analyses, examined and adjusted for publication bias, performed influence and cumulative meta-analyses, and assessed evidence quality using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for all-cause, cardiovascular, or other mortality estimates. RESULTS: This review included 14 retrospective and 12 prospective observational studies (1 213 756 participants) from 3220 records. Risk of bias was low to moderate; exclusion of 3 high-risk studies did not alter conclusions. Hearing loss was associated with excess all-cause mortality (HR, 1.13; 95% CI, 1.07-1.19; I2 = 77%; n = 21; 95% prediction interval [PI], 0.93-1.37) and cardiovascular mortality (HR, 1.28; 95% CI, 1.10-1.50; I2 = 60%; n = 6; 95% PI, 0.84-1.96), while DSL was associated with larger excess risks (all-cause: HR, 1.40; 95% CI, 1.30-1.51; I2 = 34%; n = 10; 95% PI, 1.18-1.66; cardiovascular: HR, 1.86; 95% CI, 1.31-2.65; I2 = 0%; n = 2), after adjustment for demographics and comorbidities. Prespecified meta-regression sufficiently explained heterogeneity, with longer follow-up duration weakening the pooled association, leaving low (29%) residual heterogeneity. Meta-regression among audiometric studies showed a dose-response association (doubling of HR per 30-dB increase in HL). Self-reported and audiometric effect sizes were similar, with lower heterogeneity in the latter. Associations were robust to trim-and-fill adjustment for publication bias and single-study influence and cumulative meta-analyses. Associations with accident/injury, cancer, and stroke mortality were inconclusive, with only 1 to 3 studies. Overall evidence quality was moderate. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, HL and DSL were associated with excess all-cause and cardiovascular mortality. Physicians caring for patients with HL should consider its relevance to general health and longevity.

Exploring the Clinical Utility of Gustatory Dysfunction (GD) as a Triage Symptom Prior to Reverse Transcription Polymerase Chain Reaction (RT-PCR) in the Diagnosis of COVID-19: A Meta-Analysis and Systematic Review.

BACKGROUND: The diagnosis of COVID-19 is made using reverse transcription polymerase chain reaction (RT-PCR) but its sensitivity varies from 20 to 100%. The presence of gustatory dysfunction (GD) in a patient with upper respiratory tract symptoms might increase the clinical suspicion of COVID-19. AIMS: To perform a systematic review and meta-analysis to determine the pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) of using GD as a triage symptom prior to RT-PCR. METHODS: PubMed and Embase were searched up to 20 June 2021. Studies published in English were included if they compared the frequency of GD in COVID-19 adult patients (proven by RT-PCR) to COVID-19 negative controls in case control or cross-sectional studies. The Newcastle-Ottawa scale was used to assess the methodological quality of the included studies. RESULTS: 21,272 COVID-19 patients and 52,298 COVID-19 negative patients were included across 44 studies from 21 countries. All studies were of moderate to high risk of bias. Patients with GD were more likely to test positive for COVID-19: DOR 6.39 (4.86-8.40), LR+ 3.84 (3.04-4.84), LR- 0.67 (0.64-0.70), pooled sensitivity 0.37 (0.29-0.47) and pooled specificity 0.92 (0.89-0.94). While history/questionnaire-based assessments were predictive of RT-PCR positivity (DOR 6.62 (4.95-8.85)), gustatory testing was not (DOR 3.53 (0.98-12.7)). There was significant heterogeneity among the 44 studies (I2 = 92%, p < 0.01). CONCLUSIONS: GD is useful as a symptom to determine if a patient should undergo further testing, especially in resource-poor regions where COVID-19 testing is scarce. Patients with GD may be advised to quarantine while repeated testing is performed if the initial RT-PCR is negative. FUNDING: None.

Time course and clinical characterization of cisplatin-induced ototoxicity after treatment for nasopharyngeal carcinoma in a South East Asian population.

BACKGROUND: The purpose of this study was to characterize the clinical course of hearing loss in patients with nasopharyngeal carcinoma (NPC) and the clinical factors affecting its severity. METHODS: The time course of hearing loss in patients with NPC was assessed using threshold shift from baseline and Common Terminology Criteria for Adverse Events (CTCAE) grade. RESULTS: In the chemoradiotherapy (CRT) groups, the threshold shift was significantly higher from 3 months at 4 kHz (P = 2.30 × 10-9 , concurrent CRT only) but not within 2 years posttreatment in the radiotherapy (RT) group. The CRT groups had worse CTCAE grades than the RT group (percentage of latest CTCAE grade ≥1: 64.9% vs 29.0%, respectively). Cumulative cisplatin dose and cochlear RT dose significantly affects threshold shifts, especially at high frequencies. CONCLUSION: Although cisplatin led to high frequency hearing impairment from about 3 months posttreatment, RT conferred no significant hearing impairment in the first 2 years.

Pursuing Mirror Image Reconstruction in Unilateral Microtia: Customizing Auricular Framework by Application of Three-Dimensional Imaging and Three-Dimensional Printing.

BACKGROUND: Advances in three-dimensional imaging and three-dimensional printing technology have expanded the frontier of presurgical design for microtia reconstruction from two-dimensional curved lines to three-dimensional perspectives. This study presents an algorithm for combining three-dimensional surface imaging, computer-assisted design, and three-dimensional printing to create patient-specific auricular frameworks in unilateral microtia reconstruction. METHODS: Between January of 2015 and January of 2016, six patients with unilateral microtia were enrolled. The average age of the patients was 7.6 years. A three-dimensional image of the patient's head was captured by 3dMDcranial, and virtual sculpture carried out using Geomagic Freeform software and a Touch X Haptic device for fabrication of the auricular template. Each template was tailored according to the patient's unique auricular morphology. The final construct was mirrored onto the defective side and printed out with biocompatible acrylic material. RESULTS: During the surgery, the prefabricated customized template served as a three-dimensional guide for surgical simulation and sculpture of the MEDPOR framework. Average follow-up was 10.3 months. Symmetric and good aesthetic results with regard to auricular shape, projection, and orientation were obtained. One case with severe implant exposure was salvaged with free temporoparietal fascia transfer and skin grafting. CONCLUSIONS: The combination of three-dimensional imaging and manufacturing technology with the malleability of MEDPOR has surpassed existing limitations resulting from the use of autologous materials and the ambiguity of two-dimensional planning. This approach allows surgeons to customize the auricular framework in a highly precise and sophisticated manner, taking a big step closer to the goal of mirror-image reconstruction for unilateral microtia patients. CLINCIAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Mandibular Contouring During Orthognathic Surgery Using the Modified Hunsuck Technique.

Square face or prominent mandibular angle is a major concern in Asian women. In class III patients, mandibular setback may lead to a wider lower face that is not preferred in Asian culture. In order to achieve better aesthetic outcomes, simultaneous mandibular contouring to reduce the width of the lower face is required for some patients. This article details the authors' procedures modified from Hunsuck techniques of sagittal split osteotomy. This modified Hunsuck technique provides an alternative option to obtain a desirable mandibular outline. The long-term stability is also comparable to traditional methods.

Long-term outcomes of nasopharyngectomy using partial maxillectomy approach.

OBJECTIVES/HYPOTHESIS: To determine the long-term outcomes of a prospective cohort of 20 patients who had nasopharyngectomy using an open partial-maxillectomy approach. METHOD: A prospective cohort study of the surgical outcomes of patients with recurrent T1 (rT1) and rT2 nasopharyngeal carcinoma recurrence. RESULTS: There were 14 male and six female patients. The mean age was 49 years. The mean duration of follow-up was 60.4 months. All of the surgical margins were free of malignancy. Ten patients (50%) developed recurrences. The 5-year local control rate, disease-free, disease-specific, and overall survivals were 70%, 48.9%, 70.2%, and 66.7%, respectively. There were no major intraoperative complications. The most common morbidity was pain. The median length of hospitalization was 4 days. CONCLUSION: Early local recurrence of nasopharyngeal carcinoma can be treated surgically using a partial maxillectomy approach. The long-term outcomes are similar to nasopharyngectomy performed using the more common approaches. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1103-1107, 2016.