Outcomes of Active Middle Ear Implants: Speech Perception and Quality of Life.

OBJECTIVE: To evaluate audiological outcomes, quality of life, and complications in patients implanted with Active middle ear implants (AMEI). The secondary objective is to investigate the required duration after implantation to reach satisfactory outcomes. METHODS: This retrospective study included 31 patients implanted with Active middle ear implants (AMEI) with different methods of floating mass transducer attachment. Patients with incomplete medical records and those who did not respond to postoperative follow-up were excluded. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), speech reception threshold (SRT), and speech discrimination score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. RESULT: There are no significant differences found in PTA and SRT between the 3-, 6-, and 12-month visits. The speech reception threshold (SRT) showed a statistically significant improvement at 3, 6, and 12 months post-operative measures compared to pre-operative. Additionally, the SDS exhibited a significant increase only after 12 months, compared to the 3-month time point. However, satisfaction levels did not significantly differ between the 6-month and 12-month measurements following surgery. CONCLUSION: The Vibrant Soundbridge improves subjective satisfaction scores and audiological test scores in patients with different types of hearing loss. AMEI has a low risk of medical or surgical complications, the ease of using a hearing implant, and the social benefits of good hearing and communication.

Octyl-2-cyanoacrylate Tissue Adhesive Closure Versus Subcuticular Suture for Post-Auricular Incisions.

BACKGROUND: Skin closure techniques in otolaryngology vary based on surgeon preference and wound site. Octyl-2-Cyanoacrylate may be a safe, rapid, and cost-effective option for post-site closure. AIM: This randomized controlled trial study aimed to compare Octyl-2-Cyanoacrylate and conventional subcuticular sutures in ear surgeries, assessing wound closure results in both case and control groups. METHODS: This prospective, randomized, controlled, single-blind study was conducted at Ohud Hospital from May 2021 to May 2022. Ear surgery and cochlear implantation in patients were examined, and each group was randomly assigned to receive Dermabond TM and deep layer subcuticular sutures closure. Incisions were assessed at various time points, including 3 weeks, 6 weeks, 6 months, and 1 year post-surgery. The patient and observer Scar Assessment Scale was used, and two independent ear surgeons used the Stony Brook Scar Evaluation Scale for initial scar assessment. RESULTS: This study involved 126 ear surgery and cochlear implantation patients randomized to use cyanoacrylate tissue adhesive or subcuticular suture for port site closure. The study found that tissue adhesive (OCA) was faster and more efficient than standard sutures, saving an average of 12 min per incision in each ear. Incision cosmesis showed immediate results and significant differences, and patient satisfaction with OCA wound closure was higher than standard sutures. CONCLUSION: The findings confirmed that cyanoacrylate tissue adhesive significantly reduced the time needed for skin closure during ear surgery and showed immediate cosmetic improvements without any documented instances of bleeding, hematoma, infection, or wound separation. LEVEL OF EVIDENCE: This is a randomized controlled trial, it follows Level 2 of evidence. Randomized trial or observational study with dramatic effects Laryngoscope, 134:4036-4041, 2024.

Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04425-6.

Efficacy of gelfoam middle ear packing in type-1 tympanoplasty: systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the surgical outcomes of type-1 tympanoplasty with and without gelfoam middle ear packing. METHODS: PubMed, CENTRAL, Scopus, Web of Science, and Google Scholar databases were screened from inception until October 2022. The included RCTs were evaluated for risk of bias, and the quality of each outcome was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Nine RCTs with 773 participants (gelfoam = 381 and non-gelfoam = 392) were analyzed. The overall study quality varied: low risk (n = 4 RCTs), some concerns (n = 3 RCTs), and high risk (n = 2 RCTs). There were no significant differences between both arms regarding the graft uptake rate (moderate certainty), hearing improvement rate (moderate certainty), type of impedance audiometry (moderate certainty), and ear discharge (low certainty). The mean change in air-bone gap was significantly higher in the non-gelfoam arm compared with the gelfoam arm (low certainty). However, the non-gelfoam group had superior hearing improvement in only the early postoperative period (i.e., one month); however, after two, three, and six months, there were no significant differences between both arms. The rate of ear fullness was significantly higher in the gelfoam arm compared with the non-gelfoam arm (moderate certainty). CONCLUSION: Among patients undergoing type-1 tympanoplasty, the surgical outcomes did not significantly differ between both arms. The practice of middle ear packing with gelfoam needs to be standardized.

Cochlear Implantation: The Volumetric Measurement of Vestibular Aqueduct and Gusher Prediction.

This study aimed to validate the role of 3D segmentation in measuring the volume of the vestibular aqueduct (VAD), and the inner ear, and to study the correlation between VAD volume and VAD linear measurements at the midpoint and operculum. The correlation with other cochlear metrics was also studied. We retrospectively recruited 21 children (42 ears) diagnosed with Mondini dysplasia (MD) plus enlarged vestibular aqueduct (EVA) from 2009 to 2021 and who underwent cochlear implantation (CI). Patients' sociodemographic data were collected, and linear cochlear metrics were measured using Otoplan. Vestibular aqueduct width and vestibular aqueduct and inner ear volumes were measured by two independent neuro-otologists using 3D segmentation software (version 4.11.20210226) and high-resolution CT. We also conducted a regression analysis to determine the association between these variables and CT VAD and inner ear volumes. Among the 33 cochlear implanted ears, 13 ears had a gusher (39.4%). Regarding CT inner ear volume, we found that gender, age, A-value, and VAD at the operculum were statistically significant (p-Value = 0.003, <0.001, 0.031, and 0.027, respectively) by regression analysis. Moreover, we found that Age, H value, VAD at the midpoint, and VAD at the operculum were significant predictors of CT VAD volume (p-Value < 0.04). Finally, gender (OR: 0.092; 95%CI: 0.009-0.982; p-Value = 0.048) and VAD at the midpoint (OR: 0.106; 95%CI: 0.015-0.735; p-Value = 0.023) were significant predictors of gusher risk. Patients' gusher risk was significantly differentiated by gender and VAD width at the midpoint.

Cochlear implantation: Predicting the scala tympani volume of the pediatric recipients.

OBJECTIVES: The main aim of this study was to estimate the volume of the Scala Tympani (ST) of our pediatric cochlear implant (CI) recipients from the computed tomography (CT) images. Then, to study the association between ST volume and both demographic characteristics and cochlear parameters. METHODS: A retrospective study on the CT scans of pediatric CI patients at a tertiary referral CI center. Congenital or acquired cochlear defects were excluded. Two reviewers, with the same level of experience, blindly measured the main cochlear parameters and studied its anatomy. Then, the interrater reliability was tested to measure any differences between the two readings. After that, the ST volume of the included patients was calculated and analyzed. Furthermore, the correlations between the main cochlear parameters and ST volume were studied to propose a formula for estimating the ST volume from the cochlear duct length (CDL). RESULTS: The mean predicted ST volume among our pediatric CI recipients was 38.51 ± 5.54 µl (range; 24.47-52.57 µl). The statistical analysis revealed that all cochlear parameters (A, B, H, and CDL values) could be significant predictors of the ST volume (p=<0.0001). CONCLUSION: The main cochlear parameters along with the CDL are positively linked to the ST volume. There are considerable differences in cochlear size and scala tympani volume among our pediatric population. These findings confirm the importance of pre-operative planning for proper electrode array selection.

The Influence of the COVID-19 Pandemic on the Hearing Impaired.

Background In this study, we aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic-induced social restrictions, including face masks, on patients with hearing problems. Methodology This cross-sectional survey study was conducted in an ENT tertiary care center. After signing the consent form, we invited study subjects with hearing disabilities who were using unilateral or bilateral hearing aids to participate in filling out the study survey. The study questionnaire was completed by 80 subjects. The questionnaire included various questions about the respondent's demographics, hearing aids, and communication with a face mask during COVID-19 restrictions. All statistical analyses were performed using SPSS version 19 (IBM Corp., Armonk, NY, USA). Results Overall, 40% of the study sample agreed that understanding people wearing face masks is harder because their speech is muffled, whereas 10% disagreed, and 50% were neutral. While 41.3% agreed that understanding is harder because they cannot see their mouth moving, 23.8% disagreed, and 35% were neutral. More than half of the study sample (55%) agreed that they are worried about how they will communicate with others if wearing face masks becomes more common. However, 50% of the participants thought that they can still hear people when they speak to them from a safe distance. Of note, 71.3% of subjects disagreed about tinnitus being worse since the lockdown. Conclusions The widespread use of face masks had a significant impact on the daily communication and interactions of people with hearing impairments. More research is needed to find creative ways to help these patients improve their daily communication and social interactions.

Foreign Body Aspiration in a Child With a Rare Tracheal Bronchus.

A tracheal bronchus is an unusual bronchial division anomaly in which an accessory bronchus arises from the trachea or main bronchus and travels to the higher lobe territory. This report discusses a case of incidentally diagnosed tracheal bronchus after foreign body removal via bronchoscopy. A one-year-old boy presented to the hospital with cough and noisy breathing after choking on peanuts. On examination, he had mild tachypnea with non-prominent subcostal retractions and diminished airflow in the left lung. Rigid bronchoscopy revealed a foreign body in the trachea at the level of the left main bronchus, which was completely removed in one piece under vision using fiberoptic forceps. A tracheal bronchus is an unusual congenital abnormality, with most cases being asymptomatic. Appropriate reporting of such anomalies may help healthcare practitioners promptly diagnose, manage, and avoid complications in the tracheal bronchus.

Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance.

PURPOSE: Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to  review the surgical and clinical outcomes of cochlear implantation among patients with EVA. MATERIALS AND METHODS: A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900). RESULTS: A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients. CONCLUSION: Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.

Clinical, Radiological, and Histopathological Patterns of Allergic Fungal Sinusitis: A Single-Center Retrospective Study.

Objectives To explore the clinical, pathological, and imaging characteristics of allergic fungal sinusitis (AFS) and to analyze the correlation of disease duration with imaging and histopathology findings. Methods We reviewed all cases of AFS managed at the otorhinolaryngology department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Demographic and clinical features were collected, as well as imaging and histopathological findings, which were analyzed by time from onset. Results Forty-six patients were diagnosed AFS, representing 11.8% of total sinusitis cases; 25 (54.3%) were female, with mean (SD) age=33.57 (11.76). Patients presented with multiple symptoms of chronic rhinosinusitis (43, 93.5%), chronic headache (14, 30.4%), and hyposmia (2, 4.3%), and 36 (78.3%) were diagnosed late (≥5 years after onset). AFS involved all four sinuses in 32 (69.6%) patients and was bilateral in >53.5% of infected sinuses. Imaging showed increased intrasinus attenuation (88.2%-95.3%), complete opacification (74.4%-85.3%), sinus expansion (35.3%-51.2%), remodeling (20.6%-37.2%), wall thinning (41.2%-58.1%), and involvement of adjacent soft tissue (11.8%-25.6%), depending on the sinus type. Histology evidenced eosinophilic mucin (45.7%), eosinophils (91.3%), fungal hyphae (93.5%), and Charcot-Leyden crystals (6.5%). Patients who were diagnosed late had a higher percentage of imaging and pathological lesions, principally, the expansion and wall thinning of involved sinuses (p<0.050). Conclusion AFS represents a significant proportion of chronic sinusitis cases treated in the otorhinolaryngology department and is often diagnosed late with extensive forms. Major efforts should be made to improve the early diagnosis and management of such disease, including raising awareness about this entity among general practitioners and family physicians to enhance clinical suspicion and detection rate.

The Effect of Ice Cream Intake on Pain Relief for Patients After Tonsillectomy.

Introduction The post-tonsillectomy pain can lead to a decrease in fluid and food intake, followed by dehydration, which can slow down the repair process and make pain control harder. Different groups of analgesics have their own side effects. Therefore, the consideration of non-pharmacological ways to control pain can be of great value such as ice cream and other cold drinks. Aim The purpose behind this study is to assess whether the use of ice cream after tonsillectomy with or without adenoidectomy in children reduces pain in the immediate postoperative period, as well as to compare the effect of ice cream and diet at room temperature on post-tonsillectomy pain in children. Materials and methods Each patient's post-operative pain was evaluated and assessed by nursing staff prior to discharge using two reliable pain scale: FLACC scale (F: Face, L: Legs, A: Activity, C: Cry, C: Consolability) for patient less than seven years and Wong Baker pain scale (Face 0, very happy because he doesn't hurt, Face 1, hurts a little bit, Face 2, hurts a little more, Face 3, hurts even more, Face 4, hurts a whole lot, Face 5, hurts as much as you can imagine, although you do not have to be crying to fell this bad) for patient more than seven years. Results The ice cream intake is significantly associated with having no pain (p-value 0.014). In univariate regression, compared to preschool, school-aged children have significant effect with the ice cream intake postoperatively (OR = 0.286, p-value 0.039) while sex and instrument used to assess pain score were having no significant effect with the ice cream intake postoperatively. Conclusion Further research is needed in order to validate the effectivity of ice cream intakes after tonsillectomy in our region.

A Rare Case of Thyroid Metastasis Secondary to Hidden Undiagnosed Lung Adenocarcinoma.

The majority of thyroid lesions are primary in origin while secondary metastases to thyroid are considered a rare incidence. However, presentation of such cases with no signs of lung cancer can be extremely challenging to diagnose. Here, we present a 64-year-old man, an ex-smoker of 70 pack-years, who presented with a complaint of hoarseness of voice with associated dyspnea, choking episodes, weight loss, and hemoptysis. With no investigation abnormalities indicating lung adenocarcinoma, he was transferred to the Otolaryngology Department as being suspicious of thyroid cancer. A laryngoscopy demonstrated an immobile right vocal cord and pooling of secretions while a computed tomography (CT) scan showed a right thyroid lobe nodule, upper mediastinal lymphadenopathy, and pleural effusion. The patient underwent a total thyroidectomy. Biopsies from the lymph nodes and lung were obtained, and all demonstrated lung adenocarcinoma. Thus, a diagnosis of primary lung adenocarcinoma with thyroid and mediastinal lymph nodes metastases was established. Despite being a rare clinical presentation, thyroid metastasis should be considered and evaluated for a primary origin according to the associated clinical history and presentation.

Allergic Fungal Otomastoiditis in a Patient without Allergic Fungal Rhinosinusitis: A Case Report.

BACKGROUND Allergic fungal rhinosinusitis is an inflammatory condition involving the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer. In 2013 Chen et al. reported the first case of middle ear allergic otomastoiditis in a patient who tested negative for allergic sinus-nasal disease. To the best of our knowledge, this is the second such case report to be published. CASE REPORT Our patient was a 27-year-old immune-competent woman presenting with chronic left-side otorrhea and hearing loss for 2 years. An audiogram showed low- and middle-frequency, mild-to-moderate left-sided conductive hearing loss. A coronal view computed tomography (CT) image of the temporal bone showed coalescent air cells in the left mastoid with opacification of the left middle ear, but no evidence of bony erosion. Diagnosis confirmed by swab culture taken at a clinic showed Aspergillus flavus. The main treatment in such cases is usually a combination of surgical and medical therapy. CONCLUSIONS We present the second case report of allergic fungal otomastoiditis, showing an allergic reaction to fungi in the middle ear and formation of mucin in a symptomatic patient. Otolaryngologists need to be aware of the presence of this sensitivity, both in the clinic and the operating theater.