High fluence in laser stapedotomy aggravates transient subjective dizziness.

BACKGROUND: Laser fenestration in stapedotomy has thermal effect to the vestibule. AIMS/OBJECTIVES: To evaluate the role of energy density (fluence) in the severity of postoperative vestibular symptoms. MATERIALS AND METHODS: The retrospective chart-review study included 84 patients with otosclerosis that underwent primary laser stapedotomy. Surgical outcomes, including nystagmus, and subjective vestibular symptoms during one-month follow-up, were compared between potassium titanyl phosphate (KTP) and CO2 laser. According to this study and literature, we assessed the relationship between laser parameters and the incidence of persistent vestibular symptoms lasting more than one week after surgery. RESULTS: The KTP and CO2 laser group included 48 and 36 patients, respectively. Fluence was different between the KTP (637 J/cm2) and CO2 (141 J/cm2) laser (p < .001). The KTP group showed gradual decrease in dizziness during one-month observation period, while the CO2 group exhibited a steep recovery curve in the first postoperative week (9 and 4 d of duration, respectively). The incidence of persistent vestibular symptoms was correlated with both fluence (r = 0.80, p = .01) and spot size (r = -0.74, p = .01). CONCLUSIONS AND SIGNIFICANCE: Appropriate setting of parameters with lower fluence is desirable for the efficiency and safety of laser stapedotomy.Abbreviations: ABG: air-bone gap; SD: standard deviation.

Gait and Age-Related Hearing Loss Interactions on Global Cognition and Falls.

OBJECTIVES: Age-related hearing loss (ARHL) is considered a risk factor for cognitive impairment and falls. The association may be modulated by gait performance because ARHL is related to mobility decline, which strongly contributes to cognitive impairment and falls. We investigated the interactive effects of gait and ARHL on global cognition and falls among older adults. STUDY DESIGN: Retrospective cohort study. METHODS: The auditory acuity of 810 community-dwelling older adults was measured using a pure-tone average of hearing thresholds at 1,000 and 4,000 Hz in the better-hearing ear. Participants were then stratified as follows: normal hearing, ≤25 dB; mild hearing loss (HL), >25 and ≤40 dB; and moderate to severe HL, >40 dB. Gait speed was assessed as an indicator of gait performance and fall occurrence within the previous year. Global cognition was determined using the Montreal Cognitive Assessment (MoCA) test. RESULTS: A total of 320 (39.5%) and 233 (28.8%) participants had mild and moderate to severe HL, respectively. Hierarchical multiple and logistic regression analyses showed interactions between gait performance and moderate hearing loss on both global cognition and the occurrence of falls. Specifically, older adults with moderate hearing loss who walked slowly showed lower MoCA scores and a higher incidence of falls, whereas those with decent gait speed did not show such a tendency. CONCLUSION: Our results suggest that poor gait performance might modulate the effects of ARHL, leading to cognitive decline and falls. Poor cognitive performance and falls may be prevalent in older adults with ARHL, especially in those with slower gait and moderate hearing loss. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:857-863, 2022.

Hearing loss and increased gait variability among older adults.

BACKGROUND: The influence of age-related hearing loss on slow gait has been suggested; however, whether it is associated with increased gait variability, an important predictor of fall risk, remains unclear. RESEARCH QUESTION: Is poor auditory acuity associated with increased gait variability, and does this gait change relate to accidental falls among older adults with hearing loss? METHODS: We studied 107 older adults (mean age, 76.5 years; 80.5 % women). Auditory acuity was measured using a pure tone average (PTA) of hearing thresholds for 0.5-4 kHz tones in the better-hearing ear. Hearing loss was defined as a PTA of >25 dB. Gait speed and spatiotemporal variability (i.e., stride length and time variabilities) were assessed using a 5-m electronic walkway. We also assessed the occurrence of multiple falls within the previous year. RESULTS: Fifty-two participants (48.6 %) experienced hearing loss. Multiple regression analysis adjusted for potential covariates showed that poor PTA was associated with slower gait speed and stride length variability, but not stride time variability. Among older adults with hearing loss, fall occurrence was associated with an increased stride length variability and not a slow gait or increased stride time variability. SIGNIFICANCE: The association between hearing loss and increased gait variability observed in the present study suggests that age-related hearing loss can jeopardize gait control during daily activities. This leads to increased gait variability and increased risk of accidental falls. Our results provide additional information on how age-related hearing loss increases the risk of falls.

An Unusual Invasive Ectopic Thymoma in the Thyroid and Anterior Mediastinum.

An 81-year-old woman with a 2-year history of dysphagia detected a cervical mass. Computed tomography showed a thyroid tumor extending through the superior and anterior mediastinum. Analysis of an incisional biopsy specimen revealed a thymoma. Total resection of the thyroid and mediastinal tumor was performed. The thymoma invaded the anterior tracheal wall and left brachiocephalic vein. Pathologic examination revealed thymoma type B1 concomitant with B2 and B3 (World Health Organization classification), Masaoka IVb, and T3 N2 M0-IVb, with cervical lymph node metastasis. Clinicians must be cautious during radical operations for invasive ectopic thymomas.

Increased number of IgG4-positive plasma cells in chronic rhinosinusitis.

CONCLUSION: High levels of IgG4-positive plasma cells were observed in tissue samples from ∼30% of patients with chronic rhinosinusitis who satisfied the comprehensive diagnostic criteria for IgG4-related disease. Detection of increased numbers of IgG4-positive plasma cells in the nasal cavity or paranasal sinuses might not be sufficient to make a diagnosis of IgG4-related rhinosinusitis, and a comprehensive evaluation is required. OBJECTIVES: This study aimed to clarify the clinicopathological characteristics of IgG4-positive plasma cells in patients with chronic rhinosinusitis. METHOD: This study examined nasal mucosal specimens from 35 patients and assigned them to high-IgG4 and low-IgG4 groups based on infiltration of IgG4-positive plasma cells. It compared the pathological characteristics of the two groups, including the presence of fibrosis, phlebitis, hyperplasia of the nasal glands and infiltration of inflammatory cells. RESULTS: No cases of chronic rhinosinusitis showed storiform fibrosis or obliterative phlebitis. The mean number of IgG4-positive plasma cells in samples from all patients was 29.8 ± 40.3/high-power field. Eleven of the 35 cases (31.4%) were classified as high-IgG4. Hyperplasia of the nasal glands was observed significantly more frequently in the high-IgG4 group than in the low-IgG4 group (p = .03).

[Otologic Manifestations in Patients with ANCA Associated Vasculitis-Comparative Analysis among Microscopic Polyangiitis, Granulomatosis with Polyangiitis and Eosinophilic Granulomatosis with Polyangiitis].

Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitides (AAVs) include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), the incidences of which are reported to be increasing in Japan. We reviewed the clinical records of 20 cases with systemic AAVs (five cases with MPA, nine cases with GPA, and six cases with EGPA), who visited our otolaryngology department with otological symptoms from 2004 to 2014, and compared the otological characteristics among the diseases. Otologic symptoms appeared as an initial symptom(s) in 40% of MPA cases, 56% of GPA cases, and 83% of EGPA cases. GPA and EGPA cases showed a variety of symptoms such as otalgia, otorrhea, hearing loss, ear fullness, tinnitus and dizziness, while MPA cases showed only hearing loss and ear fullness, but otalgia or otorrhea. AAVs and otitis media associated with ANCA vasculitis (OMAAV) are usually diagnosed shortly after the appearance of otological symptoms in GPA cases, while the final diagnosis is delayed in EGPA cases. Furthermore, the diagnosis of OMAAV was made after the diagnosis of AAV in most cases of EGPA. More than half of MPA cases did not meet the diagnostic. criteria for OMAAV. It is noteworthy that in a significant number of AAV patients with ear disease, otological symptoms are supposed to appear as an initial symptom(s). Therefore, otolaryngologists have a major role to achieve early diagnosis of AAV. The patients with adult-onset inflammation of the middle ear, inner ear or both should undergo careful examinations, and they should be closely followed even if the diagnosis is uncertain.

Delayed restoration of maximum speech discrimination scores in patients with idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To assess possible delayed recovery of the maximum speech discrimination score (SDS) when the audiometric threshold ceases to change. METHODS: We retrospectively examined 20 patients with idiopathic sudden sensorineural hearing loss (ISSNHL) (gender: 9 males and 11 females, age: 24-71 years). The findings of pure-tone average (PTA), maximum SDS, auditory brainstem responses (ABRs), and tinnitus handicap inventory (THI) were compared among the three periods of 1-3 months, 6-8 months, and 11-13 months after ISSNHL onset. RESULTS: No significant differences were noted in PTA, whereas an increase of greater than or equal to 10% in maximum SDS was recognized in 9 patients (45%) from the period of 1-3 months to the period of 11-13 months. Four of the 9 patients showed 20% or more recovery of maximum SDS. No significant differences were observed in the interpeak latency difference between waves I and V and the interaural latency difference of wave V in ABRs, whereas an improvement in the THI grade was recognized in 11 patients (55%) from the period of 1-3 months to the period of 11-13 months. CONCLUSION: The present study suggested the incidence of maximum SDS restoration over 1 year after ISSNHL onset. These findings may be because of the effects of auditory plasticity via the central auditory pathway.

Bilateral hearing impairment as the initial symptom of sympathetic ophthalmia.

IMPORTANCE: Sympathetic ophthalmia (SO), a rare bilateral panuveitis following penetrating ocular trauma or ocular surgery to one eye, shares a strikingly similar ocular pathology to that of Vogt-Koyanagi-Harada disease (VKH). Audiovestibular dysfunction is a major extraocular manifestation of VKH; however, to date, only a few cases of sympathetic ophthalmia associated with hearing loss have been reported from ophthalmologists, but not otolaryngologists. Accordingly, little is known about the audiovestibular findings in patients with SO. We herein present two cases of SO with preceding bilateral hearing loss. OBSERVATIONS: The patient in Case 1, an 80-year-old female, experienced acute bilateral hearing loss. Five days after the onset of hearing loss, she presented with sudden bilateral blurred vision. In Case 2, a 32-year-old female noticed acute bilateral hearing loss and also experienced acute bilateral blurred vision the subsequent day. Patient 1 had a history of a penetrating injury to the right eye 25 days before the onset of hearing loss, while patient 2 had previously undergone right vitreous surgery twice for the treatment of a myopic macular hole and retinal detachment 36 and 43 days prior to the current symptom onset. Both cases were diagnosed as SO based on ocular findings of bilateral panuveitis and the history of ocular insult. Patient 1 carried HLA-DR4, HLA-DR15, HLA-A33, HLA-A24, HLA-B44 and HLA-B52, and patient 2 carried HLA-DR4. Audiograms showed bilateral mild to moderate sensorineural hearing loss in both cases, with normal auditory brainstem responses and deteriorated distortion product otoacoustic emission amplitudes. In addition, the significant recruitment phenomenon observed in case 1 suggested a cochlear origin of the hearing loss. Both patients received corticosteroid therapy, and the cochlear signs and symptoms recovered within one month. CONCLUSIONS AND RELEVANCE: This is the first report to describe the comprehensive audiovestibular findings in patients with SO. In the present study, acute bilateral hearing loss developed a couple of days prior to the onset of bilateral visual loss and auditory examinations suggested a cochlear etiology in both cases.

Ex vivo visualization of the mouse otoconial layer compared with micro-computed tomography.

HYPOTHESIS: Micro-computed tomography (micro-CT) is useful for assessing the 3-dimensional (3D) morphology and age-related changes of the otoconial layer. BACKGROUND: Wriggle mouse Sagami (WMS) is a mutant of the plasma membrane Ca2+ ATPase type2 gene (Atp2b2) with deficits in the saccular otoconia. We examined the effectiveness of micro-CT in evaluating the otoconial layer of WMS and C57BL/6J mice. METHODS: Otic capsules of C57BL/6J mice at different fixation time were examined using micro-CT to evaluate the effects of the fixation time on the otoconial layer. Otic capsules of Atp2b2(wri/wri), Atp2b2(wri/+), and Atp2b2(+/+) mice at P14, P21, and the age of 3 months were used to analyze age-related changes in the otoconial layer. A series of cross-section and 3D reconstructed images of the otoconial layer were obtained. The micro-CT findings were compared with the otic capsule findings cleared in methyl salicylate using stereomicroscopy. RESULTS: Micro-CT produced high-resolution images of the otoconial layer, thereby providing information regarding the spatial configuration and 3D curvature. There were no changes between the different fixation times. In the Atp2b2(wri/+) and Atp2b2(+/+) mice, the saccular and utricular otoconial layers were normal among all age groups. In the Atp2b2(wri/wri) mice, the saccular otoconial layer decreased on P14 and was absent on P21, whereas the utricular otoconial layer disappeared at 3 months of age. CONCLUSION: We obtained precise information regarding the mouse otoconial layer with minimum artifacts. This method is expected to improve our understanding of the physiologic function and age-related changes in otolith organs.

Nasopharyngeal pleomorphic adenoma presenting as otitis media with effusion: case report and literature review.

Most tumors arising in the nasopharynx are malignant and frequently develop otitis media with effusion (OME). On the contrary, benign nasopharyngeal tumors are very rare, and pleomorphic adenoma, which is a benign mixed tumor of the nasopharynx, is also rarely encountered. We herein report a case of nasopharyngeal pleomorphic adenoma which initially presented as OME. This tumor completely blocked the orifice of the Eustachian tube but was removed by a combination of transnasal and transoral endoscopic resection. A defect in the mucous membrane was covered with polyglycolic acid sheet and fibrin glue. Mucous membrane completely covered the exposed tubal cartilage without adhesion near the tubal orifice. OME and hearing loss completely subsided 3 months after the surgery. She was disease-free 2 years after the surgery. Use of polyglycolic acid sheet could be a feasible mesh for closure of surgical defect without scarring, and it also led to healing of OME.

[A case report: primary nasal tuberculosis].

A 62-year-old female visited us complaining of lacrimination and the swelling of the left side of the nasal dorsum. Granulation tissues were seen on the anterior-lateral wall of the left nasal cavity, and an imaging study revealed a mass occupying both the left nasal cavity and the anterior ethmoid sinuses invading the face with erosion of the nasal bone. Histological examination showed an epithelioid granuloma without caseous necrosis which mostly suggested sarcoidosis. The affected lesions became larger 11 months after the initial examination, and a biopsy was performed again, which revealed the same pathological findings. Although the biopsy specimen was negative based on the PCR findings, tubercle bacillus was detected in the culture 7 weeks later. The patient was finally diagnosed as having primary tuberculosis of the nose and paranasal sinuses because systemic examination showed no evidence of tuberculosis in other areas. She was treated with antituberculosis medication, and the affected nasal lesions disappeared. It is important to perform a biopsy and tissue culture repeatedly when we encounter an intractable and undiagnosed disease in the nasal cavity.

[Intralabyrinthine schwannoma extending into the round window niche and internal auditory canal].

Intralabyrinthine schwannomas (ILSs) are rare benign neoplasms arising from distal branches of the cochlear, superior vestibular, or inferior vestibular nerves. We report on a case of ILS with extensions to the round window niche and internal auditory canal (IAC) in a 47-year-old male. The patient noticed sudden hearing loss and tinnitus in his left ear at the age of 36, received steroid therapies, but was left with complete deafness. He had suffered from repetitive vertigo attacks for 6 months at 41. At 46 when he presented with deterioration of his left tinnitus, he was finally diagnosed as having ILS on enhanced MRI and constructive interference in steady-state analysis. The tumor was located in all turns of cochlea, vestibule, and the fundus of the IAC. Because follow-up MRI suggested growth of the IAC tumor, we performed total removal of the tumor via the translabyrinthine and transcanal approaches. The tumor had invaded only the cochlear nerve in the IAC and appeared in the round window niche in the middle ear. Pathological examination showed an Antoni A type schwannoma with fibrous changes of the semicircular canals. We should remember this inner

[Tonsillectomy in recurrent IgA nephropathy after renal transplantation].

Many reports suggest tonsillectomy efficacy in subjects with early-stage IgA nephropathy (IgAN). Post-renal-transplant treatment in recurrent IgAN must, however, be assessed carefully. Recent reports show that tonsillectomy to also be effective in such recurrent cases. We studied 13 subjects with recurrence diagnosed histopathologically in allogenic kidney transplantation involving tonsillectomy from March 2008 to March 2010. Tonsillectomy was done on average of 74 months (15-180 months) after transplantation. Subjects averaged 44.8 years of age (29-67 years old). Buried tonsil was most common and 12 of 13 involved pus. One subject suffered slight bleeding 1 week after tonsillectomy, manageable conservatively. Steroid pulse therapy was added in 1 case after tonsillectomy due to histopathological renal biopsy suggesting severe renal injury. In most cases, serum creatinine (SCr) and urinary findings improved after tonsillectomy, which is thus expected to be effective in subjects with recurrent early-stage IgAN following renal transplantation, not only in those with IgAN.

[Audiological analysis and peri-and postoperative complications in bone-anchored hearing aid surgery].

The bone-anchored hearing aid (BAHA) has advantages over conventional hearing aids in sound quality and speech reception in silence, but requires surgery and may have peri-and postoperative complications. We evaluated audiological findings and complications in 12 subjects (13 ears)-8 men and 4 women aged 20-71--undergoing BAHA surgery from September 2001 to October 2005. Surgery was for single-sided deafness in one subject. Mean warble tone thresholds with BAHA were 29.9dB and 65.2dB without. Functional gains ranged from 16 to 52dB (mean: 35.3dB). Dural exposure or venous hemorrhage was seen in 4 ears, and mastoid cells opened and a skin flap was damaged in 1 ear each. No severe complications occurred perioperatively. Skin reactions categorized into grade 1 or more were recognized in nearly 70% of ears during the first postoperative year but most were a grade 1 reaction and skin reactions decreased with time. Skin overgrowth occurred in 1 ear immediately after an abutment separated accidentally from the fixture. All complications were treated in outpatient clinics. No fixture extrusion occurred. The decision to proceed with BAHA surgery thus required fully informed consent based on knowledge of peri-and postoperative complications.

Modified paraffin-embedding method for the human cochlea that reveals a fine morphology and excellent immunostaining results.

CONCLUSION: A modified paraffin-embedding method could be applied to histopathological and immunohistochemical studies of the human cochlea. The complementary use of molecular and immunohistochemical techniques by means of this method is thus considered to be a valuable tool for the future study of the human inner ear. OBJECTIVE: To propose a new paraffin-embedding method for the morphological and immunohistochemical study of the human cochlea. METHODS: Five human temporal bones were harvested at autopsy. The temporal bone specimens were fixed in 20% buffered formalin, decalcified with EDTA, cropped to a cube of approximately 15 mm, embedded in paraffin, and then cut into 6 microm thick sections. The sections were stained with hematoxylin and eosin, and immunostained with anti-prestin and anti-neurofilament antibodies. RESULTS: Although paraffin-embedded sections cannot show the excellent morphology of the delicate membranous labyrinth obtained with celloidin, this technique successfully preserved the morphology of the cochlea, especially the organ of Corti, thereby enabling us to obtain excellent immunostaining results.

Additional heterozygous 2507A>C mutation of WFS1 in progressive hearing loss at lower frequencies.

OBJECTIVES/HYPOTHESIS: To describe the audiological profiles in a Japanese family with autosomal dominant hereditary sensorineural hearing loss (SNHL) and to identify the causative gene. STUDY DESIGN: A family study at an academic tertiary referral center. METHODS: A family with autosomal dominant hereditary SNHL was enrolled. Hearing loss (HL) of affected members showed mid-frequency SNHL in childhood and progressed at lower frequencies with age, resulting in low-frequency SNHL. To understand the pathology of HL of this family, we performed a genetic analysis of WFS1, TECTA, and GJB2 by direct sequencing, and further audiovestibular examinations, including speech audiometry, distortion product otoacoustic emissions, electrocochleography, auditory brainstem responses, and electronystagmography for some affected members. RESULTS: A heterozygous A-to-C nucleotide transversion (c.2507A>C), resulting in a lysine-to-threonine substitution at codon 836 (K836T) was identified in exon 8 of WFS1. K836T was segregated with HL in the 15 participants in the genetic study but was not detected in the 212 normal chromosomes. Only polymorphic changes were detected in TECTA and GJB2. Audiovestibular examinations indicated purely cochlear HL and normal vestibular function. The summating potential/action potential ratios in electrocochleography increased in the bilateral ears of the proband. CONCLUSIONS: The family described with autosomal dominant inheritance of K836T of the WFS1 gene demonstrates a progressive hearing loss in the lower frequencies.

Subcutaneous emphysema and pneumomediastinum after translaryngeal intubation: tracheal perforation due to unsuccessful fiberoptic tracheal intubation.

A 77-year-old man was scheduled to undergo a cervical lymph node biopsy under general anesthesia. Although awake, nasotracheal fiberoptic intubation was initially planned because of an anticipated difficult airway, the attempt was unsuccessful. Orotracheal intubation was subsequently performed under direct laryngoscopy without difficulty. After initiating positive pressure mechanical ventilation, subcutaneous and mediastinal emphysema developed. The cause of this emphysema was considered to be tracheal perforation after an unsuccessful attempt at fiberoptic tracheal intubation.