Predictive Factors and Audiometric Outcome Comparison Between Titanium Prosthesis and Autologous Incus in Traumatic Ossicular Injury.

OBJECTIVES: To investigate the etiology and ossicular pathology of traumatic ossicular injury in Taiwan and examine the hearing outcomes and predictive factors between the titanium prosthesis and autologous incus groups. METHODS: We retrospectively analyzed patients with traumatic ossicular injury from 2011 to 2020 in Taiwan. Patients were divided into the titanium or autologous group according to the surgical materials used. The audiometric outcomes and predictive factors of ossiculoplasty were analyzed between groups. RESULTS: Twenty patients with ossicular chain discontinuity were enrolled (8 in the titanium group and 12 in the autologous group). The postoperative hearing threshold (26.6 ± 8.9 dB) and air-bone gap (10.3 ± 5.6 dB) improved significantly compared with the preoperative hearing threshold (50.7 ± 13.3 dB) and air-bone gap (29.9 ± 11.0 dB). The improvements in the hearing threshold and air-bone gap were not significantly different between the titanium and autologous groups. Our patients presented an improvement in hearing restoration with 65% closure of the air-bone gap in 0 to 10 dB range and 30% in 11 to 20 dB range, without sensorineural hearing loss during surgery. Univariate regression analysis revealed that vertigo, benign paroxysmal positional vertigo, and temporal bone fracture may serve as negative factors influencing the air-bone gap gain. CONCLUSIONS: Ossiculoplasty with both titanium prosthesis and autologous materials demonstrated favorable hearing recovery in traumatic ossicular injury. Vertigo, benign paroxysmal positional vertigo, and temporal bone fracture may serve as negative predictive factors of the hearing benefit after surgery.

Comparative Study of Endoscopic and Microscopic Type I Tympanoplasty in Terms of Delayed Facial Palsy.

OBJECTIVE: Delayed facial palsy is a complication of otologic surgery. Tympanoplasty is commonly employed in chronic otitis media. We compared the incidence and characteristics of delayed facial palsy and hearing restoration between endoscopic and microscopic tympanoplasty for the treatment of simple chronic otitis media. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: We retrospectively analyzed 468 patients who underwent type I tympanoplasty from January 2009 to April 2017. Patients were divided into transcanal endoscopic ear surgery and microscopic ear surgery groups. Their epidemiological profiles were reviewed and the outcomes of tympanoplasty were analyzed. Blood sample tests for herpes simplex virus and varicella-zoster virus immunoglobulin M and immunoglobulin G were arranged in patients with delayed facial palsy. RESULTS: Transcanal endoscopic ear surgery exhibited similar benefits to microscopic ear surgery in graft-taking rate and hearing restoration but had a shorter operation time (P < .01). Eight patients (1.71%) developed delayed facial palsy, but no statistically significant difference was observed between the 2 surgical approaches. All patients tested negative for varicella-zoster virus and herpes simplex virus immunoglobulin M and positive for immunoglobulin G of the same viruses; however, the titer did not exhibit a 4-fold increase, implying that patients did not have active viral infections. CONCLUSION: Transcanal endoscopic ear surgery is an ideal alternative for simple tympanoplasty. The incidence of delayed facial palsy was not significantly different between the 2 approaches. Because of the favorable prognosis and the absence of direct serological evidence supporting viral reactivation, treatment with antivirals may not be required.

Autophagy Is Deficient and May be Negatively Regulated by SERPINB3 in Middle Ear Cholesteatoma.

HYPOTHESIS: Whereas autophagy has been linked to various human diseases, whether it also plays a role in cholesteatoma is virtually unknown. This study aimed to investigate the activity and regulation of autophagy in cholesteatoma. BACKGROUND: The treatment of middle ear cholesteatoma has been challenging due to an insufficient understanding of the underlying disease mechanism. METHODS: Expression of microtubule-associated protein 1A/1B-light chain 3 (LC3), the autophagy protein marker, and phosphorylated Akt (p-Akt), and mammalian target of rapamycin (p-mTOR), the known autophagy regulators, in fresh retroauricular skin and cholesteatoma tissue samples was analyzed by immunoblotting. The results were further confirmed by immunohistochemistry and statistical analyses. Cell proliferation of primary retroauricular skin- and cholesteatoma-derived fibroblasts was evaluated by methyl thiazol tetrazolium (MTT) assay. Ectopic expression of serine proteinase inhibitor, clade B, member 3 (SERPINB3) in the fibroblasts was achieved by electroporation and the expression was detected by immunoblotting. RESULTS: LC3 expression was significantly decreased in cholesteatoma in most of the 15 paired retroauricular skin/cholesteatoma tissue samples. However, p-Akt and p-mTOR expression in the cholesteatoma samples was not significantly different from that in the control subjects. Immunohistochemical studies further demonstrated an inverse correlation between LC3 expression and cholesteatoma. The cholesteatoma fibroblasts proliferated faster than the retroauricular skin fibroblasts, and had higher SERPINB3 but lower LC3 expression. Furthermore, overexpression of SERPINB3 in the retroauricular skin fibroblasts enhanced cell proliferation and downregulated LC3 expression. CONCLUSION: Autophagy is significantly suppressed in cholesteatoma tissues, which may not involve the Akt/mTOR signaling pathway. More importantly, SERPINB3 may promote cell proliferation and negatively regulate autophagy in cholesteatoma fibroblasts. Together, these findings warrant further investigation into the pathogenic mechanism of cholesteatoma.

The association of genetic polymorphisms in interleukin-1 receptors type 1 and type 2 with age-related hearing impairment in a Taiwanese population: a case control study.

BACKGROUND: Age-related hearing impairment (ARHI) is a major disability among the elder population. Chronic inflammation is an important factor in the development of ARHI. Interleukin-1 (IL-1) plays a key role in inflammation and may be associated with ARHI. The aim of this study is to analyze the associations of single nucleotide polymorphisms (SNPs) of IL-1 receptor genes with ARHI in an elderly population in Taiwan. METHOD: Participants ≥65 years of age were recruited for audiometric tests and genetic analyses. The bilateral pure-tone average (PTA) of high-tone hearing levels was calculated for ARHI evaluation. The associations of SNPs of the IL-1 receptor type 1 gene (IL1R1) (rs3917225 and rs2234650) and type 2 gene (IL1R2) (rs4141134 and rs2071008) with ARHI were analyzed in 182 ARHI-susceptible (case) and 176 ARHI-resistant (control) participants. RESULTS: The G allele of IL1R1 rs3917225 showed a decreased risk of ARHI after adjustments for sex, age, and noise exposure. The GG genotype of IL1R1 rs3917225 in all hereditary models and the TT genotype of IL1R2 rs2071008 in the recessive model also showed decreased risks of ARHI after adjustments. CONCLUSION: These findings suggest that IL1R1 and IL1R2 polymorphisms may contribute to the decreased risk of ARHI in the elderly population.

Prevalence of Persistent Tinnitus and Dizziness in an Elderly Population in Southern Taiwan.

OBJECTIVES: Tinnitus and dizziness are common among the elderly. The conditions may increase depression, and patients may become susceptible to falls, thereby affecting the quality of life of the geriatric population. Investigating the prevalence of persistent tinnitus and chronic/recurrent dizziness in an elderly population and analyzing the association of certain comorbidities with tinnitus and dizziness in southern Taiwan were the main purposes of this study. MATERIALS AND METHODS: This was a cross-sectional study performed in a metropolitan hospital. Hearing tests were conducted in a total of 597 volunteers aged ≥65 years involving 322 (53.9%) men and 275 (46.1%) women recruited in the study. The pure tone average (PTA) and hearing handicap (HH) score were calculated. Patients completed questionnaires regarding the history of hypertension and diabetes and symptoms of tinnitus and dizziness. The association of gender, age, PTA/HH, body mass index (BMI), hypertension, diabetes, and metabolic syndrome (MetS) with tinnitus and dizziness were analyzed. RESULTS: The prevalence of persistent tinnitus and chronic/recurrent dizziness was 32.0% and 24.1%, respectively. Tinnitus or dizziness were not associated with age, BMI, hypertension, diabetes, and MetS but was associated with hearing impairment. Women and those with fasting glucose levels <100 mg/dL were more likely to experience dizziness. CONCLUSION: Persistent tinnitus and dizziness were common in an elderly population in southern Taiwan. These findings may help develop strategies to promote the quality of life in the elderly population.

The Association of GRM7 Single Nucleotide Polymorphisms with Age-Related Hearing Impairment in a Taiwanese Population.

OBJECTIVES: Age-related hearing impairment (ARHI) is a major disability among the elderly. This study aimed to analyze the association of single nucleotide polymorphisms (SNPs) of metabotropic glutamate receptor 7 (GRM7) gene with ARHI in an elderly population in Taiwan. MATERIALS AND METHODS: This was a community-based study performed in a metropolitan hospital. Participants ≥65 years of age were recruited. Participants with a pure tone average (PTA) of speech frequencies in the better ear of >35 decibel hearing level (dBHL) were classified into the case group, whereas those with PTA ≤25 dBHL were classified into the control group. The association of SNPs rs11928865, rs1353828, rs9814809, and rs9880404 with ARHI was analyzed. RESULTS: In 106 cases and 190 controls, alleles of all SNPs were found not to be associated with ARHI. The genotype of rs9880404 was found to be associated with ARHI in a dominant pattern, but the genotypes of rs11928865, rs1353828, and rs9814809 were found not to be associated with ARHI. CONCLUSION: GRM7 SNPs are associated with susceptibility to ARHI, but the significance of this finding in a Taiwanese population differed from that observed in European studies. Further studies may help to determine Taiwanese (Asian)-specific SNPs associated with ARHI.

Glutathione peroxidase 3 gene polymorphisms and the risk of sudden sensorineural hearing loss.

The glutathione peroxidase 3 gene (GPX3) is reported to be a risk factor for arterial ischaemic stroke and cerebral venous thrombosis. GPX3 may be one of the aetiologies of sudden sensorineural hearing loss (SSNHL), which might be attributed to the genetic effect of GPX3 by influence reactive oxygen species (ROS). Unbalanced ROS have been associated with susceptibility to SSNHL. Therefore, we conducted a case-control study with 416 SSNHL cases and 255 controls. Five single nucleotide polymorphisms (SNPs) were selected. The genotypes were determined using TaqMan genotyping assays. Each SNP was tested using the Hardy-Weinberg equilibrium (HWE), and the genetic effects were evaluated using three inheritance models. All five SNPs were in HWE. As the result, the AG genotype of rs3805435 had an adjusted odds ratio (OR) of 0.54 (95% confidence interval = 0.37-0.79, p = 0.001) compared with the AA genotype in the SSNHL cases. The GG and AG genotypes of the SNP rs3805435 were associated with SSNHL under the dominant model (p = 0.002, OR = 0.58). In conclusion, these results suggest that GPX3 polymorphisms influence susceptibility to SSNHL in southern Taiwan.

Surgical Treatment of External Auditory Canal Cholesteatoma - Ten Years of Clinical Experience.

OBJECTIVE: To describe the clinical manifestations of external auditory canal (EAC) cholesteatoma and evaluate the surgical outcomes of reconstruction using an inferior pedicled soft-tissue periosteum flap. MATERIALS AND METHODS: A total of 28 patients were enrolled in this retrospective study conducted at Kaohsiung Medical University Hospital in Taiwan between January 2004 and December 2013. EAC cholesteatoma was classified according to the disease extent. The surgery was performed to reconstruct a smooth contour of EAC. RESULTS: The average age of the 28 patients (9 males and 19 females: 30 surgical ears) was 53.7 years. The most common clinical manifestations were unilateral otalgia (63.3%) and otorrhea (46.7%), and the most frequent locations of EAC cholesteatoma with bony invasion were the posterior-inferior (40%), inferior (30%), posterior (20%), and posterior-inferior-anterior (10%) aspects. Based on Naim's staging systems of EAC cholesteatoma, 26 ears (86.7%) were classified as stage III and 4 ears (13.3%) as stage IV. All patients received surgical management via a postauricular approach, and the average length of postoperative follow-up was 61.5 months (range 8-131 months). One patient had recurrence after surgery for 1 year 3 months. CONCLUSION: Bony canaloplasty and obliteration with an inferior pedicled soft-tissue periosteum flap is a reliable procedure for EAC cholesteatoma.

A Comparative Study of Endoscopic and Microscopic Approach Type 1 Tympanoplasty for Simple Chronic Otitis Media.

OBJECTIVE: Tympanoplasty is a common surgery for chronic otitis media. We analyzed the results of endoscopic and microscopic approaches for type 1 tympanoplasty in patients with simple chronic otitis media. MATERIALS AND METHODS: We evaluated the records of 95 patients (100 ears) who underwent type 1 tympanoplasty from 2011 to 2014. Group 1 underwent tympanoplasty with a microscopic approach (50 ears), and Group 2 underwent tympanoplasty with an endoscopic approach (50 ears). The epidemiological profiles and postoperative results, including hearing gain, duration of surgery, perioperative nausea or vomiting, and graft success rate, were reviewed. RESULTS: The epidemiological profiles and preoperative hearing status were similar in both groups. Postoperatively, both groups had equal improvements in hearing and air-bone gap as well as equal perforation rates. However, the endoscopic group suffered less perioperative nausea or vomiting and had a shorter operative time. CONCLUSION: The endoscopic approach for tympanoplasty offers superior visualization and shorter operative time than conventional surgery, in addition to equal hearing outcomes and perforation rates. Furthermore, observations of fewer tissue injuries, better cosmetic outcomes, and lesser perioperative nausea and vomiting suggest that the endoscopic approach is a better choice for surgery.

Phosphodiesterase 4D gene polymorphisms in sudden sensorineural hearing loss.

The phosphodiesterase 4D (PDE4D) gene has been reported as a risk gene for ischemic stroke. The vascular factors are between the hypothesized etiologies of sudden sensorineural hearing loss (SSNHL), and this genetic effect might be attributed for its role in SSNHL. We hypothesized that genetic variants of the PDE4D gene are associated with susceptibility to SSNHL. We conducted a case-control study with 362 SSNHL cases and 209 controls. Three single nucleotide polymorphisms (SNPs) were selected. The genotypes were determined using TaqMan technology. Hardy-Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated according to three inheritance modes. We carried out sex-specific analysis to analyze the overall data. All three SNPs were in HWE. When subjects were stratified by sex, the genetic effect was only evident in females but not in males. The TT genotype of rs702553 exhibited an adjusted odds ratio (OR) of 3.83 (95 % confidence interval = 1.46-11.18) (p = 0.006) in female SSNHL. The TT genotype of SNP rs702553 was associated with female SSNHL under the recessive model (p = 0.004, OR 3.70). In multivariate logistic regression analysis, TT genotype of rs702553 was significantly associated with female SSNHL (p = 0.0043, OR 3.70). These results suggest that PDE4D gene polymorphisms influence the susceptibility for the development of SSNHL in the southern Taiwanese female population.

Upregulation of phosphorylated HSP27, PRDX2, GRP75, GRP78 and GRP94 in acquired middle ear cholesteatoma growth.

Cholesteatoma is a destructive and expanding growth of keratinizing squamous epithelium in the middle ear or petrous apex. The molecular and cellular processes of the pathogenesis of acquired middle ear cholesteatoma have not been fully understood. In this study, comparative proteomic analysis was conducted to investigate the roles of specific proteins in the pathways regarding keratinocyte proliferation in cholesteatoma. The differential proteins were detected by comparing the two-dimension electrophoresis (2-DE) maps of the epithelial tissues of 12 attic cholesteatomas with those of retroauricular skins. There were 14 upregulated proteins in the epithelial tissues of cholesteatoma in comparison with retroauricular skin. The modulation of five crucial proteins, HSP27, PRDX2, GRP75, GRP78 and GRP94, was further determined by RT-PCR, Western blot and immunohistochemistry. Phosphorylation of HSP27 at Ser-82 was identified by mass spectroscopy. The results of this study suggested that phosphorylated HSP27 is the end expression of two potential signal-transduction pathways, and together with PRDX2, they are very likely involved in the proliferation of keratinocytes in cholesteatoma. Upregulations of GRP75, GRP78 and GRP94 in keratinocytes may be able to counter endoplasmic reticulum stress, to inhibit cell apoptosis, to prevent protein unfolding and to promote cholesteatoma growth.

Cholesteatoma growth and proliferation: relevance with serpin B3.

OBJECTIVES/HYPOTHESIS: The mechanisms of cholesteatoma proliferation and growth remain unclear. The objective of this study is to discover the potential mechanisms of the proliferation and growth of cholesteatoma by direct experimental assessments on cholesteatoma tissues from patients. STUDY DESIGN: Retrospective study by the comparisons between cholesteatoma tissues and retroauricular skin tissues from the patients. METHODS: Two-dimensional gel electrophoresis, LC-MS/MS analysis and immunohistochemistry were performed to investigate specific protein expression in cholesteatoma tissues compared with retroauricular skin tissues collected from the patients. Western blotting analysis was conducted to verify the regulation of specific proteins found by 2-DE, and to determine the changes of associated potential modulators in cholesteatoma proliferation and growth. RESULTS: Twelve serpin B3 isoforms were found by 2-DE and identified by LC-MS/MS analysis, which is coherent with the results exhibited by immunohistochemistry and western blot. Up-regulation of STAT3 and down-regulations of cathepsin K and cathepsin L were represented using western blot. CONCLUSIONS: The data in this study suggested serpin B3, STAT3, cathepsin K, and cathepsin L are associated with the proliferation and growth of cholesteatoma, and these proteins may be influential factors in cholesteatoma growth.

Analysis of auditory and vestibular function in patients with unilateral Meniere's disease.

CONCLUSION: The percentage of the unilateral weakness of the caloric response also reflects the clinical progress of Meniere's disease (MD), including clinical hearing loss. OBJECTIVE: To evaluate the relationship between hearing status and vestibular function in patients with MD. METHODS: Seventy-nine patients with unilateral definite MD underwent bithermal air caloric testing, vestibular evoked myogenic potential (VEMP) testing, and pure tone audiometry (PTA). The stages of the disease, clinical hearing level of the diseased ears, and dPTA (the difference in hearing level between ears in each patient) were compared with the percentage of the unilateral weakness of the caloric response and the interaural amplitude difference (IAD) ratio of the VEMP response. RESULTS: Twenty ears (25.3%) revealed normal caloric responses and 59 ears (74.7%) showed reduced caloric responses. Testing revealed that the VEMPs were normal in 49 ears (62%), while 30 ears (38%) had abnormal VEMPs. The percentage of the unilateral weakness of the caloric response was positively correlated with the clinical hearing level of the diseased ears (p = 0.006) and the dPTA (p = 0.013).

Electromyographic endotracheal tube placement during thyroid surgery in neuromonitoring of recurrent laryngeal nerve.

Intraoperative neuromonitoring (IONM) is widely used in thyroid surgery. This study aimed to investigate the influence of neck extension on electromyographic (EMG) endotracheal tube displacement and to determine the necessity of routinely checking the final electrode position after the patient had been fully positioned. A consecutive 220 patients undergoing thyroidectomy were enrolled. All patients were intubated with the EMG endotracheal tube under direct laryngoscopy. The electrode position and tube displacement were routinely checked and measured by laryngofiberoscopy before and after patient positioning. The patients were divided into two groups. In Group I (n=110), the EMG tube was taped and fixed to the right mouth angle before full neck extension. In Group II (n=110), the EMG tube was disconnected from the circuit tube and was not taped until full neck extension. In all patients, we ensured that the final electrode position was the optimal position with laryngofiberoscopic examination. The tube displacement after neck extension ranged from 16 mm upward to 4 mm downward in Group I and from 12 mm upward to 5 mm downward in Group II. The rate of tube displacement greater than 10 mm was 12.7% in Group I and 3.6% in Group II. Successful monitoring was achieved in all patients after the final optimal position of electrodes was ensured routinely. The electrode position can be severely displaced after the patient has been fully positioned. Verification of ideal position of electrodes before the beginning of the operation is a necessary step to guarantee functional intraoperative neuromonitoring.

Electromyographic study of differential sensitivity to succinylcholine of the diaphragm, laryngeal and somatic muscles: a swine model.

Neuromuscular blocking agents (NMBAs) might diminish the electromyography signal of the vocalis muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve. The aim of this study was to compare differential sensitivity of different muscles to succinylcholine in a swine model, and to realize the influence of NMBAs on neuromonitoring. Six male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without the use of an NMBA. The left recurrent laryngeal nerve, the spinal accessory nerve, the right phrenic nerve and the brachial plexus were stimulated. Evoked potentials (electromyography signal) of four muscle groups were elicited from needle electrodes before and after intravenous succinylcholine bolus (1.0 mg/kg). Recorded muscles included the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscles. The onset time and 80% recovery of control response were recorded and analyzed. The testing was repeated after 30 minutes. The onset time of neuromuscular blocking for the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscle was 36.3 ± 6.3 seconds, 38.8 ± 14.9 seconds, 52.5 ± 9.7 seconds and 45.0 ± 8.2 seconds during the first test; and 49.3 ± 10.8 seconds, 40.0 ± 12.2 seconds, 47.5 ± 11.9 seconds and 41.3 ± 10.1 seconds during the second test. The 80% recovery of the control response for each muscle was 18.3 ± 2.7 minutes, 16.5±6.9 minutes, 8.1±2.5 minutes and 14.8±2.9 minutes during the first test; and 21.5±3.8 minutes, 12.5 ± 4.3 minutes, 10.5 ± 3.1 minutes and 16.4 ± 4.2 minutes during the second test. The sensitivity of the muscles to succinylcholine, ranked in order, was: the vocalis muscles, the triceps brachii muscle, the trapezius muscle and the diaphragm. We demonstrated a useful and reliable animal model to investigate the effects of NMBAs on intraoperative neuromonitoring. Extrapolation of these data to humans should be done with caution.

The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation.

BACKGROUND AND OBJECTIVE: Dexmedetomidine is characterized with effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, it should be suitable for awake fibreoptic intubation (AFOI). METHODS: We enrolled 30 oral cancer patients with limited mouth openings who were undergoing AFOI for elective surgery. Patients were randomly allocated into two groups; the Dex group (n = 16) that received dexmedetomidine (1.0 microg kg(-1)) infusion and the Control group (n = 14) that received fentanyl (1.0 microg kg(-1)) infusion. Main outcomes were evaluated by grading scores presenting conditions for nasal intubation and postintubation. Other analysed parameters included airway obstruction, haemodynamic changes, consumption time for intubation, amnesia level and satisfaction. RESULTS: Intubation score (1-5) representing condition for nasal intubation was significantly better in the Dex group [2(1-3)] than in the Control group [3(2-5)] (P = 0.001). Postintubation score (1-3) representing tolerance to intubation also showed more favourable results in the Dex group [1(1-3)] than in the Control group [2(2-3)] (P = 0.002). The Dex group showed significantly reduced haemodynamic response to intubation than the Control group. Incidence requiring temporary haemodynamic support was higher in the Dex group but not of significance. Both levels of amnesia and satisfaction score were significant in the Dex group. Other analysed parameters such as consumption time for intubation, airway obstruction score and postoperative adverse events did not differ significantly. CONCLUSION: Combination of dexmedetomidine loading with topical anaesthesia provides significant benefit for AFOI in intubation condition, patient tolerance, haemodynamic response, amnesia and satisfaction. Dexmedetomidine is effective for AFOI in anticipated difficult airway with only minor and temporary haemodynamic adverse effects.

Clinical analysis of intratympanic tympanosclerosis: etiology, ossicular chain findings, and hearing results of surgery.

CONCLUSION: The success rate (57.5%) in this study is not high for surgical treatment of tympanosclerosis, and therefore lends further evidence that intratympanic tympanosclerosis has been considered intractable for reconstructive surgery. OBJECTIVE: To investigate the clinical findings and surgical results of intratympanic tympanosclerosis. METHODS: From January 1989 to December 2006, a total of 1523 tympanoplasties were performed. Of these, 84 tailored tympanomastoidectomies were performed for tympanosclerosis in 80 patients. RESULTS: The incidence of intratympanic tympanosclerosis with chronic ear disease was 5.5%. Chronic otitis media was the most common etiologic factor for the tympanosclerosis (79 ears, 94.1%). Tympanosclerosis in the middle ear cavity was most often found around the malleus handle (67 ears, 79.8%), and more than half of the cases of tympanosclerosis (43 ears, 51.2%) had multiple areas affected by the sclerotic tissue. Tympanosclerotic fixation of the stapes was found in 31 ears (36.9%), and an intact ossicular chain was seen in 57 ears (67.9%). There was a postoperative improvement in hearing in 42 ears (57.5%).

Early recognition of nasopharyngeal cancer in adults with only otitis media with effusion.

OBJECTIVE: To assess the probability of nasopharyngeal carcinoma (NPC) being present among adults who appeared to suffer only from otitis media with effusion (OME). DESIGN AND SETTING: The clinical features of 87 adults suffering from OME but who demonstrated no other apparent symptoms and signs suggestive of NPC at the Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, between January 2003 and December 2004, were analyzed. A routine nasopharyngeal biopsy was performed. RESULTS: Five patients revealed NPCs (four nonkeratinizing carcinomas and one squamous cell carcinoma). OME was deemed to have resulted from upper respiratory infection in 20 patients (23.0%), chronic paranasal sinusitis in 15 patients (17.3%), allergic rhinitis in 16 patients (18.4%), NPC in 5 patients (5.7%), various other known etiologies in 11 patients (12.6%), and unknown etiologies in 20 patients (23.0%). The incidence of NPC among adults suffering from OME but featuring no other symptoms and signs suggestive of NPC was 5.7% (5 of 87 patients). Such a figure appeared to be greater than that in some other reports because NPC tends to feature a greater prevalence in Taiwan. Therefore, biopsy of the postnasal space for adults who appear to feature only OME when NPC is strongly suspected is necessary for the early diagnosis of NPC. CONCLUSIONS: We conclude that Taiwanese adults with only OME, the cause of which is unclear, should be subjected to an appropriate medical examination and biopsy of the nasopharynx to exclude NPC.

Seizure after local anesthesia for nasopharyngeal angiofibroma.

We report a young male patient who experienced seizure after local injection of 3 mL 2% lidocaine with epinephrine 1:200,000 around a recurrent nasal angiofibroma. After receiving 100% oxygen via mask and thiamylal sodium, the patient had no residual neurologic sequelae. Seizure immediately following the injection of local anesthetics in the nasal cavity is probably due to injection into venous or arterial circulation with retrograde flow to the brain circulation. Further imaging study or angiography should be done before head and neck surgeries, especially in such highly vascular neoplasm.

Analysis of mastoid findings at surgery to treat middle ear cholesteatoma.

OBJECTIVES: To analyze mastoid findings, such as facial nerve dehiscence (FND), labyrinthine fistula, and dural exposure; to review its incidence at cholesteatoma surgery; to analyze its association with semicircular canal fistula; and to elucidate its relationship with dural exposure. DESIGN: One hundred fifty-two patients (65 males and 87 females; 155 ears) were enrolled in a retrospective study of tympanoplasty with or without mastoidectomy. SETTING: Medical university center hospital. RESULTS: The incidence of FND after exenteration of disease was 29.7% (46/155 ears) for total surgical procedures, 29.7% (43/145 ears) for initial procedures, and 30% (3/10 ears) for revision procedures. The prevalence of FND in the tympanic segment only was 87%, with 8.7% in the vertical segment only and 4.3% in both segments. Three patients (2.0%) developed facial palsy postoperatively, with 8 lateral semicircular canal fistulas (5.2% of total ears operated on), half of these with concomitant FND. The incidence of dural exposure of the mastoid tegmen in the entire surgical group was 16.8% (26 ears), 38.5% with concomitant FND. CONCLUSIONS: The overall incidence of FND in our sample was high at 29.7%, with rates of lateral semicircular canal fistula and dural exposure of 5.2% and 16.8%, respectively. The relationship between FND incidence and presence of lateral semicircular canal fistula was positive in our study. The surgeon should bear in mind that the location of FND with cholesteatoma coincides with the most common area of iatrogenic facial nerve injury during otologic surgery.