Combining multimodal magnetic resonance brain imaging and machine learning to unravel neurocognitive function in non-neuropsychiatric systemic lupus erythematosus.

OBJECTIVE: To study whether multimodal brain MRI comprising permeability and perfusion measures coupled with machine learning can predict neurocognitive function in young patients with SLE without neuropsychiatric manifestations. METHODS: SLE patients and healthy controls (HCs) (≤40 years of age) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine learning-based model (i.e. glmnet) was constructed to predict TTS. RESULTS: Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood-brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, false discovery rate P < 0.05). A machine learning-trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, P < 0.0005). CONCLUSION: Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically significant BBB leakage and microstructural abnormalities. A machine learning-constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.

Evaluating the accuracy of a self-administered smartphone hearing test application in a geriatric population.

BACKGROUND: As the global population ages, hearing loss becomes increasingly prevalent, and is associated with neurocognitive and psychiatric comorbidities, impacting quality of life. Early screening and timely intervention might prevent or delay cognitive decline, a gap in care that can potentially be addressed by self-administered smartphone hearing tests. OBJECTIVE: This study aims to evaluate the accuracy of Mimi™ (Berlin, Germany), a commercially available self-administered smartphone hearing test compared to pure tone audiogram (PTA) in terms of both hearing levels and hearing thresholds in our local geriatric population > 65 years-old. METHOD: Fifty-two participants above 65 years of age requiring conventional audiograms were recruited from a National Referral University Hospital Otolaryngology clinic from March to June 2022. All participants were administered the conventional PTA tests in a sound-proof booth conducted by audiology technicians followed by Mimi™ Hearing Test in a quiet clinic room. Comparisons between the hearing levels of both tests were analyzed using Spearman's rank correlation coefficient, Bland-Altman plots and Gwet's Kappa which looked at concordance. Hearing thresholds were then analysed using the Wilcoxon signed rank (SR) test. RESULTS: Mimi™ showed strong to very strong correlation with good agreement compared to readings obtained from formal PTA. Concordance in determining hearing loss also showed substantial to almost perfect agreement at each individual frequency, with values of kappa falling between 0.735-0.857. In terms of thresholds, there were no significant differences in thresholds given by both tests except for 2.0 kHz, HFPTA and 4FPTA (p < 0.05). CONCLUSION: Mimi™ serves as a good screening tool for detection of moderate hearing loss for early pickup and treatment except at higher frequencies. The smartphone hearing test is also less accurate in determining the extent of hearing loss and formal PTA after hearing loss is detected on screening should still be standard of care.

Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis.

Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = -0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = -0.375, p = 0.013) rather than a round window catheter (SDM = -0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = -0.379, p = 0.039) than the use of methylprednisolone (SDM = -0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls.

Association of Benign Paroxysmal Positional Vertigo with Depression and Anxiety-A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the extent to which Benign Paroxysmal Positional Vertigo (BPPV) is associated with a higher prevalence of depression and anxiety in patients. DATA SOURCES: Three databases including PubMed, Embase, and The Cochrane Library were searched by two independent authors from inception to June 12, 2022 for observational studies and randomized controlled trials investigating the association between BPPV and depression and anxiety. We included studies published as full-length articles in peer-reviewed journals with an adult population aged at least 18 years who have BPPV, detected through validated clinical methods like clinical diagnosis, interview and Dix-Hallpike test. RESULTS: A total of 23 articles met the final inclusion criteria and 19 articles were included in the meta-analysis. BPPV was associated with a 3.19 increased risk of anxiety compared to controls, and 27% (17%-39%) of BPPV patients suffered from anxiety. Furthermore, the weighted average Beck's Anxiety Inventory score was 18.38 (12.57; 24.18), while the weighted average State-Trait Anxiety Index score was 43.08 (37.57; 48.60). CONCLUSION: There appears to be some association between BPPV and anxiety, but further studies are required to confirm these associations. Laryngoscope, 134:526-534, 2024.

An Innovative 3-dimensional Model of the Epitympanum for Teaching of Middle Ear Anatomy.

OBJECTIVE: To facilitate teaching of the anatomy of the epitympanum, we developed and evaluated the effectiveness of an interactive 3-dimensional (3D) computer model that can be viewed from all angles. STUDY DESIGN: Questionnaire-based prospective randomized controlled trial. SETTING: Undergraduate medical education program. SUBJECTS AND METHODS: The model was created using Google Sketchup, a 3D modeling software. We recruited 72 graduating medical students and randomized them into 2 groups. One group was given the 3D model and reading materials on the epitympanic anatomy (3D group), while the other group relied on reading material and pictures (2-dimensional [2D] group). A questionnaire and anatomy quiz assessed the utility of the 3D model in learning the anatomy of the epitympanum. RESULTS: The mean age of the participants was 22 years. There were no statistically significant differences in demographics and previous experience with 3D models. The 3D group was significantly more confident in its ability to identify structures of the epitympanum on pictures and computed tomography scans when compared to the 2D group. Most participants were in favor of the model as a useful learning tool and preferred to use it with an instructor. In the anatomy quiz, the 3D group fared significantly better, achieving a mean score of 65.1% compared to 32.4% in the 2D group (P < .001). CONCLUSION: The 3D teaching model of the epitympanum is efficacious in short-term recall. By allowing the learner to visualize relations of the epitympanum from all directions, the model aids in appreciation of anatomy and identifications of structures of this region.

The use of the facial clinimetric evaluation scale as a patient-based grading system in Bell's palsy.

OBJECTIVES/HYPOTHESIS: The severity of Bell's facial palsy is monitored through physician-graded instruments, like the House-Brackmann or Sunnybrook Facial Grading System (FGS). These instruments primarily measure the degree of facial muscle impairment and its resulting asymmetry, but neglect the other functional aspects of facial disability. The aim of this study is therefore to compare the FGS with a patient-graded quality-of-life (QOL) instrument, Facial Clinimetric Evaluation Scale (FaCE). STUDY DESIGN: Prospective longitudinal study. METHODS: Twenty-one patients with newly diagnosed Bell's palsy were recruited. All patients received standard treatment with a corticosteroid. They were scored with the FGS at every visit, and they also completed the FaCE at baseline and when they recovered from their palsy. RESULTS: At presentation, there was a positive correlation between the FGS score and the total FaCE score (ρ = 0.63, P = .002). However, when individual domains of the FaCE score were analyzed separately, the domains of facial comfort and lacrimal score did not have significant correlation with the FGS. Similarly, at the end of follow-up, the amount of improvement in FGS and the amount of improvement in the FaCE domains of facial comfort, lacrimal control, and social function showed insignificant and low correlation (P < .05). CONCLUSIONS: This is the first longitudinal study comparing scores on the FGS and FaCE in patients with Bell's palsy. Our findings suggest that without patient-based QOL assessments such as the FaCE, certain functional aspects of facial disability may be overlooked by physician-graded instruments, which focus on facial aesthetics. LEVEL OF EVIDENCE: 4.

Clinical audit of the microbiology of otorrhoea referred to a tertiary hospital in Singapore.

INTRODUCTION: Otorrhoea is a common complaint in Ear, Nose and Throat clinics. This study aimed to establish the pathogens involved in cases of otorrhoea in Singapore, their sensitivity patterns and the effectiveness of empirical management. METHODS: A retrospective chart review was conducted on 91 patients with otorrhoea who had undergone swab cultures between July 2010 and February 2011. RESULTS: Of the 91 cases, 53% were diagnosed empirically as bacterial otitis externa and 25% as otomycosis. Aerobic bacteria accounted for 35.8% of the microorganisms cultured, while 34.7% were fungi and 29.5% were anaerobic bacteria. Pseudomonas (P.) aeruginosa and Staphylococcus (S.) aureus made up 31.6% and 21.0% of the microorganisms, respectively. 20% of S. aureus grown was methicillin-resistant. Aspergillus was the most common fungus and 19% of cultures were polymicrobial. 38% of patients had their treatment changed on the basis of culture results, as no improvement was observed on follow-up. P. aeruginosa was sensitive to ciprofloxacin and gentamicin in 81.8% and 76.0% of patients, respectively, while S. aureus was sensitive to cloxacillin in 93.8% and clindamycin in 87.5% of patients. CONCLUSION: The common microorganisms involved in otorrhoea in Singapore are P. aeruginosa, Aspergillus and S. aureus. Resistant strains of Pseudomonas spp. are now present. Methicillin-resistant S. aureus is increasingly prevalent and highly sensitive to vancomycin. Aminoglycoside and fluoroquinolone-containing eardrops are suitable first-line topical antimicrobials. Cloxacillin may be started should a concomitant oral antimicrobial be warranted empirically or for S. aureus infections. Otomycosis should be considered in patients who show no improvement with antibiotics.

Fabrication of patient specific fasciaform molds for formaldehyde fasciaform grafting tympanoplasty.

In this paper, we report a procedure for making a patient specific Fasciaform Mold for a Formaldehyde Fasciaform Grafting Tympanoplasty procedure based on Computer Tomography (CT) of the patient's temporal bone. Three dimensional ear canal models were first reconstructed from the CT scans of patients. The models were then used by CNC (Computer Numeric Control) machines for making stainless steel molds as well as rapid prototyping machines for producing acrylic based polymer molds. Both a stainless steel mold and a pair of plastic acrylic molds were produced for Formaldehyde Fasciaform Grafting Tympanoplasty. The procedure is found to be feasible in producing a patient specific fasciaform mold within a reasonable time.