Soluble tumor necrosis factor receptor type 1 is an alternative marker of urinary albumin-creatinine ratio and estimated glomerular filtration rate for predicting the decline of renal function in subjects with type 2 diabetes mellitus.

BACKGROUND: Urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rates (eGFR) help predict worsening diabetic kidney disease (DKD) but have their limitations. Soluble tumor necrosis factor receptor type 1 (sTNFR1) is a biomarker of DKD. The predictive abilities of sTNFR1 and UACR plus eGFR have not been compared. METHODS: This prospective cohort study included patients with type 2 diabetes (T2D) to identify the risk factors of worsening DKD. Renal events were defined as > 30 % loss in eGFR based on consecutive tests after 6 months. The associations of sTNFR1, UACR, and eGFR levels and the risks of renal events were tested using a Cox regression model and the area under the curve (AUC) was compared between sTNFR1 levels and UACR plus eGFR using receiver-operating characteristic (ROC) analysis. The accuracy of stratification was evaluated using Kaplan-Meier analysis. RESULTS: Levels of sTNFR1 and UACR were associated with risks of > 30 % decline in eGFR after adjusting for relevant factors. The association between sTNFR1 levels and renal outcomes was independent of UACR and eGFR at baseline. The AUC of sTNFR1 level was comparable with that of combined UACR and eGFR (0.73 vs. 0.71, respectively, p = 0.72) and the results persisted for quartile groups of sTNFR1 and risk categories of Kidney Disease: Improving Global Outcomes (KDIGO) (0.70 vs. 0.71, respectively, p = 0.84). Both stratifications by sTNFR1 levels and KDIGO were accurate. CONCLUSION: sTNFR1 could be an alternative marker for identifying patients with diabetes at risk of declining renal function.

Bilateral cochlear implants in a MELAS patient.

BACKGROUND: Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a maternally inherited mitochondrial disease that affects various systems in the body, particularly the brain, nervous system, and muscles. Among these systems, sensorineural hearing loss is a common additional symptom. METHODS: A 42-year-old female patient with MELAS who experienced bilateral profound deafness and underwent bilateral sequential cochlear implantation (CIs). Speech recognition and subjective outcomes were evaluated. RESULTS: Following the first CI follow-up, the patient exhibited improved speech recognition ability and decided to undergo the implantation of the second ear just two months after the initial CI surgery. The second CI also demonstrated enhanced speech recognition ability. Subjective outcomes were satisfactory for bilateral CIs. CONCLUSIONS: MELAS patients receiving bilateral CIs can attain satisfactory post-CI speech recognition, spatial hearing, and sound qualities.

Soluble tumor necrosis factor receptor type 1 predicts cardiorenal outcomes and better associated with distinct cardiovascular or renal outcomes than precedential renal or cardiovascular events in type 2 diabetes mellitus.

Background: Inflammations are the crucial pathogenesis of chronic complications of type 2 diabetes mellitus (T2DM). Objectives: The timeline of cardiovascular and renal complications of T2DM and whether soluble tumor necrosis factor receptor type 1 (sTNFR1) levels predict cardiorenal outcomes were still elusive. Design: Prospectively observational study. Methods: Chinese patients with T2DM were enrolled. Cardiorenal composite events defined by either cardiovascular composite events (all-cause mortality, acute coronary syndrome, or non-fatal stroke) or renal composite events (a decline of >30% of renal function or worsening status of albuminuria) were followed. Associations of sTNFR1 levels and cardiovascular, renal, and cardiorenal composite events were analyzed in regression models presented by hazard ratio (HR) and 95% confidence interval (95% CI). Results: Among 370 subjects, 42 cardiovascular and 86 renal composite events occurred. Higher sTNFR1 levels were related to higher frequency and risks of cardiovascular composite events (HR 1.07, 95% CI 1.01-1.13, p = 0.009) and renal composite events (HR 1.05, 95% CI 1.02-1.09, p < 0.001). Occurrences of cardiovascular composite events were not predicted by precedential renal composite events. sTNFR1 levels were proved to be associated with risks of cardiorenal composite events in Cox regression sequential models (adjusted HR 1.04, 95% CI 1.00-1.08, p = 0.03). The results were consistent in all subgroup analyses. Conclusion: Levels of sTNFR1 were associated with cardiorenal complications of T2DM and the predictabilities of TNFR1 levels were better than precedential cardiovascular or renal events.

Breast cancer larger than 2.5 cm with tumor-free radioisotope-hot sentinel nodes has higher risk of non-hot axillary lymph node metastasis.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is the standard axillary staging approach for early breast cancer with clinically negative axillary involvement. Adequate SLNB should include the removal of not only radioactive tracer-labeled lymph nodes (hot nodes or SLNs) but also suspicious unlabeled nodes (non-hot nodes or non-SLNs). However, the biopsy of non-hot nodes is highly dependent on the surgeons' experiences. This article aims to facilitate the surgeon's decision making by elucidating parameters that correlate with non-hot node metastasis. METHODS: From 2013 to 2016, clinically node-negative (cN0) breast cancer patients receiving axillary SLNB using single Tc-99m tracer method at our institute were recruited. Patients were excluded if they had received prior neoadjuvant chemotherapy. Among them, cases that have at least one non-isotope-hot node biopsied were retrospectively reviewed with a particular focus on patients with pathologically negative isotope-hot SLNs. The correlation of clinicopathological data with metastasis to axillary lymph nodes and sentinel lymph nodes was analyzed with the Chi-squared test, Fisher's exact test, and multivariate logistic regression. Receiver operating curve (ROC) was applied for continuous variables that predicted non-hot node metastasis; relapse-free survival (RFS) and locoregional relapse-free survival (LRRFS) were compared by Kaplan-Meier analysis. RESULTS: In 632 isotope-hot SLN negative patients, T stage showed a correlation with non-isotope-hot SLN metastasis (p = 0.035, odds ratio (OR) 9.65). Tumors larger than 2.5 cm best predict non-isotope-hot SLN metastasis (area under curve (AUC) = 0.71). With a median follow up of 41.80 months, locoregional relapse-free survival was significantly worse in cases with non-hot node metastasis (66.2% vs. 69.0%, p = 0.001). CONCLUSION: In the setting of SLNB using single radioisotope tracer, non-hot node metastasis in cases with negative hot SLN still carries a higher locoregional recurrence rate (13.3%). For early breast cancer larger than 2.5 cm, removal of suspicious non-hot nodes should be included for a precision therapy.

Factors influencing surgeon decision-making by measuring waiting time for pediatric ventilation tube insertions.

BACKGROUND: The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. METHODS: Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how these factors influenced clinical decision-making were also identified. RESULTS: The waiting time decreased as patient age increased (p < 0.001), and increased as the recent frequency of upper respiratory tract infection diagnosis increased (p < 0.001). Patients who received simultaneously bilateral ventilation tube insertions had shorter waiting time than those who had unilateral surgery (p < 0.01) and patients who had undergone ventilation tube insertions in a tertiary referral center generally had longer waiting times (p < 0.001). CONCLUSION: The waiting time of ventilation tube insertions for pediatric otitis media with effusion can be influenced by many factors. Patients with older age and undergone simultaneously bilateral ventilation tube insertion had shorter waiting time. Patients who had more upper respiratory tract infection episodes and who received ventilation tube insertions in a tertiary referral center setting were subject to longer waiting times.

Soluble tumor necrosis factor receptor 2 is associated with progressive diabetic kidney disease in patients with type 2 diabetes mellitus.

BACKGROUND: Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes. MATERIALS AND METHODS: A total of 364 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a >30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests. RESULTS: Seventy-three patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes (area under the curve 0.63, 95% confidence interval 0.57-0.70, p < 0.001), yielding a sensitivity of 75.3% and a specificity of 51.2%. The association of sTNFR2 levels ≥1.608 ng/mL to renal outcomes was significant after adjusting for relevant variables (hazard ratio 2.27, 95% confidence interval 1.23-4.20, p = 0.009) and remained consistent across subgroups stratified by age, sex, systolic blood pressure, eGFR, albuminuria, and the use of renin-angiotensin system blockers. CONCLUSIONS: Higher circulating levels of sTNFR2 are independently associated with an eGFR decline and progressive albuminuria in patients with type 2 diabetes.

Predictors of hearing outcomes after stapes surgery in otosclerosis.

Background: The current surgical treatment of otosclerosis is stapes surgery; however, few studies have reported the predictors of surgical outcomes.Aim/objective: This study aimed to investigate the prognostic predictors for postoperative hearing outcomes.Materials and methods: A total of 181 ears in 152 patients undergoing stapes surgery at a tertiary referral centre in Taiwan from 1996 to 2016 were retrospectively enrolled and preoperative and intraoperative parameters were obtained. Univariate and multivariate analyses were used to determine independent predictors of postoperative hearing outcomes. A regression model was also established. Hearing success was defined as a postoperative air-bone gap (ABG) ≤10 dB.Results: In univariate analysis, the absence of floating footplate during surgery (p = .003) and small preoperative ABG (p = .014) were associated with successful hearing outcomes. Multivariate logistic regression analysis further revealed the absence of floating footplate during surgery (p = .010) and small preoperative ABG (p = .015) remained independent predictors of postoperative hearing success.Conclusions and significance: Preoperative audiometric data and intraoperative finding may provide surgeons and patients with a better insight into surgical outcomes.

Epidemiology of common otologic surgical procedures in pediatric patients: A population-based birth cohort study.

OBJECTIVE: It is generally recognized the most common pediatric otologic surgical procedure is ventilation tube insertion (VTI). Tympanoplasty and mastoidectomy are more frequently performed on adults. In this study we examined the incidence and age distribution of these procedures by use of a population-based birth cohort design, in order to provide an overall view of the role of these procedures in the pediatric population. MATERIALS AND METHODS: We used the national health insurance research database in Taiwan. We retrieved data on all patients born in the years 2000 and 2001, subsequently underwent VTI, tympanoplasty or mastoidectomy from 2000 to 2013. The incidence and age distribution of these procedures were analyzed. RESULTS: The cumulative incidence of VTI, tympanoplasty, and mastoidectomy was 0.41%, 0.02% and 0.025%, respectively. VTI were more often performed on children 4 or 5 years of age. Tympanoplasties are frequently done on children older than 5, and 30.7% of them had earlier VTI. The time interval from VTI to tympanoplasty was 5.18 ±â€¯2.27 years (mean ±â€¯SD). Mastoidectomies are more often performed on children from 2 to 9 years of age. CONCLUSIONS: VTI was the most frequent otologic surgery for the pediatric population, and was more often performed on children 4-5 years old. Also, tympanoplasty is more frequently performed on children older than 5, and a third of them had prior VTI. Overall, the time interval from VTI to tympanoplasty was 5.18 years. Furthermore, children with cleft palate and congenital metabolic disorder were more prone to otologic surgical procedures.

Middle ear lipoma mimicking a congenital cholesteatoma: A case report and review of the literature.

OBJECTIVE: To describe a case of middle ear lipoma, review the current literature, and discuss the surgical approach. METHODS: Published case reports in the English literature of lipomas restricted to the middle ear were reviewed. The presentation, location, and management of the middle ear lipomas were analyzed. RESULTS: Histological examination of the resected middle ear lesion was compatible with lipoma. Review of the literature suggests middle ear lipomas are rare and involve the epitympanum. CONCLUSION: Lipomas should be included in the differential diagnosis for middle ear lesions. Adequate surgical exposure can be achieved through a transcanal approach, with particular attention to carefully elevate the tympanic membrane off the malleus, preserving the integrity of the ossicular chain.

Minimally traumatic stapes surgery for otosclerosis: Risk reduction of post-operative vertigo.

BACKGROUND: The author (Dr. Shiao) modified traditional stapes surgery (TSS) specifically for patients with otosclerosis. The proposed technique, referred to as minimally traumatic stapes surgery (MTSS), reduces the risk of subjective discomfort (i.e. vertigo and tinnitus) following surgery. This paper compares the effectiveness of MTSS with that of TSS. METHODS: The medical records of patients with otosclerosis after stapes surgery (TSS or MTSS) were analyzed. Outcome variables included post-operative vertigo, tinnitus, and hearing success. Multivariate logistic regression analysis was used to determine the correlation between surgical technique and outcome variables. RESULTS: TSS was performed in 23 otosclerosis ears and MTSS was performed in 33 otosclerosis ears. The risk of post-operative vertigo was significantly lower among patients that underwent MTSS (27%) than among those that underwent TSS (83%, p < 0.001). No differences in the incidence of tinnitus were observed between the two groups. Post-operative audiometric outcomes were also equivalent between the two groups. However, multivariate logistic regression analysis revealed a correlation between post-operative vertigo and surgical technique (p < 0.001). CONCLUSION: MTSS involves a lower risk of vertigo than does TSS. MTSS helps to prevent damage to the footplate, thereby reducing the risk of footplate floating. Therefore, MTSS provides a means to overcome some of the limitations associated with the narrow surgical field in Asian patients.

Learning curve of tonsillectomy.

OBJECTIVE: To determine the time required to sufficiently educate a well-trained surgeon to perform tonsillectomy. MATERIAL AND METHODS: From July 1, 2000 to June 30, 2008, we analyzed 110 patients who underwent bilateral tonsillectomy. All the procedures were performed by 16 ENT surgeons trained in the same tertiary referral medical center during their residency. This training included a 4-year training program before 2002, and a 5-year training program thereafter. We stratified the patients into groups according to each surgeon's residency year at the time the operations were performed. Operation time, estimated blood loss and length of hospital stay of these patients were compared by the surgeon's residency year and by different training program of residency. RESULTS: There was a trend of decreased operation time in the senior year of residency, especially for 5th year surgeons, without reaching statistical significance. When comparing different training program, the operation time was statistically shorter in the 5-year training program than in the 4-year training program. However, no difference was noted in estimated blood loss and hospital stay length. CONCLUSION: The operation time of residents in the 5-year training program was shorter than that of residents in the 4-year training program, which implies that extending the training program by one year may improve the quality of training.

Endocan expression is correlated with poor progression-free survival in patients with pancreatic neuroendocrine tumors.

Endocan expression has been reported to be associated with aggressive tumor progression and poor outcomes in various cancers, such as breast cancer, renal cell cancer, lung cancer, gastric cancer, and pituitary adenomas. However, the prognostic significance of endocan in neuroendocrine tumors remains unknown. Thus, the aim of this study was to determine the correlation between endocan expression in pancreatic neuroendocrine tumor (PNET) tissues and progression-free survival. This study included 73 patients with confirmed PNETs who were treated in a single tertiary center in north Taiwan between 1992 and 2015. Immunohistochemical endocan expression and microvessel density (MVD) were examined, and the relationships between these parameters and other clinicopathological characteristics were analyzed. The abovementioned patients were divided into groups according to their endocan expression levels (≥1% or <1%) and median MVDs. Negative endocan expression (P = .002) and a high MVD (P < .001) were significant and favorable prognostic factors for progression-free survival. However, positive endocan expression was significantly associated with a low MVD (P = .037) and tumor mitosis (Ki-67 index) (P = .028). Multivariate Cox regression analysis showed that positive endocan expression (hazard ratio: 4.778, P = .018) and lymph node involvement (hazard ratio: 5.121, P = .005) were independent prognostic factors for tumor recurrence.In conclusion, endocan expression was correlated with poor clinical outcomes in PNETs. Our data indicated that endocan expression may be a reliable marker for predicting tumor recurrence in patients with PNETs.

A case of adrenal Cushing's syndrome with bilateral adrenal masses.

UNLABELLED: A functional lesion in corticotrophin (ACTH)-independent Cushing's syndrome is difficult to distinguish from lesions of bilateral adrenal masses. Methods for distinguishing these lesions include adrenal venous sampling and (131)I-6ß-iodomethyl-19-norcholesterol ((131)I-NP-59) scintigraphy. We present a case of a 29-year-old Han Chinese female patient with a history of hypercholesterolaemia and polycystic ovary syndrome. She presented with a 6month history of an 8kg body weight gain and gradual rounding of the face. Serial examinations revealed loss of circadian rhythm of cortisol, elevated urinary free-cortisol level and undetectable ACTH level (<5pg/mL). No suppression was observed in both the low- and high-dose dexamethasone suppression tests. Adrenal computed tomography revealed bilateral adrenal masses. Adrenal venous sampling was performed, and the right-to-left lateralisation ratio was 14.29. The finding from adrenal scintigraphy with NP-59 was consistent with right adrenal adenoma. The patient underwent laparoscopic right adrenalectomy, and the pathology report showed adrenocortical adenoma. Her postoperative cortisol level was 3.2µg/dL, and her Cushingoid appearance improved. In sum, both adrenal venous sampling and (131)I-NP-59 scintigraphy are good diagnostic methods for Cushing's syndrome presenting with bilateral adrenal masses. LEARNING POINTS: The clinical presentation of Cushing' syndrome includes symptoms and signs of fat redistribution and protein-wasting features.The diagnosis of patients with ACTH-independent Cushing's syndrome with bilateral adrenal masses is challenging for localisation of the lesion.Both adrenal venous sampling and (131)I-NP-59 scintigraphy are good methods to use in these patients with Cushing's syndrome presenting with bilateral adrenal masses.

Emergence of Refractory Otomastoiditis Due to Nontuberculous Mycobacteria: Institutional Experience and Review of the Literature.

BACKGROUND: Nontuberculous mycobacteria (NTM) infection has attracted increasing attention in recent years; however, NTM otomastoiditis is extremely rare. Surgery combined with antibiotic therapy is the current mainstay of treatment; however, the reported duration of medication still varies. In this study, we aimed to analyze patients with NTM otomastoiditis and establish a more efficient treatment strategy. METHODS: Medical records and temporal bone images of patients with NTM otomastoiditis were retrospectively analyzed. In addition, a comprehensive review of cases with NTM otomastoiditis in the literature was also performed. RESULTS: Twenty-two patients were identified in our institution, and all patients had refractory otorrhea. The rates of granulation tissue, otalgia, and facial palsy were 90.9%, 31.8%, and 9.1%, respectively. Soft tissue attenuation via imaging studies was demonstrated in all of the middle ear cavities. All patients received medical treatment, 20 (90.9%) underwent surgery, and 4 (18.2%) underwent revision surgery. The median time to cure was similar between the "prolonged-course" and "standard-course" antibiotic groups (3.0 vs 3.3 months; P = .807). However, the former had a longer median duration of antibiotic therapy (6.0 vs 3.0 months; P = .01). In the literature review, 54 (96.4%) patients received medical treatment, 51 (91.1%) underwent surgery, and 27 (48.2%) underwent revision surgery. CONCLUSIONS: NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery, which is the mainstay of treatment, should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after a dry ear is achieved.

The combination of the ankle brachial index and brachial ankle pulse wave velocity exhibits a superior association with outcomes in diabetic patients.

OBJECTIVE: Patients with type 2 diabetes mellitus (T2DM) and peripheral arterial disease are classified as having very high cardiovascular risks. We therefore sought to determine whether assessments of the ankle brachial index (ABI) and brachial ankle pulse wave velocity (baPWV) together exhibited a superior association with the outcomes of T2DM. METHODS: A retrospective analysis of patients receiving ABI and baPWV during the period 2005-2007 was performed. Patients A total of 452 subjects were enrolled and followed-up for a mean 5.8 years after being grouped according to the ABI (<0.9 vs. ≥0.9) and baPWV (<1,700 cm/s vs. ≥1,700 cm/s). RESULTS: The outcomes were all-cause mortality and composite events (all-cause mortality, hospitalization for coronary artery disease, stroke, re-vascularization, amputation and diabetic foot). Inter-group differences in the smoking rate, duration of diabetes, systolic and pulse blood pressure, anti-platelet drugs, estimated glomerular filtration rate, and urine albumin excretion were significant. During the follow-up period, 17 (3.7%) individuals died and composite events were recorded in 64 cases (14.1%). A low ABI plus high baPWV was found be associated with poor outcomes compared with a normal ABI plus low baPWV (p<0.001). Meanwhile, a low ABI plus high baPWV was associated with an increased risk of all-cause mortality [hazard ratio (HR) 17.01, 95% confidence interval (CI) 1.57-183.73, p=0.019] and composite events (HR 8.53, 95% CI 3.31-21.99, p<0.001). CONCLUSION: In this study, the outcomes of patients with a low ABI plus high baPWV were the worst, while the subjects with a low ABI plus low baPWV or normal ABI exhibited similar outcomes. Therefore, the ABI plus baPWV exhibits a better association with the outcomes of T2DM.

The protective effect of adenoidectomy on pediatric tympanostomy tube re-insertions: a population-based birth cohort study.

OBJECTIVES: Adenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making. STUDY DESIGN: Retrospective birth cohort study. METHODS: This study used the National Health Insurance Research Database for the period 2000-2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age. RESULTS: Adenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p = 0.002 and longer time to re-insertions, p = 0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41-0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2-4 years were most prone to have tube re-insertions, followed by the age group of 4-6 years. CONCLUSIONS: Adenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.

Controversial issues of optimal surgical timing and patient selection in the treatment planning of otosclerosis.

The aim of this study was to analyze the impact of clinical factors on the outcomes of otosclerosis surgery and support patients' access to evidence-based information in pre-operative counseling to optimize their choices. A total of 109 ears in 93 patients undergoing stapes surgery in a tertiary referral center were included. Variables with a potential impact on hearing outcomes were recorded, with an emphasis on factors that were readily available pre-operatively. Hearing success was defined as a post-operative air-bone gap ≤10 dB. Logistic regression analysis was used to determine the factors independently contributing to the prediction of hearing success. The mean follow-up period was 18.0 months. Univariate and multivariate analyses indicated that none of the pre-operative factors (piston type, age, sex, affected side, tinnitus, vertigo, and pre-operative hearing thresholds) affected hearing success significantly (all p > 0.05). In conclusion, self-crimping Nitinol piston provides comparable hearing outcomes with conventional manual-crimping prostheses. However, Nitinol piston offers a technical simplification of a surgical procedure and an easier surgical choice for patients. In addition, age is not a detriment to hearing gain and instead might result in better use of hearing aids in older adults, thus facilitating social hearing recovery. Finally, hearing success does not depend on the extent of pre-operative hearing loss. Hence, patients with poor cochlear function should not be considered poor candidates for surgery. The predictive model has established recommendations for otologists for better case selection, and factors that are readily available pre-operatively may inform patients more explicitly about expected post-operative audiometric results.

Otitis media with effusion in children with cleft lip and palate: a narrative review.

OBJECTIVE: Repair surgery of cleft lip and palate (CLP) can produce satisfactory cosmetic results but the problem of recurrent otitis media with effusion (OME) secondary to CLP may persist. This can cause long-term hearing loss and affect linguistic, academic, and personal development. The aim of this review is to provide the most recent information regarding OME in children with CLP. METHODS: All papers referring to children with CLP and OME were identified from searches in Medline, PubMed, Cochrane Library, and Web of Science. Abstracts were read and relevant papers were obtained. Additional studies were obtained from the references of the selected articles. RESULTS: Both current and previous research on OME in children with CLP focused on the controversy over treatment strategies. Evidence on the optimal treatment for OME in CLP children was lacking. Ventilation tube surgery using the same anesthetic as lip or palate procedures was not well-supported. After summarizing the literature review, a flowchart of management guidance for such patients is also recommended. Updated reviews such as this will provide clinicians and patients/parents with a valuable reference. CONCLUSIONS: The lack of evidence on the optimal treatment for OME in children with CLP should prompt a relatively conservative approach. However, only a consensus between patients/parents and surgeons regarding the most suitable treatment strategy for OME can ensure the greatest benefit to individual patients.

Decision making in the choice of surgical management for preauricular sinuses with different severities.

OBJECTIVES: The preauricular sinus is a common congenital abnormality of the preauricular soft tissues. Here, we demonstrate the decision making in the choice of surgical management of preauricular sinuses based on disease severity. In addition, a method termed figure 8 incision with extended fistulectomy is introduced. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS: Between January 2003 and February 2010, a total of 90 patients (109 ears) underwent surgery for preauricular sinuses in our hospital. METHODS: After controlling the infection, the patients received definite surgery. They were classified into 3 groups according to the operative methods. We recorded the clinical conditions and any recurrences during the follow-up period. RESULTS: Group I patients (48 ears) had a trace inflammatory condition and underwent a simple sinusectomy. The recurrence rate was 2.08%. Group II (31 ears) and group III (30 ears) patients had more highly inflamed tissue and underwent a local wide excision and a figure 8 incision with extended fistulectomy, respectively. The recurrence rate in group II was 22.58%. Meanwhile, none of the group III cases showed a recurrence. In our study, there were 8 recurrent cases in 109 ears, yielding a recurrence rate of 7.34%. CONCLUSION: Simple sinusectomy is an adequate surgical technique for preauricular sinuses with a mild inflammatory condition. For more severe cases, the figure 8 incision with extended fistulectomy can achieve adequate wound exposure for radical excision of the inflamed tissue and a satisfactory surgical outcome.

New therapeutic strategy for treating otitis media with effusion in postirradiated nasopharyngeal carcinoma patients.

BACKGROUND: Postirradiation otitis media with effusion (OME) is the most common radiotherapy-associated otologic complication associated with nasopharyngeal carcinoma (NPC). This study's aim was to evaluate the efficacy of laser myringotomy followed by intratympanic steroid injection (LMIS) for treating OME in postirradiated NPC patients. METHODS: From August 2002 to January 2006, 27 newly diagnosed NPC patients who developed OME after a full course of radiotherapy were enrolled. Laser myringotomy was performed followed by once-weekly administration of steroids (0.5mL dexamethasone at a concentration of 5.0mg/mL) into the middle ear for 3 consecutive weeks. The success rate of dry eardrum perforation and the prognostic factors associated with OME resolution were analyzed. RESULTS: The procedure was performed on 44 ears of 27 patients. The mean follow-up period was 37 weeks. Of the 44 ears, 23 (52.3%) developed persistent eardrum perforation, 18 (40.9%) developed recurrent OME, and three (6.8%) were disease-free on follow-up. Of the 23 ears with persistent eardrum perforation, 18 (78.3%) were diagnosed as dry perforation. The absence of pretreatment mastoiditis was an independent factor associated with OME resolution (p<0.001). CONCLUSION: LMIS is a quick, minimally invasive, office-based technique that can be repeatedly performed to treat highly recurrent postirradiation OME, and it results in relatively slight pain to NPC patients. Long-lasting dry eardrum perforation allows for adequate middle ear ventilation and drainage and guarantees sustained relief from symptoms. The absence of preoperative mastoiditis is a favorable prognostic factor associated with OME resolution.