The Role of Steroids in the Preservation of Hearing and Vestibular Function in Cochlear Implantation.

OBJECTIVE: Cochlear implant surgery is guided by principles of atraumatic insertion as to protect the inner ear. Previous studies suggest the potential benefit of steroids in patients undergoing cochlear implantation (CI), although the optimal route of administration has yet to be determined. We aim to systematically review the human studies of hearing and vestibular function preservation in patients undergoing CI receiving perioperative steroids and to discuss their role. DATA SOURCES: Search performed in PubMed, EMBASE, and CENTRAL databases in December 2023. REVIEW METHODS: Studies comparing several methods of steroid delivery and conventional management for patients undergoing CI were identified. Primary outcomes included hearing and vestibular function preservation. Secondary outcomes included reported adverse events, routes of steroid administration, and the presence of a control group without steroid administration. RESULTS: A total of 15 studies (N = 659) met inclusion criteria. Methodology, doses, route of steroid administration, and follow-up duration differed between most studies. Audiometric, vestibular, and hearing preservation (HP) results were inconsistent. In 12 studies, perioperative steroids were associated with either increased HP or vestibular function preservation. Only two studies reported adverse events related to oral corticosteroid therapy. CONCLUSIONS: There is a tendency for perioperative steroids to have a positive impact, at least in the short term, on hearing and vestibular function preservation in CI. Topical corticosteroid therapy appears to have a superior risk-benefit profile. There is a need for future carefully designed randomized controlled trials to determine the ideal route of steroid administration and its real impact in the long term. Laryngoscope, 134:3458-3465, 2024.

Pars tensa and tympanicomalleal joint: proposal for a new anatomic classification.

PURPOSE: The tympanic membrane (TM) belongs to the ear. Despite its place in the ear anatomy, can we give it also a different anatomic classification? The main objective is to clarify the nature of TM, tympanic bone and malleus to propose a new anatomic classification. METHODS: This cadaveric study was performed in two human heads and six fresh temporal bones. A study of the temporomandibular joint, external acoustic meatus (EAM), TM and middle ear structures was conducted. A medical literature review englobing anatomy, embryology, histology and phylogeny of the ear was performed and the results were compared with the results of the dissection. RESULTS: The external ear is constituted by the auricle and the EAM. This last segment is made by a cartilaginous and an osseous portion. The osseous portion of the EAM is constituted mainly by tympanic bone. The external ear is separated from the middle ear by the TM. Inside the middle ear, there are three ossicles: malleus, incus and stapes, which allow the conduction of sound to the cochlea. Based on the anatomic dissection and medical literature review of the tympanic bone, malleus and TM, we propose that these structures are interconnected like a joint, and named it "Tympanicomalleal joint". CONCLUSIONS: It seems that the TM can be part of a joint that evolved to improve sound transmission and middle ear protection. Thinking TM has part of a joint may help in the development of more efficient reconstructive surgical techniques.

[Quality of Life of Children with Otitis Media and Impact of Insertion of Transtympanic Ventilation Tubes in a Portuguese Population]. / Qualidade de Vida das Crianças com Otite Média e Impacto da Colocação de Tubos de Ventilação Transtimpânicos numa População Portuguesa.

INTRODUCTION: Quality of life is an important measure for health-outcome evaluation. Although otitis media is one of the most common childhood diseases, its impact on Portuguese children's quality of life is unknown. The aim of this study is to determine the quality of life of Portuguese children with chronic otitis media with effusion and/or recurrent acute otitis media and the short-term impact of transtympanic ventilation tubes, using the Portuguese version of the OM-6 questionnaire, a valid, reliable and sensitive instrument to evaluate the health-related quality of life in children with otitis media. MATERIAL AND METHODS: This study was conducted in a tertiary referral center, to where children are referred from primary care and hospital pediatric consultations. The Portuguese version of the OM-6 questionnaire was applied to children with chronic otitis media with effusion and/or recurrent acute otitis media. The instrument was re-administered at two months postoperatively to a group of children who underwent tympanostomy tube placement, to evaluate the change in quality of life with the surgical procedure. RESULTS: The study involved a sample of 169 children, aged between 6 months and 12 years (mean: 4.20 ± 2.05 years). The average score in the survey was 3.3 ± 1.47, of a maximum of 7 (worst quality of life). The domains 'caregiver concerns', 'hearing loss' and 'physical suffering' had the highest scores. The domain 'hearing loss' was correlated with the domain 'speech impairment' (rs = 0.41; p < 0.001) and the domain 'physical suffering' correlated with the domain 'activity limitation' (rs = 0.47; p < 0.001). There was a correlation between the score on 'hearing loss' and the presence of conduction hearing loss (χ2 (6) = 24.662; p = 0.022). Children with chronic otitis media with effusion had lower scores on the domain 'physical suffering', while children with recurrent acute otitis media had lower scores in the domain 'hearing loss' and higher scores in the domain 'emotional distress'. There was an improvement in the quality of life in all the dimensions studied by the questionnaire after surgery. The improvement was large in 55%, moderate in 15% and small in 10% of the cases. The presence of otorrhea postoperatively did not decrease the quality of life improvement achieved with surgery. CONCLUSION: Otitis media has a negative impact on Portuguese children quality of life. Tympanostomy tubes improve quality of life related to the middle ear in most children. The application of validated disease-specific questionnaires allows an enhanced understanding of the impact of otitis media on Portuguese children quality of life and of the success of therapeutic measures.

Introdução: A qualidade de vida é uma medida importante de avaliação de resultados em saúde. Embora a otite média seja uma das doenças mais comuns na infância, o seu impacto na qualidade de vida das crianças portuguesas não é conhecido. O objetivo deste estudo é determinar a qualidade de vida das crianças portuguesas com otite média crónica com efusão e/ou otite média aguda recorrente e o impacto a curto-prazo da colocação de tubos de ventilação transtimpânicos, utilizando a versão portuguesa do questionário OM-6, um instrumento válido, confiável e sensível para avaliar a qualidade de vida relacionada com saúde em crianças com otite média. Material e Métodos: Este estudo foi realizado num hospital de nível terciário, para onde as crianças são referenciadas a partir dos cuidados de saúde primários e da consulta de pediatria hospitalar. O questionário OM-6 foi administrado em crianças com otite média crónica com efusão e/ou otite média aguda recorrente. O instrumento foi readministrado aos dois meses de pós-operatório a um grupo de crianças submetidas a colocação de tubos de ventilação transtimpânicos, para avaliar a alteração da qualidade de vida com o procedimento cirúrgico. Resultados: O estudo envolveu uma amostra de 169 crianças, com idades entre os 6 meses e os 12 anos (média: 4,20 ± 2,05 anos). A pontuação média no questionário foi de 3,3 ± 1,47, num máximo de 7 (pior qualidade de vida). Os domínios 'preocupações do cuidador', 'perda auditiva' e 'sofrimento físico' apresentaram as pontuações mais elevadas. O domínio 'perda auditiva' correlacionou-se com o domínio 'alterações da fala' (rs = 0,41; p < 0,001) e o domínio 'sofrimento físico' correlacionou-se com o domínio 'limitação da atividade' (rs = 0,47; p < 0,001). Observou-se correlação entre a pontuação no domínio 'perda auditiva' e a presença de hipoacusia de condução (χ2 (6) = 24,662; p = 0,022). Crianças com otite média crónica com efusão apresentaram pontuação mais baixa no domínio 'sofrimento físico', ao passo que crianças com otite média aguda recorrente apresentaram pontuação mais baixa no domínio 'perda auditiva' e pontuação mais alta no domínio 'sofrimento emocional'. Registou-se uma melhoria da qualidade vida em todas as dimensões estudadas pelo questionário após o procedimento cirúrgico. A melhoria foi considerada grande em 55%, moderada em 15% e pequena em 10% dos casos. A presença de otorreia no pós-operatório não mostrou comprometer a melhoria da qualidade de vida obtida com o procedimento cirúrgico. Conclusão: A otite média tem um impacto negativo na qualidade de vida das crianças portuguesas. A colocação de tubos de ventilação transtimpânicos melhora a qualidade de vida na maioria das crianças. A aplicação de questionários validados doença-específicos permite uma melhor compreensão do impacto que a otite média apresenta na qualidade de vida das crianças portuguesas e do sucesso do tratamento.