ABSTRACT
Background and Objectives@#This study aimed to evaluate the clinical features and the clinical factors associated with prognosis of sudden sensorineural hearing loss (SSNHL) in diabetic patients. @*Subjects and Methods@#Forty-nine diabetic with unilateral SSNHL were retrospectively included. All patients received systemic high dose steroid therapy within one month after onset and had more than one month of follow-up audiogram. The basic characteristics of the patients, initial and follow-up audiograms, laboratory data, and methods of steroid treatment were collected. @*Results@#Compared to reference values in healthy subjects, 79%, 55%, and 45% of the patients had higher values of mean neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), respectively. Older patients had significantly less degree of hearing loss, but they also had significantly worse hearing thresholds in the unaffected ear. After steroid treatment, less than half patients (47%) showed hearing recovery. Simultaneous intratympanic dexamethasone (ITD) injections with systemic steroid did not confer an additional hearing gain or an earlier recovery rate in diabetic patients with SSNHL. In the multivariate analysis, initial hearing thresholds of affected ear and timing of steroid treatment were significantly associated with hearing prognosis in diabetic patients with SSNHL. @*Conclusions@#Diabetic patients with SSNHL tended to have increased NLR, LMR, and PLR, which are reported to be associated with microvascular angiopathy. Simultaneous ITD injections to improve hearing recovery in diabetic patients with SSNHL seems unnecessary.
ABSTRACT
Background and Objectives@#The conjunctivodacryocystorhinostomy (CDCR) is rarely performed in epiphora, which is caused by complete proximal bicanalicular obstruction. The purpose of this study is to analyze the characteristics, clinical results and complications of patients who underwent CDCR.Subjects and Method We enrolled 12 patients who underwent CDCR due to proximal canalicular obstruction from 2006 to 2019. We retrospectively analyzed the causes of epiphora, trauma history, the cause of revision operation and the clinical outcome. @*Results@#A total of 12 patients (7 males and 5 females) underwent CDCR (mean age 46 years). The causes of trauma were such as laceration (n=7, 58%) and iatrogenic (n=1, 8%), idiopathic obstruction (n=4, 33%). After the initial surgery, 5 patients (41%) were categorized in good outcome and the Jones tube was located well in 6 (50%) patients. Revision surgery was performed in 6 (50%) cases, with 4 cases having good outcome. The success rate of CDCR, including revision surgery, was increased to 83%. Most common cause of revision surgery was tube migration. In addition, the subjective outcome in patients with traumatic causes were worse but it had no statistical significance compared to that of patients with idiopathic and iatrogenic causes (p=0.07). @*Conclusion@#About a half of the patients had good recovery rate after the initial operation. The outcome increased to 83% after revision operation. The success rate of CDCR for traumatic patients was worse than for those with idiopathic and iatrogenic causes. It seems that accompanied eyelid damage in traumatic patients may have affected the result of success rate.
ABSTRACT
Background and Objectives@#Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs. @*Results@#A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (p=0.007) and took longer time to completely recover (p<0.001). @*Conclusion@#Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.