Advances in 3D Inner Ear Reconstruction Software for Cochlear Implants: A Comprehensive Review.

Auditory impairment stands as a pervasive global issue, exerting significant effects on individuals' daily functioning and interpersonal engagements. Cochlear implants (CIs) have risen as a cutting-edge solution for severe to profound hearing loss, directly stimulating the auditory nerve with electrical signals. The success of CI procedures hinges on precise pre-operative planning and post-operative evaluation, highlighting the significance of advanced three-dimensional (3D) inner ear reconstruction software. Accurate pre-operative imaging is vital for identifying anatomical landmarks and assessing cochlear deformities. Tools like 3D Slicer, Amira and OTOPLAN provide detailed depictions of cochlear anatomy, aiding surgeons in simulating implantation scenarios and refining surgical approaches. Post-operative scans play a crucial role in detecting complications and ensuring CI longevity. Despite technological advancements, challenges such as standardization and optimization persist. This review explores the role of 3D inner ear reconstruction software in patient selection, surgical planning, and post-operative assessment, tracing its evolution and emphasizing features like image segmentation and virtual simulation. It addresses software limitations and proposes solutions, advocating for their integration into clinical practice. Ultimately, this review underscores the impact of 3D inner ear reconstruction software on cochlear implantation, connecting innovation with precision medicine.

Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery.

Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.

Malignant tumors of the external auditory canal: diagnosis, treatment, genetic landscape, biomarkers, and clinical outcome.

Malignant tumors of the external auditory canal (EAC) are rare neoplasms that appear in the head and neck area. A common feature of these malignancies is their rarity, as well as their delayed diagnosis due to the appearance of non-specific symptoms that mimic various benign otologic conditions. The reported histological types of cancer of the external ear are: squamous cell carcinoma, basal cell carcinoma, malignant melanoma, Merkel cell carcinoma, angiosarcoma, adnexal carcinoma (including ceruminous adenocarcinoma and adenoid cystic carcinoma), and lymphoma (Lancet Oncol. 2005;6:411-20. doi: 10.1016/S1470-2045(05)70208-4). Several therapeutic interventions have been proposed, primarily orientated towards the cure of the patient, placing the surgical excision of the lesions at the tip of the spear. Subsequently and depending on the clinical stage and the pathological characteristics of the tumor, radiation, chemotherapy, a combination thereof, or some form of palliative treatment for particularly advanced cases, may be recommended. The aim of all the above-mentioned approaches is the complete resection of the mass with negative surgical margins along with lymph node dissection, the elimination of any residual disease or metastasis, and the improvement of survival. The anatomical complexity of the region will always remain a demanding challenge. Nevertheless, advances in the fields of ear microsurgery, imaging, radiation, molecular biology, and genomics have led to remarkable outcomes compared to the past, with a view to the patient's quality of life. Large, well-organized, and prospective studies with the participation of multiple centers in contrast to existing retrospective studies with a limited number of patients will help to establish universally accepted guidelines. The exploration of the molecular and genetic background of these cancers in conjunction with the search for new biomarkers and target molecules seems promising for providing upgraded and more personalized treatment modalities for the future.

A Foreign Body Lodged in the Glottis of a Toddler for a Prolonged Time: Anatomical Considerations and Review of the Literature.

Our scope is to present the unusual case of an impacted foreign body in a child's larynx for a prolonged period due to recurrent misdiagnosis and review the literature emphasizing the laryngeal foreign body. A toddler girl from a rural region was initially referred to a primary pediatric care center due to a sudden choking episode. The mother made an unsuccessful attempt to pull out a possible foreign body by blind finger sweeping. After 22 days of recurrent misdiagnosis and unsuccessful conservative therapies, the child developed hoarseness of voice and dyspnea during physical exertion. The patient underwent a flexible nasopharyngolaryngeal endoscopy, which observed a foreign body in the glottis, and an emergency microlaryngoscopy. Persistence of laryngeal symptoms in a child with a sudden choking episode should always raise the suspicion of a respiratory tract foreign body impaction. The most appropriate therapeutical approach is rigid bronchoscopy under general anesthesia.

The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches.

The eustachian tube (ET) has a crucial role in the physiology of the middle ear. Thus, any condition that renders the tube dysfunctional is directly implicated with middle ear pathophysiology, like in the case of acute otitis media and otitis media with effusion. Children are more vulnerable to pathologies of the middle ear, primarily due to the immature development of their eustachian tubes. Otitis media with effusion, apart from being a burden for hearing, with direct consequences for speech development, may also be implicated in cholesteatoma formation. Medical therapy is not practically effective for the treatment of effusion. Moreover, the established surgical approaches, like grommets and adenoidectomy, deal only indirectly with the problem since they are not addressing the dysfunctional ET itself. An emerging interventional approach that intends to restore the function of the tube is the transnasal balloon dilation of the cartilaginous part of the ET. Growing international experience indicates that this promising technique is safe and effective. In the current review, we aim to provide background information on the anatomy, physiology, and pathophysiology of the ET and to present the progress of the balloon dilation technique with emphasis on pediatric patients.

Carbonic anhydrase-9 expression in head and neck cancer: a meta-analysis.

The purpose of the study was to compare CA-9 positivity versus CA-9 negativity in head and neck malignancies and to correlate levels of CA-9 with tumor grade, size, and nodal status. Overall and disease-free survival were also compared for CA-9 positive and negative tumors. A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1990 and 2009. Carbonic anhydrase IX, CA IX, CA-9, head and neck, and survival were used as search terms. Random-effect meta-analytical techniques were conducted for outcome measures of overall survival and disease-free survival. Sixteen studies matched the selection criteria, reporting on 1,470 patients. Eight hundred and forty two specimens were reported as being CA-9 positive or negative: 512 (60.81%) were CA-9 positive and 330 (39.19%) were CA-9 negative. Nine hundred and eighty specimens had levels of CA-9 expression recorded: 547 (55.82%) had high levels of CA-9 and 433 (44.18%) had low CA-9 levels. Survival was significantly reduced if the tumor was positive for CA-9 (P < 0.0001). Disease-free survival is significantly reduced in patients with CA-9 positive (P = 0.0008) head and neck malignant tumors. The presence of CA-9 in head and neck malignant tumors is associated with reduced overall survival and disease-free survival.

Foreign bodies of the ear and nose in children and its correlation with right or left handed children.

OBJECTIVE: Foreign bodies (FB) of the ear and nose are common findings in the pediatric population. The objective of this project is to present our experience of cases presented to our department and to correlate the insertion of the FB in relation to the child's handedness. METHODS: This project was carried out at the Department of Otorhinolaryngology Head and Neck Surgery of "Aghia Sophia" Children's Hospital (Athens, Greece), between December 2007 and August 2008. Data collected includes age and sex of the child, time elapsed between the insertion of the FB and its removal, type of FB, site of insertion, description of the child's handedness, conditions of removal and complications. RESULTS: 46 FB were removed from the nasal cavities. On the right nasal cavity, 29/31 (93.55%) children were right handed and 2/31 (6.45%) were left handed. On the left nasal cavity, 11/14 (78.57%) were right handed and 3/14 (21.43%) children were left handed. One right handed child had a FB in both nasal cavities. 44 FB were removed from the ear (external auditory canal: EAC), 30 (68.18%) from the right EAC and 14 (31.82%) from the left. On the right EAC, 28/30 (93.33%) children were right handed and 2/30 (6.67%) were left handed. Children with FB of the left EAC were 9/14 (64.29%) right handed and 5/14 (35.71%) left handed. CONCLUSIONS: Children insert FB into their nasal cavities randomly (P=0.308). As a result, there is no correlation with the child's handedness and right/left nasal cavities FB insertion. On the other hand, children do insert FB into their right/left EAC according whether they are right/left handed (P=0.014). Consequently, right handed children insert FB into their right EAC and left handed children into their left EAC.

Is mucociliary transport velocity related to symptoms in chronic rhinosinusitis patients?

Mucociliary transport velocity (MTV) measured by rhinoscintigraphy is considered a reliable measure of mucociliary clearance, one of the mechanisms that are distorted in chronic rhinosinusitis (CRS). The aim of this study was to investigate possible correlation of MTV with the severity of patients' symptoms. We have studied thirty-seven CRS patients who completed the 20-item sinonasal outcome test (SNOT-20) form, a reliable measure of health related quality of life and were also examined by rhinoscintigraphy with technetium-99m macroaggregated albumin. Our findings showed that the MTV of our patients ranged from nil to 4.17mm/min with a mean value of 1.74+/-1.055 mm/min. The SNOT-20 scores varied from 0.3 to 3.7 with a mean of 1.6+/-0.922. The correlation between SNOT-20 score and MTV was not statistically significant (Spearman's r=-0.191). In conclusion, although rhinoscintigraphy is widely accepted as a reliable test of mucociliary velocity and clearance, it did not correlate with subjective measures of the severity of CRS.

Cutting-edge technologies for diagnosis and monitoring of snoring in children.

Snoring is a very common problem in children and may be an indication of obstructive sleep apnea (OSA). Appropriate diagnosis is of importance due to detrimental effects of OSA. Polysomnography is considered the gold standard for the diagnosis of OSA. However, it is impractical for several reasons and this is why other tests have been developed as alternatives to formal polysomnography (PSG) for the assessment of children with snoring. In this mini-review basic features of PSG as well as alternative tests are presented and future perspectives are provided in addition to current guideline for the diagnosis and monitoring of childhood snoring. The aim of this review is to highlight briefly currently developed technologies that seem promising for the evaluation of snoring.

A meta-analysis on the effectiveness of propranolol for the treatment of infantile airway haemangiomas.

OBJECTIVE: To study the effectiveness of propranolol in infantile airway haemangiomas and compare the effectiveness of propranolol vs. different therapies. METHODS: A literature search of Ovid, Embase, the Cochrane database, Google™ Scholar, and Medline using PubMed as the search engine was performed to identify studies that analysed the effect of propranolol treatment in children with airway haemangiomas. Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS: Thirteen studies, comprising 36 patients were included in the analysis. Propranolol was found to be an effective intervention for the resolution of infantile airway haemangiomas (P<0.00001). Meta-analysis of effectiveness of propranolol vs. steroids, CO(2) laser, or vincristine showed that propranolol is the most effective treatment. CONCLUSIONS: This meta-analysis demonstrated that propranolol should be recommended as a first-line treatment in infantile airway haemangiomas. However, because of the possible side effects of propranolol, current infantile haemangioma treatment centres recommend a full cardiovascular and respiratory review be performed prior to initiation of therapy.

Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis.

A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.

PFAPA syndrome in children: A meta-analysis on surgical versus medical treatment.

OBJECTIVE: To compare the range of medical and surgical therapies for children with PFAPA syndrome. METHODS: A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS: The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/- adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P<0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P=0.83). CONCLUSIONS: The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/- adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms.

Multiple lung abscesses due to acinetobacter infection: a case report.

Acinetobacter species are well-known causes of nosocomial infections. Recent increasing evidence emphasize on the role of these pathogens in community-acquired infections.We report a case of a 16-yr-old female with fever, sore throat, productive cough, malaise and the presence of lung consolidation with multiple abscesses on radiographic examination. The patient had no significant medical history. After a detailed diagnostic work-up the diagnosis of community acquired Acinetobacter pneumonia with multiple lung abscesses was made. The Acinetobacter stain was susceptible to a variety of antimicrobial agents and the patient's condition improved rapidly. A new computed tomography chest scan, three months later, confirmed full recovery.The presence of lung abscesses due to Acinetobacter infection is an extremely uncommon manifestation of the disease. This case underlines the emergent role which these, often multi-drug resistant, bacteria may play in the future, perhaps in community infections as well.

Impaired mucociliary clearance in allergic rhinitis patients is related to a predisposition to rhinosinusitis.

Although mucociliary clearance has been shown to be impaired in patients with allergic rhinitis and chronic rhinosinusitis, its exact role in relation to a predisposition to rhinosinusitis is unknown. To investigate this possible association, we conducted a prospective study of 125 patients with allergic rhinitis. Of this group, 23 patients were classified as being sinusitis-prone based on their history of antibiotic consumption for the treatment of rhinosinusitis; the remaining 102 patients were deemed to be not sinusitis-prone. The saccharine test was used to evaluate mucociliary clearance in all patients. Several variables-age, sex, smoking habits, rhinitis severity, and medication history-were examined. We found that the sinusitis-prone patients had a significantly greater mucociliary clearance time than did those who were not prone (median: 15 and 12 min, respectively; p = 0.02). No other statistically significant differences were seen between the 2 groups with respect to any other variables that might have affected mucociliary clearance. We conclude that impaired mucociliary clearance in allergic rhinitis patients is associated with a predisposition to rhinosinusitis.