Complications and prognosis associated with intra-tympanic steroid injection to treat sudden sensorineural hearing impairment.

PURPOSE: The purpose of this study was to measure the incidence of complications in sudden sensorineural hearing loss (SSNHL) patients treated with intra-tympanic steroid injection (ITSI) and compare hearing recovery rates. MATERIALS AND METHODS: 123 patients with unilateral SSNHL receiving ITSIs were included in this study. Post-ITSI complications were documented including otalgia, dysgeusia, vertigo (duration>1 h), and persistent eardrum perforation. The pain intensity was evaluated with visual analog scale (VAS). Hearing was measured before ITSI and at 1 month after the final ITSI. We compared our patients' hearing threshold between presence and absence of different complications. RESULTS: 47.2% patients experienced post-injection otalgia with the average VAS score 3.2 (range 2-6). Five (4.1%) and six (4.9%) patients exhibited vertigo and persistent eardrum perforations, respectively. The patients were divided into three groups based on the absence of complications and the presence of vertigo and eardrum perforation. The hearing threshold improvements did not differ significantly among the three groups (p = 0.366). Although the difference was not significant (p = 0.664), the proportion of patients experiencing post-ITSI vertigo who were on contemporaneous oral steroids was lower than the proportion of non-vertigo patients on such steroids. CONCLUSION: The incidences of otalgia, vertigo, and persistent eardrum perforation in SSNHL patients treated with ITSI were 47.2%, 4.1% and 4.9%, respectively. We found no association between concurrent oral steroid use and the incidence of post-ITSI eardrum perforation or vertigo. Although statistical significance was lacking, patients who did not take contemporaneous oral steroids may have a higher rate of prolonged post-ITSI vertigo.

Geriatric sudden deafness.

PURPOSE: Sudden sensorineural hearing loss, briefly sudden deafness (SD), in the elderly remains less investigated despite rapidly aging population in most countries around the world. This study investigated whether aging process affects the treatment outcome of SD in the elderly. PATIENTS AND METHODS: Eighty patients with SD, comprising 40 geriatric patients aged >65 years and 40 non-geriatric patients aged 55-64 years, were enrolled in this study. All patients underwent an inner ear test battery including audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP), and caloric tests. RESULTS: Pre-treatment mean hearing level in the geriatric group (94 ± 16 dB) did not significantly differ from non-geriatric group (89 ± 20 dB). After treatment for 3 months, mean hearing gain in the geriatric group (22 ± 18 dB) with an improvement rate of 65%, did not significantly differ from non-geriatric group (21 ± 28 dB) with 58% improvement rate. Both inter-subject and intra-subject analyses revealed that the aging process greatly influenced the cVEMP and oVEMP responses, while less influenced the caloric responses. CONCLUSION: The treatment outcome of SD in geriatric patients aged >65 years did not significantly differ from that in non-geriatric patients aged 55-64 years, indicating that aging process did not affect treatment outcome of SD. Unlike treatment outcome for the presbycusis is unsatisfactory, treatment outcome for the elderly with SD could be favorable.

Sudden Deafness during Antepartum versus Postpartum Periods.

OBJECTIVE: This study reviewed our experience in treating sudden deafness in antepartum (pregnant) and postpartum women during the past 2 decades. METHODS: From 1997 to 2016, we have recorded sudden deafness in 16 antepartum (mean age, 32 years) and 3 postpartum (mean age, 31 years) women. Sudden deafness occurred during the 1st, 2nd, and 3rd trimesters in 5, 4, and 7 antepartum women, respectively. In contrast, the mean interval between giving birth and symptom onset in the 3 postpartum women was 18 days. Each patient underwent an inner ear test battery. RESULTS: In 8 antepartum women treated by dextran infusion, the outcome as regards hearing was improved in 7 patients (88%) and unchanged in 1 patient. In contrast, the other 8 antepartum women selected no treatment, and only 1 patient (12%) achieved hearing improvement, exhibiting a significantly better outcome when receiving dextran treatment. For the postpartum women, 2 patients had hearing improvement when treated by antioxidants, while 1 patient retained unchanged hearing without treatment. CONCLUSION: Medication is needed in sudden deafness in antepartum or postpartum women rather than waiting for a natural course. No adverse effects have been identified in any of the mothers or offspring 1 year after delivery.

Clinical Features and Complications of External Auditory Canal Foreign Bodies in the ENT Emergency Unit.

Objective: To determine the risk factor for developing complications in patients undergoing removal procedures for foreign bodies (FBs) in the external auditory canal (EAC) in the otolaryngology (ENT) emergency unit. Methods: Cases involving patients with EAC FBs treated at the ENT emergency unit of a tertiary medical center were retrospectively recruited. Patients were classified into the age < 10 years and ≥10 years groups. Univariate analyses of the complication rates were performed in all patients and the two age groups. Results: The mean age of the 457 patients was 29.9 ± 19.9 (range, 1.0-89.0) years; 42.7% (n = 195) were under 10 years of age, and 57.1% (n = 261) were male. Complications following FB removal occurred in 40 cases (8.8%), with EAC laceration being the most common (4.4%). Patients under 10 years of age had a higher risk of developing complications than those over 10 years (13.8% vs 5.0%, P = .001), with the younger group also showing an increased risk of EAC laceration (6.7% vs 2.7%, P = .039). Conclusion: Patients under 10 years of age had a significantly-higher rate of complications after EAC FB removal in the ENT emergency unit. Sedation or surgical removal under general anesthesia should be considered to minimize the risk of complications after a failed removal under direct vision in this patient group. Further studies are warranted to verify this implication for clinical practice.

Factors Related to Cholesteatoma Formation in External Auditory Canal Osteomas and Treatment Algorithm.

Objectives: Osteomas in the external auditory canal (EAC) can lead to stenosis, and impair epithelium migration and self-cleaning capability, thereby trapping keratinized epithelium and triggering the development of cholesteatoma. Our study aims to identify the risk of cholesteatoma development in patients with osteoma and proposes a stepwise approach to managing patients with EAC osteoma. Methods: The maximum diameter of the osteoma was measured in axial and coronal views on high-resolution computed tomography (HRCT). We calculated the relative obstruction ratio caused by the osteoma in the axial and coronal views. Prior to surgery, otoscopy was employed to identify pedicle formation. The patients were categorized into 2 groups based on the presence of cholesteatoma. Results: We identified 43 patients diagnosed with EAC osteoma. A total of 9 (20.9%) patients with EAC osteomas developed cholesteatoma and the other 34 (79.1%) did not. The maximum diameter of osteomas with and without cholesteatoma was 12.67 ± 4.09 and 7.67 ± 3.27 mm, respectively (P < .001). In the group without cholesteatoma, 21 osteomas had pedicles while the other 13 did not. In the cholesteatoma group, 2 osteomas had pedicles and 7 did not (P = .037). No difference was observed in the relative obstruction ratio between these 2 groups. Conclusions: Our findings indicate that larger osteomas are more likely to develop cholesteatoma, while the formation of a pedicle may reduce the occurrence of cholesteatoma. In symptomatic patients, preoperative evaluation, including HRCT and otoscopy, is vital for assessing the extent of the osteoma and the potential coexistence of cholesteatoma. These factors are critical for preoperative consultations and surgical planning.

[Effects of Different Modified Materials on Soil Fungal Community Structure in Saline-Alkali Soil].

Studying the effects of different modified materials on the physicochemical properties and fungal community structure of saline-alkali soil can provide theoretical basis for reasonable improvement of saline-alkali soil. High-throughput sequencing technology was used to explore the effects of five treatments, namely, control (CK), desulfurization gypsum (T1), soil ameliorant (T2), organic fertilizer (T3), and desulfurization gypsum compounds soil ameliorant and organic fertilizer (T4), on soil physicochemical properties and fungal community diversity, composition, and structure of saline-alkali soil in Hetao Plain, Inner Mongolia. The results showed that compared with those in CK, the contents of available phosphorus, available potassium, organic matter, and alkali hydrolysis nitrogen were significantly increased in modified material treatments, and the T4 treatment significantly decreased soil pH. Modified treatments increased the Simpson and Shannon indexes of fungi but decreased the Chao1 index. The dominant fungi were Ascomycota, Basidiomycota, and Mortierellomycota, and the dominant genera were Mortierella, Conocybe, Botryotrichum, Fusarium, and Pseudogymnoascus. The application of modified materials increased the relative abundance of Ascomycota, Basidiomycota, Fusarium, and Pseudogymnoascus, while decreasing the relative abundance of Mortierellomycota, Chytridiomycota, and Mortierella. LEfSe analysis showed that modified treatments altered the fungal community biomarkers. Correlation analysis showed that pH and available potassium were the main environmental factors affecting fungal community structure. The results can provide scientific basis for improving saline-alkali soil and increasing soil nutrients in Hetao Plain, Inner Mongolia.

Importance of age at 2nd implantation and interimplant interval to the outcome of bilateral prelingually deafened pediatric cochlear implantation.

BACKGROUND: In Taiwan, the number of cases of sequential bilateral pediatric cochlear implantation (CI) is increasing but data regarding its effectiveness and impact of the reimbursement policy are lacking. We examined the speech perception and quality of life (QOL) of bilateral prelingually deaf children who underwent sequential CI, considering the effects of age at the time of second implantation and interimplant interval. METHODS: We enrolled 124 Mandarin-speaking participants who underwent initial cochlear implant (CI1) in 2001-2019 and a second CI (CI2) in 2015-2020. Patients were followed up for ≥2 years and were categorized into groups based on age at the time of CI2 implantation (<3.5, 3.6-7, 7.1-10, 10.1-13, and 13.1-18 years) and interimplant interval (0.5-3, 3.1-5, 5.1-7, 7.1-10, and >10 years). We evaluated speech perception, device usage rates, and QOL using subjective questionnaires (Speech, Spatial, and Qualities of Hearing and Comprehension Cochlear Implant Questionnaire). RESULTS: Speech perception scores of CI2 were negatively correlated with ages at the time of CI1 and CI2 implantation and interimplant interval. Older age and a longer interimplant interval were associated with higher nonuse rates for CI2 and worse auditory performance and QOL. Among individuals aged >13 years with interimplant intervals >10 years, up to 44% did not use their second ear. Patients aged 7.1 to 10 years had better speech perception and higher questionnaire scores than those aged 10.1 to 13 and 13.1 to 18 years. Furthermore, patients aged 10.1 to 13 years had a lower rate of continuous CI2 usage compared to those aged 7.1 to 10 years. CONCLUSION: Timely implantation of CI2 is essential to achieve optimal outcomes, particularly among sequentially implanted patients with long-term deafness in the second ear and no improvement with hearing aids following CI1 implantation. For CI2 implantation, an upper limit of age of 10 years and interimplant interval of 7 years are essential to prevent suboptimal outcomes. These data can provide useful information to implant recipients, their families, and medical and audiological professionals, enabling a comprehensive understanding of the benefits and potential impacts of the timing of CI2 implantation.

An early report of exoscope-assisted otologic surgery.

BACKGROUND: Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution. METHODS: Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed. RESULTS: Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty. CONCLUSION: Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.

Perianal Basal Cell Carcinoma-A Systematic Review and Meta-Analysis of Real-World Data.

(1) Background: BCC is a sporadic disease that develops in areas of the skin not exposed to the sun. Perianal BCC, which occurs in the anorectal region, accounts for less than 0.2% of all BCC cases. There have been only a few reported cases of the disease, with fewer than 200 cases reported in total. Given the diagnostic challenges and potential for misdiagnosis, we conducted a systematic review of perianal basal cell carcinoma using real-world data to provide comprehensive and detailed information on the disease. (2) Methods: The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020. Patients' clinical pathologic features, tumor characteristics, treatment modalities, and outcomes were presented. (3) Results: The results of 41 studies involving 140 patients were analyzed. The most common symptoms reported by patients at presentation were anorectal bleeding, pain, and pruritus. Ulceration was the most frequently observed tumor characteristic. The majority of patients underwent local excision as their primary treatment, with only eight patients experiencing a recurrence. Our analysis did not reveal any statistically significant differences in the outcomes of different treatment modalities. (4) Conclusions: Identifying perianal BCC poses a significant challenge as it closely resembles other anal diseases, thereby making it difficult to differentiate between the different conditions. However, a wide local excision with clear margins is considered an effective treatment option for most patients. Alternative treatments, such as radiotherapy, may be recommended for patients who are unable to undergo surgery.

Recurrent sudden sensorineural hearing loss-A literature review.

Objective: Sudden sensorineural hearing loss (SSNHL) is one of the few emergent otologic conditions. Although more than half of all patients would benefit from timely treatment, recurrence occasionally develops unexpectedly. The aim of our study is to evaluate the recurrence rate after SSNHL, and present the prognosis after first-episode and recurrent SSNHL. Methods: A literature search was conducted of the PubMed and Embase electronic databases. Results: Seven studies with a total of 3781 patients were included, and 96 patients experienced recurrence. The recurrence rate ranged between 1.4% and 17%. The average time to recurrence was about 2 years in most studies. The majority of the studies reported using systemic steroids for treating first-episode SSNHL, and one study used a plasma expander in patients with recurrent SSNHL. The recovery rate for first-episode patients was 58%-79%, while that for recurrent SSNHL ranged widely, from 21% to 86%. There were no common risk factors for SSNHL recurrence among the studies, although low-frequency hearing loss, the presence of tinnitus during follow-up, and an increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio have been proposed. Conclusion: Understanding the recurrence rate, risk factors, and prognosis after recurrence of SSHNL is crucial for comprehensive medical care; in this respect, further prospective studies with long-term follow-up may be instructive. Level of Evidence: 4.

Declining prevalence of pediatric sudden deafness during the past two decades.

OBJECTIVE: This study compared the prevalence of sudden deafness (SD) in children to investigate the evolution of pediatric SD during the past two decades. METHODS: From 1996 to 2005, totaling 358 SD patients were experienced. Of them, 25 patients (7%) aged <15 years were assigned to Group A. In contrast, 5 patients (2%) aged <15 years of 242 SD patients encountered during the period 2006-2015 were assigned to Group B. All patients underwent audiovestibular function testing. RESULTS: The measles-mumps-rubella (MMR) vaccination reached to 95% vaccination rate in Taiwan after 1994. As 1994 (MMR vaccination years) + 11 (mean age of pediatric SD) equals 2005, this study found that declining prevalence of pediatric SD was from 7% (1996-2005) to 2% (2006-2015) at our hospital, consistent with declining annual cases of SD in Taiwan during the past decades. A significantly higher abnormality rate of mean hearing level (93%) than abnormal caloric responses (20%) was identified indicating that pediatric SD predominately affected the cochlear partition. CONCLUSION: The prevalence of pediatric SD cases has significantly declined during the past 20 years, probably due to global vaccination policy. Other causal factors such as growing numbers of hospital and advancement in radiological diagnostic technique may also contribute to the declining prevalence.