Comparison of side effects of different steroids used in intratympanic injections.

OBJECTIVES: This study aimed to compare the side effects of different steroids used in the intratympanic injections (IT). METHODS: One hundred and sixty patients diagnosed with sudden sensorineural hearing loss and undergoing IT were assigned to four groups based on the type or concentration of steroids administered (Group DM5: 5 mg/ml Dexamethasone sodium phosphate; Group DM10: 10 mg/ml Dexamethasone sodium phosphate; Group MP: 40 mg/ml Methylprednisolone sodium succinate; Group BM: 4 mg/ml Betamethasone sodium phosphate). Each group comprised 40 patients, and all participants received IT six times. The study assessed and compared the degrees and duration of pain, dizziness, and tympanic membrane damage following IT. Patients were asked to report the pain they felt using the numeric rating scale (NRS). RESULTS: NRS scores for pain after IT showed significant differences among the four groups (p < 0.001). The average NRS scores for pain in each group were as follows: Group DM5: 1.53 ± 1.04; Group DM10: 1.45 ± 1.30; Group MP: 4.33 ± 2.22; Group BM: 6.03 ± 1.46. The durations of pain after IT also exhibited significant differences among the four groups (p < 0.001), with the longest duration observed in Group MP at 31.93 ± 15.20 min. CONCLUSION: Different types of steroids could lead to varying degrees of pain when used in IT. Betamethasone could cause the most severe pain, and methylprednisolone could result in the longest duration of pain.

The use of vestibular evoked myogenic potentials (VEMP) in the diagnosis of otolithic dysfunction of patients with obstructive sleep apnea: a survey of awareness and recognition of otorhinolaryngology medical staffs.

PURPOSE: To assess awareness and recognition of vestibular function tests in otorhinolaryngology medical staffs, especially the vestibular evoked myogenic potentials (VEMP) testing in patients with obstructive sleep apnea (OSA). METHODS: A survey was delivered via either email or a social media app. The medical staffs of the Chinese Medical Association of Otolaryngology Head and Neck Surgery from various branches were enrolled. Study data were collected and managed with an online data collection tool. RESULTS: A total of 1781 emails and 623 social media messages were sent to 2404 otorhinolaryngology medical staffs. One hundred and fifty-seven of them participated in the survey, including 24 via emails and 133 via the social media app. Regarding the knowledge of VEMP, only 59 (37.6%) of them agreed that OSA could be related to vertigo/dizziness/imbalance and 28 (17.8%) believed that OSA could result in VEMP abnormalities and would factor this in diagnosing the impairment of the vestibular function of OSA patients. A total of 7.6% of the respondents had never heard of the VEMP tests. Responses regarding the minimum age at which VEMP are possible ranged from younger than 6 months to greater than 18 years of age. Beliefs regarding the utility and reliability of VEMP varied, with 'unsure' being the most frequent response. In addition, only 17.8% of otolaryngologists indicated some access to the VEMP test. CONCLUSIONS: Knowledge and beliefs about the role of VEMP in diagnosing otolithic organ dysfunction caused by OSA in otorhinolaryngology vary widely. It is important for otorhinolaryngology medical staffs to learn the latest literatures and updated knowledge through continuing education.

Gut microbiota and metabolite variations in a migraine mouse model.

Migraine is a prevalent clinical disorder characterized by recurrent unilateral throbbing headache episodes accompanied by symptoms such as nausea, vomiting, photophobia, and phonophobia. Despite its common occurrence, the diagnosis, pathophysiology, and treatment of migraine remain controversial. Extensive research has implicated the gut microbiota in various central nervous system disorders, including anxiety disorders, depression, and Parkinson's disease. Some studies have also suggested that migraine may stem from disruptions to neurohormones and metabolism. This study aimed to investigate the disparities in gut microbiota and metabolites between migraine mice model and normal mice to shed light on the underlying mechanisms and potential therapeutic approaches. Distinct differences in gut microbial composition were observed between the migraine mouse model and normal mouse, indicating a potential correlation between these variations and the pathogenesis of migraine. This study provides evidence of differences in gut microbiota composition and metabolites between a migraine mouse model and normal mice, which showed that Akkermansiaceae constituted the most abundant taxon in the sham injection mouse group, while Lachnospiraceae constituted the most prevalent group in the migraine mouse model group. The associations between the abundances of Akkermansia muciniphila and Lachnospiraceae bacteria and metabolites suggested their potential roles in the pathogenesis of migraine. The altered abundance of Lachnospiraceae observed in migraine-afflicted mice and its correlations with changes in metabolites suggest that it may affect the host's health. Thus, probiotic therapy emerges as a possible treatment for migraine. Moreover, significant disparities in gut metabolites were observed between the migraine mouse model and normal mice. These alterations encompass multiple metabolic pathways, suggesting that metabolic disturbances may also contribute to the development of migraines.

Optimal timing of salvage intratympanic steroids in idiopathic sudden sensorineural hearing loss.

Background: Salvage intratympanic steroids (ITS) works in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of initial therapy, but optimal timing of administration is unknown. Methods: Two hundred and seventy patients with ISSNHL were included. Among them, 180 were treated with ITS and standard medical treatment (SMT) and the other 90 received SMT along. The hearing threshold before and after salvage treatment were compared. The relationship between the salvage starting time and hearing recovery was analyzed. Results: The hearing of ITS group improved more than that of the SMT group in all frequency bands. The effect of both strategies decreases with the delay of the starting time. ITS can improve hearing even if being administrated 5 weeks after onset while SMT failed after 3 weeks. Conclusion: Patients with profound ISSNHL can obtain extra hearing recovery from salvage ITS. The earlier salvage starts, the greater the patient benefits.

Characteristics of clinical details and endolymphatic hydrops in unilateral and bilateral Ménière's disease in a single Asian group.

Objectives: To elucidate the characteristics of the clinical details and endolymphatic hydrops (EH) in bilateral Ménière's disease (BMD). Methods: A total of 545 patients with definite MD were enrolled. Demographic variables; the age of onset; disease course; inner ear function; the coexistence of related disorders such as migraine, delayed MD, drop attacks, and autoimmune diseases; familial history; and characteristics of EH were analyzed. Results: In the study population, the prevalence of BMD was 15.4%. The disease duration of BMD (84.0 ± 89.6 months) was significantly longer than that of unilateral MD (UMD, 60.1 ± 94.0 months) (P = 0.001). As evaluated by hearing thresholds and cervical and ocular vestibular evoked myogenic potentials, inner ear functions were more deteriorated in BMD (P < 0.05) than in UMD. The proportions of delayed MD and a family history of vertigo were significantly larger in BMD (P < 0.05). EH was observed in 100% of cases on the clinically affected side and 6.1% of cases on the unaffected side. Conclusion: A low prevalence of BMD, longer disease duration, higher frequencies of delayed MD, and family history of vertigo in patients with BMD were significant findings observed in the present study. All affected ears presented with EH, and a low percentage of unaffected sides presented with EH.

Auditory Manifestations of Vestibular Migraine.

Objectives: To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss. Methods: A total of 166 patients with VM were enrolled. Demographic variables, age of onset, disease course, distribution of vestibular attacks, characteristics of hearing loss, and the coexistence of related disorders, such as visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, tinnitus, aural fullness, and phonophobia, were analyzed and compared. Results: Patients with VM can manifest otalgia (8.4%), tinnitus (51.8%), aural fullness (41%), and phonophobia (31.9%). Of 166 patients, the prevalence of VMw was 21.1% (n = 35). Patients with VMw mainly manifested mild and easily reversible low-frequency hearing loss. The proportions of tinnitus and aural fullness were significantly larger in patients with VMw than that in patients with VMo (P < 0.05). The duration of vestibular symptoms was significantly shorter in patients with VMw (P < 0.05). However, the age of onset, disease course, gender, frequency of vestibular attacks, the coexistence of visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, and phonophobia had no significant difference between the two groups. Conclusion: Auditory symptoms were common in patients with VM. The hearing loss of VM was characterized by a mild and easily reversible low-frequency hearing loss, accompanied by higher proportions of tinnitus and aural fullness, and a shorter duration of vestibular symptoms compared with patients with VMo.

Clinical features and prognostic factors of pediatric idiopathic sudden hearing loss from moderate to profound degree.

BACKGROUND: The pediatric idiopathic sudden sensorineural hearing loss (PISSNHL) is not rare in the clinics, however, the prognostic factors of PISSNHL are still unclear. OBJECTIVES: To investigate the clinical and audiologic characteristics associated with prognosis in PISSNHL. MATERIAL AND METHODS: Clinical and audiological characteristics and possible prognostic factors were retrospectively evaluated in 76 PISSNHL patients aged less than 19 years. RESULTS: Hearing loss was moderate in nine patients, severe in 21 patients, profound in 46 patients. Among five types of audiogram, 3.9% were classified as ascending, 11.8% as descending, 25.0% as flat, 55.3% as profound, and 3.9% as concave. The recovery rate according to Siegel's criteria was 55.3%. There was no significant difference between the recovery group and the poor recovery group in terms of age, sex, laterality of hearing loss, the onset of treatment, and accompanying symptoms (p > 0.05). The initial hearing levels and the audiogram type were significantly different in the two groups (p < 0.001) according to univariate analysis, while only the initial hearing level was significantly different (p = 0.046) according to multivariate analysis. CONCLUSIONS AND SIGNIFICANCE: Prognosis of PISSNHL was mainly related to initial hearing at onset. An initial hearing level greater than 80 dB was a poor prognostic factor.

U0126 pretreatment inhibits cisplatin-induced apoptosis and autophagy in HEI-OC1 cells and cochlear hair cells.

Deafness is the most common sensory disorder in the world. Ototoxic drugs are common inducing factors of sensorineural hearing loss, and cochlear hair cell (HC) damage is the main concern of the present studies. Cisplatin is a widely used, highly effective antitumor drug, but some patients have experienced irreversible hearing loss as a result of its application. This hearing loss is closely related to HC apoptosis and autophagy. U0126 is a specific inhibitor of the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) signaling pathway and has neuroprotective effects. For example, the neuroprotective effect of U0126 on ischemic stroke has been widely recognized. In neural cells, U0126 can prevent death due to excess glutamate, dopamine, or zinc ions. However, no studies of U0126 and ototoxic drug-induced injury have been reported to date. In the present study, we found that U0126 pretreatment significantly reduced the apoptosis and autophagy of HCs in auditory House Ear Institute-Organ of Corti 1 (HEI-OC1) cells and cochlear HCs. In addition, U0126 reduced the cisplatin-induced production of reactive oxygen species as well as the cisplatin-induced decrease in the mitochondrial membrane potential. These findings suggest that U0126 may be a potential therapeutic candidate for the prevention of cisplatin-induced ototoxicity.

The outcomes of endoscopic myringoplasty: packing with gelatin sponge versus packing with nothing.

Background: Packing with gelatin sponge has long been widely used in myringoplasty. However, there is no research on packing with nothing.Aims/objectives: To analyse the differences between packing with gelatin sponge and packing with nothing.Material and methods: Patients with tympanic membrane perforation were randomly divided into a packing with gelatin sponge group and a packing with nothing group. Differences between the groups were compared.Results: The operation time of group A (34.00 ± 1.05 min) was significantly shorter than that of group B (42.20 ± 1.40 min; p < .00); 1 patient (2.86%) in group A and 35 patients (100%) in group B had a dry ear time of longer than 1 week (p < .001). Ten patients (28.57%) in group A and 24 patients (68.57%) in group B had aural fullness after the operation (p < .001). The air-bone gap (ABG) in group A was smaller than that in group B at 1 week, 1 month, 2 months and 3 months after the operation (p < .05).Conclusion and significance: Group A achieved the same good results, but it had a short operation time, an early dry ear time, a low incidence of aural fullness and early recovery of hearing.

PD-L1 and PD-1 expressed in trigeminal ganglia may inhibit pain in an acute migraine model.

BACKGROUND: Neurogenic inflammation, mediated by the activation of primary neurons, is thought to be an important factor in migraine pathophysiology. Programmed cell death ligand-1 (PD-L1) can suppress the immune response through the Programmed cell death-1 receptor. However, the role of PD-L1/PD-1 in migraine remains unclear. In this study we evaluated the expression and role of PD-L1/PD-1 in the trigeminal ganglia in an animal model of acute migraine. METHODS: Acute nitroglycerin induces acute mechanical hyperalgesia that can be used as a readout of migraine-like pain. We investigated the expression of PD-L1 and PD-1 in the trigeminal ganglia in a mouse model by means of immunofluorescence labeling, quantitative reverse transcription-polymerase chain reaction and western blotting. We explored the effects of PD-1 in a migraine model by the von Frey test and by analyzing the expression of calcitonin gene-related peptide, interleukin-1ß (IL-1ß), interleukin-18 (IL-18), Tumor Necrosis Factor-α (TNF-α), interleukin-6 (IL-6) and transient receptor potential vanilloid (TRPV4) after the intravenous injection of a PD-1 inhibitor. RESULTS: PD-L1 and PD-1 immunoreactivity were present in healthy trigeminal ganglia neurons. The mRNA levels of PD-L1 and PD-1 were significantly elevated 2 h, 4 h and 6 h after acute nitroglycerin treatment (p < 0.05). The protein levels of PD-L1 were significantly increased 2 h, 4 h and 6 h after treatment, and PD-1 was significantly increased at 2 h and 6 h. The blockade of PD-1 increased acute nitroglycerin-induced hyperalgesia, and this effect was accompanied by a more significant increase in calcitonin gene-related peptide, IL-1ß, TNF-α, IL-6 and IL-18 in the trigeminal ganglia. CONCLUSION: These findings suggest that PD-L1 and PD-1 might inhibit migraine-like pain by downregulating CGRP and inflammatory factors in the trigeminal ganglia. The use of PD-L1 and PD-1 as analgesics should be further studied.

Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss.

PURPOSE: Our study investigated correlations between clinical characteristics, particularly hearing recovery, interval time between onset and three-dimensional fluid attenuation inversion recovery magnetic resonance imaging (3D-FLAIR MRI), and the signal intensity of post-contrast 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (SSNHL). METHODS: The study enrolled 100 SSNHL patients. The signal intensities and asymmetry ratios of the inner ear structures, including the cochleae, vestibules and vestibulocochlear nerve, were evaluated and calculated. The relationships between the clinical characteristics and MRI findings were assessed. RESULTS: After intravenous gadolinium (Gd) injection, 3D-FLAIR revealed high signal intensities in 65 patients. The corrected asymmetry ratios of cochlea correlated closely with interval time between onset and MRI. The asymmetry ratios of the inner ear structures were significantly lower in patients with final complete to partial hearing recovery. The corrected asymmetry ratios of the inner ear structures correlated with initial/final pure tone audiometry (PTA) and hearing recovery in the affected ear. Notably, it was shown that the corrected asymmetry ratios identified a poor prognosis for hearing recovery, with a sensitivity and specificity of 67.9% and 75.0% in the cochlea, 83.3% and 75.0% in the vestibule, and 52.4% and 81.2% in the vestibulocochlear nerve, respectively. CONCLUSIONS: Post-contrast 3D-FLAIR after intravenous Gd injection in SSNHL can be used to assess the permeability of the blood-labyrinth and blood-nerve barriers. The asymmetry ratios of the inner ear structures may identify patients with poor prognosis for hearing recovery. Signal characteristics are closely related to interval time between onset and MRI.

Intratympanic dexamethasone for managing pregnant women with sudden hearing loss.

OBJECTIVE: This study aimed to investigate the effect and safety of intratympanic dexamethasone in pregnant women with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: We performed a prospective study on pregnant women who suffered from ISSNHL and were treated in our clinic during 2016. The patients received intratympanic treatment three to four times a week. A pure tone audiogram (PTA) was performed before treatment and patients were followed up until 2 months after treatment was finished. RESULTS: A total of six pregnant women were included. All of the patients tolerated intratympanic treatment well. The mean improvement in hearing was 48 ± 7.33 dB. There were no complications, including permanent perforation of the ear drum or middle ear infection. Each patient delivered a healthy newborn. CONCLUSION: Intratympanic dexamethasone is effective and safe for treating pregnant women with ISSNHL. Further randomized, controlled studies on this treatment need to be performed.

Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease.

OBJECTIVES/HYPOTHESIS: To study the differential diagnosis of vestibular migraine (VM) and Ménière disease (MD) by using magnetic resonance imaging (MRI) of intratympanic gadolinium. STUDY DESIGN: Prospective cohort study. METHODS: Definite MD patients (n = 30) and definite or probable VM patients (n = 30) were included, and the two groups were age and sex matched. Three-dimensional real inversion recovery (3D-real-IR) MRI was performed 24 hours after bilateral intratympanic gadolinium to assess the presence and degree of endolymphatic hydrops (EH). Response rates, amplitudes, latency, and response threshold of cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs) were tested by using air-conducted sound. Pure tone audiometry was used to evaluate the level of hearing loss. RESULTS: Different degrees of EH were observed in the cochlea and vestibule in the affected ears of MD patients, but only suspicious cochlear hydrops and no vestibular hydrops was noted in the VM patients. The correlation between the degree of EH and low-frequency hearing loss was statistically significant. Only the response threshold for c/oVEMP differentiated the MD-affected side from VM. The latency and amplitude for c/oVEMP showed no significant difference between groups. CONCLUSIONS: Characteristic pathological changes of MD include EH in the inner ear, and 3D-real-IR MRI helps differentiate VM from MD. VM and MD behaved similarly in vestibular dysfunction and their transduction pathway, but MD appeared to be more severe than VM. An association in their pathophysiology may play a part in these responses. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:2382-2388, 2017.

[Clinic significance of CT scan in diagnosis and management unsudden unilateral sensorineural hearing loss].

OBJECTIVE: To investigate the clinic significance of the temporal bone high-resolution CT in discovering unilateral sensorineural hearing loss of adolescents, and to provide the basis for the rational using of medical resources. METHOD: A retrospective study was conducted on 28 outpatients with unilateral sensorineural hearing loss at unsure time. Their medical history and CT examine were reevaluated,combined with associated articles in this report. RESULT: All of the 28 patients with unilateral sensorineural hearing loss had the normal external ear and middle ear and received CT scan. Nine out of twenty-eight cases had inner ear malformation. Among the nine cases, 1 cases was Mondini malformation and 1 cases was common cavity, 5 cases were single stenosis of IAC, and 2 cases were semicircular canal and vestibular malformation. 19 cases were not found abnormal by CT, and 4 cases had had suffered from mumps. CONCLUSION: CT scan was available in diagnosis of unsudden unilateral sensorineural hearing loss, which would help us to use medical resource more rationally.

[Importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo].

OBJECTIVE: To evaluate the importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo (BPPV) and its clinical characteristics. METHODS: The medical records of 288 BPPV patients treated during January 2009 to December 2010 were reviewed and analyzed. The definite diagnosis was established by re-examinations. RESULTS: Among them, 39 (13.5%) were diagnosed by re-examinations or return visits. And 25 patients received a correct diagnosis on the first visit and 14 were diagnosed on return visits. Their ages, gender distribution and the times of particle-repositioning maneuver were the same as the overall profiles. The rate of horizontal semicircular canal BPPV was higher in the 39 re-examined patients than the overall rate (46.15% vs 22.22%). And the latencies decreased during the second examination in 18 patients. CONCLUSION: Re-examinations and return visits are useful for diagnostic clarifications in the suspected BPPV patients.