Drainage of Inferiorly Extended Peritonsillar Abscess Using an Endoscope and Radiofrequency Device: Technical note.

Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the larynx is atypical. Accurate diagnosis and prompt treatment are required because airway obstruction, descending mediastinitis, or thrombophlebitis may result. We evaluated surgical outcomes of inferiorly extended PTA (IEPTA) using an endoscope and a radiofrequency device for intraoral drainage. We retrospectively reviewed the medical records of 56 patients with IEPTA who underwent incisional drainage between 2013 and 2021. Two experienced surgeons performed intraoral drainage using an endoscope and a radiofrequency device (endoscopic group [EG]) or without such devices (WEG). Thirty (male: 26, female: four; mean age: 51.3 years), and 26 (male: 21, female: five; mean age: 55.9 years) patients in the EG and WEG, respectively, were evaluated. The mean hospitalization durations were 6.7 and 14.5 days for the EG and WEG, respectively (p<0.01). There were significant between-group differences regarding the number of tracheostomies conducted to secure an airway or surgical field (EG: four (13.3%); WEG: 16 (61.5%); p<0.01. The hospitalization duration for patients undergoing tracheostomy was significantly shorter in the EG than in the WEG (9.3 vs. 18.5 days, respectively; p=0.01). No significant difference in the mean hospital stay was observed for patients who did not undergo tracheostomy ([EG: 6.3, WEG: 8.2] days; p=0.081). IEPTA drainage using an endoscope and a radiofrequency instrument can reduce duration of hospitalization and tracheostomy procedures compared with the conventional method. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03362-0.

EEG-controlled tele-grasping for undefined objects.

This paper presents a teleoperation system of robot grasping for undefined objects based on a real-time EEG (Electroencephalography) measurement and shared autonomy. When grasping an undefined object in an unstructured environment, real-time human decision is necessary since fully autonomous grasping may not handle uncertain situations. The proposed system allows involvement of a wide range of human decisions throughout the entire grasping procedure, including 3D movement of the gripper, selecting proper grasping posture, and adjusting the amount of grip force. These multiple decision-making procedures of the human operator have been implemented with six flickering blocks for steady-state visually evoked potentials (SSVEP) by dividing the grasping task into predefined substeps. Each substep consists of approaching the object, selecting posture and grip force, grasping, transporting to the desired position, and releasing. The graphical user interface (GUI) displays the current substep and simple symbols beside each flickering block for quick understanding. The tele-grasping of various objects by using real-time human decisions of selecting among four possible postures and three levels of grip force has been demonstrated. This system can be adapted to other sequential EEG-controlled teleoperation tasks that require complex human decisions.

Adaptive Discount Factor for Deep Reinforcement Learning in Continuing Tasks with Uncertainty.

Reinforcement learning (RL) trains an agent by maximizing the sum of a discounted reward. Since the discount factor has a critical effect on the learning performance of the RL agent, it is important to choose the discount factor properly. When uncertainties are involved in the training, the learning performance with a constant discount factor can be limited. For the purpose of obtaining acceptable learning performance consistently, this paper proposes an adaptive rule for the discount factor based on the advantage function. Additionally, how to use the advantage function in both on-policy and off-policy algorithms is presented. To demonstrate the performance of the proposed adaptive rule, it is applied to PPO (Proximal Policy Optimization) for Tetris in order to validate the on-policy case, and to SAC (Soft Actor-Critic) for the motion planning of a robot manipulator to validate the off-policy case. In both cases, the proposed method results in a better or similar performance compared with cases using the best constant discount factors found by exhaustive search. Hence, the proposed adaptive discount factor automatically finds a discount factor that leads to comparable training performance, and that can be applied to representative deep reinforcement learning problems.

Activation of the Complement System on Human Endothelial Cells by Urban Particulate Matter Triggers Inflammation-Related Protein Production.

Exposure to particulate matter (PM) is becoming a major global health issue. The amount and time of exposure to PM are known to be closely associated with cardiovascular diseases. However, the mechanism through which PM affects the vascular system is still not clear. Endothelial cells line the interior surface of blood vessels and actively interact with plasma proteins, including the complement system. Unregulated complement activation caused by invaders, such as pollutants, may promote endothelial inflammation. In the present study, we sought to investigate whether urban PM (UPM) acts on the endothelial environment via the complement system. UPM-treated human endothelial cells with normal human serum showed the deposition of membrane attack complexes (MACs) on the cell surface via the alternative pathway of the complement system. Despite the formation of MACs, cell death was not observed, and cell proliferation was increased in UPM-mediated complement activation. Furthermore, complement activation on endothelial cells stimulated the production of inflammation-related proteins. Our results revealed that UPM could activate the complement system in human endothelial cells and that complement activation regulated inflammatory reaction in microenvironment. These findings provide clues with regard to the role of the complement system in pathophysiologic events of vascular disease elicited by air pollution.

Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis.

BACKGROUND: The efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty. METHODS: PubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case-control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs). RESULTS: Thirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024-0.056) than in the no splint group (0.087, 95% CI 0.055-0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups. CONCLUSIONS: These findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.

Periorbital Emphysema Presenting With Diplopia After Rhinoplasty.

Periorbital emphysema is a well-known but very rare complication after rhinoplasty. Here, we present a case of periorbital emphysema presenting with diplopia and eyeball deviation after rhinoplasty. All symptoms disappeared spontaneously within days, without any complications.

Esthetic nasolabial angle according to the degree of upper lip protrusion in an Asian population.

BACKGROUND: The positioning of the nasal tip is as esthetically important as the tip projection when rhinoplasty is being considered. It is not uncommon for Asians to have a protruding upper lip and teeth that affect the nasolabial angle (NLA). This study aimed to find the preferred NLA according to the degree of upper lip protrusion in an Asian population. METHODS: A left-side lateral photograph of each participant was used for simulation of six different tip angles by using a photoshop program. First, the angles of the upper lip protrusion were changed into 10, 20, and 30° by a perpendicular line to the Frankfort line in each image; then, the NLAs were changed into six different angles (from 75 to 110°) for each of the three angles of upper lip protrusion for each model. Newly transformed images of nasal tips, six for the male model and six for the female model, were made by using presentation software slides and were placed in a random order. Then, 120 Korean raters were asked to choose the most preferred image from among the slides. RESULTS: In 10° of upper lip protrusion, the preferred mean ± standard deviation (SD) NLAs for the male and female models were 88.7 ± 6.4° and 92.9 ± 6.9°, respectively. In 20° of upper lip protrusion, the preferred mean ± SD NLAs for the male and female models were 80.9 ± 6.9° and 83.9 ± 5.7°, respectively. In 30° of upper lip protrusion, the preferred mean ± SD NLAs for the male and female models were 78.4 ± 5.5° and 79.0 ± 5.4°, respectively. CONCLUSION: In an Asian population, the preferred NLA was changed to a more acute angle according to the degree of upper lip protrusion.

Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo.

OBJECTIVES: We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). METHODS: A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. RESULTS: The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. CONCLUSION: Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.

Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus.

BACKGROUND AND OBJECTIVES: We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. SUBJECTS AND METHODS: Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. RESULTS: A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). CONCLUSIONS: Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.

Intralesional triamcinolone injections for the treatment of preauricular sinus infections.

OBJECTIVES: The aim of this study is to confirm the effect of adjuvant intralesional triamcinolone acetonide injections (TRIAM) for the treatment of an infected preauricular sinus (PAS). METHODS: The medical charts of 103 patients diagnosed with PAS from March 2013 to December 2015 were reviewed and documented. The mean duration of treatment and postoperative follow-up period were compared between patients who received TRIAM and patients who received conventional treatment. RESULTS: Fifteen patients received TRIAM. The mean duration of treatment was 12.5±11.0days in patients treated with TRIAM, which was significantly shorter than patients without TRIAM (25.5±25.7days, p=0.010). In addition, the percentage of patients experiencing early recovery (within 10days) was 4.15 times higher with TRIAM (95% confidence interval: 1.07-16.13, p=0.040). The mean postoperative follow-up period revealed a similar tendency; patients treated with TRIAM required a shorter follow-up period (8±2.6days) than patients not treated with TRIAM (13.5±7.4days). However, this difference was not significant (p=0.242). CONCLUSION: Although the sample was small, patients with PAS infections who were treated with TRIAM as an adjuvant therapy required a significantly shorter treatment duration than patients receiving conventional treatment alone. This finding suggests a beneficial effect of TRIAM for the short-term control of PAS infections. Clinicians should consider TRIAM as an adjuvant treatment option.

Endonasal extended columellar strut in Asian rhinoplasty.

BACKGROUND: Recently, sculpturing of projected and sharp nasal tips, as is usual in the white population, has been of great concern in Asian rhinoplasty. However, tip surgery in Asians should be performed in a different way due to anatomic differences. The authors used an endonasal rhinoplasty to correct the position of lower lateral cartilage by adopting a modified columellar strut. This novel technique of an endonasal extended columellar strut (EECS) could project the nasal tip significantly while avoiding hard fixation. This study aimed to evaluate the usefulness of the EECS in Asians. MATERIALS AND METHODS: A retrospective study was performed with 40 patients who underwent EECS from March 2012 to August 2014. Photographs taken preoperatively and postoperatively were analyzed. The tip projection, the ratio of the length of the infratip lobule to the total length of the tip, and a columellar labial angle change were measured. Overall, surgical outcomes were rated into three grades (excellent, good, and fair) by two experienced rhinoplasty surgeons (J.Y.K., M.S.C.). All the patients were asked to rate their cosmetic satisfaction by using a visual analog scale (10 points). RESULTS: Postoperative nasal tip projection significantly increased, from 24.2 to 26.7 mm (p < 0.01). The ratio of the length of the infratip lobule to the total length of the tip mildly increased, from 0.45 to 046 in men, and remained unchanged, at 0.48, in women. The columellar labial angle significantly increased, from 86.9° to 93.7° (p < 0.01). Surgical outcomes were rated by two experienced surgeons as excellent (40%), good (42%), and fair (18%). Subjectively, patients graded their satisfaction at ∼ 8.7 on the visual analog scale. CONCLUSION: This novel EECS technique enabled satisfactory tip projection in Asians while maintaining a natural ratio of infratip lobule to total length of tip and leaving no external scar.

Usefulness of Curved-Shaft Needles for Infiltrating the Sphenopalatine Area.

The objective of this study is to evaluate what types of needles are optimal and efficient for infiltrating the sphenopalatine area during endoscopic sinus surgery. Prospective, randomized, open-labeled study was designed. Sixty-three sides of nasal cavities of 45 patients were randomly assigned to three groups with different needle shapes. The group 1 needles had a straight shaft, the group 2 had an obtuse curved shaft, and the group 3 had an arch-shape shaft. The infiltration time for group 1 was longer than that for group 2 and group 3. There was significant difference in the secondary infiltration time between group 1 and group 3 (p = 0.005). We devised new curved-shaft needles that can utilize the 'lever effect' and showed that they are more efficient than straight shaft needles for infiltrating the sphenopalatine area.

Acute-Onset Tinnitus Is Associated with Contralateral Hearing in Sudden Deafness.

OBJECTIVE: We aimed to evaluate the prognostic factors for acute-onset tinnitus associated with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) and to assess the relationship between these factors and the final recovery. METHODS: A total of 770 patients with unilateral ISSNHL were enrolled retrospectively and their medical records reviewed. Patients were classified into two groups according to the presence of acute-onset tinnitus at the initial examination. Patient characteristics and the results of pure-tone audiometry were compared between the two groups initially and 3 months later. RESULTS: A total of 70.9% (n = 546) of patients had tinnitus initially. There was no significant difference in the mean hearing thresholds of the affected ear irrespective of accompanying tinnitus. In contrast, patients with tinnitus in the affected ear tended to have significantly better mean hearing thresholds in the nonaffected ear (p < 0.05). The logistic regression analysis revealed that better mean hearing thresholds in the nonaffected ear were associated with tinnitus occurrence (p < 0.05). Better hearing thresholds in the nonaffected ear, younger age, absence of dizziness, low-tone hearing loss, and combined intratympanic dexamethasone injection were associated with full recovery (p < 0.05). However, tinnitus was not an independent risk factor for full recovery. CONCLUSION: Better contralateral hearing was associated with both an increased incidence of concurrent tinnitus and a better final recovery. However, tinnitus was not related to full recovery.

A rare case of intranasal vascular leiomyoma.

Vascular leiomyoma (VL) is a solitary and rare form of leiomyoma that usually occurs in the skin or subcutaneous tissue of the lower extremities. Intranasal VL is extremely rare, probably due to the lack of smooth muscle in the nasal cavity. In this study, we report a case of a 70-year-old woman with VL of the inferior nasal turbinate. An endoscopic examination revealed a pinkish globular mass at the inferior turbinate. A preoperative CT scan exhibited a highly enhanced mass originating from the inferior turbinate, and haemangioma was suspected. The patient underwent complete excision of the mass endoscopically, and the histopathological report indicated that the mass was a VL. The tumour was determined to be negative for progesterone and estrogen receptors by immunohistochemical staining. The postoperative period was uneventful. There was no local recurrence during the 12-month follow-up period.

Unexpected rare complication of the facial paralysis in a patient with an antrochoanal polyp following canine fossa puncture.

Canine fossa puncture (CFP) combined with endoscopic sinus surgery is a simple and effective method for treating antrochoanal polyps, particularly those that originate in the anterior, inferior or medial aspect of the antrum. Several complications can occur following CFP, including facial paraesthesia and dental numbness. However, facial palsy is extremely rare after CFP. We postulated that a possible mechanism of facial palsy is pressure injury to the soft tissues adjacent to the puncture site, which can damage the buccal branch of the facial nerve during CFP.

Therapeutic effect of combined steroid-lipoprostaglandin E1 for sudden hearing loss: a propensity score-matched analysis.

OBJECTIVES: The aim of this study is to analyze the synergistic effect of combined steroid-lipoprostaglandin E1 for the treatment of sudden hearing loss. METHODS: A prospective observational, non-randomized study with a historical cohort was performed at a university hospital. Between 2005 and 2012, 421 patients with idiopathic sudden sensorineural hearing loss were enrolled in this study and treated with combined steroid-lipoprostaglandin E1 treatment. Additionally, 132 patients were prospectively enrolled and treated with steroid treatment alone between January 2013 and March 2014. After performing a propensity score-matched analysis, final hearing levels and the degree of recovery were compared according to treatment options. RESULTS: A total of 240 patients were enrolled after propensity score-matching, with 180 patients classified as combined steroid-lipoprostaglandin E1 treatment group (group I) and 60 patients as steroid treatment alone group (group II). The final hearing level (35.56±34.64dB) in group I was not significantly different from that in group II (34.64±24.67dB) (p<0.05). Logistic regression analysis revealed that the combined treatment did not influence recovery, and the probability of recovery was 1.881 times higher in the absence of dizziness (95% confidence interval: 1.022-3.464, p=0.042), and 1.026 times higher in patients with better hearing in healthy ears (95% confidence interval: 1.010-1.041, p=0.001). CONCLUSION: Compared to steroid treatment alone, combined steroid-lipoprostaglandin E1 treatment failed to improve sudden hearing loss.

Optimal dosage of methylprednisolone for the treatment of sudden hearing loss in geriatric patients: a propensity score-matched analysis.

We aimed to compare the treatment outcomes and the occurrence rates of adverse events associated with different steroid regimens in geriatric patients (aged 65 years or older) with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). After thorough medical chart reviews of 109 patients with ISSNHL between May 2006 and December 2013, we performed a propensity score-matched analysis using previously known prognostic factors, steroid regimens, and other cointerventions. Patients were divided based on their steroid regimens into group I (which initially received 48 mg of methylprednisolone daily with a subsequently tapered dose) and group II (which initially received 24 mg of methylprednisolone daily with a subsequently tapered dose). We compared final hearing and the occurrence of adverse events between the two groups. As a result, 20 pairs of propensity score-matched patients (n = 40) were enrolled. Group I patients showed better final hearing levels compared with group II patients (42.00 ± 22.35 dB and 57.38 ± 26.40 dB, respectively), although this difference was marginally significant (p = 0.058). Based on the comparative analysis of each of the frequencies in the final audiograms, lower hearing thresholds at 2 KHz were observed in group I (p = 0.049). There was no significant difference in the occurrence of adverse effects between the two groups (p>0.05). In conclusion, conventional steroid regimens produced adverse event occurrence rates that were similar to those of low-dose treatment but may also have produced superior hearing recovery. The use of steroid dose reduction in geriatric patients with ISSNHL is not preferable to conventional steroid regimens.

Combined endoscopic transnasal and intrasphenoidal septal approach for the drainage of sphenoid sinusitis with cleft lip: technical note.

Isolated sphenoiditis is an uncommon disease, particularly in children. Immediate antibiotic therapy and/or endoscopic transnasal sphenoidotomy should be performed to avoid fatal complications. However, the commonly used transnasal route is not always available in children with a cleft lip and deviated nasal septum. We report a case of acute isolated sphenoid sinusitis in a 12-year-old boy with a cleft lip and deviated nasal septum. This patient underwent combined endoscopic transnasal and intrasphenoidal septal surgery and improved without septoplasty, which may affect the later growth of the nose.