Otosclerosis and stapedotomy: hearing improvement, complications, and analysis of potential prognostic factors in a series of 93 cases.

BACKGROUND: Stapedotomy is a common treatment for conductive hearing loss in otosclerosis patients. AIMS/OBJECTIVES: Results of stapedotomy were assessed in terms of hearing improvement and risk of complications. Potential prognostic factors affecting outcomes were identified. MATERIAL AND METHODS: Retrospectively, 93 stapedotomies were evaluated. The primary outcome was hearing improvement based on postoperative ABG ≤10 dB, Belfast rule of thumb, and AC gain ≥20 dB. Secondary outcomes were postoperative complications. Additionally, prognostic factors potentially affecting outcomes were analyzed (age, gender, comorbidity, preoperative audiometry, tinnitus, or vertigo). RESULTS: A mean ABG of ≤10 dB was achieved in 59%. According to the Belfast rule of thumb, 75% achieved interaural symmetry within ≤15 dB and/or a mean AC4 of ≤30 dB. A gain in AC4 of ≥20 dB was achieved in 57% of primary surgeries. The larger the preoperative ABG, the better hearing after surgery. There was no significant difference in hearing improvement at early and late follow-ups. Transient vertigo was the most common complaint (37%). Taste disturbances were the most frequent permanent complication (14%). CONCLUSION AND SIGNIFICANCE: Stapedotomy gave good audible improvement with a low risk of complications. Preoperative ABG was the only prognostic factor affecting the hearing outcome. Only one follow-up 6-12 months seems relevant.

背景：镫骨切开术是耳硬化症患者传导性听力损失的常见治疗方法。目的：根据听力改善和并发症风险评估镫骨切开术的结果。 确定影响结果的潜在预后因素。材料和方法：回顾性评估了 93 例镫骨切除术。 主要结果是听力改善, 基于术后 ABG ≤10dB、贝尔法斯特经验法则和 AC 增益 ≥20dB。次要结果是术后并发症。 此外, 分析了可能影响结果的预后因素（年龄、性别、合并症、术前听力检查、耳鸣或眩晕）。结果：59% 的患者取得平均 ABG ≤10dB。 根据贝尔法斯特经验法则, 75% 的患者实现 ≤15dB 以内的耳间对称性和/或平均 AC4≤30dB。 57% 的初次手术实现AC4 的增益≥20dB 。 术前ABG越大, 术后听力越好。早期和晚期随访时的听力改善没有显著差异。 短暂的眩晕是最常见的主诉（37%）。 味觉障碍是最常见的永久性并发症（14%）。结论和意义：镫骨切开术带来了良好的听觉改善, 且并发症风险较低。 术前 ABG 是影响听力结果的唯一预后因素。 仅一次6-12 个月的随访似乎是相关的。.

Superficial Parotidectomy: Impact of Postoperative Drainage.

BACKGROUND: Use of suction drain after superficial parotidectomy (SP) is based on national consensus considered best practice, but there is no evidence on the effect of the treatment. The aim of the present study is to evaluate the effectiveness of drainage after SP by evaluating the rate of complications after SP in relation to the (ie, duration) of drainage and tumor size. METHODS: Retrospective analysis was performed involving data from all consecutive patients undergoing SP at the Ear, Nose, and Throat department, Regional Hospital West Jutland, Denmark, between January 1, 2011, and December 31, 2017. Demographics including comorbidity, medication, tumor size, postoperative secretion through the drainage, as well as complications (hematoma, seroma, infection, fistulas, Frey syndrome, facial nerve palsy) were registered. Patients with secretion below 25 mL were compared to patients with secretion above 25 mL, that is, drainage less than 24 hours versus longer than 24 hours. Results: Two hundred five consecutive patients undergoing SP were enrolled. The overall risk of postoperative infection was 16.2%. Ten of 33 patients with infection were also diagnosed with an hematoma or seroma. The risk of infection increased with secretion above 25 mL (27.2%) compared to patients with less than 25 mL (13.1%; P = .0318). The same accounts for the risk of seromas/hematomas (P = .0055). We found no evidence that demographics or comorbidity correlated to the secretion in the drainage, but there is a tendency toward male gender having a higher risk off secretion above 25 mL (odds ratio 1.39). CONCLUSION: Overall, the risk of complications after SP increased with secretion beyond 25 mL (ie, drainage for more than 24 hours). This applied in particular to infections and seromas/hematomas demanding treatment. The use of routine drainage after SP is questionable, and a randomized trial is warranted to unravel the necessity of postoperative drainage.

No clinical advantages of coblation tonsillectomy compared with traditional tonsillectomy.

INTRODUCTION: Tonsillectomy may be performed by several methods. It is continuously being discussed which method is preferable with regard to postoperative haemorrhage, pain, activity and nutrition. MATERIAL AND METHODS: The present study is a prospective non-randomized study of tonsillectomy. It included 198 patients aged 14-40 years who either underwent coblation tonsillectomy or traditional "cold" tonsillectomy after random allocation to different surgeons. A total of 51 patients underwent coblation tonsillectomy and 147 patients underwent traditional tonsillectomy. We tested the hypothesis that there is no difference in postoperative pain experience between the two surgical techniques. The patients were followed for nine days postoperatively. They filled in a questionnaire on postoperative pain score, activity level and food intake. RESULTS: We found no statistically significant difference in pain perception between the two groups and there was no difference in their levels of activity. The intraoperative haemorrhage was significantly reduced in the coblation tonsillectomy group, but there was no difference in postoperative haemorrhage between the two groups. CONCLUSION: The overall results of this study suggest that neither coblation tonsillectomy nor traditional tonsillectomy enjoys an advantage over the other in patients aged 14-40 years. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Herpes zoster oticus with cranial nerve affection]. / Herpes zoster oticus med kranienerveaffektion.

Herpes zoster oticus (HZO) with cranial polyneuropathy is also known as Ramsay Hunt syndrome (RHS). After primary varicella infection, the varicella zoster virus (VZV) remains dormant in the nervous system and can reactivate later in life causing RHS. This case describes a 56-year-old man with HZO and palsy of N. V, VII, VIII, IX, X and XII. Anti-viral agents might be effective in patients with RHS, although the only randomized controlled clinical trial on this subject found no significant benefit. There are no randomized controlled trials to support the use of corticosteroid therapy.

Cervical thoracic duct cyst: a differential diagnosis of left supraclavicular swelling.

We report a 79-year-old woman with a left sided neck mass that appeared to be a thoracic duct cyst (TDC). A TDC is a rare condition. Generally, it may cause local symptoms, but most likely it presents as an asymptomatic swelling. The pathogenesis of TDC is not known, but different theories on the development, including weakness of the duct wall and obstruction of the lymphoid flow, have been suggested. Sonography with needle aspiration, examination of the cyst fluid, and CT scan/MRI may raise the suspicion of the TDC diagnosis. Surgery with total excision of the cyst, followed by histopathological examination confirms the diagnosis.

Restored speech comprehension linked to activity in left inferior prefrontal and right temporal cortices in postlingual deafness.

The left inferior prefrontal cortex (LIPC) is involved in speech comprehension by people who hear normally. In contrast, functional brain mapping has not revealed incremental activity in this region when users of cochlear implants comprehend speech without silent repetition. Functional brain maps identify significant changes of activity by comparing an active brain state with a presumed baseline condition. It is possible that cochlear implant users recruited alternative neuronal resources to the task in previous studies, but, in principle, it is also possible that an aberrant baseline condition masked the functional increase. To distinguish between the two possibilities, we tested the hypothesis that activity in the LIPC characterizes high speech comprehension in postlingually deaf CI users. We measured cerebral blood flow changes with positron emission tomography (PET) in CI users who listened passively to a range of speech and non-speech stimuli. The pattern of activation varied with the stimulus in users with high speech comprehension, unlike users with low speech comprehension. The high-comprehension group increased the activity in prefrontal and temporal regions of the cerebral cortex and in the right cerebellum. In these subjects, single words and speech raised activity in the LIPC, as well as in left and right temporal regions, both anterior and posterior, known to be activated in speech recognition and complex phoneme analysis in normal hearing. In subjects with low speech comprehension, sites of increased activity were observed only in the temporal lobes. We conclude that increased activity in areas of the LIPC and right temporal lobe is involved in speech comprehension after cochlear implantation.

[When cochlear implants came to Denmark and the deaf began to hear]. / Da cochlear implant kom til Danmark og de døve blev hørende.

For several hundreds years, deafness in humans and deaf-mute humans has been a challenge to doctors and other therapists. During the last 50 years, it has become possible to treat deaf people. The reasons for this success in treatment and the introduction of the treatment in Denmark are the topics of this text. To make deaf people hear, patients were treated with electricity for more than two hundred years,in Denmark as well as other countries. This development depended on many important factors for a positive result of the treatment. The first operation of a deaf patient in Denmark was performed in Odense. Some years later the treatment began at Gentofte Hospital and later at Aarhus City Hospital. The start was slow, to some extent because of financial circumstances but also because the necessary equipment was not fully developed. There were also difficulties with selection of the most suited patients, training of patients, resistance against treatment from organisations of the deaf and from conventional teachers of the deaf. The problems were solved over a period of some years, and the population could soon see and meet patients as celebrities, i.e., previously deaf persons who could now use a telephone. More than 600 deaf people have now been operated in Denmark. The term deafness has changed its meaning, and probably there will no new cases of the deaf-mute in the future.