ABSTRACT
The purpose of this study was to examine the quality of life (QoL) and hearing thresholds of patients who underwent 2 types of stapes surgery. A retrospective cohort study was performed comparing stapedotomy with NiTiBOND prostheses (n=20) and stapedectomy with autogenous cortical bone columella (n=20), applying the Glasgow Benefit Inventory (GBI) and the Hearing Handicap Inventory for Adults outcome measures with hearing thresholds. Univariate comparative statistical methods were applied. The stapedotomy cohort had significantly better values of Social Support Score of the GBI as compared to the stapedectomy cohort (P=.016). No statistically significant difference was detected between the groups in the pre- and postoperative audiological results and the further QoL measures. Apart from the excellent postoperative audiological results of the different types of stapes surgeries, stapedotomy with NiTiBOND prostheses seems to be superior as regards QoL over stapedectomy applying autogenous cortical bone columella.
Subject(s)
Auditory Threshold , Otosclerosis , Quality of Life , Stapes Surgery , Humans , Stapes Surgery/methods , Retrospective Studies , Male , Female , Adult , Middle Aged , Auditory Threshold/physiology , Otosclerosis/surgery , Treatment Outcome , Ossicular Prosthesis , Laser Therapy/methods , AgedABSTRACT
The aim of our study was to compare the characteristics and time to initial physician contact in patients with head and neck squamous cell carcinoma (HNSCC) before and during the COVID-19 pandemic at a large Hungarian cancer center. This was a retrospective study of patients 18 years or older presenting at the regional cancer center of Pécs Clinical Center with HNSCC between 1 January 2017, and 15 March 2020 (the pre-COVID-19 period) and between 16 March 2020, and 13 May 2021 (the COVID-19 period). Demographic and clinical data were collected, and the time between initial symptom onset and initial physician contact (TTP) was determined. Descriptive and exploratory statistical analyses were performed. On average, the number of patients diagnosed with HNSCC per month during the pandemic decreased by 12.4% compared with the pre-COVID-19 period. There was a significant increase in stage I and stage II cancers (from 15.9% to 20.3% and from 12.2% to 13.8%, respectively; p < 0.001); a decrease in stage III and IVa,c cancers; and a significant increase in stage IVb cancers (from 6% to 19.9%; p < 0.001) during the pandemic. The median TTP increased during the pandemic from 43 to 61 days (p = 0.032). To our knowledge, this is the first study investigating the effect of COVID-19 on patients with HNSCC in the Central-Eastern European region. We found a bidirectional shift in cancer stages and increased TTP during the pandemic. Our findings highlight the necessity for more nuanced analyses of the effects of COVID-19.
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PURPOSE: Single-sided deaf patients following cochlear implantation often compare the sound quality of their implanted ear with normal hearing. The interaural differences can result in dissatisfaction with speech comprehension and reduced time of usage of the speech processor; hence, prolonging auditory adaptation time. The proposed calibration method presented in this study demonstrates how the frequency distribution of the cochlear implant can be set to adequately approximate the pitch perception of the contralateral normal hearing ear towards improving speech intelligibility in a noisy environment. METHODS: In 12 postlingual single-sided deaf patients, subjective interaural pitch-matching was carried out to determine new central frequencies for the reallocation of the frequency bands of their speech processor (CP910, CP950 or CP1000, Cochlear, Australia). The patients were asked to compare the pitch of the tones presented to their normal hearing ear to the pitch of individual channels of their cochlear implant (CI522 or CI622, Cochlear, Australia). A third-degree polynomial curve was fit to the acquired matching frequencies to create the new frequency allocation table. Audiological measurements (free-field aided thresholds, speech reception thresholds, and monosyllabic word recognition score) in noise, together with a Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire (short version of the original SSQ) results were evaluated prior to the pitch-matching procedure, and again, 2 weeks later. RESULTS: The free-field aided thresholds of the patients showed no greater shift than ± 5 dB following the procedure; however, their monosyllabic word recognition score in noise improved significantly (mean - 9.58%, SD 4.98%, matched pairs t test comparison: p < 0.001). The results of the SSQ12 questionnaire also showed significant improvement in speech intelligibility, sound localization, and sound quality (mean 0.96 points, SD 0.45 points, matched pairs t test comparison: p < 0.001). CONCLUSIONS: Matching the pitch perception of the implanted cochlea with the sensation of the normal hearing contralateral ear, resulted in significant changes in the quality of hearing in patients with single-sided deafness. It is plausible the procedure can usher positive results in bimodal patients or following sequential bilateral cochlear implantation.
Subject(s)
Cochlear Implantation , Cochlear Implants , Deafness , Speech Perception , Humans , Cochlear Implantation/methods , Speech Intelligibility , Deafness/surgery , Deafness/rehabilitation , Pitch PerceptionABSTRACT
Branchial cleft cyst is the most common birth defect involving the neck. Malignant transformation is known, however, differentiating from a neck metastasis of a squamous cell carcinoma of unknown primary is challenging. Even though there are strict criterias, the diagnosis of this entity remains controversial. We present the case of a 69-year-old woman, who presented with a swelling under the left side of the mandible. After diagnostic workup, fine-needle aspiration biopsy raised the suspicion of a cystic squamous cell carcinoma metastasis, therefore we performed panendoscopy and modified radical neck dissection. The pathological examination confirmed branchial cleft cyst carcinoma. After surgery, the patient received adjuvant radiation and chemotherapy. During the case workup, we present the difficulties of the diagnostic process, differential diagnostic problems, and the review of the international literature. In the case of a solitary, cystic mass on the neck without a primary tumor, we should consider the possibility of a branchiogenic carcinoma. Orv Hetil. 2023; 164(10): 388-392.
Subject(s)
Branchioma , Carcinoma, Squamous Cell , Head and Neck Neoplasms , Female , Humans , Aged , Branchioma/diagnosis , Branchioma/pathology , Branchioma/surgery , Biopsy, Fine-Needle , Diagnosis, DifferentialABSTRACT
PURPOSE: Endoscopic type I tympanoplasty was originally introduced in the 1990s and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation and is defined as microscopic type I tympanoplasty. The aim of this study is the comparison of quality-of-life (QoL) outcomes with endoscopic to that with microscopic type I tympanoplasty. METHODS: All patients, or in the case of children with the aid of a parent, were asked to complete a novel QoL questionnaire drafted by our study group. The analysis was performed with descriptive statistics-mean, SD and relative frequency-and with a mixed model (generalized least squares fit). A two-sided p value of < 0.05 was regarded as statistically significant. RESULTS: A total of 83 patients completed the questionnaire, 38 in the endoscopic group and 45 in the microscopic group. Every question represented a different. A statistically significant result was found in favor of the endoscopic approach regarding average hospitalization rate (p = 0.003) and cosmetic outcomes (p = 0.015). No statistically significant difference was otherwise observed between the groups. CONCLUSIONS: Based on our prospective cohort study, the QoL outcomes of endoscopic type I tympanoplasty in terms of postoperative pain, headache, nausea, vomiting, dizziness, taste disorder and hearing were comparable to the microscopic type I tympanoplasty. In regard to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the average hospitalization rate proved to be statistically significantly lower than in the microscopic group.
Subject(s)
Quality of Life , Tympanoplasty , Child , Humans , Tympanoplasty/methods , Prospective Studies , Treatment Outcome , Myringoplasty/methodsABSTRACT
BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS: SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS: The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS: SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.
ABSTRACT
The selective epitympanic dysventilation syndrome is a new theory of the cholesteatoma formation, the description of which was allowed by a minimally invasive surgical technique the transcanal endoscopic ear surgery some years ago. The transcanal endoscopic ear surgery provided the possibility of a certain amount of detailed anatomical knowledge to identify the new factor behind this process, namely obstruction of the ventilation pathways of the middle ear. Our goal was to draw the ear surgeons' attention to this clinical picture as cholesteatoma development and subsequent worsening of the quality of life caused by ear discharge and conductive hearing loss may be reversible or preventable. We make the syndrome more understandable by using our own anatomical drawings. In this paper, the authors present a case of selective epitympanic dysventilation syndrome, and emphasize the importance of recognition and the endoscopic ear surgical treatment as well as review the international literature.
Subject(s)
Cholesteatoma, Middle Ear , Otologic Surgical Procedures , Cholesteatoma, Middle Ear/surgery , Ear, Middle , Endoscopy , Humans , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
Recent results by the authors on proton diffractive dissociation (single, double and central) in the low-mass resonance region with emphasis on the LHC kinematics are reviewed and updated. Based on the previous ideas that the contribution of the inelastic proton-Pomeron vertex can be described by the proton structure function, the contribution of the inelastic Pomeron-Pomeron vertex appearing in central diffraction is now described by a Pomeron structure function.
ABSTRACT
Introduction and objective: Mastoid obliteration technique combines the advantages of canal wall-up (CWU) and canal wall-down (CWD) approaches in the surgery of chronic suppurative otitis media with cholesteatoma. We aim to demonstrate our experience with mastoid obliteration technique using bone dust and BonAlive® (S53P4) bioactive glass granule in a comparative prospective clinical study. Patients and methods: Between 1st of March 2012 and 31st of November 2021, mastoid obliteration surgery was performed in 14 patients using bone dust (7 cases) and BonAlive® granule (7 cases). Prior to these interventions, the patients had undergone more than three ear surgeries (CWU and CWD) generally in both groups. Changes of complaints, audiological results, and changes in quality of life were analysed in both groups, postoperatively. Results: Having performed the mastoid obliteration technique, cochlear damage did not occur in either patient group. Long-term ear discharge and vertigo were occasionally observed after performing obliteration with bone dust. However, these complaints disappeared after a while. Complications were not reported in the case of obliteration with BonAlive®. Outstanding improvement was experienced in both groups. Conclusion: In our practice, mastoid obliteration surgery, using either bone dust or BonAlive® granule, has proved to
Subject(s)
Cholesteatoma, Middle Ear , Otitis Media, Suppurative , Otologic Surgical Procedures , Bone Substitutes/administration & dosage , Bone Transplantation/methods , Bone and Bones , Cholesteatoma, Middle Ear/complications , Cholesteatoma, Middle Ear/surgery , Dust , Glass , Humans , Mastoid/surgery , Otitis Media, Suppurative/complications , Otitis Media, Suppurative/surgery , Otologic Surgical Procedures/adverse effects , Otologic Surgical Procedures/methods , Prospective Studies , Quality of Life , Treatment OutcomeABSTRACT
Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsodleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezoként felmerül a perilymphafistula lehetosége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép mutéti kezelése a dobüreg feltárását követoen a belso fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelo hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmu okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követoen exploratív tympanotomiát végeztünk, melynek során a belso fül ablakait obliteráltuk. Hallásjavulást ezt követoen sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az elozetes kerekablak-obliteráció nem zárja ki a késobbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055-2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055-2060.
Subject(s)
Cochlear Implantation , Hearing Loss, Sensorineural , Hearing Loss, Sudden , Hearing , Humans , Round Window, EarABSTRACT
Összefoglaló. A Vibrant Soundbridge aktív középfül-implantátum vezetéses, sensorineuralis és kevert típusú halláscsökkenés esetén is megoldást jelenthet a beteg hallásrehabilitációja során. Sensorineuralis halláscsökkenés esetén akkor indikálható, ha a légvezetéses hallásküszöb nem haladja meg a 80-85 dBHL-t a 3-4 kHz frekvenciákon, vezetéses, illetve kevert típusú halláscsökkenés esetén pedig akkor, ha a csontvezetéses hallásküszöb nem haladja meg a 45-65 dBHL-t a 0,5-4 kHz közti frekvenciatartományban. Az implantátum beültetését eleinte tisztán sensorineuralis halláscsökkenés esetén végezték, és csupán egyféleképpen történhetett: a rezgéskelto rendszer oldalán lévo rögzítocsipeszt rá kellett applikálni az incus hosszú nyújtványára. Azokra az esetekre, amikor a rezgéskelto rögzítése nem kivitelezheto, különbözo rögzítoelemeket (coupler) fejlesztettek ki. Az incusra való rögzítés hosszúnyújtvány-couplerrel, illetve rövidnyújtvány-couplerrel lehetséges. Vezetéses és kevert típusú halláscsökkenés esetén a kerek ablak membránjához is illesztheto a rendszer, elorehaladott otosclerosis esetén pedig a Soundbridge-implantáció stapedotomiával kiegészített változata ("power stapes") hozhat kielégíto halláseredményt. Ezek a technikák meglehetosen megnövelték a sebész szabadságát, így széles körben alkalmazott, megbízható megoldássá váltak. A Pécsi Tudományegyetem Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikáján az elmúlt évtizedben számos incusvibroplastica történt, de kerekablak-vibroplasticára is több alkalommal sor került. A jelen összefoglaló tanulmányban a Vibrant Soundbridge implantátum technikai fejlodésének történeti áttekintésén felül az alkalmazható mutéti megoldásokat mutatjuk be. Orv Hetil. 2021; 162(40): 1619-1626. Summary. The Vibrant Soundbridge active middle ear implant can provide a reliable solution for hearing rehabilitation of patients with conductive, sensorineural or mixed hearing loss. For sensorineural hearing loss, the air conduction threshold of the patient should not be more increased than 80-85 dBHL at the range of 3-4 kHz, and for conductive and mixed hearing loss, the bone conduction threshold should not be more increased than 45-65 dBHL between 0.5 and 4 kHz. The standard surgical procedure was originally designed for purely sensorineural hearing loss, and the fixation clip of the vibrating transducer needed to be crimped onto the long process of the incus. In many cases, it is impossible to crimp the vibrator onto the incus. In order to solve such circumstances, fixation clips (couplers) have been developed. There are two options to crimp the device on the incus: applying a long process coupler or a short process coupler. For conductive or mixed hearing loss, a round window soft coupler has been introduced. In advanced otosclerotic cases, a special combined technique of Soundbridge implantation with simultaneous stapedotomy can result in sufficient hearing rehabilitation. These techniques significantly broadened the scale of possibilities for the implantation, therefore, it became a widely utilized, reliable procedure. At the Department of Otorhino-laryngology, Clinical Center, University of Pécs, in addition to a noteworthy amount of incus vibroplasty, several cases of round window vibroplasty have also been performed. The aim of the present study is to summarize the history of development of the Vibrant Soundbridge and to present an overview of the applicable surgical techniques. Orv Hetil. 2021; 162(40): 1619-1626.
Subject(s)
Ossicular Prosthesis , Stapes Surgery , Hearing , Humans , Round Window, Ear , StapesABSTRACT
Herpes zoster (HZ) causes considerable pain and distress, and γ-Aminobutyric acid (GABA) and its derivatives are assumed to control this, but the available data are inconsistent. This meta-analysis and systematic review aimed to assess the effectiveness of GABA derivatives in the prevention of acute herpetic pain. The metaanalysis was conducted following the PRISMA guidelines using PICO format, registered in PROSPERO number CRD42018095758. PubMed, Web of Science, Ovid, Scopus, and EMBASE databases were searched. Records were included if they were randomized controlled trials of patients undergoing HZ infection, investigating the effect of GABA derivatives versus placebo in the treatment of HZ pain. Eligible trials were evaluated for the risk of bias. Then data were extracted and analysed. The number of patients with observed presence of pain after treatment was used to calculate odds ratio in a random effect model with the DerSimonian-Laird estimator. The I2 statistic was analysed for heterogeneity. The potential risk of bias was measured using Egger's regression test. The meta-analysis included three randomized controlled trials with a total of 297 patients. The incidence of acute HZ pain events for GABA group was significantly lower compared to placebo group,18/148 vs 44/149, respectively (OR = 0.36; 95% CI = 0.14 to 0.93; Z = 2.11; P = 0.035), Egger's test yielded P = 0.308. In conclusion, the present meta-analysis demonstrates that GABA derivatives reduce the incidence of acute herpetic pain. However, additional, well-designed randomized clinical trials are needed to determine their dose- and time-dependency regarding this symptom.
Subject(s)
Acute Pain , Herpes Zoster , Acute Pain/drug therapy , Herpes Zoster/complications , Herpes Zoster/drug therapy , Herpes Zoster/epidemiology , Humans , Incidence , gamma-Aminobutyric AcidABSTRACT
Introduction: Subtotal petrosectomy (STP) has been known for decades and it is considered being on the borderline between ear and skull-base surgery. Due to its excessive radicalism and adverse effects on hearing, it has been a forgotten surgical technique until recently. Over the last decade, due to its many benefits and the ability to combine it with modern hearing rehabilitation methods, STP has reappeared, providing a definitive solution to a number of problematic middl-ear disorders. Aim: In our retrospective clinical study, we wanted to highlight the effectiveness of STP, analyzing the efficiency of this surgery for the first time in domestic patient records, and to report our own experiences to date. Method: We processed data from 45 surgeries on our 44 patients. In addition to presenting the various surgical indications, we review the steps of the operation, analyze the audiological results, including the various methods of hearing rehabilitation, and also analyze the complications that have occurred. Our results are also summarized in the light of international professional literature. Results: Of our 44 patients, 23 were female and 21 were male. Patients had a mean age of 44.6 ± 20.5 years and a mean follow-up of 23 ± 16 months. Of our patients, 25 (57%) had undergone at least two previous unsuccessful ear operations, and 6 (14%) had deafness before surgery. The most common indication was chronic otitis media with cholesteatoma. 13 patients underwent 14 cochlear implantations (23%), in addition 6 patients received bone anchored hearing aids (BAHA) (14%), and 2 patients (5%) underwent VSB (Vibrant Soundbridge) placement against the round window membrane. Complications occurred in 11 of our patients, the most common of which was cerebrospinal fluid leak (5 cases, 11%) and wound dehiscence (3 cases, 7%). Data from 3 patients were available for processing the audiological results. Conclusion: STP is an extremely favorable surgical solution for a number of middle-ear pathologies that have previously caused major problems. The main reason for its growing popularity is that it can be combined with a number of modern, effective methods of hearing rehabilitation. Orv Hetil. 2020; 161(14): 544-553.
Subject(s)
Otologic Surgical Procedures/methods , Adult , Cholesteatoma, Middle Ear/surgery , Female , Humans , Male , Middle Aged , Otitis Media/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
ABSTRACT
BACKGROUND: Several studies have suggested that monitoring the depth of anaesthesia might prevent the development of postoperative cognitive decline. We aimed to conduct a meta-analysis to investigate the effects of bispectral index (BIS) monitoring in anaesthesia. METHODS: We searched in six major electronic databases. Trials were included if they discussed anaesthesia with and without BIS monitoring or low (<50) and high (≥50) BIS levels and which measured the risk of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). RESULTS: We included fourteen studies in the systematic review, eight of which were eligible for meta-analysis. BIS proved to be protective against POD at 1 day postoperatively in a cohort of 2138 patients (16.1% vs. 22.8% for BIS vs. no BIS groups, respectively; relative risk [RR] 0.71; 95% confidence interval [CI] 0.59 to 0.85, without significant between-study heterogeneity I2 = 0.0%, P = 0.590). The use of BIS was neutral for POCD at 1 week but protective for POCD at 12 weeks (15.8% vs. 18.8% for BIS vs. no BIS groups, respectively; RR = 0.84, CI: 0.66 to 1.08), without significant between-study heterogeneity (I2 = 25.8%, P = 0.260). The neutral association at 1 week proved to be underpowered with trial sequential analysis. In the comparison of low BIS versus high BIS, the incidence of POD at 1 day was similar in the groups. CONCLUSION: Our findings suggest a protective effect of BIS compared to not using BIS regarding the incidence of POD at 1 day and POCD at 12 weeks. However, limitations of the evidence warrant further investigation to identify those groups of patients by age, comorbid conditions and other individual variables who would benefit the most from the use of BIS monitoring.
Subject(s)
Consciousness Monitors , Postoperative Complications/diagnosis , Delirium/diagnosis , Delirium/prevention & control , Humans , Postoperative Cognitive Complications/diagnosis , Postoperative Cognitive Complications/prevention & control , Postoperative Complications/prevention & controlABSTRACT
The aim of this study was to visualize the tumor propagation and surrounding mucosal field in radiography-based 3D model for advanced stage HNSCC and combine it with HPV genotyping and miRNA expression characterization of the visualized area. 25 patients with T1-3 clinical stage HNSCC were enrolled in mapping biopsy sampling. Biopsy samples were evaluated for HPV positivity and miR-21-5p, miR-143, miR-155, miR-221-5p expression in Digital Droplet PCR system. Significant miRNA expression differences of HPV positive tumor tissue biopsies were found for miR-21-5p, miR-143 and miR-221-5p compared to the HPV negative tumor biopsy series. Peritumoral mucosa showed patchy pattern alterations of miR-21-5p and miR-155 in HPV positive cases, while gradual change of miR-21-5p and miR-221-5p was seen in HPV negative tumors. In our study we found differences of the miRNA expression patterns among the HPV positive and negative tumorous tissues as well as the surrounding mucosal fields. The CT based 3D models of the cancer field and surrounding mucosal surface can be utilized to improve proper preoperative planning. Complex evaluation of HNSCC tissue organization field can elucidate the clinical and molecular differentiation of HPV positive and negative cases, and enhance effective organ saving therapeutic strategies.
Subject(s)
Imaging, Three-Dimensional/methods , MicroRNAs/genetics , Mouth Neoplasms/pathology , Mucous Membrane/pathology , Oropharyngeal Neoplasms/pathology , Papillomavirus Infections/complications , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Biomarkers, Tumor/genetics , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/genetics , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/virology , Child , Child, Preschool , Female , Follow-Up Studies , Gene Expression Regulation, Neoplastic , Genomics/methods , Humans , Infant , Infant, Newborn , Male , Middle Aged , Mouth Neoplasms/diagnostic imaging , Mouth Neoplasms/genetics , Mouth Neoplasms/virology , Mucous Membrane/diagnostic imaging , Mucous Membrane/metabolism , Mucous Membrane/virology , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/genetics , Oropharyngeal Neoplasms/virology , Papillomaviridae/isolation & purification , Papillomavirus Infections/virology , Prognosis , Survival Rate , Young AdultABSTRACT
OBJECTIVE: Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. METHODS: We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. RESULTS: Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). CONCLUSIONS: Endoscopic stapes surgery is a valid alternative to the microscope. LEVEL OF EVIDENCE: 2a Laryngoscope, 130: 2019-2027, 2020.
Subject(s)
Endoscopy , Microsurgery , Stapes Surgery/methods , Humans , Treatment OutcomeABSTRACT
BACKGROUND: Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty. OBJECTIVE OF REVIEW: The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty. TYPE OF REVIEW: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. SEARCH STRATEGY: A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics-Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, 'myringoplasty OR (tympanoplasty AND perforation)' into the search query. We applied only a 'human' filter. We excluded non-English studies. Additional records were identified by checking the references of relevant studies. EVALUATION METHOD: Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome. RESULTS: Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82-1.77; I2 = 0.0%), the postoperative hearing results (WMD = -1.13; 95% CI: -2.72-0.45; I2 = 78.1%) and the operation time (WMD = -21.11; 95% CI: -42.60-0.38; I2 = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30-14.76; I2 = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37-32.73; I2 = 0.0%, P = 0.839), when compared with the microscopic approach. CONCLUSIONS: Based on our meta-analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.
Subject(s)
Endoscopy , Microsurgery , Tympanic Membrane Perforation/surgery , Tympanoplasty , Humans , Treatment OutcomeABSTRACT
BACKGROUND/AIM: The role of microRNAs (miRNA) in carcinogenesis is related to their genome-regulatory function. The aim of the present study was to identify and compare miRNA expression signatures of meso- and hypopharynx squamous cell cancers in consideration of the cancer field hypothesis. PATIENTS AND METHODS: Thirteen snap-frozen biopsy series of tumors and peritumoral tissues from the meso- and hypopharynx were analyzed regarding their miRNA expression with quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Significant miRNA expression changes of miR-21, -27a, -34a, -143 and -146a were found in peritumoral tissues that were dependent from the tumor location and the distance from the primary tumor site. CONCLUSION: miRNA expression analysis was found to be appropriate for molecular segregation of tumor location and peritumoral tissue segments, and appears to be a promising marker for cancer field characterization.