Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study.

The study investigated surgical interventions to improve dysphagia in patients with lateral medullary syndrome (LMS), along with optimal scheduling of surgery and prognostic factors. In this retrospective, single-center cohort study, dysphagia patients with LMS who underwent surgery between January 2010 and December 2021 were enrolled. The National Outcomes Measurement System (NOMS) was used to classify swallowing function (level 1: only tube feeding, level 5: without tube feeding). Patients were divided into four groups. Groups 1 and 2, LMS onset within 1 year, and groups 3 and 4, onset after 1 year. Groups 1 and 3 had infarctions confined to the oblongata. Groups 2 and 4 had infarctions extending to the cerebellum. The primary outcome was the time to achieve NOMS ≥ 5. The final NOMS level and pathological findings were considered. Nineteen cases were included. Group 4 comprised one case and was excluded. The mean overall preoperative NOMS was 1.11. The mean time to NOMS ≥ 5 was 9.6 months (95% confidence interval: 5.04-14.2), and that to NOMS ≥ 5 was 1.67 (1.07-2.26), 11.4 (4.71-18.1), and 7.6 (5.15-10.1) months for groups 1, 2, and 3, respectively. Group 1 achieved NOMS ≥ 5 earlier than groups 2 and 3 (P = 0.01 and 0.03, respectively). The overall final NOMS value was 4.68. Fourteen patients had atrophy or fibrosis of the cricopharyngeal muscle. In conclusion, surgery was effective for effective for treating dysphagia in LMS patients. However, improvement is prolonged if > 1 year has passed since onset or the infarction extended to the cerebellum.

Prevention of cuff injury of the intubation tube by blunt window opening in tracheostomy.

One of the intraoperative complications of tracheostomy under general anesthesia is cuff injury of the intubation tube. In the present study, we investigated whether a blunt tracheal opening is a useful method to avoid cuff injury. A retrospective cohort study was conducted to examine patients who underwent tracheostomy under general anesthesia at a single institution from January 1, 2017 to July 31, 2021. Electrocautery was used to thin the connective tissue between the tracheal rings, and bluntly open the trachea with mosquito forceps or similar instruments. Primary outcomes included cuff injury rate, number of surgeons involved, and career as otolaryngologist at the time of surgery. The secondary outcome was perioperative complications. Of the 64 cases, 3 had cuff injuries. 2 of the 3 had cuff injuries during the creation of an anteriorly based flap. 16 surgeons were involved ranging from the first to sixth year as an otolaryngologist, with the third year of otolaryngologist being the most common. The median physician year for instructors was 18 years. The most common postoperative complication was granulation in 9 cases. There were no cases of incorrect cannula insertion or difficulty in cannula insertion. A blunt tracheal opening was considered useful as a method to prevent cuff injury.

The Hearing Outcomes of Cochlear Implantation in Waardenburg Syndrome.

Objectives. This study aimed to determine the feasibility of cochlear implantation for sensorineural hearing loss in patients with Waardenburg syndrome. Method. A retrospective chart review was performed on patients who underwent cochlear implantation at the University of Tokyo Hospital. Clinical classification, genetic mutation, clinical course, preoperative hearing threshold, high-resolution computed tomography of the temporal bone, and postoperative hearing outcome were assessed. Result. Five children with Waardenburg syndrome underwent cochlear implantation. The average age at implantation was 2 years 11 months (ranging from 1 year 9 months to 6 years 3 months). Four patients had congenital profound hearing loss and one patient had progressive hearing loss. Two patients had an inner ear malformation of cochlear incomplete partition type 2. No surgical complication or difficulty was seen in any patient. All patients showed good hearing outcome postoperatively. Conclusion. Cochlear implantation could be a good treatment option for Waardenburg syndrome.

Differences in Postoperative Hearing Outcomes and Vertigo in Patients with Otosclerosis Treated with Laser-Assisted Stapedotomy versus Stapedectomy.

BACKGROUND: Otosclerosis is an abnormal bone growth in the otic capsule that can result in hearing loss. In this study, we compared postoperative hearing outcomes and vestibular symptoms between patients treated with laser-assisted stapedotomy versus stapedectomy. METHODS: The medical charts of 99 ears treated with stapes surgery were retrospectively reviewed. RESULTS: A stapedotomy, partial stapedectomy, or total stapedectomy was conducted in 77, 16, and 56 ears, respectively. The ears treated with partial- and total stapedectomies were unified into one stapedectomy group. The postoperative changes in the air-bone gap after stapedotomies were significantly larger than those after stapedectomies at 1, 2, and 4 kHz. The postoperative changes in the air conduction threshold after stapedotomies were significantly larger than those after stapedectomies at 1, 2, 4, and 8 kHz. The postoperative changes in the bone conduction threshold at 0.5, 1, 2, and 4 kHz did not differ between the groups. The postoperative vertigo duration after stapedotomies was significantly shorter than that after stapedectomies. CONCLUSIONS: Surgery-induced sensorineural hearing losses were similar for stapedotomies and stapedectomies. However, stapedotomies were more effective and atraumatic than stapedectomies because of the better postoperative hearing results at middle and high frequencies and the shorter postoperative vertigo.