Endoscopic-Assisted Presigmoid Approach to the Internal Auditory Canal. A Feasibility Study.

HYPOTHESIS: The retrolabyrinthine (presigmoid) approach has been utilized in various skull base surgeries but has not been fully utilized in the management of internal auditory canal (IAC) lesions, such as vestibular schwannoma (VS). Microsurgical retrolabyrinthine approach provides limited visualization of the IAC, while endoscopic-assisted techniques allow for further lateral exposure with labyrinthine preservation. BACKGROUND: Traditional approaches to the IAC have the disadvantage of hearing sacrifice or retraction of brain tissue. With the introduction of endoscopic techniques and enhanced visualization, access to this region of complex anatomy is possible. METHODS: Radiomorphometric and anatomical dissection was performed on two cadaveric temporal bones. High-resolution computed tomography was used to segment and delineate the volume of the IAC. Projected accessible IAC was compared to actual postdissection data with preservation of the posterior semicircular canal (PSCC) via the retrolabyrinthine corridor. RESULTS: While preserving the PSCC, the 0° and 30° endoscopes visualized 57.1% and 78.6% of the IAC for cadaver 1, and 64.0% and 76.0% of the IAC for cadaver 2, respectively. Sacrificing the PSCC, the 0° and 30° endoscopes provided visualization of 78.6% 85.7% of the IAC for cadaver 1, and 88.0% and 95.1% of the IAC for cadaver 2, respectively. CONCLUSIONS: Retrolabyrinthine approach to resection of VS is a potentially viable hearing-preserving alternative to traditional approaches. This approach provides access to the majority of the IAC, while angled endoscopes or sacrifice of the PSCC can provide additional access toward the fundus. Further studies are needed to determine the clinical feasibility of this approach.

Does Transcranial Direct Current Stimulation reduce central and peripheral muscle fatigue in recreational runners? A triple-blind, sham-controlled, randomized, crossover clinical study.

BACKGROUND: Runners seek health benefits and performance improvement. However, fatigue might be considered a limiting factor. Transcranial Direct Current Stimulation (tDCS) has been investigated to improve performance and reduce fatigue in athletes. While some studies showing that tDCS may improve a variety of physical measures, other studies failed to show any benefit. OBJECTIVE: To evaluate the acute effects of tDCS on central and peripheral fatigue compared to a sham intervention in recreational runners. METHODS: This is a triple-blind, controlled, crossover study of 30 recreational runners who were randomized to receive one of the two interventions, anodal or sham tDCS, after the fatigue protocol. The interventions were applied to the quadriceps muscle hotspot for 20 min. Peak torque, motor-evoked potential, and perceived exertion rate were assessed before and after the interventions, and blood lactate level was assessed before, during, and after the interventions. A generalized estimated equation was used to analyze the peak torque, motor-evoked potential, and blood lactate data, and the Wilcoxon test was used for perceived exertion rate data. RESULTS: Our findings showed no difference between anodal tDCS and sham tDCS on peak torque, motor-evoked potential, blood lactate, and perceived exertion rate. CONCLUSION: The tDCS protocol was not effective in improving performance and reducing fatigue compared to a sham control intervention. BRAZILIAN CLINICAL TRIALS REGISTRY: RBR-8zpnxz.

COVID-19-related chemosensory changes: Findings from a prospective national database.

Objective: The aim of this study was to review findings from a large prospective national database of chemosensory disturbances associated with coronavirus disease 2019 (COVID-19) infection. Data Sources: The Virginia Commonwealth University Smell and Taste Center national database of COVID-19 chemosensory disturbances. Methods: A series of online surveys, first opened on April 10, 2020, was made accessible nationwide to any adult with sudden chemosensory dysfunction since January 2020. Participants received subsequent follow-up surveys 14 days, 1 month, 3 months, and 6 months after enrollment. An additional survey was sent to all participants on May 28, 2022 to assess long-term outcomes. Information pertaining to demographics, symptoms, comorbidities, treatments, and life impact was collected. Results: Of 363 participants who reported complete smell recovery, 51.2% recovered within 1 month, 70% within 3 months, and 79% within 6 months, while 8.8% took over 1 year to completely recover. Among all participants, 7.5% had no smell recovery. Positive predictors of recovery included age <40, male gender, and the presence of nasal congestion. Negative predictors included difficulty breathing and prior head injury. Many participants reported a decrease in quality of life and the presence of potential safety hazards associated with decreased smell loss. Conclusions: Most subjects with COVID-19-related chemosensory dysfunction recover, with the majority noting complete recovery within weeks of infection. Those aged over 40 years and female gender were associated with lower rates of recovery. A considerable number of participants reported significant impact on quality of life and safety.

Increased Incidence of Vestibular Disorders in Patients With SARS-CoV-2.

Objective: Determine the incidence of vestibular disorders in patients with SARS-CoV-2 compared to the control population. Study Design: Retrospective. Setting: Clinical data in the National COVID Cohort Collaborative database (N3C). Methods: Deidentified patient data from the National COVID Cohort Collaborative database (N3C) were queried based on variant peak prevalence (untyped, alpha, delta, omicron 21K, and omicron 23A) from covariants.org to retrospectively analyze the incidence of vestibular disorders in patients with SARS-CoV-2 compared to control population, consisting of patients without documented evidence of COVID infection during the same period. Results: Patients testing positive for COVID-19 were significantly more likely to have a vestibular disorder compared to the control population. Compared to control patients, the odds ratio of vestibular disorders was significantly elevated in patients with untyped (odds ratio [OR], 2.39; confidence intervals [CI], 2.29-2.50; P < 0.001), alpha (OR, 3.63; CI, 3.48-3.78; P < 0.001), delta (OR, 3.03; CI, 2.94-3.12; P < 0.001), omicron 21K variant (OR, 2.97; CI, 2.90-3.04; P < 0.001), and omicron 23A variant (OR, 8.80; CI, 8.35-9.27; P < 0.001). Conclusions: The incidence of vestibular disorders differed between COVID-19 variants and was significantly elevated in COVID-19-positive patients compared to the control population. These findings have implications for patient counseling and further research is needed to discern the long-term effects of these findings.

Effect of disease, freezing of gait, and dopaminergic medication in the biomechanics of trunk and upper limbs in the gait of Parkinson's disease.

INTRODUCTION: Parkinson's disease (PD) causes gait abnormalities that may be associated with an arm swing reduction. Medication and freezing of gait (FoG) may influence gait characteristics. However, these comparisons do not consider differences in gait speed and clinical characteristics in individuals with PD. OBJECTIVE: This study aims to analyze the effect of FoG and medication on the biomechanics of the trunk and upper limbs during gait in PD, controlling for gait speed and clinical differences between groups. METHODS: Twenty-two people with a clinical diagnosis of idiopathic PD in ON and OFF medication (11 FoG), and 35 healthy participants (control) were selected from two open data sets. All participants walked on the floor on a 10-m-long walkway. The joint and linear kinematic variables of gait were compared: (1) Freezers and nonfreezers in the ON condition and control; (2) Freezers and nonfreezers in the OFF condition and control; (3) Group (freezers and nonfreezers) and medication. RESULTS: The disease affects the upper limbs more strongly but not the trunk. The medication does not significantly influence the joint characteristics but rather the linear wrist displacement. The FoG does not affect trunk movement and partially influences the upper limbs. The interaction between medications and FoG suggests that the medication causes more substantial improvement in freezers than in nonfreezers. CONCLUSION: The study shows differences in the biomechanics of the upper limbs of people with PD, FoG, and the absence of medication. The future rehabilitation protocol should consider this aspect.

Awareness campaigns for cochlear implants: Are we making an impact?

OBJECTIVE: This study aimed to determine if the major public awareness campaign for cochlear implants 'International Cochlear Implant Day' influenced national and international public interest as measured by internet search activity. METHODS: Weekly search volume data in the United States, Canada, Australia, Germany, United Kingdom, Brazil, India, Japan, and a 'Worldwide' group for the search topic 'cochlear implant' was collected from Google Trends over a 5-year period (2017-2021). The 'Campaign' window was defined as 1 week before, the week of, and 2 weeks after International Cochlear Implant Day (February 25th). 'Non-Campaign' weeks were considered any data outside the 'Campaign' window. RESULTS: Of the studied regions, the United States, United Kingdom, Australia, India, and 'Global' demonstrated a significant increase in internet search activity between 2017 and 2021. Although some individual years showed significant increases during the 'Campaign' period for Canada, Germany, Brazil, and Japan, none showed statistically significant increases over the 5-year period studied. CONCLUSION: Public awareness campaigns are recognized crucial elements to delivering effective healthcare, but their success varies worldwide. While data from Google Trends suggests that cochlear implant awareness campaigns can translate into increased internet searches, greater efforts can be made in select countries to improve public interest.

Considerations for Use of the MAUDE Database in Otolaryngology-Head & Neck Surgery Research.

The use of the US Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) to analyze adverse events linked to medical devices has grown in recent years. MAUDE facilitates post-market surveillance, contributing to the assessment of device performance and the identification of potential safety concerns. The database is instrumental not only for mandatory reporters such as manufacturers and healthcare facilities but also offers a platform for voluntary submissions from clinicians and patients, thus widening the scope of data collection. While the database offers valuable data, there are important limitations that must be understood in order to encourage appropriate interpretation of findings. This commentary highlights the major advantages and disadvantages of the MAUDE database, as well as describes possible areas for improvement in adverse event reporting.

GABA Supplementation, Increased Heart-Rate Variability, Emotional Response, Sleep Efficiency and Reduced Depression in Sedentary Overweight Women Undergoing Physical Exercise: Placebo-Controlled, Randomized Clinical Trial.

Gamma-aminobutyric acid (GABA) serves as a pivotal neurotransmitter implicated in the pathogenesis of stress, anxiety, sleep-related disorders, and heart rate (HR) reactions. Heart-rate variability (HRV), modulated by the sympathetic and parasympathetic branches of the autonomic nervous system (ANS), offers insights into cardiac autonomic control and cardiovascular well-being. The present study aimed to explore the impact of GABA supplementation on emotional metrics, sleep quality, and HRV in sedentary women with overweight or obesity partaking in physical exercise. A randomized, double-blind, placebo-controlled clinical trial was undertaken involving 30 sedentary women with overweight or obesity. Volunteers were assigned randomly to two groups: the intervention group receiving GABA (200 mg) once daily for a total of 90 supplementation doses, and the placebo group. Both groups engaged in physical exercise, while the supplementation regimen spanned 90 days. Assessments were conducted at three intervals: baseline (T0), midway through the study (T45), and study culmination (T90). Following 90 days of GABA supplementation, the intervention group demonstrated enhancements in habitual sleep efficiency, as indicated by reductions in Pittsburgh Sleep Quality Index (PSQI) scores. Moreover, an improved emotional response was observed, characterized by diminished negative affect. GABA supplementation yielded ameliorations in depression scores as per the Depression, Anxiety, and Stress Scale (DASS-21). Notably, an augmented HRV was noted, attributed to heightened parasympathetic autonomic nervous system predominance. GABA supplementation elicited noteworthy enhancements in heart rate variability, emotional response, depression mitigation, and sleep efficiency following a 90-day supplementation.

Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease.

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.

Effects of oral HPΒCD-angiotensin-(1-7) supplementation on recreational mountain bike athletes: a crossover study.

BACKGROUND: Supplementation with Angiotensin-(1-7) [(Ang-1-7)] has received considerable attention due to its possible ergogenic effects on physical performance. The effects of a single dose of Ang-(1-7) on the performance of mountain bike (MTB) athletes during progressive load tests performed until the onset of voluntary fatigue have previously been demonstrated. This study tested the effects of Ang-(1-7) in two different exercise protocols with different metabolic demands: aerobic (time trial) and anaerobic (repeated sprint). METHODS: Twenty one male recreational athletes were given capsules containing an oral formulation of HPßCD-Ang-(1-7) (0.8 mg) and HPßCD-placebo (only HPßCD) over a 7-day interval; a double-blind randomized crossover design was used. Physical performance was examined using two protocols: a 20-km cycling time trial or 4 × 30-s repeated all-out sprints on a leg cycle ergometer. Data were collected before and after physical tests to assess fatigue parameters, and included lactate levels, and muscle activation during the sprint protocol as evaluated by electromyography (EMG); cardiovascular parameters: diastolic and systolic blood pressure and heart rate; and performance parameters, time to complete (time trial), maximum power and mean power (repeated sprint). RESULTS: Supplementation with an oral formulation of HPßCD-Ang-(1-7) reduced basal plasma lactate levels and promoted the maintenance of plasma glucose levels after repeated sprints. Supplementation with HPßCD-Ang-(1-7) also increased baseline plasma nitrite levels and reduced resting diastolic blood pressure in a time trial protocol. HPßCD-Ang-(1-7) had no effect on the time trial or repeat sprint performance, or on the EMG recordings of the vastus lateralis and vastus medialis. CONCLUSIONS: Supplementation with HPßCD-Ang-(1-7) did not improve physical performance in time trial or in repeated sprints; however, it promoted the maintenance of plasma glucose and lactate levels after the sprint protocol and at rest, respectively. In addition, HPßCD-Ang-(1-7) also increased resting plasma nitrite levels and reduced diastolic blood pressure in the time trial protocol. TRIAL REGISTRATION: RBR-2nbmpbc, registered January 6th, 2023. The study was prospectively registered.

The association of subjective and objective sleep measures with chronic tinnitus.

STUDY OBJECTIVES: Poor sleep is a prevalent complaint in the population with chronic tinnitus, but the relationship between the two is not well-characterized. The objective of this study was to understand how subjective and objective measures of sleep compare in patients with or without chronic tinnitus. METHODS: This prospective cohort study included consecutive adult patients who presented to a sleep laboratory between January 19, 2017, and January 10, 2020. All patients underwent an in-laboratory nocturnal polysomnogram and filled out questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Tinnitus Screener, and Tinnitus Handicap Inventory, among others. RESULTS: The study included 1,968 participants, out of which 284 (14.4%) reported chronic tinnitus. Patients with chronic tinnitus were younger (51.6 years vs 54.1 years; P < .05) and more likely female (16.4% vs 11.7%; P < .005). They demonstrated worse subjective sleep quality (PSQI: 11.3 vs 9.5; P < .0005) and increased sleepiness (Epworth Sleepiness Scale: 9.8 vs 8.6; P < .005). In the objective sleep parameters only the total sleep time was increased in chronic tinnitus (311.5 vs 294.5 minutes; P < .05) and total arousals were decreased (41.7 vs 47; P < .005). Sleep stage N3 was higher in those with chronic tinnitus (14.9% vs 13.0%; P < .05). In multivariable analyses, as PSQI increases the odds of chronic tinnitus increases. This effect was modified by age: In those younger than 55 years of age, the odds of the presence of chronic tinnitus was 1.10 (95% confidence interval, 1.03, 1.17) times higher as PSQI increased. CONCLUSIONS: Chronic tinnitus is associated with significant changes in qualitative sleep (higher PSQI) but no major differences in quantitative sleep measures were observed. CITATION: Weingarten JA, Islam A, Dubrovsky B, Gharanei M, Coelho DH. The association of subjective and objective sleep measures with chronic tinnitus. J Clin Sleep Med. 2024;20(3):399-405.

Effects of exhaustive whole-body exercise and caffeine ingestion on muscle contractile properties in healthy men.

BACKGROUND: The influence of exhaustive whole-body exercise and caffeine ingestion on electromechanical delay (EMD) has been underexplored. This study investigated the effect of exhaustive cycling exercise on EMD and other parameters of muscle contractile properties and the potential ability of caffeine to attenuate the exercise-induced impairments in EMD and muscle contractile properties. METHODS: Ten healthy men cycled until exhaustion (88±2% of V̇O2max) on two separate days after ingesting caffeine (5 mg.kg-1 of body mass) or cellulose (placebo). Parameters of muscle contractile properties of the quadriceps muscles were assessed via volitional and electrically evoked isometric contractions, performed before and 50 minutes after ingestion of the capsules, and after exercise. Muscle recruitment during volitional contractions was determined via surface electromyography. RESULTS: Exhaustive cycling exercise did not affect volitional and relaxation EMD (P>0.05) but increased evoked EMD. In addition, the exhaustive cycling exercise also increased muscle recruitment at the beginning of volitional isometric muscle contraction (P<0.05). The peak twitch force, maximal rate of twitch force development, and twitch contraction time were all compromised after exhaustive cycling exercise (P<0.05). Acute caffeine ingestion had no effect on muscle contractile properties (P>0.05), except that caffeine increased twitch contraction time at postexercise (P<0.05). CONCLUSIONS: Exercise-induced decline in peripheral components of the EMD might be compensated by an increase in the muscle recruitment. In addition, acute caffeine ingestion had minimal influence on exercise-induced changes in muscle contractile proprieties.

Progressive strength training can reverse sarcopenia stage in middle-aged and older adults regardless of their genetic profile.

The aim of this study was to verify the association of the ACTN3-R577X polymorphism with sarcopenia stage, according to the Revised European Consensus on the Definition and Diagnosis of Sarcopenia, in middle-aged and older adults, pre- and post- ST. In the 12-week longitudinal study, 71 middle-aged and older adults were evaluated; the participants were assigned to either control or intervention group. The intervention group underwent progressive ST three times a week. All participants underwent blood collection, DNA extraction, genotyping of the ACTN3-R577X polymorphism, anthropometric evaluations, and diagnostic tests for sarcopenia. The last two tests were repeated after 12 weeks. No association of the ACTN3-R577X polymorphism with sarcopenia stage was observed before and after 12 weeks. However, the intervention group remained non-sarcopenic (n = 25, p <0.05) or achieved changes in sarcopenia stage (from sarcopenic to non-sarcopenic) (n = 13, p <0.05). Our study demonstrates that progressive ST performed regularly can reverse or prevent sarcopenia regardless of genotype for the ACTN3-R577X polymorphism.

Clinical Predictors of Pulsatile Tinnitus in Patients With Idiopathic Intracranial Hypertension: An Age-Matched Cohort Study.

INTRODUCTION: Pulsatile tinnitus (PT) occurs in many but not all patients with idiopathic intracranial hypertension (IIH). It is poorly understood why some patients with IIH develop PT, yet others do not. The purpose of this study was to determine if any clinical findings differ between those with and without PT in IIH, potentially shedding light on a pathophysiologic mechanism. METHODS: Age-matched cohort analysis of patients with documented IIH and presence or absence of PT was performed, collecting data including body mass index (BMI), blood pressure, visual acuity, cerebrospinal fluid (CSF) opening pressure, sleep apnea, migraines, and transient visual obscurations, among others. Independent-sample t test and χ2 test were used to analyze continuous and binary variables, respectively, with multivariate analysis conducted including variables statistically significant on univariate analysis. RESULTS: Eighty subjects with IIH met the inclusion criteria (40 PT+, 40 PT-). CSF opening pressure showed no significant difference between the two groups. The PT+ cohort was found to have an average BMI of 45.1 kg/m 2 , which was significantly higher than the PT- group (37.7 kg/m 2 ; p = 0.0023). PT+ pulse pressure (60.1 mm Hg) was also significantly higher than the PT- group (51.6 mm Hg; p = 0.019). PT+ patients were also significantly more likely to have sleep apnea ( p < 0.001) and migraines ( p = 0.0036). Multiple logistic regression revealed an adjusted odds ratio of 13.9 for sleep apnea, 4.1 for migraines, and 1.01 for every increase in unit of BMI. CONCLUSION: Among patients with IIH, presence of PT is associated with higher BMI and pulse pressure, and increased incidence of sleep apnea and migraines. Given no significant difference in CSF pressures between the two groups, PT may not be a product of increased disease severity but may be related to sequelae of obesity, such as increased pulse pressure and sleep apnea.

Intratemporal facial nerve neurofibroma causing facial paralysis in an infant: Case report and review of the literature.

This article describes the first recorded case of intratemporal neurofibroma in an infant. A literature review of all other existing cases of intratemporal neurofibroma is performed, finding that the majority of cases involve multiple segments and can be found in the mastoid segment most often. Most common symptoms described included facial paralysis, otalgia, and conductive hearing loss, respectively.

Postural control of prolonged standing in people with Parkinson's disease.

People with Parkinson's disease (pwPD) have reduced adaptability to postural control during prolonged standing compared to neurologically healthy individuals (control). Objective. The study aimed to characterize postural changes during prolonged standing and their effect on postural control in pwPD compared to control. We recorded the body sway of the second lumbar vertebra of 23 pwPD and 23 control while they performed prolonged standing (15 min). The number and amplitude of the body sway patterns (shifts, fidgets, and drifts), the root mean square, velocity, and frequency of the body sway were analyzed. The number of shifts in the anterior-posterior (AP) and medial-lateral (ML) directions was greater for the pwPD than the control. In addition, the amplitudes of shifts in the AP direction and fidgets in the AP and ML directions were greater for the pwPD than the control. Our results show that: (1) A larger number of shifts of body sway suggest references positions are frequently changing; (2) Fidgets is a pumping mechanism and can be sensory-demand action to restore mechanoreceptors activity on the foot sole; and (3) No drift changes may suggest there is no slow migration of reference position. We conclude that pwPD exhibits different behavior than healthy ones during prolonged standing, suggesting that prolonged standing could distinguish individuals with Parkinson's disease.

Effect of 12 weeks of strength training on the static balance of the elderly / Efeito de 12 semanas de treinamento de força sobre o equilíbrio estático de idosos

Abstract Aging has a direct impact on balance due to changes in sensory and motor response, sarcopenia, reduced muscle strength and range of motion that occur in the elderly. In this context, strength training (ST) programs are seen as a valuable strategy to minimize the deleterious effect of aging on strength production and balance in this population. The purpose of the study was to evaluate the effect of 12 weeks of progressive intensity ST on static balance variables in the elderly. The study included 23 elderly with an average age of 65±8.61 years, of both sexes, who performed a twelve-week strength training program, with a frequency of three times a week and with progressive intensity (60 - 85% of 1-RM). Balance was assessed before and after the intervention period, through stabilometric assessment on a force plate. After the intervention, there was a reduction in the anteroposterior amplitude (p=0.01), in the anteroposterior velocity (p=0.01) and in the total displaced area (p=0.04). It is concluded that the strength training can be used as a key tool to minimize the deleterious effect of aging on the maintenance of static balance.

Resumo O envelhecimento tem impacto direto no equilíbrio devido a alterações da resposta sensorial e motora, sarcopenia e redução da força muscular e da amplitude de movimento que ocorre nos idosos. Nesse contexto, programas de treinamento de força (TF) são vistos como valiosa estratégia para minimizar o efeito deletério do envelhecimento na produção de força e no equilíbrio dessa população. O objetivo do estudo foi avaliar o efeito de 12 semanas de TF com intensidade progressiva sobre as variáveis de equilíbrio estático em idosos. Participaram do estudo 23 idosos com idade média de 65±8,61 anos, de ambos os sexos, que realizaram um programa de TF de doze semanas, com frequência de três vezes por semana e com intensidade progressiva (60 - 85% de 1-RM). O equilíbrio foi avaliado antes e após o período de intervenção, por meio de avaliação estabilométrica em plataforma de força. Após a intervenção houve redução na amplitude anteroposterior (p=0,01), na velocidade anteroposterior (p=0,01) e na área total deslocada (p= 0,04). Conclui-se que o treinamento de força pode ser utilizado como ferramenta chave para minimizar o efeito deletério do envelhecimento na manutenção do equilíbrio estático.

Gun shot injuries to the temporal bone: Anatomic predictors of mortality.

PURPOSE: To explore anatomic predictors of mortality from gunshot wounds involving the temporal bone. METHODS: A retrospective search of radiology reports was performed for all patients with CT reports suggestive of gunshot wounds (GSW) to the TB (2000-2020). All cases were reviewed by the senior author to confirm injury to the temporal bone. Detailed demographic and radiographic data were collected. MAIN FINDINGS: A total of 120 patients met inclusion criteria. The majority of patients were male (n = 101) and the average age was 32.9. The squamosa was the most commonly involved subsite (n = 90), followed by the mastoid (n = 43). Squamosal entry site had the highest associated mortality (89.7 %). For those with known disposition, 65.8 % (79 of 120) expired on the same hospital admission. Inpatient otolaryngology consultation was noted in 18.3 % (n = 22) of patients, with poor outpatient follow-up. CONCLUSIONS: This series represents the largest survey of GSW to the temporal bone to date. Although associated mortality is high and outpatient follow-up poor, otolaryngologists should be aware of associated morbidities to facilitate both inpatient and subsequent outpatient management.