Sensorineural hearing loss after cardiac surgery: a systematic review.

BACKGROUND: Sensorineural hearing loss (SNHL) may occur following cardiac surgery. Although preventing post-operative complications is vitally important in cardiac surgery, there are few guidelines regarding this issue. This review aimed to characterize SNHL after cardiac surgery. METHOD: This systematic review was registered on PROSPERO and conducted in accordance with PRISMA guidelines. A systematic search of the PubMed, Embase and Cochrane Library were conducted from inception. Eligibility determination, data extraction and methodological quality analysis were conducted in duplicate. RESULTS: There were 23 studies included in the review. In the adult population, there were six cohort studies, which included 36 cases of hearing loss in a total of 7135 patients (5.05 cases per 1000 operations). In seven cohort studies including paediatric patients, there were 88 cases of hearing loss in a total of 1342 operations. The majority of cases of hearing loss were mild in the adult population (56.6%). In the paediatric population 59.2% of hearing loss cases had moderate or worse hearing loss. The hearing loss most often affected the higher frequencies, over 6000 Hz. There have been studies indicating an association between hearing loss and extracorporeal circulation, but cases have also occurred without this intervention. CONCLUSION: SNHL is a rare but potentially serious complication after cardiac surgery. This hearing loss affects both paediatric and adult populations and may have significant long-term impacts. Further research is required, particularly with respect to the consideration of screening for SNHL in children after cardiac surgery.

Effect of epithelial stem cell transplantation on noise-induced hearing loss in adult mice.

Noise trauma in mammals can result in damage to multiple epithelial cochlear cell types, producing permanent hearing loss. Here we investigate whether epithelial stem cell transplantation can ameliorate noise-induced hearing loss in mice. Epithelial stem/progenitor cells isolated from adult mouse tongue displayed extensive proliferation in vitro as well as positive immunolabelling for the epithelial stem cell marker p63. To examine the functional effects of cochlear transplantation of these cells, mice were exposed to noise trauma and the cells were transplanted via a lateral wall cochleostomy 2 days post-trauma. Changes in auditory function were assessed by determining auditory brainstem response (ABR) threshold shifts 4 weeks after stem cell transplantation or sham surgery. Stem/progenitor cell transplantation resulted in a significantly reduced permanent ABR threshold shift for click stimuli compared to sham-injected mice, as corroborated using two distinct analyses. Cell fate analyses revealed stem/progenitor cell survival and integration into suprastrial regions of the spiral ligament. These results suggest that transplantation of adult epithelial stem/progenitor cells can attenuate the ototoxic effects of noise trauma in a mammalian model of noise-induced hearing loss.

Malignant peripheral nerve sheath tumour arising in the submandibular gland.

Malignant peripheral nerve sheath tumours (MPNSTs) are tumours that arise from or differentiate towards cells of the peripheral nerve sheath. They are extremely rare with an incidence of 0.001% in the general population. The most common association is with neurofibromatosis 1-an incidence of 5%-42% in this subset of the population is quoted in the literature. These tumours are aggressive with a high rate of local recurrence. Complete surgical excision remains the mainstay of treatment. A literature search found only three case reports of MPNSTs originating in the salivary glands-in all other cases the parotid gland. We present here the first documented case of a patient presented with an MPNST of the submandibular gland managed surgically by a specialty centre.

Snap, crackle and pop: when sneezing leads to crackling in the neck.

Spontaneous perforation of the pharynx is an unusual condition. Due to its non-specific presentation and general lack of awareness, diagnosis and intervention may be delayed resulting in potential complications. This case reports a rare spontaneous perforation of the pyriform sinus after a forceful sneeze, leading to cervical subcutaneous emphysema and pneumomediastinum.

Does incidental mastoid opacification on computerized tomography necessitate referral to ENT?

OBJECTIVE: The prevalence of incidental temporal bone disease on magnetic resonance imaging has been widely reported in the medical literature. Despite this, there currently is little evidence regarding incidental otological disease on computerized tomography (CT). Thus, the study aimed to review the CT prevalence of asymptomatic adult ear disease and evaluate the appropriateness of ear, nose, and throat (ENT) referral following its discovery. STUDY DESIGN: Retrospective observational study of 468 CT scans. METHODS: All CT head scans performed between January 2015 and January 2016 containing the keyword mastoid in the radiological report initially were recruited for the study. Scans performed in the pediatric population following head trauma or for otological indications were excluded, leaving 468 eligible radiological images. The presence of prior otological disease or referral subsequently was established using electronic patient records. RESULTS: Mastoid and/or middle ear opacification was noted to be present in 62 patients (13%). Of these patients, 10 subsequently were found to have prior otological intervention or review. Following exclusion of these patients, the rate of incidental temporal bone disease was recorded as 11%. CONCLUSION: Data from this study suggests that incidental findings in an asymptomatic individual do not necessitate referral or further intervention. Furthermore, it is the author's recommendation that radiological findings be closely correlated with clinical examination to reduce false diagnosis and inappropriate referral to ENT. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2860-2865, 2017.