Ear,Nose & Throat Journal

This study aimed to investigate the clinical manifestations, treatment, and prognosis of traumatic pneumolabyrinth caused by tympanic membrane (TM) perforation.

Clinical data were collected from 3 cases of traumatic pneumolabyrinth occurring between 2015 and 2021 and 22 cases were identified from 20 articles in PubMed database that reported pneumolabyrinth due to tympanum-penetrating injury.

Nonoperative treatment was performed in Cases 1 and 3. Middle ear inspection was performed 1 year after the injury due to worsening vertigo upon head movement in Case 2.

Hearing outcomes and vestibular evaluations were presented for the 3 cases, and all comparable cases in the literature were reviewed.

All 25 patients had a history of traumatic TM perforation, with perforations mostly located in the posterior or posterior superior quadrant (16 cases). Air signs were observed in the vestibule in all 25 patients, 15 of whom revealed stapes luxation into the vestibule. Conservative treatments were performed in 8 cases, and exploratory surgery in 17 cases. Most patients were free of vertigo (23/25). There were no significant hearing improvements in 15 cases, while hearing recovery or improvement was observed in 9 cases.

The clinical manifestations of pneumolabyrinth due to tympanum-penetrating injuries vary widely. Importantly, the degree of hearing loss is not directly related to the subjectively perceived vertigo but to the location and extent of pneumolabyrinth.

Lymphoepithelial-like carcinoma of the salivary glands (LELCSG) is a rare tumour of unknown aetiology. No studies have reported the imaging features of primary LELCSG.

The clinical information and imaging features of eight patients with LELCSG were reviewed. Computed tomography (n = 4 patients) and magnetic resonance imaging (n = 4 patients) features were analysed by two radiologists to identify the location, number, size, shape, boundary, signal intensity and enhancement of LELCSG.

The study included four women and four men, and the mean size of the tumours was 32.88 ± 3.41 mm (range, 27–38 mm). The tumours affected the parotid gland in six cases and the submandibular gland in two cases. The eight cases were evaluated by radiologists. All tumours were lobulated; three had clear edges and five had blurred edges. There was no necrosis in six tumours, while two tumours exhibited slight necrosis without bleeding. All eight tumours showed multiple nodular changes and extensive fusion. Four tumours with magnetic resonance imaging (MRI) were isointense or slightly hyperintense on T1-weighted imaging (T1WI) and obvious homogeneous enhancement on contrasted enhanced T1WI scan, while slightly hyperintense on T2-weighted imaging (T2WI). The other four lesions were isodense on computed tomography (CT) scan. The degree of enhancement varied among the eight tumours. The necrotic zones of the eight tumours did not exhibit any enhancement.

LELCSG is a lobulated, multi-nodular tumour, with some fused nodules. LELCSG lesions showed isointensity or slight hyperintensity on T1WI MRI, slight hyperintensity on T2WI MRI and isodense on CT scan. Larger tumours may exhibit some necrosis, but the necrotic cysts were relatively rare. Uniform enhancement was observed in non-necrotic areas on enhanced CT and MRI scan. The multi-nodular feature may be valuable for diagnosis.

The aim of this study was to investigate the incidence of stoma recurrence and the therapeutic strategy outcomes in relation to survival that have been adopted over the past few decades using a monoclonal antibody, specifically nivolumab.

This study included a total of 487 patients diagnosed with laryngeal carcinoma undergoing either a laryngectomy or salvage surgery after conservative interventions at the ENT Unit of Federico II University in Naples, Italy, between 2011 and 2021. Following a minimum 2.5-year follow-up and a maximum 21-year follow-up, the results revealed that only 38 patients suffered a stomal recurrence.

Despite various adopted treatment strategies, the literature reports lower patient survival rates. Following a total laryngectomy, stomal recurrence represents a therapeutic management challenge due to a poor prognosis for nearly every treated case. According to the literature, in fact, despite a low incidence (ie, 0.8–31.3%), the overall mortality rate increases from 77% to 100% after three years. Nevertheless, introducing immunotherapy into cancer treatment has resulted in an observable revolution in the treatment of different types of cancers over the years.

In light of recorded data on survival following the use of the nivolumab, the case presented in this study allows a new perspective of successfully treating recurrences of squamous carcinoma of the head and neck.

Cutaneous malignant melanoma (CMM) is one of the most aggressive skin tumors. Sentinel lymph node biopsy (SLNB) is an important test before thorough treatment of melanoma. The aim of this study was to investigate cancer-specific survival (CSS) in patients with head and neck CMM after negative SLNB and to analyze predictors of decreased survival.

Based on the Surveillance, Epidemiology and End Results (SEER) database, a study was conducted using data from patients with head and neck CMM after negative SLNB. The demographic, clinical, and pathological characteristics of the case population were analyzed. Cox univariate, Kaplan–Meier analysis, and multivariate Cox regression models were used to explore predictors of decreased survival; propensity score matching (PSM) analysis was used to reduce confounding bias, and outcomes were compared between the wide margin excision and narrow margin excision groups.

A total of 1597 confirmed head and neck CMM patients with SLNB-negative were found. A Breslow>4.0 mm was the highest independent risk predictor for patients (HR 3.82, 95% CI 2.04-7.16, P < .001), and significant risk independent predictors also included a high mitotic rate >4 (HR 1.54, 95% CI 1.06-2.25, P = .023). Age< 60 years old was a significant survival predictor (HR 0.56, 95% CI .37-.85, P = .007), and not scalp and neck CMM were also important factors for longer survival (auricle skin: HR .51, 95% CI .29-.90, P = .02; unspecified parts of face: HR .59, 95% CI .40-.87, P = .007). After harmonizing baseline data by PSM, it was found that the extent of surgical resection did not affect patient survival.

This study analyzed the risk factors affecting CSS in patients with CMM of the head and neck region with SLNB-negative and observed a statistically significant difference in the prognosis of patients with CMM in different aesthetic subunits of the head and neck region. Close clinical follow-up for this population is necessary, and periodic medical examinations should be carried out.

Pharyngocutaneous fistula (PCF) is the one of the major complications after total laryngectomy (TL), which can result in saliva leakage, rupture of major vessels, and increased hospitalization. Several flaps have been tried to prevent PCF during TL, and they are usually associated with donor site morbidity and uncertain viability in case of previously irradiated patients. This study aimed to report a novel bilateral pedicled thyroid gland flap (TGF) technique for delicate and effective reinforcement of neopharynx suture line after TL.

Bilateral pedicled TGF was performed for the reinforcement of neopharynx T-shape suture sites after TL in this case series.

A total of five cases of the TGF were performed during TL, with four of them being salvage setting following previous chemoradiation therapy (CRT). The well-adapted and viable TGF status was confirmed by post-operative computed tomography scan and normally preserved thyroid hormone levels in all patients. No post-operative infections, hemorrhage, hypothyroidism, hypoparathyroidism, or PCF were reported.

The TGF is an effective and reliable flap in TL patents and should be considered as a method in neopharynx reconstruction, even in salvage TL following prior CRT.

Endoscopic sinus surgery (ESS) is the standard treatment strategy for chronic rhinosinusitis (CRS) resistant to medical treatment, and it is known to have postoperative complications and recurrences, which in turn result in suboptimal outcomes. Several methods are used to prevent postoperative scarring, adhesions, oedema, infection or recurrences in cavities. The role of steroids in improving postoperative outcomes is well established. They can be administered systemically or locally to enhance drug delivery into paranasal sinuses. In this study, we used triamcinolone irrigation immediately following surgery on one side of the nose, in patients with bilateral disease. The objective of this study was to evaluate the effect of intra-operative triamcinolone irrigation on postoperative outcomes, in patients with bilateral pansinusitis.

It was an interventional randomized controlled study, conducted at a tertiary care centre in North India. The analysis of 58 patients with bilateral pansinusitis was done from September 2020 to August 2021. At the conclusion of ESS, each patient was randomized to receive triamcinolone irrigation (4 ml of 40mg/ml solution) once and followed by merocel (polyvinyl acetal) packing on one side, while the contralateral side was packed with merocel soaked with saline. Nasal cavities were evaluated using a Hopkins rod endoscope in the postoperative 1^st, 3^rd, 8^th and 12^th weeks to look for the presence of postoperative crusting, oedema, polypoidal changes, and discharge. Perioperative sinus endoscopic scores (POSE) were used for endoscopic staging.

The most commonly affected age group was 31-45 years accounting for 39.7%. Males were affected more (63.7%) than the female population (36.3%). There was a reduction in the average POSE scores at the treatment site at all follow-up stages with a significant reduction in crusting, oedema, and scarring in the treatment site (P-value <0.001).

Triamcinolone irrigation effectively improves postoperative outcomes and reduces early postoperative complications in CRS patients.

To explore the degree to which patients undergoing unilateral endoscopic sinus surgery (ESS) experience post-operative contralateral sinonasal symptoms and determine risk factors for contralateral symptomatology following unilateral ESS.

Patients who underwent unilateral surgery for chronic rhinosinusitis (CRS) were contacted and asked if they felt symptomatic on the contralateral side at that point in time. Nasal Obstruction Symptom Evaluation (NOSE) scores were obtained based on contralateral symptomatology they recalled at the following time points: pre-ESS, 1 month post-ESS, and 3 months post-ESS. Demographics, contralateral symptomatology, and NOSE scores were compared between those with 2 or fewer sinusotomies versus 3 or more sinusotomies.

Of the 97 patients included in this study, 24% of patients reported contralateral congestion, a median of 24 months post-ESS, and more than 10% of patients reported other contralateral symptoms including swelling, rhinorrhea, difficulty breathing, and hyposmia post-ESS. Those with 2 or fewer sinusotomies were more likely to feel that they had developed worsened sensation of contralateral sinus swelling (P = .008). The median amount of time from the participants’ index surgery until the time they were interviewed was 24 months. There were no differences in long-term contralateral symptomatology between those who did and did not have septoplasty (27%).

Patients who have unilateral ESS for CRS may experience long-term contralateral symptoms. Having a septoplasty did not affect contralateral symptoms.

Our aim is to describe the location and course of the greater palatine canal (GPC) by analyzing its relationship with anatomical landmarks that can be used during endoscopic sinus surgery. This information might help prevent injury to the neurovascular bundle.

A retrospective evaluation of paranasal sinus CT scans of 100 consecutive random patients, 200 sides, was performed. Five measurements related to the course of the GPC were conducted, from cranial to caudal. The anatomical landmarks were the inferior bony border of the sphenopalatine foramen to the cranial entrance of the GPC, the distance from the most dorsal, and inferior bony insertion of the middle turbinate and the inferior turbinate bones to the anterior margin of the GPC. The angle between the horizontal palatine bone and the GPC, its length, and the prevalence of osteophytes in GPC was also assessed.

The mean distance of the inferior border of the sphenopalatine foramen to the cranial entrance of the GPC was 9.39 ± 1.72 mm. The mean distance of the dorsal insertion of the middle turbinate to the anterior margin of the GPC was 3.89 ± 0.93 mm. The distance of the dorsal insertion of the inferior turbinate to the anterior margin of the GPC was 3.16 ± 0.81 mm. The mean angle between the horizontal palatine bone and the GPC was 114.33 ± 10.92º and the mean length of the GPC was 30.23 ± 3.74 mm. None of the measurements showed a significant difference between the two sides.

The landmarks used are easy to locate and assess on CT scans. These findings may help to make dissection safer in pathologies related to the pterygopalatine fossa, lateral sphenoid sinus or adjacent skull base.

Our objective was to study the efficacy and safety of intratymapanic dexamethasone (ITD) for treating in Méniere’s disease in southern China.

A total of 124 patients with Méniere’s disease were randomly divided into 2 groups: ITD group (n = 62) and intratympanic lidocaine (ITL) group (n = 62). The ITD group was further randomly divided into 2 groups based on dexamethasone dosage: ITD1 (2 mg/ml) (n = 31) and ITD2 (5 mg/ml) group (n = 31). Symptom alleviation and complications were recorded after every treatment.

Vertigo was improved in 65% of patients who received ITD compared with 55% of patients who received ITL patients (P < .05). Three patients in the ITD2 group had from otomycosis, and 2 of these patients had a perforation; no tympanic membrane perforation was observed in the ITL and ITD1 group.

Compared with lidocaine, dexamethasone is more effective in alleviating vertigo, and a lower concentration of dexamethasone can reduce the occurrence of complications.

Chronic otitis media is a long-term infection of the middle ear. It is characterized by persistent discharge from the middle ear through a perforated tympanic membrane. It is one of the most common causes of preventable hearing loss, especially in developing countries. Precise estimation of the size of tympanic membrane perforation is essential for successful clinical management. In this study, we developed a smartphone-based application to calculate the ratio of the area of tympanic membrane perforation to the area of the tympanic membrane. Twelve standardized patients and 60 medical students were involved to assess the area of tympanic membrane perforation, in particular, the percentage of perforation size.

In total, 60 student doctors (including year 5 and year 6 medical students, intern and post-graduate year training of doctors) were recruited during their rotation at the Otolaryngology department of Taipei Medical University Shuang-Ho Hospital. Twelve standardized patients with chronic otitis media were recruited through a single otology practice. Oto-endoscopic examination was performed for all patients by using a commercially-available digital oto-endoscope, and clinical images of the tympanic membrane perforation were obtained. To demonstrate the variability of perforation size estimation by different student doctors, we calculated the percentage of perforation using the smartphone-based application for 12 tympanic membranes objectively and compared the results with those visually estimated by the 60 student doctors subjectively.

The variance in the visual estimation by the 60 student doctors was large. By contrast, variances in smartphone-based application calculations were smaller, indicating consistency in the results obtained from different users. The smartphone-based application accurately estimated the presence of perforation for tympanic membranes with high consistency. The differences in visual estimations can be considerably great and the variances can be large among different individuals.

The smartphone-based application is a dependable tool for precisely evaluating the size of tympanic membrane perforation.

Perioperative risk stratification of pediatric patients undergoing airway intervention remains crucial in identifying those at a higher risk of requiring postoperative intensive care unit (ICU) care. Here we determined the likelihood of and possible risk factors for developing perioperative adverse respiratory events (PAREs) requiring ICU care after various pediatric endoscopic airway surgeries (EASs).

We conducted a retrospective chart review of pediatric patients who were aged <18 years and underwent EAS between 2015 and 2021. Early postoperative adverse events within 24 h of surgery were recorded and analyzed.

Overall, 99 patients who underwent EAS were included. The age at the time of the intervention ranged from 8 months to 18 years. Fifty-eight patients, median age was 4.83 years, underwent papilloma debulking with no high likelihood of PARE in this patient subgroup (OR = 0.48; 0.16–1.44). Twenty-five patients, median age was 9.72 years, underwent balloon dilation of laryngotracheal stenosis with no increase in the likelihood of PARE in this patient population (OR = 2.02; 0.65–6.28). Early postoperative respiratory events occurred in 16 patients (16.2%). Most of these events (75%) manifested within 4 h after surgery. In a univariate analysis, intervention at the level of the subglottis or 2 or more laryngeal subsites increased the risk of PARE (OR = 6.57; 1.11–12.52 and OR = 3.73; 1.93–22.34, respectively). In a multivariate analysis, only intervention in the subglottic area maintained its effect (OR = 6.84; 1.82–25.65).

Respiratory adverse events following pediatric EAS are not uncommon, and the majority are encountered shortly after surgery. Intervention in the subglottic area was an independent predictor of PARE.