OtoRhinoLaryngology

Acoustic neuroma quality of life: are we missing the point?

Drop attacks, hydrops severity, and disease duration in hydropic ear disease (Menière's)

Fortuitous discovery of non-fluorocholine-fixing papillary carcinoma of vesicular variant of the thyroid Abstract Purpose Characterization of thyroid nodules is crucial to propose surgical intervention for histological verification. Cervical ultrasound potentially combined with fine needle aspiration is recommended, and fluorocholine positron emission tomography (FCH-PET), commonly used in prostatic cancers, has been evaluated in the diagnosis of thyroid cancers in recent publications. Methods We present two cases of patients with multinodular thyroid and primary hyperparathyroidism. The preoperative assessment consisted of an ultrasound, a MIBI scintigraphy and an FCH-PET in favor of a parathyroid adenoma. Results The imaging examinations pointed to a diagnosis of a parathyroid adenoma. In both cases, papillary thyroid carcinoma, missed by FCH-PET, was discovered incidentally at a distance from the parathyroid adenoma during the surgical procedure. Conclusions These are the first descriptions of thyroid papillary carcinoma without preoperative FCH-PET identification. These clinical cases are contrary to recent publications showing a benefit of this examination in the diagnosis of thyroid cancers.

Tinnitus is multicausal and may not only be related to DNA variants

Outcomes in modified transoral resection of diverticula for Zenker's diverticulum Abstract Purpose Transoral resection of Zenker's diverticulum (TORD) was first reported in 2010. We present results for our modified approach to transoral resection (MTORD)—full-thickness cricopharyngeal myectomy, diverticulum sac excision, and suture closure of the pharyngotomy—and evaluate its safety and efficacy compared to endoscopic stapling and open approaches. Methods A retrospective study was performed in patients who underwent transoral resection of Zenker's diverticulum using MTORD, endoscopic stapler-assisted diverticulotomy (ESD), or trancervical diverticulectomy (TCD) from July 2009 to August 2017. Pre-operative evaluation included barium swallow and subjective characterization of swallowing dysfunction using the EAT-10 and Reflux Symptom Index (RSI). Complications, length of hospitalization, recurrence, and revision rates were also evaluated. Results Of 92 patients reviewed, 18 underwent MTORD, 45 underwent ESD and 29 underwent TCD. Major complications were only observed in ESD and TCD. Recurrence which required revision surgery was only observed in ESD. EAT-10 and RSI scores significantly improved and RSI scores normalized post-operatively for all approaches in short-term (< 1 year) follow-up. Conclusions MTORD is a safe and effective option for complete Zenker's diverticulectomy. Complication rates are low. To date, no patient has required reoperation, although more cases and longer term follow-up are needed for more complete comparison to ESD and traditional open excision.

The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas Abstract Purpose Preoperative localization of a parathyroid adenoma is usually obtained by the combination of ultrasound and scintigraphy with technetium-99m methoxyisobutylisonitrile. We evaluated the role of F18-fluorocholine in neck positron emission tomography/magnetic resonance imaging as a novel tool for localizing parathyroid adenomas. Methods Patients with primary hyperparathyroidism were recruited from February 2016 to August 2017 and F18-fluorocholine positron emission tomography/magnetic resonance imaging was performed to localize the parathyroid adenoma prior to surgery. We compared sensitivity and accuracy of this modality with ultrasound and technetium-99m methoxyisobutylisonitrile scintigraphy using the verified location of the diseased parathyroid as found in surgery. Results Nineteen patients were included in our study (15 women and 4 men, mean age 60.5 ± 9.8 years). Positron emission tomography/magnetic resonance imaging precisely localized the pathologic parathyroid gland in 16/19 cases (84.2%) and predicted the diseased side in 19/19 cases (100%). Ultrasound and technetium 99 m methoxyisobutylisonitrile sestamibi scintigraphy predicted the location of the parathyroid adenoma in 16/19 (84.2%) and 14/19 (74%), respectively. In 3/19 patients, positron emission tomography/magnetic resonance imaging localized the parathyroid adenoma where as other modalities failed. Positron emission tomography/magnetic resonance imaging was more accurate when compared to each modality separately (p < 0.001, p = 0.017), however, when comparing the three modalities all together no differences were found (p = 0.506). Conclusions Localizing parathyroid adenomas with F18-fluorocholine positron emission tomography/magnetic resonance imaging may be a promising secondary imaging modality.

Inter-rater reliability between experienced and inexperienced otolaryngologists using Koo's drug-induced sleep endoscopy classification system Abstract Purpose An ideal, drug-induced sleep endoscopy (DISE) classification system should cover all the upper airways, be simple and practical, and quantify the severity of any obstruction. Excellent validity and reliability are essential. We explored the inter-rater reliability of Koo's DISE classification system in the hands of experienced and inexperienced otolaryngologists. Methods We retrospectively analyzed video images of 100 patients who underwent DISE examination in our hospital between 2015 and 2018. Three experienced and three inexperienced otolaryngologists reviewed and scored all images. We calculated the inter-rater reliabilities of the two groups of otolaryngologists. Results Independent of the extent of experience with DISE, detection of retropalatal obstructions (overall agreement: 0.87; kappa value: 0.60), and the degree of such obstructions (overall agreement: 0.67; kappa value: 0.52) were more consistent than were the detection of retrolingual obstructions (overall agreement: 0.61, kappa value: 0.37) and the degree of retrolingual obstructions (overall agreement: 0.20, kappa value: 0.35). Inexperienced observers were in good agreement for palatal obstructions and experienced observers were in good agreement for tongue-base obstructions. All of the otolaryngologists found it difficult to detect a lateral pharyngeal wall obstruction at the retrolingual level. Conclusion Koo's DISE classification system focuses on surgical treatment, especially by otolaryngologists, and the degree of agreement between the experienced and inexperienced observers was relatively high. The participants' level of experience had a strong impact on scoring. The less-experienced otolaryngologists tended to overlook tongue-base obstructions, focusing instead on relatively simple retropalatal obstructions. In the future, development of a DISE classification system that can be accepted globally will be necessary.

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss Abstract Objectives To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation. Methods Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared. Results The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected. Conclusions The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

Which imaging modality in cochlear implant candidates? Abstract Purpose There is no guideline or consensus on preoperative radiologic imaging modality despite the fact that it has a vital importance in appropriate candidacy selection of cochlear implantation. We aimed to find out the role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) on surgical planning, intraoperative technique in cochlear implant candidates. Methods The clinical charts, imagings, and operative reports of patients who underwent cochlear implant surgery at a tertiary institution were retrospectively examined. Results 611 patients (503 children and 108 adult) were enrolled into the study. We found 11 different pathologies in MRI which could not be seen in HRCT. However, we decided the side of surgery according to MRI in only three of them in which the pathology was cochlear nerve hypoplasia. Two patients with cochlear nerve hypoplasia were children with prelingual deafness and one was adult with perilingual deafness. Moreover, we changed the surgical planning of side according to both imaging modalities in nine patients. Seven of them were children and two were adult. One of these adults had cochlear anomaly, and another had bilateral temporal bone fracture. Conclusions We suggest both imaging modalities in pediatric candidates. However, in adults, we think that superiority of either imaging modalities is still contradictive. We had only three adult patients and the decision of the side of surgery was made according to MRI in one of them and to both imaging modalities in the other two adults.

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model Abstract Purpose A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach. Methods In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations. Results The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel. Conclusions Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.