BACKGROUND: Superior semicircular canal dehiscence syndrome (SCDS) produces a wide spectrum of vestibular and auditory abnormalities due to the presence of a "third mobile window." While enhanced otolith-mediated respons...BACKGROUND: Superior semicircular canal dehiscence syndrome (SCDS) produces a wide spectrum of vestibular and auditory abnormalities due to the presence of a "third mobile window." While enhanced otolith-mediated responses are well recognized, the behavior of high-frequency semicircular canal function remains debated. Many patients show reduced superior canal vestibulo-oculomotor reflex (VOR) gains despite preserved or exaggerated utricular responses. OBJECTIVE: To investigate the relationship between dynamic semicircular canal responses assessed by video Head Impulse Test (vHIT) and otolith responses assessed by oVEMPs in people with superior semicircular canal dehiscence. METHODS: Fifty-three patients with SCDS underwent full vestibular testing including vHIT of all six semicircular canals, cervical and ocular vestibular-evoked myogenic potentials (cVEMPs, oVEMPs) to 500-Hz BCV, and high-frequency oVEMPs to 4,000-Hz stimuli. RESULTS: Superior semicircular canals showed the largest VOR gain reductions, with the left anterior (LA) canal most affected (mean gain 0.86 ± 0.18). Bilateral SCDS exhibited significantly lower gains than unilateral SCDS, with mean LA gain falling below the functional threshold (0.68 ± 0.14). In contrast, all patients demonstrated enhanced utricular responsiveness, including increased 500-Hz oVEMP amplitudes and consistent 4-kHz N10 responses. CONCLUSION: Our findings confirm the presence of high-frequency oVEMP hyperresponsiveness, yet with a VOR pseudo-hypofunction due to a loss of high-frequency mechanical energy through the dehiscence, which diminishes the utricular vortex and cupular deformation. This frequency-dependent hydrodynamic dissociation provides a comprehensive mechanistic framework for interpreting vestibular test batteries in SCDS. Combined assessment with vHIT and high-frequency oVEMPs offers a powerful, physiologically grounded diagnostic approach.
BACKGROUND: Transoral robotic surgery (TORS) is a minimally invasive approach for treating early-stage malignant or benign tumors of the pharynx and larynx. This study represents the first real-world, single-arm, early f...BACKGROUND: Transoral robotic surgery (TORS) is a minimally invasive approach for treating early-stage malignant or benign tumors of the pharynx and larynx. This study represents the first real-world, single-arm, early feasibility evaluation of clinical performance and perioperative safety of da Vinci Single-Port (SP) for treating various benign or early-stage malignant tumors of the pharynx and larynx in Mainland Chinese population. METHOD: A real-world, single-arm, single-center, early feasibility study (ChiCTR2300078809) enrolled 15 patients with a heterogeneous benign or early-stage malignant tumors of pharynx and larynx, who received da Vinci single port-assisted transoral robotic surgery (SP-TORS) from July 2023 to May 2024. The primary endpoint was intraoperative conversion rate, and the secondary endpoints included intraoperative bleeding, surgical duration, length of stay (LOS), ICU admission, postoperative pain score (VAS) and recovery of swallowing functions (MDADI). RESULTS: All 15 patients successfully completed SP-TORS without intraoperative conversion, ICU admission, intraoperative or postoperative massive bleeding. The median intraoperative bleeding volume and surgical duration were 5 ml and 60 min, respectively. The median LOS was 4 days with relatively low postoperative VAS. MDADI indicated all patients significantly recovered swallowing functions 1 month after surgery. CONCLUSION: Our preliminary institutional experience demonstrated clinical feasibility and acceptable perioperative safety for treating early-stage malignant or benign tumors of the pharynx and larynx in the Mainland Chinese population through SP-assisted transoral robotic surgeries.
Yılmaz Topçuoğlu MS, Schuler PJ, Hopkins C
… +9 more, Cherkes M, Ciller M, Costa S, Glibbery N, Kovács P, Mitrea-Sireţeanu L, Zieliński J, Westhoff JH, Baumann I
PURPOSE: Management of patients with choanal atresia (CA) involves various aspects. While a recent study revealed variability in CA management practices across German Ear, Nose, Throat (ENT) departments, the actual curre...PURPOSE: Management of patients with choanal atresia (CA) involves various aspects. While a recent study revealed variability in CA management practices across German Ear, Nose, Throat (ENT) departments, the actual current state of care in Europe and worldwide remains to be elucidated, which was the aim of this study. METHODS: An online survey was conducted on preoperative diagnostics, surgical procedures, and postoperative care in CA patients. A total of 116 ENT departments from 46 countries and six continents participated. RESULTS: The median number of CA repairs performed annually across all continents was three. Unilateral CA repair was performed by 64% of ENT departments in patients under five years and by 30% in patients over five years. Preoperative hearing tests were not standard (19%). Computed tomography (CT) was often performed (84%). Endoscopic transnasal CA repair was the main approach (81%). The posterior vomer was routinely resected by 57% of participants. Stents were always or mostly used by 33%. Saline irrigations (77%), topical corticosteroids (37%), and perioperative antibiotics (32%) were recommended as postoperative nasal care measures. Recurrences were attributed to scarring (71%), granulation tissue (40%), and insufficient vomer resections (21%). CONCLUSION: While some practices align with existing recommendations, other aspects require further discussion. The age at which patients should undergo unilateral CA repair still needs clarification. Preoperative hearing tests were not commonly implemented. CT imaging was widely used despite the associated radiation exposure. Over half of the participants resected the posterior vomer. The use of stents and perioperative antibiotics should be discussed further.
OBJECTIVE: This prospective study aims to explore the effect of combining speaking valves with swallowing training on early decannulation in tracheostomy patients with dysphagia. METHOD: A total of 43 tracheostomy patien...OBJECTIVE: This prospective study aims to explore the effect of combining speaking valves with swallowing training on early decannulation in tracheostomy patients with dysphagia. METHOD: A total of 43 tracheostomy patients with dysphagia were randomized to a trial group (n=21, speaking valves plus swallowing training) or a control group (n=22, swallowing training alone) alongside routine care. Outcomes including decannulation rate, alveolar-arterial oxygen gradient [P(A-a)O2], nutritional/inflammatory markers, Penetration-Aspiration Scale (PAS) scores, and suctioning requirements were evaluated over a one-month intervention period. RESULT: After the one-month intervention, the decannulation rate was significantly higher in the trial group (57.1%, 12/21) than in the control group (0%, 0/22) (P<0.05). Both groups showed post-treatment improvements, but the trial group demonstrated significantly greater reductions in P(A-a)O2, PAS scores, suctioning frequency, and suction volume compared to controls (all P<0.05). Furthermore, while both groups exhibited increased albumin and prealbumin alongside decreased neutrophils and C-reactive protein (CRP) levels, these improvements in nutritional and inflammatory markers were significantly more pronounced in the trial group (P<0.05). CONCLUSION: Combining speaking valves with swallowing training facilitates early decannulation, improves oxygenation, enhances swallowing safety, and reduces airway secretions. The observed favorable trends in nutritional and inflammatory markers are likely multifactorial, reflecting the broader benefits of this multimodal rehabilitation approach.
PURPOSE: The aim of this study is to multidimensionally evaluate sensory processing profiles, postural stability, and health-related quality of life in adult hearing aid users and to compare the findings with those of no...PURPOSE: The aim of this study is to multidimensionally evaluate sensory processing profiles, postural stability, and health-related quality of life in adult hearing aid users and to compare the findings with those of normal-hearing individuals. METHODS: A total of 52 adults participated in the study, including 21 hearing aid users (mean age: 47.48 ± 10.55 years) and 31 age- and gender-matched normal-hearing individuals (mean age: 41.94 ± 10.89 years). Sensory processing was assessed using the Adolescent/Adult Sensory Profile, postural stability was evaluated by computerized dynamic posturography, and quality of life was measured using the SF-36 Health Survey. Group comparisons and associations between variables were analyzed using appropriate statistical methods. RESULTS: Hearing aid users demonstrated significantly lower scores in the Sensory Seeking, Taste/Smell Processing, and Activity Level subscales compared with normalhearing individuals. In the postural stability assessment, composite balance as well as visual and vestibular subsystem scores were significantly lower in the hearing loss group. Significant correlations were observed between selected sensory processing subdimensions and postural stability parameters. Regarding quality of life, hearing aid users showed significantly poorer Social Functioning scores, while the difference in Physical Functioning did not remain significant after multiple-comparison correction. CONCLUSIONS: Hearing loss appears to affect not only auditory function but also sensory processing, postural control, and aspects of quality of life. These findings support the need for a multidimensional approach in the clinical evaluation and rehabilitation of adult hearing aid users.
PURPOSE: Masseter vestibular-evoked myogenic potentials (mVEMPs) assess vestibular function through the vestibulo-masseteric reflex. While tone burst (TB) stimuli are commonly used, narrowband chirp stimuli may improve r...PURPOSE: Masseter vestibular-evoked myogenic potentials (mVEMPs) assess vestibular function through the vestibulo-masseteric reflex. While tone burst (TB) stimuli are commonly used, narrowband chirp stimuli may improve response rates and neural synchronization. This study compares the effectiveness of TB and chirp stimuli in bone-conducted mVEMP testing. METHODS: Thirty-five healthy participants (70 ears) underwent mVEMP testing using a bone conduction vibrator. We evaluated response obtainability, P1 and N1 latencies, and P1-N1 amplitude in bone-conducted mVEMPs using 500 Hz TB and 500 Hz narrowband level-specific (NB LS) chirp stimuli. RESULTS: The response rate for the NB LS chirp stimulus (80.0%) was significantly higher than that for the TB stimulus (42.9%) (p < 0.001). Logistic regression analysis indicated that the likelihood of obtaining a response with chirp stimuli was 5.333 times higher than with TB stimuli (p < 0.001). Additionally, chirp stimuli produced significantly shorter latencies and higher amplitudes (p < 0.001). CONCLUSION: In bone-conducted mVEMPs, NB LS chirp stimuli improve response rates, shorten latencies, and increase amplitudes, suggesting greater reliability and efficiency in vestibular assessment.
PURPOSE: The purpose of this study was to examine the relationship between serum 25(OH)D levels and olfactory function in adults, given the emerging recognition of vitamin D as a neurosteroid with potential influence on...PURPOSE: The purpose of this study was to examine the relationship between serum 25(OH)D levels and olfactory function in adults, given the emerging recognition of vitamin D as a neurosteroid with potential influence on sensory pathways. Specifically, the study aimed to determine whether vitamin D status is associated with olfactory threshold and identification performance, to explore the presence of a biologically plausible dose-response pattern, and to assess the predictive value of serum vitamin D levels for olfactory dysfunction. METHODS: In this cross-sectional study, 161 adults were enrolled, including 98 with vitamin D deficiency and 63 with sufficient levels. Serum 25(OH)D was measured by HPLC and categorized into four groups (< 10, 10-20, 20-30, ≥ 30 ng/mL). Olfactory threshold and identification were assessed using the Sniffin' Sticks rapid screening kit. Group comparisons, subgroup analyses, correlation tests, multiple linear regression, and ROC analysis (threshold < 7) were performed. RESULTS: Vitamin D-deficient participants had significantly lower threshold and identification scores than controls (p = 0.008 and p < 0.001). Both scores increased stepwise across vitamin D subgroups (p < 0.001). Serum 25(OH)D correlated positively with threshold (r = 0.302) and identification (r = 0.432) (both p < 0.001); in the deficiency group, the correlation persisted only for threshold. Vitamin D was an independent predictor of identification (β = 0.041; p < 0.001). ROC analysis indicated that severe vitamin D deficiency (cutoff ≈ 10 ng/mL) was strongly associated with threshold-level olfactory impairment (AUC 0.636; specificity 95%). CONCLUSION: Serum vitamin D level is associated with olfactory function, particularly odor identification, and shows a biologically plausible dose-response pattern. Vitamin D appears to be a specific risk indicator rather than a standalone diagnostic marker for olfactory dysfunction.
PURPOSE: The isthmus connects the two lateral lobes of the thyroid gland. It remains unclear whether nodules in the isthmus signify a higher risk of thyroid malignancy. METHODS: We searched PubMed, Scopus, and the Web of...PURPOSE: The isthmus connects the two lateral lobes of the thyroid gland. It remains unclear whether nodules in the isthmus signify a higher risk of thyroid malignancy. METHODS: We searched PubMed, Scopus, and the Web of Science Core Collection through June 2025 for English literature containing sufficient information to analyze the risk of malignancy for thyroid nodules in different locations. Non-English studies, pediatric populations, research focused on small subsets with specific characteristics, and animal or tissue studies were excluded. Random-effects meta-analyses were conducted to estimate the pooled odds ratios (OR), and the JBI Critical Appraisal Checklist was used for quality assessment. The study was registered with PROSPERO (CRD420251103875). RESULTS: We included 27 studies with 33,474 patients. The median age was 49 years, and 78% were female. Isthmus nodules were associated with higher odds of thyroid cancer (OR 1.46; 95% confidence interval [CI] 1.08 to 1.98). To address moderate heterogeneity, a sensitivity analysis excluding studies with a potentially high risk of bias revealed a consistent trend with a pooled OR of 1.90 (95% CI, 1.38 to 2.60). CONCLUSION: This meta-analysis demonstrates an increased risk of malignancy for thyroid nodules in the isthmus compared to those in the lobes. Although the findings suggest a potential benefit of lowering the biopsy threshold for isthmus nodules, this should be interpreted with caution due to the observational design and possible biases.
PURPOSE: To explore, using numerical simulations, the biomechanical behavior of otoconia during the Garaycochea maneuver in torsional-vertical down-beating positioning nystagmus (TVP-DBNy) associated with benign paroxysm...PURPOSE: To explore, using numerical simulations, the biomechanical behavior of otoconia during the Garaycochea maneuver in torsional-vertical down-beating positioning nystagmus (TVP-DBNy) associated with benign paroxysmal positional vertigo (BPPV), and to propose a modified maneuver designed for execution under controlled conditions compatible with a mechanical-repositioning-chair (MRC). METHODS: A high-resolution three-dimensional micro-computed tomography (μCT) reconstruction of a human membranous labyrinth was used to simulate TVP-DBNyrelated conditions. The main clinical scenarios producing TVP-DBNy where included: short-arm of the posterior canal (PC); distal portion of the long-arm of the PC; and a contralateral anterior canal (AC). Endolymphatic flow was modeled using the Navier-Stokes equations, and otoconia of different sizes (5-20 μm) were introduced as Lagrangian particles. Two maneuver protocols were simulated: the original Garaycochea maneuver and a modified sequence simulated under idealized, controlled conditions consistent with MRC-based execution. RESULTS: The original maneuver did not consistently promote otoconial transport toward the utricular macula across all simulated scenarios. The modified maneuver resulted in trajectories that favored otoconial progression toward the utricle under the specific kinematic conditions simulated, with limited displacement observed for the smallest particles. CONCLUSION: The simulations suggest that symptom improvement after the standard maneuver may be associated with scenarios in which most particles remain near the utricular side of the horizontal ampulla. The proposed modification provides mechanistic insight into possible personalized repositioning strategies but should be interpreted as exploratory and hypothesis-generating, conditional on the modeled conditions, rather than as evidence of clinical superiority.
PURPOSE: Idiopathic subglottic stenosis (iSGS) is a rare, progressive fibroinflammatory disease that predominantly affects middle-aged women. Although endoscopic treatments have improved, recurrence rates remain high and...PURPOSE: Idiopathic subglottic stenosis (iSGS) is a rare, progressive fibroinflammatory disease that predominantly affects middle-aged women. Although endoscopic treatments have improved, recurrence rates remain high and no standardized therapeutic approach has been defined. This exploratory retrospective pilot study aimed to assess feasibility, safety and explore the preliminary signal of benefit of intralesional injection of centrifuged autologous lipoaspirate as an adjunct to endoscopic balloon dilation in patients with iSGS. METHODS: A retrospective pilot observational study was conducted at the Tracheal Team of the University Hospital of M. and the Otorhinolaryngology Unit of S.O. Hospital, B., I., from 2015 to 2024. Twenty-six adult women with histologically confirmed iSGS and at least 12 months of follow-up were included. Patients received either standard endoscopic balloon dilation with intralesional corticosteroid injection (n=19) or balloon dilation followed by injection of centrifuged autologous lipoaspirate (n=7). The primary outcome was recurrence within 24 months, defined as the need for reintervention due to symptomatic restenosis. Secondary outcomes included time-to-recurrence, Subglottic Stenosis-6 (SGS-6) scores, and perioperative complications. RESULTS: Overall, recurrence occurred in 16 of 26 patients (61.6%). Recurrence was lower in the lipoaspirate group (2/7, 28.6%) compared with the standard group (14/19, 73.7%), with Pearson's χ² of 4.4 (P = 0.036; Fisher's exact P=0.06). Median time-to-recurrence was longer in the lipoaspirate group (482 days) than in the standard group (240 days) (Long-rank test p=0.047). CONCLUSIONS: In this retrospective pilot study, patients with idiopathic subglottic stenosis treated with intralesional injection of centrifuged autologous lipoaspirate following endoscopic balloon dilation showed a preliminary signal of lower recurrence rate and longer recurrence-free survival.
Corrales-Millán R, Maza-Solano J, Benito-Navarro JR
… +12 more, García-García V, Gámiz-Maroto MJ, Márquez-Moyano JA, de la Puerta LPS, Caballero-García A, Guillamón-Fernández D, Ortiz-Rueda M, Alonso-Blanco D, Reyes-Tejero IM, Loaiza-Garreton JP, Müller-Locatelli N, Cuvillo-Bernal A
PURPOSE: To evaluate the real-world effectiveness of mepolizumab in patients with severe,uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), assessing its impacton sinonasal symptoms, endoscopic findings, ast...PURPOSE: To evaluate the real-world effectiveness of mepolizumab in patients with severe,uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), assessing its impacton sinonasal symptoms, endoscopic findings, asthma control, systemic corticosteroiduse, and quality of life (QoL) over 12 months. METHODS: RINOSUR 2.0 was a prospective multicenter cohort study conducted in southernSpain. Ninety-six adult patients with severe, uncontrolled bilateral CRSwNP receivedmepolizumab as add-on therapy and were followed for 12 months. Outcomes wereassessed at baseline, 6, and 12 months. Primary endpoints included the 22-itemSinonasal Outcome Test (SNOT-22), visual analogue scale (VAS) symptom scores,and Nasal Polyp Score (NPS). Asthma control was evaluated using the Asthma ControlTest (ACT). Health utility was derived from SNOT-22 using a validated mappingalgorithm to estimate quality-adjusted life years (QALYs). RESULTS: Mean SNOT-22 improved from 65.2 + 19.9 at baseline to 29.9 + 19.7 at 12 months(change -35.3; p<0.001), with 86.5% achieving the minimal clinically importantdifference. NPS decreased from 5.5 + 1.7 to 2.5 + 1.7 (p<0.001). ACT increased from17.1 + 5.4 to 23.4 + 3.4 (p<0.001). Health utility improved from 0.431 + 0.135 to 0.671+ 0.134, corresponding to a gain of 0.14 QALYs in the first year. Systemiccorticosteroid exposure was significantly reduced (p<0.001). Clinical improvement wasindependent of prior surgical extent after adjustment for baseline severity. Treatmentwas well tolerated. CONCLUSION: In routine practice, mepolizumab provides sustained improvements in QoL, endoscopicpolyp burden, and asthma control in severe CRSwNP, translating into clinicallymeaningful health utility gains.
INTRODUCTION: Tinnitus, the perception of sound without external stimuli, affects approximately 14.4% of adults, significantly impacting quality of life. Previous cross-sectional research has shown that individuals who e...INTRODUCTION: Tinnitus, the perception of sound without external stimuli, affects approximately 14.4% of adults, significantly impacting quality of life. Previous cross-sectional research has shown that individuals who engage in greater levels of physical activity (PA) reported lower tinnitus severity. While these findings are promising, they are limited by the inherent constraints of cross-sectional designs. Hence, the current study investigated whether longitudinal changes in PA are associated with concurrent changes in tinnitus severity. METHODS: In an observational longitudinal study, 2,751 individuals with subacute and chronic tinnitus were recruited through an online survey. Data were collected at baseline and three annual follow-ups (T2, T3, or T4), assessing demographic variables, tinnitus severity (Likert scale), and PA using the International Physical Activity Questionnaire (IPAQ). Associations between changes in PA and tinnitus severity were analyzed using discrete-time Cox proportional hazards regression, adjusted for demographic and health-related confounders, such as age, sex, hearing loss, noise exposure, stress, anxiety, and depression. RESULTS: Higher levels of leisure-time vigorous-intensity physical activity were associated with a lower hazard of reporting stable or increased tinnitus severity relative to baseline during follow-up (HR = 0.966; 95% CI: 0.957-0.975, p < 0.001). Participants who were physically inactive at baseline but increased their physical activity to meet World Health Organization recommendations at any follow-up time point exhibited a 64.2% lower hazard of reporting stable or increased tinnitus severity relative to baseline (HR = 0.358; 95% CI: 0.310-0.413, p < 0.001). Conversely, participants who became physically inactive during follow-up showed a 60.7% higher hazard of reporting increased tinnitus severity relative to baseline (HR = 1.607; 95% CI: 1.215-2.127, p < 0.001). CONCLUSION: In this longitudinal observational study, higher and sustained levels of physical activity-particularly vigorous-intensity leisure-time activity-were consistently associated with more favorable tinnitus severity trajectories over time, whereas reductions in physical activity were associated with worsening tinnitus severity.
PURPOSE: To conduct a scoping review to assess the extent and type of evidence on the use of IRT as a diagnostic tool for thyroid nodule detection and classification. METHODS: This review followed the JBI Scoping Review...PURPOSE: To conduct a scoping review to assess the extent and type of evidence on the use of IRT as a diagnostic tool for thyroid nodule detection and classification. METHODS: This review followed the JBI Scoping Review methodology and included studies involving IRT assessments of the thyroid gland in patients from clinical, academic, or experimental settings. Electronic searches were conducted in PubMed, Embase, Web of Science, Scopus, and Google Scholar. RESULTS: A total of 28 studies published between 2009 and 2025 were included after screening 2,687 records. Most studies used static IRT (SIRT) or dynamic IRT (DIRT), many of them integrating artificial intelligence (AI) tools. The assessed studies demonstrated temperature differences between malignant nodules, benign nodules, and healthy tissues, particularly under thermal stress. AI classifiers, especially convolutional neural networks (CNN), have demonstrated enhanced diagnostic performance, with reported accuracies reaching up to 98.4%. However, results varied due to differences in imaging protocols, camera resolution, and patient-specific factors such as subcutaneous fat thickness. CONCLUSION: IRT shows promising potential as an adjunctive diagnostic tool for assessing thyroid nodules, particularly when combined with AI and dynamic protocols. However, standardization and further validation in diverse populations are needed.
PURPOSE: To evaluate hemodynamics in the sigmoid sinus of sigmoid sinus wall dehiscence (SSWD)-pulsatile tinnitus (PT) patients with idiopathic intracranial hypertension using four-dimensional (4D) flow MRI. METHODS: Thi...PURPOSE: To evaluate hemodynamics in the sigmoid sinus of sigmoid sinus wall dehiscence (SSWD)-pulsatile tinnitus (PT) patients with idiopathic intracranial hypertension using four-dimensional (4D) flow MRI. METHODS: Thirty-five SSWD-PT patients with idiopathic intracranial hypertension were prospectively enrolled, together with 35 age-, sex-matched healthy controls and underwent MRI. Hemodynamics in the sigmoid sinus were evaluated by 4D flow MRI. Receiver operating characteristic curves and logistic regression analysis evaluated the ability of the hemodynamic indicators to differentiate SSWD-PT patients from healthy controls. RESULTS: PT patients presented significantly increased maximum velocity [86.77 ± 7.92 cm/s vs. 46.32 (38.89, 53.96) cm/s], maximum through-plane velocity (Vtp_max) (63.83 ± 16.89 cm/s vs. 45.65 ± 10.92 cm/s), backward flow volume [0.27 (0.06, 0.84) mL vs. 0.04 (0.01, 0.06) mL], regurgitant fraction [10.73 (2.11, 24.30) % vs. 0.47 (0.17, 1.31) %], and average wall shear stress (WSSavg) [0.27 (0.24, 0.33) N/m vs. 0.14 (0.11, 0.19) N/m] (all p < 0.001). Average velocity (18.47 ± 2.69 cm/s vs. 21.97 ± 6.66 cm/s), average through-plane velocity [5.06 (3.25, 7.74) cm/s vs. 20.30 ± 6.44 cm/s], forward flow volume [3.70 (2.40, 5.44) mL vs. 6.90 ± 3.50 mL], and average blood flow (4.16 ± 2.03 mL/s vs. 7.42 ± 3.67 mL/s) were significantly decreased in PT group (all p < 0.05). Abnormal vortex or turbulent flow occurred in 88.6% of patients, none in controls (p < 0.001). The combination of Vtp_max and WSSavg showed the highest ability to differentiate SSWD-PT patients from healthy controls (AUC = 0.956). CONCLUSION: SSWD-PT patients have hemodynamic changes in the sigmoid sinus. The combination of Vtp_max and WSSavg may serve as a valuable noninvasive indicator for differentiating SSWD-PT patients from healthy controls.
Shah A, Sarkar S, Chenniappan S
… +21 more, Samal DK, Ramasubbu MK, Parida PK, Pradhan P, Preetam C, K V, K V A, G A, Sharma P, Chakraborty S, Mishra A, Mittal Y, Kumar A, Swarup A, Chidambaram K, Adhikari A, Shaikh Z, Punia R, Kharwanlang M, Saleem S, K A
PURPOSE: To compare the outcomes of conventional tympanoplasty and endoscopic total annular excision tympanoplasty in chronic otitis media (COM) mucosal type with large and subtotal perforations; in terms of graft uptake...PURPOSE: To compare the outcomes of conventional tympanoplasty and endoscopic total annular excision tympanoplasty in chronic otitis media (COM) mucosal type with large and subtotal perforations; in terms of graft uptake and hearing improvement. METHODS: Study design: Single blinded RCT. SETTING: Department of ENT at AIIMS Bhubaneswar, India. The study was a single-blinded RCT done in patients of COM mucosal type, attending the Department of ENT at our Institute, during the period of January,2022 to March,2023. Patients with subtotal perforation with an Air Bone gap (AB gap) of > / = 20 deciBel (dB) were included in the study. They were divided into 2 arms of 30 patients each, one group underwent a conventional tympanoplasty while the other group had an endoscopic total annular excision (TAE) tympanoplasty. Graft uptake was measured by otoendoscopy at 6 months and 34 months postoperatively, hearing gain by Pure Tone Audiometry (PTA) and patient satisfaction by Chronic Ear Survey to asses quality of life. RESULTS: There was no significant difference among the groups in terms of age, gender, occupation, or socioeconomic status. The median preoperative Air conduction (AC), Bone conduction (BC), AB gap or Speech reception threshold were also not significantly different among the groups. 25 patients (83.3%) of TAE had an intact neotympanum, compared to 24(80%) in the control group(p-value = 0.565). The patients who underwent TAE tympanoplasty had a median reduction in Air-Bone gap of 12.50 dB, while those in the conventional tympanoplasty group had a median reduction of 8.0 dB (p value = 0.011). The median postoperative Speech Reception Threshold (SRT) in the TAE tympanoplasty group was 35.00, whereas in the control group it was 40.00 (p value = 0.009). CONCLUSION: TAE tympanoplasty is a safe and effective surgery for mucosal type of chronic otitis media with subtotal perforation, and correlates clinically. TAE tympanoplasty showed better improvement in AB gap and postop SRT.