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IMPORTANCE: Clinicians should understand how patients who were treated with laryngeal cancer surgery think about this later on and what factors may be related with regretting surgery. OBJECTIVE: To assess variables associated with a positive attitude toward laryngeal cancer surgery. DESIGN, SETTING, AND PARTICIPANTS: This combination of 2 cohorts, based on patient interviews and questionnaires, was studied in 16 hospitals in Germany. Participants scheduled for laryngeal cancer surgery were enrolled before surgery and followed up until 1 year after surgery. Data collection began on November 28, 2001, and ended on March 15, 2015. Statistical analysis was performed from August 21, 2023, to January 19, 2024. MAIN OUTCOMES AND MEASURES: The attitude toward surgery was measured with the Psychosocial Adjustment After Laryngectomy Questionnaire (scores range from 0 to 100, with high scores representing a positive attitude toward the surgery) at 1 year after surgery. In multivariate regression analysis, the following variables were investigated: type of surgery, number of surgeries to the larynx, receipt of radiotherapy and chemotherapy, quality of life, speech intelligibility (objectively measured), age, sex, educational level, employment status, having a partner or not, counseling by patient association, and shared decision-making. RESULTS: Patients (n = 780; mean [SD] age, 60.6 [10.4] years; 701 [90%] male) who had received counseling from the patient association reported a more positive attitude toward surgery (adjusted B = 8.8; 95% CI, 1.0-16.6). Among patients after total laryngectomy, those with a university degree had a less positive attitude toward their surgery (adjusted B = −50.8; 95% CI, −84.0 to –17.6); this result was not observed in patients after partial laryngectomy (adjusted B = –4.8; 95% CI, −15.1 to 5.4). Among patients after partial laryngectomy, the attitude toward surgery was most positive in those who had experienced shared decision-making (mean [SD] questionnaire score, 84 [20] in those without a wish and 83 [20] in those with a wish for shared decision-making). Those who had wished they could decide together with the physician but where this eventually was not experienced expressed the most regret toward surgery (mean [SD] score, 71 [22]). There was no association between attitudes toward surgery and type of surgery (total vs partial laryngectomy) and all other variables tested. CONCLUSION AND RELEVANCE: In this cohort study, most patients with head and neck cancer reported a positive attitude toward surgery, suggesting low levels of decision regret. Counseling by members of patient associations as well as individualized shared decision-making prior to surgery may have a positive impact on decision regret and is advisable in daily practice.

Drug delivery to the inner ear presents a unique challenge due to the complex inner ear anatomy and its tight physiological barriers. This study investigates the degradation behavior of intracochlear drug delivery implants (IDDI) composed of dexamethasone and poly(lactic-co-glycolic acid) (PLGA) or polyethylene glycol–poly(lactic-co-glycolic acid) (PEG-PLGA), respectively. IDDI were incubated in artificial perilymph and implants' degradation kinetics, morphological changes, water uptake behavior, and pH alterations were assessed. Microscopy revealed significant changes in appearance, with PLGA IDDI exhibiting rapid expansion, reaching up to 183 % in diameter and 185 % in length. PEG-PLGA implants showed gradual expansion, reaching a maximum of 178 % in diameter and 144 % in length. Despite these morphological changes, the IDDIs could still be applicable in terms of cochlear dimensions in combination with cochlear implants (CI) in humans or in a domestic pig animal model. Scanning electron microscopy analysis demonstrated surface alterations of PLGA implants, while PEG-PLGA implants remained shape-stable. Gravimetric analysis and gel permeation chromatography revealed distinct degradation profiles, with PLGA implants displaying rapid water uptake and mass loss, while PEG-PLGA implants showed delayed water uptake and minimal mass reduction. pH measurements using the pH-sensitive fluorescent dye SNARF™-1 showed initial pH reduction in artificial perilymph for PLGA implants while PEG-PLGA implants maintained pH stability.

Graphical abstract:

To evaluate the benefit of a preoperative three-dimensional (3D) planning tool for surgically placing the bone conduction floating mass transducer (BC-FMT) of the Bonebridge (BB) bone conduction implant.

To evaluate the feasibility and hearing outcome of a biocompatible degradable dexamethasone releasing implant for continuous drug delivery to the round window membrane in patients with idiopathic sudden sensorineural hearing loss (ISSHL) and insufficient recovery after systemic high dose glucocorticoid therapy.

To determine whether intracochlearly applied dexamethasone will lead to better control of drug levels, higher peak concentrations, and lower base-to-apex concentration gradients in the scala tympani (ST) of the guinea pig than after intratympanic (round window RW) application.

ABSTRACTThis case report describes the use of transcranial magnetic theta burst stimulation (TBS) in the treatment of incapacitating tinnitus accompanied by symptoms of severe depression. Tinnitus is known to be associated with hyperactivity and maladaptive cortical reorganization of the central auditory system. Combined with anxiety and depression, it can occasionally constitute a psychiatric emergency. Recently, it has been demonstrated that tinnitus can be temporarily suppressed by non-invasive transcranial magnetic stimulation. TBS is a newly developed technique for rapid and lasting modulation of cortical excitability. Herein, we present a case of a 54-year-old woman with incapacitating tinnitus that has significantly decreased after three cycles of 1-week treatment with continuous TBS to the temporo-parietal auditory association cortex. According to the Tinnitus Questionnaire, tinnitus intensity decreased from 84 points before to 59 points after treatment. Hamilton Rating Scale for Depression score dropped from 44 to 23 points. TBS showed to be efficient, well-tolerated, and practical in the management of distressing tinnitus accompanied by symptoms of severe depression.

Drugs applied to the middle ear enter perilymph through the bony otic capsule.

Objectives/Hypothesis:To establish safe dosing protocols for the treatment of patients with Meniere's disease with intratympanic gentamicin.

Local application of dexamethasone-21-dihydrogen-phosphate (Dex-P) to the round window (RW) membrane of guinea pigs produces a substantial basal-apical concentration gradient in scala tympani (ST) perilymph.

Different methods of pure-tone audiometry analysis in sudden hearing loss studies show a lack of agreement with respect to outcome, and the choice of outcome measure influences sample size calculation.

Objectives:The distribution of gentamicin along the fluid spaces of the cochlea after local applications has never previously been demonstrated. Computer simulations have predicted that significant basal‐apical concentration gradients might be expected, and histologic studies indicate that hair cell damage is greater at the base than at the apex after local gentamicin application. In the present study, gradients of gentamicin along the cochlea were measured.

Despite its invasiveness, the temporary implantation of a microcatheter into the middle ear cavity is an appropriately safe method for providing continuous drug delivery to the inner ear.

Tuning curves, spontaneous activity, and rate-intensity (RI) functions were obtained from units in the chick cochlear nerve. The characteristic frequency (CF) was determined from each tuning curve. The shape of each RI function was subjectivelyevaluated and assigned to one of four RI types. The breakpoint, discharge rate at the highest SPLs, and slopes of the primary and secondary segments were quantified for each function. The CF and RI type were then related to these variables. A new RI function was observed in which the discharge activity in the secondary segment diminished as stimulus level increased above the breakpoint. This function was called a “sloping-down” type. In 959 units, saturating, sloping-up, sloping-down, and straight RI types were identified in 39.2, 35.5, 12.6, and 12.7% of the sample, respectively. The slope of the primary segment was nearly the same in each of the four types and averaged 5.48 S · s−1· dB−1across all units. The slopes of the secondary segments formed four groupings when segregated by RI type based on the subjective assignments and averaged 0.03, 1.22, −0.90, and 3.95 S · s−1· dB−1in the saturating, sloping-up, sloping-down, and straight types, respectively. The data describing the secondary segments of all units were fit with a multi-compartment polynomial and showed a continuous distribution that segregated, with some overlap, into the different RI categories. The proportion of RI types, as well as the secondary and primary slopes were approximately constant across CFs. In addition, it would appear that the other parameters that define the four types were, for the most part, homogeneously distributed across the frequency axis of the chick inner ear. Finally, a comparison of RI functions having a common CF suggested that the compressive nonlinearity that determines RI type may be a phenomenon localized to individual hair cells in the bird ear.

That a theoretical basis for quantifying drug distribution in the inner ear with local applications can be established.

The etiology, pathogenesis, histopathologic diagnosis, prognosis, and treatment of giant cell reparative granulomas of the skull are controversial. We report a 14-year-old girl with an advanced recurrent giant cell reparative granuloma of the skull base and paranasal sinuses whose only clinical manifestation was a loss of vision. After undergoing endovascular catheter embolization, the patient underwent repeated surgical resections of the mass via a combined frontobasal and modified infratemporal approach followed by radiation therapy. Histopathologic examination confirmed the diagnosis of giant cell reparative granuloma. A traumatic event in the patient's history-a fossa canina abscess followed by tooth extraction 14 months before admission-supports the theory of a reactive reparative process as a pathogenetic mechanism for this disease. Histopathologic criteria and clinical aggressiveness must be considered to achieve adequate treatment of giant cell lesions of the skull.