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Objectives/hypothesis: To evaluate the efficacy and safety of a slow-release form of bepotastine salicylate (HL151, Belion CR) in patients with perennial allergic rhinitis (PAR).Study Design: Double-blind, placebo-controlled multicenter comparative study.Methods: Two hundred seventy-two PAR patients (aged 19-65 years) were studied to determine the efficacy and safety of HL151 (20 mg once daily administration) relative to those of a placebo in terms of improvements in total and nasal symptom scores. The subjects were randomized to the placebo (n = 138) or HL151 group (n = 134, 20 mg orally once daily for 4 weeks), and reflective and instantaneous total nasal symptom scores (TNSS) were measured daily in comparison with baseline. Among 272 subjects, 229 subjects (119 in the placebo group, 110 in the HL151 group) who completed the study were included for efficacy analysis.Results: Instantaneous and reflective TNSS and nasal symptoms such as rhinorrhea, nasal itching, and sneezing at 2 and 4 weeks showed that HL151 was superior to the placebo (all P < .05). There were no significant differences in terms of adverse events and adverse drug reactions between the two groups. Regarding serious adverse events, there was only one case of acute hepatitis B, which was reported not to be associated with HL151.Conclusions: This multicenter trial showed that once-daily use of HL151 is efficacious and safe in adult patients with PAR and could improve compliance due to its convenience.Level Of Evidence: 1b Laryngoscope, 131:E702-E709, 2021. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: There is no study regarding intraoperative neural monitoring (IONM) of the external branch of the superior laryngeal nerve (EBSLN) during transoral thyroidectomy. The objective of this study was to evaluate the feasibility and success rate of electrical identification of the EBSLN during transoral robotic or endoscopic thyroidectomy. Study Design: Case series study. Methods: We studied a cohort of 76 patients (87 nerves at risk, (NARs)) who underwent transoral robotic or endoscopic thyroidectomy and simultaneous intermittent IONM between July 2017 and May 2019. We performed the standard IONM procedure plus routine neural monitoring of the EBSLN. IONM and surgical outcome data were prospectively collected. Results: Sixty‐one patients underwent the robotic procedure, and 15 patients underwent the endoscopic procedure. Thirty‐seven external branches of the superior laryngeal nerves at risk (42.5%) were electrically identified using electromyography signals (31 NARs, 35.6%) or cricothyroid muscle twitches (6 NARs, 6.9%). The mean pre‐(S1) and post‐dissection (S2) amplitudes of the EBSLN were 372 ± 147 and 351 ± 159 μV, respectively. The identification rates were not different between the robotic and endoscopic procedures. In comparing the early 20 NARs (18 patients) and the later 67 NARs (58 patients), the identification rate was higher in the later cases, although the difference was not statistically significant (25.0% vs. 47.8%, P =.079). Conclusion: IONM of the EBSLN is feasible and useful in identifying and preserving the nerve during transoral thyroidectomy, although the identification rate of the nerve is relatively low. Level of Evidence: 4 Laryngoscope, 131:E671–E676, 2021 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate clinical characteristics and possible associated factors of idiopathic sudden sensorineural hearing loss (ISSNHL) in children using univariate and multivariate analyses. Study Design A retrospective case series with comparisons. Methods From January 2007 to December 2013, medical records of 37 pediatric ISSNHL patients were reviewed to assess hearing recovery rate and examine factors associated with prognosis (gender; side of hearing loss; opposite side hearing loss; treatment onset; presence of vertigo, tinnitus, and ear fullness; initial hearing threshold), using univariate and multivariate analysis, and compare them with 276 adult ISSNHL patients. Results Pediatric patients comprised only 6.6% of pediatric/adult cases of ISSNHL, and those below 10 years old were only 0.7%. The overall recovery rates (complete and partial) of the pediatric and adult patients were 57.4% and 47.2%, respectively. The complete recovery rate of the pediatric group (46.6%) was higher than that of the adult group (30.8%, P = .040). According to multivariate analysis, absence of tinnitus, later onset of treatment, and higher hearing threshold at initial presentation were associated with a poor prognosis in pediatric ISSNHL. Conclusions The recovery rate of ISSNHL in pediatric patients is higher than in adults, and the presence of tinnitus and earlier treatment onset is associated with favorable outcomes. Level of Evidence 4 Laryngoscope, 125:2209-2215, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate the significance of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in vestibular neuritis. Study Design Retrospective, case-control study. Methods The study subjects were patients who received treatment for vestibular neuritis between January 2009 and December 2013, and a control group composed of 70 age- and sex-matched healthy subjects who received laboratory testing as part of a routine health checkup. The subjects underwent a complete blood cell count and counts of the various cell subtypes to compare NLR and PLR in the vestibular neuritis patients and controls. The associations between laboratory test results and values of the vestibular function test and clinical information were examined. In addition, a subgroup analysis according to the duration of spontaneous nystagmus was performed. Results The mean NLR and PLR values of the patient group were significantly higher than those of the control group. Although caloric test outcomes and hospitalization period were not significantly correlated with blood profiles, the duration of dizziness needing antivertiginous drugs was positively correlated with NLR and PLR ( P = .021, P = .020, respectively). In addition, NLR was negatively correlated with the length of time between symptom start and blood sampling ( P = .005). The NLR and PLR value of patients with nystagmus for more than 5 days were significantly higher than those of patients whose nystagmus ceased within 5days. Conclusions This is the first report to evaluate the significance of NLR and PLR in vestibular neuritis. NLR and PLR should be taken into consideration as simple and reliable parameters for predicting the cause and severity of the disease. Level of Evidence 3b Laryngoscope, 125:E257-E261, 2015 [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the usefulness of acoustic parameters as an indicator of laryngopharyngeal reflux (LPR) treatment efficacy. Study Design: A prospective case series analysis. Materials and Methods: From January to September 2005, we prospectively analyzed 40 patients who were diagnosed with laryngopharyngeal reflux by 24-hour ambulatory double-probe pH monitoring. Laryngopharyngeal reflux patients were treated medically and voice analysis was conducted three times: before treatment, 1 to 2 months after treatment, and 3 to 4 months after treatment. Jitter, shimmer, and harmonic-to-noise ratio (HNR) were analyzed as the acoustic parameters. Pre- and posttreatment reflux symptom index and reflux finding score were documented. Results: Jitter, shimmer, and HNR had improved significantly at 1 to 2 months after treatment and were maintained at 3 to 4 months after treatment. Jitter was significantly correlated with reflux symptom index. Conclusion: Acoustic parameters can be used as indicators of treatment efficacy for laryngopharyngeal reflux disease. [ABSTRACT FROM AUTHOR]

Objectives: Although many bacteriology studies on tonsillar diseases have been completed, all have been confined to children and were characterized by a paucity of cases. The purpose of this study was to analyze the underlying bacterial pathogens in tonsillar disease. Methods: A retrospective study was performed on 824 patients who underwent elective tonsillectomy with or without adenoidectomy. We analyzed the differences between the bacterial pathogens in recurrent tonsillitis and tonsillar hypertrophy with regard to age, season, and antibiotic sensitivity. Results: Among 824 cases, 966 bacterial strains from the tonsil core were isolated. In recurrent tonsillitis, Staphylococcus aureus was the most common pathogen (30.3%), followed by Haemophilus influenzae (15.5%) and group A β-hemolytic Streptococcus ( Streptococcus pyogenes, 14.4%). In patients over 14 years of age, quite differently from other age groups, Klebsiella pneumoniae was isolated at a significantly higher percentage. In tonsillar hypertrophy, H. influenzae was isolated most commonly (31.4%) regardless of age, followed by S. pyogenes (24.2%), S. aureus (22.9%), and Streptococcus pneumoniae (12.6%). Furthermore, mixed infection was common because of its high resistance to penicillin. In both groups, S. pneumoniae was more common in younger patients, whereas K. pneumoniae was relatively common in adults. We found no differences in the detection rate by season; however, H. influenzae was frequently isolated in the tonsillar hypertrophy group regardless of seasonal variations. We also found no difference in the antibiotic sensitivity between the two groups; however, strains resistant to penicillin were relatively prevalent and showed a high sensitivity to third-generation cephalosporin. Conclusions: We observed some differences in the types of bacteria in the tonsillar core between the recurrent tonsillitis and tonsillar hypertrophy groups. Our study indicates that essential bacteria have been changing and, thus, we need to change our choice of antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to investigate how the expression of the RANK-RANKL-OPG system mediates the formation and differentiation of osteoclasts and causes bone resorption in cholesteatoma., Methods: An immunohistochemical analysis was carried out in 22 cholesteatoma tissues obtained during middle ear surgery and 15 normal postauricular skin tissues to examine the expression of RANKL and OPG., Results: All 22 cases of cholesteatoma and the 15 cases of normal postauricular skin expressed RANKL and OPG. The count and rate of RANKL-positive cells in cholesteatoma was significantly higher than in normal postauricular skin. The count and rate of OPG-positive cells in normal postauricular skin was significantly higher than in cholesteatoma. The ratio of the positive expression rates of RANKL and OPG in cholesteatoma was statistically higher than in normal postauricular skin., Conclusions: We provide evidence suggesting that RANKL, which activates osteoclasts, plays a significant role in the mechanism of bone destruction in cholesteatoma, and that the ratio of RANKL to OPG may be a reliable indicator of bone destruction in cholesteatoma.