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Objective: The aim of this study was to investigate the clinical implications of diabetes for the management of idiopathic sudden sensorineural hearing loss (ISSNHL).Study Design: Retrospective study.Setting: Tertiary referral center.Subjects and Methods: ISSNHL patients (N = 403) who received inpatient management between January 2015 and December 2018 were analyzed. All were managed by a uniform treatment protocol of high-dose steroid therapy and salvage intratympanic steroid injections. Treatment results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery's criteria 3 months after the start of treatment. We compared the clinical parameters and treatment outcomes of ISSNHL with and without diabetes. We also evaluated the influence of diabetes on the prognosis of ISSNHL by propensity score matching.Results: Overall, of the 403 ISSNHL patients, 94 (23.3%) had diabetes, and 11 were newly diagnosed with diabetes. The patients with diabetes were older than those without diabetes (P < .001), and their initial hearing threshold was significantly higher (P < .001). The diabetic patients were hospitalized for a longer period, and their hearing recovery rate was lower. However, when age, sex, and initial hearing level were adjusted by propensity score matching, the diabetic patients and matched controls yielded similar treatment results.Conclusions: ISSNHL with diabetes usually presents with severe hearing loss and requires longer hospitalization. However, diabetes itself may not influence the prognosis of ISSNHL. Proper management must be provided in ISSNHL with diabetes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid‐attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL). Study design: Case series with comparisons. Setting: Tertiary referral centre. Participants: Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment. Intervention: Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium. Main outcome measures: The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analysed, and the relationships between hearing recovery and MR image findings were assessed. Results: Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8 (9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (P < 0.001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR = 5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (P = 0.001). Conclusions: Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic SSNHL. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging in acute vestibular neuritis.Study Design: A prospective observational study.Methods: Twenty-nine vestibular neuritis patients were enrolled between January 2017 and June 2017. Vestibular function tests, comprising the caloric and video head impulse tests and vestibular-evoked myogenic potential measurements, were performed. Precontrast, 10-minute, and 4-hour delayed-enhanced 3D-FLAIR MR images using double-dose IV gadolinium were obtained. After laterality and extent of inner ear enhancement were defined, the patients were divided into groups based on the patterns of enhancement, and clinical parameters were analyzed according to the groups.Results: Twenty patients (20 of 29, 69.0%) had obviously asymmetric enhancement of the affected inner ear structures on 4-hour delayed images, whereas only three patients (10.3%) had marked enhancement on 10-minute delayed images. The duration of spontaneous nystagmus (DurSN) was significantly longer in the patients with enhancement, especially with enhancement of the whole inner ear, including the vestibule and semicircular canals (P < 0.033). Spontaneous nystagmus resolved within 12 days in patients without laterality of enhancement, and within 16 days in ipsilesional enhancement confined to the inner auditory canal and fundus. Other results of vestibular function tests did not reveal any significant associations with MR enhancement.Conclusions: Contrast enhancement of the vestibular nerve and inner ear structures can be identified on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in acute vestibular neuritis. The extent of inner ear enhancement may be associated with the DurSN.Level Of Evidence: 4. Laryngoscope, 1946-1951, 2018. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bell's palsy and Ramsay Hunt syndrome ( RHS). Study Design Prospective observational study. Methods Patients with acute severe facial paralysis of House-Brackmann (H-B) grade IV or worse and diagnosed with Bell's palsy or RHS were enrolled from August 2007 to July 2011. After treatment with oral corticosteroid, antiviral agent, and protective eye care, patients were followed up until recovery or 12 months from onset. Results Sixty-six patients with Bell's palsy and 22 with RHS were included. Multiple logistic regression analysis showed significant effect of ENoG value on recovery in both Bell's palsy and RHS. Values of ENoG were significantly worse in RHS than Bell's palsy. Chance of early recovery within 6 weeks after correction of ENoG effect was still significantly worse in RHS. Logistic regression analysis showed 90% chance of recovery within 6 months, expected with ENoG values of 69.2% degeneration (Bell's palsy) and 59.3% ( RHS). The receiver operating characteristics ( ROC) curves showed ENoG values of 82.5% (Bell's palsy) and 78.0% ( RHS) as a critical cutoff value of nonrecovery until 1 year, with the best sensitivity and specificity. Conclusions A higher chance of recovery was expected with better ENoG in Bell's palsy and RHS. Based on our data, nonrecovery is predicted in patients with ENoG value greater than 82.5% in Bell's palsy, and 78% in RHS. Level of Evidence 4. Laryngoscope, 123:2526-2532, 2013 [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2010) 39: 349–355 Objective: Defects in the mitotic checkpoint lead to aneuploidy and might facilitate tumorigenesis. However, the ploidy status in salivary duct carcinoma (SDC) has been reported to play limited role in prediction of prognosis. Thus, we need more reliable markers to reflect the rapid tumor progression in SDCs. We aimed here to investigate the expression of mitotic checkpoint proteins benzimidazole 1 homolog beta (BUB1B) and mitosis arrest-deficient 2 like 1 (MAD2L1) in SDCs and to determine their possible role as surrogate prognostic markers. Methods: We analyzed the clinical courses, pathologic findings and immunohistochemical profiles of mitotic checkpoint proteins (BUB1B and MAD2L1) in 27 pathologically confirmed SDCs. The expression status of BUB1B and MAD2L1 was compared with clinicopathologic factors and other molecular markers, such as TGF-beta, c-erb-B2, androgen receptor, vascular endothelial growth factor, and epidermal growth factor receptor, for prognostic significance. Results: High BUB1B expression was detected in 25.9% of subjects, and high MAD2L1 expression was in 55.6% of subjects. However, survival analysis revealed that mitotic checkpoint expression did not have prognostic significance in SDCs, nor did the other studied markers. Rather, the clinical variable of N classification at diagnosis (in N+ status, hazard ratio 5.19, 95% CI 1.26–21.32 for disease-free survival and hazard ratio 7.18, 95% CI 1.09–46.99 for overall survival) was strongly associated with survival and prognosis based on the Cox proportional hazard model. Conclusions: Mitotic checkpoint proteins appeared to play a limited role in predicting prognosis in SDCs. Further study is required to elucidate the exact role of mitotic checkpoint proteins in SDCs. [ABSTRACT FROM AUTHOR]

Objective: Analyze the outcomes of early surgical exploration in suspected traumatic perilymph fistulas (PLF). Method: Study Design: Retrospective case review. Setting: Tertiary otology referral center. Patients and Intervention: Nine patients (10 cases) that developed sudden sensorineural hearing loss and dizziness following head trauma underwent exploratory tympanotomy and PLF repair with the clinical impression of traumatic PLF. Outcome Measure: Postoperative hearing changes and control of dizziness. Results: All patients had sudden or progressive hearing loss and dizziness following head trauma; a car accident, slap injury, and barotraumas. Surgical exploration was performed 2 to 47 days after the trauma. Possible evidence of PLF was found in 9 cases and included: fibrous web around the oval window (OW) (n = 3), perilymph collection around the round window (RW) (n = 5), and bulging of the RW membrane (n = 1). After surgical repair, the mean hearing gain was 28dB (10~55dB); the hearing improved to serviceable levels in 6 out of 10 cases (60%). All patients had resolution of the vestibular symptoms after the surgery. Conclusion: Sudden or progressive sensorineural hearing loss accompanied by dizziness following head trauma should prompt the consideration of a traumatic PLF. Early surgical exploration is recommended to control dizziness and improve hearing outcomes. [ABSTRACT FROM AUTHOR]

Objective: Assess the efficacy and safety of ultrasound‐powered shears (Harmonic Scalpel) in free flap elevation for head and neck defects. Method: From January to August 2010, there were 15 patients enrolled, who underwent reconstructive surgery with free flap in our institution. Donor sites were radial forearm in 10, anterolateral thigh in 5, and fibula in 2. HS was used in harvesting the perforators and the vascular pedicles. Results: All the free flaps were successfully harvested within 50 to 70 min (from skin incision to pedicle ligation). Bleeding was minimal even without tourniquet application. All vascular pedicle dissections were performed without mechanical or thermal damages, and they were anastomosized to proper, recipient vessels. Conclusion: Based on our experiences, HS is a safe and efficient instrument in harvesting the free flaps, especially because of no increased risk of thermal damage to vascular pedicle. [ABSTRACT FROM AUTHOR]