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Objective: Temporal bone pneumatization (TBP) is speculated to serve as a shock absorber in temporal bone fractures (TBF), directing the fracture line away from vital structures. This study correlates TBP extent with TBF patterns and preservations of vital TB structures. Study Design: Retrospective cohort study. Setting: Tertiary referral medical center. Methods: All TBF patients referred to a single tertiary center 2017 to 2023 were evaluated. A pneumatization index score for each of their TBs was derived by counting automated‐voxel density in a 0 to 100 scale. Results were correlated to the TBF type and the violated structure(s). The ossification index was compared to previously detailed qualitative classification systems of TBP. Results: One hundred and forty‐five patients were enrolled (mean age 43 ± 17 years). Kinematics were motor vehicle accidents (46%), scooter (15%), bicycle (14%), falls (13%), and assaults (8%). The mastoid ossification index we used showed a strong correlation to all qualitative classification systems (sigmoid = 0.829; labyrinthine = 0.849; carotis = 0.863, infralabyrinthine = 0.869, all P <.001). The pneumatization index strongly correlated with capsule‐violating TBFs, with a mean of 44 ± 23 for otic capsule‐sparing TBF and 61 ± 20 for otic capsule‐violating (OCV) TBF (P <.001). The facial nerve was violated in 30 patients. Facial canal (FC) involvement was not correlated to the ossification index: it was 49 ± 23 for FC‐sparing and 44 ± 23 for FC‐violating (P =.620). Conclusion: TBP serves as a protective mechanism against OCV TBF. The more pneumatized the TB, the less likely the otic capsule will be violated in the event of a TBF with the exception of the carotid and FCs. TBP index is in strong agreement with qualitative TBP classification systems. [ABSTRACT FROM AUTHOR]

Introduction: The etiology of idiopathic sudden sensorineural hearing loss (ISSNHL) remains elusive, with vascular compromise as a proposed cause. This study aimed to explore the correlation between the vertebrobasilar vascular system laterality (VBVSL) and ISSNHL laterality. Methods: We conducted a retrospective analysis of consecutive patients diagnosed with ISSNHL from 2015 to 2020. The VBVSL pattern was established via magnetic resonance imaging scans by a neuroradiologist. ISSNHL occurring contralaterally to the basilar artery (BA) curvature or ipsilaterally to the dominant vertebral artery (VA) was designated as a "positive match," with all other scenarios classified as a "negative match." Results: Our study included 191 ISSNHL patients (median age 57 years, 89 males, 93 right ears). The majority of patients did not exhibit a positive match between ISSNHL laterality and the sides of BA curvature or dominant VA (28.8% and 36.6% for BA and VA, respectively). Notably, VA-positive match patients were significantly older than VA-negative match patients (59 vs. 53 years, p = 0.043), with a similar trend observed in BA-positive match compared to BA-negative match (59 vs. 54.5 years, p = 0.057). However, there was no significant difference in any other clinical, audiometric, or outcome factors between the positive and negative match groups. Conclusion: The findings suggest no association between VBVSL and ISSNHL laterality. Furthermore, patients in the positive match group did not exhibit distinct clinical or audiometric features compared to those without a match. [ABSTRACT FROM AUTHOR]

Objectives: Data on the association between Bell's palsy (BP) and pregnancy is scarce and there is an ongoing debate regarding the association of BP and pregnancy. Main Outcome Measures: We aimed to investigate the prevalence of BP among pregnant patients and determine the frequency of pregnant women in BP cohorts and vice versa, assess which term of the pregnancy and peripartum bears a higher risk for BP occurrence, and determine the prevalence of maternal comorbidities associated with BP during pregnancy. Design: Meta analysis. Settings: Screening standard articles and extracting data from Ovid MEDLINE (1960–2021), Embase (1960–2021), and Web of Science (1960–2021). All study types were included except for case reports. Measures: Data were pooled by means of both fixed and random‐effects models. Results: The search strategy identified 147 records. Twenty‐five of the studies that met our inclusion criteria described 809 pregnant patients with BP in a total of 11,813 BP patients and they were included in the meta‐analysis. The incidence of BP among the pregnant patients was 0.05%; The incidence of pregnant patients among all BP patients was 6.62%. Most of the BP occurrences were during the third trimester (68.82%). The pooled incidence of gestational diabetes mellitus; hypertension; pre‐eclampsia/eclampsia and fetal complications among the pregnant patients with BP was 6.3%, 13.97%, 9.54%, and 6.74%, respectively. Conclusions: This meta‐analysis revealed a low incidence of BP during pregnancy. A Higher proportion occurred during the third trimester. The association of BP and pregnancy warrants further exploration. [ABSTRACT FROM AUTHOR]

Objective: To investigate the likelihood of missing a vestibular schwannoma (VS) diagnosis in patients who present with a sudden hearing loss (SHL) that does not meet the most accepted audiometric criteria for sudden sensorineural hearing loss (SSNHL) (a decrease of ≥30 dB at three consecutive frequencies). Methods: All adult patients (>18 years) diagnosed with SHL of any severity in a tertiary care referral medical center between 2015 and 2020 and who underwent an MRI scan to rule out VS were included. Statistical analyses were conducted to evaluate the difference between the rate of VS among patients with an initial audiogram, which met the abovementioned criteria, and those who did not. Other audiometric criteria for SNHL were also evaluated (≥10 dB at ≥2 frequencies and ≥ 15 dB at one frequency). Results: Of the 332 patients included in the study, 152 met the audiometric criteria for SSNHL, and 180 did not. Both groups had a similar VS rate (8.6% vs. 8.9%, p = 0.914). Similar results were found when other audiometric criteria for asymmetric SNHL were analyzed. In a subgroup analysis of patients with VS‐associated SSNHL, neither the tumor size nor the Koos classification was associated with any of the audiometric criteria systems. Conclusion: There should be a high index of suspicion for the presence of VS in patients with an SHL of any severity. Level of Evidence: 3 Laryngoscope, 133:670–675, 2023 [ABSTRACT FROM AUTHOR]

Introduction The measurement of extended high-frequency (EHF) audiometry has become more popular recently, mainly in connection with ototoxicity and noiseinduced hearing loss. New-onset tinnitus evaluation includes a standard hearing test that shows no pathology. Objective The aim of the present study was to evaluate the possibility that acute tinnitus is essentially connected to sudden sensory neural hearing loss (SSNHL), by utilizing EHF audiometry in cases in which standard audiometry for frequencies between 250 Hz to 8 kHz is within normal limits. Methods A retrospective study was conducted between January 2009 and May 2014 that included all patients presenting with acute tinnitus and normal standard audiometry. All patients underwent EHF audiometry and were treated accordingly. Results Thirty-two patients with acute tinnitus and asymmetric sensorineural hearing loss on EHF audiometry were identified. The average deltas between the ears were between 9.2 and 33dB (worse in the affected ear). Conclusion Extended high-frequency audiometry up to 20,000 Hz should be performed in all patients with acute tinnitus and standard audiometry within normal limits. [ABSTRACT FROM AUTHOR]

Objective: To study predictors of delayed presentation, diagnosis, and treatment of idiopathic sudden sensorineural hearing loss (ISSNHL)., Study Design: Retrospective medical chart review and patient telephone survey., Setting: Tertiary medical center., Subjects and Methods: All patients who initially presented or referred with unilateral ISSNHL between 2016 and 2020 were included. Associations between epidemiological, demographic, and socioeconomic profiles and delays in presentation, diagnosis and treatment were studied., Results: A total of 518 patients were suitable for study inclusion. The total delay in the emergency department (ED) setup was a median (interquartile range, IQR) of 1 (0-1) day, 7 (6-12) days in a community otolaryngologist setup, and 15 (8-25) days in a general practitioner setup. Patients who presented to the ED first also had fewer diagnostic and treatment delays. Those who presented to a community otolaryngologist first had significantly longer presentation delay (5 [4-8] days p < 0.001) and significantly longer treatment delays (1 [1-3] days p < 0.001). Patients who presented to a general practitioner first had significantly longer presentation delays compared with ED presentation, and the longest diagnostic and treatment delays (3 [2-5], 8 [4-12] days, and 4 [2-7] days, p = < 0.01, p = <0.01, and p < 0.001, respectively). There was no association between socioeconomic status or demography and presentation, diagnostic, or treatment delays., Conclusion: Total delay in ISSNHL management is affected by the venue of the first medical encounter. General practitioners' level of awareness of the need for empiric steroidal treatment of ISSNHL without delay should be raised., Level of Evidence: 3 Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: Developing a telemedicine tool to discriminate between patients who need urgent treatment for sudden sensorineural hearing loss (SSNHL) from those who do not takes on special importance during the COVID-19 pandemic., Objective: To explore the feasibility of a telemedicine model to assist in the evaluation of new-onset unilateral sudden hearing loss (SHL) among patients who do not have access to medical resources, especially during the COVID-19 pandemic., Design, Setting, and Participants: This prospective cohort investigation of a telemedicine model was conducted at a tertiary referral medical center between May 2020 and January 2021, with the interpreting physician blinded to the results of formal audiograms. The study included a consecutive sample of adult patients (aged ≥18 years) referred to the otolaryngology emergency department in our medical center with the chief complaint of new-onset unilateral SHL., Interventions: The telemedicine model comprised 2 sequential steps: a Weber test using the Hum Test and a smartphone-based vibration, and uHear app-based audiometry., Main Outcomes and Measures: Discrimination between patients with and without SSNHL by using the telemedicine model. All diagnoses subsequently confirmed by a formal audiogram., Results: Fifty-one patients with new-onset unilateral SHL participated in the study study (median age, 45 [range, 18-76] years; 28 [54.9%] men). The sensitivity and specificity of the telemedicine model for fulfilling the audiometric criteria of SSNHL (loss of ≥30 dB in ≥3 consecutive frequencies) were 100% (95% CI, 84%-100%) and 73% (95% CI, 54%-88%), respectively. The PPV was 72% (95% CI, 53%-87%), the NPV was 100% (95% CI, 85%-100%), and the accuracy was 84.3% (95% CI, 71%-93%). Although 8 participants had false-positive results, all of them had SSNHL that did not meet the full audiometric criteria., Conclusions and Relevance: The telemedicine model presented in this study for the diagnosis of SSNHL is valid and reliable. It may serve as a primary tool for the discrimination between patients in need of urgent care for SSNHL from those who are not, especially during the COVID-19 pandemic.

Nasal packs are widely used after septoplasty and turbinectomy. We conducted a prospective, randomized, controlled clinical trial including 100 patients who underwent septoplasty with/or without turbinectomy randomized into two groups. In the first group (the Merocel group), a standard tampon was inserted at the end of surgery. In the second group (the glove finger group), the tampon was first placed inside a glove finger. The main outcomes measured were pain and bleeding during the postoperative period and during tampon removal. Consumption of pain killers and tranexamic acid were also recorded. The mean visual analog scale score 12 hours after surgery and during tampon removal in the Merocel group were 6.78 and 8.92, respectively, compared to 4.06 and 5.27, respectively, in the glove finger group (p < 0.001). A statistically significant difference in the bleeding rate and tranexamic acid consumption during tampon removal in favor of the Merocel group was shown (p < 0.001). The use of Merocel in a glove finger is significantly less painful, although a higher chance of bleeding is reported. The influence of the surgeon's experience in using this technique needs further investigation.