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Background and Objectives The quality of life after thyroidectomy, such as voice change, is considered to be as important as control of the disease. In this study, we aimed to evaluate changes in both subjective and objective voice parameters after thyroidectomy resulting in normal morbidity of the vocal cords.Materials and Method In this prospective cohort study, 204 patients who underwent thyroidectomy with or without central neck dissection at a single referral center from Feb 2015 to Aug 2016 were enrolled. All patients underwent prospective voice evaluations including both subjective and objective assessments preoperatively and then at 2 weeks, 3, 6, and 12 months postoperatively. Temporal changes of the voice parameters were analyzed.Results Values of the subjective assessment tool worsened during the early postoperative follow-up period and did not recover to the preoperative values at 12 months postoperatively. The maximal phonation time gradually decreased, whereas most objective parameters, including maximal vocal pitch (MVP), reached preoperative values at 3–6 months postoperatively. The initial decrease in MVP was significantly greater in patients undergoing total thyroidectomy, and their MVP recovery time was faster than that of patients undergoing lobectomy (p=0.001). Patients whose external branch of the superior laryngeal nerve was confirmed intact by electroidentification showed no difference in recovery speed compared with patients without electroindentification (p=0.102), although the initial decrease in MVP was lower with electroidentification.Conclusion Subjective assessment in voice quality and maximal phonation time after thyroidectomy did not show recovery to preoperative values. Aggravation of MVP was associated with surgical extent and electroidentification.

To examine the subjective and objective audiological benefits of the Osia system compared to devices commonly implanted prior to the introduction of this system.Osia recipients with either conductive hearing loss (CHL/MHL) (n = 9) or single-sided deafness (SSD) (n = 8) who underwent surgery from February 2021 to March 2022 were prospectively recruited. The audiological outcomes and usage rate of Osia implantees were compared with those of retrospectively recruited patients implanted with other devices (n = 50). The subjective satisfaction of the Osia implantees was also evaluated through questionnaires.All users of the Osia system were classified as regular users. In the CHL/MHL group, the effective gain of the Osia system (11.1 ± 14.9 dB) surpassed that of the Baha and Bonebridge (- 2.7 ± 12.6 dB) at 2 kHz (p = 0.01, Mann-Whitney U test). Among the devices, the Osia system tended to tolerate the worst bone conduction thresholds, up to the level of 61 dB. In the SSD group, the functional gain of Osia at 4 kHz (37.5 ± 3.1 dB) was higher than that of the Baha and Bonebridge group (26.9 ± 3.0 dB) (p = 0.05, Mann-Whitney U test).The Osia system yielded larger audiological gain than the Baha Attract and Bonebridge devices, especially at high frequencies, leading to substantially higher compliance. The Osia system tended to have the strongest tolerance to aggravated bone conduction thresholds among the available transcutaneous bone conduction hearing implants. Therefore, the Osia system could potentially be a good option for CHL/MHL patients with bone conduction thresholds of 50 dB HL or more, as well as patients with SSD.

Background There are only a few studies in which the clinical efficacy of SLIT has been compared between children and adults. In addition, there is a lack of research on other factors, associated with the treatment, including immunological parameters and quality of life (QOL). Objective To compare the effects of sublingual immunotherapy (SLIT) in adults and children on various factors: clinical efficacy, quality of life (QOL), satisfaction, immunological parameters, and adverse events. Methods Subjects who were sensitized to house dust mites and treated with SLIT for at least 2 years were enrolled. Seventy patients who completed questionnaires measuring nasal symptoms and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores and underwent serologic tests for immunological parameters at initial, 1-year, and 2-year follow-up were selected and divided into two groups based on age: a child group (age 4–12 years, n = 44) and an adult group (age 19–59 years, n = 26). Results The Total Nasal Symptom Score (TNSS) was significantly decreased after 2 years of SLIT in both the child and adult groups ( p Conclusion Although more adult patients were satisfied with SLIT, the clinical effects of SLIT on nasal symptoms were comparable between child and adult groups. Despite different immunological values at baseline between the two groups, changing patterns of immunological parameters did not differ.

Background and Objectives: This case series is aimed to introduce a new term, antrovestibular polyp (AVP), for an antral polyp herniating anteriorly toward the nasal vestibule and to describe an antral polyp direction of growth through the anterior and posterior fontanelles.Materials and Method: This is a retrospective study involving review of patients who underwent surgery due to maxillary sinus polyp herniating anteriorly toward the nasal vestibular area or posteriorly toward the choana at a tertiary training hospital from January 2007 through July 2016. Their demographic data, computed tomography scan findings, and endoscopic evaluations were analyzed.Results: This study included 49 subjects; 8 (16.33%, 6 males) with AVP and 41 (83.67%, 24 males) with antrochoanal polyps (ACP). The mean ages of AVP and ACP patients were 9 and 14.4 years, respectively (p=0.006). The subjects were identified as AVP when computed tomography scan showed an antral polyp directed anteriorly toward the nasal vestibular area, while polyps growing toward the choana were identified as ACP. Endoscopic review showed that AVP grew out through an accessory ostium located anterior to the uncinate process at the area of the anterior fontanelle, while ACP started from an accessory ostium of the posterior fontanelle or a widened maxillary natural ostium.

Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. Currently, evidence on cochlear implantation (CI) outcomes in patients with CN aplasia is limited. We scrutinized functional outcomes in 37 ears of 21 children with bilateral CN aplasia who underwent unilateral or bilateral CI based on cross-sectional and longitudinal assessments. The Categories of Auditory Performance (CAP) scores gradually improved throughout the 3-year follow-up; however, variable outcomes existed between individuals. Specifically, the majority of recipients with a 1-year postoperative CAP score ≤1 remained steady or achieved awareness of environmental sounds, while recipients with early stage hearing benefit had markedly improved auditory performance and could possibly discriminate some speech without lipreading. Meanwhile, intraoperative electrically evoked compound action potential was not correlated with postoperative CAP score. The dynamic range between T and C levels remained unchanged. Our results further refine those of previous studies on the clinical feasibility of CI as the first treatment modality to elicit favorable auditory performance in children with CN aplasia. However, special attention should be paid to pediatric patients with an early postoperative CAP score ≤1 for identification of unsuccessful cochlear implants and switching to auditory brainstem implants.

Specific correlations between the outcomes of cochlear implantation (CI) and hearing thresholds of the both ears in post-lingual asymmetric hearing loss (AHL) patients were not clear. To identify the variables influencing the outcome of CI in post-lingual AHL patients. We included 18 adult subjects who had CI in the worse ear due to post-lingual AHL with average hearing asymmetry of 36 dB. Speech perception scores were evaluated in the sound field with hearing aid on the better ear before CI, and with the cochlear implant in the worse ear at 3, 6, and 12 months after CI switch-on. Average increases in phonetically balanced word score, spondee word score, and everyday sentence score at 12 months from CI switch-on compared with those before CI were 38.9%p, 46.2%p, and 52.4%p, respectively. Multiple linear regression analysis showed that speech perception scores were negatively influenced by age at implantation and hearing threshold difference of both ears (HTD-Both) itself, rather than the worse or better ear hearing thresholds. Post-lingual AHL subjects with high average hearing asymmetry can benefit from CI in the worse ear, while CI outcomes can be adversely influenced by HTD-Both and age at implantation both in the short- and long-term follow-up.

Objectives To develop a simple algorithm for prescreening of obstructive sleep apnea (OSA) on the basis of respiratory sounds recorded during polysomnography during all sleep stages between sleep onset and offset. Methods Patients who underwent attended, in-laboratory, full-night polysomnography were included. For all patients, audio recordings were performed with an air-conduction microphone during polysomnography. Analyses included all sleep stages (i.e., N1, N2, N3, rapid eye movement, and waking). After noise reduction preprocessing, data were segmented into 5-s windows and sound features were extracted. Prediction models were established and validated with 10-fold cross-validation by using simple logistic regression. Binary classifications were separately conducted for three different threshold criteria at apnea hypopnea index (AHI) of 5, 15, or 30. Prediction model characteristics, including accuracy, sensitivity, specificity, positive predictive value (precision), negative predictive value, and area under the curve (AUC) of the receiver operating characteristic were computed. Results A total of 116 subjects were included; their mean age, body mass index, and AHI were 50.4 years, 25.5 kg/m2 , and 23.0/hr, respectively. A total of 508 sound features were extracted from respiratory sounds recorded throughout sleep. Accuracies of binary classifiers at AHIs of 5, 15, and 30 were 82.7%, 84.4%, and 85.3%, respectively. Prediction performances for the classifiers at AHIs of 5, 15, and 30 were AUC, 0.83, 0.901, and 0.91; sensitivity, 87.5%, 81.6%, and 60%; and specificity, 67.8%, 87.5%, and 94.1%. Respective precision values of the classifiers were 89.5%, 87.5%, and 78.2% for AHIs of 5, 15, and 30. Conclusion This study showed that our binary classifier predicted patients with AHI of ≥15 with sensitivity and specificity of >80% by using respiratory sounds during sleep. Since our prediction model included all sleep stage data, algorithms based on respiratory sounds may have a high value for prescreening OSA with mobile devices.

Background and objectives: We review the intraoperative findings and postoperative outcomes of ossiculoplasty in subjects with second pharyngeal arch (SPA)-derived ossicular anomalies. We summarize potential intraoperative complications and recommend precautions that may reduce the risk of fracture. Materials and Methods: Twenty-four patients with SPA-derived ossicular anomalies were included, and pre- and postoperative audiometric results were compared. Results: The mean air conduction threshold (56.0 &plusmn, 12.4 dB HL) was significantly improved 1 month (27.6 &plusmn, 10.1 dB HL) and 6 months (23.8 &plusmn, 13.2 dB HL) after surgery (p &lt, 0.001). The preoperative air&ndash, bone gap (ABG) (40.4 &plusmn, 7.4 dB HL) was significantly decreased at 1 month (15.1 &plusmn, 5.9 dB HL) and 6 months (11.3 &plusmn, 8.9 dB HL) postoperation. ABG closure was successful (&lt, 20 dB HL) in 21 (87.5%) patients 6 months after surgery. Intraoperative footplate fractures occurred in 3 of 24 patients. The fractures were managed successfully, and the ABG closure was successful in all cases. Conclusions: The stapes footplate is likely to be relatively thin in subjects with SPA-derived ossicular anomalies because the footplate is partially or totally derived from the SPA. Thus, a fragile footplate should be expected, and care is needed when handling the footplate. However, when complications are overcome, the audiological outcomes are excellent in most cases.

Purpose To evaluate the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) classification, a clinical scoring system, for predicting disease control status in chronic rhinosinusitis with nasal polyps (CRSwNP) and to investigate prognostic factors. Materials and methods In total, 134 CRSwNP patients who underwent functional endoscopic sinus surgery after maximal medical treatment were enrolled. These patients were categorized into four groups according to JESREC classification: 1) non-eosinophilic CRSwNP (non-ECRSwNP), 2) mild eosinophilic CRSwNP (ECRSwNP), 3) moderate ECRSwNP, and 4) severe ECRSwNP. Disease control status among the patients was evaluated at 1 year after surgery, and the patients were divided into two groups (disease-controlled and disease-uncontrolled groups) for the investigation of prognostic factors. Results There was no significant difference in disease control status between non-ECRSwNP and ECRSwNP groups (p=0.970). Age, Lund-Mackay CT scores, global osteitis scores, tissue neutrophil count, and tissue eosinophil count were associated with disease control status. In subgroup analysis of the non-ECRSwNP group, only high tissue neutrophil count was related with disease control status, whereas for the ECRSwNP group, young age, high Lund-Mackay CT scores, high global osteitis scores, and high tissue and blood eosinophil counts were associated with disease control status. Conclusion No difference in disease control status was identified between non-ECRSwNP and ECRSwNP cases. Tissue neutrophilia, however, appeared to be associated with disease control status in non-ECRSwNP cases, whereas tissue and blood eosinophilia was associated with ECRSwNP cases.