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A low skeletal muscle index (SMI), defined with cut-off values, is a promising predictor for adverse events (AEs) in head and neck squamous cell cancer (HNSCC) patients. The aim was to generate sex-specific SMI cut-off values based on AE to diagnose low SMI and to analyse the relationship between low SMI and AEs in HNSCC patients. In this present study, HNSCC patients were prospectively included in a large oncological data-biobank and SMI was retrospectively measured using baseline neck scans. In total, 193 patients were included and were stratified according to treatment modality: (chemo-)radiotherapy ((C)RT) (n = 135) and surgery (n = 61). AE endpoints were based on the occurrence of clinically relevant toxicities (Common Terminology Criteria for Adverse Events grade ≥ III) and postoperative complications (Clavien–Dindo Classification grade ≥ II). Sex-specific SMI cut-off values were generated with receiver operating characteristic curves, based on the AE endpoints. The relationship of the baseline characteristics and AEs was analysed with logistic regression analysis, with AEs as the endpoint. Multivariable logistic analysis showed that low SMI (OR 3.33, 95%CI 1.41–7.85) and tumour stage (OR 3.45, 95%CI 1.28–9.29) were significantly and independently associated to (C)RT toxicity. Low SMI was not related to postoperative complications. To conclude, sex-specific SMI cut-off values, were generated based on the occurrence of AEs. Low SMI and tumour stage were independently related to (C)RT toxicity in HNSCC patients.

OBJECTIVE To assess whether day-case major otologic ear surgery is a safe and feasible alternative to inpatient surgery, while maintaining equal complication rates, and to identify causes of admission after day-case surgery. DATA SOURCES PubMed, Embase, and Cochrane. REVIEW METHODS A systematic search was conducted. Studies reporting original data on the effect of day-case ear surgery on admission rate, patient satisfaction, and/or postoperative complications were included. Risk of bias of the selected articles was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. RESULTS A total of 1,734 unique studies were retrieved of which 35 articles discussing 34 studies were eligible for data extraction. The admission rates ranged from 0% to 88% following day-case endaural surgery, 0% to 13% following day-case stapes surgery, 0% to 82% following day-case mastoid surgery, and 0% to 15% following day-case cochlear implant surgery. Patient and parent satisfaction regarding day-case surgery ranged from 67% to 99%. Five studies comparing day-case and inpatient otologic surgery showed no difference in hearing outcome, postoperative complications, or patient satisfaction. CONCLUSION The highest pooled admission rate was seen following day-case mastoid surgery. Studies comparing day-case and inpatient care suggest hearing results and postoperative complication rates in day-case otologic surgery are similar to inpatient otologic surgery in both children and adults. Therefore, day-case major otologic surgery seems to be a safe and feasible alternative to inpatient surgery for both children and adults.

OBJECTIVES/HYPOTHESIS Two types of electrode arrays for cochlear implants (CIs) are distinguished: lateral wall and perimodiolar. Scalar translocation of the array can lead to intracochlear trauma by penetrating from the scala tympani into the scala vestibuli or scala media, potentially negatively affecting hearing performance of CI users. This systematic review compares the lateral wall and perimodiolar arrays with respect to scalar translocation. STUDY DESIGN Systematic review. METHODS PubMed, Embase, and Cochrane databases were reviewed for studies published within the last 11 years. No other limitations were set. All studies with original data that evaluated the occurrence of scalar translocation or tip fold-over (TF) with postoperative computed tomography (CT) following primary cochlear implantation in bilateral sensorineuronal hearing loss patients were considered to be eligible. Data were extracted independently by two reviewers. RESULTS We included 33 studies, of which none were randomized controlled trials. Meta-analysis of five cohort studies comparing scalar translocation between lateral wall and perimodiolar arrays showed that lateral wall arrays have significantly lower translocation rates (7% vs. 43%; pooled odds ratio = 0.12). Translocation was negatively associated with speech perception scores (weighted mean 41% vs. 55%). Tip fold-over of the array was more frequent with perimodiolar arrays (X2 = 6.8, P

Background: Low skeletal muscle mass (SMM) is associated with adverse outcomes. SMM is often assessed at the third lumbar vertebra (L3) on abdominal imaging. Abdominal imaging is not routinely performed in patients with head and neck cancer (HNC). We aim to validate SMM measurement at the level of the third cervical vertebra (C3) on head and neck imaging.Material and methods: Patients with pre-treatment whole-body computed tomography (CT) between 2010 and 2018 were included. Cross-sectional muscle area (CSMA) was manually delineated at the level of C3 and L3. Correlation coefficients and intraclass correlation coefficients (ICCs) were calculated. Cohen's kappa was used to assess the reliability of identifying a patient with low SMM.Results: Two hundred patients were included. Correlation between CSMA at the level of C3 and L3 was good (r = 0.75, p < 0.01). Using a multivariate formula to estimate CSMA at L3, including gender, age, and weight, correlation improved (r = 0.82, p < 0.01). The agreement between estimated and actual CSMA at L3 was good (ICC 0.78, p < 0.01). There was moderate agreement in the identification of patients with low SMM based on the estimated lumbar skeletal muscle mass index (LSMI) and actual LSMI (Cohen's κ: 0.57, 95%CI 0.45–0.69).Conclusions: CSMA at C3 correlates well with CSMA at L3. There is moderate agreement in the identification of patients with low SMM based on the estimated lumbar SMI (based on measurement at C3) and actual LSMI.

To assess whether day-case major otologic ear surgery is a safe and feasible alternative to inpatient surgery, while maintaining equal complication rates, and to identify causes of admission after day-case surgery.PubMed, Embase, and Cochrane.A systematic search was conducted. Studies reporting original data on the effect of day-case ear surgery on admission rate, patient satisfaction, and/or postoperative complications were included. Risk of bias of the selected articles was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias.A total of 1,734 unique studies were retrieved of which 35 articles discussing 34 studies were eligible for data extraction. The admission rates ranged from 0% to 88% following day-case endaural surgery, 0% to 13% following day-case stapes surgery, 0% to 82% following day-case mastoid surgery, and 0% to 15% following day-case cochlear implant surgery. Patient and parent satisfaction regarding day-case surgery ranged from 67% to 99%. Five studies comparing day-case and inpatient otologic surgery showed no difference in hearing outcome, postoperative complications, or patient satisfaction.The highest pooled admission rate was seen following day-case mastoid surgery. Studies comparing day-case and inpatient care suggest hearing results and postoperative complication rates in day-case otologic surgery are similar to inpatient otologic surgery in both children and adults. Therefore, day-case major otologic surgery seems to be a safe and feasible alternative to inpatient surgery for both children and adults.

Objectives Skeletal muscle mass (SMM) is most often assessed in cancer patients on abdominal computed tomography (CT) imaging at the level of the third lumbar vertebra (L3). Abdominal CT imaging is not routinely performed in head and neck cancer (HNC) patients. Recently, a novel method to assess SMM on a single transversal CT slice at the level of the third cervical vertebra (C3) was published. The objective of this study was to assess the robustness of this novel C3 measurement method in terms of interobserver agreement. Patients and methods Patients diagnosed with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) at our center between 2007 and 2011 were evaluated. Fifty-four patients with were randomly selected for analysis. Six observers independently measured the cross-sectional muscle area (CSMA) at the level of C3 using a predefined, written protocol as instruction. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs), a Bland–Altman plot and Fleiss’ kappa (κ). Results The agreement in vertebra selection between all observers was excellent (Fleiss’ κ: 0.96). There was a substantial agreement between all observers in single slice selection (Fleiss’ κ: 0.61). For all CSMA measurements, ICCs were excellent (0.763–0.969; all p

Low skeletal muscle mass (SMM) is associated with toxicities and decreased survival in head and neck cancer (HNC). Chemoradiotherapy (CRT) may exaggerate loss of SMM. We investigated the changes in SMM, their predictors, and prognostic impact of SMM in patients treated with CRT between 2012 and 2018. Skeletal muscle area (SMA) segmentation was performed on pre- and post-CRT imaging. Observed changes in SMM were categorized into: (I) Stable, (II) moderate gain (III), moderate loss, (IV) large gain, and (V) large loss. In total, 235 HNC patients were included, of which 39% had stable SMM, 55% moderate loss, 13% moderate gain, 0.4% large loss, and 0.4% large gain of SMM. After CRT, SMA decreased compared to pre-CRT (31.6 cm2 versus 33.3 cm2, p &lt, 0.01). The key predictor was a body mass index (BMI) of ≥30 kg/m2 (OR 3.6, 95% CI 1.4–9.3, p &lt, 0.01). Low SMM at diagnosis (HR 2.1, 95% CI 1.1–4.1, p = 0.03) and an HPV-positive oropharyngeal tumor (HR 0.1, 95% CI 0.01–0.9, p = 0.04) were prognostic for overall survival. Changes in SMM were not prognostic for survival. Loss of SMM is highly prevalent after CRT and a high BMI before treatment may aid in identifying patients at risk.

IntroductionOtosclerosis is a common cause of acquired conductive hearing loss and can be treated using hearing aids or surgically. Surgical success rates or surgical results are usually reported using pure-tone audiometric thresholds and/or speech discrimination scores. Audiometric results and patient-reported quality of life after stapes surgery do not seem to correlate well. It is therefore our opinion that health-related quality of life measurements should be implemented as an additional outcome measure after stapes surgery. So far, there is a lack of a valid, reliable and clinically feasible measuring tool for determining health-related quality of life in Dutch patients with otosclerosis who undergo stapes surgery.Methods and analysisA prospective validation study was designed to translate and validate the disease-specific Stapesplasty Outcome Test 25 (SPOT-25) in a population of Dutch patients with otosclerosis who undergo primary stapes surgery. A total of 125 patients with otosclerosis who will be undergoing primary stapes surgery and 50 healthy controls will be included. The patients with otosclerosis will fulfil several questionnaires preoperatively, 6 to 8 weeks postoperatively and 8 to 10 weeks postoperatively with a 2-week interval between the postoperative administrations. The patients’ audiometric results, which are measured routinely before and after undergoing primary stapes surgery, will also be used. The healthy controls will fulfil the translated SPOT-25 once. First, the original SPOT-25 will be translated from German to Dutch in a six-step process. Second, the translated SPOT-25 will be pilot-tested in a subset of patients. Lastly, validity, reliability and responsiveness of the translated SPOT-25 will be analysed.Ethics and disseminationThe research protocol was approved by the Institutional Review Board of the University Medical Center Utrecht (protocol 18–768/C; V.1, November 2018). Initially, we planned to include 50 patients. At a later stage we decided to increase the sample size to 100 patients. We notified the Institutional Review Board of this change to the protocol. The trial results will be disseminated through peer-reviewed medical journals and presented at scientific conferences.Trial registration numberNL7586.

Objectives/hypothesis To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally. Study design A retrospective cohort study of prospectively gathered data in a tertiary referral center. Methods The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated. Results Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%). Conclusions Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up. Level of evidence 2b. Laryngoscope, 128:2390-2396, 2018.

BackgroundSkeletal muscle mass (SMM) determined on computed tomography (CT) is emerging as a novel imaging biomarker. Cross-sectional area (CSA) of SMM at the level of the third lumbar vertebra (L3) on abdominal imaging is considered the clinical reference standard for measuring SMM. In certain patient groups, such as those with oncological or non-oncological lung disease like COVID-19, a chest CT may be available while an abdominal CT is not. The purpose of this study was to investigate whether determining SMM on a chest CT is a feasible alternative to abdominal CT. Research questionWhat is the correlation between SMM measurements at the level of L3 and the level of the fourth thoracic vertebra (Th4)? Study design and methods In this study we retrospectively analyzed abdominal and thoracic series of whole-body CT-scans of trauma patients (N = 47) and head and neck cancer patients (N = 194). All abdominal muscles were delineated on a single axial slice at the level of L3. The erector spinae, levator scapulae, rhomboideus minor and major and pectoralis minor and major muscles were delineated on a single axial slice at the level of Th4. CSA of the muscles at Th4 and the L3 level were compared using linear regression, and a multivariate linear regression model was established. ResultsMuscle CSA at level Th4 strongly correlates with L3 muscle CSA (r = 0.791, p < 0.05). A multivariate model incorporating the patient characteristics arm positioning, age, sex, and weight achieved a stronger correlation (r = 0.856, p < 0.05). Interpretation: Skeletal muscle CSA measured at the level of Th4 is a feasible alternative to measurements at L3. This allows diagnosing low SMM using clinically available thoracic CT-scans. SMM measurements at the level of Th4 may become a prognostic or triage tool when faced with mechanical ventilator shortage.

Low skeletal muscle mass (SMM) and sarcopenic obesity (co-presence of low SMM and obesity) are emerging prognosticators in oncology, but the prevalence and prognostic value in oropharyngeal squamous cell carcinoma (OPSCC) is not yet known.Patients with OPSCC, curative treatment intention and pre-treatment diagnostic imaging of the head and neck area were included. Patients with unknown HPV-status, palliative treatment intention or unavailable imaging were excluded, Relevant demographic and clinical characteristics were collected between 2009 and 2016. Patients were stratified into a low-, intermediate-, and high-risk group according to HPV-status, amount of pack-years, tumor and nodal stage. SMM was radiologically measured and cutoff values were determined by optimal stratification. The prognostic value of low SMM and sarcopenic obesity for overall survival (OS) and disease-free survival (DFS) was determined by Cox regression analysis and Kaplan Meier survival curves.In 216 patients, low SMM and sarcopenic obesity were present in 140 (64.8%) and 13 (6.0%) patients, respectively. On multivariate analysis, stratification into a high-risk group (HPV-negative status with ≥10-pack-years or T4-stage) was a prognostic factor for OS and DFS (HR 2.93, p 0.01) (HR 4.66, p 0.01). Of specific interest, sarcopenic obesity was a strong negative prognostic factor for OS and DFS (HR 4.42, p 0.01 and (HR 3.90, p 0.05), independent from other well-known prognostic factors such as HPV-status.Low skeletal muscle mass is highly prevalent in OPSCC patients. Sarcopenic obesity is a novel pretreatment prognosticator for OS and DFS in OPSCC and should therefore be considered in clinical decision making.

Objectives: To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions. Methods: A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively. Results: In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, –2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another. Conclusions: Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.

To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy.WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis.Eight fresh-frozen temporal bones were harvested from human cadaveric donors.At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value0.01). The crimping conditions did not differ from one another (p = 0.555).WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.

Objective: Risk assessment of second head/neck and Epstein Barr Virus (EBV)-related malignancies in patients with different nasopharyngeal carcinoma (NPC) subtypes. Methods: This is a cross-sectional study. Pathology records were retrieved from PALGA (a Dutch pathology registry database) between 1995 and 2013. Second primary malignancy (SPM) data was extracted from PALGA. Odds ratios (OR) for SPM in the head/neck, and the upper/lower airways were calculated using logistic regression. Pearson X-2-test and Fisher's exact test were used to assess the relationship between NPC (and EBV-status) with SPM. Standardized incidence rates (SIR) were calculated. Results: Histologically diagnosed NPC (keratinizing and undifferentiated and differentiated non-keratinizing subtypes) (n = 1175) were identified. NPC patients have an increased risk of second head/neck malignancies (SIR 4.7 95% CI 3.3-6.5). Keratinizing NPCs have an OR of 1.947 (95% CI 1.362-2.782) for SPM, an OR of 4.026 (95% CI 2.308-7.023) for carcinomas of the upper/lower airways, an OR of 4.306 (95% CI 2.299-8.066) for head/neck malignancies, an OR of 5.289 (95% CI 2.740-10.211) for HNSCC with a SIR of 4.7 (95CI 3.3-6.5). Non-keratinizing NPCs also have an increased risk of head/neck malignancies with a SIR of 3.2 (95% CI 1.8-5.1), but less than keratinizing NPCs (p =

OBJECTIVES/HYPOTHESIS: To prospectively evaluate surgical findings and hearing results in children undergoing surgery for congenital oval or round window malformations (class IV malformations). STUDY DESIGN: A nonrandomized, nonblinded, case series of prospectively collected data. METHODS: Fourteen consecutive pediatric patients who underwent 17 surgical procedures for congenital oval or round window malformations in a tertiary referral center were included. Postoperative pure-tone audiometry was available in 15 cases. The surgical technique for repair of the ossicular chain was dictated by the surgical findings at the time of surgery. The majority of the cases underwent ossiculoplasty using a Teflon piston, bucket-handle prosthesis, or total ossicular replacement prosthesis. Associated surgical techniques included malleus relocation and oval window drill-out procedure. The main outcome measures were preoperative and postoperative hearing status using four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Postoperative air-bone gap closure to 10 dB or less was achieved in 47%. A postoperative air-bone gap closure to within 20 dB or less was achieved in 60%. Postoperative sensorineural hearing loss did not occur in this series. CONCLUSIONS: Middle ear surgery for class IV abnormalities is feasible, but success percentages are much lower compared to other types of congenital ossicular malformations. Surgeons should be particularly careful in case of facial nerve abnormalities on computed tomography or during middle ear exploration. LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

Objective: To evaluate the diagnostic value of computed tomography (CT) in detecting otosclerosis in patients with conductive hearing loss and a clinical suspicion of otosclerosis. Data Sources: PubMed, Embase, and the Cochrane Library. Study Selection: A systematic search was conducted. Studies reporting original study data were included. Data Extraction: Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Prevalences, sensitivities, specificities, and post-Test probabilities were extracted from the included articles. Data Synthesis: Seven studies characterized by a moderate to high relevance and moderate to low risk of bias were included for data extraction. The prevalence of otosclerosis was high (up to 100%) in the majority of the included studies. In those studies with a high prevalence of disease, both positive and negative post-Test probabilities were (relatively) high: 99% and between 51% and 67% respectively. In one study with a low prevalence of disease (9%), both positive and negative post-Test probabilities were low (23% and 3% respectively). Overall, reported sensitivities ranged between 60% and 95%. Conclusion: Preoperative CT has little to add in establishing otosclerosis and may not be necessary to confirm the diagnosis. We would recommend reserving CT for those patients with suspected additional abnormalities, for specific preoperative planning, or out of legal necessity. .

Objectives/Hypothesis To prospectively evaluate surgical findings and hearing results in children undergoing surgery for congenital malformations of the ossicular chain with a mobile stapes footplate (Teunissen and Cremers class III malformations). Study Design A nonrandomized, nonblinded, prospective case series. Methods Fifteen consecutive pediatric patients who underwent 17 surgical procedures for congenital ossicular malformations with a mobile stapes at a tertiary referral center were included. In 16 cases, postoperative pure-tone audiometry was available. The surgical technique for repair of the ossicular chain was dictated by the surgical findings at the time of surgery. The majority of the cases underwent ossiculoplasty. A Teflon piston, partial ossicular replacement prosthesis, or total ossicular replacement prosthesis was used in these cases. Associated surgical techniques included malleus relocation, Silastic banding, drilling out of a bony bridge, and a combination of these techniques. Hearing loss was evaluated using preoperative and postoperative four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. Results Overall, a postoperative air-bone gap closure to 10 dB or less was achieved in 63% of the included cases. A postoperative air-bone gap closure to 20 dB or less was achieved in 75%. Postoperative sensorineural hearing loss did not occur in any of the cases. Conclusions Ossicular reconstruction is a feasible treatment option in children with congenital malformations of the ossicular chain with a mobile stapes footplate. Level of Evidence 4. Laryngoscope, 126:682–688, 2016

Background Tinnitus is a symptom defined as the perception of sound in the absence of an external source. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy, cognitive behavioural therapy, sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as sleep difficulties, anxiety or depression. As yet, no drug has been approved for tinnitus by a regulatory body. Nonetheless, over 100,000 prescriptions for betahistine are being filled every month in England, and nearly 10% of general practitioners prescribe betahistine for tinnitus. Objectives To assess the effects of betahistine in patients with subjective idiopathic tinnitus. Search methods The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018. Selection criteria Randomised controlled trials (RCTs) recruiting patients of any age with acute or chronic subjective idiopathic tinnitus were included. We included studies where the intervention involved betahistine and this was compared to placebo, no intervention or education and information. We included all courses of betahistine, regardless of dose regimens or formulations and for any duration of treatment. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Our primary outcomes included tinnitus loudness and significant adverse effects (upper gastrointestinal discomfort). Our secondary outcomes included tinnitus symptom severity as measured by the global score on a multi-item tinnitus questionnaire, depressive symptoms, symptoms of generalised anxiety, health-related quality of life, other adverse effects (e.g. headache, drowsiness, allergic skin reactions (pruritis, rashes) and exacerbation of tinnitus) and tinnitus intrusiveness. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics. Main results This review included five studies (with a total of 303 to 305 participants) comparing the effects of betahistine with placebo in adults with subjective idiopathic tinnitus. Four studies were parallel-group RCTs and one had a cross-over design. The risk of bias was unclear in all of the included studies.Due to heterogeneity in the outcomes measured and measurement methods used, very limited data pooling was possible. When we pooled the data from two studies for the primary outcome tinnitus loudness, the mean difference on a 0- to 10-point visual analogue scale at one-month follow-up was not significant between betahistine and placebo (-0.16, 95% confidence interval (CI) -1.01 to 0.70; 81 participants) (very low-quality evidence). There were no reports of upper gastrointestinal discomfort (significant adverse effect) in any study.As a secondary outcome, one study found no difference in the change in the Tinnitus Severity Index between betahistine and placebo (mean difference at 12 weeks 0.02, 95% CI -1.05 to 1.09; 50 participants) (moderate-quality evidence). None of the studies reported the other secondary outcomes of changes in depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor tinnitus intrusiveness.Other adverse effects that were reported were not treatment-related. Authors' conclusions There is an absence of evidence to suggest that betahistine has an effect on subjective idiopathic tinnitus when compared to placebo. The evidence suggests that betahistine is generally well tolerated with a similar risk of adverse effects to placebo treatments. The quality of evidence for the reported outcomes, using GRADE, ranged from moderate to very low.If future research into the effectiveness of betahistine in patients with tinnitus is felt to be warranted, it should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the development of validated, patient-centred outcome measures for research in the field of tinnitus.

OBJECTIVES/HYPOTHESIS To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry. DATA SOURCES PubMed, EMBASE, and the Cochrane Library. METHODS A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss. RESULTS Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB). CONCLUSION Moderate to high risk of bias and inconsistent results characterize the current evidence.

Background. The purpose of this systematic review was to determine the significance of the grade of dysplasia in the development of invasive carcinoma. Methods. A systematic search was performed to identify all relevant evi- dence. Titles and abstracts were screened using predefined criteria. Remaining articles were critically appraised. Absolute risks and 95% confidence intervals (CIs) were calculated. Results. Seven articles were included. Four studies demonstrated an increased risk for the development of laryngeal carcinoma from mild, moderate, and severe dysplasia. Three studies showed an increased risk between the categories of mild and moderate dysplasia. Conclusion. The risk of malignant transformation seems to increase with the grade of dysplasia, although percentages between studies are highly dissimilar. The wide variety and overlapping 95% CIs make it difficult to formulate a strong recommendation. However, moderate dysplasia is more prone for malignant transformation than previously thought, which might influence follow-up and treatment decisions in the future. V C 2015 Wiley Periodicals, Head Neck 00: 000-000, 2015

BACKGROUND: The purpose of this systematic review was to determine the prognostic value of continued smoking after diagnosis on survival and recurrence rates in head and neck cancer. METHODS: A systematic search was performed and predefined inclusion and exclusion criteria were used to screen and select the articles. The remaining articles were critically appraised. RESULTS: Six articles were used for data extraction. The survival rate of patients who continued to smoke was 21% to 35% lower compared with patients who quit smoking. The recurrence rate for continued smoking was 23% and 30% higher. In 1 study, there was no difference between continuation and cessation of smoking, and 1 study showed a higher recurrence rate for patients who continued to smoke, which was not statistically significant. CONCLUSION: There is consistent evidence that survival rates are lower and recurrence rates are higher for patients who continue to smoke after being diagnosed with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

OBJECTIVE: To evaluate the effect of piston diameter in primary stapedotomy for otosclerosis patients measured by hearing outcome. DATA SOURCES: PubMed, Embase, and the Cochrane Library. REVIEW METHODS: A systematic search was conducted. Studies reporting original data on the effect of piston diameter on pure-tone audiometric results in patients undergoing primary stapedotomy for otosclerosis were included. Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted. RESULTS: Twelve studies with moderate to high relevance and moderate risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in six studies, the majority of which did not show a statistically significant or clinically relevant difference between two pistons with a different diameter. More importantly, the differences that were found were not consistently in favor of smaller-diameter pistons or larger-diameter pistons. Mean postoperative air-bone gap ranged from 3 dB in favor of a smaller-diameter piston to 3 dB in favor of a larger-diameter piston across four studies. Permanent sensorineural hearing loss was assessed in eight studies and occurred in only one study. In this study, no difference was found between a 0.4-mm-diameter piston and a 0.6-mm-diameter piston. CONCLUSION: There is not sufficient evidence to support the superiority of the use of a larger-diameter piston compared to a smaller-diameter piston for primary stapedotomy in otosclerosis patients. LEVEL OF EVIDENCE: NA Laryngoscope, 2015.

OBJECTIVES/HYPOTHESIS: To prospectively evaluate hearing outcomes in children with otosclerosis undergoing primary stapes surgery. STUDY DESIGN: A nonrandomized, nonblinded, prospective case series. METHODS: Thirty-four consecutive pediatric patients who underwent 41 primary stapedotomies for otosclerosis in a tertiary referral center were included. Patients were included when there was evidence of otosclerotic stapes fixation and they had available postoperative pure-tone audiometry. Patients underwent primary stapedotomy with vein graft interposition and reconstruction with a regular piston, bucket handle prosthesis, or total ossicular replacement prosthesis. Hearing results were evaluated using pre- and postoperative four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Overall, a postoperative air-bone gap closure of 10 dB or less was achieved in 93% of cases and to within 20 dB in 98% of cases. Mean gain in air-conduction threshold was 23 dB for the entire case series, and mean air-bone gap closure was 23 dB. Postoperative sensorineural hearing loss, defined as changes in bone-conduction thresholds exceeding 10 dB, occurred in one case at last follow-up. The bone-conduction threshold deteriorated 13 dB in this case. CONCLUSION: Primary stapedotomy is a safe and feasible treatment option in children with juvenile otosclerosis. LEVEL OF EVIDENCE: 4. Laryngoscope, 2015.

OBJECTIVES/HYPOTHESIS: This systematic review aimed to assess the diagnostic value of computed tomography (CT) in detecting cartilage invasion among patients with laryngeal carcinoma. DATA SOURCES: PubMed, Embase, and the Cochrane Library. REVIEW METHODS: A search in the previously mentioned databases was performed to identify relevant articles. Articles comparing cartilage invasion on CT with histology were selected. After critical appraisal, articles of adequate relevance and validity were included in further analysis. Prevalences, sensitivity, specificity, positive predictive values, and negative predictive values were extracted from the included articles. RESULTS: Four studies were included in the final analysis. Only one study examined the positive predictive value and negative predictive value for invasion of any laryngeal cartilage, and they were 87% and 56%, respectively. The positive predictive value and negative predictive value for thyroid cartilage invasion were investigated in three studies and ranged from 44% to 80% and from 85% to 100%, respectively. The negative predictive value is likely underestimated due to selection bias, whereas the positive predictive value is likely overestimated. CONCLUSIONS: CT imaging is a suitable tool to assess laryngeal cartilage invasion, especially regarding the thyroid cartilage.

Objective To prospectively evaluate hearing outcomes in patients with osteogenesis imperfecta undergoing primary stapes surgery and to isolate prognostic factors for success. Study design A nonrandomized, open, prospective case series. Setting A tertiary referral center. Patients Twenty-five consecutive patients who underwent 32 primary stapedotomies for osteogenesis imperfecta with evidence of stapes fixation and available postoperative pure-tone audiometry. Intervention Primary stapedotomy with vein graft interposition and reconstruction with a regular Teflon piston or bucket handle-type piston. Main outcome measures Preoperative and postoperative audiometric evaluation using conventional 4-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. The overall audiometric results as well as the results of audiometric evaluation at 3 months and at least 1 year after surgery were used. Results Overall, postoperative air-bone gap closure to within 10 dB was achieved in 88% of cases. Mean (standard deviation) gain in air-conduction threshold was 22 (9.4) dB for the entire case series, and mean (standard deviation) air-bone gap closure was 22 (9.0) dB. Backward multivariate logistic regression showed that a model with preoperative air-bone gap closure and intraoperatively established incus length accurately predicts success after primary stapes surgery. Conclusion Stapes surgery is a feasible and safe treatment option in patients with osteogenesis imperfecta. Success is associated with preoperative air-bone gap and intraoperatively established incus length.

OBJECTIVES: Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with primary radiochemotherapy (RCT). PATIENTS AND METHODS: Consecutive patients diagnosed with LA-HNSCC and treated with primary RCT between 2007 and 2011 in our center were included. Clinical variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment head and neck CT-scans. After determining a cut-off value for low SMM, multivariate analysis was performed to identify prognostic factors for CDLT. RESULTS: Of 112 patients included, 30.4% experienced CDLT. The optimal cut-off value for low SMM as a predictor of CDLT was ≤43.2cm(2)/m(2). Using this cut-off, 54.5% patients had low SMM. Patients with low SMM experienced CDLT more frequently than patients with normal SMM (44.3% vs. 13.7%, p

OBJECTIVE: The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. DATA SOURCES: MEDLINE (PubMed), EMBASE, and the Cochrane Library. METHODS: Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). RESULTS: No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. CONCLUSION: No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

OBJECTIVES/HYPOTHESIS: To evaluate the effectiveness of bone cement on mean postoperative air-bone gap (ABG) and the proportion of ABG closure to within 20 dB in patients undergoing ossicular chain reconstruction or revision stapes surgery. DATA SOURCES: PubMed, Embase, and Central. METHODS: A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Mean differences, risk differences, and their 95% confidence intervals were extracted for the outcomes of interest. RESULTS: Twelve studies with high relevance and moderate RoB were included for data extraction. Seven of these were two-armed studies, and five were one-armed studies. ABG closure to within 20 dB was assessed in 11 studies and achieved in 60% to 94% of patients who were treated with bone cement. Mean ABG closure ranged from 15 dB to 23 dB in patients treated with bone cement across 11 studies. Most of the two-armed studies did not show a statistically significant difference between the use of bone cement and various conventional rebridging techniques, including allograft or autograft interposition and partial ossicular replacement prosthesis. CONCLUSION: There is no sufficient evidence to support superiority of use of bone cement compared to conventional techniques. It seems from the available evidence that bone cement does not underachieve in ossiculoplasty compared to conventional rebridging techniques.

Objective. To evaluate the effectiveness of the Epley maneuver compared with vestibular rehabilitation on patientreported symptom relief and conversion of the Dix-Hallpike from positive to negative in patients with posterior benign paroxysmal positional vertigo (p-BPPV). Data Sources. PubMed, Embase, and the Cochrane Library. Review Methods. A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. For outcomes of interest, absolute risk differences and their 95% confidence intervals (CIs) were extracted. Results. A total of 373 unique studies were retrieved. Five of these satisfied the eligibility criteria. One study with low RoB and 3 studies with moderate RoB showed that the Epley maneuver is more effective than vestibular rehabilitation at 1-week follow-up with regard to patient-reported symptom relief and conversion of the Dix-Hallpike maneuver from positive to negative (risk differences range from 10% [95% CI, 30-47] to 55% [95% CI, 35-71]). There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up. Most studies suggest that the Epley maneuver and vestibular rehabilitation are equally effective at 1-month follow-up. Conclusion. The Epley maneuver is more effective in treating p-BPPV than vestibular rehabilitation at 1-week follow-up. There is inconsistent evidence for the effectiveness of the Epley maneuver compared with vestibular rehabilitation at 1-month follow-up.

OBJECTIVE:To determine the protective effect of sodium fluoride on the deterioration of hearing loss in adult patients with otosclerosis.DATA SOURCES:PubMed, Embase, the Cochrane Library, and CINAHL.STUDY SELECTION:A systematic literature search was conducted. Studies reporting original study data on the deterioration of hearing loss in otosclerosis patients treated with sodium fluoride were included.DATA EXTRACTION:Directness of evidence (DoE) and risk of bias (RoB), using the Cochrane Collaboration's tool for assessing risk of bias, of the selected articles were assessed. Studies with low DoE, high RoB, or both were excluded. Absolute risks, mean deterioration of hearing in decibels, risk differences, and their 95% confidence intervals were extracted from the included studies.DATA SYNTHESIS:Our search yielded 168 original titles, of which, 2 placebo-controlled studies were eligible for data extraction. The results of these 2 studies were conflicting. One of the included studies, with high DoE and moderate RoB, reported an absolute risk reduction for deterioration of hearing loss of 18% [95% CI 17; 19] when treating with sodium fluoride. The other included study, with high DoE and moderate RoB, reported no clinically significant difference in mean deterioration of bone-conduction, air-conduction, or air-bone gap between the sodium fluoride group and the placebo group.CONCLUSION:There is weak evidence from one study with significant limitations that deterioration of hearing loss in otosclerosis patients receiving sodium fluoride treatment is less than in patients treated with a placebo.

Introduction: The diode laser, with a wavelength of 980 nm, has promising characteristics for being used for the fenestration during stapedotomy. It is known that at this wavelength absorption in pigmented tissues is high, and absorption in water is relatively low compared with medical lasers in the infrared, making it theoretically an applicable laser for stapes surgery in patients with otosclerosis. Another important advantage is that, with respect to other lasers, this device is relatively inexpensive. Despite the potential advantages, the available literature only shows limited reports of this laser being used in stapes surgery. The present article evaluates the thermal, mechanical, and acoustic properties of the diode laser during stapes surgery. Methods: For the mechanical effects, high-speed imaging with a frame rate up to 4000 f/s (=250 Ks resolution) was performed in an inner ear model. For thermal effects, the high-speed Schlieren technique was used. Acoustics were recorded by a hydrophone, incorporated in the model. Pulse settings were 100 ms, 3 W, which are the same settings used during stapes surgery. Results: The application of the diode laser resulted in limited mechanical and thermal effects. Impulse noise was low with an average of 52 (SD, 7.8) dB (A). Before carbonization of the tip of the delivery laser, fiber enhances ablation of the footplate. Conclusion: The 980-nm diode laser is a useful tool for laserassisted stapedotomy in patients with otosclerosis. Mechanical, thermal, and acoustic effects are limited and well within the safety limits. Key Words: DiodeVHearingVLaserVOtosclerosisV StapedotomyVTrauma. Otol Neurotol 00:00Y00, 2014.

Objectives/Hypothesis To assess hearing results and complications following primary stapedotomy in otosclerosis patients comparing the use of laser and conventional techniques for fenestration. Study Design Systematic literature review. Methods A systematic bibliographic search was conducted in PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Studies reporting original data on the effect of laser fenestration, compared to conventional techniques, on closure of air-bone gap in patients undergoing primary stapedotomy were included. Directness of evidence and risk of bias of the selected articles were assessed. Studies with low directness of evidence, high risk of bias, or both were not further analyzed. The absolute risks, risk differences, and 95% confidence intervals were extracted only for studies with moderate to high directness of evidence and moderate to low risk of bias. Results In total, 383 unique studies were retrieved. Eight of these (including 999 procedures) provided high or moderate directness of evidence and carried a moderate risk of bias, and were considered eligible for data extraction. The included studies show no consistent difference in postoperative air-bone gap closure or immediate postoperative vertigo. Conclusions Both footplate fractures and sensorineural hearing loss appear to occur more frequently in the conventional group than in the laser group. Therefore, we prefer laser above conventional methods for footplate fenestration in primary stapedotomy.

The aim of this study was to compare watchful waiting to the Epley maneuver as a management option for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) regarding symptom relief.PubMed, Embase, and The Cochrane Library.A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Absolute risk differences and their 95% confidence intervals (CIs) were extracted for the included studies.A total of 1448 unique studies were retrieved. Eight of these satisfied the eligibility criteria. At 1-week follow-up, all included studies reported a clinically relevant effect in favor of the Epley maneuver regarding symptom relief (absolute risk differences ranging from 20% [95% CI, 5%-37%] to 59% [95% CI, 32%-76%]) or conversion to a negative Dix-Hallpike (absolute risk differences ranging from 17% [95% CI, -5%-37%] to 64% [95% CI, 29%-79%]). At 1-month follow-up, the results of the included studies diverged further. Absolute risk differences ranged from 6% (95% CI, -24%-35%) more symptom relief in favor of watchful waiting to 79% (95% CI, 56%-88%) in favor of the Epley maneuver.All data of the selected studies show a benefit in favor of the Epley maneuver at 1-week follow-up in the management of p-BPPV. The Epley maneuver should be considered in all patients with p-BPPV.

Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

Objectives Patients with head and neck cancer (HNC) have a higher risk of malnutrition and sarcopenia, which is associated with adverse clinical outcome. As abdominal CT-imaging is often used to detect sarcopenia, such scans are rarely available in HNC patients, possibly explaining why no studies investigate the effect of sarcopenia in this population. We correlated skeletal muscle mass assessed on head and neck CT-scans with abdominal CT-imaging. Methods Head and neck, and abdominal CT-scans of trauma (n = 51) and HNC-patients (n = 52) were retrospectively analyzed. On the head and neck CT-scans, the paravertebral and sternocleidomastoid muscles were delineated. On the abdominal CT-scans, all muscles were delineated. Cross-sectional area (CSA) of the muscles at the level of the C3 vertebra was compared to CSA at the L3 level using linear regression. A multivariate linear regression model was established. Results HNC-patients had significantly lower muscle CSA than trauma patients (37.9 vs. 45.1 cm2, p

To present an easy to read systematic review concerning the genetic etiology of otosclerosis to help health care providers in counseling otosclerosis patients more accurately.PubMed, Embase, CINAHL, and the Cochrane Library.Studies on the genetic etiology of otosclerosis were selected. Association studies and family-based studies were included for further review. After quality assessment (risk of bias), data were extracted from the included studies. When available, odds ratios were presented. In case of corresponding genetic anomalies between the studies, it was the aim to combine results.The number of available studies with low risk of bias is limited to 2 association studies and 1 family-based study. These high-quality studies show that otosclerosis in Japanese patients is not linked to the NOG gene and that a polymorphism in the Sp1 binding site located on the COL1A1 gene is associated with otosclerosis as well as OTSC1. Association and family-based studies with moderate risk of bias show a statistically significant association with the ACE gene, AGT gene, OTSC2, RELN gene, TGFB1 gene, 11q13.1, OTSC2, OTSC5, OTSC8, and OTSC10. These results may be spurious associations due to their bias and low statistical power.The present systematic review shows that there is scattered evidence of limited quality and a lack of replication studies. It is not possible to point out 1 or more responsible genes, which play a key role within the genetic pathophysiologic mechanism of otosclerosis.

To evaluate whether the Carhart notch on pure-tone audiometry is reliable as a diagnostic test for predicting otosclerosis in patients with conductive hearing loss. Data Sources PubMed, Embase, the Cochrane Library, CINAHL, and Scopus.A systematic search was conducted. Studies reporting original study data were included. After assessment of directness of evidence and risk of bias of the selected articles, the prevalences and the positive and negative predictive values were extracted.A total of 1402 unique studies was retrieved. Three of these satisfied the eligibility criteria. One study provided direct evidence, while all studies carried moderate to high risk of bias. One study with moderate directness of evidence and high risk of bias was not further analyzed. In a study with a high directness of evidence, a high risk of bias, and a low prevalence of otosclerosis (8%) in patients with conductive hearing loss, the presence of a Carhart notch at 2000 Hz increased the risk of otosclerosis with 33%. In a second study with moderate directness of evidence, moderate risk of bias, and a high prevalence of otosclerosis (72%) in patients with a surgically confirmed congenital ossicular anomaly or otosclerosis, the presence of a Carhart notch at 2000 Hz increased the risk of otosclerosis with 2%.Although there is insufficient high-quality evidence regarding the diagnostic value of the Carhart notch, it seems it is a useful hint for the presence of otosclerosis, but it cannot be used to confirm a diagnosis of otosclerosis.

ObjectiveTo assess hearing results following primary stapes surgery in patients with otosclerosis, comparing local and general anesthesia.Data SourcesPubMed, Embase, the Cochrane Library, CINAHL, and Scopus.Review MethodsA systematic search was conducted, followed by assessment of directness of evidence and risk of bias. Studies reporting original data on the effect of local anesthesia, compared to general anesthesia, on closure of air-bone gap in patients undergoing stapes surgery for otosclerosis were included.ResultsA total of 257 unique studies were retrieved, of which 3 (including 417 procedures) satisfied the eligibility criteria. Assessment showed that all studies carried high risk of bias, and only 1 study provided direct evidence.ConclusionThere is no difference in postoperative air-bone gap, worsening of sensorineural hearing loss, and postoperative vertigo between the 2 groups. A statistically significant increased risk of immediate dead ear following stapes surgery performed under general anes...

Introduction Cochlear implantation is an increasingly common procedure in the treatment of severe to profound sensorineural hearing loss (SNHL) in children and adults. It is often performed as a day-case procedure. The major drive towards day-case surgery has been from a logistical, economical and societal perspective, but we also speculate that the patient9s quality of life (QoL) is at least equal to inpatient surgery if not increased as a result of rapid discharge and rehabilitation. Even though cochlear implantation seems well suited to a day-case approach and this even seems to be common practice in some countries, evidence is scarce and of low quality to guide us towards the preferred treatment option. Methods and analysis A single-centre, non-blinded, randomised, controlled trial was designed to (primarily) investigate the effect on general QoL of day-case cochlear implantation compared to inpatient cochlear implantation and (secondarily) the effect of both methods on (subjective) hearing improvement, disease-specific QoL, tinnitus, vertigo and cost-effectiveness. 30 adult patients with severe to profound bilateral postlingual SNHL who are eligible for unilateral cochlear implantation will be randomly assigned to either the day-case or inpatient treatment group. The outcome measures will be assessed using auditory evaluations, questionnaires (preoperatively, at 1-week, 3-week, 3-month and 1-year follow-up) and costs diaries (weekly during the first month postoperatively, after which once in a month until 1-year follow-up). Preoperative and postoperative outcomes will be compared. The difference in costs and benefit will be represented using the incremental cost utility/effectiveness ratio. The analyses will be carried out on an intention-to-treat basis. Ethics and dissemination This research protocol was approved by the Institutional Review Board of the UMC Utrecht (NL45590.041.13; V.5, November 2015). The trial results will be disseminated through peer-reviewed medical journals and presented at scientific conferences. Trial registration number NTR4464; Pre-results.

Hypothesis: The use of larger-diameter pistons in stapedotomy leads to better hearing outcomes compared with the use of smaller-diameter pistons. There is an interaction between stapes piston diameter and fenestration diameter. Background: Otosclerosis can be treated surgically by removing part of the stapes and bypassing the stapes footplate with a prosthesis. Available piston shaft diameters range between 0.3 and 0.8 mm. There has been a tendency toward the use of smaller-diameter pistons, because of a suspected decreased risk of cochlear trauma and subsequent sensorineural hearing loss (SNHL) with smaller pistons. However, mathematical models, temporal bone studies, and clinical studies suggest that the use of larger-diameter pistons is associated with better hearing outcomes. Methods: Three fresh-frozen, non-pathologic temporal bones were harvested from human cadaveric donors. Acoustic stimuli in the form of pure tones from 250 to 8000 Hz were generated at 110 dB sound pressure level. A total of 16 frequencies in a 1/3-octave series were used. Stapes and round window velocities in response to the acoustic stimuli were measured at multiple equally spaced points covering the stapes footplate and round window using a scanning laser Doppler interferometry system. Eight sets of measurements were performed in each temporal bone: 1) normal condition (mobile stapes), 2) stapes fixation and stapedotomy followed by insertion of 3) a 0.4-mm-diameter piston in a 0.5-mmdiameter fenestration, 4) a 0.4-mm-diameter piston in a 0.7- mm-diameter fenestration, 5) a 0.4-mm-diameter piston in a 0.9-mm-diameter fenestration, 6) a 0.6-mm-diameter piston in a 0.7-mm-diameter fenestration, 7) a 0.6-mm-diameter piston in a 0.9-mm-diameter fenestration, and 8) a 0.8-mmdiameter piston in a 0.9-mm-diameter fenestration. Results: At midrange frequencies, between 500 and 4000 Hz, round window velocities increased by 2 to 3 dB when using a 0.6-mm-diameter piston compared with a 0.4- mm-diameter piston. Using a 0.8-mm-diameter piston led to a further increase in round window velocities by 2 to 4 dB. Conclusion: Our results suggest a modest effect of piston diameter on hearing results following stapedotomy.

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the diagnostic accuracy of MRI, CT and PET-CT for detecting lymph node metastases in patients with head and neck squamous cell carcinoma.

Objectives/Hypothesis: To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally. Study Design: A retrospective cohort study of prospectively gathered data in a tertiary referral center. Methods: The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated. Results: Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P =.78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%). Conclusions: Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up. Level of Evidence: 2b. Laryngoscope, 128:2390–2396, 2018.