Search

To investigate the circannual rhythm (seasonal incidence) of idiopathic sudden sensorineural hearing loss (ISSNHL).Data were retrieved from the medical files of an original cohort of all consecutive patients with ISSNHL in a tertiary medical center between 2012 and 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed. A Google Trends analysis of the term [sudden hearing loss] and related terms between 2014 and 2020 was also performed.Most of the published series (9/12) reported the highest ISSNHL incidence in the spring and the lowest in the winter (8/12). In our local series, the incidence during the winter was significantly lower than that for the other seasons by a factor of 0.69 (95% confidence interval, 0.65-0.77; p = 0.041; r = 0.36). Google Trends data showed no significant correlation between the calendric month and the incidence of ISSNHL in any of the analyzed countries ( p = 0.873, r2 = 0.029).The ISSNHL incidence was lowest during the winter season in our cohort and reported for other cohorts worldwide. Google Trends-based model analysis did not determine any circannual rhythm.

Various thyroid pathologies are speculated to contribute to obstructive sleep apnea (OSA). The underlying mechanisms of the intricate relationship between OSA and thyroid structure and function, and whether thyroidectomy can alleviate OSA symptoms remain unclear. An assessment of the impact of thyroidectomy on OSA is warranted.A systematic review of four electronic databases (PubMed (Medline), Embase, the Cochrane library, and ClinicalTrials.gov) was performed up to February 2022. The primary outcomes were preoperative and postoperative Apnea/Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Berlin questionnaire scores, and continuous positive airway pressure (CPAP) use. A meta-analysis of continuous measures and odd ratios was conducted. Small-scale studies underwent a qualitative meta-analysis.Six cohort studies on 221 OSA patients who underwent thyroidectomies were included. The results showed that thyroidectomy was associated with significant reduction in postoperative AHI (Mean difference [MD], -6.39, 95% CI, -12.46 to -0.32), however, no significant association was found with CPAP withdrawal (Odd ratio [OR], 0.38, 95% CI, 0.12-1.18). Neither the Berlin questionnaire score (OR, 0.19, 95% CI, 0.03-1.17) nor the ESS improved postoperatively (MD, -1.04, 95% CI, -6.37 to 4.29).This meta-analysis provides a quantitative estimate for the effect of the thyroidectomy on OSA and suggests that thyroidectomy is associated with limited clinical improvement of polysomnographic measures. Future large-scale, well-designed prospective studies are necessary to validate these findings and to refine accordingly the preoperative assessment of both medical conditions individually and in combination.

This study investigated the impact of eustachian tube (ET) function (ETF) on therapeutic success on candidates for intra-tympanic administration of steroids (ITAoS), due to idiopathic sudden sensorineural hearing loss (ISSNHL).Medical chart review in two university-affiliated medical centers was performed. Included were consecutive adult patients diagnosed with unilateral ISSNHL between 2012 and 2019 who were treated with ITAoS due to incomplete or no recovery following systemic steroidal therapy. ETF was assessed by means tympanometry, before the initiation of ITAoS. The cohort was divided into an ET dysfunction group (ETD(+)) and a functioning ET group (control: ETD(-)). The audiologic response to treatment was recorded at the last follow-up.A total of 64 suitable patients [median (interquartile, IQR) age 49 (38-63) years] were enrolled. The ETD(+) group included 20 patients and the remaining 44 patients served as controls. Demographic and clinical parameters were not significantly different between the two groups at presentation. Hearing thresholds were improved significantly better, at frequencies 250, 500, 1, 2, 4, and 8 kHz (p = 0.001-0.040) in the ETD(+) group.ETD(+) is associated with better efficacy of ITAoS.

To report adverse events (AEs) associated with systemic steroid treatment in idiopathic sudden sensorineural hearing loss (ISSNHL).A retrospective chart review of consecutive patients newly diagnosed with ISSNHL necessitating systemic steroidal treatment was conducted from 1/2017 to 2/2021. Blood pressure (BP) was monitored three times daily and morning fasting glucose was monitored once daily during treatment. An AE was defined as a fasting blood glucose level 160 mg/dl, systolic BP 80 mmHg, and diastolic BP 100 mmHg.In total, 143 patients were enrolled [69 (48%) males and 74 (52%) females] of whom 29 (20%) had diabetes mellitus (DM) and 46 (32%) had hypertension (HTN). The cohort's median age (interquartile range) was 58 (37-69) years. Fifty-three patients (37%) did not complete the oral steroidal treatment due to any AE (glycemic or hypertensive). Background DM highly correlated with increased risk of a glycemic event (0.59 vs. 0.13 for diabetic and non-diabetic patients, respectively, P 0.001). HTN correlated significantly with increased risk of an overall AE (0.54 vs. 0.29 for hypertensive and non-hypertensive patients, respectively, P = 0.001). Neither pre-treatment BP nor glucose level predicted the risk of an AE (P = 0.310 and 0.521, respectively).AEs due to systemic steroidal treatment are common among ISSNHL patients. Demographic and baseline values cannot predict the risk of AEs which can occur throughout the entire duration of treatment. Patients with DM and HTN are at the greatest risk of AEs. Tight blood glucose and BP monitoring are recommended during treatment.

Radiotherapy (RT) is widely used for early glottic cancer. Patients failing this treatment are referred to surgical management of their disease. Salvage partial laryngectomy (SPL) has the advantage of preserving laryngeal function with total laryngectomy (TL) remaining as a last resort. The purpose of this study was to determine the efficacy of SPL in preventing total laryngectomy, following failed RT, for early glottic cancer.A meta-analysis of all published English literature was performed. All publications that included patients undergoing SPL were reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. The search strategy identified 154 relevant articles. A total of 15 retrospective studies that included 323 suitable patients were subsequently analyzed in this meta-analysis. The main outcome measure was the rate of laryngectomy-free survival (LFS) following SPL. The indications for salvage TL (i.e., disease recurrence and poorly functional larynxes) as well as subgroup analyses for open and trans-oral SPLs were also calculated.The overall rate of LFS following SPL was 81.2% (fixed effects model range: 75.7-86.8%). Salvage TL following SPL were performed in 96.8% due to disease recurrence and in 3.2% to poorly functional larynxes. A subgroup analysis showed a 90.4% LFS after open SPL and 78.6% following trans-oral SPL.A high rate of successful salvage partial laryngectomies, regardless of surgical technique, is to be anticipated in well-selected patients after RT failure.

Objective To evaluate the quality of leading Internet resources of information on sudden sensorineural hearing loss (SSNHL). Study design Cross-sectional descriptive design. Settings An online search by means of the Google search engine. Methods An online search was conducted using terms related to SSNHL. We defined "quality" according to scaled readability measures (Flesch Reading Ease [FRE] and Flesch-Kincaid Grade-Level [FKGL]), as well as "understandability" and "actionability" (Patient Education Materials Assessment Tool), and Clinical Practice Guideline (CPG) adherence. Scoring was performed by two independent physicians. Results The 10 most frequently encountered patient education websites were analyzed. The average FRE score was "fairly difficult" (mean 57.28, median 55.55, range 46.4-71.8) and the average FKGL score was "standard" (mean 9th grade, median 9th grade, range 5th-10th grade). Nine websites were understandable (mean 83%, median 84%, range 69-100%), and seven had good actionability scores (mean 73%, median 75%, range 50-100%). Most websites conformed with the CPG for patient education at a reasonable level (mean 5.6, median 5.5, range 3-7). Notably, all websites encouraged seeking medical help. Conclusion Internet resources for patient education on SSNHL vary in quality and are generally understandable to the average layman. There is still much room for better, more comprehensive and easier-to-read information to improve patients' medical knowledge about their condition.Level of Evidence: 1.

To assess the correlation between inflammatory markers (IM) and hearing loss (HL) in a large cohort of apparently healthy individuals.A cross sectional study.Tel-Aviv Medical Center (a tertiary referral center) Inflammatory Survey Participants Individuals who attended the Tel-Aviv Medical Center Inflammatory Survey (TAMCIS) for a routine annual health check.Out of 2,500 individuals included in the final study cohort, 1,170 (47.3%) had some hearing impairment. Those with a hearing loss in 1 or both ears had significantly higher levels of neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red blood cell counts. There was a difference between low- and high- frequencies losses associated with the inflammatory status.IM levels were associated with the presence of a HL, supporting a link between inflammatory changes and hearing loss.

ObjectiveTo compare the measured bone conduction threshold at 3 kHz with the calculated threshold in newly diagnosed sudden sensorineural hearing loss.MethodsA retrospective chart review was conducted of pure tone audiograms in confirmed sudden sensorineural hearing loss cases.ResultsOf 157 patients with sudden sensorineural hearing loss, 144 had idiopathic hearing loss, 8 had vestibular schwannoma and 5 had Ménière's disease. The r value for the correlation between the two methods of 3 kHz assessment for all patients was 0.887 (p < 0.001). The mean difference between the measured and calculated 3 kHz thresholds was 0.76 ± 7.96 dB, 0.4 ± 8.08 dB and 1.5 ± 1.8 dB in the sudden sensorineural hearing loss, idiopathic and Ménière's disease groups, respectively. The mean difference between the measured and calculated 3 kHz thresholds was significantly greater in the vestibular schwannoma group (6.86 ± 4.38 dB) than in the idiopathic group (p = 0.013).ConclusionThe 3 kHz frequency may encompass important audiometric information. A discrepancy between the measured and calculated bone conduction 3 kHz thresholds raises suspicion of an underlying vestibular schwannoma as an aetiology for sudden sensorineural hearing loss, and these thresholds should therefore be measured independently and routinely.

To characterize postoperative pain after tympanoplasty and tympanomastoidectomy and correlate between pain severity and various technical aspects of the surgery. We carried out a prospective cohort study of patients undergoing ear surgery in a tertiary referral center between 7/2018 and 7/2019. Patients filled in a pain questionnaire and scored pain intensity on a visual analog scale preoperatively and on postoperative days (POD) 1–4, 21, and 49. The responses were correlated with clinical and operative data, including surgical technique-related details. Sixty-two patients participated in the study (27 males and 35 females, average age 41.1 ± 20.02 years [range 18–68]). The median preoperative VAS was 5, followed by 6 on POD1, 5 on POD3, and 1 at 3 and 9 weeks. The preoperative questionnaire score normalized to 10 was 4.5 (32/70), 5.1 on POD1, 4.7 on POD3, 0.85 at 3 weeks and 0.85 at 9 weeks. The predictive factors for increased postoperative pain were younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus. The predictive factors for decreased pain were smoking and the addition of a mastoidectomy. None of the factors related to the surgical technique (e.g., surgical approaches, type of reconstruction, specific surgeon) significantly affected the questionnaire responses or the pain VAS intensity scores. We demonstrated that younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus were predictors of increased pain after tympanoplasty and tympanomastoidectomy, while the inclusion of a mastoidectomy was a predictor of decreased pain.

Objective To describe the effect of sinusitis on Weber test lateralization which normally lateralizes toward the ear of a conductive hearing loss and away from the ear of a sensorineural hearing loss; to investigate whether the presence of an extra-aural condition might affect Weber test results. Study design Descriptive study. Setting Tertiary referral center. Subjects and methods Consecutive adult patients with maxillary and/or frontal sinusitis were included (study group), as well as patients with normal sinus structure and function (control group) were enrolled between February and September 2019. Presence or absence of paranasal disease and middle ear aeration was confirmed by computerized tomography. Subjects with otologic condition were excluded. The physical examinations, tympanograms, and audiograms were unremarkable. The Weber test consisted of 512, 1024, and 2048 Hz tuning forks that were applied on the central incisors and frontal midline, and lateralization patterns were compared with the extent of paranasal pathology. Results There were 44 participants (M:F=26:18), age 19 to 63 years (average 51). The cohort included 39 patients with sinusitis, affecting the frontal and/or maxillary sinus(es), as well as 5 controls without evidence of paranasal disease. There was a match between the extent of paranasal disease and the results of all 3 Weber test frequencies in 35 patients (80%). Omission of the 2048 and 1024 Hz tuning forks from the analysis yielded a match in 40 (91%) and 43 (98%) patients, respectively. No Weber test lateralized to the nondiseased sinus in any subject. Weber test lateralization was observed in 11% of patients, after the sinonasal pathology was successfully addressed. Conclusion Weber test lateralization in the absence of aural pathology may be explained by asymmetry related to paranasal disease and may alert to its presence.

Recent guidelines encourage the use of Webet test (WT) as a part of the physical examination of a newly suspected sudden sensorineural hearing loss (SSNHL) patient. However, the most sensitive tuning-fork frequency has never been identified.To identify the most sensitive frequency for initial WT of patients with suspected SSNHL.Medical records of patients with confirmed SSNHL, who underwent formal audiometry in which the WT was carried out with different frequencies were analyzed.319 medical records were identified. The most sensitive WT frequency was 500 Hz, with a sensitivity of 94.49% (223/236. confidence interval 90.76-97.03). There was a non-significant difference between 1000 Hz EBO and 500 Hz EBO (The most sensitive WT frequency for SSNHL diagnosis is 500 Hz. However, the sensitivity of this frequency is 94.49%.512 or 1024 Hz should be used to better identified SSNHL. Even WT lateralization to the affected ear, does not preclude the diagnosis of SSNHL. Formal audiometry should be used in any case of medical history suspected for sudden hearing loss with normal otoscopy.

Objective To validate a smartphone-based Rinne test employing the vibration application of mobile telephones. Study design Prospective controlled clinical study. Setting Tertiary referral medical center. Methods Twenty consecutive patients hospitalized in the otolaryngology department of a tertiary medical center due to unilateral hearing loss (HL study group), and 30 consecutive inpatients on the same ward who had no otological history (controls) were enrolled. Each participant underwent the traditional 512 Hz tuning fork-based Rinne test, as well as a smartphone-based Rinne test by means of a single uncovered smartphone with a vibration application. The test results were compared to those of formal audiometry. Results The overall agreement between the traditional Rinne test and the smartphone-based test was 98%. The Sensitivity was 85% for both tests, specificity was 90% and 93% for smartphone and tuning fork tests, respectively. The smartphone-based Rinne test could correctly discriminate between patients with an air–bone gap ≥ 25 dB at 512 Hz from patients with a lower or no air–bone gap at 512 Hz. The smartphone-based Rinne could not evaluate two patients with a moderately severe/severe sensorineural hearing loss due to their inability to detect the vibrations. Conclusion A smartphone-based Rinne test was validated for the detection of an air–bone gap ≥ 25 dB at 512 Hz in the clinical setting. The validity of patient-operated smartphone-based Rinne test awaits further study. Level of evidence 2B.

Background: Fatigue is thought of as a leading cause of iatrogenic accidents. A significant deterioration in qualitative balance function has been shown in sleep deprived individuals. Aim/Objectives: To quantify the degree to which balance is impaired by sleep deprivation (SD) in post-call medical residents. Methods: Medical residents voluntarily underwent computed dynamic posturography (CDP) before and after an on-call night, at an identical time of the day. Order of test performance was random to avoid behavioral learning. Each participant served as his or her own control. Results: Seventeen residents were enrolled (median age 32years). Average sleeping duration the night before and during the night shift was 6.5 and 1 hour, respectively. The average response times difference between alert and fatigued was 10.15 milliseconds (95% CI: 6.81-13.49 milliseconds), yielding a significantly prolonged response times from 120 milliseconds before to 130 milliseconds after the night shift ( P < .001). Comparison of additional measurements of CDP performance did not differ between test conditions. Conclusion: Medical residents are fatigued due to the effect of on-call nights. Sleep deprivation prolongs response times to vestibular stimuli. This finding probably has an effect on execution of manual skills and may reflect a more generalized slowing of responses and overall performance impairment. Significance: The vestibular system is susceptible to SD.

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

OBJECTIVE To measure the subjective visual vertical (SVV) in patients suffering from peripheral vestibular disorders versus controls, using a smartphone-based test designed to simulate the bucket test, in order to validate it as an available tool for the clinician. STUDY DESIGN Prospective cohort study. SETTING Academic tertiary medical center. PATIENTS Forty-five adult patients were recruited to the study, 25 had vestibular disorders, and 20 did not (controls). INTERVENTION All patients underwent conventional bucket-SVV (b-SVV) and smartphone-based SVV (s-SVV) testing. MAIN OUTCOME MEASURES Correlation and agreement of b-SVV and s-SVV scores in patients with peripheral vestibular disorders compared to controls. RESULTS SVV score in the vestibular disorders group was significantly higher compared to controls in both testing methods (p

To investigate the impact of with tympanostomy tubes (TT) on infrared tympanic membrane thermometer (ITMT) results and to provide a systematic review of ITMT results in non-naïve tympanic membranes.Original prospective blinded case series and systematic literature review.A single tertiary university-affiliated medical center.ITMT measurements of patients with unilateral TT and contralateral naïve control ear were randomly conducted by a single investigator blinded to the TT side before and after cerumen was removed from the external auditory canals. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Google Scholar" on comparable published cases was performed.The mean paired differences (95% confidence interval [CI]) between ventilated and non-ventilated ears before and after cerumen removal were 0.08 ºC/0.14 ºF (-0.04 to 0.19 ºC/- 0.07º-0.34º) and 0.62 ºC/1.12 ºF (0.04-0.25 ºC/0.07-0.45 ºF), respectively (P 0.001 and P = 0.01, respectively).These findings support the validity and accuracy of ITMT in the setting of ventilated ears.

To study the impact of the COVID-19 pandemic on journal processing times before publication in the field of otolaryngology-head and neck surgery (ORL-HNS). Online search of original papers published in selected ORL-HNS journals in terms of times from submission to acceptance (S-A), acceptance to first online publication (A-P), and submission to online publication (S-P). Papers were divided into those published in the pre-COVID-19 era and those during the COVID-19 era. The latter were further divided into unrelated to COVID-19 and related to COVID-19. A total of 487 articles from 5 selected ORL-HNS journals were included, of which 236 (48.5%) were published during the pre-COVID-19 era and 251 (51.5%) were published during the COVID-19 era. Among them, 180 (37%) papers were not related to COVID-19, and 71 (14.5%) were related to COVID-19. The S-A duration of COVID-19-related articles was significantly shorter compared to papers submitted in the pre-COVID-19 era and to papers submitted in the COVID-19 era but unrelated to COVID-19 (median 6-34 days compared to 65-125 and 46-127, respectively) in all 5 journals. The most prominent reductions in S-A and S-P times were documented in the laryngology and otology/neurotology disciplines, respectively. Processing times of the included papers were significantly shorter in most of the selected ORL-HNS journals during the COVID-19 era compared to the pre-COVID-19 era. COVID-19-related papers were processed more rapidly than non-COVID-19-related papers. These findings testify to the possibility of markedly expediting S-P times and hopefully set a precedent for post-pandemic publishing schedules.

Background/Aims Subjective tinnitus is a common impairment throughout the world and typically cannot be cured. Coping strategies are cognitive, affective, and behavioural approaches for managing stressors like tinnitus. The aim of this study was to investigate the effects of two brief interventions on coping and tinnitus-related distress. Methods A total of 45 individuals with tinnitus in Israel were allocated into one of three groups: acceptance and commitment therapy, coping effectiveness training, or a waitlist control group. Outcomes were assessed at three time points by the Brief Coping Orientation to Problems Experienced scale and the Tinnitus Handicap Inventory, a measure of tinnitus-related distress. Results There was a significant difference among the groups on post-intervention Tinnitus Handicap Inventory assessment, but not on coping, when controlling for baseline scores. Pairwise comparisons indicated that the coping effectiveness training group scored significantly lower on the Tinnitus Handicap Inventory than the waitlist control group. Conclusions While the results are promising, a larger study is needed to further explore the efficacy of the brief coping effectiveness training intervention.

Objective To describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm. Methods A retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively. Results A total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded. Conclusions The endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.

The aims of this retrospective clinical study were to present our management protocol for the retrieval of impacted dental implants that have become displaced into the maxillary sinus cavity and to define the role of endoscopic sinus surgery in this setting. All 24 patients (25 implants) who underwent surgical retrieval of dental implants displaced into the maxillary sinus between 2012 and 2019 were included. Data on surgical interventions and complications were collected retrospectively. Eleven patients (46%) had chronic sinusitis associated with the migrated implant. All implants were successfully retrieved via transnasal endoscopic approach alone: 80% via a middle meatal antrostomy and 20% via a combined middle and inferior meatal antrostomy. Five patients required a concomitant transoral approach for oro-antral fistula repair. None required a transoral approach for displaced implant retrieval. All patients healed uneventfully without complications. Transnasal endoscopic sinus surgery via a middle meatal antrostomy or a combined middle and inferior antrostomy is recommended as the primary choice for dental implant retrieval from the maxillary sinus. A transoral approach should be performed simultaneously only for oro-antral fistula repair. This surgical protocol proved to be safe and efficient, and it obviated the need for osteotomies of the anterolateral maxillary wall.

To report our experience of a sequence of events that resulted in an iatrogenic cholesteatoma originating from the external auditory canal (EAC) years after tympanoplasty that had included a tympanomeatal flap. Data on the presentation and pathogenesis of iatrogenic cholesteatomas arising from misplaced tympanomeatal flaps during tympanoplasty without mastoidectomy were retrieved from the patients’ medical records and analyzed. Five patients were identified with cholesteatomas involving the EAC. They all had recurrent ear infections and varying degrees of conductive hearing loss. Each patient’s past surgical history included one or more tympanoplasties in which an ipsilateral tympanomeatal flap had been raised. None had undergone a mastoidectomy. Two patients presented with small cholesteatomas that had developed over an average of 6.5 years after surgery. Three patients had large cholesteatomas that had developed over an average of 33.7 years after surgery. Clinical presentations and imaging studies suggested a misplaced tympanomeatal flap as the most likely source of cholesteatoma. Tympanomeatal flap misplacement may cause iatrogenic cholesteatoma formation originating from the EAC during tympanoplasty even without mastoidectomy. These cholesteatomas can grow substantially before becoming symptomatic as they extend to and through the mastoid. They may not affect the sound conduction system until late in the course of the disease. Meticulous replacement of tympanomeatal flaps and exercising a high index of suspicion postoperatively can reduce the incidence of this complication.

Objectives Describe the histopathology of the temporal bones in MELAS (myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome. The syndrome results from a known point mutation in mitochondrial DNA. Methods Histopathology analysis of a pair of temporal bones from the oldest surviving MELAS syndrome temporal bone donor. Histopathologic findings were correlated with known premortem clinical data. Results The inner ears showed severe but incomplete atrophy of the stria vascularis for the length of the cochleae. In contrast, the organ of Corti and inner hair cells appeared intact with some loss of outer hair cells. Other than moderate loss at the basal turn, spiral ganglion cells numbers were normal. The vestibular neuroepithelium was mostly normal with the exception of moderate degeneration of the macula sacculi and partial collapse of the saccular wall on the right. The cerebral cortex had infarct-like lesions with adjacent gliosis. Conclusion This is an analysis of the oldest patient with MELAS syndrome to date, an addition to only two previously published patients. It supports the notion that hearing loss is a result of dysfunction of the stria vascularis and not loss of hair cells or neurons. Patterns of vestibular pathology are in agreement to in-vivo measurements. These findings support auditory rehabilitation with cochlear implants and may be relevant to hearing loss due to other mitochondrial mutations. Level of evidence 4.

Introduction: Sudden sensorineural hearing loss (SSNHL) can be the presenting symptom of vestibular schwannoma (VS). Usually, steroidal treatment is given before magnetic resonance imaging (MRI) is performed. Objectives: The aim of this study was to investigate whether there is a different pattern of steroidal treatment response after SSNHL in patients with and without a VS, in order to determine whether rapid hearing improvement can serve as a predictor of the presence of VS. Methods: Charts of patients with SSNHLs were reviewed. Analysis of the presenting symptoms of patients with an SSNHL with and without a coexisting VS and comparison of the response to steroids of the two groups of patients was performed. Results: A total of 420 patients were treated for SSNHLs during the study period. Treatment consisted of intraoral prednisone 1 mg/kg/day. The male-to-female ratio was 1.00:1.17, and the median age at diagnosis was 38 years (range 18–82); neither parameter correlated with the presence of VS. MRI scans demonstrated a VS in 20 patients (4.76%). Audiometric testing 7 days after steroidal treatment initiation revealed that the pure-tone average of 240 patients (60%) without VS improved, and that of the 16 (80%) patients with VS improved by the same audiometric criteria (p = 0.0007). Conclusions:Improvement of hearing within 1 week after steroidal treatment initiation in patients with SSNHLs may suggest the presence of a VS.

BACKGROUND Balance is a complex process involving the coordinated activities of multiple sensory, motor and biomechanical components. Balance function may be disturbed in subjects suffering from hearing loss but the impairment has been attributed to the pathology underlying the hearing loss. AIM The purpose of the study was to investigate the possible interference of simulated conductive hearing loss with the ability to maintain postural balance. METHODS Twenty normal-hearing subjects, 20-30 years old, underwent the computerised dynamic posturography test battery before and after plugging their external ear canals with earplugs, thus simulating a 40dB conductive hearing loss. RESULTS Eighteen females and two males were tested before and after plugging their ear canals. Average CHL was 40 ± 4.9dB. The composite equilibrium score was significantly diminished after plugging the ears with an average sway score of 73.5% (P

Submandibular gland (SMG) malignancies are exceedingly rare. Lymph node metastasis is one of the most important determinants of outcome in SMG malignancies. The aim of this study was to investigate the overall rate of occult neck nodal metastasis in SMG malignancies.The study design is a meta-analysis of all studies on patients with a primary SMG malignancy, without evidence of neck nodal metastasis, who underwent an elective neck dissection (END). The search strategy identified 158 papers that appeared in print from January 1980 to July 2020. All eligible patients from the Tel-Aviv Medical Center were analyzed and consolidated into a case series. A total of 12 retrospective studies that included 306 suitable patients met inclusion criteria.The risk for occult metastasis in primary SMG malignancies was 0.0% to 50.0%, with a fixed effect model of 19.52% (95% CI, 14.9%-24.5%). The analyzed studies included a wide range of pathologies. The most common malignancies were adenoid cystic carcinoma and mucoepidermoid carcinoma.The overall rate of occult neck metastasis in SMG malignancies is relatively high, and an END should be the default intervention in these cases. An END is unwarranted in tumors judged clinically to be low stage and low grade.

Background Masticator space involvement in oral cavity squamous cell carcinoma (OCSCC) is considered an unresectable disease. Nevertheless, achieving negative resection margins is feasible in limited masticatory space involvement. Materials and methods A multi-institutional study on OCSCC patients with masticator space invasion who underwent surgical resection. Margin status was assessed according to anatomic tumor involvement of the inframandibular and supra-mandibular notch. Results One-hundred and thirty-two patients met the inclusion criteria. Then, 67 patients (50.8%) were diagnosed with a supra-notch tumor and 65 (49.2%) with an infra-notch disease. Negative margins were more common in the infra-notch group (43.3 vs. 23.1%, p = 0.014), and positive margins were more common in the supra-notch group (41.5 vs. 23.9%, p = 0.041). Multivariable analysis demonstrated that supra-notch tumors had an increased likelihood for involved resection margins (odds ratio = 2.46, p = 0.036). Conclusion OCSCC patients with masticator space involvement are prone for positive surgical margins in tumors extending above the supra-mandibular notch.

Retraction pockets and marginal perforations of the pars tensa of the tympanic membrane (TM) are most commonly found at superior posterior quadrant (SPQ). The patulous Eustachian tube tends to manifest in the same quadrant. Variation in the structure of the TM may explain these observations.A line defined by the manubrium was used to divide the pars tensa into anterior and posterior portions. A transverse line centered on the umbo divides the pars tensa into superior and inferior parts, resulting in four quadrants. Surface areas of each of the TM quadrants were measured in a sample of 23 human adult formalin-fixed temporal bones. The TMs were completely excised, faced medially, and placed against graph paper to maintain scale measurements, photoed, and measured.TM thickness was measured on a different set of 20 human temporal bones (TB) preparations with normal external and middle ears. Four random loci were chosen from each pars tensa's TM quadrant. The thickness was measured using high-magnification power microscopy.The SPQ was the largest and thinnest of the four quadrants. It occupies 31% of the pars tensa area. It is 69 μm as compared to approximately 85 μm in the other quadrants. The radial lines between the umbo and the annulus are in descending order from superior posterior toward the anterior-superior radials.The SPQ has the largest vibratory area and is the thinnest of the four TM quadrants. Variation in the thickness of the middle, fibrous layer accounts for the variation in the thickness of the TM. These findings may explain the tendency of pathologies related to Eustachian tube dysfunction to preferentially manifest in or originate from the SPQ.

To date, there is no consensus about the benefits of paper patching over spontaneous healing in the management of isolated acute traumatic tympanic membrane perforations (IATTMP). In this systematic literature review and case series, we compared paper patching of IATTMP to spontaneous healing in terms of healing rate and time to heal. A systematic literature search of English-language studies published from 1/1975 to 9/2020 was conducted using PubMed via MEDLINE, and 201 studies were identified. Another 346 studies were derived from the references of those articles. Twenty-four studies remained after omitting duplications and articles that did not meet the inclusion criteria. Demographics, medical history, physical examination, and audiometric results in the selected publications and in a new series of patients treated for IATTMP between 1/2018 and 1/2021 in a single tertiary referral center were retrieved and analyzed. The literature review yielded 2796 ears of which 466 underwent paper patching (intervention arm). Complete perforation healing was documented in 67–97% of control arm and 92–93% of intervention arm. Our new series included 29 ears of which six underwent paper patching. Complete healing was observed in 83% and 78% in the interventional and control arms, respectively. Although paper patching and watchful waiting had similar success rates in patients with IATTMP, healing after paper patching was slightly quicker among our patients. Patching is a readily applicable and technically simple office-based intervention that should be preferentially considered for IATTMP.

Objectives To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. Methods Publications were selected by a search with 'PubMed', 'Embase' and 'Web of Science'. A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was performed. Design, setting, participant-not relevant main outcome measured Extrusion rate of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. Results Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation, and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were as follows: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. Conclusion Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time.

Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement. An institutional case series and a meta-analysis was conducted. All studies that included patients diagnosed with well-differentiated thyroid cancer (WDTC) and tracheal invasion were analyzed. Patients with low-volume tracheal invasion (according to the Shin classification) were extracted from the various studies and subsequently included in this study. The outcomes of tracheal shaving and radical resection were consolidated and compared. All recurrences and mortality over 10 years of follow-up were calculated using the Kaplan–Meier method. Institutional case series included 22 patients diagnosed with WDTC and tracheal invasion that underwent resection. There was one case of recurrence (4.5%) during the follow-up period and no mortality. The meta-analysis yielded a total of 284 patients from six studies who met the inclusion criteria. The 10-year overall survival was 82.4% for the shave group and 80.8% for the resection group. The combined Kaplan–Meier curves revealed no statistically significant difference between the two techniques (hazard ratio [HR] = 0.86, P = .768). The combined 10-year local control rate of the shave group was 90.2%. The outcomes of tracheal shaving in low-volume invasion are similar to more aggressive forms of tracheal resections. Shave resection is oncologically safe in carefully selected WDTC patients demonstrating minimal tracheal invasion.

To study optimal head position after intratympanic steroid injections to enhance drug bioavailability.Application of virtual and in vitro models of the intratympanic anatomy.The surgical 3-dimensional printing laboratory of a tertiary academic medical center.A high-resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3-dimensional model. The tympanic membrane was perforated in the posterior-inferior quadrant. Methylene blue-stained 10-mg/mL dexamethasone was administered to the middle ear cleft, after which a 3-dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice.The virtual model yielded the following position of the head as optimal: 53º rotation away from the injected ear in the vertical axis (yaw), 27º rotation toward the noninjected ear in the longitudinal axis (roll), and 10º neck extension in the transverse axis (pitch).Virtual imaging determined that 53º and 27º yaw and roll, respectively, away and 10º pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear.

BACKGROUND The aims of this study were to report our center's experience with infratemporal fossa (ITF) tumors, to review the treatment modalities and outcomes. METHODS Data of patients that underwent resection of ITF tumors in a single tertiary referral medical center were collected and analyzed. RESULTS Sixty-three patients were included. Sarcoma was the most common pathology (18; 29%). The most common surgical approach was the preauricular-orbitozygomatic approach (24; 38%), followed by endoscopic, craniofacial resection, and combined approaches. Forty-seven patients (75%) required reconstruction, 23 (49%) involving free tissue transfer. Thirty-five patients (76%) with malignant lesions required adjuvant therapy consisting of radiotherapy, chemotherapy, or both. Thirty-three patients suffered from complications related to surgery or adjuvant therapy. The three- and five-years survival rates for malignancy were 82% and 66%, respectively. CONCLUSION Complete surgical resection of ITF involving tumors is feasible, providing good long-term survival. Multidisciplinary approach is the key for success.

Objectives: To characterize blast-induced cholesteatomas (BIC) in terms of symptoms, presentation, and location within the middle ear cleft (MEC). Design: A search for all English language articles in “MEDLINE” via “PubMed” and “Google Scholar” was conducted. Results: A total of 67 ears with BIC were included. Fifty-eight ears in which the traumatic perforation failed to spontaneously close were excluded, leaving seven case reports (eight patients, nine ears) for statistical analysis. Time between blast exposure to spontaneous tympanic membrane (TM) closure was 16 days to 10 months. Time between blast exposure and cholesteatoma diagnosis was 5 months to 4 years. The cholesteatomas were diagnosed due to symptoms in two ears, as asymptomatic finding on physical examination in one ear and as asymptomatic finding in axial imaging in three ears. Conclusions: BICs can develop behind intact tympanic membrane or along with TM perforation. Based on the current review, when a TM perforation and spontaneous healing were documented, after blast exposure, MRI scan is an integral component of the follow-up. The optimal timing for MRI performance after blast exposure, is yet to be identified.

Background Marfan syndrome (MFS) is a genetic disorder affecting connective tissue. The composition of the dura can change. Consequently, lumbo-sacral dural herniations and cerebrospinal fluid (CSF) leaks are encountered, however, they have yet to been described in the temporal bone. Aims/objectives To define the prevalence of temporal bone meningocele or encephalocele among patients with MFS. Materials and methods Reviewed medical records of all adult patients, diagnosed with MFS, who were treated between 1993 and 2018 at a single academic referral institute. Head targeted CT scans were analyzed. The presence of an anterior or lateral skull base defect was recorded. Results One-hundred and one patients diagnosed with MFS were identified. Twelve of which had suitable CT scans and were enrolled in the study. The median age of patients with defects was 65 years (range 41-71). Five of the twelve patients (41.6%) had tegmen defect. Of the seven defects found, the median size of the defects was 3 mm (range 2-5 mm). All defects were in the temporal bone, none in the anterior skull base. Conclusions and significance The prevalence of radiological evidence of a temporal bone defect among patients with MFS is high. This is a new, important, and potentially life-threatening association with the syndrome.

Objective: The aim of this paper was to compare the accuracy of a smartphone-based Weber test (SPWT) with the traditional tuning fork Weber test (TFWT) in identifying and differentiating between sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). Study Design: We conducted a prospective, noncontrolled clinical study. Methods: Sixty patients referred to the emergency department due to unilateral hearing loss (HL) were enrolled. They were asked to press a single uncovered smartphone on their forehead and conduct a Weber test by means of the smartphone’s vibration application. The results were compared to the TFWT. Results: Twenty-six (43%) patients were diagnosed with a SNHL, and 34 (57%) with a CHL. The SPWT was in agreement with the TFWT (at a frequency of 512 Hz) in 55 (92%) patients. The sensitivity and specificity of the TFWT were 84.6 and 94.1%, respectively. The sensitivity and specificity of the SPWT were 76.9 and 97.1%, respectively. Conclusion: SPWT can serve as an auxiliary diagnostic tool in the absence of a 512-Hz tuning fork to assist in the identification of the type of HL and to potentially hasten the diagnosis and provision of treatment when indicated.

Objective: To compare the level of the inflammatory markers (IM) neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) among healthy subjects and those presenting with vestibular neuritis (VN). Methods: A cross-sectional retrospective study was conducted in a tertiary hospital setting. The medical records of patients (20–60 years old) who were hospitalized between the years 2005 and 2014 with the diagnosis of VN were retrieved. Inclusion criteria were: (1) acute vertigo lasting for at least 24 h, (2) absence of auditory complaints, (3) presence of horizontal unidirectional nystagmus during physical examination, (4) absence of neurological symptoms or signs. The levels of the IM were compared with levels reported among two large cohorts of healthy subjects, within the same age range. Results: A statistically significant difference was found between the levels of NLR in VN subjects compared with controls, with higher levels of NLR in VN subjects (p < 0.001), while no significant difference was found between both groups concerning the levels of PLR. Conclusion: Higher levels of IM were found among VN patients, with significantly higher levels of NLR, but not PLR. This may suggest a possible inflammatory etiology of VN.