Vocal Cord Melanosis: To Worry or Not to Worry?

Laryngeal Melanosis is a rare entity with unclear significance: whether it is a premalignant lesion for squamous cell carcinoma of the larynx or a sign of mucosal melanoma. In the few reported cases in the literature, it is descried as localised/diffused brownish discoloration of the mucosal surface of the involved subsite of the larynx. We hereby report a raised localised laryngeal melanosis of the vocal cord with an initial histopathology report of dysplasia.

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review

INTRODUCTION

Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis.

MATERIALS AND METHODS

A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes.

RESULTS

Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy.

DISCUSSION

Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.

Radiofrequency Ablation for Inferior Turbinate Hypertrophy: Predictive Factors for Short and Long-Term Outcomes

OBJECTIVES

Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated.

METHODS

A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use.

RESULTS

Study A: There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS -1.3, P < .001), trouble exercising (VAS -1.5, P < .001), trouble sleeping (VAS -0.9, P < .001), snoring (VAS -1.1, P< .001), and hyposmia (VAS -0.6, P = .004). Smoking (R² = .065, P = .047) was a predictor for less optimized and previous use of decongestive nasal spray (R² = .135, P = .005) for better short-term outcome. Study B: Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS -1.5, P < .001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P = .036). Allergy (R² = .066, P = .006), asthma (R² = .068, P = .005), and previous use of corticosteroid nasal spray (R² = .050, P = .016) were associated with a less optimized and older age (R² = .217, P < .001) with better long-term outcome.

CONCLUSION

RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome.

New-born Hearing Screening Programmes in 2020: CODEPEH Recommendations

Programmes for early detection of congenital hearing loss have been successfully implemented mainly in developed countries, after overcoming some conceptual errors argued against their implementation and some criticism of their efficacy. However, some difficulties and weaknesses are still identified in these programmes: the detection of late-onset hearing loss and the percentage of children who did not pass the screening and did not complete the process of diagnosis and treatment, these being cases that are lost in the process. The purpose of this Document is to analyse these problems to determine areas for improvement and to emphasize one of the basic principles for the success of the programmes: continuous training for the interdisciplinary team. The result of the review process carried out by CODEPEH has been drafted as Recommendations for updating the Programmes with the evidence of the last decade, including advances in screening technology, the impact of the present knowledge on congenital infection by cytomegalovirus, genetic hearing loss research and control systems of lost to follow-up cases, treatment and follow up.

Are ABO Blood Groups or Rh Antigen Perinatal Factors Affecting the Pass Rate of Transient Otoacoustic Emissions Screening Tests in Healthy Newborns during the First 48 h of Life?

Most hospitals recommend performing neonatal hearing screening. Transient evoked otoacoustic emission (TEOAE) tests represent an ideal technique for conducting this process. Previous studies have related the influence of ABO blood group and Rhesus antigens (Rh) on the susceptibility to various pathologies. However, available data about the potential relationship between ABO blood groups, Rh, and TEOAE pass rates are sparse. Recently, several authors concluded that O blood group and Rh+ are possible influential factors of TEOAE pass rates. Significantly different TEOAE amplitude response between the four main ABO blood groups were observed among normal-hearing individuals. Moreover, ABO blood groups were discussed as a possible influential factor for the development of noise-induced hearing loss later in life. The aim of this study was to investigate the relationship between ABO blood groups, Rh, and the first TEOAE pass rates in healthy newborns. Data were retrospectively collected from healthy newborns at the maternity ward of F. Borja hospital in Gandia (Spain). Rh and ABO were compared with the results of TEOAE performed within the first 48 h of life. Results: the study group included 2765 newborns. No significant correlation between ABO blood group or Rh and TEOAE pass rates was observed in comparative tables. Conclusion: ABO blood group and Rhesus antigens do not appear to have a significant impact on the pass rate of TEOAE screening in healthy newborns.

Human CTL-based functional analysis shows the reliability of a munc13-4 protein expression assay for FHL3 diagnosis

Familial hemophagocytic lymphohistiocytosis (FHL) is the major form of hereditary hemophagocytic lymphohistiocytosis (HLH); as such, it requires prompt and accurate diagnosis. We previously reported that FHL type 3 (FHL3) can be rapidly screened by detecting munc13-4 expression in platelets using flow cytometry; however, the reliability of the munc13-4 expression assay for FHL3 diagnosis is unclear. Regardless of the type of UNC13D mutation, all reported FHL3 cases examined for the munc13-4 protein showed significantly reduced expression. However, the translated munc13-4 protein of some reportedly disease-causing UNC13D missense variants has not been assessed in terms of expression or function; therefore, their clinical significance remains unclear. The aim of this study was to determine the reliability of a munc13-4 expression assay for screening FHL3. Between 2011 and 2016, 108 HLH patients were screened by this method in our laboratory, and all 15 FHL3 patients were diagnosed accurately. To further elucidate whether munc13-4 expression analysis can reliably identify FHL3 patients harboring missense mutations in UNC13D, we developed an alloantigen-specific cytotoxic T lymphocyte (CTL) line and a CTL line immortalized by Herpesvirus saimiri derived from FHL3 patients. We then performed a comprehensive functional analysis of UNC13D variants. Transient expression of UNC13D complementary DNA constructs in these cell lines enabled us to determine the pathogenicity of the reported UNC13D missense variants according to expression levels of their translated munc13-4 proteins. Taken together with previous findings, the results presented herein show that the munc13-4 protein expression assay is a reliable tool for FHL3 screening.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy

OBJECTIVE

To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored.

STUDY DESIGN

Prospective, single-group, pretest-posttest design.

SETTING

Academic tertiary care medical center.

SUBJECTS AND METHODS

This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility.

RESULTS

Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up.

CONCLUSIONS

The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.

Radiofrequency Thermal Ablation versus Bipolar Electrocautery for the Treatment of Inferior Turbinate Hypertrophy: Comparison of Efficacy and Postoperative Morbidity

Introduction Numerous surgical methods are used to treat nasal obstruction due to inferior turbinate hypertrophy. The primary goal of the therapy is to maximize the nasal airway for as extended a period of time as possible while minimizing therapeutic complications. Objectives The aim of this study was to assess the effects of radiofrequency thermal ablation (RFTA) and bipolar electrocautery (BEC) on the removal of nasal obstruction in patients with inferior turbinate hypertrophy and on nasal mucociliary clearance (MCC). Patients in both groups were also evaluated in terms of postoperative morbidity. Methods We compared the outcomes of two groups of patients: those treated with RFTA (n = 23) and those who underwent BEC (n = 20). Nasal obstruction was graded using a visual analog scale (VAS) and MCC was measured using a saccharin clearance test. Both measurements were performed before and 2 months after treatment. Results Pre- and postoperative VAS scores showed significant improvement for both groups. However, MCC results did not significantly differ between two groups. Neither edema nor crust formation persisted for more than 1 week in any patients. Conclusion Submucosal cauterization with preservation of the nasal mucosa and periosteum is as effective and safe as RFTA and should be considered when planning inferior turbinate interventions.

Auditory dyssynchrony or auditory neuropathy: understanding the pathophysiology and exploring methods of treatment

OBJECTIVE

To review the literature on auditory dyssynchrony (AD) or neuropathy which is characterized by absent auditory brainstem responses, normal otoacoustic emissions, and word discrimination disproportional to the pure tone audiogram.

RESULTS

Several papers attempt to estimate the prevalence of AD that seems to range between 0.23 and 2% in infants "at risk" for hearing impairment and it is considered to be responsible for approximately 8% of newly diagnosed cases of hearing loss in children per year. The prevalence gets even higher, reaching 10% in children with permanent hearing loss. It seems that AD is not a single disease but a spectrum of pathologies that affect the auditory pathway at the level of the inner hair cells, the synapses, or the auditory nerve. Many predisposing or contribution factors have been reported, including prematurity, hyperbilirubinemia, hypoxia, low-birth weight, immunological conditions, infectious diseases, etc. Before proposing any method of management, parents should be informed about the variation among patients and the changes that may appear in some children's audition over time. Sigh language, speech and language therapy, hearing-aids, and cochlear implantation have been used in the treatment of AD. In general, AD is rather refractory to conventional amplification and cochlear implantation has been found an effective method of management in young implanted children with severe/profound deafness and AD. However, the situation is more complicated and challenging in milder hearing losses.

CONCLUSION

The selected and proposed 30 related articles published in the International Journal of Pediatric Otorhinolaryngology aim to stimulate the related research in order to further explore the etiology, pathophysiology, and management of AD.

Prevalence of auditory neuropathy spectrum disorder in an auditory health care service

Auditory neuropathy spectrum disorder (ANSD) is characterized by impairment of the auditory nerve associated with preservation of outer hair cell function.

Objective

To establish the prevalence of ANSD in subjects with sensorineural hearing loss (SNHL).

Method

This retrospective study was carried out between 2010 and 2012 and included the charts of 2,292 individuals with SNHL. Data from otolaryngological and audiological examinations based on pure-tone and speech audiometry, impedance tests, otoacoustic emissions (OAEs), and brainstem auditory evoked potentials (BAEPs) were collected. Inclusion criteria: presence of OAEs and/or cochlear microphonic (CM); absent or altered BAEPs, and normal MRI scans of the brain.

Results

Twenty-seven (1.2%) of the 2,292 subjects with SNHL had ANSD (37% males; 63% females). Mild SNHL was seen in 29.6% of the individuals with ANSD; 55.5% had moderate SNHL; 7.4% had severe SNHL; and 7.5% had profound SNHL. In terms of age, 14.8% were aged between zero and 20 years, 44.1% were 41 to 60 years old, and 7.4% were above the age of 60.

Conclusion

ANSD was seen in 1.2% of the individuals with SNHL included in this study.

Laryngeal melanosis

OBJECTIVE

Laryngeal melanosis (LM) is an unusual condition. Little is known about its clinical significance. To learn more about this unusual disorder, we prospectively gathered data on a series of patients with LM and compared the data with the summarized findings from the cases currently available in the literature.

STUDY DESIGN

Case series with planned data collection.

SETTING

Two hundred fifty-five-bed urban indigent care hospital located on a university medical center campus. Subjects and Methods Demographics, history, examination findings, and concurrent head and neck disorders were prospectively recorded for all patients with LM who presented to our institution between 2005 and 2012.

RESULTS

Eighteen patients with laryngeal melanosis were enrolled. All patients are African American, and all have a history of chronic tobacco use. The most common presenting symptom was dysphonia, and examination most often revealed flat, pigmented lesions of the larynx. Nine patients (50%) had concomitant squamous cell carcinoma of the upper aerodigestive tract. There are 19 previous cases of laryngeal melanosis reported by 12 different authors, with a concomitant carcinoma rate of 26%. Our patients are similar in age and are all African American, with a greater percentage of women and greater rate of concomitant carcinoma. Our study represents the single largest case series of laryngeal melanosis and is more complete given the prospective nature of the data collection.

CONCLUSION

Laryngeal melanosis is an unusual disorder that is associated with chronic tobacco use. Clinicians should be aware of the association between laryngeal melanosis and squamous cell carcinoma and perform a thorough evaluation for concomitant carcinoma.

Are systemic voriconazole and caspofungin ototoxic? An experimental study with rats

Objectives

To determine whether systemic administration of voriconazole and caspofungin causes ototoxicity.

Methods

This study was conducted on 32 healthy male Wistar albino rats. The baseline auditory brainstem response (ABR) thresholds of all animals were obtained under general anesthesia. Then, the rats were randomly divided into 4 groups (groups I-IV), each group consisting of 8 rats. Rats in group I were injected intraperitoneally with voriconazole 10 mg/kg/day for 7 days, and the rats in the group II were injected intraperitoneally with caspofungin 5 mg/kg/day for 7 days. Group III received 120 mg/kg/day gentamicin for 7 days. Group IV received saline for 7 days. The animals were then observed for 7 days, and on 14th day of the trial, posttreatment ABRs of both ears were recorded.

Results

We did not find any significant differences between pretreatment and posttreatment median ABR thresholds in the voriconazole, caspofungin, or saline groups. In the gentamicin group, there was a statistically significant difference between pretreatment and posttreatment ABR thresholds.

Conclusion

Caspofungin and voriconazole did not change ABR thresholds in speech frequencies after a 7-day-period of their administration. We believe that further animal studies must be performed after administration of these agents for a longer time period, and these findings must be consolidated with histopathological investigations.

The performance of distortion product otoacoustic emissions and automated auditory brainstem response in the same ear of the babies in neonatal unit

OBJECTIVE

To identify the outcomes of hearing screening using different protocols of both Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR) tests in the same ear of the babies in a neonatal unit population.

METHODS

A cross-sectional study was carried out on babies who were admitted into a neonatal unit. By using a formula of single proportion and considering 20% drop out, the number of sample required was 114. The subjects were chosen by using a systematic random sampling. The infants selected were subjected to DPOAE followed by AABR tests screening at the same setting before discharge.

RESULTS

There were 73 newborns (61.6% male and 38.4% female) participated in this study with a total of 146 ears screened. Ototoxic medication was the most common risk factor followed by hyperbilirubinaemia and low birth weight. AABR had higher passing rate (82.9%) as compared to DPOAE (77.4%). The highest passing rate was achieved if the protocol of either passed DPOAE or AABR was used (90.4%). The rate was lower when auditory neuropathy spectrum disorder (ANSD) has been considered (82.9%). Hyperbilirubinaemia, prematurity, craniofacial malformation and ototoxic drugs seem to be the high risk factors for auditory neuropathy.

CONCLUSION

AABR has a higher passing rate as compared to DPOAE. However, the use of both instruments in the screening process especially in NICU will be useful to determine the infants with ANSD who may need different approach to management. Therefore, a protocol in which newborns are tested with AABR first and then followed by DPOAE on those who fail the AABR is recommended.

Fungal otomastoiditis: a case series in immunocompetent adults

Fungal otomastoiditis is a rare condition and is usually associated with host immunodeficiency. It is difficult to diagnose, and many cases are fatal. Treatment consists of surgical debridement, attempts to control the underlying immunological condition and antifungal chemotherapy. Individual case reports in immunocompetent patients have been published previously. We report a case series of seven with fungal otomastoiditis, all in immunocompetent patients.

Prevalence of auditory neuropathy (AN) among infants and young children with severe to profound hearing loss

Auditory neuropathy is a challenging disorder and needs special habilitative/rehabilitative approach. This study aimed to detect its prevalence among infants and young children with severe to profound hearing loss. 112 infants and young children with age ranged 6-32 months were examined and diagnosed as having severe to profound hearing loss and were referred for hearing aid fitting. Those infants were reassessed in our centers for detecting cases with auditory neuropathy. The study group was subjected to immittancemetry, behavioral observation audiometry, ABR and cochlear microphonics.

RESULTS

15 patients were found to have auditory neuropathy according to our criteria for diagnosis.

CONCLUSIONS

The prevalence of AN in the study group was 13.4%. CM were recommended to be tested routinely during ABR assessment whenever abnormal results are obtained.