Cochlear Implantation in a Patient with Granulomatosis with Polyangiitis

BACKGROUND

Granulomatosis with polyangiitis (GPA) otologic manifestations include conductive and sensorineural hearing loss (HL). Vasculitis is assumed to be the primary cause of otologic manifestations. Deaf patients and patients with HL who do not benefit from hearing aids can benefit from cochlear implants (CI). There are currently no specific guidelines for treatment of patients with GPA suited for CI.

OBJECTIVES

To assess whether patients who are deaf due to GPA are good candidates for CI and if prior surgical or medical treatment of the inflammation are needed.

METHODS

A case report is presented.

RESULTS

A 71-year-old female patient with GPA and bilateral profound HL underwent CI. Prior to CI, preparation consisted of audiological evaluations by an otolaryngologist and a rheumatologist, followed by a course of prednisone and methotrexate for middle ear and nasal inflammations. CI was performed with no complications. The speech reception threshold and the monosyllabic word discrimination score after surgery were 25 dBHL and 75%, respectively.

CONCLUSIONS

Inflammation due to GPA can be controlled medically with immunosuppressive medications without subtotal petrosectomy, as in chronic suppurative otitis media. Satisfactory audiological results can be expected.

The impact of birth weight and gestational age on acute mastoiditis in children

OBJECTIVE

Previous data correlate preterm and low birth weight (LBW) with acute otitis media, but there is a gap concerning the relations with acute mastoiditis (AM). This study investigates the effect of LBW and preterm birth on AM disease severity, neuro-otological complications, and recurrence.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary medical center.

METHODS

The cohort is retrospective in nature consisting of 294 children with AM admitted between 1999 and 2020. Data collection included: patient gestational age and birth weight, signs and symptoms, physical examination, laboratory tests, imaging findings, and long-term outcomes.

RESULTS

294 cases of AM were included, 41/281 (15%) had LBW (< 2500 g), and 46/294 (15.7%) were preterm (gestational age < 37 weeks). We found no significant differences in laboratory tests, imaging studies (CT), rate of mastoidectomy performed, or late complications between LBW and normal birth weight (NBW) and between preterm and normal gestational age children. LBW children tended to develop AM at an older age compared with NBW children, 2.28 + 1.64 Vs. 1.84 + 1.4 years, respectively (p-value = 0.016). Additionally, preterm children were more prone to develop a second event of AM, with a shorter interval between these episodes.

CONCLUSIONS

LBW and preterm birth are not independent risk factors for disease severity, need for intervention, or future complications in AM. Yet, LBW children present with AM at an older age, and preterm children are more prone for recurrent episodes of AM with a shorter interval between episodes suggesting a distinct disease course in these populations.

A Novel Device for the Evacuation of Cerumen

OBJECTIVES

The aim of this study was to assess a new device designed to safely remove cerumen from the external auditory canal in an office setting with minimal training.

METHODS

The research was conducted in the Department of Otolaryngology at Kaplan Medical Center in Israel. Patients with cerumen were treated with the device. Efficacy, safety, and pain were evaluated using scales developed for this experiment. The cerumen obstruction scale (0-5) was assessed before and after the procedure. Improvement by 2 or more grades was considered to indicate at successful procedure.

RESULTS

Fifty-nine ears in 46 patients were treated. Seventeen patients (37%) had recurrent cerumen impaction, and 14 (30.4%) used cotton swabs frequently. Fifty-two ears (88%) had hard cerumen. The procedure was successful in 51 ears (86.4%). In 48 ears (81%) there was no pain or mild pain, and in 11 ears (19%), the patient reported the procedure to be uncomfortable. Seven patients (15.2%) asked to abort the procedure because of discomfort or pain. In 39 ears (66%), the cerumen was evacuated easily. Inspection after the procedure revealed no injury in 56 ears (95%). Three ears (5%) had mild irritation of the ear canal, and none had injury to the tympanic membrane. Median length of the procedure was 30 ± 42.1 seconds (range, 2-240 seconds). The median number of insertions of the device in 1 procedure was 2 (range 1-7; SD, 1.3).

CONCLUSIONS

The tested device is an effective and safe device for the evacuation of cerumen. It can be used by general practitioners, pediatricians, and audiologists.

Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial

AIMS/HYPOTHESIS

Bariatric surgery is gaining acceptance as a 'metabolic surgical intervention' for patients with type 2 diabetes. The optimal form of surgery and the mechanism of action of these procedures are much debated. We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance.

METHODS

We performed a parallel un-blinded randomised trial of Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG) in 41 obese patients with type 2 diabetes, who were bariatric surgery candidates attending the obesity clinic. HbA1c, body composition and glucose tolerance were evaluated at baseline, and at 3 and 12 months.

RESULTS

Of the 41 patients, 37 completed the follow-up (19 RYGB, 18 SG). Both groups had similar baseline anthropometric and biochemical measures, and showed comparable weight loss and fat:fat-free mass ratio changes at 12 months. A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery (6.37 ± 0.71% vs 6.23 ± 0.69% for RYGB vs SG respectively, p < 0.001 in both groups for baseline vs follow-up).

CONCLUSIONS/INTERPRETATION

In this study, RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00667706.

FUNDING

This work was supported by grant no. 3-000-8480 from the Israel Ministry of Health Chief Scientist, the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson.