Otolaryngology adverse events following COVID-19 vaccines

OBJECTIVE

Since the outbreak of COVID-19 pandemic, the international scientific community aimed at developing a vaccine to protect against the infection and prevent serious forms of the disease. To date, various adverse events of COVID-19 vaccines have been reported, mostly mild to moderate.

MATERIALS AND METHODS

In this short communication, we reviewed available literature and described the most frequent otolaryngology adverse events reported after COVID-19 vaccination.

RESULTS

The most frequent adverse events following COVID-19 vaccine described in the literature are represented by audiovestibular symptoms, such as tinnitus, sudden sensorineural hearing loss, vertigo, and dizziness. Other side effects include facial nerve palsy, epistaxis, and oral manifestations (lichen planus, bleeding, ulcers, and vesicles).

CONCLUSIONS

COVID-19 vaccine is of utmost importance in limiting the spread of SARS-CoV-2. Otolaryngology-related side effects have been described, but none was severe or life threatening. The mechanisms underlying these effects are still mostly unknown.

Drugs inducing hearing loss, tinnitus, dizziness and vertigo: an updated guide

OBJECTIVE

The awareness of audio-vestibular side effects of drugs, such as hearing loss, tinnitus, dizziness and vertigo, has widely increased in the recent years. The present guide represents an update of the previous documents published by the authors in 2005 and 2011 on drug-induced ototoxicity and vestibulotoxicity.

MATERIALS AND METHODS

The authors performed a comprehensive analysis of audio-vestibular side effects of commercially available drugs based on the British National Formulary, a pharmaceutical reference book that contains a wide range of useful information and advice on prescription and pharmacology.

RESULTS

Commercially available drugs and their active principles have been classified based on their audio-vestibular side effects, as reported by the pharmaceutical companies and/or health agencies. Drugs have been categorized based on the field of application, the therapeutic indication and the pharmacological properties.

CONCLUSIONS

General practitioners, otolaryngology, neurology and audiology specialists should be aware of possible audio-vestibular side effects of drugs, such as hearing loss, tinnitus, dizziness and vertigo. The present guide represents a practical tool to rapidly identify potential audio-vestibular side effects of drugs as reported by the pharmaceutical companies and/or health agencies.

Dietary Restriction for The Treatment of Meniere's Disease

Meniere's disease (MD) is an idiopathic inner ear disorder characterized by spontaneous recurrent vertigo, fluctuating sensorineural hearing loss (SNHL), aural fullness and tinnitus. Endolymphatic hydrops (EH) of the inner ear is currently considered the pathophysiological mechanisms that underlies typical symptoms of MD. MD diagnosis is based on the criteria of the Baràny Society. There are many therapeutic options for MD, but none is considered effective by the scientific community. The first-line treatment commonly includes dietary modification, as low salt diet and reduction of alcohol and caffeine daily intake. Although some studies showed a positive effect of these dietary restrictions, even in the prevention of recurrences, currently there is no uniform consensus on their usefulness. New dietary approach, such SPC-flakes, are being evaluated: further assessments will be needed to validate their use in clinical practice.

Correlation between otitis media with effusion and cranial deformation in children

OBJECTIVE

Otitis media with effusion (OME), defined as the presence of fluid in the ear without signs of an acute infection, usually occurs after acute otitis media and could result in reduced sound transmission with hearing loss. Several risk factors have been suggested to be associated with OME, as well as the relationships between morphology anomalies of cranial bones and ear infections. The aim of this study is to investigate the correlation between OME and cranial deformation in a pediatric population.

PATIENTS AND METHODS

Eighteen children (13 males and 5 females) with a diagnosis of unilateral OME based on otolaryngologic examination, conductive hearing loss and an asymmetric tympanogram type were enrolled in the study. Patients underwent osteopathic and physical examinations to evaluate the presence of cranial deformations.

RESULTS

Our study showed a high percentage of skull asymmetry (94%) in the study sample; children were mainly dolichocephalic and with atypical swallowing (72%). Particularly, we observed an occipital flattening, mainly ipsilateral to the ear affected by OME.

CONCLUSIONS

The results of the present study indicated that a high percentage of children with OME present a skull asymmetry with concomitant dolichocephaly, known to be associated with high arched palate which is also related to a higher incidence of OME.

Acquired sensorineural hearing loss in children: current research and therapeutic perspectives

The knowledge of mechanisms responsible for acquired sensorineural hearing loss in children, such as viral and bacterial infections, noise exposure, aminoglycoside and cisplatin ototoxicity, is increasing and progressively changing the clinical management of affected patients. Viral infections are by far the most relevant cause of acquired hearing loss, followed by aminoglycoside and platinum derivative ototoxicity; moreover, cochlear damage induced by noise overexposure, mainly in adolescents, is an emerging topic. Pharmacological approaches are still challenging to develop a truly effective cochlear protection; however, the use of steroids, antioxidants, antiviral drugs and other small molecules is encouraging for clinical practice. Most of evidence on the effectiveness of antioxidants is still limited to experimental models, while the use of corticosteroids and antiviral drugs has a wide correspondence in literature but with controversial safety. Future therapeutic perspectives include innovative strategies to transport drugs into the cochlea, such as molecules incorporated in nanoparticles that can be delivered to a specific target. Innovative approaches also include the gene therapy designed to compensate for abnormal genes or to make proteins by introducing genetic material into cells; finally, regenerative medicine (including stem cell approaches) may play a central role in the upcoming years in hearing preservation and restoration even if its role in the inner ear is still debated.

When alarm bells ring: emergency tinnitus

OBJECTIVE

The aim of this study is to develop a diagnostic-therapeutic algorithm for those suffering from tinnitus who seek emergency aid.

MATERIALS AND METHODS

A literature review has been performed on articles from the last 30 years.

RESULTS

It is important to activate medical or surgical diagnostic and therapeutic strategies, in order to safeguard and rehabilitate the various functions affected. Psychiatric comorbidity is the most frequent pathological condition of those with serious or catastrophic tinnitus. In these cases, mortality risk is linked to suicide, morbidity to tinnitus-correlated distress.

CONCLUSIONS

Tinnitus, mainly linked to loss of hearing, is a frequent symptom among the population at large. About 7% of those affected by tinnitus turn to their doctor to solve their problem, while between 0.5 and 2% request urgent medical assistance. Their cry for help may be the result of an acute onset of tinnitus or the rapid impairment of an already chronic condition. Tinnitus is not considered an urgent ear, nose and throat (ENT) condition by the Associazione Otorinolaringologi Ospedalieri Italiani (AOOI) [Italian Association of Hospital ENT], even though there are many pathological conditions, sometimes serious, associated with tinnitus and emergency action is necessary to reduce the risk of morbidity and mortality.

Modifications to a commercially available linear mass spectrometer for mass-resolved microscopy with the pixel imaging mass spectrometry (PImMS) camera

RATIONALE

Imaging mass spectrometry is a powerful analytical technique capable of accessing a large volume of spatially resolved, chemical data from two-dimensional samples. Probing the entire surface of a sample simultaneously requires a detector with high spatial and temporal resolutions, and the ability to observe events relating to different mass-to-charge ratios.

METHODS

A commercially available time-of-flight mass spectrometer, designed for matrix-assisted laser desorption/ionization (MALDI) analysis, was combined with the novel pixel imaging mass spectrometry (PImMS) camera in order to perform multi-mass, microscope-mode imaging experiments. A number of minor modifications were made to the spectrometer hardware and ion optics so that spatial imaging was achieved for a number of small molecules.

RESULTS

It was shown that a peak width of Δm50 %  <  1  m/z unit across the range 200 ≤ m/z  ≤  800 can be obtained while also achieving an optimum spatial resolution of 25 µm. It was further shown that these data were obtained simultaneously for all analytes present without the need to scan the experimental parameters.

CONCLUSIONS

This work demonstrates the capability of multi-mass, microscope-mode imaging to reduce the acquisition time of spatially distributed analytes such as multi-arrays or biological tissue sections. It also shows that such an instrument can be commissioned by effecting relatively minor modifications to a conventional commercial machine.

Deafness in Italy: an epidemiological and socio-demographic study

OBJECTIVES

Hearing loss is very common in our society, but epidemiological data on deafness in Italy is lacking. A.I.R.S. onlus (Italian Association for Research on Deafness) yearly launches the National Day for the Fight Against Deafness (NDFAD). During this events, that are held every year, it is possible to perform a free hearing test in all the facilities that have joined the initiative throughout Italy (240 hospitals joined in 2011).

AIM

to report data collected throughout the "A.I.R.S. National Day for the Fight against Deafness" of the last years, focusing in particular but not only on audiometric outcomes.

METHODS

demographic and social data, as well as audiometric outcomes, was collected on forms that have been subsequently stored in a on-line database and analyzed with MySQL and Microsoft Excel.

CONCLUSIONS

This data are important in order to describe the "hearing health" of the Italian population, and is a first step towards creating a database with epidemiological and preventive aims, a strongly felt need both at national and at regional level.

Vogt-Koyanagi-Harada syndrome

OBJECTIVES

The objectives of this study are to review our current knowledge of the aetiopathogenesis of Vogt-Koyanagi-Harada syndrome, including viral infection, genetic factors and immunomediated mechanisms, and to discuss pathogenesis and its relevance to pharmacotherapy.

SYSTEMATIC REVIEW METHODOLOGY

Relevant publications from 1965 to 2012 on the aetiopathogenesis and pharmacotherapy of VKHS were analysed.

RESULTS AND CONCLUSION

Vogt-Koyanagi-Harada syndrome (VKHS) is a rare multisystemic autoimmune disease that affects tissues containing melanin, including the eye, inner ear, meninges, and skin. The disease is characterised by bilateral uveitis associated with a varying constellation of auditory, neurological and cutaneous manifestations. The disease occurs more frequently among people with darker skin pigmentation. Asians, Native Americans, and Hispanics are most frequently affected. It predominates in patients aged between 20 and 50years, and females are affected more frequently, with a female:male ratio of 2:1. The classic clinical course is characterised by bilateral panuveitis, hypoacusis, and meningitis, in addition to cutaneous involvement with poliosis, vitiligo, and alopecia. Although the exact cause of VKH disease remains unknown, it is thought to be a T-cell-mediated autoimmune process directed against melanocytes. VKHS classically begins with vague systemic symptoms suggestive of a viral infection, although a clear association between a specific viral agent and the disease has not been established. Genetic factors may play an important role in the loss of self-tolerance in VKHS. The HLA-DRB1*0405 allele is the main susceptibility allele for VKHS. Early and aggressive systemic corticosteroids are still the primary initial therapy for VKHS. Ocular complications may require an intravitreous injection of corticosteroids. Despite proper treatment with steroids, a number of patients experience recurrent attacks or steroid-associated complications. Thus, non steroid immunomodulatory therapy (IMT) has become necessary for the treatment of VKHS.

Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide

The present work on drug-induced ototoxicity, tinnitus and vertigo represents the update and revision of a previous guide to adverse drug reactions for italian physicians (2005). The panorama of drug-induced side effects causing ototoxicity or symptoms such as tinnitus or dizziness and vertigo has enlarged in recent years, thanks to a better knowledge and a more specific attention of pharmaceutical firms and drug-control institutions. In daily clinical practice, there is a need for the family physician and the ENT specialist or audiologist (also in consideration of the possible medico-legal implications) to focus the attention on the possible risk of otological side effects. This would allow a clinical risk-benefit evaluation, weighing the possible clinical advantage in their field of competence against possible otological side-effects. The list of active ingredients and drugs is subdivided in categories based on their audiological and otoneurological side-effects, that have been signaled by the drug companies and/or ministerial notes. Drugs have also been subcategorized with regards to the field in which they are applied, the therapeutic indications and the clinical behaviour. They have also been organized in alphabetical order, for an easier consultation. The guide above, even if initially conceived for being used in Italy, also presents a more general and international interest, expecially as for as the concepts of pharmacology and the features of the active ingredients are concerned. The guide is, therefore, useful as for as we are concerned to any physician, regardless of the country he/she operates in.

Characterization study of an intensified complementary metal-oxide-semiconductor active pixel sensor

An intensified CMOS active pixel sensor (APS) has been constructed for operation in low-light-level applications: a high-gain, fast-light decay image intensifier has been coupled via a fiber optic stud to a prototype "VANILLA" APS, developed by the UK based MI3 consortium. The sensor is capable of high frame rates and sparse readout. This paper presents a study of the performance parameters of the intensified VANILLA APS system over a range of image intensifier gain levels when uniformly illuminated with 520 nm green light. Mean-variance analysis shows the APS saturating around 3050 Digital Units (DU), with the maximum variance increasing with increasing image intensifier gain. The system's quantum efficiency varies in an exponential manner from 260 at an intensifier gain of 7.45 × 10(3) to 1.6 at a gain of 3.93 × 10(1). The usable dynamic range of the system is 60 dB for intensifier gains below 1.8 × 10(3), dropping to around 40 dB at high gains. The conclusion is that the system shows suitability for the desired application.

Towards Imaging with Polycrystalline Mercuric Iodide Semiconductor Detectors

Preparation of polycrystalline mercuric iodide very thin (1 μm) films using laser ablation and thick films (100–600μm), using hot pressing, hot wall vapor deposition and screen printing methods, fabricated as radiation detector plates are briefly described. X-ray diffraction, photoluminescence and optical microscopic measurements as well as response to nuclear radiation will be given. Finally, recent results obtained with a large area imaging pixel detector will be shown.

Dynamic position and force measurement for multiple optically trapped particles using a high-speed active pixel sensor

A high frame rate active pixel sensor designed to track the position of up to six optically trapped objects simultaneously within the field of view of a microscope is described. The sensor comprises 520 x 520 pixels from which a flexible arrangement of six independent regions of interest is accessed at a rate of up to 20 kHz, providing the capability to measure motion in multiple micron scale objects to nanometer accuracy. The combined control of both the sensor and optical traps is performed using unique, dedicated electronics (a field programmable gate array). The ability of the sensor to measure the dynamic position and the forces between six optically trapped spheres, down to femtonewton level, is demonstrated paving the way for application in the physical and life sciences.

Experimental observation of the improvement in MTF from backthinning a CMOS direct electron detector

The advantages of backthinning monolithic active pixel sensors (MAPS) based on complementary metal oxide semiconductor (CMOS) direct electron detectors for electron microscopy have been discussed previously; they include better spatial resolution (modulation transfer function or MTF) and efficiency at all spatial frequencies (detective quantum efficiency or DQE). It was suggested that a 'thin' CMOS detector would have the most outstanding properties [1-3] because of a reduction in the proportion of backscattered electrons. In this paper we show, theoretically (using Monte Carlo simulations of electron trajectories) and experimentally that this is indeed the case. The modulation transfer functions of prototype backthinned CMOS direct electron detectors have been measured at 300keV. At zero spatial frequency, in non-backthinned 700-mum-thick detectors, the backscattered component makes up over 40% of the total signal but, by backthinning to 100, 50 or 35mum, this can be reduced to 25%, 15% and 10%, respectively. For the 35mum backthinned detector, this reduction in backscatter increases the MTF by 40% for spatial frequencies between 0.1 and 1.0 Nyquist. As discussed in the main text, reducing backscattering in backthinned detectors should also improve DQE.

Enhanced imaging in low dose electron microscopy using electron counting

We compare the direct electron imaging performance at 120keV of a monolithic active pixel sensor (MAPS) operated in a conventional integrating mode with the performance obtained when operated in a single event counting mode. For the combination of sensor and incident electron energy used here, we propose a heuristic approach with which to process the single event images in which each event is renormalised to have an integrated weight of unity. Using this approach we find enhancements in the Nyquist frequency modulation transfer function (MTF) and detective quantum efficiency (DQE) over the corresponding integrating mode values by factors of 8 and 3, respectively.

Empirical electro-optical and x-ray performance evaluation of CMOS active pixels sensor for low dose, high resolution x-ray medical imaging

Monolithic complementary metal oxide semiconductor (CMOS) active pixel sensors with high performance have gained attention in the last few years in many scientific and space applications. In order to evaluate the increasing capabilities of this technology, in particular where low dose high resolution x-ray medical imaging is required, critical electro-optical and physical x-ray performance evaluation was determined. The electro-optical performance includes read noise, full well capacity, interacting quantum efficiency, and pixels cross talk. The x-ray performance, including x-ray sensitivity, modulation transfer function, noise power spectrum, and detection quantum efficiency, has been evaluated in the mammographic energy range. The sensor is a 525 x 525 standard three transistor CMOS active pixel sensor array with more than 75% fill factor and 25 x 25 microm pixel pitch. Reading at 10 f/s, it is found that the sensor has 114 electrons total additive noise, 10(5) electrons full well capacity with shot noise limited operation, and 34% interacting quantum efficiency at 530 nm. Two different structured CsI:Tl phosphors with thickness 95 and 115 microm, respectively, have been optically coupled via a fiber optic plate to the array resulting in two different system configurations. The sensitivity of the two different system configurations was 43 and 47 electrons per x-ray incident on the sensor. The MTF at 10% of the two different system configurations was 9.5 and 9 cycles/mm with detective quantum efficiency of 0.45 and 0.48, respectively, close to zero frequency at approximately 0.44 microC/kg (1.72 mR) detector entrance exposure. The detector was quantum limited at low spatial frequencies and its performance was comparable with high resolution a: Si and charge coupled device based x-ray imagers. The detector also demonstrates almost an order of magnitude lower noise than active matrix flat panel imagers. The results suggest that CMOS active pixel sensors when coupled to structured CsI:Tl can be used for conventional and advanced digital mammography due to their low noise, high resolution performance.

End-user survey for digital sensor characteristics: a pilot questionnaire study

OBJECTIVE

To survey end-user opinions on dental digital sensor characteristics for the design of a new X-ray imaging sensor.

MATERIALS AND METHODS

100 questionnaires were sent out to dentists and dental radiologists. The questionnaire consisted of six parts related to dental sensors. A: Details about the respondent; B: Prioritization of most important aspects of digital sensors; C: Rating advantages and D: disadvantages of digital sensors; F: Dental features that need to be enhanced by digital sensors; G: End-user comments.

RESULTS

Fifty-six questionnaires were returned. Contrast resolution and imaging time were assessed as the most and the least important aspects, respectively. Aspects considered as advantages by approximately 80% of respondents were: optimal contrast resolution, increased specificity, increased discrimination between diseased and healthy tissue, increased sensitivity, lower dose to the patient by more than 20%; as a disadvantage, increased patient dose was given. Dental features considered important by over 80% of the respondents were for intraoral radiographs: the visibility of caries, periapical, periodontal, and bone lesions; for panoramic radiographs: reduction of ghost images, image sharpness and bone. Bone and soft tissues on cephalograms and bone on temporomandibular joint (TMJ) tomograms were mentioned by over 70%.

CONCLUSION

The most desired characteristic for a new sensor is contrast resolution. Dose saving is not considered as important unless it is more than 20%. Examination time is not a major issue. Caries, periapical and periodontal, and bone lesions for intraoral radiographs, reduction of ghost images, image sharpness and bone for panoramic radiographs were the most frequently mentioned dental features that should be enhanced by digital sensors.

[An updated guide on drugs inducing ototoxicity, tinnitus and vertigo]

The argument of the iatrogenic side effects of pharmacological origin that can cause ototoxic effects or only disacustic symptoms like the tinnitus, without consequent degenerative effects, is enlarged in these last years. It is because of the great knowledge based on the careful attention from the pharmaceutical institutions which are responsible for the control of medicines and drugs. In the medical practice and in that specialty field born the need to gather, also in consideration of the possible medico-legal implications, those elements which will suppose the risk of otologic side effects. This will allow the physicians to evaluate the possible clinical advantage of a treatment, in their own field of competence, balancing them with their possible side effects in the otologic field. For this purpose, we have elaborated some updated lists of drugs with possible side effects of ototoxicity, tinnitus and vertigo; furthermore, we considered these drugs as could theoretically have influence on the auditory neurochemical progressing since they have excitatory or inhibitory action on the neurotransmitters and their receptors, but not signaled by the sources of institutional information.

DPOAE modifications induced by pure tone overstimulation in guinea pigs

Distortion Product Otoacoustic Emissions (DPOAEs) shows a vulnerability to acoustic overstimulation that is easily detectable by changes in amplitude, frequency distribution and time course. The frequency-specific changes in DPOAE provide more information than the more general changes in click evoked otoacoustic emissions. In this work five anesthetized guinea pigs were examined for changes DPOAE after exposure to pure tones. The noise was a 110 dB SPL pure tones for 45 minutes and the fatiguing tone centered on the geometric mean (GM) of primaries or 2/3 of GM. The most measurable effects were obtained in the latter conditions. The main DP level reduction lasts about one hour after exposure, but the complete recovery is observable only after 24 hours. The frequency distribution of fatiguing effects on the DP- audiogram shows a remarkable fine tuning and a pattern like a low-pass filter. After four hours, in one guinea pig, it is observable an enhancement of the DP amplitude, compared to the pre-exposure level; in another guinea pig, a second overstimulation produced a more extensive and time-lasting effects than the first exposure.

Functional results of sub-total laryngectomy

Sub-total laryngectomy (crico-hyoido-pexy and crico-hyoido-epiglotto-pexi), while achieving a radical oncological control results in a functional neolarynx efficacious in swallowing as well as in phonatory activities. 102 out of the 122 patients, treated with sub-total laryngectomy, underwent functional evaluations: the results appear to be extremely variable within each group. A better performance in crico-hyoido-epiglotto-pexi (CHEP) rather than in crico-hyoido-pexi (CHP) has been observed in these patients. However, a good life quality and social rehabilitation was assured to patients in both cases.

[Comments on organization and activity of ENT day hospital department: three years of experience]

The authors deal with organizational and technical aspects concerning otorhinolaryngological day hospital's management. They explain purposes and reasons leading to the establishment of this sort of service; they analyse related problems and the adopted methodologies for simplifying admission procedures. They report a statistical survey regarding the period from May 1991 to May 1994, concerning surgical and medical operations, and instrumental diagnostic researches performed at the IV ENT Department of "La Sapienza" University of Rome. The statistical analysis concerning the 1526 patients sent to this department, shows the downright prevalence of surgical operations performed in operating room (52%). Ambulatory operations and instrumental diagnostic researches account respectively for 39.6% and for 29.3% of all hospitalizations. Among all surgery operations performed in operating room stand out the notice incidence of therapeutical and diagnostic microlaryngoscopies. The most frequent ambulatory operations were the removal of tracheal cannula (21%), while TC was the most frequent of all instrumental diagnostic researches. A careful selection of patients, on the basis of their general condiction, account for the low incidence of subjects not discharged within 24 hours. After having analyzed the survey's data, the authors underline advantages and finalities of day hospital: a shorter hospital stay, reduction of hospitalization's costs, and a larger related number of patients to be contented. Finally they hope that this sort of service will spread more.

Suppression tuning characteristics of 2f1-f2 distortion product otoacoustic emissions

The 2f1-f2 distortion product otoacoustic emission (DPOAE) is suppressed by a third tone following a frequency selective pattern and outlining tuning curves which are generally similar to neural and psychophysical findings. The most effective suppressor tone lies between f1 and f2; less suppressive effects are produced by an added tone that lies in the 2f1-f2 site. The slope of iso-suppression curves is much steeper on the higher flank than on the lower flank of the suppression curve (respectively 100-115 dB/octave and 25-35 dB/octave). A suppression fine structure can be observed in the region of the tip especially for higher DPs probably connected with the fine structure of distortion products and with the instability of cochlear activity. A saturation point, around 70 dB or more has been evidenced on the growth rate functions. Continuous and interrupted suppressor presentation can induce some differences in the responses. Suppression of DPOAEs can provide a wider knowledge on active non-linear mechanisms in the cochlea, and on frequency selectivity also in a clinical context.

Comparative efficacy of cefotetan and clindamycin plus amikacin as antimicrobial prophylaxis for major head and neck surgery

A total of 41 patients were randomly allocated to receive either cefotetan (total dose, 20 g) or clindamycin (total dose, 12 g) plus amikacin (total dose, 5 g) as perioperative antimicrobial prophylaxis for major head and neck surgery. The two groups were similar in age, male to female ratio, stage of cancer, and the various types of surgery. No patient received radiotherapy or chemotherapy before surgery. The wound infection rate was 4% in the group of patients receiving cefotetan and 0% in the group receiving clindamycin plus amikacin. No major side effects were observed in either group. On the basis of this study a five-day perioperative course with cefotetan may be considered effective antimicrobial prophylaxis in patients undergoing major head and neck oncologic surgery.