Journal of Otorhinolaryngology, Hearing and Balance Medicine

Obstructive sleep apnea (OSA) is a heterogenous disease process that cannot be adequately categorized by AHI alone. There is a significant prevalence of OSA in the general population with ongoing efforts to evaluate the risk factors contributing to OSA and its associated clinical implications. Only by improving our understanding of OSA can we advance our methods in the diagnosis and treatment of OSA. For this article, the authors reviewed keywords of obstructive sleep apnea diagnosis and therapy in the databases of Embase, Medline, and Medline ePub over the past 3 years, excluding any articles that only addressed sleep apnea in children under age 17 years. This review article is divided into three main sections. First, we will investigate the use of novel screening tools, biomarkers, anthropometric measurements, and novel wearable technologies that show promise in improving the diagnosis of OSA. There is mention of comorbid conditions seen in OSA patients since certain disease combinations can significantly worsen health and should raise our awareness to diagnose and manage those concomitant disorders. The second section will look at the current and developing treatment options for OSA. These include positive airway therapy (PAP), mandibular advancement device (MAD), exciting new findings in certain medications, orofacial myofunctional therapy (OMT), hypoglossal nerve stimulation therapy (HGNS), and other surgical options. We will conclude with a section reviewing the current Clinical Practice Guidelines for Diagnostic Testing in Adults with Obstructive Sleep Apnea from 2017, which strongly advises polysomnography (PSG) or home sleep apnea testing (HSAT), along with comprehensive sleep evaluation for uncomplicated patients with a clinical presentation of OSA. Full article

Introduction: The purpose of this study was to qualitatively explore the experiences of chronic dizziness diagnosis and management within the health care system. Methods: This qualitative phenomenological study used focus groups to interview a convenience sample of individuals with chronic dizziness (n = 13) and vestibular physical therapists (n = 15). Focus group data were systematically analyzed using a descriptive coding process. Results: Two major themes emerged from interviews with individuals with dizziness: (1.) complexities navigating the health system and (2.) loss of self-identity. Three major themes emerged from interviews with vestibular physical therapists: (1.) patients have a complex, multi-factorial presentation, (2.) importance of the multidisciplinary care team, and (3.) behavior influences outcomes. Individuals with chronic dizziness identified many challenges in effectively navigating the health system and receiving an effective diagnosis and management, including the patient–provider relationship, with negative impacts on quality of life. Vestibular physical therapist data concurred and validated these experiences. Conclusion: Given the complex, multi-factorial nature of dizziness, increased use of the biopsychosocial model in a multidisciplinary dizziness clinic may inform a more holistic approach for this patient population and improve future outcomes for individuals with chronic dizziness. Full article

Background: This study aimed to identify clinical characteristics and classifications of nasal septal deviations associated with revision septoplasty. Methods: The cross-sectional study design included 652 patients undergoing septoplasty at a tertiary referral center. We classified patients according to Baumann’s validated septal deviation classification and assessed similarities and differences regarding septal pathologies and types of nasal septal deviations in both groups. Results: The sample comprised 600 primary surgery cases and 52 revision cases. In primary surgeries, type 1 septal deviations were most common (60.3%), followed by type 5 (10.5%) and type 3 (10.0%). In revision surgeries, type 1 deviations (36.5%) were most common, followed by type 3 (25.0%) and type 2 (17.3%). Group comparisons revealed that type 2 and type 3 septal deviations, high septal deviations, and septal perforations were significantly more frequent in revision cases. Common septal pathologies included an oblique septum (98.0%), ipsilateral septal crest (76.4%), contralateral turbinal hyperplasia (42.5%), and vomeral spur (39.9%). Conclusions: This study suggests that using validated classification systems for septal deviations, which combine various pathologies, can provide a more clinically relevant assessment and improve patient counseling and treatment. Full article

Background: Ménière’s disease (MD) lacks a universally accepted pathogenesis model. Recent research has revisited the vascular hypothesis. This study aims to compare the cerebrovascular burden in patients with MD and age-matched controls, investigating the potential role of cerebrovascular dysfunction in MD. Methods: A total of 145 patients (70 MD, 75 controls) underwent magnetic resonance imaging (MRI) assessment for small-vessel disease (SVD) markers (including Fazekas and EPVS scores), cortical strokes, and baseline comorbidities. Statistical analyses were performed to compare the cerebrovascular burden between the groups, adjusting for potential confounders. Results: The MD group exhibited significantly higher mean SVD scores across various measures compared to controls (p < 0.05). This association persisted even after adjusting for age, sex, and comorbidities (ORs ranging from 1.746 to 2.495, p < 0.05). Neither the presence of cortical strokes nor comorbidities significantly differed between groups. Conclusions: This study is the first to compare cerebrovascular burden between MD patients and controls. The findings suggest that cerebrovascular dysfunction may contribute to MD incidence. Further research is needed to elucidate the relationship between cerebrovascular disease and MD, potentially leading to novel therapeutic avenues. Full article

Obstructive sleep apnea (OSA) is a prevalent pathology with current modalities of treatment including continuous positive airway pressure (CPAP), surgery, weight loss, hypoglossal nerve stimulation, and pharmacotherapy. While CPAP is the current standard treatment for OSA, lack of tolerance and side effects necessitate alternative modalities of treatment. Various pharmacologic agents exist with mechanisms that may target OSA. Early trials have demonstrated efficacy of noradrenergic-antimuscarinic combinations to stimulate the airway, promote pharyngeal muscle tone, and prevent airway collapse. These agents, which we discuss in detail, have demonstrated significant reductions in apnea-hypopnea index (AHI) and lowest oxygen saturations based on preliminary studies. Glucagon-like peptide 1 receptor agonists (GLP-1RA), which stimulate endogenous insulin, reducing glucagon release, and decreasing gastric emptying, have shown positive results for OSA patients through weight loss with reductions in AHI. In this narrative review article, we highlight the mechanisms, current data, and future potential for multiple drug classes, including respiratory stimulants and GLP-1RAs. Full article

Schwannoma is a neoplasm originating from cells surrounding and insulating axons in peripheral nerves. It usually presents benign behaviour with slow growth. A significant portion of cases occur in the head and neck region but rarely in the oral cavity, where the tongue is the most frequently affected organ. This article describes the case of a man presenting an asymptomatic mass on the dorsal aspect of the tongue that sought attention at the Integrated Therapies in Otorhinolaryngology Department of the Policlinico Campus Bio-Medico Foundation in Rome. After clinical and radiological examinations, the patient underwent surgical treatment under local anaesthesia. A literature search was conducted on PubMed and Google Scholar. Only complete case reports published in English from 1923 to 2023 were selected. A total of 183 cases were considered after the selection of relevant articles and the elimination of duplicates. The resulting data confirm that the most common presentation of this pathology consists of a painless mass in the oral tongue; usually, this lesion is removed surgically via a transoral approach, but different variations were described depending on the dimensions and position of the lesion. Full article

Ménière’s disease (MD) has an unclear cause. The microvascular dysregulation of the inner ear has been increasingly pointed out as a potential contributor. This study investigates the prevalence of cardiovascular risk factors (CVRFs) in MD patients compared to those with posterior circulation cerebral infarction (POCI). CVRFs like hypertension, diabetes, dyslipidemia, obesity, coronary heart disease, and smoking were assessed in both MD and POCI patients. Brain MRI identified POCI etiology as “small vessel occlusion” (SVO) or “other etiology” (OE). This study included 64 MD and 84 POCI patients. Compared to MD, POCI OE showed a higher prevalence of CVRFs across various age groups, including hypertension, diabetes, dyslipidemia, and smoking. Notably, the odds of having POCI OE were significantly higher for individuals with hypertension and smoking. On the other hand, POCI SVO showed a similar prevalence of CVRFs compared to MD. This study revealed no significant differences in CVRF prevalence between MD and smaller vessel POCI. However, a clear distinction emerged when comparing MD to POCI with the involvement of larger blood vessels. Further research is needed to confirm these findings and explore potential shared risk factors between POCI (SVO) and MD. Full article

Background: Obstructive sleep apnea (OSA) was associated with atrial fibrillation (AF) as well as the recurrence of AF after rhythm control strategy. However, the data on continuous positive airway pressure (CPAP) and recurrent AF after catheter ablation with pulmonary vein isolation (PVI) remain unclear. We conducted this systematic review and meta-analysis to evaluate the effect of CPAP treatment in OSA patients after atrial fibrillation ablation. Methods: We searched MEDLINE and Embase databases from inception to September 2023 to identify studies that assess the effect of CPAP in OSA patients on the recurrence of AF after PVI. Data from each study were combined using the random effects model. Results: Eight studies (one randomized controlled trial and seven cohort studies) with 1487 OSA patients (660 in the CPAP group and 827 in the control group) were included. The use of CPAP in OSA patients was associated with significantly lower AF recurrence after PVI (odds ratio (OR) = 0.36, 95% conference interval (CI) 0.25–0.53, p < 0.001). The results of sensitivity analysis remain the same as the main analysis. Conclusions: Our meta-analysis demonstrated that CPAP treatment was associated with lower rates of AF recurrence after PVI. Full article

Cochlear implantation is the therapy used for patients with severe to profound sensorineural hearing loss. For the success of the surgery, it is important that each surgical step is performed with meticulous precision, starting from the correct patient position on the operating table. In elderly or obese patients, this can be difficult to achieve due to cervical rigidity. With this technical note, we want to describe a new position from orthopedic surgery to perform a posterior tympanotomy accurately, ensuring a safe procedure and avoiding unpleasant complications. Full article

Objective: The primary objective of this research is to conduct a systematic review of the available studies and evidence to determine if there is a significant relationship between otosclerosis and psychiatric disorders. By critically evaluating the existing data, this study aims to provide insights into the potential interplay between these medical conditions. Data Sources: PubMed, Embase, Ebsco, Proquest, and Web of Science Review Methods: PubMed, Embase, Ebsco, Proquest, and Web of Science databases were queried for original English articles from 1950 to 2023. This review was conducted in accordance with the 2020 PRISMA guidelines. The publications were screened by two independent viewers. The Newcastle–Ottawa Scale quality instrument was used to assess the quality of studies. Results: Initially, 153 abstracts were screened for eligibility. After a rigorous selection process, five studies met the criteria, collectively encompassing 262 patients diagnosed with otosclerosis. The reported mean ages ranged from 25 to 52 years. A combined assessment of psychiatric disorder rates among otosclerosis patients revealed a rate of 36%. Depression, anxiety, and schizophrenia were the most common mental illnesses reported in all six studies. One of the studies specifically examined psychiatric disorder rates before and after stapedectomy, revealing a statistically significant decrease in depressive and anxiety-related symptoms following the surgical intervention. Conclusions: This systematic review emphasizes the emerging evidence connecting otosclerosis with psychiatric disorders and underscores the importance of adopting a multidisciplinary approach to assess and manage otosclerosis patients. Full article

The universal newborn hearing screening (NHS) program was implemented in Russia in 2008 to replace the high-risk newborn hearing screening. More than 95% coverage and significant improvement in early detection and intervention is achieved. Meanwhile, it was shown that current OAE-based hearing screening missed 13% of newborns with genetically ascertained hereditary sensorineural hearing loss (SNHL). The aim of the study is to assess the results of genetic investigation and NHS in a large cohort of Russian children with bilateral SNHL and to study the feasibility of implementation of combined hearing and genetic screening in Russia. Genetic, audiological and NHS data of 1292 pediatric patients with bilateral SNHL born in 2008–2021 were analyzed. GJB2 sequencing was performed for all subjects, 644 patients had pathological GJB2 genotype, 406 of them were homozygous for c.35delG variant. The group of 155 GJB2-negative patients were searched for other SNHL genes, The pathological genotypes were identified at 87 patients. The most frequent genes were STRC (21.8%), USH2A (16.1%), OTOF (8%) and SLC26A4 (6.9%). Children with confirmed genetic etiology passed NHS in 21% of cases. The perspectives of implementation of national comprehensive newborn hearing and genetic screening including whole exome sequencing technologies are discussed. Full article

Speech intelligibility is a concern for public health, especially in non-ideal listening conditions where listeners often listen to the target speech in the presence of background noise. With advances in technology, synthetic speech has been increasingly used in lieu of actual human voices in human–machine interfaces, such as public announcement systems, answering machines, virtual personal assistants, and GPS, to interact with users. However, previous studies showed that speech generated by computer speech synthesizers was often intrinsically less natural and intelligible than natural speech produced by human speakers. In terms of noise, listening to synthetic speech is challenging for listeners with normal hearing (NH), not to mention for hearing-impaired (HI) listeners. Recent developments in speech synthesis have significantly improved the naturalness of synthetic speech. In this study, the intelligibility of speech generated by commercial synthesizers from Google, Amazon, and Microsoft was evaluated by both NH and HI listeners in different noise conditions. Compared to a natural female voice as the baseline, listeners’ listening performance suggested that some of the synthetic speech was significantly more intelligible even at rather adverse listening conditions for the NH cohort. Further acoustical analyses revealed that elongated vowel sounds and reduced spectral tilt were primarily responsible for improved intelligibility for NH, but not for HI due to their impairment at high frequencies and possible cognitive decline associated with aging. Full article

This study aimed to compare the diagnostic efficacy of the Halmágyi–Curthoys head impulse (thrust) test and Romberg’s test in detecting vestibular hypofunctioning among two groups of 50 vertigo patients each; the two groups were randomly assigned. The assessment utilized the visual analog scale (VAS) to quantify subjective experiences of vertigo. The results revealed distinctive patterns in the detection of vestibular hypofunctioning, highlighting the strengths and limitations of each test. The Halmágyi–Curthoys head impulse test demonstrated utility in identifying vestibular hypofunctioning and its effect on vestibulo–ocular reflexes, particularly in cases with sudden head movements. Romberg’s test was useful in assessing postural instability in vestibular hypofunctioning due to defects in vestibulospinal reflexes. The integration of VAS scores provided valuable subjective insights into the patient experience. This comparative analysis contributes to a nuanced understanding of diagnostic tools for vestibular hypofunctioning in vertigo patients, offering clinicians valuable information for tailored assessments and interventions. Full article

Background: Body image is a potential psychological burden after total laryngectomy (TL) with devastating effects on patients’ health-related quality of life (HRQOL) and communication. This study focused on TL patients to determine the prevalence of dissatisfied body image and whether they have poorer HRQOL and difficulty adjusting to their new voice than TL patients with satisfied body image. It also aimed to investigate the potential predictors of body image. Methods: A multicenter cross-sectional study was conducted. For TL patients, the Body Image Scale (BIS), the European Organization for Research on Cancer Quality of Life Questionnaire, Core and Neck Module (EORTC QLQ C30 and EORCT H&N35), and the Self-Experiences of Communication after Laryngeal cancer (SECEL) were used. Patients were categorized as dissatisfied with their body image if the BIS score was ≥8. Multiple regression analysis was performed using the BIS as the dependent measure and HRQOL (QLQ C30 and H& N35) and communication (SECEL) as independent variables. Results: Overall, 31.3% of TL patients had dissatisfied body image, significantly worse HRQOL, and difficulty adjusting to their new voice than patients with satisfied body image. The regression model showed that social eating and socializing (H&N35) and adjustment to their new voice (SECEL) were independent predictors of body image. The model explained 52% of the variance. Conclusions: Screening TL patients at risk for body image concerns may help develop effective interventions to optimize HRQOL and patient communication. Full article

Implantation of two electrical stimulators of different cranial nerves in one patient is rare. We report the case of a forty-seven-year-old patient already implanted with a trigeminus nerve stimulator. In addition, this patient suffered from hearing problems. In one ear, the patient was deaf. On the other side, the patient wore a bone conduction hearing aid to improve hearing. In this complex situation, we decided to check the possibility of cochlear implantation on the deaf side. Finally, we managed to provide electrical stimulation of the auditory pathway of the deaf ear to improve the patient’s hearing tests. In addition, this case report shows how the trigeminus stimulator interferes with the electrical stimulation in auditory evoked potentials measurement of the auditory brainstem and cortex via EABR (evoked auditory brainstem response) resp. EALR (evoked auditory late response). Full article

Even if the management of parotid gland tumors depends on the histopathological subtype, preoperative imaging of parotid gland tumors is clinically relevant. Preoperative imaging gives insight into the differentiation between benign and malignant tumors, which might potentially decrease the number of unnecessary aggressive surgeries. Characteristic imaging findings on cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), can help narrow the differential diagnosis and guide the further management of patients presenting with parotid masses. While MRI is imperative for the determination of perineural spread, which is frequently encountered with malignant parotid tumors, CT is important for the evaluation of osseous invasion. Furthermore, multi-parametric MRI protocols provide insights into the tumor behavior and internal composition, which is helpful in the case of benign mixed tumors and others. While distant metastasis is uncommon with parotid neoplasms, PET/CT provides a valuable tool for the improved evaluation of loco-regional and distant metastatic disease. This article discusses the imaging features of common benign and malignant parotid tumors. Full article

Objective—The objective of this study was to systematically assess meta-analyses to determine the lacunae in the literature for PCF following laryngectomy. Methods—Bibliometric analysis were carried out on meta-analyses on PCF after total laryngectomy for laryngeal cancer in the PubMed database. Results—Twenty-four meta-analyses were considered eligible and chosen for analysis. Six meta-analyses (25%) focused on the risk factors for PCF in TL. Four meta-analyses (16.6%) focused on the role of the onlay flap. Four meta-analyses (16.6%) focused on the timing of feed initiation. Three meta-analyses (12.5%) focused on using a stapler for pharyngeal closure. Two meta-analyses focused on types of pharyngeal reconstruction. Other meta-analyses analyzed the use of salivary bypass tubes, the method of pharyngeal closure, organ preservation protocols on PCF, primary and secondary TEP, and the effect of non-surgical treatment on PCF. Conclusion—Despite plenty of published meta-analyses, there is a lack of scrutiny on certain critical aspects of PCF. Full article

Background: En block resection of squamous cell carcinoma (SCC) of the concha represents a reconstruction challenge, due to the complex topography and difficult access. Objective: The objective of the present paper is to describe the chemically assisted dissection (CADISS) of SCC originating in the auricular concha and the following reconstruction of the conchal cavity with a post-auricular island flap (PIF), taking care to minimize injury to the donor site. Methods: Twenty-six patients having a diagnosis of SCC of the auricular concha were included in the study. ‘En bloc’ removal of the tumor was accomplished, leaving the adjacent conchal cartilage attached to the tumor and using the CADISS technique to preserve the deep perichondrium. A PIF was used to repair the auricular conchal defect. Results: Flaps were normal at 10 days and at 1-month follow-up. No tumor recurrence was observed. No complications were observed. According to the SCAR scale, good aesthetic outcomes were achieved in all cases, both at the auricular concha and at the donor site. Conclusion: CADISS facilitates the complete removal of the tumor with the preservation of the surrounding normal tissues. A post-auricular island flap can be easily pulled through a post-auricular tunnel to repair the defect and the donor site can be closed primarily. Full article

Despite the evolution of hearing aids and cochlear implants, noisy environments are reportedly still an important hurdle for persons with hearing loss, especially in the process of speech recognition. The development of pre-processing algorithms and the pairing with a wireless device can bring relief to this situation, but it is still under scrutiny whether one or the other is more effective. The purpose of this study was to compare the benefits of speech recognition in a noisy environment by recipients of cochlear implants when using the pre-processing automatic algorithms or when using a wireless microphone. Twenty-nine participants were selected, aged 14 to 83, suffering from sensorineural hearing loss and recipients of cochlear implants for at least 6 months. The proprietary Cochlear Limited SCAN technology uses pre-processing algorithms to attenuate various noises; the wireless device MiniMic2 uses a 2.4 GHz connection to facilitate communications between the recipient and the signal source. Participants were asked to repeat 20 sentences randomly generated by the adaptive Italian Matrix Sentence Test, first while using the SCAN technology and then with the wireless MiniMic2. Both signal and noise were administered through a single loudspeaker set 1 m away from the subject. Significantly better results in speech recognition of noise were achieved with the wireless MiniMic2 when compared to the SCAN technology. Full article