<i>Background and Objectives:</i> Although numerous studies have explored various predictors of positive airway pressure (PAP) adherence, the potential impact of objective sleep scoring data obtained during PAP titration on adherence has not been thoroughly investigated. The objective of this study was to evaluate the association between objective sleep parameters obtained from PAP titration, including sleep efficiency (SE), wake after sleep onset (WASO), and sleep latency (SL), and short-term PAP adherence in individuals with obstructive sleep apnea (OSA). <i>Materials and Methods:</i> A total of 227 individuals with a confirmed diagnosis of OSA underwent overnight PAP titration and were subsequently divided into adherence and non-adherence groups. Baseline demographic characteristics, clinical data, diagnostic polysomnography results, and PAP titration data were obtained for all subjects. Paired sample <i>t</i>-tests were utilized to assess differences in sleep parameters between diagnostic polysomnography and PAP titration within each group. Binomial logistic regression was used to evaluate the predictive value of changes in SE, WASO, and SL for PAP adherence and to determine optimal cut-off values. A χ<sup>2</sup> analysis was conducted to assess the relationship between categorical improvements in SE and WASO and adherence to PAP therapy. <i>Results:</i> Among the study cohort, 176 (77.5%) participants were classified as adherent, while 51 (22.5%) participants were classified as non-adherent. SE during PAP titration (83.3 ± 12.6%) was significantly higher compared to baseline polysomnography (80.9 ± 12.4%, <i>p</i> = 0.020), and WASO was significantly reduced (63.9 ± 58.9 min vs. 77.7 ± 67.2 min, <i>p</i> = 0.016). No significant difference was observed in SL between the two groups. Logistic regression analysis indicated that increased SE (odds ratio [OR]: 1.025, <i>p</i> = 0.039) and decreased WASO (OR: 0.994, <i>p</i> = 0.027) both served as significant predictors of PAP adherence, but the overall predictive ability of these indicators was modest (area under the curve 0.60 for SE; 0.62 for WASO). The optimal thresholds distinguishing adherence were ΔSE ≥ 2.39% and ΔWASO < −1.5 min. Participants who exhibited improvements in SE (χ<sup>2</sup> = 5.296, <i>p</i> = 0.021) and WASO (χ<sup>2</sup> = 6.877, <i>p</i> = 0.009) demonstrated a significantly higher likelihood of adhering to PAP therapy. <i>Conclusions:</i> The findings demonstrate that objective increases in sleep quality, specifically elevated SE and decreased WASO during initial PAP titration, are significantly associated with short-term PAP adherence among patients with OSA.
Diabetes mellitus (DM) has been suggested as a potential risk factor for tinnitus, but evidence remains inconclusive. This meta-analysis aimed to evaluate the association between DM and tinnitus by systematically reviewing and synthesizing data from observational studies. A comprehensive literature search was conducted in PubMed, Embase, and Web of Science up to August 16, 2024. Observational studies with a sample size of at least 100 participants that assessed the relationship between DM and tinnitus were included. Studies involving populations with specific diseases were excluded. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and sensitivity and subgroup analyses were performed. Publication bias was evaluated using funnel plots and Egger’s regression test. Twelve studies comprising 2,277,719 participants were included. The pooled analysis revealed a significant association between DM and tinnitus (OR: 1.18, 95% CI: 1.06–1.31, P = 0.002), with moderate heterogeneity (I² = 51%). Sensitivity analyses confirmed the robustness of these findings. Subgroup analyses showed no significant differences by geographical region, mean age, sex distribution, tinnitus diagnosis method, or model used for association estimation. Publication bias was not detected (Egger’s test P = 0.29). These findings suggest that DM is significantly associated with an increased risk of tinnitus. Further research is warranted to explore underlying mechanisms and causal relationships. Nonetheless, the results underscore the importance of monitoring tinnitus in patients with diabetes.
Özlem Konukseven, Yeter Saçlı, Ayşenur Küçük Ceyhan
Objective: Despite the many medical problems arising from sleep disturbances, few studies have been conducted on vestibular disorders. In this study, we aimed to investigate the relationship between dizziness, sleep quality, severity of insomnia and duration of sleep, in young adults with dizziness.
Methods: Forty-nine individuals aged 20-40 years, with normal hearing and complaints of dizziness with an unknown origin were included. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Dizziness Handicap Inventory (DHI) were used.
Results: There was a very strong positive correlation between the PSQI and the ISI (r=0.838, p<0.001). Strong positive correlations were observed between PSQI and the total DHI scores (r=0.660, p<0.001), as well as between ISI and DHI scores (r=0.673, p<0.001). In addition, both PSQI and ISI showed strong positive correlations with the physical subscale of the DHI (r=0.673 and r=0.662, respectively; p<0.001 for both). A significant positive correlation was also found between the daytime dysfunction component of the PSQI and the total DHI score (r=0.640, p<0.001). Moreover, sleep duration was moderately and negatively correlated with the emotional subscale of the DHI (r=-0.454, p=0.001), indicating that shorter sleep duration was associated with greater emotional impairment related to dizziness.
Conclusion: Our study showed a high correlation between sleep quality, insomnia severity and dizziness in young adults with dizziness. With inventory, clinicians can contribute to improving people’s quality of life by detecting dizziness associated with sleep disorders.
Alireza Zonnour, Reza Shahnazar, Abolfazl Jamshidi
et al.
Abstract Objective To identify the prevalence of cranial nerve (CN) palsy and its associated factors in malignant otitis externa (MOE). Methods In a retrospective study, records of MOE patients from 2011 to 2014 were reviewed. MOE and CN involvement were evaluated based on patient demographics, clinical, and paraclinical data. Results Overall, 119 MOE patients with a mean age of 65.9 ± 11.3 were included. 69.7% were male, and 63.0% had a history of diabetes. The most common symptoms and signs were otalgia (97.5%), otorrhea (44.5%), and ear canal erythema/edema (24.4%). Thirty‐three patients (27.7%) had CN involvement. The facial nerve was mostly involved (26.1%). Skull base osteomyelitis (SBO) was present in 59 patients. When excluding patients younger than 30 and older than 80, age decade was correlated with CN palsy. 66.9% of patients with CN palsy and 65.6% without CN palsy were male, which was significantly different. The following factors were not significantly different between patients with and without CN palsy: Comorbidities, signs and symptoms, diagnostic delay, erythrocyte sedimentation rate level, fasting blood sugar, hemoglobin A1c level, antifungal therapy, hospitalization duration, and SBO on imaging. Tinnitus was correlated with SBO evidence on imaging (specificity: 96.7%). Conclusion CN involvement occurs in about three out of 10 MOE patients. Male gender and advanced age may be related to a higher incidence rate of CN palsy. Tinnitus can be a specific indicator of SBO. These findings could help in better decision‐making for early interventions. Level of Evidence 4.
Abstract Purpose Hypoxia is a common feature of laryngocarcinoma. Alterations in lipid metabolism are an important metabolic rewiring phenomenon for malignant cells to maintain their rapid proliferation in the hypoxic microenvironment, which makes most cancers, including laryngocarcinoma, difficult to cure. However, the mechanisms involved in lipid metabolism in laryngocarcinoma is still unclear. This study aimed to clarify the changes in lipid metabolism of laryngocarcinoma cells under hypoxic conditions and explore the related mechanisms. Methods Hep2 cells were incubated in a normoxic or hypoxic environment (5% CO2 and 1% O2) at 37 °C for 24 h. CCK-8 cell viability assay and colony formation assay were performed to detect cells proliferation. And lipid metabolic indices including TG and NEFA were determined by kits. The mechanism involved in the regulation of lipid metabolism was explored by RNA-seq and bioinformatic analysis. The MIF inhibitor ISO-1 and JAK inhibitor XL019 were used to verify the mechanism. Finally, a tumour xenograft model was applied to further verify these results in vivo. Results Hypoxia promoted cell proliferation and increased the levels of TG and NEFA in Hep2 cells. Three genes, MIF, ENO2, and LDHA, that were screened by the intersection of hypoxia gene sets and fatty gene sets and were verified by qPCR. The MIF levels were elevated when cells were exposed to hypoxia. Through GSEA and RNA-seq analysis, the JAK/STAT pathway was screened. Hypoxia increased MIF levels and activated the IL-6/JAK/STAT pathway. The MIF inhibitor ISO-1inhibited cell proliferation under hypoxia and reversed the change in TG levels and IL-6 levels. And ISO-1 reversed the expression pattern of the screened genes in the JAK/STAT pathway. Finally, a tumour xenograft model further verified these results in vivo. Conclusion Hypoxia induced reprogramming of lipid metabolism in laryngocarcinoma cells through the MIF/IL-6/JAK-STAT pathway. This study revealed one mechanism that allows laryngocarcinoma cells to adapt to the hypoxic tumour microenvironment. Therefore, a drug targeting the MIF/IL-6/JAK-STAT pathway might be a promising therapeutic option for the treatment of laryngocarcinoma.
Julian Künzel, Moritz Brandenstein, Florian Zeman
et al.
Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.
Gregory J. Basura, Joshua D. Smith, Susan Ellsperman
et al.
Abstract Hypothesis Squamous cell carcinomas (SCC) of the external auditory canal (EAC) may harbor unique genomic alterations that may explain aggressive behavior and differentiate these tumors from cutaneous SCCs of other subsites. Background EAC SCCs arise in a non‐ultraviolet‐exposed region of the head and neck, are often locally aggressive and may metastasize to lymph nodes or distant sites. The genomic alterations underlying cutaneous SCC of other sites are well‐documented; however, mutational profiles of EAC SCC are less well characterized and may contribute to the unique anatomic site, high rates of recurrence and tumor spread. We performed targeted sequencing of a cohort of primary EAC SCCs to identify recurring and potentially targetable genomic alterations. Methods Genomic DNA was extracted from formalin‐fixed paraffin‐embedded specimens of 7 EAC SCCs and subjected to targeted DNA sequencing using a 227‐gene panel. Somatic alterations and gene copy number alterations were annotated using our validated, in‐house bioinformatics pipelines. Results In our EAC SCCs, we found recurrent alterations in TP53 and genes of receptor tyrosine kinase (eg, EGFR, FGFR) and PI3K pathways (eg, PIK3CA), similar to cutaneous SCCs of other head and neck sites. We also observed a high frequency of telomerase reverse transcriptase amplification and DNA methyltransferase 1 alterations, both of which are rarely observed in cutaneous SCCs of other sites. Conclusion These data represent the first step toward precise molecular characterization of EAC SCCs that may lead to an enhanced understanding of tumor biology and modernized precision medicine approaches for unique tumors. Level of Evidence: NA
Mysore V. Tejesvi, Mysore V. Tejesvi, Mysore V. Tejesvi
et al.
Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA) is the most common periodic fever syndrome in children with unknown etiology, effectively treated with tonsillectomy. Earlier we have shown that tonsil microbiome is different in patients with PFAPA as compared to that in controls. Recently, fungal microbiome, mycobiome, has been linked to the pathogenesis of inflammatory diseases. We now investigated the role of mycobiome of tonsils in PFAPA. Random forest classification, a machine learning approach, was used for the analysis of mycobiome data. We examined tonsils from 30 children with PFAPA and 22 control children undergoing tonsillectomy for non-infectious reasons. We identified 103 amplicon sequence variants, mainly from two fungal phyla, Ascomycota and Basidiomycota. The mean relative abundance of Candida albicans in the tonsil mycobiome was 11% (95% CI: 19 to 27%) in cases and 3.4 % (95% CI: -0.8% to 8%) in controls, p =0.104. Mycobiome data showed no statistical difference in differentiating between PFAPA cases and controls compared to a random chance classifier (area under the curve (AUC) = 0.47, SD = 0.05, p = 0.809). In conclusion, in this controlled study, tonsillar mycobiome in children with PFAPA syndrome did not differ from that of the controls.
Cila Umat, Nor Haniza Abdul Wahat, Sakinah Che Ross
et al.
Objectives: This study examined the quality of life (QoL) of the parents and siblings of hearing-impaired children with cochlear implants (CIs). Design: This is a cross-sectional, questionnaire-based study. The questionnaire consists of three sub-domains - interaction, emotional well-being and support for the hearing-impaired child and the overall QoL -- and two open-ended questions for participants to provide comments and suggestions to enhance their family's QoL. A total of 63 questionnaires were e-mailed or mailed to families who met the inclusion criteria. Setting: The study was conducted under the Center for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur. Participants: A total of 79 parents and 23 siblings from 44 families of children with CI participated in this study. Main outcome measures: The mean score for each of the sub-domain and the overall QoL for both subject groups were computed. The answers for the open-ended questions were listed and organized into themes. Results: There were significant correlations between the overall QoL score and each of the test domains for the parents' group (p < 0.01). For the siblings' group, only the interaction and support domains were significant. Interaction was the main sub-domain affecting the parents' QoL but for siblings, this could not be determined. A total of 60% of the pooled comments were classified as ‘concerns’. As for the suggestions, 38.7% requested some form of support, mainly financial (41.7%). Conclusions: Families with hearing impaired children with CI have numerous concerns that need to be addressed, even though, on average, they were satisfied with their overall QoL. Keywords: Quality of life (QoL), Cochlear implants, Families, Parents, Siblings
Saleh Mohebbi, Jakob Lexow, Alexander Fuchs
et al.
Introduction: Different approaches have been developed to find the position of the internal auditory canal (IAC)in middle cranial fossa approach. A feasibility study was performed to investigate the combination of cone beam computed tomography (CBCT), optical coherence tomography (OCT), and laser ablation to assist a surgeon in a middle cranial fossa approach by outlining the internal auditory canal (IAC). Materials and Methods: A combined OCT laser setup was used to outline the position of IAC on the surface of the petrous bone in cadaveric semi-heads. The position of the hidden structures, such as IAC, was determined in MATLAB software using an intraoperative CBCT scan. Four titanium spheres attached to the edge of the craniotomy served as reference markers visible in both CBCT and OCT images in order to transfer the plan to the patient. The integrated erbium-doped yttrium aluminum garnet laser was used to mark the surface of the bone by shallow ablation under OCT-based navigation before the surgeon continued the operation. Result: The technical setup was feasible, and the laser marking of the border of the IAC was performed with an overall accuracy of 300 μm. The depth of each ablation phase was 300 μm. The marks indicating a safe path supported the surgeon in the surgery. Conclusion: The technique investigated in the present study could decrease the surgical risks for the mentioned structures and improve the pace and precision of operation.
Background: Tinnitus is one of the most common and distressing otological problems. Oxidative processes are one of the mechanisms involved in tinnitus. Therefore, in the present study, the concentrations of antioxidant micronutrients (Cr and Mn) were determined in the serum of the patients with tinnitus in comparison with healthy subjects.
Methods: In this case-control study, 55 patients with tinnitus and 47 healthy volunteers were enrolled, after matching age and sex. The concentrations of Cr and Mn were measured via flameless atomic absorption spectroscopy. Comparisons were made using Student’s t test.
Findings: There was a significant decrease in mean Cr level of serum in patients with tinnitus comparing to the controls (P < 0.001). Moreover, there were no statistically significant differences between the mean serum levels of Mn in patients with tinnitus and controls (P = 0.770).
Conclusion: In the present study, a relationship was seen between the serum level of trace element, Cr, and the occurrence of tinnitus. Trace elements are related to nutrition; so; investigation trace elements can be cost-effective and must be evaluated and considered in designing the treatment regimen for patients complaining of tinnitus. However, defining such a cause-and-effect relationship needs several prospective studies to be done.
Bijan Kumar Adhikary, Subhra Deb Biswas, Avick Das
et al.
Introduction
Foreign bodies are common ENT emergencies. Histories are usually forthcoming from the patient himself or the relatives . Three occult foreign bodies are reported here, which were missed even by treating doctors, with discussion about steps to avoid such errors in future.
Case Series
Case 1: Though the history was apparent, the foreign body was removed only after 13 years from the Zygomatic region.
Case 2: The parents were aware of the foreign body but inadequate investigations led to a delayed diagnosis.
Case 3: The history clinched the diagnosis. Pre operative localization and separate incision to remove the foreign body saved the vital structures.
Discussion
A high index of suspicion, meticulous history and proper investigation like x-ray or CT scan or MRI of the diseased area may help in locating the hidden foreign bodies in the ENT region.
Daniela Patricia Vaz, Juliana Maria Gazzola, Solange Martiliano Lança
et al.
Vertigem Posicional Paroxística Benigna (VPPB) pode alterar o equilíbrio corporal em pacientes idosos. OBJETIVO: Observar os efeitos da manobra de Epley em idosos com VPPB, avaliando os aspectos clínicos e funcionais do equilíbrio corporal. Forma de estudo: clínico e prospectivo. MÉTODO: Após o diagnóstico da doença (teste de DixHallpike), os testes Time Up and Go (TUGT), Clinical test of Sensory Interaction and Balance (CTSIB) e o teste de membros inferiores (MMI) foram realizados antes e após a manobra de reposicionamento de Epley modificada. RESULTADOS: O gênero feminino foi o mais prevalente e a média etária foi de 70,10 anos (DP = 7,00). Todos os pacientes apresentaram ductolitíase de canal posterior. Os seguintes sintomas melhoraram após a manobra: a instabilidade postural (p = 0,006), náusea e vômito (p = 0,021) e zumbido (p = 0,003). Em relação ao TUGT e o escore do teste de MMII, observou-se diminuição significante do tempo pós-manobra de Epley (p < 0,001). Observou-se melhora no CTSIB pós-manobra de Epley nas condições 2 (p < 0,003), condição 3 (p < 0,001), condição 4 (p < 0,001), condição 5 (p < 0,001), e condição 6 (p < 0,001). CONCLUSÃO: Houve melhora nos aspectos clínicos e funcionais do equilíbrio corporal em idosos com VPPB após o tratamento com a Manobra de Epley modificada.<br>Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. OBJECTIVE: To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. METHOD: This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. RESULTS: Most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). CONCLUSION: Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.
Brazilian Journal of otorhinolaryngology 78 (3) May/June 2012 http://www.bjorl.org.br / e-mail: revista@aborlccf.org.br Electronystagmography (ENG) and videonystagmography (VNG) are important tools in otoneurological diagnosis and are widely used in Brazil. The caloric test, included in the set of ENG and VNG evaluations, is the only test that analyzes each labyrinth separately. It consists of hot or cold stimulation of the external ear canal, intending to warm up or cool down the wall of the lateral semicircular canal causing endolymph convection currents. These currents cause further deviation from the dome of the stimulated semicircular canal. Heat stimuli are used worldwide in the routine workup of the vestibular system and can be performed with water or air. In Brazil, we face the problem of the large variability in the values of the slow component speed of nystagmus in air-stimulated ENG or VNG, which follows standards from each clinic, not always in compliance with international standards. In order to establish a reference, the Department of Otoneurology of the Brazilian Association of Otorhinolaryngology and Neck and Facial Surgery ABORL-CCF decided to study the response to an air caloric test in healthy individuals in different age groups with the aim of providing colleagues with information regarding international standards of air stimulation (24 o and 50 o C) for the Brazilian population. After publication, the values will be adopted by members of the Department of Otoneurology and their respective clinics, as a criterion for identifying vestibular dysfunction upon ENG or VNG. The study of the caloric test with air at 24 ° and 50 °C, during 1 minute, with air flow of 8 liters / minute, using the air stimulation equipment available in our country, was held at USP, UNIFESP, UFMG and UNICAMP in healthy individuals, males and females, aged between eight and 80 years. There was no spontaneous nystagmus in our sample of healthy individuals. The post-caloric nystagmus Slow Component Angular Velocity (SCAV) minimum value was 3o/s and the maximum was 46o/s. The results of 211 caloric tests with air at 24° and 50°C, alternately in each ear (total of four stimulations in each healthy individual) were subjected to statistical analysis. Air caloric test reference values EDITORIAL Braz J Otorhinolaryngol. 2012;78(3):2. BJORL.org
IgG4-related systemic disease, including autoimmune pancreatitis, is a multi-organ disorder characterized by elevated serum immunoglobulin G4 (IgG4) concentration and IgG4-positive plasma cell infiltration. We report a case of a 66-year-old woman with IgG4-related hearing disorder, presenting with fluctuating mixed hearing loss with middle ear effusion. The serum IgG4 level was elevated and pathological examination revealed dense infiltration of IgG4-positive lymphocyte in the renal parenchyma, lung tissue and lacrimal gland. With intravenous methylprednisolone at a dose of 60 mg daily, improvement of hearing loss were observed. No recurrence was observed for 6 months with mainternance of prednisolone and methotrexate.
Cunha, Daniele Andrade da, Silva, Giselia Alves Pontes da, Silva, Hilton Justino da
Introduction: Some children who breathe through the mouth and present nocturnal obstructive apnea can present a delay in the pondero-statural growth. Objective: The objective of this article is to analyze the orofacial myofunctional alterations found in oral breathers and the effects on their nutritional status. It focuses on the importance of the interdisciplinary team following up with the overall oral breathing alterations. Method: The used method was a literature's revision based on articles published in indexed scientific magazines, books and post-graduation works. Most articles were identified on LILACS, MEDLINE, and SCIELO databases. Results: A relation between oral breathing and an alteration in the general feeding process is noticeable and associated with difficulties in smelling, tasting, and orofacial myofunctional disorders, what comes to have an effect on the nutritional status. Final commentaries: The wide range of causes involved in oral breathing requires an interdisciplinary team trained to identify such alterations, enabling preventive measures to be undertaken, in order to avoid alterations in the general health, regular development of the face, as well as in the nutritional status in these individuals' relevant growth stages.