OtoRhinoLaryngology

RETRACTED ARTICLE: Commentary on safety of outpatient admission and comparison of different surgical techniques in adult tonsillectomy

Response to "Drop attacks, hydrops severity and disease duration in hydropic ear disease (Menière's)"

Whose nose does not know? Demographical characterization of people unaware of anosmia Abstract Purpose For functionally anosmic subjects, the sense of smell is basically useless in daily activities—they are unlikely to detect the threatening smell of rotten food, gas or smoke, or to enjoy the flavor of food or the smell of perfumes. Although this appears very distressing, functionally anosmic subjects in our sample seemed not to be aware or bothered with impaired olfaction and enrolled for the study targeted to people with a normal sense of smell. Methods In the large sample of 9139 subjects who declared themselves to have a normal sense of smell, we have retrospectively found a notable proportion of scores indicating functional anosmia. Results When we look at the overall Sniffin' Sticks score, 0.45% of the sample was functionally anosmic and this fraction increased to 3.4% when the identification score of 8 points and below was used. We present demographical information of those subjects, who despite their inability to use smell in daily life, consider themselves healthy. Conclusions Data offer a new perspective on the importance of olfaction in daily life and supports the notion about the importance of using screening tools in clinical practice.

Response to the Letter to the Editor: "Pediatric otogenic lateral sinus thrombosis: focus on the prognostic role of contralateral venous drainage"

Bilateral nasal septal chemical cautery: a safe and effective outpatient procedure for control of recurrent epistaxis, our experience in 134 patients Abstract Purpose To assess the effectiveness and complications of bilateral nasal septal cautery using silver nitrate in anterior nasal epistaxis. Methods This prospective study was carried out on 180 consecutive patients presenting with epistaxis to a general ENT clinic. Local anaesthetic cautery was performed using 5% lidocaine hydrochloride and 0.5% phenylephrine hydrochloride spray in all the patients except eight children that were 4 years or younger that were done under general anaesthetic. Visible vessels in Little's areas were cauterised using two silver nitrate sticks each side. Patients were prescribed naseptin cream and followed-up. We classified re-bleeds as follow: 0–1 episodes: significant improvement, 2–3 episodes: moderate improvement, 4 + episodes: no improvement. Results We analysed 134 (74%) patients who were seen at follow-up. Age range was 5–88 years (mean 25, median 15), there were 89 (67%) males. Children made up 60% (81) of the study population (aged 16 years and under), of these 56 (69%) were male. Significant improvement was seen in 93% (124) of the study population, but there were relapses in two children (1.5%) and only moderate improvement in eight patients (6%). There was no significant complication in the study population, but 11 patients had crusting at the sites of cautery at follow-up. Conclusions Bilateral silver nitrate cauterisation is an effective method of treating recurrent epistaxis with low risk of complications.

Impact of bilateral nasal polyposis on the interoptic and interzygomatic distance Abstract Purpose To identify and determine variations on eye distance in patients with bilateral nasal polyposis (BNP) compared to a healthy control group. Methods This is a case–control study that included 20 BNP patients and 40 healthy controls. We included all patients with BNP confirmed by pathology and a computed tomography scan. A healthy control group was admitted, filtered by the exclusion criteria of nasal polyposis, craniofacial malformations, and encephalocele. Paranasal sinus CT scans were performed in all participants, and two measures were evaluated, the interoptic (soft tissue) and the interzygomatic (bone structure) distances. Results A total of 20 BNP subjects, 13 (65%) male and 7 (35%) female, with a mean age of 38.8 years, and 40 healthy controls, 16 (40%) male and 24 (60%) female with a mean age of 43.2 years, were included. The mean interoptic distance was 69.7 mm (71.9 mm men, 66.4 mm women) and interzygomatic distance was 103.1 mm (104.5 mm men, 100.6 mm women). A significant increase of the interoptic (p < 0.001) and interzygomatic (p < 0.002) measurements was found in patients with polyposis compared to the controls. In the receptor operative curve analysis, the interoptic distance had an area under a curve of 96% and the threshold that maximizes the sensitivity and specificity was 59.85 mm (sensitivity 90%, specificity 95%, PPV 90%, NPV 95%). Conclusions An increase in ocular and orbital distances was identified in patients with BNP. Polyposis may be identified by measuring eye separation. The established cut point distance identifies patients that may benefit from follow-up. Further research in this study line is suggested.

Endoscopic versus conventional septoplasty: objective/subjective data on 276 patients Abstract Purpose Endoscopic approach represents a valid alternative to conventional septoplasty. The aim of this study is to analyze the objective and subjective data on 276 patients, who underwent traditional (147) or endoscopic (129) septoplasty. Methods This is a prospective observational study on 276 consecutive patients affected by deviated nasal septum (DNS), who underwent isolated septoplasty between 2011 and 2018. 147 of them were treated using an "open" approach, while 129 were treated with an endoscopic approach. The two groups were compared 3 months after surgery: the objective results (complications such as bleeding, hematoma, pain, synechiae, septal tears and incomplete correction), objective (rhinomanometric data) and subjective measurements (NOSE questionnaires). Results Both techniques are effective in decreasing nasal obstruction and discharge. Complications such as pain, synechiae, early postoperative bleeding, septal tears and incomplete correction are less frequent in the endoscopic group (p < 0.05). The rhinomanometric analysis reveal improvement in both groups without statistical differences. Subjective questionnaires show a good symptoms relief with an improved quality of life in all 276 patients without statistical difference between the two gropus. Conclusions Both techniques are effective in reducing nasal obstruction and related symptoms with fewer overall complications in the endoscopic approach. The endoscope provides improved field of view, less mucosal damages and a more anatomic dissection. Finally, such approach can be a valuable teaching tool for assistants, residents and students.

Increased TSLP, IL-33, IL-25, IL-19, IL 21 and amphiregulin (AREG) levels in chronic rhinosinusitis with nasal polyp Abstract Objective Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease. The surrogate indicating biomarkers in patients with CRSwNP need further evaluation. The aim of this study was to investigate the association of thymic stromal lymphopoietin (TSLP) and amphiregulin (AREG) cytokines in patients with CRSwNP. Methods Sinonasal tissue samples were collected from 33 patients with CRSwNP and 29 controls. Levels of AREG, IL-19, IL-21, IL-25, IL-33 and TSLP in nasal polyp and control sinonasal tissues were determined following the enzyme-linked immunosorbent assay method. Results We found that AREG, IL-19, IL-21, IL-25, IL-33 and TSLP levels were significantly higher in the CRSwNP group compared to the control group (p < 0.000; p < 0.000; p < 0.000; p < 0.000; p < 0.003; p < 0.021, respectively). Conclusions Our findings indicated that AREG, IL-19, IL-21, IL-25, IL-33 and TSLP were significantly increased in tissue samples of CRSwNP patients and may be considered as molecular indicators and targets for therapeutic developments for patients with CRSwNP.

Vestibular function in panic disorder patients: a vestibular-evoked myogenic potentials and video head impulse test study Abstract Purpose To evaluate the function of the utriculus and sacculus and their central connections by ocular and cervical vestibular-evoked myogenic potentials (oVEMPs and cVEMPs), and the function of high-frequency VOR of the semicircular canals by video head impulse test (vHIT) in patients with panic disorder (PD). Methods Forty-eight patients with PD (21 with agoraphobia) and 20 sex- and age-matched healthy controls took part in the investigation. The vestibulo-ocular reflex (VOR) gains and latencies and peak-to-peak amplitudes of sound-induced VEMPs were measured and compared with those of healthy controls. Results Any statistical differences in the parameters of cVEMP and oVEMP responses between both PD patients groups and between patients and healthy controls were not observed. Also, significant differences between VOR in patients and healthy controls were not found. The VOR gain, bilaterally in the three semicircular canals was within normal limits (0.8–1.2) for 67%, and higher for 33% of the patients with PD. Overt and covert saccades were not observed. The relationship between higher VOR gains and the increase of postural instability when a sensory conflict exists (standing on foam pad with eyes closed) for patients with PD was established. Conclusion The VEMPs and vHIT tests demonstrated that there is no evidence of hypofunction of the semicircular canals in the high-frequency spectrum of VOR functioning. Nor are there any indications of impairment of the otolith system in patients with PD, regardless of their subjective vestibular sensations. The findings of the current study confirm the proposed link between anxiety, panic symptoms and postural instability in PD patients.

Exploring the feasibility of the combination of acoustic voice quality index and glottal function index for voice pathology screening Abstract Purpose The aim of this study was to explore the diagnostic value of the combination of Acoustic Voice Quality Index (AVQI) and Glottal Function Index (GFI) as a screening tool for voice disorders, and to compare the AVQI measurements obtained using oral and smartphone (SP) microphones. Methods A study group consisted of 183 adult individuals including 86 subjects with normal voice and 97 patients with pathological voice. Voice recordings were performed simultaneously with an oral AKG Perception 220 and SP iPhone 6s microphones. To evaluate the diagnostic accuracy differentiating normal and pathological voice, the receiver-operating characteristic statistics [area under curve (AUC), positive and negative likelihood ratios (LR+ and LR−)], and correct classification rate (CCR) were used. Results The AVQI cut-off scores of 3.31 for oral and 3.32 for SP microphones were associated with very good test accuracy (AUC = 0.857 and AUC = 0.818), resulting in balance between sensitivity and specificity (70.0% vs 86.0% and 70% vs 87.0%). The CCR reached 78%. The combined AVQI and GFI cut-off scores of 6.65 for oral and 7.1 for SP microphones corresponded with excellent test accuracy (AUC = 0.976 and AUC = 0.965) and sensitivity and specificity (93.0% vs 93.0% and 91.0% vs 94%). Very respectable levels of LR+ and LR− both for oral microphone (13.3 and 0.08) and for SP microphone (15.6 and 0.10) voice recordings were achieved. CCRs of 93% and 92% confirmed the results of ROC statistics. Conclusions Combination of AVQI and GFI measurements significantly improved diagnostic accuracy in differentiating normal vs pathological voice.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com