Objectives. To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. Methods. This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. Results. A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05&#x2009;&#xb1;&#x2009;3.17 years (range 1&#x2013;18 years). Twenty patients (28.57&#x0025;) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69&#x0025;) in the group with IEM. Nine out of twenty patients (45.00&#x0025;) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00&#x0025;), mean age 8.33 years (range 7&#x2013;10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00&#x0025;) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00&#x0025;) had improvement in speech but continued to receive education in special schools. Four patients (20.00&#x0025;) had poor progress after surgery. Conclusion. The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.

Sok Yan Tay

Rosslyn Anicete

Kun Kiaang Henry Tan

A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore

Sensorineural hearing loss is mainly acquired and affects an estimated 1.3 billion humans worldwide. It is related to aging, noise, infection, ototoxic drugs, and genetic defects. It is essential to identify reversible and preventable causes to be able to reduce the burden of this disease. Inflammation is involved in most causes and leads to tissue injury through vasospasm-associated ischemia. Vasospasm is reversible. This review summarized evidence linking inflammation-induced vasospasm to several forms of acquired sensorineural hearing loss. The link between vasospasm and sensorineural hearing loss is directly evident in subarachnoid haemorrhage, which involves the release of vasoconstriction-inducing cytokines like interleukin-1, endothelin-1, and tumour necrosis factor. These proinflammatory cytokines can also be released in response to infection, autoimmune disease, and acute or chronically increased inflammation in the ageing organism as in presbyacusis or in noise-induced cochlear injury. Evidence of vasospasm and hearing loss has also been discovered in bacterial meningitis and brain injury. Resolution of inflammation-induced vasospasm has been associated with improvement of hearing in autoimmune diseases involving overproduction of interleukin-1 from inflammasomes. There is mainly indirect evidence for vasospasm-associated sensorineural hearing loss in most forms of systemic or injury- or infection-induced local vascular inflammation. This opens up avenues in prevention and treatment of vascular and systemic inflammation as well as vasospasm itself as a way to prevent and treat most forms of acquired sensorineural hearing loss. Future research needs to investigate interventions antagonising vasospasm and vasospasm-inducing proinflammatory cytokines and their production in randomised controlled trials of prevention and treatment of acquired sensorineural hearing loss. Prime candidates for interventions are hereby inflammasome inhibitors and vasospasm-reducing drugs like nitric oxide donors, rho-kinase inhibitors, and magnesium which have the potential to reduce sensorineural hearing loss in meningitis, exposure to noise, brain injury, arteriosclerosis, and advanced age-related and autoimmune disease-related inflammation.

Michael Eisenhut

Evidence Supporting the Hypothesis That Inflammation-Induced Vasospasm Is Involved in the Pathogenesis of Acquired Sensorineural Hearing Loss

Background. Grommet insertion is one of the most commonly performed minor surgical procedures in otolaryngological practice. For such minor procedures in the outpatient, local anaesthetics are preferred; this is even more so in adults especially for grommet insertion. This study described our experience with the use of phenol as a local anaesthetic agent for grommet insertion in adults. Methods. Phenol was used as a local anaesthetic agent that was applied topically for grommet insertion in adult patients as outpatient procedures between January and September 2018 in two tertiary hospitals. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 23.0 computer software. Results. Nineteen ear drums were operated in patients aged between 20 and 52 years. No pain or discomfort was reported by 89.5&#x25; and 94.7&#x25; had no bleeding. There was no vertigo in all the cases that completed the procedures. Conclusion. This preliminary result shows that the use of phenol as a topical local anesthetic is simple, safe, and effective especially in resource-limited environments.

AbdulAkeem Adebayo Aluko

Use of Phenol as a Local Anaesthetic for Adult Grommet Insertion in Resource-Limited Settings: A Preliminary Report

Aim. Preoperative decongestion with Moffett&#x2019;s solution is routine practice in sinonasal procedures providing an ideal operative field. Anecdotally, it is related to postoperative throat pain, yet a quantitative relationship has not been established. We compare the incidence and severity of postoperative throat pain after application of Moffett&#x2019;s solution against Cophenylcaine decongestion. Methodology. A total of thirty patients from two consultants were recruited. The intervention arm (twenty) was decongested with Moffett&#x2019;s solution and the control arm (ten) with Cophenylcaine. The primary outcome was self-reported postoperative throat pain as measured by visual analogue scale (VAS) at 2 hours, 4 hours, 6 hours, and next morning. Results. There was a significantly higher VAS for throat pain in patients decongested with Moffett&#x2019;s solution in the early postoperative period (2 hours p=0.03, 4 hours p=0.04). Conclusion. Moffett&#x2019;s solution is associated with a greater severity of transient postoperative throat pain compared to topical Cophenylcaine. We recommend further studies to identify means to minimise this side effect. Clinical Trial Registration. This paper has been registered with the Australian and New Zealand Clinical Trials Registry under the registration number: <a target="_blank" href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377548">ACTRN12619000772145</a>.

Dominic Ku

Kartik Vasan

Eugene Wong

Evan Tseros

Narinder Pal Singh

Moffett&#x2019;s Solution Causes Significantly Greater Postoperative Throat Pain Compared to Cophenylcaine in Sinonasal Surgery

Context. This case series discusses surgical management of esophageal perforations that occurred following cervical spine hardware placement. Purpose. (1) Determine presenting symptoms of esophageal perforation after anterior cervical spine hardware placement. (2) Discuss surgical management of these resulting esophageal perforation complications. Design/Setting. Case series of six patients at a tertiary-care, academic medical center. Patient Sample. Six patients with pharyngoesophageal perforations following anterior cervical spine surgery (ACSS). Outcome Measures. Date of ACSS, indication for ACSS, level of hardware, location of esophageal or pharyngeal injury, symptoms at presentation, surgical intervention, type of reconstruction flap, wound culture flora, and antibiotic choice. Methods. A retrospective review of patients with an esophageal or hypopharyngeal injury in the setting of prior ACSS managed by the otolaryngology service at a tertiary, academic center between January 2015 and January 2019. Results. Six patients who experienced pharyngoesophageal perforation following ACSS are included in this study. Range of presentation was two weeks to eight years following initial hardware placement. Five patients presented with an abscess and all had evidence of perforation on initial CT or esophagram. All patients underwent repair with a sternocleidomastoid flap with two patients eventually requiring an additional pectoralis myofascial flap for a persistent esophageal leak. Five patients eventually attained ability to tolerate oral nutrition. An algorithm detailing surgical reconstructive management is proposed. Conclusions. Esophageal perforations in the setting of prior ACSS are challenging clinical problems faced by otolaryngologists. Consideration should be given to early drainage of abscesses and spine surgery evaluation. Spinal hardware removal is recommended whenever possible. Utilization of a pedicled muscle flap reinforces primary closure and allows coverage of the vertebral bony defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are necessary to optimize esophageal perforation repair.

Thomas S. Lee

Eric N. Appelbaum

Derek Sheen

Reintine Han

Benjamin Wie

Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series

Purpose. Chronic rhinosinusitis (CRS) patients often complain of nasal obstruction, which may cause sleep impairment for them. The goal of this study was to investigate the influence of functional endoscopic sinus surgery (FESS) on sleep related outcomes in CRS patients. Materials and Methods. CRS patients who received FESS were included in this study. Prior to FESS and 3 months after surgery the patients were asked about the severity of nasal obstruction and completed the 20-item Sinonasal Outcome Test (SNOT-20), along with the Epworth Sleepiness Scale (ESS) questionnaire. Endoscopic examination, acoustic rhinometry, and polysomnography were performed in all patients. They were divided into four groups according to their preoperative apnea hypopnea index (AHI) scores: nonobstructive sleep apnea syndrome (non-OSAS), mild OSAS, moderate OSAS, and severe OSAS. Results. A total of 96 subjects completed the study. The scores of the sleep domain of the SNOT-20 and ESS decreased in all of the AHI groups, with the exception of the severe OSAS group, after FESS. A reduction in the AHI of less than 5 was achieved in 9 patients (13.2&#x25;) after FESS. Conclusions. Our results showed that FESS improved sleep quality in CRS patients, except those with severe OSAS, and a preoperative lower AHI was the only significant predictor of post-FESS OSAS outcome.

Rong-San Jiang

Kai-Li Liang

The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis

Design and Setting. A retrospective study was conducted on all 2WW referrals made to our tertiary head and neck centre in a 12-month period. Methods. Sensitivity, specificity, and PPV of presenting complaints in H&#x26;N cancer diagnosis using Excel&#xae; and the statistical package SPSS&#xae;. Results. The sensitivity and specificity of 2005 NICE guidelines in detecting H&#x26;N cancers were 91.2&#x25; and 59&#x25;, respectively; their PPV was 9&#x25;. The sensitivity and specificity of 2015 NICE guidelines were 75.4&#x25; and 71&#x25;, respectively; their PPV was 10.3&#x25;. Eight out of 85 patients who presented with unilateral sore throat for more than 4 weeks, with or without otalgia and normal otoscopy, had H&#x26;N cancer (PPV 9.5&#x25;). Conclusions. Although the 2015 NICE guidelines have a high rate in detecting H&#x26;N cancers, consideration of reincluding unilateral sore throat in the referral criteria might be necessary.

Ahmed Allam

Hazem Nijim

Persistent Unilateral Sore Throat: Should It Be Included in the 2-Week Wait Referral Criteria by NICE

Background. Tonsillectomy is one of the most commonly performed surgical procedures in children. It is performed for sleep-disordered breathing and infective symptoms. Despite advances in instrumentation and perioperative care, posttonsillectomy haemorrhage (PTH) remains a significant complication, which should be audited regularly. Methods. A retrospective case series of all tonsillectomies performed in patients &#x3c;15 years old in the Auckland region during 2017 was performed. Demographic, clinical, and surgical data were extracted and analysed. Univariate analysis was performed to compare patients with and without PTH. Results. A total of 2177 tonsillectomies were performed during the study period, 64&#x25; in a public hospital and 36&#x25; in a private hospital. The overall PTH rate was 3.6&#x25; (0.23&#x25; occurring within the first 24 hours (primary) and 3.4&#x25; after 24 hours (secondary)). Mean time to PTH was 6.6 &#xb1; 3 days (range: 1-16 days). 90&#x25; of PTH occurred within the first 10 days and 99&#x25; by 14 days. Return to theatre was required in 28&#x25; of these cases, representing 1&#x25; of all tonsillectomies. There were no deaths or major complications in this cohort. The only differences observed between patients with PTH and those without were that children with PTH had smaller tonsils (p=0.004) and were less likely to have associated OME (p&#x3c;0.001). Conclusion. It is important to report institutional tonsillectomy outcomes and associated complications. These results show that PTH rates in Auckland remain within acceptable limits according to the literature.

Andr&#xe9;s Alvo

Andrew Hall

James Johnston

Murali Mahadevan

Paediatric Posttonsillectomy Haemorrhage Rates in Auckland: A Retrospective Case Series

Background. Otitis media with effusion (OME) in adults is less prevalent than in the pediatric population but still causes considerable morbidity. It has been suggested that laryngopharyngeal reflux (LPR) may have a role in the aetiology of adult OME. Reflux advances to the laryngopharynx and, subsequently, to other regions of the head and neck such as oral cavity, nasopharynx, nasal cavity, paranasal sinuses, and even middle ear with clinical manifestations being asthma, sinusitis, and otitis media. Objective. To determine the prevalence ratio of otitis media with effusion in laryngopharyngeal reflux. Methods. Observational analytic with cross sectional design. Result. 9 of 28 subjects experienced OME in LPR group, and 2 of 28 subjects in non-LPR group. Statistically there was significant difference between the two groups with p-value 0.02 and with 95&#x25; confidence interval range of 1.066-18.990. Conclusion. The prevalence ratio of otitis media with effusion in laryngopharyngeal reflux group is 4.5 times that in non-laryngopharyngeal reflux group.

Mahastini Karyanta

Siswanto Satrowiyoto

Dian Paramita Wulandari

Prevalence Ratio of Otitis Media with Effusion in Laryngopharyngeal Reflux

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International Journal of Otolaryngology&nbsp;publishes original research articles and review articles in all areas of otolaryngology-head and neck surgery.

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International Journal of Otolaryngology publishes original research articles and review articles in all areas of otolaryngology-head and neck surgery.

International Journal of Otolaryngology