Κυριακή 12 Φεβρουαρίου 2023

Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjectives To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome. Methods A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days. Results The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25–0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26–0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I2 = 52.1%). The OR was 0.31 (95% CI, 0.21–0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I2 = 0.0%). Conclusion Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome. Level of Evidence Level I.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients? Data Sources PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched. Study Selection Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study. Data Extraction Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted. Data Synthesis Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables. Conclusions The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes. Methods Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map. Results Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = −20 to 50 dB, Z = −2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = −4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = −20% to 90%, Z = −4.412, p
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell’s Palsy in Adults—A Systematic Review and Meta-analysis

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective Bell's palsy is typically treated with oral corticosteroids (40–60 mg daily). Concomitant antivirals are currently not recommended. The objective of this systematic review and meta-analysis was to examine the effect of high-dose versus standard-dose corticosteroids, without antivirals, in the management of Bell's palsy. Databases Reviewed Embase, MEDLINE, PubMed, CINAHL, Cochrane Library. Methods A systematic review and meta-analysis was performed according to PRISMA guidelines. Studies comparing high-dose (≥80 mg) or standard-dose (40–60 mg) corticosteroid therapy for Bell's palsy were included. Exclusion criteria were coexisting antiviral treatment, nonoral drug delivery, and facial palsy due to other causes. Risk of bias was assessed using ROBINS-I. A weighted estimate of treatment effects across trials as odds ratios (OR) using a Mantel–Haenzel random-effects model was calculated. Results Three articles were included in the analysis, representing 485 patients. There was a significant decrease in nonrecovery with high-dose, compared with standard-dose, corticosteroids at 6 months follow-up (OR = 0.17, 95% confidence interval = 0.05–0.56, p = 0.004). Overall adverse events were 5.8% (n = 28), all reported in one study in the high-dose group (transient elevated liver enzymes and fecal occult blood). Conclusions Our analysis shows a favorable effect of high-dose corticosteroid in the treatment of Bell's palsy. It is the first to evaluate this effect without the use of antivirals in keeping with current treatment recommendations. As all included studies had a serious risk of bias, future research should focus on larger trials with more robust methodology. This will allow for more up-to-date and large-scale analyses where more valid conclusions can be drawn that may potentially influence treatment protocols.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Roid Rage: Historical Perspective on the Emergence of Oral Steroids as a Treatment of Idiopathic Sudden Sensorineural Hearing Loss

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjectives To review the historical circumstances that led to the emergence of corticosteroid therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) and to discuss how this history has influenced current perspectives on the condition. Methods PubMed and Google scholar were used to identify articles of ISSNHL and oral corticoid steroid use. Historical articles accessed through our institutional medical library were also reviewed. Results The use oral corticosteroids as a treatment for ISSNHL was seemingly influenced by three key historical circumstances that, together, provided the substrate for the treatment's use in ISSNHL. First, ISSNHL was a frustrating condition with uncertainty regarding its etiology and few reliable treatment options. Second, the discovery of corticosteroids was awarded the Nobel Prize in 1950, which led to widespread application of this therapy. Third historical circumstance was the evolution and emergence of more rigorous methodological study designs in clinical research. In 1980, these events culminated in a double-blind study evaluating the effectiveness of oral steroids for treatment of ISSNHL. Interestingly, this study is often misrepresented as a randomized controlled trial, which ultimately contributed to adoption of a new standard for treatment in ISSNHL. Research subsequent to these historical events has challenged the notion of corticosteroids as a gold standard but has not altere d the historically established paradigm of corticosteroid treatment. Conclusions The use of steroids as a treatment for ISSNHL evolved from our specialty's need to address a complex condition, a novel therapeutic discovery, and a landmark study that met emerging methodological standards. Despite these strong historical foundations, ISSNHL remains a condition with an unknown etiology and the therapeutic value of corticosteroids remains unpredictable despite their gold standard label.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Recurrent Benign Paroxysmal Positional Vertigo in DFNB16 Patients with Biallelic STRC Gene Deletions

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective Deletions of STRC gene (DFNB16) account for 12% of isolated congenital mild to moderate hearing loss (HL). In mice, the stereocilin protein, encoded by STRC, is present in the vestibular kinocilium embedded in the otoconial membrane of the utricular macula. Despite this, effects on vestibular function have not been widely investigated. The aim of this study was to investigate the prevalence of benign paroxysmal positional vertigo (BPPV) in a cohort of DFNB16 patients. Study Design Observational descriptive epidemiological study. Setting Single-center study, in a tertiary referral center. Patients Older than 5 years, with a genetic diagnosis of HL related to biallelic STRC gene deletions, diagnosed between 2015 and 2021 Intervention Patients or their parents were interviewed to determine whether they had experienced vertigo or episodes of BPPV. Main Outcome Measure Criteria were at least five acute episodes of rotatory vertigo, each lasting less than 1 minute, episodes triggered by changes in specific head position, and an absence of neurological symptoms. Results Sixty-four patients having mild (33%) to moderate (66%) HL were included. Median age was 15 years (range, 6–48 yr). Prevalence of BPPV was 39% (25 of 64). Median age of first onset was 13 years (range, 3–18 yr). Conclusions This study showed recurrent BPPV and early age of onset in patients with biallelic STRC gene deletions. BPPV may be associated with the HL phenotype in patients with STRC gene deletions. It is important to inform patients and families of this potential risk such that appropriate management can be proposed.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Impedance Change as an Indicator of Cochlear Implant Failure

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective In February 2020, Advanced Bionics initiated a field action notice to remove the MS Ultra (V1) implant from circulation. In this study, we quantify a single site's incidence with device failure and examine the relationship between impedance change and declining speech perception. Study Design Retrospective/cohort study. Setting Tertiary healthcare center. Patients Forty-nine adult patients (52 devices) were implanted between October 2017 and December 2019, with the following exclusion criteria: 15%. Device failures were confirmed through analyses completed by the manufacturer. Results To date, 21% (11/52) of devices have met all three criteria for a confirmed failure with an average decline in speech perception of 27.7 ± 22%. The average length of time for detection of device failure was 21.9 ± 5 months postimplantation. An additional 7 devices (13%) are currently being monitored for failure but have not yet met full criteria. There was no predictive relationship between degree of impedance change and speech perception scores. Electrodes along the entire array (channels 1–16) can be affected. Conclusions Impedance values can be used as a reliable indicator of device malfunction, thus facilitating patient counseling and early intervention. No correlation was identified between impedance changes and speech perception scores.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Growth Rates of Pulmonary Carcinoid Tumors and Hamartomas

AlexandrosSfakianakis shared this article with you from Inoreader
imageBackground Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas. Methods A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400–600 days; and more than 600 days. Results Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas (P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days. Conclusions Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Differentiating Peripherally Located Pulmonary Noncalcified Hamartoma From Carcinoid Using CT Radiomics Approaches

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective This article aimed to differentiate noncalcified hamartoma from pulmonary carcinoid preoperatively using computed tomography (CT) radiomics approaches. Materials and Methods The unenhanced CT (UECT) and contrast-enhanced CT (CECT) data of noncalcified hamartoma (n = 73) and pulmonary carcinoid (n = 54; typical/atypical carcinoid = 13/41) were retrospectively analyzed. The patients were randomly divided into the training and validation sets. A total of 396 radiomics features were extracted from UECT and CECT, respectively. The features were selected by using the minimum redundancy maximum relevance and the least absolute shrinkage and selection operator to construct a radiomics model. Clinical factors and radiomics features were integrated to build a nomogram model. The performance of clinical factors, radiomics, and nomogram models on the differential diagnosis between noncalcified hamartoma and carcinoid were investigated. Diagnostic performance of radiologists was also explored. Result In regard to distinguishing noncalcified hamartoma from carcinoid, the areas under the receiver operating characteristic curves of the clinical, radiomics, and nomogram models were 0.88, 0.94, and 0.96 in the training set UECT, and were 0.85, 0.92, and 0.96 in the training set CECT, respectively. The areas under the curve of the 3 models were 0.89, 0.96, and 0.96 in the validation set UECT, and were 0.79, 0.90, and 0.94 in the validation set CECT, respectively. The nomogram model exhibited good calibration and was clinically useful by decision curve analysis. Nomogram did not show significant improvement compared with radiomics, neither for UECT nor for CECT. Diagnostic performance of radiologists was lower than both radiomics and nomogram model. Conclusions Radiomics approaches may be useful in distinguishing peripheral pulmonary noncalcified hamartoma from carcinoid. Radiomics features extracted from CECT provided no significant benefit when compared with UECT.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:

Investigation of the Value of T2 Mapping in the Prediction of Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjectives Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eosCRSwNP) usually have more extensive sinus disease, severe symptoms, and poorer disease control compared with patients with non-eosCRSwNP. Separating these entities will be crucial for patient management. The purpose of this study is to investigate T1, T2, and apparent diffusion coefficient (ADC) values of the nasal polyps in patients with CRSwNP and evaluate the usefulness of these parameters for differentiating these diseases. Methods Sinonasal magnetic resonance imaging was performed in 36 patients with eosCRSwNP and 20 patients with non-eosCRSwNP (including T1 mapping, T2 mapping, and diffusion-weighted imaging) before surgery. The T1, T2, and ADC values were calculated and correlated with pathologically assessed inflammatory cells of nasal polyps. Results Significant higher T2 value, higher eosinophil count, and lower lymphocyte count of the nasal polyps were observed in eosCRSwNP than those in non-eosCRSwNP. There was no significant difference in T1 or ADC values between the 2 groups. T2 value was correlated with eosinophil count and lymphocyte count in CRSwNP. The area under the curve of T2 value for predicting eosCRSwNP was 0.78 with 89.9% sensitivity and 60.0% specificity. Conclusion T2 value is a promising imaging biomarker for predicting eosCRSwNP. It can help to distinguish eosCRSwNP from non-eosCRSwNP.
View on Web
Αναρτήθηκε από στις Δεν υπάρχουν σχόλια:
Εγγραφή σε: Αναρτήσεις (Atom)