Antonios Tzagaroulakis

Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: A control study

BACKGROUND AND OBJECTIVE: Although systemic steroids in sudden sensorineural hearing loss (SSHL) appears to be the most effective and the most widely accepted treatment today, a significant number of patients do not respond to steroid treatment or they cannot receive steroids for medical reasons. Intratympanic (IT) administration of steroids appears to be an alternative or additional method of management without the side effects of intravenous steroids. The aim of this study is to investigate the effectiveness and safeness of IT administration of steroids in patients who had not responded to IV treatment and to compare treatment efficacy with controls. STUDY DESIGN AND SETTING: Our study consisted of 37 patients with SSHL who, at the end of 10 days of therapy with intravenous steroids as a 1st line treatment, had pure-tone 4-frequency (0.5, 1, 2, and 4 kHz) average (PTA) of worse than 30 dB or worse than 10 dB from the contralateral ear (defined as failed intravenous treatment). They were randomized into 2 groups, treatment and control. The 19 patients of the treatment group received approximately 0.5 mL sterile aqueous suspension of methylprednisolone acetate in a concentration of 80 mg/2 mL by direct injection. The procedure was carried out 4 times within a 15-day period. An audiogram was performed before each injection and approximately 1.5 months after the last session. RESULTS: All patients tolerated the procedure well. No perforation or infection was noticed in any of the patients at their last visit. With regard to the 19 patients who received intratympanic treatment, in 9 patients, the PTA threshold improved more than 10 db, in 10 patients there was no change greater than 10 db, and no patients deteriorated more than 10 db. In the control group, none of the patients showed any change greater than 10 db. The difference was statistically significant (P = 0.002). The treatment group showed an improvement in mean PTA of 14.9 dB, whereas the control group showed a deterioration of 0.8 dB, and this difference also was statistically significant (P = 0.0005). IT treatment (P = 0.0001), better post-IV PTA (P = 0.0008), and absence of vertigo (P = 0.02) were good predictors of the outcome. In contrast, sex, age, affected ear, days to admission, and pattern of the initial audiogram showed no significant influence on the outcome. CONCLUSION AND SIGNIFICANCE: IT steroid administration after failed intravenous steroids is a safe and effective treatment in sudden sensorineural hearing loss.

Biofilms in Ear, Nose, and Throat Infections: How Important are They?

Background: Biofilms present a new challenging concept in sustaining chronic, common antibiotic‐resistant ear, nose, and throat (ENT) infections. They are communities of sessile bacteria embedded in a matrix of extracellular polymeric substances of their own synthesis that adhere to a foreign body or a mucosal surface with impaired host defense. The aim of this paper is to review the literature on ENT diseases that can be attributed to biofilm formation and to discuss options for future treatment.

Grommets in otitis media with effusion : the most frequent operation in children. But is it associated with significant complications?

IntroductionOtitis media with effusion is one of the most frequent diseases in children, and its management requires the attention of general practitioners, pediatricians and ear, nose and throat (ENT) surgeons. The main complications associated with tympanostomy tube insertion, are: (1) purulent otorrhea (10–26% of cases), in which local otic preparations might be effective, and biofilm-resistant tubes may decrease this complication in the future; (2) myringosclerosis (39–65% of operated ears), with usually no serious sequelae; (3) segmental atrophy (16–75% of cases); (4) atrophic scars and pars flaccida retraction pockets (28 and 21% of operated ears, respectively); (5) tympanic membrane perforations (3% of cases, although with T-tubes, the incidence may be as high as 24%); (6) cholesteatoma (1% of cases), although tympanostomy tubes may sometimes prevent, rather than contribute to its development; (7) granulation tissue (5–40% of instances), when the duration of tube retention is prolonged.ConclusionIt would appear that the complications associated with tympanostomy tube insertion are more frequent than anticipated, reaching 80% of operated ears under specific circumstances and in certain subgroups of children. These complications may resolve with conservative management, but in persistent cases surgical removal of the tubes is mandatory.

GSTT1 , GSTM1 , GSTM3 and NAT2 polymorphisms in laryngeal squamous cell carcinoma in a Greek population

OBJECTIVE It is well known that laryngeal squamous cell carcinoma is strongly related to tobacco and alcohol consumption. Accumulating evidence suggests that alterations of detoxification enzymes, such as glutathione S-transferases and N-acetyltransferases, influence the risk of cancers associated with tobacco smoke and alcohol. METHODS This was a retrospective case-control study. The study group consisted of 88 Greek patients with laryngeal squamous cell carcinoma; there were also 102 control subjects. Frequencies of the genotypes GSTT1, GSTM1, GSTM3 and NAT2 were evaluated by polymerase chain reaction restriction fragment polymorphism. RESULTS The distribution of overall genotypes was 55.68 per cent rapid acetylator and 44.32 per cent slow acetylator in patients, and 36.27 per cent rapid acetylator and 63.72 per cent slow acetylator in controls. The odds ratio for rapid acetylator status in cases versus controls was 2.207 (95 per cent confidence interval 1.23-3.95, p = 0.0087). CONCLUSION This study demonstrated a significant relationship between rapid acetylator genotypes and laryngeal squamous cell carcinoma in a Greek population.

Sensory cell regeneration and stem cells: what we have already achieved in the management of deafness.

Background/Objective: Genetic manipulation of the cell-cycle exit, induction of new hair cells (HCs) through gene modification therapy, and introduction of stem cells (SCs) into damaged cochleas potentially offer exciting new strategies in treating sensorineural hearing loss. Materials and Methods: Literature review from Medline and database sources. Study Selection: Ex vivo models, animal studies, in vitro studies, and review articles. Data Synthesis: Embryonic SCs, neural SCs, or bone marrow SCs survive in the mammalian inner ear after transplantation. The scala media and the modiolus seem more functionally appropriate injection sites. The clear evidence that transplanted neural SCs can adopt the morphologic phenotypes of HCs was the most significant milestone achieved in the related research. The normal cytoarchitecture in the organ of Corti may also be restored through mouse atonal homologue 1 transgene expression and transduction of the nonsensory cells, producing clinically measured improvement in hearing thresholds. Embryonic SC-derived neurons have the potential for synapse formation with auditory HCs and reinnervation of the auditory epithelia. However, fluctuations in survival rates, functional recovery of the spiral-ganglion neurons, integration to the host tissue, and potential immune barriers are also areas of utmost importance. Conclusion: There is an already exciting progress in the fields of sensory cell regeneration and SC research in an attempt to restore hearing or prevent deafness. However, further understanding of the underlying mechanisms of auditory genetics, continuing investigation of the human genome, refinement of the delivering techniques, and specification of the therapeutic strategies have to be developed before functional regeneration of the cochlea can be achieved in clinical practice.

Actinomycosis of the thyroid gland masquerading as a neoplasm

Actinomycetal infections involving the head and neck often pose a diagnostic puzzle to the otolaryngologist. A rare case of unilateral thyroid swelling due to actinomycosis is described. Although the clinical, laboratory and imaging studies strongly suggested a thyroid neoplasm, the histological examination revealed the presence of Actinomyces sp. in the excised lesion. The manifestations of actinomycosis of the head and neck, its pathogenesis and the difficulties encountered in the diagnosis and treatment of the disease are hereby reviewed.

Recurrent ceruminous adenocarcinoma of the external auditory canal.

Ceruminous adenocarcinoma is a rare malignant neoplasm of the glandular structures of the external auditory canal. The true incidence and behavior of these rare tumors are still unclear due to confusing terminology, classification and histological definitions. Therefore, the ENT surgeon faces major difficulties in choosing the method of management – conservative or more radical surgery – with the addition or not of radiotherapy. We report a 57-year-old male patient with a recurrence of a previously excised (maybe partially) and irradiated ceruminous adenocarcinoma of the right external auditory canal. Aggressive surgery was considered as the treatment of choice. However, the patient refused this approach and, as a consequence, a conservative excision was performed but with histologically confirmed healthy margins. To our surprise, the patient showed an excellent response and he is disease free 3 years following the last operation. Although recurrences usually occur within months after inadequate management, some may happen even 7 years post treatment. Therefore, routine long-term follow-up was advised.

Chondrosarcoma of the Thyroid Cartilage

Objectives: In the present case report, we describe a rare laryngeal chondrosarcoma of the thyroid cartilage in a woman to emphasize the specific clues that can lead the clinician to an early and accurate diagnosis. Methods: The clinical course of a 49-year-old female is presented and discussed. The up-to-date literature on the diagnosis, clinical behaviour, follow-up and treatment of this tumour is reviewed. Results and Conclusions: Laryngeal chondrosarcoma of the thyroid cartilage is a rare entity, especially in women. It is a slowly growing tumour easily confused with benign chondroma. The symptomatology depends on the pattern of growth. Hoarseness, dyspnoea, dysphagia and palpable neck mass are the symptoms most frequently encountered. A significant minority of the patients have no formal complaints. Special precautions during tissue sampling enable a reliable histological confirmation. Calcification within the cartilage in the CT should also alert the clinician to a possible chondrosarcoma. Organ preservation procedures are feasible and curative in early-stage disease.

A Novel Technique in the Operative Treatment of Pyriform Sinus Carcinoma

Pyriform sinus carcinoma is a highly malignant carcinoma of the head and neck region as a result of its location and its potential for metastatic spread. Decisions regarding the operative procedure remain very difficult. In this paper, we present a modified partial laryngo-pharyngectomy in which, following extended vertical laryngectomy, the cancerous mass is removed from the involved pyriform sinus and the remaining hypopharynx is reconstructed by using the preserved outer perichondrium of the resected thyroid cartilage. This technique has been applied with adequate success during the last five years in five cases in our department. It is indicated when a pyriform sinus carcinoma does not extend to the pyriform apex and does not involve the anterior and posterior laryngeal commissures, paraglottic space, retrocricoid region and posterior pharyngeal wall beyond the midline. All patients treated were male and middle-aged. Our technique appears to be a reliable alternative for the operative treatment of pyriform sinus carcinoma.

Sudden Sensorineural Hearing Loss: Prognostic Factors

Abstract Objectives: Sudden sensorineural hearing loss (SSHL) remains a challenge for the clinician since in the majority of cases no definite cause is recognized. The prognosis regarding the final hearing outcome is quite variable, and treatment is mainly based on the intravenous (IV) corticosteroid administration. Various prognostic factors have been reported in the literature: age, tinnitus, electronystagmographic (ENG) findings, hearing level, shape of audiogram, brainstem evoked response audiometry (BSER) findings, and time of initiation of treatment in the final hearing outcome. The aim of the present study was to assess the prognostic significance of demographic, epidemiologic, neurootologic, otologic, and audiometric factors with regard to the hearing outcome of patients with SSHL. Methods: The present study assessed the hearing outcome in 114 patients with SSHL who received the following treatment: Prednisolone IV 1 mg/kg/day for 10 days divided in 3 doses gradually tapered for 5 days, Acyclovir 4 g/day for 5 days divided in 5 doses, Buflomedil hydrochloride 300 mg IV divided in 3 doses for 10 days, Ranitidine IV during steroid treatment. They all had a 12-month follow-up of pure tone and BSER audiometry. Results: The statistical analysis revealed that older age, ENG findings, flat/descending shapes, or total deafness in the initial audiogram, late identification of wave V during the follow-up, worse initial PTA thresholds, and delayed patients’ presentation were significantly correlated to poorer hearing outcome. Conclusions: The present study revealed that there are certain factors that affect prognosis in SSHL. This is very important in counseling patients and may affect current clinical practice.