Inge Wegner

Stapedotomy in osteogenesis imperfecta : a prospective study of 32 consecutive cases

Objective To prospectively evaluate hearing outcomes in patients with osteogenesis imperfecta undergoing primary stapes surgery and to isolate prognostic factors for success. Study Design A nonrandomized, open, prospective case series. Setting A tertiary referral center. Patients Twenty-five consecutive patients who underwent 32 primary stapedotomies for osteogenesis imperfecta with evidence of stapes fixation and available postoperative pure-tone audiometry. Intervention Primary stapedotomy with vein graft interposition and reconstruction with a regular Teflon piston or bucket handle-type piston. Main Outcome Measures Preoperative and postoperative audiometric evaluation using conventional 4-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. The overall audiometric results as well as the results of audiometric evaluation at 3 months and at least 1 year after surgery were used. Results Overall, postoperative air-bone gap closure to within 10 dB was achieved in 88% of cases. Mean (standard deviation) gain in air-conduction threshold was 22 (9.4) dB for the entire case series, and mean (standard deviation) air-bone gap closure was 22 (9.0) dB. Backward multivariate logistic regression showed that a model with preoperative air-bone gap closure and intraoperatively established incus length accurately predicts success after primary stapes surgery. Conclusion Stapes surgery is a feasible and safe treatment option in patients with osteogenesis imperfecta. Success is associated with preoperative air-bone gap and intraoperatively established incus length.

Insufficient Evidence for the Effect of Corticosteroid Treatment on Recovery of Vestibular Neuritis

The authors studied the effect of corticosteroid treatment on clinical recovery and recovery of vestibular function in patients with vestibular neuritis. The comprehensive search (March 29, 2012) yielded 496 original papers, of which 5 (including 199 patients) during full-text screening satisfied our eligibility criteria. Methods assessment showed that 1 study (30 patients) provided direct evidence and carried low risk of bias. Two studies properly reported on their random and concealed allocation of treatment. In 1 study, patients were not randomly allocated to treatment. Blinding of outcomes was lacking in 2 studies, whereas outcome data were clearly incomplete for 2 studies. Given the wide variety in outcome measures and scales and follow-up duration, the meaning of the size of reported effects is not clear. Therefore, the reported effects cannot simply be compared between studies, and this precludes pooling of study results. Still, there are large differences between studies in the size of the reported absolute effects after the placebo treatment. Moreover, the difference in effects between treatments is rather small and does not always favor corticosteroids. The moderate to high risk of bias of studies precludes firm conclusions, whereas the reported short-term effects on symptom recovery and improvement of peripheral vestibular function are too small to be clinically important. No long-term effect on symptom recovery has been shown. Recommendations or decisions for corticosteroid treatment in patients with vestibular neuritis cannot be based on current best evidence and therefore should be discussed with the patient.

Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: A systematic review.

The purpose of this systematic review was to determine the prognostic value of continued smoking after diagnosis on survival and recurrence rates in head and neck cancer.

Laser versus conventional fenestration in stapedotomy for otosclerosis: A systematic review

To assess hearing results and complications following primary stapedotomy in otosclerosis patients comparing the use of laser and conventional techniques for fenestration.

Rapid Systematic Review of Repeated Application of the Epley Maneuver for Treating Posterior BPPV

Objective To evaluate the effect of repeated application of the Epley maneuver on patient-reported symptom relief and resolution of nystagmus in patients with posterior benign paroxysmal positional vertigo (p-BPPV). Data Sources PubMed, Embase, and the Cochrane Library. Methods A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Success percentages and mean values were extracted. Results A total of 955 unique studies were retrieved. Fourteen of these satisfied the eligibility criteria. All of the included studies carried a high relevance and a moderate RoB. The majority of studies were 1-armed trials, in which the Epley was repeated only in case previous attempt(s) had failed. The maneuver was not repeated if it was successful. In 32% to 90% of patients, the first treatment session was successful. Reported cumulative success percentages ranged from 40% to 100% after the second session, 67% to 98% after the third session, 87% to 100% after the fourth session, and 100% in the studies in which patients received 5 sessions. One study evaluating the effect of multiple maneuvers in a single session showed a rise in success percentages from 84% for 1 maneuver to 90% after 2 maneuvers and 92% after 3 maneuvers. Conclusion Multiple studies with moderate RoB show a beneficial effect of multiple sessions of the Epley maneuver in p-BPPV patients who are not fully cleared of symptoms after the first session.

Feasibility of using head and neck CT imaging to assess skeletal muscle mass in head and neck cancer patients

OBJECTIVES Patients with head and neck cancer (HNC) have a higher risk of malnutrition and sarcopenia, which is associated with adverse clinical outcome. As abdominal CT-imaging is often used to detect sarcopenia, such scans are rarely available in HNC patients, possibly explaining why no studies investigate the effect of sarcopenia in this population. We correlated skeletal muscle mass assessed on head and neck CT-scans with abdominal CT-imaging. METHODS Head and neck, and abdominal CT-scans of trauma (n=51) and HNC-patients (n=52) were retrospectively analyzed. On the head and neck CT-scans, the paravertebral and sternocleidomastoid muscles were delineated. On the abdominal CT-scans, all muscles were delineated. Cross-sectional area (CSA) of the muscles at the level of the C3 vertebra was compared to CSA at the L3 level using linear regression. A multivariate linear regression model was established. RESULTS HNC-patients had significantly lower muscle CSA than trauma patients (37.9 vs. 45.1cm2, p<0.001, corrected for sex and age). C3 muscle CSA strongly predicted L3 muscle CSA (r=0.785, p<0.001). This correlation was stronger in a multivariate model including sex, age and weight (r=0.891, p<0.001). DISCUSSION Assessment of skeletal muscle mass on head and neck CT-scans is feasible and may be an alternative to abdominal CT-imaging. This method allows assessment of sarcopenia using routinely performed scans without additional imaging or additional patient burden. Identifying sarcopenic patients may help in treatment selection, or to select HNC patients for physiotherapeutic or nutritional interventions to improve their outcome.

A systematic review of computed tomography detection of cartilage invasion in laryngeal carcinoma.

This systematic review aimed to assess the diagnostic value of computed tomography (CT) in detecting cartilage invasion among patients with laryngeal carcinoma.

Outcomes of Different Laser Types in Laser-assisted Stapedotomy: A Systematic Review

Objective To assess hearing results and complications following primary stapedotomy in otosclerosis patients, comparing different laser types. Data Sources Pubmed, Embase, The Cochrane Library, CINAHL, and Scopus. Study Selection A systematic bibliographic search was conducted to identify all original articles, comparing hearing outcome between different lasers used for fenestration in stapedotomy. Data Extraction Directness of evidence and risk of bias of the selected articles were assessed. Studies with low or moderate directness of evidence, or high risk of bias, were not further analyzed. Data Synthesis The absolute risks, risk differences, and 95% confidence intervals were extracted only for the studies with high directness of evidence and moderate to low risk of bias. Conclusion A total of 383 unique articles were retrieved. Four studies provided direct evidence, whereas all studies carried moderate to high risk of bias. After exclusion of the studies that did not provide direct evidence and/or carried high risk of bias, 2 studies were considered eligible for data extraction. This best available evidence shows a slightly better air-bone gap closure for CO2 laser compared to potassium titanyl phosphate laser, but the clinical relevance is unclear. The risk difference of 28.1% [95% confidence interval, 22.8, 33.4] between CO2 and erbium yttrium aluminium garnet favors CO2 laser. Unfortunately, this current best available evidence is insufficient to draw any definitive conclusions on which laser to use for fenestration in stapedotomy.

Rapid Systematic Review of the Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo

Objective The aim of this study was to compare watchful waiting to the Epley maneuver as a management option for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) regarding symptom relief. Data Sources PubMed, Embase, and The Cochrane Library. Methods A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Absolute risk differences and their 95% confidence intervals (CIs) were extracted for the included studies. Results A total of 1448 unique studies were retrieved. Eight of these satisfied the eligibility criteria. At 1-week follow-up, all included studies reported a clinically relevant effect in favor of the Epley maneuver regarding symptom relief (absolute risk differences ranging from 20% [95% CI, 5%-37%] to 59% [95% CI, 32%-76%]) or conversion to a negative Dix–Hallpike (absolute risk differences ranging from 17% [95% CI, –5%-37%] to 64% [95% CI, 29%-79%]). At 1-month follow-up, the results of the included studies diverged further. Absolute risk differences ranged from 6% (95% CI, –24%-35%) more symptom relief in favor of watchful waiting to 79% (95% CI, 56%-88%) in favor of the Epley maneuver. Conclusion and Recommendations All data of the selected studies show a benefit in favor of the Epley maneuver at 1-week follow-up in the management of p-BPPV. The Epley maneuver should be considered in all patients with p-BPPV.

Local versus General Anesthesia in Stapes Surgery for Otosclerosis A Systematic Review of the Evidence

Objective To assess hearing results following primary stapes surgery in patients with otosclerosis, comparing local and general anesthesia. Data Sources PubMed, Embase, the Cochrane Library, CINAHL, and Scopus. Review Methods A systematic search was conducted, followed by assessment of directness of evidence and risk of bias. Studies reporting original data on the effect of local anesthesia, compared to general anesthesia, on closure of air-bone gap in patients undergoing stapes surgery for otosclerosis were included. Results A total of 257 unique studies were retrieved, of which 3 (including 417 procedures) satisfied the eligibility criteria. Assessment showed that all studies carried high risk of bias, and only 1 study provided direct evidence. Conclusion There is no difference in postoperative air-bone gap, worsening of sensorineural hearing loss, and postoperative vertigo between the 2 groups. A statistically significant increased risk of immediate dead ear following stapes surgery performed under general anesthesia was reported in 1 study.