Cochlear Implantation in Children with Meningitis: A Multicenter Study on Auditory Performance and Speech Production Outcomes

BACKGROUND

This study aims to evaluate speech production outcomes and auditory performance in children with post-meningitis deafness who were treated with cochlear implants. Additionally, the study assesses the impact of electrode insertion depth on surgical outcomes.".

METHODS

We conducted a study on 66 pediatric patients with bilateral postmeningitis hearing loss who were being prepared for cochlear implantation at four tertiary referral academic institutions. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) were evaluated after the first and second years following implantation. The patients were divided into two groups based on electrode insertion depth: one group had full electrode insertion (more than two-thirds), while the other had partial electrode insertion (less than two-thirds). We compared the SIR and CAP scores between the two groups to assess the impact of electrode insertion depth on outcomes.

RESULTS

Before implantation, the median CAP score was one, but it improved significantly to six within two years after the procedure (P-value < 0.001). Similarly, the median SIR score before implantation was one, but it improved significantly to three within two years after surgery (P-value < 0.001). However, there was no significant difference between the partial and full electrode insertion groups in terms of CAP and SIR scores during the follow-up evaluations conducted after the first and second years.

CONCLUSION

The study found that cochlear implantation significantly improved speech production skills and auditory performance in children with postmeningitis deafness. Importantly, the amount of electrode insertion at the time of implantation did not have a significant impact on the outcomes.

Topical Tretinoin in the Management of Thick-skinned Rhinoplasty Patients

Background

Despite the increasing popularity of cosmetic surgeries, some patients still experience skin problems, particularly those with thick nasal skin. Isotretinoin is a commonly used drug for severe acne, and its effects on rhinoplasty aesthetic results have recently been studied. This placebo-controlled clinical trial aimed to investigate the effects of topical tretinoin gel on the cosmetic outcomes of rhinoplasty in patients with thick nasal skin.

Methods

Forty-nine individuals were randomly allocated to either the treatment group or the control group in Mashhad, Iran from 2019 to 2021. The treatment group received topical tretinoin gel (0.05%) beginning on the 31st postoperative day and continued for six months, while the control group received a usual dermatological recommendation as a placebo. Patients were assessed during the first, third, and sixth months after the intervention, and their cosmetic results were evaluated by an expert surgeon and dermatologist.

Results

There were no significant differences in baseline features between the two groups. The median score given by the surgeon was not significantly different between the groups. However, the median score given by the dermatologist was significantly higher in the treatment group during the first, third, and sixth months (P<0.001). Patient satisfaction scores were also significantly higher in the treatment group during the third and sixth months compared to the control group. (P=0.02 and 0.01, respectively).

Conclusion

Topical tretinoin gel could effectively reduce acne in patients with thick nasal skin after rhinoplasty and increase patient satisfaction in the early months following surgery. However, it did not significantly affect final cosmetic outcomes.

Association between Serum Vitamin D Levels and Risk of Sudden Sensorineural Hearing Loss: A cross-sectional Study

Background

Sudden sensorineural hearing loss (SSNHL) is an autoimmune diseases of the inner ear which is usually defined by acute onset of hearing loss in one or both ears, of 30 dB or more on at least three contiguous audiometric frequencies within 3 days or less. This study aimed to compare the serum levels of 25-hydroxyvitamin D (VitD) between patients with SSNHL and healthy controls.

Methods

A total of 50 patients with SSNHL and 50 healthy individuals without hearing loss as control group were enrolled in this study. Serum levels of VitD and other related laboratory tests such as calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) were measured and compared between two study groups.

Results

Serum level of VitD was significantly lower in patients suffering from SSNHL compared to the healthy controls (26.55 ± 14.44 vs. 33.51 ± 14.21, P = 0.017, respectively). VitD insufficiency was observed in 70% (n = 35) of the patients with SSNHL as compared to 44% (n = 22) of healthy individuals, demonstrating a significant difference between two study groups. However, no statistically difference was observed for serum levels of Ca, P, and PTH.

Conclusion

This study indicated an increased prevalence of VitD insufficiency in subjects with SSNHL, suggesting a possible association between serum VitD levels and the development of SSNHL. VitD may protect the hearing loss through its antioxidant role.

Evaluation of Sudden Sensory-Neural Hearing Loss Patients Treated with Systemic Steroids with Additional Intratympanic Dexamethasone Injection in Different Intervals; a Clinical Trial Study

Sudden Sensory-Neural Hearing Loss (SSNHL) is one of the most important otologic emergency. Although adding intratympanic (IT) steroids to systematic steroid may be beneficial, the exact timing of the IT injections to provide the best response needs further investigations. To compare different protocols in treting sudden sensorineural hearing loss. We performed a clinical trial study on 120 patients from October 2021 to February 2022. All patients were prescribed 1 mg/Kg daily oral prednisolone. After randomization to three groups, the control group received standard twice a week IT steroid injections in 12 days (four total injections) while intervention groups 1 and 2 received once and twice a day IT injections for ten days. Audiometric study repeated 10-14 days after the last injection and assessed based on the Siegel criteria. We used the Chi-Square, Analysis of Variance (ANOVA), Kruskal-Wallis's tests where appropriate. The most clinical improvement was found in the standard treatment group, and group-2 had the greatest number of patients with no improvement; however, no overall significant difference was observed among the three groups (p-value: 0.066; Pearson Chi-Square). Less frequent IT injections in patients already on systemic steroids provide similar results to more frequent injections.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03641-4.

Oral Isotretinoin Treatment in Rhinoplasty: A Review

The achievement of best outcome in rhinoplasty is very important for both of the patients and plastic surgeons. Since the skin characteristics (e.g. nasal thickness and sebaceous hypertrophy) has clear role on the result, many related interventions have been proposed in recent decades to gain an appropriate result. Accordingly, isotretinoin firstly introduced to treat some type of acne, has been suggested controversially to be used in rhinoplasty. Although the early uncertain studies implied on its side effects, the recent more powerful studies and evidences indicate that isotretinoin is remarkably effective to obtain proper outcome. Nevertheless, its prescription to patients need to be evaluated and personalized. More discussion on this regard are presented in the text.

Middle Ear Primary Oncocytic Schneiderian Papilloma: A Case Report

Introduction

Chronic otitis media is a significant health problem, but middle ear and mastoid neoplasms, either benign or malignant, are extremely rare.

Case Report

Here is a report from a 51-year-old female who presented persistent otorrhea with an aural polyp. The patient was operated on with the probable diagnosis of cholesteatoma. During surgery, a fragile mass was discovered, and histopathologic examination reported the diagnosis of a primary oncocytic Schneiderian papilloma. Microscopically it has pseudostratified epithelium of columnar cell epithelium with eosinophilic granular cytoplasm and hyperchromatic nuclei. The treatment of choice for Schneiderian papillomas is complete surgical removal.

Conclusions

Although very rare, oncocytic Schneiderian papilloma should be considered a differential diagnosis of ear neoplasms such as auditory canal polyps.

Predicting round window visibility by HRCT during cochlear implantation in children

Objective: The present study aimed to radiologically evaluate the visibility of round window during cochlear implantation by high-resolution computed tomography (HRCT) imaging of temporal bone. Study design: This was a cross-sectional descriptive analytic study. Methods: Two new radiologic measurements were evaluated on the presurgical HRCT of temporal bone, including (1) the angle between the line parallel to coronal axis that passes through the middle of the round window niche (RWN) and the line that connects the anterior portion of facial nerve (FN) to the middle of the RWN (RWN angle) and (2) the vertical distance between this coronal plane and the anterior portion of the FN, modified facial recess distance (MFRD). The measurements were then compared with the visibility of the round window (RW) during operation, as reported by the surgeon. Result: The present study compared the abovementioned CT scan findings of cochlear implanted children in visible (n = 21) and nearly invisible (n = 21) RW during surgery, as reported by the surgeon. The analysis revealed that both MFRD (P < 0.01) and RWN angle (P < 0.04) were significantly different between the two groups. Conclusion: the RWN angle and MFRD are fairly reliable predictors of round window visibility during cochlear implantation.

Combined Effects of Retinoic Acid and Hydro-Alcoholic Extract of Rosa Damascena Mill on Wound in Diabetic Rats

Retinoic acid and Rosa damascena are compounds that have considerable effects in the cellular proliferation and synthesis of extracellular matrix. The present study was designed to assess the combined effects of retinoic acid and Rosa damascena mill on wound in diabetic rats. Seventy-two rats were used in this study. Diabetes was induced by a single intraperitoneal injection of streptozotocin (60 mg. Kg(-1)). Then, a full thickness wound was created on dorsal surface of all animals. After that, rats were divided, into three groups; control (normal saline), positive control (Phenytoin), and  case (combined of 0.1% Tretinoein lotion and hydro-alcoholic extract of Rosa damascena mill). Afterward, wounds were evaluated macroscopically and microscopically on days 5, 10 and 15. Macroscopic and microscopic evaluations showed a significant improvement (p<0.05) of wounds in case group on 5(th) and 10(th) days when compared to positive control and control groups. The combination of Retinoic acid and hydro-alcholic extract of Rosa damascena mill can accelerate wound healing in diabetic rats.