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Since sinonasal intestinal-type adenocarcinomas (ITAC) show resemblance to colorectal adenocarcinomas, we aimed to investigate novel prognostic factors of outcome, with particular focus on the role of tumor budding (TB). Retrospective clinico-pathological single-institution study on consecutive ITAC patients between 1996 and 2020. Histopathological parameters including conventional subtypes and TB features (low, intermediate, high) were evaluated with the aid of pancytokeratin (AE1/AE3) immunohistochemical staining. Parameters were correlated to clinical data and outcome. A total of 31 ITAC patients were included. Overall, 19/31 patients (61.3%) presented with stage III/IV disease. Presence of lymph node or distant metastases was rare (1/31 patient, 3.2%). Treatment protocols consisted of tumor resection in 30/31 patients (96.8%) and primary radiochemotherapy in 1/31 patient (3.2%). Adjuvant radiation therapy was conducted in 20/30 surgically treated patients (66.7%). The 3- and 5-year overall survival (OS) was 83.9% and 78.3% and the 3- and 5-years disease-specific survival (DSS) 83.7% % and 78.5%, respectively. The presence of intermediate/high TB (defined as ≥ 5 buds) was associated with both, worse DSS (log rank p = 0.03) and OS (log rank p = 0.006). No patient with low TB revealed progressive disease or died of the disease. No association between TB and tumor stage or conventional tumor subtype was found. Tumor budding seems to be an independent prognostic factor of worse outcome in ITAC.

Objectives Enlarged vestibular aqueduct (EVA) is a common finding associated with inner ear malformations (IEM). However, uniform radiologic definitions for EVA are missing and various 2D-measurement methods to define EVA have been reported. This study evaluates VA volume in different types of IEM and compares 3D-reconstructed VA volume to 2D-measurements. Methods A total of 98 high-resolution CT (HRCT) data sets from temporal bones were analyzed (56 with IEM; [cochlear hypoplasia (CH; n = 18), incomplete partition type I (IPI; n = 12) and type II (IPII; n = 11) and EVA (n = 15)]; 42 controls). VA diameter was measured in axial images. VA volume was analyzed by software-based, semi-automatic segmentation and 3D-reconstruction. Differences in VA volume between the groups and associations between VA volume and VA diameter were assessed. Inter-rater-reliability (IRR) was assessed using the intra-class-correlation-coefficient (ICC). Results Larger VA volumes were found in IEM compared to controls. Significant differences in VA volume between patients with EVA and controls (p p r = 0.78, VA operculum: r = 0.91), in CH (VA midpoint: r = 0.59, VA operculum: r = 0.61), in EVA (VA midpoint: r = 0.55, VA operculum: r = 0.66) and in controls (VA midpoint: r = 0.36, VA operculum: r = 0.42). The highest IRR was found for VA volume (ICC = 0.90). Conclusions The VA diameter may be an insufficient estimate of VA volume, since (1) measurement of VA diameter does not reliably correlate with VA volume and (2) VA diameter shows a lower IRR than VA volume. 3D-reconstruction and VA volumetry may add information in diagnosing EVA in cases with or without additional IEM.

ZusammenfassungDer laryngopharyngeale Reflux (LPR) ist durch ein Aufstoßen von gastralem bzw. gastroduodenalem Sekret wie auch von gasförmigem Inhalt in den oberen aerodigestiven Trakt charakterisiert, wodurch eine Schädigung der Schleimhäute u. a. im Larynx- und Pharynxbereich resultieren kann. Eine Reihe von Symptomen wie das klassische retrosternale Brennen und saure Aufstoßen oder weitere, teils sehr unspezifische Symptome wie Heiserkeit, chronischer Husten, zervikales Globusgefühl oder Hypersekretion von Mukus können daraus resultieren. Bei heterogener Studienlage und dem Fehlen eines Goldstandards ist, wie kürzlich zusammengefasst, die Diagnosestellung des LPR schwierig und umstritten. Die Therapieoptionen des LPR werden aufgrund der dünnen Datenlage ebenfalls kontrovers diskutiert und können neben medikamentösen auch konservative diätetische Maßnahmen umfassen. Das Ziel der nachfolgenden Übersichtsarbeit ist daher, die verfügbaren therapeutischen Optionen des LPR kritisch zu diskutieren und für den praktischen klinischen Alltag zusammenzufassen.

Objectives The COVID‐19 pandemic bears the risk of delayed cancer diagnoses. Methods Study on the diagnostic pathway of sinonasal malignancies during the COVID‐19 pandemic. Results Median time from first symptom to treatment initiation was not increased during the pandemic: 137 days (interquartile range [IQR] 104‐193) vs 139 days (IQR 103‐219) (P = .60). Median time from first appointment at our institution to treatment initiation was even reduced in 2020: 18 days (IQR 11‐25) vs 11 days (IQR 7‐17) (P = .02). A trend toward advanced tumor stages during the pandemic was seen: 11/30 patients (36.7%) ≥ stage 4 in 2018 to 2019 vs 12/19 patients (63.2%) ≥ stage 4 in 2020 (P = .064). Conclusion Both, time to diagnosis and time to treatment initiation were similar during the pandemic. However, a higher proportion of advanced tumors stages was observed. Despite the pandemic, we provided a swift diagnostic workflow, including a virtual tumor board decision and a prompt treatment initiation. Level of Evidence: 4., The COVID‐19 pandemic bears the risk of delayed cancer diagnoses. This is a retrospective study on the diagnostic pathway of sinunasal malignancies during the COVID‐19 pandemic. Both, time to diagnosis and time to treatment initiation were similar during the pandemic. However, a higher proportion of advanced tumors stages was observed. Despite the pandemic, we provided a swift diagnostic workflow, including a virtual tumor board decision and a prompt treatment initiation.

Objective A “gold standard” for quantitatively diagnosing inner ear malformations (IEMs) and a consensus on normative measurements are lacking. Reference ranges and cutoff values of inner ear dimensions may add in distinguishing IEM types. This study evaluates the volumes of the cochlea and vestibular system in different types of IEM. Study Design Retrospective cohort. Setting Tertiary academic center. Patients High-resolution CT scans of 115 temporal bones (70 with IEM; cochlear hypoplasia [CH]; n = 19), incomplete partition (IP) Types I and III (n = 16), IP Type II with an enlarged vestibular aqueduct (Mondini malformation; n = 16), enlarged vestibular aqueduct syndrome (n = 19), and 45 controls. Interventions Volumetry by software-based, semiautomatic segmentation, and 3D reconstruction. Main Outcome Measures Differences in volumes among IEM and between IEM types and controls; interrater reliability. Results Compared with controls (mean volume, 78.0 mm3), only CH showed a significantly different cochlear volume (mean volume, 30.2 mm3; p < 0.0001) among all types of IEM. A cutoff value of 60 mm3 separated 100% of CH cases from controls. Compared with controls, significantly larger vestibular system volumes were found in Mondini malformation (mean difference, 22.9 mm3; p = 0.009) and IP (mean difference, 24.1 mm3; p = 0.005). In contrast, CH showed a significantly smaller vestibular system volume (mean difference, 41.1 mm3; p < 0.0001). A good interrater reliability was found for all three-dimensional measurements (ICC = 0.86–0.91). Conclusion Quantitative reference values for IEM obtained in this study were in line with existing qualitative diagnostic characteristics. A cutoff value less than 60 mm3 may indicate an abnormally small cochlea. Normal reference values for volumes of the cochlea and vestibular system may aid in diagnosing IEM.

This paper provides a new hypothetical explanation for the etiopathology and pathophysiology of Menière’s Disease (MD), which to date remain unexplained, or incompletely understood. The suggested hypothesis will explain the close connection of MD and Migraine, the coexistence of endolymphatic hydrops (ELH) and Menière attacks and the signs of inflammation detected in the inner ears of MD patients. Although as yet unproven, the explanations provided appear highly plausible and could pave the way for the generation of the first animal model of MD – an invaluable asset for developing new treatment strategies. Furthermore, if proven correct, this hypothesis could redefine and also reset the actual name of Menière’s Syndrome to Menière’s Disease.

Background The question how to treat the clinically negative neck in sinonasal malignancies is controversial. Objectives To investigate patterns of treatment failure and to assess outcome measures in patients with primary sinonasal malignancies. Methods Retrospective cohort study of patients treated for primary malignant sinonasal malignancies. Results Lymph node (LN) metastases at initial presentation were present in 8 of 152 patients (5.3%). Ipsi- and contralateral LN levels 1 and 2 were identified as nodal basins at risk. We found a 5-year overall survival (OS) of 75.2% and disease free survival of 61.1%. Among patients with cN0 neck, nodal recurrence free survival was not different between patients with and without elective neck treatment ( P = .23). On logistic regression analysis, we found initial T classification as an independent factor for achievement of complete remission (CR) and OS. Conclusions LN metastases at initial presentation are rare and initial T classification was identified as the most important prognostic factor for OS and CR, emphasizing the need for a thorough initial staging of the primary tumor.

ZusammenfassungWesentliche und neue Impulse, die das Behandlungskonzept für ambulante phonochirurgische Eingriffe am unsedierten Patienten betreffen, stammen aktuell aus dem angloamerikanischen Sprachraum. Die dort etablierten „office-based procedures“ werden als eine Alternative zu vielen konventionellen operativen Larynxeingriffen in Vollnarkose propagiert. Maßgeblich für diese Entwicklung ist der Einsatz neuer endoskopischer Techniken in Kombination mit photoangiolytischen Laserverfahren (KTP-Laser und blauer Laser), die eine sichere und effiziente ambulante Phonochirurgie ermöglichen. Die Akzeptanz seitens der Patienten ist hoch, da ambulante Eingriffe als risikoärmer gelten. Ungeachtet der verbreiteten Euphorie fehlen weiterführende Studien, welche die medizinischen Entscheidungskriterien und das Sicherheitsmanagement bei dieser neuen ambulanten Ausrichtung der Kehlkopfchirurgie bewerten.

Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician.Presentation of the current database to provide an overview of the etiology, progress and treatment for everyday clinical practice.Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature.The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided.The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed.HINTERGRUND: Die prolongierte ulzerierende Laryngitis ist eine seltene, gutartige, über Monate andauernde entzündliche Veränderung des Larynx. Der lupenlaryngoskopische Befund lässt einen malignen Prozess vermuten und kann somit eine Herausforderung für den behandelnden Hals-Nasen-Ohren-Arzt (HNO-Arzt) darstellen.Darstellung der aktuellen Datenlage, um einen für den klinischen Alltag hilfreichen Überblick über Ätiologie, Verlauf und Therapieoptionen zu geben.Präsentation von 3 Fallbeispielen aus der Abteilung für Phoniatrie und Klinische Logopädie der ORL-Klinik des Universitätsspitals Zürich. Analyse und Diskussion der aktuellen Studienlage und von Einzelfallberichten aus der englischsprachigen Literatur.Ätiologie und prädisponierende Faktoren sind unklar. Ein vorangegangener Atemwegsinfekt mit Husten und Heiserkeit scheint die häufigste Ursache zu sein. Die Erkrankung weist einen selbstlimitierenden Krankheitsverlauf ohne strukturell dauerhafte Folgen auf. Biopsien sollten vermieden werden.Der typische laryngoskopische Befund zeigt umschriebene korrespondierende lanzettförmige Ulzerationen im mittleren Stimmlippendrittel. Der Krankheitsverlauf scheint selbstlimitierend zu sein und ohne strukturell dauerhafte Folgen abzulaufen. Deswegen sollten eine gute Patientenaufklärung und engmaschige laryngoskopische Kontrollen vorgenommen werden.

Zusammenfassung Einleitung Bei symptomatischen Mastoidhöhlen nach Ohroperationen besteht die Therapie der Wahl in der chirurgischen Verkleinerung. Hierbei stehen verschiedene Methoden und Materialien zur Obliteration zur Verfügung. Allogenes Material ist leicht verfügbar, kann jedoch zu Wundinfektionen aufgrund von Abstoßungsreaktionen, Granulationen und Entzündungsreaktionen führen, weshalb autologes Material aufgrund seiner guten Biokompatibilität häufig bevorzugt wird. Ziel dieser Studie war es, die Langzeitergebnisse von Patienten nach Mastoidhöhlenobliteration mit allogenem und autologem Material im Hinblick auf das Auftreten von Rezidivcholesteatomen, die Anzahl der Revisionsoperationen und den Einfluss der Operation auf die Lebensqualität zu vergleichen. Methoden Patienten, die sich einer Mastoidhöhlenobliteration mit dem allogenen Material Hydroxylapatit-Matrix (HMM) unterzogen, wurden retrospektiv in die Studie eingeschlossen. In einem prospektiven Studienteil wurden Patienten eingeschlossen, welche sich einer Mastoidhöhlenobliteration mit autologem Rekonstruktionsmaterial (AutoM) unterzogen. Bei allen Patienten wurde neben einer ausführlichen Aktenanalyse eine Reintonaudiometrie durchgeführt und bei der postoperativen Untersuchung das Zürcher Mittelohrinventar (Zurich Chronic Middle Ear Inventory [ZCMEI-21]) zur Erhebung der gesundheitsbezogenen, krankheitsspezifischen Lebensqualität ausgefüllt. Ergebnisse Insgesamt wurden 22 Patienten mit einem durchschnittlichen Alter von 56,9 Jahren (SD 18,7 Jahre) und HMM (mittleres Nachuntersuchungsintervall: 88,3 Monate; SD 21,9 Monate) sowie 25 Patienten mit einem Durchschnittsalter von 52,4 Jahren (SD 13,7 Jahre) und AutoM (mittleres Nachuntersuchungsintervall: 13,5 Monate; SD 9,5 Monate) in die Studie eingeschlossen. Die audiologische Revisionsfreiheit lag nach einem Jahr für HMM bei 100% und für AutoM bei 85%. Die Rezidivfreiheit lag nach einem Jahr für HMM bei 95% und für AutoM bei 100%. Die Gruppen unterschieden sich weder hinsichtlich des postoperativen Hörergebnisses noch der postoperativen Lebensqualität. Diskussion Die Obliteration von Mastoidhöhlen ist eine chirurgische Herausforderung. Es zeigte sich kein relevanter Unterschied zwischen den verwendeten Materialien im Hinblick auf die Rezidivrate, das Hören und die Lebensqualität über den für beide Gruppen beobachteten Zeitraum von 13,5 Monaten. Die oft fehlende subjektive Symptomatik zusammen mit der hohen Rate an Rezidivcholesteatomen und Revisionsindikationen unterstreicht die Notwendigkeit einer regelmäßigen klinischen Nachsorge inklusive der Ohrmikroskopie bei chronischen Mittelohrerkrankungen und lässt regelmäßige Nachuntersuchungen dringend empfehlen.

ZusammenfassungDie Differenzialdiagnose von Erkrankungen des vestibulären Labyrinths stellt eine grosse Herausforderung dar, da sich hinter dem sehr häufigen Leitsymptom «Schwindel» viele verschiedene und v. a. seltene Erkrankungen verbergen können. Der vorliegende Beitrag gibt einen Überblick über die für den HNO-Arzt wichtigen seltenen Erkrankungen des vestibulären Labyrinths ausgehend von ihrer klinischen Präsentation als akutes (AVS), episodisches (EVS) oder chronisches vestibuläres Syndrom (CVS). Der Schwerpunkt liegt dabei auf den EVS, sortiert nach ihrer Dauer und dem Vorhandensein von Triggern (Sekunden, ohne Trigger: Vestibularisparoxysmie, Tumarkin-Krise; Sekunden, lärm- und druckinduziert: Syndrome des «dritten Fensters»; Sekunden bis Minuten, positionsabhängig: seltene Varianten und Differenzialdiagnosen des benignen paroxysmalen Lagerungsschwindels; Stunden bis Tage, spontan: intralabyrinthäre Schwannome, Tumoren des endolymphatischen Sacks, Autoimmunerkrankungen des Innenohres). Des Weiteren werden seltene Differenzialdiagnosen eines AVS (Neuritis vestibularis inf., Otolithenfunktionsstörungen, vaskuläre Ursachen, akute bilaterale Vestibulopathie) und eines CVS (bilaterale Vestibulopathie) erläutert. Dabei werden insbesondere die entscheidenden diagnostischen Massnahmen für die Identifikation der einzelnen Krankheitsbilder und die Warnzeichen für potentiell gefährliche Ursachen (z. B. Labyrinthinfarkt/-blutung) dargelegt. Somit dient dieser Beitrag dem HNO-Arzt in Klinik und Praxis als eine Art «Vademecum» für die zügige Identifikation und zeitnahe Therapie seltener Erkrankungen des Gleichgewichtsorgans.

Since most pharmacological treatments in case of esophageal food impaction (EFI) are unsuccessful, an endoscopy is usually required to resolve EFI. We present the first results of a budesonide orodispersible tablet (BOT) as a medical treatment option before endoscopy. We evaluated all patients with a suspected EFI to receive BOT before emergent endoscopy at a tertiary hospital between March 2019 and June 2020. A total of eight patients received BOT before endoscopy. Mean age was 50.1 years and 87.5% were male. In 38% (3/8) of patients the EFI resolved without endoscopic intervention. No adverse events occurred. After endoscopy, a diagnosis of EoE was established in 75%. This case series demonstrate the potential of BOT as medical rescue therapy in case of EFI.

Different types of chronic middle ear disease (CMED) present with differing severity of single symptoms, such as discharge, vertigo or hearing loss, which impair health-related quality of life (HRQoL). Here, we aimed to (i) investigate characteristics of HRQoL and (ii) evaluate the association between HRQoL and hearing among different types of CMED. In this prospective longitudinal cohort study, we included adult patients undergoing surgical treatment for CMED. Primary outcomes included HRQoL assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) and hearing assessed by pure-tone audiometry. In the included 108 patients (51% females), CMED were chronic otitis media (COM) with (n = 46) or without (n = 22) cholesteatoma, persistent mastoid cavity (with [n = 15] or without [n = 10] recurrent cholesteatoma), revision ossiculoplasty for hearing restoration (n = 14), and postinflammatory meatal fibrosis (n = 1). Preoperatively, the mean ZCMEI-21 score showed statistically significant differences among different types of CMED (p = 0.007) with persistent mastoid cavity without cholesteatoma exhibiting the highest score (34.1, SD 7.7) indicating poor HRQoL. At a mean follow-up period of 183 days, no statistically significant differences in the ZCMEI-21 scores among different types of CMED were observed (p = 0.67). This study objectifies differences in HRQoL among different types of CMED. In patients with indication for functional surgery only, e.g., persistent mastoid cavity without cholesteatoma, the worst HRQoL was observed. Yet, in these types of CMED, HRQoL guides decision for treatment. Moreover, differences in HRQoL among different types of CMED were not closely associated with hearing, but largely depended on other symptoms, such as discharge or vertigo.

Current surgical microscopes suffer from inherent constraints in achievable viewing angles and require manual interaction to control settings. Overcoming these limitations may provide benefits for otologic surgical procedures.We present a first feasibility and usability assessment of a novel commercial surgical microscope featuring a virtual-reality interface and hands-free control of a robot-mounted 3D-camera.Overall practicability of using the device for otologic procedures could be confirmed in theThe novel virtual reality 3D-microscope bears potential to provide benefits for various otologic procedures, which will be evaluated more quantitatively in clinical follow-up studies.

SUMMARY Objectives Semi–occluded vocal tract exercises are widely applied to improve vocal performance in speakers, singers, and voice patients. This study investigates immediate lip trill effects on standard voice assessment measures including voice range profiles, jitter, maximum phonation time, and Dysphonia Severity Index in vocally healthy women. Study Design Experimental study. Setting Otolaryngology clinic within tertiary hospital. Subjects and Methods Twenty-five vocally healthy women between 19 and 58 years (mean 38.4) were assessed before and after 3 minutes of standardized lip trill training combined with defined voice fundamental frequency and intensity modulations. Main outcome measures were fundamental frequency (F 0 ) during counting (F 0 counting), the singing voice range profile parameters minimum, maximum and range of F 0 and voice sound pressure level (voice SPL), jitter (%), maximum phonation time (MPT), and the Dysphonia Severity Index (DSI). Wilcoxon signed rank test was applied to determine significant changes after exercise. Results After exercise the singing F 0 and SPL range significantly increased from 549 (SD 217) to 612 (238) Hz and 45.1 (10.1) to 47.3 (9.8) dBA, resepctively ( P P 0 during counting showed a highly significant increase from 198 (SD 25.6) to 209 Hz (SD 25.4, P Conclusions In vocally healthy women, lip trill training immediately facilitates increases in mean F 0 during counting, and singing F 0 and SPL range. Future studies should investigate, if changes to these parameters indicate immediate responsiveness to voice exercise also in voice patients, and if these findings transfer to long-term effects through prolonged training.

Purpose To establish a standardized reporting system of cholesteatoma, the ChOLE classification has recently been introduced. We here aimed to systematically investigate the association between the ChOLE classification and (i) hearing, (ii) recidivism rate, and (iii) postoperative complications. These data may increase the utility of the ChOLE classification in clinical practice and research by stratifying patients according to expected outcomes or risks for complications. Methods In this prospective multicentric study, we included adult patients undergoing tympanomastoid surgery due to cholesteatoma. Main outcome measures included the association of the ChOLE classification system with (i) audiometric data including air conduction (AC) and bone conduction (BC) pure-tone average (PTA), and the air–bone gap (ABG), (ii) recidivism and complication. Results A total of 160 patients suffering from cholesteatoma were included. ChOLE stage distribution was stage I in 23 (14%), stage II in 128 (80%), and stage III in 9 (6%) patients. The ChOLE stage was associated with the postoperative AC PTA (p = 0.05) and the postoperative BC PTA (p = 0.02). Further, the status of the ossicular chain after surgery (ChOLE subdivision “O”) was associated with both the postoperative ABG (p = 0.0001) and the postoperative AC PTA (p = 0.003). Moreover, we found an association between complications (ChOLE subdivision “L) and both the postoperative BC PTA (p = 0.04) and the postoperative ABG (p = 0.04). No association between the ChOLE stage was found to both cholesteatoma recidivism and surgical complications. Conclusion The ChOLE classification is a new system to classify cholesteatomas. We provide evidence that hearing outcomes vary among different ChOLE stages. In particular, hearing outcomes are associated with the ChOLE subdivision “O” and “L”. Thus, the ChOLE classification system has a predictive value regarding hearing outcomes.

Prosthetic rehabilitation in patients undergoing reconstructive surgery using vascularized free flaps is challenging, and functional rehabilitation of the patient with a fixed prosthesis is rare. Virtually planned maxillofacial reconstruction including simultaneous dental implantation according to the prosthodontic ideal position of the implants could further enhance dental rehabilitation. The data of 21 patients undergoing fibula free flap reconstructive surgery with CAD/CAM patient-specific reconstruction plates during the years 2015-2018 were analysed, including the applicability of the virtual plan, flap survival, duration of surgery, ischemia time, simultaneous dental implantation, implant exposure, and postoperative complications. The virtual plan could be translated to surgery in all cases. In total, 76 dental implants were simultaneously placed during primary reconstruction in the 21 patients. For 38.1% of these patients, the implants could be uncovered in secondary surgery; the mean duration until exposure was 7.6 months. The implant survival rate was 97.4% (74/76). Wound infection requiring a secondary intervention occurred in 23.8% of patients during follow-up. Virtually planned reconstruction with a fibula free flap, simultaneous dental implantation, and CAD/CAM plates allows early and functional dental rehabilitation. A dental workflow should be integrated into the virtual planning, and prosthetically favourable implant positions should determine the position of the fibula segments.

Purpose This study analyzed the radiologic outcomes of patients with unilateral mandibular condylar fractures treated with open reduction–internal fixation (ORIF) through a transoral approach. Patients and Methods In this retrospective study, the radiologic images of 40 patients who underwent open reduction–internal fixation through a transoral approach were presented to 2 independent examiners. All patients underwent the surgical procedure between January 2015 and December 2016 at the Department of Cranio-Maxillofacial Surgery at UniversitatsSpital Zurich and were included in a previous functional outcome study. The surgical results were analyzed and graded as poor, acceptable, or good. The examiners declared whether they would have made any intraoperative revisions if the radiologic information had been available. Finally, the examiners estimated the required duration of elastic intermaxillary fixation (IMF) from the radiologic images, which was compared with the actual duration. Results Fracture reduction was classified as good in 33 cases (82.5%), acceptable in 5 cases, and poor in 2 cases by one examiner and as good in 32 cases (80%), acceptable in 6 cases, and poor in 2 cases by the other examiner. The inter-rater reliability was determined to be good (Cohen κ = 0.92). Correct osteosynthesis placement was found in 19 cases by one examiner and in 21 cases by the other examiner, with good inter-rater reliability (κ = 0.8). Moderate inter-rater reliability (κ = 0.4) was found for the required duration of elastic IMF. Furthermore, the estimated elastic IMF duration matched the actual duration in fewer than half of the cases. Conclusions It is feasible to achieve reliably good radiologic results when operating on condylar process fractures by a transoral approach with endoscopic assistance and angled instruments. Intraoperative 3-dimensional imaging enables instant quality control and prompts surgical revision if needed.

Objective To assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration. Methods Patients who had undergone canal wall-down mastoidectomy for chronic otitis media with creation of a persistent mastoid cavity and underwent revision tympanomastoid surgery including mastoid cavity obliteration using autologous material were included. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air–bone gap (ABG) were assessed. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively. Results A total of 25 patients (16 females and 9 males; mean age 51.6 years, 14 right and 11 left ears) were included. Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. Compared to the preoperative visit, patients showed a significantly reduced AC PTA at the postoperative visit (mean difference: − 4.1; SD = 10.4, p = 0.045). The mean ZCMEI-21 score changed from 31.7 (SD = 14.5) preoperatively to 17.4 (SD = 15.1) postoperatively (mean difference: − 14.3; SD = 19.1; p = 0.0002). The mean ZCMEI-21 score changes were neither correlated to the AC PTA shift (p = 0.60) nor to the ABG shift (p = 0.66). Conclusions This is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. The improvement in HRQoL was not correlated to the hearing improvement. As a clinical implication, we provide evidence for a substantial subjective benefit of the surgical obliteration of a symptomatic mastoid cavity and, therefore, encourage this surgical procedure.

BACKGROUND Knowledge of medial orbital wall (MOW) and anterior skull base (ASB) infiltration is of uttermost importance for staging and therapy planning of advanced sinonasal tumors. METHODS We assessed the diagnostic performance of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) for MOW and ASB infiltration compared to intraoperative exploration. RESULTS Both CT and MRI yielded higher diagnostic accuracy for MOW infiltration (Reader 1: 83.6% CT; 89.0% MRI, Reader 2: 91.8% CT, 93.2% MRI) than for ASB infiltration (Reader 1: 82.2% CT, 82.2% MRI, Reader 2: 67.7% CT, 67.7% MRI). Both modalities were equal to the gold standard, except for ASB assessment by Reader 2 with MRI. A postoperative change of T classification is common (Reader 1: 28.8%, Reader 2: 31.5%). CONCLUSIONS CT and MRI are accurate methods for the assessment of MOW infiltration. ASB assessment is challenging and false-positive and false-negative findings are common with both methods, emphasizing the need for intraoperative exploration.

Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

Single water swallow (SWS) high-resolution manometry (HRM) may miss relevant esophageal motility disorders. Solid test meal (STM) during HRM and lately the functional lumen imaging probe (FLIP) have been shown to be of diagnostic value in the assessment of motility disorders. We aimed to assess the diagnostic yield of STM and FLIP in non-obstructive dysphagia (NOD). Patients assessed for dysphagia with both HRM and FLIP between April 2016 and August 2019 were analyzed for signs of non-obstructive EGJ outflow obstruction (EGJOO) according to Chicago Classification 3.0 (CCv3) and CC adapted for the use with solid swallows (CC-S), followed by an individual group-specific analysis. Five subjects without dysphagia served as control group. Standard HRM- and FLIP-values as well as esophagograms and Eckardt Scores were analyzed. Forty-two patients were identified (male/female, 14/36, median age 62). Twenty-five (59.5%) were diagnosed with EGJOO during STM only (= SWS-negative patients; CC-S). The EGJ distensibility index (EGJ-DI) of symptomatic patients was significantly lower compared to the control group (p = 0.006). EGJ-DI was 2/mmHg in 67% and 88% of patients diagnosed according to CC-S and CCv3, respectively. The IRP during STM showed a significant association to the corresponding EGJ-DI values (p

Purpose The 8th edition of the TNM Cancer Staging Manual incorporates depth of invasion (DOI) into the pathologic tumor classification for oral squamous cell carcinoma (OSSC). While deep invading tumors with small tumor diameters (TD) have been categorized as early stage tumors in the 7th edition, they are now upstaged, potentially influencing the decision to initiate adjuvant radiotherapy (RT). Methods OSCC patients surgically treated with curative intent between 2010 and 2019 were consecutively included. Tumors were staged based on TD only (according to the 7th edition TNM Cancer Staging Manual), then restaged based solely on DOI. Results Of the 133 included patients, 58 patients (43.6%) had a different pT-stage when using DOI instead of TD for staging (upstaging in 23.3%). Overall survival (OS) was significantly worse in patients who were upstaged with DOI. In addition, stratification by adjuvant RT showed significant worse OS in upstaged patients without receiving adjuvant RT. Conclusions DOI seems to be an import indicator for adjuvant RT in OSCC-patients.

OBJECTIVE The aim of this study was to compare the mechanical properties of orthodontic aligners among different commercially available 3D printing devices. MATERIALS AND METHODS Five 3D printers (Ka:rv LP 550, Swinwon; "KAR"), (L120, Dazz 3D; "L12"), (MiiCraft 125, Miicraft Jena; "MIC"), (Slash 2, Uniz; "SLS") and (Pro 95, SprintRay; "PRO") were used to prepare orthodontic aligners with dental resin (Tera Harz TC-85DAW, Graphy). The central incisors of each aligner were cut, prepared and evaluated in terms of Martens-Hardness (HM), indentation-modulus (EIT ) and elastic-index (ηIT ) as per ISO14577-1:2002. Force-indentation curves were recorded and differences among printers were checked with generalized linear regressions (alpha=5%). RESULTS Statistically significant differences were seen for all mechanical properties (P

ZusammenfassungEine alltagseinschränkende, pathologische Stimmermüdung (Vocal Fatigue) wird v. a. bei BerufssprecherInnen (z. B. LehrerInnen) zunehmend beobachtet und als Indikator für komplexe Stimmstörungen betrachtet. Da bislang wenig systematische Studien zu diesem Phänomen existieren, fehlt bislang eine einheitliche Diagnostik. Anhand der Kasuistik eines Berufssprechers werden Möglichkeiten einer strukturierten Erhebung von Vocal Fatigue vorgestellt und im Hinblick auf ihre laryngoskopischen, instrumentell akustischen („performance fatigue“) und subjektiven Merkmale („perceived fatigue“) diskutiert. Zudem wird eine Abgrenzung zu den Modellen Vocal Effort, Vocal Demand und Vocal Demand Response nach Hunter et al. (2020) vorgenommen.

The purpose of this investigation of untreated monozygotic and dizygotic twins was to identify the genetic and environmental components to the facial soft tissue growth.The sample consisted of 52 untreated monozygotic twins (36 male and 16 female) and 46 untreated dizygotic twins (23 male and 23 female) from the Forsyth Moorrees Twin Study (1959-1975).Lateral cephalograms were taken at 12 and 17 years of age and traced to analyse facial convexity, nasolabial angle, upper and lower lip thickness, upper and lower lip profile and nose prominence. The genetic and environmental components of variance were analysed with structural equation modelling for multilevel mixed-effects model.At 12 years of age, strong additive genetic influence was seen for facial convexity (70%), upper lip profile (66%) and nose prominence (65%), whereas strong dominant genetic components were found for upper lip thickness (56%). Nevertheless, under unique environment influence were nasolabial angle (58%), lower lip profile (51%) and lower lip thickness (64%). At 17 years of age, only upper lip thickness (55%) and nose prominence (84%) were under strong additive genetic control, while the rest of the variables were under strong dominant genetic control. The only exception was lower lip thickness (61%), which is still influenced by the unique environment.Although monozygotic/dizygotic twins share at least part of their genome, at both times either additive, dominant or environmental components were found. Nevertheless, at 17 years of age most of the variables are either under additive or dominant genetic influence.

OBJECTIVES To identify the 10 most numerically prolific authors publishing in the field of orthodontics for each year over the last decade (2011-2020), describe the characteristics of these outputs and identify trends in the types of study being published. MATERIALS AND METHODS A Scopus literature search was conducted to identify the 10 most numerically prolific publishing authors in orthodontics for each year during this decade. Number and characteristics of all publications for each author were analysed with descriptive and inferential statistics. RESULTS Forty-nine different individual authors were identified who were collectively prolific for between 1-8 years within the assessment decade. These authors published a total of 2025 papers, with a median annual output of 18 papers per year; however, half of these authors published between 15-24 papers per year (range 5-200). Amongst authors, 2 or more collaborated on only 7% of the identified papers. The median number of authors per paper was 5 (range 1-27) with significant variation according to study design (P

Laryngopharyngeal reflux (LPR) is defined as backflow of gastral or gastroduodenal content into the upper aerodigestive tract and characterized by a variety of unspecific symptoms such as chronic cough, globus sensation, or mucus hypersecretion. Due to the lack of a gold standard and the heterogeneity of studies, the diagnosis of LPR is still problematic and challenging. However, in patients with characteristic symptoms and endoscopic findings, with an increased reflux symptom index, a pathologic reflux finding score (RFS), pathologic 24 h esophageal or oropharyngeal pH monitoring, and without any other underlying condition, the diagnosis of LPR is probable. In the following review, we critically discuss the abovementioned methods as well as more recent tools such as measurements of pepsin concentrations in the saliva for diagnosis of LPR.Der laryngopharyngeale Reflux (LPR) ist definiert als ein Zurückfließen von gastralem bzw. gastroduodenalem Sekret in den Larynx- bzw. Pharynxbereich und ist durch ein sehr breites Spektrum an teils unspezifischen Symptomen wie beispielsweise chronischem Husten, zervikalem Globusgefühl oder Hypersekretion von Mukus im Larynx und Pharynx charakterisiert. Aufgrund des Fehlens eines Goldstandards und der heterogenen Studienlage gestaltet sich die Diagnosestellung des LPR jedoch weiterhin schwierig und wird in absehbarer Zeit weiterhin kontrovers diskutiert werden. Insgesamt kann man jedoch davon ausgehen, dass bei suggestiver Anamnese mit erhöhten Scores im Reflux Symptom Index (RSI), entsprechenden endoskopischen Befunden mit pathologischem Reflux Finding Score (RFS) und auffälliger ösophagealer oder oropharyngealer 24-h-pH-Metrie ohne Hinweise auf eine andere Grunderkrankung die Diagnose eines LRP wahrscheinlich ist. In der vorliegenden Übersichtsarbeit sollen die genannten Methoden ebenso wie neuere Werkzeuge bei der Diagnose des LPR kritisch diskutiert werden.

Zusammenfassung: Im Gegensatz zu den nicht ungewöhnlichen Exostosen im äußeren Gehörgang, sind Hyperostosen/Osteome des inneren Gehörgangs (IG) rare Veränderungen. In der Kasuistik zeigte sich bei einer akuten sensorineuralen Schwerhörigkeit rechts eine Hyperostose im IG mit Einengung des Meatus acusticus internus beidseits. In der Literatur sind Ausfälle des VII. und VIII. Hirnnervs beschrieben, wobei ein Kausalzusammenhang kontrovers diskutiert wird. Entsprechend muss die Indikation zur chirurgischen Intervention äußerst zurückhaltend gestellt werden. Trotz der Aufarbeitung von fast 1000 Magnetresonanz(MRT)-/Computertomographie(CT)-Untersuchungen konnte keine weitere Hyperostose im Felsenbein nachgewiesen werden. Es handelt sich folglich um eine sehr seltene Erkrankung, welche als Differenzialdiagnose angesehen werden sollte.

Zusammenfassung Hintergrund Es sind unterschiedliche Knochenleitungshörgeräte (KLHG) verfügbar, die auf unterschiedliche Art mit dem Stimulationsort in Kontakt stehen. Ziel dieser Arbeit ist eine experimentelle Evaluation eines neuen transkutanen KLHG, das ohne Anpressdruck an die Haut angekoppelt wird. Material und Methoden Die Messungen wurden an einem Thiel-konservierten Ganzkopfkadaver durchgeführt. Zur Stimulation zwischen 0,1 und 10 kHz wurde ein Adhear verwendet, das über einen Signalgenerator und Verstärker direkt mit 1Vrms aktiviert wurde. Die Kopplung des KLHG erfolgte am Mastoid über ein Hautpflaster. Die Vibrationen des Schädels wurden am ipsi- und kontralateralen Promontorium und an der ipsi-, top- und kontralateralen Schädeloberfläche mittels 3D-Laser-Doppler-Vibrometers registriert. Insgesamt wurden ~200 Punkte auf der Schädeloberfläche (~15–20 mm Abstand) gemessen. Die Daten wurden mit entsprechenden Messungen verglichen, bei denen ein Baha Power als KLHG verwendet wurde. Dieses wurde am Mastoid über einen 5-Newton-Stahlbügel an die Haut gekoppelt. Ergebnisse Die ipsi- und kontralateralen promontorialen Vibrationen bei Stimulation mit dem Adhear sind in ihrer frequenzspezifischen Amplitude und Phase wie auch in der Zusammensetzung der Bewegungskomponenten mit der Stimulation mittels Baha Power am Stahlbügel vergleichbar. Ebenso erfährt die Schädeloberfläche unter beiden Ankopplungsarten eine vergleichbare komplexe räumliche Bewegung. Schlussfolgerungen Obwohl das Adhear ohne Anpressdruck und das Baha Power am Stahlband mit 5N an die Haut über dem Mastoid gekoppelt werden, unterscheiden sich die untersuchten Parameter kaum.

Background Head and neck cutaneous squamous cell carcinoma (HNCSCC) is a non-melanoma skin cancer that is mostly caused by solar ultraviolet radiation exposure. While it usually has an excellent prognosis, a subset of patients (5%) develops nodal metastasis and has poor outcomes. The aim of this study was to systematically review the literature and evaluate the prognostic factors of HNCSCC in order to better understand which patients are the most likely to develop metastatic disease. Methods A comprehensive literature search was performed on PubMed and EMBASE to identify the studies that evaluated the prognostic factors of HNCSCC. Prognostic factors were deemed significant if they had a reported p-value of Results The search yielded a total of 958 citations. Forty studies, involving a total of 8535 patients, were included in the final analysis. The pre-operative/clinical prognostic factors with the highest proportion of significance were state of immunosuppression (73.3%) and age (53.3%); while post-operative/pathological prognostic factors of importance were number of lymph nodes involved with carcinoma (70.0%), margins involved with carcinoma (66.7%), and tumor depth (50.0%). Conclusion This systematic review is aimed to aid physicians in assessing the prognosis of HNCSCC and identifying the subsets of patients that are most susceptible to metastasis. It also suggests that immunosuppressed patients with a high-risk feature on biopsy, such as invasion beyond subcutaneous fat, could possibly benefit from a sentinel lymph node biopsy. Graphical abstract

In the rare case of intractable, posterior, non-sphenopalatine artery epistaxis, ligation of ethmoidal arteries using an external approach like a Lynch-type incision is required. Orbital complications, especially extra-ocular motility disorders with diplopia, are known, but in the literature rarely described. Our aim was to analyse the complication type, rate, and outcome of ethmoidal artery ligation for epistaxis. Data between 2012 and 2017 of patients treated with ethmoidal artery ligation were analysed retrospectively and through a telephone interview using a non-standardized questionnaire. Data of 18 patients (m/f = 3/15) aged 53–83 years were reviewed. Epistaxis recurred in only one patient after 1 month. Five patients (28%) suffered from diplopia shortly after surgery. Motility analysis revealed full recovery with free motility in four out of five reported cases after 4–8 months, one patient still reports intermittent mild diplopia more than 1 year postoperatively. In patients with intractable, non-sphenopalatine artery epistaxis, anterior ethmoidal artery ligation was highly effective. Diplopia, however, occurred in one-third of our patient group. Information about motility restriction with longer standing diplopia are mandatory when consenting patients for ligation of ethmoidal arteries. Special care needs to be taken during dissection in the region of the trochlea and superior oblique muscle. Level of evidence: Case Series, level 4

Epithelial-myoepithelial carcinoma (EMC) can be a challenging diagnosis due to a lack of obvious invasion and bland cytology. We report an unusual case of a low-grade EMC with prominent fibrous stroma, an extensive solid-oncocytic differentiation and limited areas of morphological clearly identifiable characteristic biphasic (tubular) differentiation, clear cells and PAS-positive secretions/calcifications. Both areas were investigated by next generation sequencing (Oncomine comprehensive assay) and revealed a typical concordant HRAS p.Q61R mutation. An additional heterogeneous ARID1A (p.E672*) terminating mutation with loss of heterozygosity, which could be visualized predominantly in the solid-oncocytic differentiation by immunohistochemical loss of ARID1A protein expression, was found. This is the first case of an EMC of the salivary gland to be described with two separate tumor clones involving concordant HRAS and heterogeneous ARID1A mutations. The latter seem to be a "second hit" and was predominantly found in the solid-oncocytic differentiation, suggesting a potential morpho-molecular association.

OBJECTIVES: The aim of the present study was to investigate current treatment practices and self-reported effectiveness in Meniere’s disease. MATERIALS and METHODS: Members of two Italian Meniere’s disease support (n=170) with ≥6-month history of Meniere’s disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life, work, or travel as included in the Social Life and Work Impact of Dizziness Questionnaire before and after recent treatments were queried. RESULTS: Twenty-four different treatments were reported for Meniere’s disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being the most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments, 78%-89% of respondents indicated limitations in family or social life, work, or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6±4.6, p

Summary Objectives The validity and sensitivity to change of instrumental acoustic measurements in patients with functional dysphonia have been controversially discussed. This work examines combined voice therapy effects on standard acoustic measurements, and if these agree with perceptual and subjective voice outcomes. Study design Retrospective study. Methods Thirty-nine patients (26 women, 13 men) aged 20–70 years (mean: 46.3, standard deviation 12.8) with functional dysphonia were investigated before and after combined voice therapy. Instrumental parameters included mean and range of speaking fundamental frequency (fo) and intensity (SPL (dBA)); maximum SPL and mean fo of calling voice; minimum, maximum, range of singing voice fo and SPL, jitter (%), and the Dysphonia Severity Index. Voice Handicap Index-9 international was used for subjective and Grading-Roughness-Breathiness-Asthenia-Strain scale for perceptual assessment. Differences were investigated by Wilcoxon signed ranks test and coherences by Spearman rank correlation coefficient. Results After treatment, the speaking voice fo range (7–8.13 semitones) and SPL range (12.9–14.85 dB(A)) were significantly larger (P 0.05). Conclusions Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger fo and SPL speaking voice range after treatment indicate an altered voice technique. These instrumental measures may be clinical indicators of therapy success and transfer effects.

Patients with Fabry disease (FD) report impaired quality of life and excessive daytime sleepiness. Obstructive sleep apnea (OSA) is frequently reported among patients with FD; however, its prevalence and its influence on quality of life and daytime sleepiness in this population are unclear. Patients with FD in a cohort from the University Hospital Zurich (n = 52) were one-to-two matched to healthy adult controls (n = 104) according to age, sex, and body mass index. Participants underwent structured interviews (including Short Form-36) and level-3 respiratory polygraphy. An apnea-hypopnea index of ≥ 5/h was defined as OSA and the severity of FD was quantified with the Mainz Severity Score Index (MSSI). Conditional logistic regression was used to compare the outcomes. In patients with FD the mean MSSI was 13.3 ± 10.5 points and OSA prevalence was 19.2% vs. 9.0% in the matched control group (p = 0.09). The apnea-hypopnea index was significantly higher in patients with FD than in the control group (0.5/h [0.2–3.0] vs. 0.2/h [0.1–1.8], p = 0.026). OSA severity was associated with impaired quality of life in four dimensions for the whole study population. Furthermore, patients with FD did report significantly higher daytime sleepiness (Epworth Sleepiness Scale 7.6 points vs. 6.3 points; p = 0.01) than healthy controls. Patients with mild FD do not have a higher OSA prevalence than matched control subjects. Differences in OSA severity did not reach clinical significance. Further studies are warranted to determine the impact of OSA in patients with moderate-to-severe FD.

There are no instruments available to comprehensively assess health-related quality of life (HRQoL) in chronic otitis media (COM) in Italian-speaking countries. The Zurich chronic middle ear inventory (ZCMEI-21) is a well-established instrument for the assessment of HRQoL in COM. The objective of this study was to translate and cross-culturally adapt the ZCMEI-21 into Italian and validate this questionnaire for measuring HRQoL in patients with COM.Prospective multicenter study.Three University hospitals (northern Italy, central Italy, southern Italy).Adult patients suffering from COM (n = 128).Following international guidelines, the ZCMEI-21 was translated into Italian (ZCMEI-21-It). Validation was performed by psychometric test statistics. Moreover, ZCMEI-21-It total and subscale scores were compared and correlated with 1) the scores of the original validation study, 2) to a question that directly addresses HRQoL, and 3) to the scores of the EQ-5D-5L, a generic questionnaire assessing HRQoL.From three study centers, a total of 128 patients with COM were included. Cronbach's α was 0.86 indicating a high reliability. Between the ZCMEI-21-It total score and the question that directly addresses HRQoL, we found a strong correlation (r = 0.62, p 0.0001). Between the ZCMEI-21-It total score and the EQ-5D-5L scores, we expectedly found moderate correlations (descriptive system score: r = 0.39, p 0.0001; visual analog scale: r = 0.30, p = 0.008).We translated the ZCMEI-21 questionnaire into Italian and validated the ZCMEI-21-It in a prospective multicenter study. The ZCMEI-21-It is the first instrument that comprehensively assesses relevant dimensions of HRQoL in Italian-speaking patients affected by COM.

The aim of this study was to investigate the contralateral hearing of patients with sporadic vestibular schwannoma (VS).Retrospective cohort study.Pure-tone audiograms of the contralateral ear from patients with a wait-and-scan strategy were compared to the ones who received therapy. Due to a possible bias caused by the therapy, hearing thresholds before and after radiotherapy or surgery were compared separately with the wait-and-scan group.From 1979 to 2017, 508 patients with sporadic VS could be included in the study. Of these, 240 received regular controls in the sense of wait-and-scan, 72 underwent radiotherapy (63 audiograms before and 43 after radiotherapy), and 196 had a surgery (186 audiograms before and 146 after surgery). Age-normalized hearing thresholds of the contralateral ear from patients with a wait-and-scan strategy were compared to ones who received therapy. In addition, hearing thresholds were compared to norm values.There was no evidence for a difference in the contralateral hearing of patients with sporadic VS between the wait-and-scan and therapy groups. The mean difference of hearing thresholds in our sample to norm values was found to be larger for the high frequencies and more pronounced in male patients.There was no evidence for a difference in the contralateral hearing loss of patients with sporadic VS between the wait-and-scan and therapy groups. However, there was some indirect indication of poorer contralateral hearing in all patients with sporadic VS compared to normative values.

ObjectiveVentilation of the middle ear and mastoid air cells is believed to play an important role in the pathogenesis of chronic ear disease. Traditionally, ventilation is assessed by computed tomography. However, this exposes patients to cumulative radiation injury. In cases with a perforation in the tympanic membrane, tympanometry potentially presents a non-invasive alternative to measure the ventilated middle-ear and mastoid air cell volume. This study hypothesised that total tympanometry volume correlates with ventilated middle-ear and mastoid air cell volume.MethodTotal tympanometry volume was compared with ventilated middle-ear and mastoid air cell volume on computed tomography scans in 20 tympanic membrane perforations.ResultsThere was a high correlation between tympanometry and computed tomography volumes (r = 0.78; p < 0.001). A tympanometry volume more than 2 ml predicted good ventilation on computed tomography.ConclusionThese results may help reduce the need for pre-operative computed tomography in uncomplicated cases with tympanic membrane perforations.