Balloon Dilation of the Eustachian Tube: A Randomized Controlled Trial with 6 Months Follow-Up.

BACKGROUND: Obstructive Eustachian tube dysfunction in adults is common. The purpose of this study was to examine whether balloon dilation of the Eustachian tube can improve ventilation of the middle ear among adult patients with mild chronic Eustachian tube dysfunction. METHODS: This study included patients aged ≥18 years with unilateral chronic Eustachian tube dysfunction confirmed with an abnormal tympanometry and a retracted tympanic membrane. Patients were treated daily with nasal steroid spray and Valsalva maneuver for 2 months. If Eustachian tube dysfunction persisted, they were enrolled in the study and randomized to balloon dilation of the Eustachian tube or control. All patients underwent otomicroscopy, tympanometry, pure-tone audiometry and the Eustachian Tube Dysfunction Questionnaire-7. Follow-up visits were completed at 3 weeks, 3 months, and 6 months. RESULTS: In total, 24 patients completed the study (13 balloon dilation of the Eustachian tube, 11 control). The balloon dilation of the Eustachian tube group showed normalization from retraction or serous otitis media in 9 out of 13 patients (P = .0006) compared to 0 out of 11 patients in the control group. In the balloon dilation of the Eustachian tube group, 9 out of 13 patients showed an improvement in tympanometry from B to C/A or from C to A (P = .04) compared to 3 out of 11 patients in the control group. The audiometric data showed no difference (P = .38). There was no significant difference in mean Eustachian Tube Dysfunction Questionnaire-7 score between the two groups (P = .35). In the balloon dilation of the Eustachian tube group, 69% answered that they had benefitted from the treatment. CONCLUSION: The procedure is feasible and no complications were reported. The study indicates that balloon dilation of the Eustachian tube may be a beneficial treatment in a selected group of adult patients with mild chronic Eustachian tube dysfunction.

Hearing and Disease-Specific Health-Related Quality of Life in Patients with Otosclerosis after Stapedotomy - a Trial of the SPOT-25 Questionnaire.

BACKGROUND: The study aims to investigate the effect of stapedotomy on audiology measurements and the disease-specific health-related quality of life for patients with otosclerosis using the Danish Stapesplasty Outcome Test-25 as a quality of life measuring tool. METHODS: In this study, 50 patients who had undergone stapedotomy at our department between September 2017 and December 2020 were included. Data collection was performed by audiometric testing (pure tone and speech audiometry) in the pre- and postoperative settings. Health-related quality of life was assessed pre- and postoperatively in 30 patients using the validated Danish Stapesplasty Outcome Test-25. RESULTS: The mean improvement in air conduction thresholds was 27.7 dB and the mean improvement in air-bone gap was 21.8 dB. Health- related quality of life improved significantly after stapes surgery in all subscores of the Stapesplasty Outcome Test-25 (hearing, mental condition, social restriction, and general), except for "tinnitus." The improvement in the audiometric data correlated significantly with the improvement in "total score" and "hearing function" but not with "tinnitus," "social restrictions," and "mental condition." CONCLUSION: Stapedotomy leads to significant improvement in hearing and health-related quality of life. The Stapesplasty Outcome Test-25 can be used as a valuable supplement to the hearing test by assessing health-related quality of life.

[MRI for middle-ear cholesteatoma diagnostics].

Non-echoplanar diffusion-weighted magnetic resonance imaging (non-EPI-DWMRI) for depicting middle-ear cholesteatoma has a sensitivity as well as specificity at around 90%. It is the accumulated keratin, which results in a high-intensity signal. The detection limit is 3 mm. When applying non-EPI-DWMRI as part of post-operative follow-up, first scan is recommended around one year post-operatively followed by annual scans, until a possible recidive is expected to have reached the detection limit. In children, a closer follow-up is suggested, as paediatric cholesteatomas are more aggressive.

Validity and Test-Retest Reliability of the translated Stapesplasty Outcome Test 25 for Measurement of Disease-Specific Quality of Life in Patients with Otosclerosis.

OBJECTIVES: To assess the validity and test-retest reliability of the Danish Stapesplasty Outcome Test 25 (SPOT-25) version. MATERIALS AND METHODS: The German SPOT-25 questionnaire-consisting of 25 questions within the subscores "hearing function," "tinnitus," "mental condition," "social restrictions," and "general quality of life," found to be significant in terms of health-related quality of life in patients with otosclerosis-was translated into Danish in a three-step process according to the guidelines provided by the International Collegium of Rehabilitative Audiology. In total, 35 patients with otosclerosis were included as cases and 35 individuals without ear-problems as controls. The SPOT-25 questionnaire was filled out once by the patients and twice by the controls. Pure tone average (0.5, 1, 2, and 3 kHz) (PTA4) was obtained for cases. RESULTS: The SPOT-25 clearly discriminated the individuals with otosclerosis from con-trols within all subscores (p<0.001). The internal consistency within the subscores was good to excellent with Cronbach alpha values of 0.85-0.95. The reproducibility (estimated by the control group) was moderate to high, with an intraclass correlation of 0.58-0.94 within the subscores. Although the SPOT-25 subscores within "hearing" and "social restrictions" showed a moderate correlation with PTA4 (Pearson correlation coefficient 0.51 and 0.42, respectively), this was not the case for the subscores regarding "tinnitus," "mental condition," and the "general." CONCLUSION: The SPOT-25 questionnaire can be used as a valuable complement to audiometric data in patients with otosclerosis, especially for estimating factors such as tinnitus and "mental condition," which do not correlate with the audiometric data.

Validating the 7-item Eustachian Tube Dysfunction Questionnaire in Danish.

INTRODUCTION: Eustachian tube dysfunction (ETD) may result in hearing loss, chronic otitis and cholesteatoma. With advances in treatment options, the identification of patients with obstructive ETD is becoming increasingly important. The objective of this study was to validate a Danish translation of the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7). METHODS: All participants underwent tympanometry, otomicroscopy and completed the ETDQ-7. We included 34 ears from patients with obstructive ETD who had abnormal tympanometry curves but no history of cholesteatoma or adhesive otitis. As a control group, 48 otherwise healthy ears with a normal tympanometry curve were included from patients with known sensorineural hearing loss or normal hearing. RESULTS: A Cronbach's alpha of 0.77 indicated a good internal consistency reliability of the questionnaire. The mean ETDQ-7 score in the obstructive ETD group was 31 versus 13.5 in the control group (p = 0.00). A receiver operating characteristics analysis produced an area under the curve of 94%, showing excellent discriminatory abilities between the groups. CONCLUSIONS: The ETDQ-7 has previously been validated in English, German, Dutch and Portuguese, demonstrating good clinical relevance. The Danish translation of the ETDQ-7 has produced similar results and may be valuable in diagnosing obstructive ETD and in monitoring the effect of balloon dilation of the Eustachian tube. FUNDING: none. The study was approved by the Danish Data Protection Agency (VD-2018-33, I-Suite 6229).

Extracranial internal carotid artery tortuosity may cause vocal cord palsy.

BACKGROUND: Clinical practice made us suspect that vocal cord palsy (VCP) can be associated with extracranial internal carotid artery (ICA) tortuosity. OBJECTIVES: To find evidence for a causative relation between ICA tortuosity and VCP. METHODS: This single-center, retrospective study comprised 66 patients with VCP. A total of 45 patients without VCP served as control group. Patient charts were reviewed for etiology and side of VCP. CT scans were reviewed independently by two radiologists for imprint in the jugular vein (JV) caused by a tortuous ICA, considered an indirect sign of potential vagus nerve affection. RESULTS: A total of 33 patients had idiopathic VCP. ICA tortuosity causing a JV imprint with >10% JV lumen reduction was found more frequently on the paretic sides of patients with idiopathic VCP (15-24%) than in controls (3-9%), with p<.05 for observer 2 and p=.07 for observer 1. In patients with idiopathic VCP and JV imprint with >10% JV lumen reduction on one or both sides (n = 9), both observers found JV imprint with >10% JV lumen reduction more frequently on the side of VCP (p<.05). CONCLUSIONS: ICA tortuosity causing a JV imprint may be the cause of VCP in some of the cases of VCP currently regarded as idiopathic.

[Workup and treatment of Eustachian tube dysfunction in adults].

Symptoms of Eustachian tube dysfunction are frequent and multiple. Therefore, clear definitions and diagnostic criteria are important in order to achieve appropriate patient flow. So far, there has been a lack of consensus on this subject, but the proposed definitions and diagnostic criteria in this review may aid to achieve this. Tubomanometry is a diagnostic tool to evaluate Eustachian tube function, and balloon dilation of the Eustachian tube can be a helpful treatment in patients with Eustachian tube dysfunction.

Large discrepancies in otomycosis treatment in private ear, nose, and throat clinics in Denmark.

INTRODUCTION: Otomycosis is a fungal infection of the external ear canal that can involve the middle ear in case of tympanic membrane perforation and also extend to the auricle. Fungi cause 7-15% of external otitis. Diagnosing otomycosis is often based entirely on non-specific clinical signs and symptoms. A multitude of antifungal drugs are available. Some are ototoxic in animals, a few are proven safe, but the ototoxicity of many drugs remains unknown. The aim of this study was to describe how otomycosis was diagnosed and treated by private ear, nose, and throat (ENT) consultants in Denmark and to investigate if the patient's immune status and the presence of a tympanic membrane perforation affected the chosen treatment modality. METHOD: A questionnaire on the treatment of otomycosis was sent to 147 private ENT consultants. RESULTS: In total, 103 (70%) responded. 95% performed intensive aural cleaning using an otomicroscope. The initial diagnosis was based on symptoms as only 20% required to see fungal hypha. 42% sent material for culture and sensitivity (C + S) before starting treatment and 92% sent for C + S if treatment failed. 89% used a variety of topical antifungal drugs as the first line of medical treatment. Antiseptics were used in 5%. The presence of a tympanic membrane perforation did not alter the treatment modality. Only 13% treated immunocompromised patients differently. CONCLUSION: The initial diagnosis was based on non-specific symptoms and there were large discrepancies in the chosen antifungal treatment. Topical antifungal drugs were preferred. Additional research is needed. FUNDING: Department of Otorhinolaryngolgy and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark. The Danish Association of Research-interested Otorhinolaryngology Consultants: Kim Werther, Peter Tingsgaard, Mads Stougaard, Steen Telmer, Henrik Møller, Liviu Guldfred. TRIAL REGISTRATION: No trial registration was necessary as the questionnaire was anonymous and contained no patient data.

Graft take-rates after tympanoplasty: results from a prospective ear surgery database.

OBJECTIVE: To present a prospective ear surgery database and investigate the graft take-rate and prognostic factors for graft take-rate in tympanoplasty using the database. STUDY DESIGN: Prospective database study. SETTING: Tertiary referral center. PATIENTS: A total of 1606 cases undergoing tympanoplasty types I to IV were registered in the database in the period from February 2004 to November 2013. INTERVENTION: A total of 837 cases underwent myringoplasty/tympanoplasty type I. MAIN OUTCOME MEASURE: Graft take-rate and prognostic factors (age, discharge at time of surgery, tuba function, technique, graft material, and revision surgery) for tympanoplasty type I were studied. A comparison with the graft take-rates for tympanoplasty types II to IV and/or cholesteatoma was made. RESULTS: A user-friendly ear surgery database with fast data entry and direct import of audiometric data was developed. The graft take-rate was found to be 93.0% at 2 to 6 months and 86.6% at more than 12 months. Except for a discharging ear at the time of surgery, no significant differences using χ² test of association were found when comparing graft take-rates for different prognostic factors or more advanced tympanoplasty with or without cholesteatoma. A long-term graft take-rate overestimation of 6% was found if cases with defaulted follow-up because of early reperforation were not included. CONCLUSION: A prospective database can be used to study prognostic factors and reduce bias in reporting the graft take-rate. Prospective databases are needed for high-quality longitudinal studies but require a continuous and daily effort of involved surgeons and therefore need to be convenient and fast to use.

Comparison of two bone anchored hearing instruments: BP100 and Ponto Pro.

OBJECTIVE: This study aimed at investigating if there were differences in auditory performance, operation, or user preference between the Ponto Pro or the BP100, two bone anchored hearing instruments (BAHI) with modern sound processing technology. DESIGN: Subjects wore the devices in daily life in a crossover study for periods ranging from 25 to 63 days. A speech-in-noise test was carried out as well as measures of noise reduction and feedback suppression algorithms. User satisfaction was reported using the NSH and the GHABP questionnaires. At the end of the test, subjects selected one of the devices for permanent use. STUDY SAMPLE: Twelve first-time users of BAHIs. RESULTS: Eight subjects selected the Ponto Pro; four selected the BP100. The Ponto Pro was rated as easier to operate than the BP100, the visual appearance of the Ponto Pro was rated as nicer than that of the BP100, and speech understanding was rated higher with the Ponto Pro than with the BP100. Speech-in-noise tests showed improvements using directional microphones with the Ponto Pro. CONCLUSIONS: 67% of the subjects opted for permanent use of the Ponto Pro, which, compared to the BP100, was rated to have a nicer look, to be easier to operate, and to yield better speech intelligibility.

Effect of vasoactive intestinal peptide and pituitary adenylate cyclase-activating polypeptide on pancreatic, hepatic and duodenal mucosal bicarbonate secretion in the pig.

BACKGROUND AND METHOD: The potency of pituitary adenylate cyclase-activating polypeptide (PACAP) and the related vasoactive intestinal peptide (VIP) on pancreaticobiliary and duodenal mucosal bicarbonate secretion (DMBS) was studied in anaesthetized pigs. VIP, PACAP27 and PACAP38 were infused at doses of 250, 500, 1,000, 2,000 and 6,000 pmol/kg x h. RESULTS: Infusion of VIP in these concentrations increased the portal plasma concentrations of VIP from 9 to 102, 220, 600, 850 and 3,795 pM, respectively. At doses of 1,000 and 6,000 pmol/kg.h all three peptides significantly stimulated pancreatic bicarbonate secretion, VIP from 0.0 to 0.3 and 7.6 mmol/h, PACAP27 from 0.0 to 2.3 and 8.2 mmol/h, and PACAP38 from 0.0 to 0.2 and 7.4 mmol/h, respectively. Only during infusion of 6,000 pmol/kg.h did the three peptides elicit a significant increase in hepatic bicarbonate output. At this dose VIP increased hepatic bicarbonate output from 0.4 to 3.8 mmol/h, PACAP27 from 0.3 to 3.6 mmol/h, and PACAP38 from 0.1 to 1.4 mmol/h, respectively. Infusion of VIP (500, 1,000, 2,000 and 6,000 pmol/kg.h) dose-dependently and significantly enlarged DMBS from 0.09 to 0.19, 0.41, 0.54 and 0.53 mmol/h, respectively. A significant effect of PACAP27 and PACAP38 on DMBS was only obtained at a dose of 6,000 pmol/kg.h, and at this dose VIP-induced DMBS was 4- and 8-fold higher than that induced by PACAP27 and PACAP38, respectively. CONCLUSIONS: VIP, PACAP27 and PACAP38 all have a pharmacological effect on both DMBS and pancreaticobiliary bicarbonate secretion. When comparing these results with the distribution of VIP/PACAP neurons and relevant receptors, it seems likely that VIP and PACAP have a physiological importance as neurotransmitters in the pancreas and duodenum, but not in the liver. The differences in the effect of VIP and PACAP on DMBS observed in this study indicate that there are variations between pancreatic and duodenal PACAP/VIP receptor subtypes, or that the duodenal inactivation of the peptides is different from the inactivation in the pancreas.