Comparison of endoscopic and microscopic stapedotomy in the same patients: a prospective randomized controlled trial.

PURPOSE: This study aimed to conduct a comparative analysis of audiological and postoperative clinical outcomes between the endoscopic and microscopic stapedotomy approaches. METHODS: This study employed a randomized, controlled design. Twenty-seven patients with bilateral otosclerosis underwent stapedotomy in both ears, with randomized allocation of the surgical technique (endoscopic vs. microscopic) for the first operated ear. Air-bone gap (ABG) and ABG gain were measured at least 12 months postoperatively. Postoperative outcomes including pain (Visual Analog Scale-VAS), dizziness, early-term (day 1) and late-term (6 months) dysgeusia were evaluated. The Glasgow Benefit Inventory (GBI) assessed health-related quality of life at one month postoperatively, and operative time was measured. RESULTS: This study compared endoscopic (n = 27 ears) and microscopic (n = 27 ears) stapedotomy for otosclerosis. Both groups achieved similar hearing improvement with no significant differences in pre-operative and post-operative bone/air conduction thresholds, ABG, and ABG gain (all p > 0.05). The endoscopic stapedotomy group demonstrated reduced postoperative pain (lower VAS scores, p < 0.001), lower early dysgeusia (3.7% vs. 33.3%, p = 0.005), shorter operative time (47.3 vs. 75.4 min, p < 0.001) and improved patient-reported outcomes (higher GBI score, p = 0.014) when compared to microscopic stapedotomy group. No significant differences were observed in postoperative dizziness or late-term dysgeusia between groups. CONCLUSION: This study found similar hearing improvement with both endoscopic and microscopic stapedotomy for otosclerosis. However, the endoscopic approach showed advantages in reduced postoperative pain, early dysgeusia, and operative time, with improved patient-reported quality of life. These findings suggest endoscopic stapedotomy as a valuable alternative to the conventional microscopic approach.

The Comparison of Electroacoustic and Subjective Voice Quality in Type 3 and 4 Transoral Laser Cordectomy for Early-Stage Glottic Carcinoma.

One of the main issues in early-stage glottic carcinoma management is the voice quality following different types of treatment modalities. In type 3 and 4 transoral laser cordectomies, the voice outcomes can show significant differences due to the extent of the vocal muscle resection. This study aims to compare the voice quality in patients who underwent type 3 and 4 laser cordectomy for early-stage glottic carcinoma. A total of 30 patients who underwent type 3 (15 patients) and type 4 (15 patients) laser cordectomy for T1a glottic carcinoma between May 2018 and 2020 were included in this retrospective comparative study. Electroacoustic voice analysis and Voice Handicap Index-10 were performed in the postoperative twelfth month and the outcomes were compared between two laser cordectomy groups. The mean age of all patients was 48.6 ± 4.2 years. Noise-to-harmonic ratio, jitter, shimmer, pitch perturbation quotient and amplitude perturbation quotient values were significantly different between two groups (p < 0.05). Fundamental frequency and Voice Handicap Index-10 scores showed no statistically significant difference (p > 0.05). This study reports significantly better results for type 3 against type 4 laser cordectomy by means of objective voice analysis outcomes, except fundamental frequency. On the other hand, self-reported subjective analysis showed very similar results for both groups. Further studies combining data with multiple objective and subjective analyses with larger patient series and longer follow-up are warranted.

Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures.

It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.

Cartilage Chips in Rhinoplasty.

OBJECTIVE: This study reveals that the cartilage chips can be a good solution for camouflage and augmentation in rhinoplasty. METHODS: In this study, 64 patients who had undergone rhinoplasty from 2014 to 2019 were retrospectively studied. The average age was 31. Forty-nine patients had primary and 15 revision rhinoplasties. Cartilage chips were cut into less than 0.5-mm thickness dimensions changing from 2 to 10 mm. They were used to fill deep radix, depressions at the key area, supratip area, around the grafts to prevent their visibility at the tip. In addition, they were used in the fascia for augmentation. The cartilage chips were sculpted from the septal cartilage in 47, rib in 16, and ear cartilage in one case. RESULTS: They were applied on the radix in 25, middle vault in 37, supratip area in 32, and on the tip in 12 cases. In 30 cases, cartilage chips were mixed with cartilage dust for better fixation and camouflage. They were placed in the fascia in three cases for dorsal augmentation. Complications were seen in three cases in the form of irregularities. CONCLUSION: Cartilage chips are found to be a powerful solution in terms of camouflage and augmentation.

The new "cubism" graft technique in tympanoplasty: A randomized controlled trial.

OBJECTIVES: The aim of this prospective, randomized-controlled study is to analyze the outcomes of a new graft technique in tympanoplasty and compare its outcomes with cartilage island graft plus extra perichondrium. METHODS: A total of 44 patients with noncomplicated chronic otitis media were included in this prospective randomized-controlled clinical trial. Patients were randomly divided into 2 double-layer graft groups: The cartilage island graft + cubism graft (study group) and the cartilage island graft + extra perichondrium (control group). The main outcome measures of the study were the air-bone gap (ABG), ABG gain, and graft status. RESULTS: Graft success rate was 100% and 95.5% in the study group and the control group, respectively. There were statistically significant differences in the postoperative first month ABG and ABG gain between study and control groups (P < .05). ABG and ABG gain showed no significant differences in the postoperative sixth month between groups (P > .05). CONCLUSION: This study revealed that both graft techniques have satisfactory functional and morphological results compared to preoperative findings. The use of cubism graft with cartilage island graft has significantly better auditory outcomes in short-term and similar results in long-term compared to double-layered cartilage island graft with extra perichondrium. Cubism graft is a highly promising graft technique with its many advantages. LEVEL OF EVIDENCE: 1b.

A novel graft-harvesting technique in tympanoplasty: the cubism graft.

BACKGROUND: The slicing method that is used for thinning the cartilage graft may cause forming complications in tympanoplasty. Besides, double-layered grafting techniques may be required when graft medialization is observed. METHOD: This article presents a new and controlled graft cartilage thinning and the cubism graft-harvesting technique in tympanoplasty. CONCLUSION: Thanks to this new technique, over-curling and undesirable fractures of the cartilage island graft can be prevented and the obtained cartilaginous dust can be mixed with platelet-rich fibrin to form the cubism graft. This combined cartilage thinning and cubism graft technique provided 100% graft success and an average air-bone gap gain of 16.3 ± 2.9 dB (10.7-22.3 dB) in our series of 22 patients. In conclusion, 100% graft success, successful tympanic membrane re-epithelialization and significant auditory improvement can be achieved with this method.

Evaluation of significant gene expression changes in congenital and acquired cholesteatoma.

Etiopathogenesis of acquired and congenital cholesteatoma is still unclear. The clinical behavior of adult acquired, pediatric acquired and congenital cholesteatomas show differences. The scope of the this study was to detect the matrix metalloproteinase (MMP), tissue inhibitors of metalloproteinase (TIMP) and epidermal growth factor receptor (EGFR) gene expression changes in cholesteatoma perimatrix and to compare these changes among congenital cholesteatoma, adult acquired cholesteatoma and pediatric acquired cholesteatoma. A total of 16 genes including MMPs, TIMPs and EGFR were analyzed in the samples of 32 cholesteatoma tissues. Real-time PCR was used for detection of the gene expression levels. Data analyses were achieved by ΔΔCT method (Light Cycler 480 Quantification Software) and Statistical Package for Social Sciences (SPSS) version 22.0. The expression levels of MMP-2, -9, -10, -11, -13, -14, -15, -16 and EGFR genes were significantly higher in acquired cholesteatoma than healthy tissue (p < 0.05). There was a statistically significant decrease (3.34 times more) in the mean TIMP-2 gene expression level in acquired cholesteatoma compared to healthy tissue (p < 0.05). There was a significant increase in the mean expression level of MMP-7 gene and a decrease in the mean expression level of TIMP-1 gene (3.12 times more) in congenital cholesteatoma compared to healthy tissue (p < 0.05). This study indicates that increased expression levels of some particular MMP genes and EGFR gene and decreased expression levels of TIMP genes may play an important role in the development of cholesteatoma. Further, MMP-9, MMP-13 and MMP-14 genes may have a remarkable role in the development of more aggressive cholesteatoma forms. The authors concluded that overexpression of MMP-9, MMP-13 and MMP-14 may cause stronger inflammation associated with cholesteatoma.

Transcutaneous Suture Tip Plasty: The Technique and Outcomes.

PURPOSE: Radical resections and invasive techniques have been mostly replaced with more conservative techniques. The aim of this study was to assess the objective and the subjective functional and aesthetic outcomes of transcutaneous suture tip plasty. METHODS: A total of 20 patients were included in the study. Patients were treated with transcutaneous suture tip plasty. Functional results were assessed with pre- and postoperative 6-month Sino-Nasal Outcome Test (SNOT-22) and acoustic rhinometry. The pre- and postoperative 6-month mean values of first minimal cross-sectional area (MCA1), second minimal cross-sectional area (MCA2), the distance from the tip of the probe to the first minimal cross-sectional area, the distance from the tip of the probe to the second minimal cross sectional area, nasal volume 1, and nasal volume 2 were measured. Facial analysis was made with the Rhinobase software, designed for facial analysis. RESULTS: The mean pre- and postoperative SNOT-22 scores were 25.55 ± 6.64 and 15.70 ± 8.11, respectively (P < .05). The mean pre- and postoperative nasolabial angles were 82.26º ± 5.69º and 101.47º ± 7.70º, respectively (P < .05). The mean pre- and postoperative nasofrontal angles were 144.30º ± 3.81º and 138.25º ± 3.26º, respectively (P < .05). The mean pre- and postoperative nasal length was 54.22 ± 4.62 mm and 49.95 ± 2.75 mm, respectively (P < .05). The mean pre- and postoperative tip projection was 25.77 ± 3.64 mm and 28.40 ± 2.97 mm, respectively (P < .05). Only postoperative MCA2 values on the right and left side were significantly different from preoperative MCA2 values (P < .05). None of the remaining postoperative acoustic rhinometry scores significantly differed from preoperative scores. Two patients (10%) required revision at around 1 month after surgery due to suture loosening and breakage. CONCLUSIONS: Especially in the era of minimal invasive surgery, transcutaneous suspension tip plasty is promising, with rapid and reliable functional and cosmetic results. Further studies with longer follow-up durations are needed to assess the long-term outcomes of this technique.