Comparison of trigeminal lateralization with differing stimulants

Trigeminal-specific stimulants have been shown to activate different receptors preferentially and this likely accounts for variation in sensory perception.It is unclear whether trigeminal sensitivity is similar across different transient receptor potential(TRP)receptors or if dysfunction of different receptors results in differing patient symptoms.Therefore,a prospective cohort study was conducted,consisting of trigeminal lateralization testing with three different stimulants(eucalyptol,isothiocyanate,acetic acid),olfaction testing with Sniffin'Sticks,and measurement of various patient‐reported outcome measures(PROMs).A total of 50 participants were enrolled across the olfactory spectrum.Mean TDI score was 27.1±8.3(range 7.0–39.5)with 38%normosmic and 62%dysosmic.Mean trigeminal lateralization scores out of 20 in the overall cohort were 16.18(2.78)for eucalyptol,14.94(3.49)for mustard oil,and 15.28(3.68)for vinegar.Eucalyptol showed a significant correlation with threshold scores of Sniffin'Sticks.A significant correlation was found between acetic acid and various PROMs.None of the lateralization scores of the trigeminal stimulants correlated to each other significantly and there was no correlation to age.The lack of correlation suggests that the measured sensitivity of one type of TRP receptor may not translate to similar sensitivity of the other receptors.Additional investigations with TRPV1 and TRPA1 agonists are needed to corroborate our findings.

Identification of microbial contaminants in sinus rinse squeeze bottles used by allergic rhinitis patients

Objective:To identify whether irrigation devices become contaminated when used by patients with allergic rhinitis (AR).Methods:Ten AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus rinse system and instructed on its proper use,cleaning,and storage.Two squeeze bottles (bottle A and bottle B) were given to each patient for twice-a-day rinsing.Bottle A was used in the morning and analyzed after four weeks.Bottle B was used in the evening and analyzed after 8 weeks of use.Microbial contaminants were cultured from the nose pieces and the inner surface of the bottles obtained from patients.Results:Seventeen sinus rinse devices (17/20) from all individuals in this study grew bacteria commonly in the nozzles.Twenty-four bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus.In addition,no correlation was apparent between the length of bottle use and the degree of contamination (r =0.13,p =0.76).During the study period,no patient developed acute sinus infections.Conclusion:Microbial contamination of the sinus rinse system occurs commonly,even in uninfected AR patients;however no evidence exists linking this to clinically relevant sinus infections.

The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis

Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for alternative therapies.Upper airway surgery is one alternative,but substantial side effects hamper efficacy.A new alternative is an implantable hypoglossal nerve stimulator (HNS).These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery.Several recent trials investigated the efficacy of these devices.The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.Methods:A comprehensive literature search of PubMed and Scopus was performed.Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults.Studies with objective and subjective endpoints in sleep were included for analysis.Adverse events from trials were also recorded.Results:Across 16 studies,381 patients were analyzed.At 6 months (p =0.008),mean SAQLI improved by 3.1 (95%CI,2.6-3.7).At 12 months (p < 0.0001),mean AHI was reduced by 21.1 (95%Cl,16.9-25.3),mean ODI was reduced by 15.0 (95%CI,12.7-17.4),mean ESS was reduced by 5.0 (95%CI,4.2-5.8),mean FOSQ improved by 3.1 (95%CI,2.6-3.4).Pain (6.2%:0.7-16.6),tongue abrasion (11.0%:1.2-28.7),and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events.Conclusions:HNS is a safe and effective treatment for CPAP refractory OSA.Further study comparing HNS to other therapies is required.

Update on oral and oropharyngeal cancer staging-International perspectives

Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.

Is the incidence of anaplastic thyroid cancer increasing: A population based epidemiology study

Objective:To provide an understanding of the incidence of anaplastic thyroid cancer within the United States.Methods:Patients in the Surveillance,Epidemiology,and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of anaplastic thyroid cancer using ICDO-3 codes.Patients were categorized into cohorts based on their year of diagnosis.Results:1527 patients were diagnosed with anaplastic thyroid cancer within the SEER 18 registries.The age-adjusted incidence rate was 0.2 per 1,000,000 people (95% CI:0.0-0.5) in 1973 and was 1.2 per 1,000,000 people (95% Cl:0.8-1.6) in 2014 (average annual percent change:3.0% [95% CI:2.2%-3.7%]).Patients tended to be of older age (mean age:70.5 [range 15.0-102.0]),of female sex (62.8%),and Caucasian (81.1%).Finally,survival over time remained the same,as median disease specific survival months was 4.00 (95% CI:2.26-5.74) from 1995 to 1999 and 4.00 (95% Cl:3.26-4.74) from 2010 to 2014.Conclusions:The incidence rate of anaplastic thyroid cancer has increased from 1973 to 2014.Interestingly,median survival in months did not greatly change overtime.Based on this increasing incidence,physicians must act appropriately to identify patients with anaplastic thyroid cancer as it possesses a high morbidity and mortality.

Anosmia, hyposmia, and dysgeusia as indicators for positive SARS-CoV-2 infection

Introduction As cases of the novel coronavirus,also known as severe acute respiratory syndrome coronavirus 2(SARS-Cov-2)continue to rise,the way in which healthcare is practiced has been markedly impacted.The presence of this new threat has changed the paradigm of society as many self-quarantine,socially distance,and avoid contact to mitigate the rapid spread of the virus.As new evidence regarding SARS-Cov-2 from the World Health O'rganization(WHO)and Central of Disease Control and Prevention(CDC)are reported,medical practice guidelines are in constant flux regarding patient care.In the span of the recent weeks,elective surgeries have been cancelled,non-urgent office visits rescheduled,and even practice of physical exams and diagnostic tests have changed.

Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea

Objective:Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA).Method:Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic.Those who underwent concurrent palatal or tongue base sleep surgery were excluded.Outcomes included simultaneous procedures,apnea-hypopnea index (AHI),lowest oxyhemoglobin saturation (LSAT),and Epworth Sleepiness Scale (ESS).Results:Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery.The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71％).Concurrent procedures included the following:torus mandibularis excision (n =1),endoscopic sinus surgery (n =4),septoplasty (n =10),inferior turbinate reduction (n =12),and nasal valve repair (n =2).AHI improved signiflcantly from (39.7 ± 21.2) eventslh to (22.6 ± 22.7) events/h after HMS (P ＜ 0.01),which represented a 43％ reduction.LSAT significantly increased from (82.2％ ± 9.9％) to (86.6％ ± 6.2％),P ＜ 0.01.There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2),P =0.904.A subset of patients with severe OSA (AHI ＞ 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h,P ＜ 0.01.Conclusion:HMS without palatal or tongue base sleep surgery improves OSA severity.It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.

Is SARS-CoV-2 (COVID-19) postviral olfactory dysfunction (PVOD) different from other PVOD?

Background:The SARS-CoV-2 virus continues to spread rapidly across the globe af-flicting many with Coronavirus Disease 2019(COVID-19).As the infection rates rise,a growing number of SARS-CoV-2 positive individuals have been reported to complain of olfactory distur-bances at an alarming rate.Postviral olfactory dysfunction(PVOD)is a well-known phenome-non that may explain the olfactory dysfunction reported by SARS-CoV-2 infected individuals.Methods:A scoping literature review was performed to identify studies that investigated the mechanisms of postviral olfactory dysfunction.Studies demonstrating pathophysiological,his-tological,immunochemical,and epidemiological outcomes of PVOD were included.Results:Fourteen studies were included in addition to one international news article.Three studies reported destruction of the olfactory epithelium following intranasal inoculation of various viral strains in mice.Three studies isolated pathogenic,anosmia inciting viruses(Para-influenza virus,Human Coronavirus,Rhinovirus)through nucleic acid amplification.Eleven studies demonstrated female predilection in patients with PVOD and COVID-19 associated ol-factory dysfunction,of which the majority were over 50 years old.Conclusions:PVOD and COVID-19 associated olfactory dysfunction demonstrates considerable similarities in epidemiological trends and disease sequela of other viruses to suggest identical pathophysiological mechanisms.Further studies such as intranasal inoculation and histological biopsies are needed to support our hypothesis.

Telehealth in the times of SARS-CoV-2 infection for the otolaryngologist

Objective:In response to the American Academy of Otolaryngology e Head and Neck Surgery’s recommendations to limit patient care activities in the times of SARS-CoV-2,many elective surgeries have been canceled without patient clinics transitioning to virtual visits.With regulations for telemedicine loosened,new possibilities for the practice of otolaryngology have opened.To address the uncertain duration of this pandemic,a review was conducted of current literature on use of telemedicine services in the current SARS-CoV-2 pandemic and in previous national emergencies to reveal the role telemedicine can play for otolaryngology practices.Data sources:Pubmed articles with an independent search query were utilized.Methods:Literature review performed by one author searched for all published Englishlanguage literature on telehealth in the SARS-CoV-2 era.Articles were considered for discussion if they provided relevant developments for telemedicine in the context of the SARSCoV-2 pandemic.Results:Telemedicine can be up-scaled in the current SARS-CoV-2 pandemic where exposure containment is of the utmost priority.With patient interaction possible through virtual communication,telemedicine allows continued patient care while minimizing the risk of viral spread.In the realm of otolaryngology,telemedicine has been used in the past during disasters with other studies demonstrating high diagnostic concordance with inpatient visits.Many institutions have recognized the potential for such care as they begin utilize both virtual visits and in-person care during this pandemic.Conclusion:To limit the spread of SARS-CoV-2,we support the AAO-HNS recommendation for the adoption of novel ways to employ telemedicine in this era.Many emergency departments and health care systems have the infrastructure necessary for synchronous video telemedicine visits that can be leveraged to provide quality care with patients.With the continued need to socially distance,telemedicine can protect both physicians and patients from unnecessary exposure to the virus.

Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy

Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.

Programmed death 1 (PD-1) and ligand (PD-L1) inhibitors in head and neck squamous cell carcinoma: A meta-analysis

Background: PD-1 and PD-L1 inhibitors have emerged as promising treatments for patients with head and neck squamous cell carcinoma (HNSCC).Methods: Systematic review and meta-analysis of PD-1 and PD-L1 inhibitors in HNSCC. Outcomes: median overall survival (mOS), median progression-free survival (mPFS), Response Evaluation Criteria in Solid Tumors (RECIST) and treatment-related adverse events (TRAEs).Results: Eleven trials reported data on 1088 patients (mean age: 59.9 years, range: 18-90). The total mOS was 7.97 months (range: 6.0-16.5). Mean mPFS for all studies was 2.84 months (range: 1.9-6.5). PD-1 inhibitors had a lower rate of RECIST Progressive Disease than PD-L1 inhibitors (42.61%, 95% confidence interval [CI]: 36.29-49.06 vs. 56.79%, 95% CI: 49.18-64.19,P < 0.001). The rate of TRAEs of any grade (62.7%, 95% CI: 59.8-65.6) did not differ.Conclusions: Meta-analysis shows the efficacy of PD-1 and PD-L1 inhibitors in HNSCC and suggests a possible difference in certain RECIST criterion between PD-1 and PD-L1 inhibitors. Future work to investigate the clinical significance of these findings is warranted.

Preferences in stapes surgery among American otological society otologists

Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

Hyperbaric oxygen therapy in malignant otitis externa:A systematic review of the literature

Objective:To review the role of adjuvant hyperbaric oxygen therapy(HBOT)in the treatment of malignant otitis externa(MOE).Data sources:PubMed,Scopus,Web of Science,Science Direct,and Cochrane Library were searched for the following concepts:“hyperbaric oxygen”and“malignant or necrotizing otitis externa.”Methods:Studies were included if they contained(1)patients with reported evidence of MOE,(2)employment of adjuvant HBOT,(3)details on patients’medical condition,and(4)documented survival outcomes.Extracted information included patient demographics,underlying medical conditions,infectious etiology,signs and symptoms,medical and surgical treatments,duration of medical treatment,mean follow up time,HBOT setting,number of HBOT sessions,complications,survival rate,and all-cause mortality.Results:A total of 16 studies comprising 58 patients(mean age 68.0 years)were included.Diabetes was present in 94.7%of cases and Pseudomonas spp(64.3%)was the most common infectious agent.Cranial nerve VII was involved in 55.2%of cases.Overall,the disease cure rate with adjuvant HBOT was 91.4%and all-cause mortality was 8.6%.Among those who had cranial nerve VII involvement,72.0%had return of function and 93.8%of them survived.Conclusion:HBOT may be an effective treatment option for refractory or advanced MOE but its efficacy remains unproven due to lack of strong scientific evidence.However,its therapeutic value should not be underestimated given good results and few adverse events reported in this study.

Emergent and urgent otologic surgeries during the SARS-CoV-2 pandemic: a protocol and review of literature

Objective:To review guidelines for otologic procedures during the SARS-CoV-2 pandemic and to present a protocol for emergent or urgent mastoidectomy at our institution.Data sources:Guidelines regarding emergent and urgent otologic procedures from otolaryngo-logic societies are reviewed.We described a protocol for emergent or urgent mastoidectomy at our institution.Conclusion:Patients requiring urgent or emergent mastoidectomy during the COVID-19 pandemic require prompt treatment.We make the following recommendations:Emergent or urgent otologic procedures should be performed in a contained environment,such as a tent created by the microscope drape.The surgical team should practice using instruments in the tent setup to prepare for real cases.Otologic procedures should adhere to guidelines set for high-risk procedures.

Neck dissection does not add to morbidity or mortality of laryngectomy

Objectives:To examine the national rates of complications,readmission,reoperation,death and length of hospital stay after laryngectomy.To explore the risks of neck dissection with laryngectomy using outcomes.Methods:The American College of Surgeons National Quality Improvement Program(ACS-NSQIP)database was reviewed retrospectively.The database was analyzed for patients undergoing laryngectomy with and without neck dissection.Demographic,perioperative complication,reoperation,readmission,and death variables were analyzed.Results:754 patients who underwent total laryngectomy during this time were found.Demographic analysis showed average age was 63 years old,566(75.1%)were white,and 598(79.3%)were male.Of these patients,520(69.0%)included a neck dissection while 234(31.0%)did not.When comparing patients who received a neck dissection to those who did not,there were no significant differences in median length of hospital stay(12.5 days w/vs.13.3 days w/o,P=0.99),rates of complication(40%w/vs.35%w/o,P=0.23),reoperation(13.5%w/vs.14%w/o,P=0.81),readmission(14%w/vs.18%w/o,P=0.27),and death(1.3%w/vs.1.3%w/o,P>0.99).Furthermore,neck dissection did not increase the risk of complication(P=0.23),readmission(P=0.27),reoperation(P=0.81),death(P=0.94),or lengthened hospital stay(P=0.38).Conclusions:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies.These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.

Are demographics associated with mucoepidermoid or acinic cell carcinoma parotid malignancies in children?

Objective:To identify possible associations between patient demographics and parotid cancer histological type in pediatric patients.Methods:Pediatric patients(ages:birth-18.0 years)in the Surveillance,Epidemiology,and End Results(SEER)database were included from 1973 to 2014 based on a diagnosis of mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland using the ICD O-3 codes of C07.9 and 8430 or 8550.Patients were classified into the following cohorts:<14 and 14-18 years of age based on the mean age at diagnosis.Results:Three hundred and three pediatric patients were diagnosed with mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland within the SEER 18 registries.Female pediatric patients 14-18 years of age were 7.68 times more likely to have an acinic cell carcinoma(adjusted OR:7.68[95%Cl:2.01-29.44]).When stratified by histological type,58.9%of female pediatric patients≥14 years of age had an acinic cell carcinoma as compared to 37.3%of male pediatric patients≥14 years of age,36.5%of female pediatric patients<14 years of age,and 34.0%of male pediatric patients<14 years of age(P=0.01).Conclusions:Based on this study,pediatric female patients between the ages of 14 and 18 years are the most likely cohort to have acinic cell carcinoma.The results of this study may assist providers during the work up of a pediatric patient with a suspected parotid malignancy.

Predictors of occult lymph node metastasis in cutaneous head and neck melanoma

Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.

Nasal endoscopy protocols in the era of COVID-19

Introduction COVID-19,the respiratory illness caused by the novel SARSCoV-2 virus has rapidly emerged as a serious global health concern.As of March 12,2020,the World Health Organization(WHO)has declared this virus a pandemic.1 In the United States,there have been 35,841 cases diagnosed and 465 deaths,with both prevalence and mortality continuing to escalate.2 The WHO and has enacted various protocols for healthcare institutions internationally in an attempt to slow the spread of disease,3 including adjustments for procedures performed by otolaryngologists.This paper aims to review the current literature pertaining to adjustments in nasal endoscopy protocols and appropriate precautions in the era of COVID-19.

Opioid prescribing patterns within otolaryngology

Objective:Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.Methods:The is a prospective,single-center pilot study.An online,anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents,fellows,and attending surgeons,and advanced practice providers (APP).The survey consisted of questions including demographics,most commonly prescribed analgesic and the average number of opioid tablets prescribed postoperatively for eleven of the most common adult procedures within Otolaryngology.Results:Forty-two participants responded to the survey.Of the 42 respondents,20 were attending surgeons,11 junior level residents (year 1-3),6 senior level residents (year 4-5),and 5 A.P.P.s.The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication.Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range:5 to 90).Neck dissection,parotidectomy,and thyroidectomy procedures all averaged over 20 tablets.Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0-20).Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets vs 14.1 tablets for residents (P =0.034).Conclusion:We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures.Establishment of standardized post-operative narcotic guidelines is warranted.

Cochlear implantation in patients with Meniere’s disease:A systematic review

Background:Meniere’s disease(MD)is an idiopathic disorder of the inner ear,which manifests as cochleo-vestibular dysfunction.Hearing loss will progress to a profound levelin a subset of patients with MD,and vestibular interventions can independently cause loss of hearing.The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD.Materials and methods:A systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI.Demographic information,disease history,MD symptoms,outcomes measures,and complications related to CI were extracted from included studies.Results:In total,17 studies were included,and 182 patients with MD underwent CI.The weighted-mean age was 61.9 years(range 27-85).Study objective and methodology varied,and there was significant heterogeneity in CI outcome measures reported.In total,179(98.3%)of 182 patients reported objective improvements in at least one hearing metric after CI.A total of 69 patients(37.9%)reported vertigo or severe dizziness prior to CI,compared to 22 patients(15.4%)postoperatively.Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score(THI).Quality of life assessments varied between studies.Complications rates were low with only nine patients(4.9%)reporting a serious CI-related complication.Conclusions:This systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes,and heterogeneity in study design and outcomes measured.Despite these limitations,this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD.The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.