Life Threatening Stridor Due to Primary Laryngeal Tuberculosis

Tuberculosis is a potentially serious infectious disease. In otorhinolaryngology practice, lymph node infection is the most common site of predilection followed by the larynx. Laryngeal tuberculosis (LTB) typically presents with dysphagia, odynophagia and hoarseness. We reported a case of primary LTB presenting with acute upper airway obstruction and respiratory distress mimicking acute supraglottitis which requires emergency tracheostomy. Therefore, in acute upper airway obstruction, the appropriate initial investigation should be done to rule out TB to make sure early treatment can be given and it may prevent complications of disease to the patient. .

Impact of COVID-19 on the Practice of Otorhinolaryngology in Nigeria

Background: The 2019 novel corona virus disease (COVID-19) pandemic broke out in Wuhan, Hubei province in China in December 2019. Available research so far showed that Otolaryngologists had an elevated risk of exposure to SARS-CoV-2 due to the high viral load in the respiratory tract, which is the primary area of examination and instrumentation. We aimed to present our findings on the impact of this pandemic on Otolaryngology practice in Nigeria. Materials and Methods: This study was conducted online in September, 2020 amongst otolaryngologists in secondary and tertiary health centers across Nigeria using the survey monkey. Analysis was done using SPSS version 20. Results: A total of 102 ORL practitioners in Nigeria were assessed in this study. The mean age of the respondents was 42.4 ± 7.9 years;majority (54.9%) were Consultants and their duration of ORL practice ranged between 1 - 37 years. All the respondents felt being an ENT Surgeon exposes them to higher risk of contracting COVID-19 in their practice while 93% of them felt unsafe to perform throat examination during COVID-19 pandemic. Similarly, 74.5% feel unsafe to perform rhinoscopy while 67.7% of the respondents feel unsafe to do anterior rhinoscopy, posterior rhinoscopy and rigid nasal endoscopy. Conclusion: Otolaryngologist is at high risk of being infected with SARS COV-2 as they cope with upper respiratory tract during diagnosis, clinical review, sampling and surgery. The pandemic has affected almost all aspects of Otolaryngologic practice in Nigeria.

Aging effect and test-retest reliability of the sinusoidal harmonic acceleration test and velocity step test using nanotorque rotatory chair

Introduction:Rotatory chair testing has been used to evaluate horizontal canal function.Frequently used tests include sinusoidal harmonic acceleration test(SHAT)and velocity step test(VST).Objectives:Assessment of age effect on the SHAT and VST and assessment of test-retest reliability of the parameters of those two tests.Methods:A prospective study was performed on 100 subjects with no ear or vestibular complaints and normal vestibular evaluation.They were divided into two groups;Group A:below 50 years of age and Group B:50 years of age or above.SHAT was presented at frequencies 0.02,0.04,0.08,0.16,0.32,0.64 Hz with a peak velocity of 60°/s.VST was performed using a maximum velocity of 100°/s with acceleration and deceleration of 200°/s2.Thirty subjects were tested twice to assess reliability.Results:Study participants ranged in age from 20 to 67 years.Regarding group A,the mean age was30.92±7.31 and 55.36±4.61 for group B.No significant differences were found in SHAT parameters between the two groups.As well,there was no significant difference in VST per-rotatory time constant,however,post-rotatory time constant was significantly longer for Group B(P value<0.05).Intraclass correlation coefficient(ICC)values showed moderate to good reliability(ICC 0.5800.818)for SHAT parameters for the lower frequencies and indicated moderate reliability for VST time constant(ICC 0.5090.652).Conclusions:Age has no significant effect on the parameters of SHAT and VST.Test-retest reliability is generally good for both tests.

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease;a case report

Ménière’s disease(MD)patients may suffer episodes of sudden falls,named Tu markin drop attacks(DAs).This fall occurs abruptly and without warning or loss of consciousness.DAs usually aggravate the clinical picture of MD and are challenging to manage.The present report describes a case treated by cochlear implantation(CI)due to concomitant deafness and offers some clinical considerations for this condition.A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side.He suffered from intermittent attacks of vertigo,ear fullness,and tinnitus and,in the last year,had developed DAs and experienced 14 episodes in the previous six months.The preoperative category of acoustic performance was 3.The Dizziness Handicap Inventory(DHI)questionnaire showed a total score of 46,which indicated a moderate degree of disability.A CI was planned for the right side.The patient did not report any further DAs episode for two years since then.The postoperative category of acoustic performance became 11,and the postoperative DHI questionnaire showed a decrease in the total score(from 46 to 19),which indicated a mild disability.Unilateral CI effectively alleviated the DAs associated with bilateral MD.Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients:An analytical cross-sectional study

Objective:To describe audiological symptoms,audiometric profile,and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection(positive RT-PCR test)and asymptomatic patients(negative RT-PCR test).Methods:An analytical cross-sectional study was conducted using data obtained from clinical charts,physical examination,audiometry,and distortion product otoacoustic emission on 40 patients[case patients(CP)]recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22asymptomatic participants with a negative RT-PCR test[non-case(NC)].Results:Sixty-two patients(mean age:31.1 and 28.2 years in the CP and NC groups,respectively)were included.All participants were young without significant comorbidities,risk factors for hearing loss or otological history.Vertigo(5%),tinnitus(17.5%)and aural fullness/hearing loss(35%)were found in the CP group.A statistically significant difference was found in specific frequencies(1000,4000,and 8000 Hz)and pure tone average(low and high conversational frequencies with increased threshold in the PC group compared with the NC group),which was not found in distortion product otoacoustic emission.Conclusion:Audiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection.SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

Acute Mastoiditis Clinical Course and Management in Patients Presented to Khartoumar Ear, Nose and Throat Hospital during the Period from November 2017 to November 2019

Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.

Non-Traditional Management of Vestibular Migraine (Review)

Objectives: Vestibular migraine is one of the most common causes of episodic vertigo in adults and even in children. Traditional;management may have a side effect on the long run. So the aim of this review is to explain the other non-medical lines of management for patients with migraine. Methods: English articles from Medline and Cochrane library were searched and reviewed. Results: Evidence indicates that non-traditional management has a prophylactic and therapeutic effect on migraine patients with all its steps. Conclusion: Due to the possible side effects of pharmacological drugs and drug addictions, the use of non-traditional management alone or in combination with normal cures have been proposed. However, further constructive studies are required.

Effects of IL-17 on Expression of GRO-α and IL-8 in Fibroblasts from Nasal Polyps

Recent studies indicated that interleukin（IL）-17, growth-related oncogene（GRO）-α and IL-8 play an important role in the pathogenesis of nasal polyps. However, the effects of the increased amount of IL-17 and the production of GRO-α and IL-8 in human nasal polyp fibroblasts are not completely understood. This study aimed to determine the effects of the increased IL-17 on the changes of GRO-α and IL-8 expression in human nasal polyp fibroblasts and further investigate the mechanism of neutrophil infiltration in nasal polyps. Nasal polyp fibroblasts were isolated from six cases of human nasal polyps, and the cells were stimulated with five different concentrations of IL-17. Real-time fluorescence quantitative polymerase chain reaction（RT-PCR） was used to detect the mRNA expression of GRO-α and IL-8. The mRNA of GRO-α and IL-8 was expressed in unstimulated controls and remarkably increased by stimulation with IL-17. Moreover, the levels of GRO-α and IL-8 produced by fibroblasts were increased gradually with the increases in IL-17 concentrations. The present study showed that nasal fibroblasts can produce GRO-α and IL-8, and their production is remarkably enhanced by IL-17 stimulation, thereby clarifying the mechanism of the IL-17 mediated neutrophil infiltration in nasal polyps. These findings might provide a rationale for using IL-17 inhibitors as a treatment for nasal inflammatory diseases such as nasal polyps.

Teleaudiology practice in COVID-19 pandemic in Egypt and Saudi Arabia

Objective:To evaluate the audiologists’attitudes and practice towards teleaudiology,as well as to assess the audiological services provided in Egypt and Saudi Arabia during the COVID-19 pandemic.Methods:A cross sectional study was conducted among 112 audiologists who were recruited through convenience sampling.Multinomial logistic regression was used to test the association between practice of tele audiology as a dependent variable and some independent variables.Results:25.4%of the studied sample were practicing tele audiology.Participants’age and attitude toward telemedicine were the independent predictors of tele audiology practice at p value≤0.05.Conclusion:The tele audiology practice is essential.Therefore,raising the knowledge of audiologist about the great value of practicing tele audiology is very important,infrastructure,equipment,and technology especially telecommunication should be improved and facilitated for both audiologist and patients.

Role of the periotic mesenchyme in the development of sensory cells in early mouse cochlea

Objective:To investigate the role of the periotic mesenchyme(POM)in the development of sensory cells of developing auditory epithelium.Methods:Developing auditory epithelium with or without periotic mesenchyme was isolated from mice at embryonic days 11.5(E11.5),E12.5 and E13.5,respectively,and cultured in vitro to an equivalent of E18.5’s epithelium in vivo.Then,the explants were co-stained with antibodies targeting myosin VIIA,Sox2 and BrdU.Results:More hair cells in E11.5 t 7 DIV,E12.5 t 6 DIV and E13.5 t 5 DIV auditory epithelia were found upon culture with POM(225.90±62.44,476.94±100.81,and 1386.60±202.38,respectively)compared with the non-POM group(68.17±23.74,205.00±44.23,and 1266.80±38.84,respectively).Moreover,regardless of developmental stage,the mesenchymal tissue increased the amount of cochlear sensory cells as well as the ratio of differentiated hair cells to total sensory cells.Conclusions:The periotic mesenchyme promotes the development of cochlear sensory cells,and its effect depends on the developmental stage of the auditory epithelium.

Stability of computed tomography densitometry in patients with otosclerosis:a two-year follow-up

Objectives:To quantify the progression of otosclerosis in the unoperated ear between two stapedotomy procedures for patients with bilateral otosclerosis which can help to determine whether a HRCT scan should be re-performed before the second surgery for patients who already received HRCT imaging before the initial surgery.Methods:35 patients who underwent bilateral stapedotomy were included.Two rounds of HRCT examination and audiometry were performed at the time of the first surgery and second surgery on the ear that was not operated on during the initial surgery.The relationship between the changes in HRCT densitometry and audiometry over time was analyzed.Results:The second round of HRCT did not add significant information about the changes to the otosclerosis lesions in either the imaging diagnosis or the HRCT density values except for small changes in the HRCT densitometry readings at the area anterior to the inner auditory(P=0.01).While the changes in HRCT manifestation are small,changes near the fissula ante fenestram(FAF)were still positively correlated with the air bone gap(ABG)of patients(p=0.031,r=0.388).Conclusions:The progression of lesions in otosclerosis is slow resulting in small and insignificant changes to the HRCT features.Therefore,a repeat HRCT evaluations prior to surgery is not necessary for patients who have had a previous HRCT evaluation within 2 years of the operation.The small changes in HRCT manifestation near the FAF were still correlated with negative effects on the ABG which could cause worsened hearing thresholds over this timeframe。

Exogenous BDNF and Chondroitinase ABC Consisted Biomimetic Microenvironment Regulates Survival,Migration and Differentiation of Human Neural Progenitor Cells Transplanted into a Rat Auditory Nerve

Current putative regeneration oriented studies express possible role of stem cell based implantation strategy in the restoration of fundamental perception of hearing. The present work utilizes a rat auditory nerve (AN) directed transplantation of human neural progenitor cells (HNPCs) as a cell replacement therapy for impaired auditory function. Groups of b-bungarotoxin induced auditory function compromised female rats were used to transplant HNPCs in the nerve trunk. In the treatment groups, brain derived neurotrophic factor (BDNF), peptide amphiphile nanofiber bioactive gel (Bgel) and Chondroitinase ABC (ChABC), a digestive enzyme that cleaves the core of chondroitin sulphate proteoglycans, were added along with HNPCs while the control groups were with PA inert gel (Igel) and devoid of ChABC. Six weeks post transplantation survival, migration, and differentiation of HNPCs were studied and compared. The groups treated with BDNF and Bgel showed improved survival and differentiation of transplanted HNPCs while the ChABC treated group showed significant migration of HNPCs along the AN and elongation of neuronal fibers along the nerve towards the cochlear nucleus (CN) which was characterized by immunocytochemical markers for human Nuclei (HuN), human mitochondria (HuM) and neuronal β-tubulin (Tuj1). These findings show that addition of BDNF and ChABC consisted Bgel environment facilitated HNPC survival, migration and differentiation along the transplanted rat AN towards the CN. This transplantation strategy provides unique experimental validation for futuristic role of cell based biomaterial consisted neurotrophic factor application in clinically transferable treatment of sensorineural hearing loss (SNHL) along with cochlear implants (CI).

Unusual Expansive Mass in the Thyroid Cartilage

Introduction: Giant cell tumor of the larynx is an uncommon entity with only 42 reported cases in the literature, of which 32 involved the thyroid cartilage. These tumors most commonly occur in the epiphysis of the long bones of female patients in the third decade. Case Report: We present a 57-year-old man with hoarseness and a growing anterior neck mass for the past 5 months. Endoscopic examination revealed a submucosal swelling of the left supraglottic area. CT and MRI of the larynx showed a large, expansive mass at the left thyroid cartilage. The anterior neck mass was biopsied and histopathological analysis showed mononuclear cells and homogeneously distributed multinucleated giant cells. A giant cell tumor of the larynx was suspected. The patient underwent a supracricoid subtotal laryngectomy. Conclusion: Giant cell tumor of the larynx is an uncommon entity, with very few cases reported in the literature. These tumors should be included in the differential diagnosis of a patient with hoarseness and anterior neck swelling. There is no consensus regarding the management, although surgical excision is the most frequently employed treatment with excellent outcomes.

Targeting the phosphoinositide-3-kinase/protein kinase B pathway in airway innate immunity

The airway innate immune system maintains the first line of defense against respiratory infections.The airway epithelium and associated immune cells protect the respiratory system from inhaled foreign organisms.These cells sense pathogens via activation of receptors like toll-like receptors and taste family 2 receptors(T2Rs)and respond by producing antimicrobials,inflammatory cytokines,and chemokines.Coordinated regulation of fluid secretion and ciliary beating facilitates clearance of pathogens via mucociliary transport.Airway cells also secrete antimicrobial peptides and radicals to directly kill microorganisms and inactivate viruses.The phosphoinositide-3-kinase/protein kinase B(Akt)kinase pathway regulates multiple cellular targets that modulate cell survival and proliferation.Akt also regulates proteins involved in innate immune pathways.Akt phosphorylates endothelial nitric oxide synthase(eNOS)enzymes expressed in airway epithelial cells.Activation of eNOS can have anti-inflammatory,antibacterial,and anti-viral roles.Moreover,Akt can increase the activity of the transcription factor nuclear factor erythroid 2 related factor-2 that protects cells from oxidative stress and may limit inflammation.In this review,we summarize the recent findings of non-cancerous functions of Akt signaling in airway innate host defense mechanisms,including an overview of several known downstream targets of Akt involved in innate immunity.

Progress of high-frequency surgical device in laparoscopic surgery

High-frequency surgical device is a category of electric surgical instruments which has replaced mechanical scalpel in incising,coagulating or desiccating tissue.

The Treatment of Peripheral Vestibular Dysfunction Using Caloric Vestibular Stimulation in Patients with Cerebral Hypertensive Crisis

Background: To verify the efficacy of caloric vestibular stimulation in patients with peripheral vestibular dysfunction after cerebral hypertensive crisis. Methods: Enrolled in the study were 60 patients with peripheral vestibular dysfunction caused by a cerebral hypertensive crisis, docu-mented by vestibulometry. Thirty patients underwent standard treatment plus caloric vestibular stimulation, and 30 control group patients received standard treatment alone. Results: After the two-week treatment course, the sensation of vertigo was observed in 40.0% ± 8.9% of treatment group patients compared with 80.0% ± 7.3% of control group patients (t = 3.46;p < 0.001). Spontaneous vestibular somatic reactions were found in 46.7% ± 9.1% of the study treatment group in contrast to 86.7% ± 6.2% of the control group (t = 3.63;p < 0.001). Spontaneous nystagmus was seen in 40.0% ± 8.9% of treatment group patients compared with 93.3% ± 4.6% of control subjects (t = 5.31;p < 0.001). Spontaneous vestibular vegetative reactions were observed in 33.3% ± 8.6% of patients receiving study treatment in contrast to 93.3% ± 4.6% of control group patients (t = 6.16;p < 0.001). Also, 53.3% ± 9.1% of study treatment group patients showed asymmetry of labyrinths compared with 86.7% ± 6.2% of patients from the control group (t = 3.03;p < 0.001). Conclusion: Caloric vestibular stimulation was shown to be an effective treatment for peripheral vestibular dysfunction in patients with cerebral hypertensive crisis. During the 14-day treatment of cerebral hypertensive crisis, complete labyrinthine function recovery occurred in 46.7% of treatment group patients who underwent caloric vestibular stimulation as opposed to 13.3% of control group patients who received standard treatment alone.

Evaluation on Effectiveness of a New System as well as Analysis on Optimal Horizontal Eye Position for Vertical Video Head Impulse Test

Objective To compare the performances among three different systems for video head impulse test(vHIT),and to identify an optimal target angle for precisely evaluating the function of vertical semicircular canals in vHIT.Methods A two-center prospective study was done.Participants were sit 1.2 m away from the wall in a noise-proved room that dedicated for vHIT experiments.During the comparison experiments,similar settings were ensured in both hospitals,with the same distance to wall and angle of staring.For each equipment,the procedures followed the developers’recommendations.The same examiner performed the comparison between two systems in one location.For the eye-position projects,targets were placed on the wall sequentially at the pre-marked lines for different angles.For the comparison projects,9 and 13 participants were recruited,respectively.Any participant with otologic or vestibular disorders was excluded.A total of 26 healthy participants were recruited in the eye-position experiments,16 of which were further involved in inter-examiner tests.Results Our evaluations of three different systems showed that a new vHIT system,VertiGoggles®ZT-VNG-I(VG)performed as good as the long-tested Otometrics®ICS impulse(Oto)and EyeSeeCam®(ESC).During the comparison,we validated 25-degree,instead of right ahead at 0 degree,is a better place to set the targets when torsion was applied at vertical semicircular canal planes.Conclusion The new VG system is good for clinical practices.Furthermore,we proposed a new protocol to set the targets 25 degrees from right ahead after tilting head 45 degrees to evaluate vertical canals during vHIT.

Novel heterozygous USH1C mutation impacts hair cell mechanotransduction and causes progressive hearing loss

Hearing loss is one of the most common sensory disorders worldwide,affecting approximately 466 million people,including 34 million children[1].Genetic mutations accounts for approximately 60%of inherited hearing loss cases[2,3].These genetic changes result in a wide variety of clinical manifestations,ranging from nonsyndromic hearing loss(NSHL)to over 400 syndromes involving hearing loss and from mild adult-onset hearing loss to profound congenital deafness,covering the entire spectrum of Mendelian inheritance.

Artificial Water Channel that Couples with Cell Protrusion Formation

In natural systems,water transport across the cellular plasma membranes is mainly mediated by naturally occurring channel protein aquaporins(AQPs),which lead to a series of important physiological functions including cell migration.The construction of artificial analogs of the natural AQPs would generate a new strategy for treating AQP-related diseases.In this report,an artificial water channel has been developed from a unimolecular tubular molecule,which featured structural encapsulation of a single-file water wire composed of oppositely orientated dipolar water molecules.This AQP-like structure endowed the artificial channel in living cells with AQP-like water permeability and selectivity.Interestingly,the artificial channel coupled with cell protrusion formation by mediating water transmembrane transport,leading to cell shape change and migration acceleration.The artificial channel-facilitated cell migration showed application in enhancing in vivo healing of traumatic injury.

18例先天性内耳发育不良继发脑脊液耳漏诊疗总结（英文）

目的:介绍先天性内耳发育不良继发耳源性脑脊液渗漏的临床表现、诊断、手术方法及预后。创新点:总结了先天性内耳发育不良所致的脑脊液耳漏儿童与成人的畸形特点,为先天性内耳畸形导致的脑脊液耳漏提供诊疗参考。方法:回顾性分析2007～2017年我组18例内耳发育不良继发耳源性脑脊液渗漏患者,随访至少4个月,平均随访时间为3年。介绍所有患者的临床表现特点,包括自述症状、影像学表现、手术方法及修复方法、术中渗漏位置、术后病程、手术成功率等。结论:在先天性内耳发育不良所致的脑脊液耳漏中,儿童的内耳畸形情况较成人更为严重。最常见的症状是脑膜炎、听力障碍和脑脊液耳漏或鼻漏。高分辨率CT(HRCT)对本病具有较高的诊断准确率。最常见的瘘口位于椭圆窗周围,包括镫骨足板和环形韧带。