Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background: Interdigitating dendritic cell sarcoma (IDCS) is a very rare haematologic malignant tumour that arises from antigen-presenting cells. While it primarily affects the lymph nodes, extranodal manifestations have been observed, and there is a slight male predominance. Due to its rarity, diagnosing IDCS can be challenging, as illustrated in our case report of a 61-year-old woman. Methods: In this case presentation, the oncological management of a patient suspected of having malignant melanoma metastasis in the neck lymph nodes is discussed. This includes otorhinolaryngological examinations, fine needle aspiration biopsy, PET CT imaging, and histological analysis with immunohistochemistry. Results: The patient’s medical history included the excision of a pigmented lesion from the left ala of her nose, which was diagnosed as malignant melanoma. After surgical treatment, she experienced a tumour-free period of one year; however, during a follow-up ultrasonography three pathological lymph nodes were detected on the left side of her neck. Initially, a nodal metastasis of melanoma was suspected. Yet, fine needle aspiration cytology revealed myofibroblastic tumour invasion, and a re-biopsy showed no signs of malignancy. To further investigate, PET-CT scans were conducted, and a modified radical neck dissection was performed based on the findings. The histological analysis of the lymph nodes revealed an IDCS, a second independent tumour distinct from the initially diagnosed malignant melanoma, originating from the submandibular, upper jugular, and mid-jugular lymph nodes. Conclusions: This case highlights the diagnostic difficulties associated with IDCS. Initially, the clinical suspicion of malignant melanoma was considered, necessitating further examinations and a multidisciplinary approach to reach a final diagnosis and provide the patient with appropriate treatment. Full article

Since the inception of cochlear implantation, the field of technological advancements associated with cochlear implantation has continued to evolve, providing patients with sensorineural hearing loss access with greater sound appreciation capabilities. These advances include evolving cochlear implantation criteria, including increased residual hearing and single-sided deafness; changes in electrode design; options for hearing preservation; and advancements in connectivity, to name a few. This article reviews the various aspects of the recent advancements in relation to cochlear implantation. Full article

Background/Objectives: Hearing aids are essential for managing hearing loss, yet their accessibility, consistent use, and maintenance remain challenging in public healthcare systems, particularly in low- and middle-income countries (LMICs) such as South Africa. Despite the availability of these services, many patients struggle with device utilization, resulting in suboptimal rehabilitation outcomes. This study explores patient experiences with hearing aids in South Africa’s public healthcare sector. This study aimed to (1) assess patients’ experiences with hearing aid access, including waiting times and service delivery; (2) identify challenges related to hearing aid maintenance and repairs in the public sector; (3) explore factors influencing consistent hearing aid use, including social, psychological, and practical barriers; and (4) propose strategies to enhance hearing aid provision and aftercare services in South Africa. Methods: This descriptive qualitative study was conducted at two public healthcare facilities in Johannesburg. Purposive sampling was used to recruit 15 adult hearing aid users who had received government-funded hearing aids within the past 12 months. Semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis. Results: Participants reported long waiting periods (up to a year) for hearing aids, with poor communication regarding timelines. Challenges included difficulties adjusting to amplification, discomfort, and battery shortages, leading to inconsistent use or device abandonment. Social stigma and lack of family support further discouraged consistent use. Repair services were slow, with waiting times exceeding three months. Participants recommended decentralized battery distribution, structured follow-up appointments, improved aftercare, awareness campaigns, and mobile audiology services to improve accessibility and usability. Conclusions: While public hearing aid provision is essential for hearing rehabilitation, systemic inefficiencies, maintenance issues, and social barriers limit its impact. Strengthening aftercare services, decentralizing hearing aid distribution, and increasing public awareness could significantly improve hearing aid accessibility and adherence. Furthermore, policy interventions that incorporate tele-audiology, community-based maintenance programs, and integrated healthcare approaches are crucial in ensuring sustainable hearing healthcare outcomes. Full article

Background/Objectives: Long-term prosthetic stability in ossicular chain reconstruction (OCR) surgery may be affected by multiple factors, including prosthesis type. We compared audiometric outcomes including air–bone gap (ABG) and air conduction pure-tone average (AC PTA) over a multi-year period in titanium clip partial prosthetics and other titanium partial and total ossicular reconstruction prostheses. Methods: This was a retrospective study of 92 adult patients (19–74 years) receiving primary, second-look, or revision OCR at a single institution between 2017 and 2021. ABG and AC PTA at short (3–6 months) and long-term (>12 months) postoperative follow-up were compared among patients receiving clip partial prosthetics, traditional PORPs, and TORPs. Results: Overall, AC PTA and ABG were significantly improved in the short term and did not significantly deteriorate in the long term. Clip partial prostheses had significantly lower AC PTAs and ABGs than TORPs in both the short and long term and no difference with PORPs. There was also no significant deterioration in audiometric outcomes in either clip partials, PORPs, or TORPs over time. Clip partials had the highest rate of short- and long-term surgical success (i.e., ABG ≤ 20 dB) with 62.2% and 54.1%, respectively. Cholesteatoma and revision status were not independent predictors of long-term ABG success. Conclusions: The clip partial prosthesis seems to demonstrate similar, and potentially increased, resilience compared to the PORP and TORPs in both the short and long term. They may have comparable effects on audiometric outcomes to PORPs, demonstrating postoperative ABG and AC PTAs that reflect the previous literature. Clip partials appear to be a safe and effective prosthetic for OCR in patients with intact stapes regardless of cholesteatoma or revision status. Full article

Background/Objectives: This study focuses on examining treatment outcomes of sinonasal squamous cell carcinoma (SNSCC) when induction chemotherapy is added to definitive treatment regimens. A systematic literature search was conducted in the following four bibliographic databases: Embase, MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL). A total of 604 patients across 12 studies were included in the final review. Methods: This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled survival curves were derived from reconstructed individual patient data using Guyot et al.’s methodology, in which K-M curve drops are measured relative to the numbers-at-risk and number of events. Results: In this study, 71% of patients were male and 93% presented with late-stage (T3–4) cancer. The 24-month and 60-month overall survival rates were 55.1% and 35.0%, respectively. The 24-month disease-free survival was 44.4% and remained relatively stable at 42.1% at 60 months. The local control rate remained stable from 24 to 60 months at 72.7%. Conclusions: Compared to the results from the existing literature, this review reveals an overall survival and disease-free survival (DFS) that is comparable to that of other multimodality treatment options. The local control rate (LCR) was also high. This review suggests that induction chemotherapy can be utilised for patients with advanced SNSCC. Full article

Background: The nasal septal swell body (NSB) is a thickened area of the nasal septum with erectile tissues, located above the nasal floor. We hypothesized that the presence of the NSB in this space exerts favorable effects to generate laminar nasal airflow by developing its morphology as adjusted to nasal septal deviation (NSD). Patients and Methods: We objectively measured the NSB morphology in 152 patients by computed tomography (CT) and assessed its relationship with the width of the inferior turbinate (IT), the severity of NSD, and the patency of the nasal airflow passage (NAP). Results: In the patients with moderate or severe NSD, the mean widths of the NSB, IT, and NAP were significantly narrower at the convex side compared to the paired concave side, with the degree being more prominent in the severe-NSD group. A positive correlation was observed between the degree of the NSD angles and the difference in the widths of the NSB (r = 0.805) and IT (r = 0.609). Conclusions: These results imply novel roles of the NSB in the maintenance of physiological nasal airflow to generate a laminar airflow from the nostrils toward the middle nasal meatus at a constant rate. Full article

Objectives: Slag injuries in industrial settings pose risks of hearing loss and complications. The aim of this study is to provide specialists with a better understanding of the sequelae, treatment, and long-term outcomes that a patient may have following a slag injury to the tympanic membrane. Data Sources: PubMed, Embase, and Web of Science. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), multiple databases were queried for articles published from inception to 2023 describing Tympanic membrane injuries from welding. The publications were screened by two independent viewers. The Joanna Briggs Institute 2017 Critical Appraisal Checklist was used to assess the quality of studies. Results: A total of 227 articles were identified, and 9 full-text articles were included in this review, comprising a total of 18 patients. The patients’ ages ranged from 18 to 75 years. Most commonly, patients were welding overhead in a tight working space, and none of the patients were wearing protective ear equipment in addition to their welding masks. Patients experienced otalgia (n = 10; 55%), hearing loss (n = 11; 65%), vertigo (n = 6; 35%), chronic otorrhea (n = 5; 29%), and facial paralysis (n = 4; 23%). A total of 12 patients (70.6%) required surgery, most requiring debridement of metallic foreign body multiple times, some undergoing surgery up to four years post-injury. Conclusions: Tympanic membrane injuries from welding are often overlooked. They cause hearing loss and facial nerve damage. Following a period of observation, sturdy reconstruction with cartilage grafting is recommended, given the poor vasculature and inflammation after this injury. Full article

Background and Clinical Significance: GLI1 gene alterations have recently been identified as a pathological phenomenon associated with a distinct novel entity of mesenchymal neoplasms. They have been reported to occur in any soft tissue of the body, with a specific affinity for the head and neck region. The aim of this article is to increase awareness of this entity and provide a detailed summary of the modes of presentation and diagnostic and therapeutic issues surrounding these tumours occurring in the head and neck region. Case Presentation: We report the case of a 39-year-old male patient with ACTB::GLI1 fusion-related mesenchymal tongue tumour who was successfully treated by surgery. Conclusions: GLI1-altered mesenchymal tumours in the head and neck may harbour various clinical presentations. Larger series are needed to better define the clinicopathological range of this novel entity. We suggest a follow-up period of at least 2 years with imaging, followed by a clinical follow-up of 3 years. Certain clinicopathological features may warrant further and more extensive follow-up. Full article

Background/Objectives: Galvanic vestibular stimulation (GVS) integrated into virtual reality (VR) environments enhances immersion and mitigates cybersickness. It is well known that GVS can affect standing balance. Most studies have investigated the effects of GVS in VR in seated conditions. The purpose of this study was to evaluate the impact of joint GVS and VR with moving visual stimulus on standing balance. Methods: Using a repeated measures counter-balanced design, motion sickness, postural sway, and velocity utilizing the center of pressure (COP) along the mediolateral (ML) and anteroposterior (AP) axes were obtained in 18 subjects during optokinetic (OPK) stimulus (black and white vertical bars moving from left to the right) in VR across three interventions: GVS in the same direction of visual stimulus—left to right ear (Positive GVS), GVS in the opposite direction of visual stimulus—right to left ear (Negative GVS), and without GVS (Null GVS). Motion sickness symptom scoring was obtained using the Pensacola Diagnostic Index. Results: The PDI score was increased significantly in the Negative GVS. The root mean square and sway range of COP along ML was greater during the Positive GVS and Negative GVS than the Null GVS, while, along AP, it was only greater during Negative GVS. During Positive GVS, mean positive and negative peak velocities, only in ML, were increased and decreased, respectively. During Negative GVS, only negative peak velocities in both ML and AP directions were decreased. Conclusions: This research highlights the importance of testing combined VR and GVS to assess standing balance while mitigating cybersickness. Full article

Epistaxis, commonly referred to as nosebleeds, is a frequent clinical presentation with etiologies spanning from localized trauma to systemic conditions and medication effects. Despite its high prevalence, management approaches vary significantly depending on the cause and severity. To provide a comprehensive review of current management strategies for epistaxis, focusing on initial interventions, evaluation techniques, and preventive measures. A structured review of the literature was conducted to identify effective strategies for the initial management, evaluation, and prevention of epistaxis. Emphasis was placed on practical applications for clinicians in both emergency and outpatient settings. Initial Management: Direct pressure and topical vasoconstrictors remain the first-line interventions. Persistent cases may require nasal packing or cautery. Evaluation: Identification of underlying causes such as hypertension, coagulopathies, and structural nasal abnormalities is crucial, particularly in recurrent or severe cases. Laboratory tests and imaging may aid in diagnosis and management planning. Prevention: Patient education on nasal hygiene, avoidance of nasal trauma, and maintenance of a humidified environment are critical in reducing recurrence. Integrating effective initial management with thorough evaluation and preventive strategies significantly improves patient outcomes. Full article

Background: Hyperthyroidism, characterized by excessive thyroid hormone production, presents in diverse clinical forms, including overt and subclinical disease. Accurate and timely diagnosis is critical to prevent complications such as cardiac dysfunction, osteoporosis, and thyroid storm. Objective: To provide a comprehensive review of the clinical presentation, diagnostic methods, and management strategies for hyperthyroidism, focusing on current practices, advancements, and challenges in treatment. Methods: This review synthesizes findings from peer-reviewed literature on the diagnosis and management of hyperthyroidism. Results: Thyroid function tests (TFTs) are the cornerstone of hyperthyroidism diagnosis, with suppressed TSH levels and elevated T3 and/or T4 levels confirming overt disease. Thyroid receptor antibodies (TRAb) are critical for diagnosing autoimmune hyperthyroidism and predicting relapse risk. Iodine scintigraphy is utilized in specific cases, such as suspected toxic adenoma or multinodular goiter. Management strategies include beta-blockers for symptomatic relief, though side effects such as bradycardia and fatigue may occur. Antithyroid medications, including methimazole and propylthiouracil, inhibit hormone synthesis, with remission more likely in patients with low TRAb levels and small goiters. Definitive treatments include radioactive iodine therapy (RAI), which effectively reduces thyroid activity but often results in hypothyroidism, and thyroidectomy, a surgical option for large goiters or malignancy, with potential complications like hypocalcemia and recurrent laryngeal nerve injury. Conclusions: The management of hyperthyroidism necessitates a personalized approach integrating diagnostic precision, emerging innovations, and patient-centered care. Full article

Background: Fluctuating conductive hearing loss resulting from middle ear conditions, such as otitis media, is the most common cause of hearing loss in children, with Indigenous Peoples experiencing otitis media at a rate three times higher than non-Indigenous populations. Children with chronic hearing loss face increased educational, social, and economic challenges. However, treating and documenting fluctuating hearing loss remains difficult due to its sporadic and invisible nature, frequently leading to delayed or missed identification and inconsistent management. Methods: A comprehensive literature search was completed with a librarian, but few resources were located for this condition and population. Results: This practical guideline aims to improve the documentation and subsequent management of otitis media in school-aged children, with a focus on rural and Indigenous communities in Canada, where access to healthcare professionals may be limited. Conclusions: Despite efforts to raise awareness about otitis media in rural and Indigenous communities, there are still few accessible tools for caregivers to track the severity of fluctuating hearing loss. This guideline aims to help fill this gap. Full article

Background: Spatial release from masking (SRM) is the improvement in speech intelligibility when the masking signals are spatially separated from the target signal. Young, normal- hearing listeners have a robust auditory sys-tem that is capable of using the binaural cues even with a very small spatial separation between the target and the maskers. Prior studies exploring SRM through simulated cochlear implant (CI) speech have been completed using substantial spatial separations, exceeding 45° between the target signal and masking signals. Nevertheless, in re-al-world conversational scenarios, the spatial separation between the target and the maskers may be considerably less than what has been previously investigated. This study presents SRM data utilizing simulated CI speech with young, normal-hearing listeners, focusing on smaller but realistic spatial separations between the target and the maskers. Methods: Twenty-five young, normal-hearing listeners participated in this study. Speech identification thresholds, the target-to-masker ratio required to accurately identify 50% of the target words, were measured for both natural speech and simulated CI speech. Results: The results revealed that young, normal-hearing listeners had significantly higher speech identification thresholds when presented with simulated CI speech in comparison to natural speech. Furthermore, the amount of SRM was found to be greater for natural speech than for the simulated CI speech. Conclusions: The data suggests that young normal-hearing individuals are capable of utilizing the interaural level difference cues in the simulated cochlear implant signal to achieve masking release at reduced spatial separations between the target and the maskers, highlighting the auditory system’s capability to extract these interaural cues even in the presence of degraded speech signals. Full article

Head and neck masses are a significant diagnostic challenge and differential diagnoses range from inflammatory, infectious, and neoplastic conditions. Timely, accurate evaluation is essential for optimal patient outcomes. This review highlights a systematic approach to diagnosing head and neck masses through comprehensive history, physical examination, and a variety of diagnostic tools. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are integral in diagnosis. Fine-needle aspiration (FNA) biopsy is a minimally invasive option for a preliminary diagnosis. However, in cases where it may be inconclusive or when extensive tissue sampling is needed to confirm a diagnosis, open tissue biopsy is considered. Collaboration among a multidisciplinary team (surgeons, radiologists, and pathologists) is vital in developing an effective individualized treatment plan. Early detection and accurate diagnosis of head and neck masses are critical for achieving favorable clinical outcomes. Full article

Obstructive sleep apnea (OSA) is a heterogenous disease process that cannot be adequately categorized by AHI alone. There is a significant prevalence of OSA in the general population with ongoing efforts to evaluate the risk factors contributing to OSA and its associated clinical implications. Only by improving our understanding of OSA can we advance our methods in the diagnosis and treatment of OSA. For this article, the authors reviewed keywords of obstructive sleep apnea diagnosis and therapy in the databases of Embase, Medline, and Medline ePub over the past 3 years, excluding any articles that only addressed sleep apnea in children under age 17 years. This review article is divided into three main sections. First, we will investigate the use of novel screening tools, biomarkers, anthropometric measurements, and novel wearable technologies that show promise in improving the diagnosis of OSA. There is mention of comorbid conditions seen in OSA patients since certain disease combinations can significantly worsen health and should raise our awareness to diagnose and manage those concomitant disorders. The second section will look at the current and developing treatment options for OSA. These include positive airway therapy (PAP), mandibular advancement device (MAD), exciting new findings in certain medications, orofacial myofunctional therapy (OMT), hypoglossal nerve stimulation therapy (HGNS), and other surgical options. We will conclude with a section reviewing the current Clinical Practice Guidelines for Diagnostic Testing in Adults with Obstructive Sleep Apnea from 2017, which strongly advises polysomnography (PSG) or home sleep apnea testing (HSAT), along with comprehensive sleep evaluation for uncomplicated patients with a clinical presentation of OSA. Full article

Introduction: The purpose of this study was to qualitatively explore the experiences of chronic dizziness diagnosis and management within the health care system. Methods: This qualitative phenomenological study used focus groups to interview a convenience sample of individuals with chronic dizziness (n = 13) and vestibular physical therapists (n = 15). Focus group data were systematically analyzed using a descriptive coding process. Results: Two major themes emerged from interviews with individuals with dizziness: (1.) complexities navigating the health system and (2.) loss of self-identity. Three major themes emerged from interviews with vestibular physical therapists: (1.) patients have a complex, multi-factorial presentation, (2.) importance of the multidisciplinary care team, and (3.) behavior influences outcomes. Individuals with chronic dizziness identified many challenges in effectively navigating the health system and receiving an effective diagnosis and management, including the patient–provider relationship, with negative impacts on quality of life. Vestibular physical therapist data concurred and validated these experiences. Conclusion: Given the complex, multi-factorial nature of dizziness, increased use of the biopsychosocial model in a multidisciplinary dizziness clinic may inform a more holistic approach for this patient population and improve future outcomes for individuals with chronic dizziness. Full article

Background: This study aimed to identify clinical characteristics and classifications of nasal septal deviations associated with revision septoplasty. Methods: The cross-sectional study design included 652 patients undergoing septoplasty at a tertiary referral center. We classified patients according to Baumann’s validated septal deviation classification and assessed similarities and differences regarding septal pathologies and types of nasal septal deviations in both groups. Results: The sample comprised 600 primary surgery cases and 52 revision cases. In primary surgeries, type 1 septal deviations were most common (60.3%), followed by type 5 (10.5%) and type 3 (10.0%). In revision surgeries, type 1 deviations (36.5%) were most common, followed by type 3 (25.0%) and type 2 (17.3%). Group comparisons revealed that type 2 and type 3 septal deviations, high septal deviations, and septal perforations were significantly more frequent in revision cases. Common septal pathologies included an oblique septum (98.0%), ipsilateral septal crest (76.4%), contralateral turbinal hyperplasia (42.5%), and vomeral spur (39.9%). Conclusions: This study suggests that using validated classification systems for septal deviations, which combine various pathologies, can provide a more clinically relevant assessment and improve patient counseling and treatment. Full article

Background: Ménière’s disease (MD) lacks a universally accepted pathogenesis model. Recent research has revisited the vascular hypothesis. This study aims to compare the cerebrovascular burden in patients with MD and age-matched controls, investigating the potential role of cerebrovascular dysfunction in MD. Methods: A total of 145 patients (70 MD, 75 controls) underwent magnetic resonance imaging (MRI) assessment for small-vessel disease (SVD) markers (including Fazekas and EPVS scores), cortical strokes, and baseline comorbidities. Statistical analyses were performed to compare the cerebrovascular burden between the groups, adjusting for potential confounders. Results: The MD group exhibited significantly higher mean SVD scores across various measures compared to controls (p < 0.05). This association persisted even after adjusting for age, sex, and comorbidities (ORs ranging from 1.746 to 2.495, p < 0.05). Neither the presence of cortical strokes nor comorbidities significantly differed between groups. Conclusions: This study is the first to compare cerebrovascular burden between MD patients and controls. The findings suggest that cerebrovascular dysfunction may contribute to MD incidence. Further research is needed to elucidate the relationship between cerebrovascular disease and MD, potentially leading to novel therapeutic avenues. Full article