ENT Hospital Research Articles

Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study.

Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus.

Pediatric surgery for middle ear cholesteatoma: analysis of 47 cases

The clinical data of 47 children (52 ears) with middle ear cholesteatoma at Eye & ENT Hospital, Fudan University from January 2021 to February 2024 were prospectively collected. There were 30 males and 17 females, with a mean age of (8.5±2.8) years. Surgical procedures included endoscopic tympanoplasty (29 ears), combined endoscopic/microscopic tympanoplasty (8 ears) and microscopic tympanoplasty (15 ears). After endoscopic surgeries, the mean air conduction hearing threshold, mean bone conduction hearing threshold and air bone gap were (28.4±10.4) dB HL, (12.4±5.9) dB HL and (16.0±6.3) dB HL, respectively, which were significantly improved compared with preoperative indicators [(40.2±14.0) dB HL, (16.3±6.8) dB HL and (23.9±9.8) dB HL, respectively] (all P<0.05). There were statistically significant differences in the postoperative mean air conduction hearing threshold and air bone gap among three surgical groups, and the value of endoscope group was lower than those of microscope group and endoscope combined with microscope group (all P<0.05). After a follow-up of 5.6 (1.2, 11.5) months, no statistically significant differences were observed in the rate of successful tympanic membrane healing between endoscope group and microscope group (P=0.747). One ear in the endoscope group experienced recurrence three years after surgery, and no intracranial and extracranial complications occurred. The current study indicates that endoscopic surgery for pediatric cholesteatoma improves hearing with good results.

Comparison of microdrill versus diode laser in endoscopic stapedotomy

Objective: To compare the surgical time, auditory outcomes and safety between microdrill and diode laser in endoscopic stapedotomy. Methods: The data of patients with otosclerosis who underwent endoscopic stapedotomy in Eye and ENT Hospital of Fudan University from January 2020 to December 2023 were retrospectively analyzed. The patients were divided into microdrill group and laser group according to treatment method. Surgical time, hearing level and complications were compared between the two groups. Results: A total of 148 patients (41 males and 107 females) aged (42.8±7.7) years were included. There were 81 cases in the microdrill group and 67 cases in the laser group, respectively. No statistically significant differences in age, gender, duration of disease and surgical side were detected between the two groups (all P>0.05). Preoperative air-bone gap (ABG) was (27.0±5.5) decibel hearing level (dB HL) in microdrill group and (25.0±5.1) dB HL in laser group, with no statistically significant difference (P=0.191). Postoperative ABG was (14.0±2.6) dB HL and (12.1±2.7) dB HL in microdrill group and laser group, respectively, and there was no statistically significant difference between the two groups (P=0.595). Compared with preoperative results, postoperative ABG decreased in both groups (both P<0.05). Postoperative vertigo was observed in 7 patients (8.6%) in the microdrill group and 6 patients (9.0%) in the laser group, respectively (P=0.947). The surgical time in microdrill group [(53.0±9.0) min] was shorter than that in laser drilling group [(59.3±12.8) min] (P<0.001). Conclusion: Postoperative improvement in hearing level after microdrill is similar to diode laser, but microdrill has shorter surgical time.

Anterior Segment Pharmacological Accommodative Changes and Its Impact on the Circumferential Anterior Chamber Angle after ICL V4c Implantation: Angle following ICL implantation.

To investigate the pharmacological accommodative changes of the anterior segment and its impact on the circumferential anterior chamber angle (ACA) after implantable collamer lens (ICL) implantation using swept-source optical coherence tomography (SS-OCT). Eye and ENT Hospital, Fudan University, Shanghai, CHINA. Prospective randomized contralateral eye study. Eight men and 24 women (mean age, 28.2 ± 5.8 years; range, 19-42 years); 64 eyes were included at 3 months after ICL implantation. One eye per patient was randomly assigned to undergo tropicamide instillation (mydriasis group), and the contralateral eye underwent pilocarpine instillation (miosis group). SS-OCT examinations were performed before and after instillation to measure angle parameters. Trabecular-iris angle 500 (TIA500), angle opening distance 500 (AOD500), trabecular-iris space area (TISA500), angle opening distance circumference area 500 (AODA500), trabecular-iris circumference volume 500 (TICV500), and central vault (ICL to crystalline lens [ICL-L]) were evaluated. Relative to baseline levels, TIA500, AOD500, and TISA500 values all increased significantly in both groups (all P < 0.01). AODA500 and TICV500 values increased by 19.7% and 12.1%, respectively, in the mydriasis group (all P < 0.001), and these values similarly increased by 23.4% and 27.7%, respectively, in the miosis group (all P < 0.001). After instillation, the ICL-L decrease in the miosis group was significantly larger than that in the mydriasis group (P = 0.004). Mean AOD500, TISA500, and TICV500 in the miosis group were significantly larger than those in the mydriasis group (all P ≤ 0.036), especially at 8 and 10 o'clock (all P ≤ 0.014). Correlation analyses indicated that the increase in anterior chamber angle parameters was positively correlated with the change in ICL-L for both groups. Pilocarpine induced a more significant increase in ACA than tropicamide, because of different mechanism of anterior segment changes. We recommend circumferential meridian scan to assess angle status.

Improving the Accuracy of Lens Formulas for in-the-bag Intraocular Lens Implantation in Marfan Syndrome Patients with Ectopia Lentis.

To improve the accuracy of intraocular lens (IOL) power calculation formulas by modifying the effective lens position (ELP) equations for patients with Marfan Syndrome (MFS) and ectopia lentis (EL) undergoing in-the-bag IOL implantation. Eye and ENT Hospital of Fudan University. Retrospective cohort study. The formula-specific ELP was obtained from the SRK/T, T2, Holladay I, and HofferQ formulas. The back-calculated ELP was obtained based on the vergence formula using preoperative biometry, postoperative refraction, and the IOL power. The Generalized Linear Models or Gradient Boosting Machines were used to predict ELP or ELP error. A total of 255 patients (255 eyes) were assigned randomly into a training set and a validation set (7:3 ratio). Linear correlation identified axial length(AL), corneal height, and white-to-white as predictors for ELP and ELP error for patients with shorter AL (AL ≤ 24 mm). For those with longer AL (AL > 24 mm), AL and the central corneal radius were identified as the primary predictors. Incorporating these predictors into the modified ELP formula significantly improved the accuracy in the validation set, including SRK/T, T2, Haigis, Holladay I, and HofferQ formulas. The improvement was more pronounced in patients with shorter AL. Additionally, the GLM-modified formulas outperformed both the Barrett Universal II and Kane formulas. The accuracy across different ocular dimensions was comparable among the modified formulas, based on which an online calculator was developed. Using the more accurately predicted ELP can significantly improve the accuracy of existing formulas in patients with MFS.

Clinical characteristics and ultrasound biomicroscopic evaluation of anterior segment dysgenesis: a retrospective cross-sectional study.

Anterior segment dysgenesis (ASD) encompasses a range of congenital disorders affecting the development of the eye's anterior segment, often leading to significant visual impairment and glaucoma. Although numerous studies have focused on the genetic basis of ASD, few have comprehensively compared the clinical features across ASD subtypes. This study aims to address this gap by describing and comparing the clinical characteristics and ultrasound biomicroscopy (UBM) imaging features of various ASD subtypes in a Chinese tertiary medical center. A retrospective review of medical records was conducted for hospitalized patients diagnosed with ASD in the Eye & ENT Hospital, Fudan University between January 2013 and December 2022. Patients were enrolled consecutively. Demographic data, clinical manifestations, and UBM images of various ASD subtypes were analyzed. A total of 1,031 patients were included in the analysis. Primary congenital glaucoma (PCG) was the most prevalent, affecting 396 patients (625 eyes), whereas congenital ectropion uveae (CEU) was the rarest, affecting 8 patients (13 eyes). All subtypes exhibited a spectrum of characteristic clinical manifestations. UBM imaging revealed distinct anterior segment abnormalities characteristic of each subtype. Trabeculodysgenesis was implicated in glaucoma pathogenesis across multiple ASDs, including PCG, aniridia, Axenfeld-Rieger syndrome, Peters anomaly, CEU, iris coloboma, and microcornea, whereas persistent fetal vasculature and congenital fibrovascular pupillary membrane exhibited completely closed angles in glaucomatous eyes. Our study provides comprehensive insights into the clinical features and UBM characteristics of ASD subtypes, enhancing diagnostic accuracy and guiding appropriate interventions.

Rhegmatogenous Retinal Detachment Secondary to Type I Stickler Syndrome: Diagnosis, Treatment and Long-Term Outcomes.

This study aimed to clarify the genetic diagnosis of rhegmatogenous retinal detachment (RRD) secondary to type I Stickler syndrome (STL1) and evaluate the anatomical and functional outcomes of surgical treatment. This retrospective study included 11 patients with RRD secondary to STL1. Familial and sporadic cases of STL1 were diagnosed at the Eye & ENT Hospital, Fudan University, between 2017 and 2023. To clarify the genetic diagnosis, next-generation sequencing was performed in suspected STL1 cases. Further, standard ocular examinations and surgical treatment were performed. Nine variants of COL2A1, including four novel mutations (c.394G>T, c.2977G>T, c.3003+2dup, and c.3853G>C), were screened and identified. The pathogenicity of all variants was conclusively demonstrated. Among patients who underwent vitrectomy, the mean age at RRD was 11.5 years, and the mean follow-up was 32.9 months. The average number of surgical procedures required during the follow-up was two; 90.9% of eyes achieved final attachment, and best corrected visual acuity (BCVA) significantly improved in 81.8% of the eyes, with a middle postoperative logMAR BCVA of 0.52 compared with the preoperative value (p = 0.0148). High intraocular pressure (81.8%) and cataract (72.7%) were the most common complications. Our study expands the spectrum of COL2A1 mutations and provides a novel diagnostic strategy for STL1. By combining clinical manifestations with genetic testing, STL1 could be accurately diagnosed. With proper surgical treatment and long-term follow-up, the prognosis of RRD in patients with STL1 could be improved.

Anatomical investigation of the venous system in pedicled nasal septal mucosal flap and its application in nasal skull base reconstruction

Objective: To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers. Methods: Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap. Results: The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived. Conclusions: The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.

Comparison of long-term visual quality after keratorefractive lenticule extraction and implantable collamer lens V4c for high myopia.

To compare the long-term refractive outcomes and visual quality after keratorefractive lenticule extraction (KLEx) and EVO-implantable collamer lens (ICL) implantation for high myopia. Eye & ENT Hospital of Fudan University, Shanghai, China. Retrospective study. This study included 31 KLEx-treated patients (31 eyes, spherical equivalent: -7.62 ± 1.22 diopters [D]) and 32 ICL-treated patients (32 eyes, spherical equivalent: -8.22 ± 1.18 D). Refractive outcomes and objective visual quality were examined. Subjective visual quality was evaluated by a customized questionnaire. Patients' satisfaction was graded. 5 years postoperatively, the efficacy (KLEx: 0.96 ± 0.20; ICL: 1.03 ± 0.20; P = .164) and safety indices (KLEx: 1.12 ± 0.20; ICL: 1.21 ± 0.19; P = .067) were comparable. Statistically higher proportions of ICL-treated eyes achieved a postoperative uncorrected distance visual acuity of 20/20 or better ( P = .035). Refractive predictability was similar between the 2 groups ( P = .947), whereas more KLEx-treated eyes had myopic refractive errors ( P < .001). Total coma was significantly higher after KLEx ( P = .020), and greater total trefoil was observed after ICL implantation ( P = .006). Haloes were the primary visual disturbance in both groups (KLEx: 64.5%; ICL: 93.8%). The incidences of haloes ( P < .001), glare ( P = .004), and starbursts ( P = .043) were notably higher after ICL implantation. The patient's satisfaction scores were similar (KLEx: 9.10 ± 1.27; ICL: 9.10 ± 1.27; P = .894). For high myopia, EVO-ICL yielded better long-term refractive outcomes than KLEx. Haloes were the chief concern in both groups, with a significantly higher incidence after ICL implantation.

Clinical Predilection Features of Middle Ear Adenomatous Neuroendocrine Tumors: A Review of 10 Patients and a Special Case Is Attached.

Introduction: Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare middle ear lesions characterized by nonspecific symptoms, signs, and imaging findings. Diagnosis typically relies on postoperative pathological assessment. This study investigated the diagnostic utility of the predilection sites and clinical characteristics of MEANTs. Methods: A retrospective analysis was conducted on clinical data from 10 patients with histologically confirmed MEANTs, admitted to Eye & ENT Hospital of Fudan University between March 2016 and March 2023. Results: The median age of the patients at diagnosis was 39.3 years. Hearing loss (n = 8) and ear pain (n = 6) were the most prevalent clinical symptoms in the patients diagnosed with MEANTs. Endoscopic examination revealed diverse symptoms, predominantly presenting as non-pulsatile masses with distinct boundaries and quasi-circular shapes within the external auditory canal, often accompanied by abundant blood vessels (n = 4). Tumors were typically confined to the middle/lower tympanic chambers or eustachian tube and were frequently associated with tympanic sclerosis, particularly around the pharyngeal tube (n = 3). Pathologically, MEANTs exhibited CD56 positivity or weak positivity, along with positive staining for CKpan and Syn, negativity for S100, and Ki67 ≤3%. Personalized surgical interventions were chosen by all the patients based on lesion severity, with no subsequent radiotherapy or chemotherapy administered postoperatively. No tumor progression was noted during the postoperative follow-up. In addition, a noteworthy case was presented in which MEANT initially manifested in the middle or lower tympanic cavity and eustachian tubes. Over 2 years, the tumor progressively grew, invading the middle tympanum and surrounding ossicles, ultimately achieving complete resection with no recurrence observed during subsequent follow-up. Conclusions: A possible diagnosis of middle ear adenoma should be considered when encountering non-pulsatile tumors with clearly demarcated inner boundaries within the external auditory canal accompanied by abundant quasi-circular vessels and the presence of new bone or neoplasm at the pharyngeal tympanic canal orifice observed during preoperative examinations or surgical procedures.

Atypical Mumps; are We Heading Towards an Outbreak?

Mumps, caused by the mumps virus, is a contagious disease primarily affecting children and young adults. While typically presenting with salivary gland swelling and systemic symptoms, mumps can lead to various complications including SNHL, orchitis/ oophoritis, aseptic meningitis. Recent observations suggest atypical features in mumps cases, raising concerns of a potential outbreak in India. To discuss the etiopathogenesis and clinical presentation in cases of atypical mumps with increasing number of cases, a prospective multicentric study was conducted across five major centers - SMS Medical College Jaipur, RDBP Jaipuria Hospital, Jaipur, Shri Ashwini Saxena ENT Hospital Rewari, AIIMS Bhubaneswar and SP Medical College Bikaner, in India to evaluate patients with acute salivary gland swellings. Clinical and laboratory data were collected, including demographics, presenting symptoms, history of vaccination, imaging findings, and treatment outcomes. Patients were followed for four weeks post-treatment to monitor for delayed complications. Among 53 patients, a bimodal age distribution was observed, with peaks in early adolescents and middle-aged individuals. Vaccination status was recorded based on recall. Fever and salivary gland swelling were predominant symptoms, with a significant proportion experiencing submandibular gland involvement. Elevated serum amylase and CRP levels correlated with disease severity and prolonged symptomatic resolution. Notably, cases of sensorineural hearing loss (SNHL) and airway complications emerged as significant concerns. The study highlights a shift in mumps demographics, with higher age groups affected and increased incidence of complications like SNHL and airway compromise. International trends also suggest periodic outbreaks and evolving clinical manifestations post-COVID-19 pandemic. Factors contributing to mumps resurgence include lack of vaccination or vaccine efficacy, population immunity, and seasonal variations. India appears to be facing a potential mumps outbreak, characterized by atypical features and increased risk of complications like SNHL and airway compromise. Serum amylase and CRP serve as valuable markers for disease severity. Early recognition and management of complications are crucial, emphasizing the importance of mumps immunization to mitigate the impact of the disease. ENT specialists should remain vigilant for emerging complications, particularly SNHL, advocating for comprehensive immunization strategies.

SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus

IntroductionTinnitus is a common ailment that affects 10%–15% of adults worldwide. Comorbidities associated with tinnitus often include hearing loss, emotional distress and sleep disorders, with insomnia being a common issue...

Evaluating the effectiveness of large language models in patient education for conjunctivitis

AimsTo evaluate the quality of responses from large language models (LLMs) to patient-generated conjunctivitis questions.MethodsA two-phase, cross-sectional study was conducted at the Eye and ENT Hospital of Fudan University. In...

Clinical analysis of 50 patients with abnormal pulsatile tinnitus in sigmoid sinus

Objective: To analyze the disease characteristics, diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus. Methods: Fifty patients (from Shandong Provincial ENT Hospital, Shandong University between February 2014 and July 2020) with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively. The tinnitus characteristics, imaging findings, surgical methods, intraoperative findings and postoperative tinnitus changes were recorded. The patients were followed up for 6-12 months. The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery. There were 50 patients with unilateral venous pulsatile tinnitus, including 49 females and 1 male. The age ranged from 17 to 67 years, with a median age of 44 years. There were 45 cases of right tinnitus and 5 cases of left tinnitus. The degree of tinnitus before operation was grade Ⅱ or above, including 4 cases of gradeⅡ, 11 cases of grade Ⅲ, 22 cases of grade Ⅳ and 13 cases of grade Ⅴ. Results: Thirty-seven cases were cured, 8 cases were ineffective (no change in tinnitus), 3 cases were markedly effective (tinnitus grade decreased by 3 in 2 cases, 4 in 1 case), and 2 cases were effective (tinnitus grade decreased by 1). The difference of tinnitus grade before and after operation was statistically significant (Z=-5.70,P<0.05). Temporal bone CT showed 36 cases of sigmoid diverticulum (including 17 cases with sigmoid sinus dehiscence), 12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus. Thirty-five cases were performed with closure of sigmoid sinus diverticulum, 4 cases were performed with resurfacing of the sigmoid plate, 5 cases were performed with narrowing of sigmoid sinus, 4 cases were performed with simple opening of pre sigmoid mastoid air chamber, 1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus, and 1 case was performed with opening of pre sigmoid mastoid air chamber combined with closure of sigmoid sinus diverticulum. Conclusions: Venous pulsatile tinnitus is common in women. The common causes may be sigmoid sinus wall abnormalities such as sigmoid sinus diverticulum and perisigmoid bone defect. Imaging examinations are helpful for diagnosis. Venous pulsatile tinnitus can be treated with surgery.

Hearing, balance, and imaging assessment in adolescent Menière's disease: A retrospective analysis.

To retrospectively analyze clinical features in adolescent Menière's disease (MD). The medical records of adolescents with MD (11-17 years old) from May 2014 to March 2023 in Shandong Provincial ENT Hospital were retrospectively analyzed, including clinical features, a battery of auditory and vestibular function tests, sensory organization test, and imaging assessments. Patients with recurrent vertigo of childhood (RVC) were as controls. Compared with RVC, adolescent MD showed higher pure tone average threshold (p < .001), lower speech discrimination score (p = .014), and lower otoacoustic emission pass rates (p = .005). Adolescents with MD exhibited significant reduction in equilibrium score (Conditions 1, 5, and 6; p1 = .035; p5 = .033; p6 = .003), composite sensory score (p = .014), and vestibular sensory score (p = .029). Adolescents with bilateral MD exhibited worse performance in equilibrium score and strategy score compared to adolescents with unilateral MD. For the affected ear, the more severe endolymphatic hydrops detected by gadolinium-enhanced magnetic resonance imaging, the higher the auditory brainstem response threshold (r = .850, p = .007), and the lower the otoacoustic emission pass rate (r = -.976, p < .001). Adolescent MD has similar vestibular information inputs with that of RVC, but the ability for the nerve center to use these clues to maintain balance is worse in adolescents with MD. There were potential differences in vestibular weights in adolescents with unilateral and bilateral MD, also potential effects on vision and proprioception. Level 4.

Clinical characteristics, management, and outcomes of post COVID-19 mucormycosis in a private ENT hospital in Surat: a retrospective analysis

Clinical characteristics, management, and outcomes of post COVID-19 mucormycosis in a private ENT hospital in Surat: a retrospective analysis

Risk Factors for Graft Failure After Penetrating Keratoplasty in Eastern China from 2018 to 2021.

BACKGROUND Penetrating keratoplasty (PK) remains the most common corneal transplant method in China. In this paper we aim to analyze the outcomes and the potential factors associated with graft failures of PKs in one of the largest keratoplasty centers in Eastern China during the past 4 years. MATERIAL AND METHODS A retrospective review was performed on 502 eyes from 481 recipients undergoing PKs from January 2018 to December 2021 at the Eye and ENT Hospital of Fudan University. Graft failures presenting between the first postoperative day and 8 weeks were defined as early graft failure and failures presenting between 8 weeks and the end of the 1-year follow-up as late failure. Cox proportional hazards regression models and logistic regression models were used to assess the association between factors and failures. RESULTS Of the 93 failed cases, 36 were classified as early failure and 57 as late failure. Risk factors, expressed as hazard ratio (HR) and confidence interval (CI), for the failures include the following: burns (HR: 12.56, 95% CI [2.4, 65.71]), nonsuppurative inflammation (HR: 11.06, 95% CI [2.49, 49.03]), suppurative inflammation (HR: 12.49, 95% CI [2.76, 56.37]), immune disease (HR: 1.70, 95% CI [0.64, 4.48]), low donor endothelial cell density (ECD) (HR: 0.92/100 cells, 95% CI [0.87, 0.98]), and surgical complications (HR: 1.83, 95% CI [1.06, 3.17]). Two social factors were strongly negatively associated with late failures: completion of compulsory education (HR: 0.45, 95% CI [0.21-0.94]) and marriage (HR: 0.27, 95% CI [0.09-0.81]). CONCLUSIONS Indications, surgical complications, immune disease of the recipient, and lower donor ECD were risk factors for failure. Social factors also affect the ocular health after PK in the long term.

Efficacy of cochlear implantation in cochlear nerve deficiency children – A single center study

PurposesThe objective of this research was to interpret and analyze the imaging, audiological features and cochlear implantation outcomes in cochlear nerve deficiency children. Material and methodsRetrospective analysis. Results25 prelingual hearing loss children diagnosed cochlear nerve deficiency (CND), the age range from 1 to 15 (mean age, 5.04), underwent cochlear implantation at Ear Nose and Throat Hospital - Ho Chi Minh City (ENT hospital – HCMC) from 2016 to 2023. All children had sensorineural hearing loss (SNHL) from severe to profound degree. Magnetic resonance imaging (MRI) showed cochlear nerve hypoplasia in 76 % and cochlear nerve aplasia in 24 % of cases. Inner ear malformations were found in 52 % of cases. The mean Categories of Auditory Performance (CAP) score at 1 year after surgery was 4.8. At 6 months and 1 year after surgery, the mean CAP score of the aplasia group was significantly lower than that of the hypoplasia group (p < 0.05). ConclusionsIn cochlear nerve deficiency children, auditory perception and speech performance still improved after cochlear implantation. However, this progress was significantly limited in cochlear nerve aplasia group.

Correlation of posterior segment lesions with anterior segment biometric parameters and FBN1 genotype in patients with Marfan syndrome

Objective: To investigate the characteristics of posterior segment lesions in Marfan syndrome (MFS) patients and their relationship with anterior segment biometric parameters and FBN1 genotype. Methods: A cross-sectional study was conducted. A total of 121 MFS patients, 76 males and 45 females, with an average age of (11.72±11.66) years, who visited the Department of Ophthalmology, Eye & ENT Hospital of Fudan University from January 2013 to March 2023 were included. The presence of posterior scleral staphyloma was observed using B-mode ultrasound, and macular lesions were identified and classified using the atrophy-traction-neovascularization system based on ultra-widefield fundus images, color fundus images, and optical coherence tomography scans. Anterior segment biometric parameters, including axial length of the eye, average corneal curvature, corneal astigmatism, horizontal corneal diameter, anterior chamber depth, and lens thickness, were collected, and the direction and extent of lens dislocation were observed. Molecular genetic analysis of FBN1 gene mutations in patients was performed using next-generation sequencing based on a panel of ocular genetic diseases, and the impact of the genotype and anterior segment biometric parameters on the posterior segment manifestations was analyzed. Results: Sixty patients exhibited posterior segment lesions, including retinal detachment (4 cases, 3.31%), macular lesions (47 cases, 38.84%), and posterior scleral staphyloma (54 cases, 44.63%). There was statistically significant difference in axial length of the eye between patients with and without posterior scleral staphyloma [23.09 (22.24, 24.43) and 27.04 (25.44, 28.88) mm], between patients with and without macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.78) mm], and between patients with and without atrophic macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.79) mm] (all P<0.001). There was statistically significant difference in anterior chamber depth between patients with and without macular lesions [3.11 (2.75, 3.30) and 3.34 (3.09, 3.60) mm] (P<0.05). There was also statistically significant difference in corneal astigmatism between patients with and without posterior scleral staphyloma [2.15 (1.20, 2.93) and 1.40 (1.00, 2.20) diopters] (P<0.05). The location and region of the FBN1 gene mutation not only showed statistically significant difference from the positive rates of posterior scleral staphyloma and macular lesions (all P<0.05), but also influenced the occurrence of atrophic macular lesions (both P<0.05). Patients with FBN1 mutations located in the transforming growth factor β regulatory sequence had the highest proportion of posterior scleral staphyloma and macular lesions (both 10/11). Conclusions: Posterior scleral staphyloma and macular lesions have a relatively high incidence in MFS patients and tend to progress to more severe grades. The age, axial length of the eye, anterior chamber depth, corneal astigmatism, and location and region of the FBN1 gene mutation are factors affecting the posterior segment lesions in MFS patients.

Comparison of the efficacy of carelizumab combined with chemotherapy and chemotherapy alone in the induction therapy of locally advanced hypopharyngeal carcinoma

Objective: To compare the efficacy and safety of carrelizumab combined with the modified TPF regimen (docetaxel, cisplatinand capecitabine) and TPF regimen alone in larynx preservation strategy for locally advanced resectable hypopharyngeal squamous cell carcinoma. Methods: A cohort study was conducted. Patients with locally advanced resectable hypopharyngeal carcinoma (cT3-4aN0-3bM0) who were treated at the Eye & ENT Hospital of Fudan University from January 2017 to April 2023 were enrolled in the study. One group was treated with a modified TPF regimen (TPF group) for 2-3 cycles (retrospective data), and the other group was a prospective phase Ⅱ trial with a modified TPF regimen combined with carrelizumab (TPFC group) for three cycles. The patients with complete or partial remission of the primary focus were treated with sequential radical radiotherapy and/or drug therapy. The patients in the TPFC group were treated with carrelizumab at the end of radiotherapy with a maximum of up to 18 doses. The patients with stable or progressive disease were given radical surgery, and those who refused the surgery were given radical chemoradiotherapy. Objective response rate (ORR), overall survival rate, progression-free survival (PFS) rate, larynx preservation rate (LPR), and adverse reactions were compared between the two groups. Results: There were 51 male patients in the TPFC group, with an median age of 57 (35, 69) years. Meanwhile, 44 patients were in the TPF group, among which 43 were male and one was female, with an median age of 62 (46, 70) years. The ORR of the TPFC group was higher than that of the TPF group [82.4% (42/51) vs 63.6% (28/44), P=0.039]. During a median follow-up of 24.4 (18.5, 31.4) months, the TPFC group showed a higher 2-year survival rate (84.8% vs 64.6%, P=0.013) and 2-year LPR (66.6% vs 48.6%, P=0.045) than those in the TPF group. In patients with poor effect of induction therapy for hypopharyngeal carcinoma, surgical combination therapy significantly prolonged the 2-year PFS rate (77.9% vs 18.2%, P<0.001) and 2-year survival rate (76.9% vs 45.5%, P=0.005)than those of non-surgical combination therapy. The incidences of nausea and/or vomiting, reactive cutaneous capillary endothelial proliferation, thyroid dysfunction, and rash were increased in the TPFC group (all P<0.05). There was no treatment-related death. Conclusion: Carrelizumab combined with a modified TPF regimen has good efficacy and safety and can improve the LPR of locally advanced hypopharyngeal carcinoma.