Objectives: The study systematically reviewed the existing literature on the management of autoimmune inner ear disease (AIED). Study Design: Systematic review. Methods: We performed a literature search of Embase, NCBI, Cochrane, and Web of Science databases from April 1990 to April 2020. Inclusion criteria included studies that were retrospective or prospective in nature evaluating the treatment of AIED with audiometric data measuring hearing outcomes during treatment. Hearing improvement was the primary study outcome and improvement in vestibular symptoms was the secondary study outcome. Results: Sixteen of 412 candidate articles were included in our study. Systemic steroid treatment is most commonly described. Alternative treatment modalities included intratympanic steroid treatment, methotrexate, cyclophosphamide, azathioprine, infliximab, etanercept, adalimumab, golimumab, methylprednisolone, rituximab, and anakinra. Conclusion: Systemic corticosteroids are the first line treatment of AIED. Intratympanic steroids are a potential adjuvant or alternative treatment for patients who cannot tolerate or become refractory to steroid treatment. Steroid nonresponders may benefit from biologic therapy. Alternative treatment modalities including nonsteroidal immunosuppressants and biologics have been studied in small cohorts of patients with varying results. Prospective studies investigating the efficacy of biologic and nonsteroidal therapy are warranted.
Tonsillectomy and adenotonsillectomy are frequently performed operations. They are typically done as a day-of-surgery admission with discharge on the first postoperative day. Five hundred consecutive tonsillectomies and adenotonsillectomies performed by the authors were retrospectively reviewed to determine if these procedures could safely be performed on an outpatient basis. Primary postoperative hemorrhage was found to be rare using the suction cautery technique. Secondary hemorrhage occurred most commonly on the sixth postoperative day and the overall postoperative bleed rate was 7%. Our conclusion was that suction cautery tonsillectomy and adenotonsillectomy were safe to perform on an outpatient basis.
Glandular carcinomas of the larynx are aggressive neoplasms that comprise less than 1% of all laryngeal malignancies. Adenocarcinoma, not otherwise specified, is the most common histologic type. The rarity of these lesions has prohibited clarification of definitive therapy. Traditionally, radical surgery is performed because of the usually high stage at presentation and the relative insensitivity to radiotherapy. A case of glottic T1 adenocarcinoma, not otherwise specified, is reported. The tumor presented clinically as a vocal fold granuloma. The treatment modalities included endoscopic excision with the carbon dioxide laser and postoperative radiotherapy. The patient has been followed up for 39 months without evidence of recurrence or metastases. The current literature is reviewed in regard to treatment of laryngeal glandular carcinomas.
Objective Eosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL-5), have demonstrated efficacy in controlling eosinophil-driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti-IL-5 drugs on chronic ear disease. Study Design Retrospective chart review. Setting University of Florida Health, an academic medical center. Methods A review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections. Results After starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow-up. The remaining 2 patients did not have effusions at the time when anti-IL-5 therapy was initiated, and they have not relapsed since starting treatment. Conclusion EOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti-IL-5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti-IL-5 therapies.
Objectives (1) Evaluate hearing outcomes of patients after planned malleus removal during ossicular chain reconstruction. (2) Analyze hearing results for titanium (Ti) and hydroxyapatite (HA) total ossicular prostheses (TOPs) and partial ossicular prostheses (POPs). (3) Compare Ti and HA partial prostheses. Study Design Retrospective case series with chart review. Setting Tertiary health care organization. Subjects and Methods A chart review was conducted of 139 consecutive patients who presented with chronic otitis media with perforation (with or without cholesteatoma) and were treated with initial-stage tympanoplasty (with or without mastoidectomy) and managed with TOP (n = 22) or POP (n = 117) between July 2010 and July 2015. The malleus was completely removed in all cases. Hearing was assessed via bone and air conduction pretone averages (0.5, 1, 2 kHz) pre- and postoperatively. Air-bone gap (ABG) and change in ABG (ΔABG) were analyzed. Pre- and postoperative values were compared. Results The overall mean ABG decreased from 29.4 ± 12.3 dB to 18.2 ± 11.4 dB postoperatively ( P < .001) with a mean ΔABG of 14.5 dB (95% CI, 12.793-16.203). Overall success was achieved by 69.1%. The POP group achieved higher success (70.9%) than the TOP group (59.1%; P = .0001). Mean ABG decreased significantly within surgical groups (TOP and POP) and prosthesis material groups (Ti and HA; all P < .001). Ti had statistically higher success than HA in both techniques: POP ( P = .0478) and TOP ( P = .0251). There was a 98% graft take rate. Conclusion Planned malleus removal during ossicular chain reconstruction, regardless of disease extent, allows for simpler reconstruction and comparable favorable results to preservation of the malleus and should be considered during surgical planning.
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