Objective: Ventilation tube (VT) insertion is usually recommended before cochlear implantation (CI) in pediatric cochlear implant candidates with recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME). However, there is no consensus on whether the VT is beneficial even after CI, that is, whether the tube should be removed or left in place during CI. This study aimed to assess the effect of tube placement after CI, especially on the incidence of post-CI AOM, in pediatric cochlear implant recipients who had undergone VT insertion before CI because of recurrent AOM or chronic OME. Study Design: A retrospective medical record review. Setting: A tertiary referral cochlear implant center. Patients: This study recruited 58 consecutive ears of children who underwent VT insertion followed by CI at age 7 years or younger between 2004 and 2021. Before October 2018, we removed the VT simultaneously with CI (removed group, 39 ears), while since then, the tube has remained in place during CI (retained group, 19 ears). Intervention: Therapeutic. Main Outcome Measure: The primary outcome was the proportion of ears that developed AOM at post-CI 6 months in the removed and retained groups. Results: The age at CI was significantly higher in the removed group than in the retained group (mean [standard deviation]: the removed group, 2.9 [1.2] yr; the retained group: 1.5 [0.8] yr; p < 0.001). The removed group showed a significantly higher proportion of ears with post-CI AOM (8 of 39 ears; 20.5%) than the retained group (none of 19 ears; 0%) 6 months after CI ( p = 0.044). The AOM-free proportion at post-CI 12 months was 76.9% in the removed group and 83.3% in the retained group, demonstrating no significant difference ( p = 0.49), probably because the VT was spontaneously extruded in the retained group at a median of 6.5 months after CI. Throughout the study period, 17 ears (13 from the removed group) were affected by post-CI AOM. Of these, three ears in the removed group and two in the retained group after spontaneous extrusion of the VT were hospitalized and treated with intravenous antibiotics for AOM that had failed to respond to oral antibiotic therapy. Only one ear in the removed group required an explanation of the infected implant. None suffered from chronic perforation of the tympanic membrane or secondary cholesteatoma after VT insertion or meningitis associated with post-CI AOM. Conclusion: Our results suggest that in CI for children who already have a VT because of a recurrent AOM or chronic OME, retaining the tube in position, rather than removing the tube, may decrease the incidence of AOM at least within 6 months after CI, during which most cochlear implant device infection was reported in the pediatric population.
Background and Objectives Cervical lymph node enlargement is observed in various diseases, including malignant lymphoma (ML). Open biopsy of the enlarged lymph node is frequently required for diagnosis, especially when ML is suspected. Serum levels of soluble interleukin 2 receptor (sIL-2R) may be useful as a biomarker of ML. This study aimed to determine whether the measurement of serum sIL-2R levels might be useful to diagnose ML.
Materials and Methods We retrospectively reviewed the data of 281 patients who had undergone open cervical lymph node biopsy at our institution between 2015 and 2019, including 157 males and 124 females (age range, 5–90 years). Data on the patients' age, final diagnosis, and serum sIL-2R levels were obtained from their medical records.
Results Overall, 184 cases of MLs and 97 cases of other diseases (non-MLs [NMLs]) were recorded. The mean age was significantly higher and mean serum sIL-2R levels were significantly higher in the ML group than in the NML group. In the ML group, the serum sIL-2R levels were significantly higher in patients with T cell lymphoma than in those with B cell lymphoma. The area under the receiver operating characteristic curve of the serum sIL-2R level for predicting ML was 0.711, and a serum sIL-2R level of 1,246 U/mL was associated with the maximum value of the sensitivity + specificity for the diagnosis of ML. Multivariate analysis revealed that the area under the receiver operating characteristic curve increased to 0.758 for patients aged >61 years and patients with serum sIL-2R levels of >1,246 U/mL.
Conclusions Among patients presenting with cervical lymphadenopathy, the measurement of serum sIL-2R levels could be useful for distinguishing between patients with and without ML, with a cutoff level of 1,246 U/mL for the diagnosis of ML.
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