Τρίτη 15 Ιουνίου 2021

Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) for Tinnitus: A Retrospective Study

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Ear Nose Throat J. 2021 Jun 15:1455613211016896. doi: 10.1177/01455613211016896. Online ahead of print.

ABSTRACT

OBJECTIVE: Current studies still find insufficient evidence to support the routine use of repetitive transcranial magnetic stimulation (rTMS) in tinnitus. This study aimed to assess response of tinnitus to treatment with rTMS and identify factors influencing the overall response.

METHODS: Between January 2016 and May 2017, 199 tinnitus patients were identifi ed from a retrospective review of the electronic patient record at the Sun Yat-sen Memorial Hospital. All patients received rTMS treatment. Their clinicodemographic profile and outcomes, including the tinnitus handicap inventory (THI) and visual analog scale (VAS) scores, were extracted for analysis.

RESULTS: Regarding the THI results, 62.3% of all patients responded to rTMS. The analysis of the VAS score revealed an overall response rate of 66.3%. Both percentages were close to the patient's subjective assessment result, of 63.8%. Patients with tinnitus of less than 1-week duration had the highest response rate to rTMS in terms of either THI/VAS scores or the patient's subjective assessment of symptoms. Tinnitus duration was recognized as a factor influencing the overall response to the treatment.

CONCLUSIONS: Repetitive transcranial magnetic stimulation treatment is effective for patients with tinnitus, but its efficacy is affected by tinnitus duration. Tinnitus patien ts are advised to attend for rTMS as soon as possible since therapy was more effective in those with a shorter duration of disease of less than 1 week.

PMID:34128408 | DOI:10.1177/01455613211016896

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Prevalence of retromolar canal and its association with mandibular molars: study in CBCT

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Surg Radiol Anat. 2021 Jun 15. doi: 10.1007/s00276-021-02787-6. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate the presence and characteristics of the retromolar canal and association with mandibular molars using cone-beam computed tomography (CBCT).

STUDY DESIGN: CBCT images of 200 consecutive patients were analyzed using the Anatomage Invivo 5® software. Retromolar canal present evaluated the type of trajectory, buccal or lingual location, uni or bilateral, origin and final diameters. Pearson's Chi square test was used to verify the association between the retromolar canal and the presence of the third molar (p ≤ 0.05).

RESULTS: The prevalence of the retromolar canal was 24.5%. The oblique trajectory was the most common (33.3% on the right side and 50% on the left side). Buccal location was the most frequent (right side 50% and left side 70%). The unilateral canal was the most frequent (77.6%). As for the caliber, the diameters vary from 1.12 to 2.37 mm. Regarding the association between the retromolar canal and the third molar, there was no statistically significant difference (right side p = 0.60 and left side p = 0.90).

CONCLUSION: The retromolar canal is not a rare anatomical variation showing a prevalence of 24.5%. Surgical procedures should consider the presence of the retromolar canal to avoid excessive bleeding, considering its significant caliber.

PMID:34129064 | DOI:10.1007/s00276-021-02787-6

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Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus

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Eur Arch Otorhinolaryngol. 2021 Jun 15. doi: 10.1007/s00405-021-06933-z. Online ahead of print.

ABSTRACT

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone.

METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire.

RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood staine d nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up.

CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

PMID:34129085 | DOI:10.1007/s00405-021-06933-z

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Comparison of cervical and ocular vestibular-evoked myogenic potential responses between tone burst versus chirp stimulation

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Eur Arch Otorhinolaryngol. 2021 Jun 15. doi: 10.1007/s00405-021-06936-w. Online ahead of print.

ABSTRACT

PURPOSE: To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults METHODS: This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1-n1, n1-p1), peak to peak amplitude (p1-n1 amplitude and n1-p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli.

RESULTS: VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.01 5, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively).

CONCLUSION: The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice.

PMID:34129084 | DOI:10.1007/s00405-021-06936-w

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Auswirkungen der COVID-19-Pandemie auf Konsultationen & Diagnosen in den HNO-Praxen in Deutschland

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Laryngorhinootologie
DOI: 10.1055/a-1510-9686

Hintergrund Während der ersten Monate der COVID-19-Pandemie kam es zu einer deutlichen Reduktion in der Frequentierung der Institutionen im Gesundheitswesen. Dieser Umstand beeinflusste die rechtzeitige Diagnosestellung und subsequente Therapieeinleitung in nahezu sämtlichen Fachgebieten. Ziel der vorliegenden Untersuchung ist die Evaluation eines hypothetisch veränderten Gesundheitsbewusstseins in Bezug auf die ambulante Konsultation von HNO-Ärzten in Deutschland. Material und Methoden Diese Studie nutzte die anonymisierten Daten aus 146 HNO-Praxen in Deutschland und umfasste 162724 Patienten im 2. Quartal 2019, 158077 im 3. Quartal 2019, 128342 im 2. Quartal 2020 und 149153 im 3. Quartal 2020. Das erste Outcome war der Unterschied in der Anzahl der Patienten mit mindestens einem Besuch in diesen Praxen zwischen dem zweiten und dritten Quartal 2019 und dem zweiten und dritten Quartal 2020. Das zweite Outcome war die Anzahl der Patienten mit neuen Diagnosen pro Praxis, definiert als Diagnosen, die zuvor nicht in der Datenbank für einen bestimmten Patienten dokumentiert waren. Ergebnisse Die Anzahl der Patienten pro Praxis war im 2. Quartal 2020 im Vergleich zum 2. Quartal 2019 signifikant geringer (879 versus 1108; p<0,001). Beim Vergleich des 3. Quartals 2020 mit dem 3. Quartal 2019 zeigten sich keine signifikanten Unterschiede (1022 versus 1083; p=0,261). Diagnosen von Otitis media (-43%), akuten Infektionen der oberen Atemwege (-42%), chronischen Erkrankungen der oberen Atemwege (-21%) und Hörsturz (-20%) nahmen im 2. Quartal 2020 verglichen zum 2. Quartal 2019 signifikant ab. Im 3. Quartal 2020 gab es im Vergleich zum 3. Quartal 2019 darüber hinaus einen signifikanten Rückgang der Patientenzahlen für akute Infektionen der oberen Atemwege (-26%) und Otitis media (-25%). Schlussfolgerungen Die vorliegenden Ergebnisse sind, neben einer Vermeidung von Arztkontakten vonseiten der PatientInnen, sowohl auf die reduzierte Terminvergabe durch die HNO-Praxen als auch auf die konsequente Einhaltung und Umsetzung der Abstands- bzw. Hygieneregeln im Sinne der Verwendung von Atemschutzmasken (FFP2/KN95) zurückzuführen.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Anterior cervical surgery to treat diffuse idiopathic skeletal hypertrophic combined with cervical disc herniation: A case report

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Medicine (Baltimore). 2021 Jun 4;100(22):e26097. doi: 10.1097/MD.0000000000026097.

ABSTRACT

RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by calcification of anterolateral ligaments of the spine and the rest of the body. DISH combined with disc herniation induces complex symptoms and is more difficult to treat. Here, we describe a complicated case of a patient diagnosed with DISH as well as cervical disc herniation that was successfully treated using anterior cervical surgery.

PATIENTS CONCERN: A 69-year-old Asian male experienced dysphagia and weakness in his left limbs. He also experienced a stiff neck and right slant over a 6-month period.

DIAGNOSIS: An X-ray revealed calcification of the C4-7 vertebral front edge and a narrowed intervertebral space between C5/6. Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) both showed compression of the spinal cord at the cervical 5/6. Esophagography revealed that osteophytes in the anterior margin of vertebral body (C4-C7) oppressed the esophagus.

INTERVENTIONS: An operation focused on anterior cervical C5/6 disc fusion and anterior vertebral C4-7 osteophyte removal was performed.

OUTCOMES: After the operation, X-ray and CT showed that most osteophytes were removed and spinal cord compression was relieved. One day following the operation, both dysphagia and numbness in limbs were improved. Strong recovery was observed at the three-month follow-up exam.

LESSONS: This complex DISH combined with disc herniation case is rarely observed in patients. Anterior cervical disc fusion and anterior vertebral osteophyte removal were effective treatment measures. This case study provides insight into treating cases presented with cervical spine complications associated with DISH combined with other ailments.

PMID:34087855 | PMC:PMC8183831 | DOI:10.1097/MD.0000000000026097

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Thresholds, Firing Rates, and Order of Recruitment of Anterior Temporalis Muscle Single-Motor Units During Experimental Masseter Muscle Pain

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J Oral Facial Pain Headache. 2021 Spring;35(2):93-104. doi: 10.11607/ofph.2719.

ABSTRACT

AIMS: To test the hypothesis that, in comparison with control, experimental noxious stimulation of the right masseter muscle would result in significant changes in the firing rates, thresholds, and recruitment orders of single-motor units (SMUs) of the nonpainful, synergistic right anterior temporalis muscle during goal-directed isometric biting task performance.

METHODS: Twenty he althy volunteers received an infusion of hypertonic saline (HS; 5% sodium chloride) into the right masseter to produce pain intensity of 40 to 60 on a 100-mm visual analog scale (VAS). Isotonic saline (IS) infusion was a control. Standardized biting tasks were performed with an intraoral force transducer, and intramuscular electromyographic activity was recorded from the right anterior temporalis muscle. Tasks (slow and fast ramp biting tasks, two-step biting task) were performed in 3 blocks: baseline, HS infusion, and IS infusion. Across blocks, SMU thresholds and firing rates were statistically compared, and SMU recruitment sequences were qualitatively compared. Statistical significance was set at P < .05.

RESULTS: No significant differences (P > .05) were noted between HS and IS infusion blocks in thresholds or firing rates of anterior temporalis SMUs. Individual SMUs showed increases or decreases in thresholds or firing rates or changes in recruitment sequences mostl y during HS compared to IS infusion.

CONCLUSION: The reorganization of SMU activity that has been suggested to occur in both painful and nonpainful agonist jaw muscles may involve not only recruitments and de-recruitments of SMUs, but may also extend to more subtle increases and/or decreases in firing rates, thresholds, and recruitment sequences of individual SMUs in the nonpainful synergistic muscles.

PMID:34129654 | DOI:10.11607/ofph.2719

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