Consequences of Stapes Surgery On Tongue Morphological Characteristics and Sensory Function

Ozadje: Domnevali smo, da manipulacija živca horde timpani (HT) med operacijo stapesa zaradi otoskleroze negativno vpliva na zaznavanje okusa, dvotočkovno diskriminacijo in morfologijo kapilarnih zank fungiformnih papil (FP) na jeziku. Metode: Po končani operaciji stapesa zaradi otoskleroze je kirurg ocenil stopnjo manipulacije živca HT kot: (1) nemanipulirano, (2) minimalno manipulirano, (3) srednje močno manipulirano, (4) močno manipulirano ali (5) presekano. Bolniki, ki so bili operirani na stapesu zaradi otoskleroze, so bili testirani en dan pred operacijo ter en mesec in šest mesecev po operaciji. Okus smo testirali s testnimi trakovi za sladko, slano, kislo in grenko, splošni občutek za dotik pa s statično dvotočkovno diskriminacijo. Za določitev števila kapilarnih zank fungiformnih papil (Npapillae) in skupnega rezultata morfologije krvnih žil (NBItotal) smo uporabili ozkopasovno kontaktno endoskopijo (NBI). Teste smo izvajali na ipsilateralni (testni) strani jezika in na kontralateralni (kontrolni) strani jezika. Rezultati: V raziskavo smo vključili 52 bolnikov z otosklerozo. Preverjanje predpostavk pred izvedbo korelacijskih testov ni pokazalo povezanosti med podatki glede manipulacije živca HT, zato statističnih testov korelacije nismo opravili. Na testni strani jezika smo v šestmesečnem obdobju ugotovili statistično značilno zmanjšanje okusa za sladko (p = 0,003), slano (p = 0,035), kislo (p = 0,036) in grenko (p = 0,013). Statistično pomemben vpliv na prisotnost disgevzije za sladko smo ugotovili en mesec po operaciji (p < 0,005). Pooperativno zmanjšanje statične dvotočkovne diskriminacije ni bilo statistično značilno (p = 0,056). Ugotovili smo statistično značilno zmanjšanje števila kapilarnih zank fungiformnih papil Npapillae (p = 0,009) in skupnega rezultata morfologije krvnih žil NBItotal (p = 0,005). Na kontrolni strani jezika nismo zaznali statistično značilnih sprememb. Zaključki: Manipulacija živca HT poslabša zaznavanje okusa ter zmanjša gostoto kapilarnih zank fungiformnih papil in poslabša njihove morfološke lastnosti. Manipulacija živca HT ne vpliva na občutek za dotik na jeziku.Background: We have assumed that the Chorda tympani (HT) manipulation during stapes surgery for otosclerosis has negative impact on taste sensation, two point discrimination and fungiform papillae capillary network morphology. Methods: After stapes surgery for otosclerosis, the surgeon graded the degree of manipulation of HT nerve as: (1) unmanipulated, (2) minimally manipulated, (3) moderately manipulated, (4) severely manipulated, or (5) severed. Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. The taste was tested with taste strips for sweet, salty, sour and bitter. General sensation was tested with a static two-point discrimination. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). Tests were performed on ipsilateral (test) side of the tongue and on contralateral (control) side of the tongue. Results: In our study, 52 patients with otosclerosis were included. Prior to planned correlation tests the assumptions have been tested, revealing there is no relationship between the data regarding the manipulation of the HT nerve, so statistical correlation tests were not performed. During the follow-up, statistically significant decrease of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up was identified. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p < 0.005). Postoperative decrease in two-point discrimination score was not statistically significant (p = 0.056). There was a statistically significant decrease of NBItotal (p = 0.005) and Npapillae (p = 0.009). On the control side of the tongue, no statistically significant changes were detected. Conclusions: HT manipulation affects taste sensation as well as fungiform papillae capillary network density and its morphology. General sensation of the tongue is not influenced by HT manipulation

Unraveling the etiology of pediatric vertigo and dizziness

Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood—BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1–17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was centralhowever, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential

Indicators of pediatric peripheral vestibular disorder

Objectives: This study aims to present characteristics of pediatric patients with peripheral vertigo and dizziness and their clinical workup results in the tertiary otorhinolaryngology center. We wanted to investigate whether the detailed history could replace the extensive vestibular testing and whether the clinical presentation could guide the first contact physician to appropriately directed specialist referral. Methods: Retrospective case review of consecutive pediatric vertigo and dizziness patients referred to the tertiary otorhinolaryngology center from 2015 to 2020. The data about the signs and symptoms of vertigo and dizziness and the results of audiological and vestibular tests were collected. Results: Of 257 children aged 10.9±4.3 years (R: 1–17 years), 32 (12.5%) had peripheral, and 49 (19%) had central vertigo and dizziness. Acute vestibulopathy was diagnosed in 22/257 (8.5%) children, sudden sensorineural hearing loss and benign paroxysmal positional vertigo in 5/257 (2%) children each. 60% of children with peripheral vertigo and dizziness had emesis, and 55.6% had nausea. 8% of children had spontaneous horizontal-rotatory nystagmus that followed Alexander’s law. Goodman and Kruskal’s л for determining whether the type of nystagmus could predict the type of vertigo and dizziness (central or peripheral) was 0.481 (p = 0.001). 12/26 (60%) of children with peripheral vertigo and dizziness had emesis compared to 14 (30.04%) children without emesis, a difference in proportions of 0.296 (p = 0.024, chi-square test of homogeneity). Binomial logistic regression to ascertain the effects of duration, nausea and emesis on the likelihood of the presence of peripheral vertigo was statistically significant (χ2(3) = 10.626, p = 0.014). Conclusion: Unlike adults, peripheral vestibular causes of vertigo and dizziness in children may be rare but have the same typical signs and symptoms. The detailed history and careful clinical examination are crucial in differentiating between peripheral and central causes. This guides the first contact physician for further referral to appropriate specialists included in a multidisciplinary workup. Namely, nausea, emesis, horizontal nystagmus and a longer duration of symptoms in a child with vertigo and dizziness indicate a peripheral etiology. Therefore, a referral to an otorhinolaryngologist is reasonable

Novel GRHL2 gene variant associated with hearing loss

In contrast to the recessive form, hearing loss inherited in a dominant manner is more often post-lingual and typically results in a progressive sensorineural hearing loss with variable severity and late onset. Variants in the GRHL2 gene are an extremely rare cause of dominantly inherited hearing loss. Genetic testing is a crucial part of the identification of the etiology of hearing loss in individual patients, especially when performed with next-generation sequencing, enabling simultaneous analysis of numerous genes, including those rarely associated with hearing loss. We aimed to evaluate the genetic etiology of hearing loss in a family with moderate late-onset hearing loss using next-generation sequencing and to conduct a review of reported variants in the GRHL2 gene. We identified a novel disease-causing variant in the GRHL2 gene (NM_024915: c.1510C>Tp.Arg504Ter) in both affected members of the family. They both presented with moderate late-onset hearing loss with no additional clinical characteristics. Reviewing known GRHL2 variants associated with hearing loss, we can conclude that they are more likely to be truncating variants, while the associated onset of hearing loss is variable

The importance of early genetic diagnostics of hearing loss in children

Hearing loss is one of the most common sensory deficits. It carries severe medical and social consequences, and therefore, universal newborn hearing screening was introduced at the beginning of this century. Affected patients can have hearing loss as a solitary deficit (non-syndromic hearing loss) or have other organs affected as well (syndromic hearing loss). In around 60% of cases, congenital hearing loss has a genetic etiology, where disease-causing variants can change any component of the hearing pathway. Genetic testing is usually performed by sequencing. Sanger sequencing enables analysis of the limited number of genes strictly preselected according to the clinical presentation and the prevalence among the hearing loss patients. In contrast, next-generation sequencing allows broad analysis of the numerous genes related to hearing loss, exome, or the whole genome. Identification of the genetic etiology is possible, and it makes the foundation for the genetic counselling in the family. Furthermore, it enables the identification of the comorbidities that may need a referral for specialty care, allows early treatment, helps with identification of candidates for cochlear implant, appropriate aversive/protective management, and is the foundation for the development of novel therapeutic options

Slovenian Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12), Vertigo (DHI, NVI) and TINNITUS (THI)

To provide physicians and patients with the tools needed to evaluate patients’ problems and health-related quality of life by cross-culturally adapting and validating the Chronic Otitis Media Questionnaire 12 (COMQ-12), the Dizziness Handicap Inventory (DHI), the Neuropsychological Vertigo Inventory (NVI) and the Tinnitus Handicap Inventory (THI)

Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation: A Prospective Tertiary Center Study

(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBItotal (p = 0.005), Npapillae (p = 0.009), sensation of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation

Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation: A Prospective Tertiary Center Study

(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBItotal (p = 0.005), Npapillae (p = 0.009), sensation of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p &lt; 0.005). Postoperative decrease in two-point discrimination score did not reach a statistical significance (p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation

Cross-cultural adaptation and validation of nasal obstruction symptom evaluation questionnaire in Slovenian language

Nasal obstruction is highly subjective perception with numerous efforts being made towards objective measuring. Many instruments in quality of life studies encompass subjective symptom of nasal obstruction, but only NOSE has been properly validated and is easy to use in every day practice

A language-independent hearing screening self-test at school-entry

Abstract The usage of a tablet-based language-independent self-test involving the recognition of ecological sounds in background noise, the Sound Ear Check, was investigated. The results of 692 children, aged between 5 and 9 years and 4 months, recruited in seven different countries, were used to analyze the validity and the cultural independence of test. Three different test procedures, namely a monaural adaptive procedure, a procedure presenting the sounds dichotically in diotic noise, and a procedure presenting all the sounds with a fixed signal-to-noise ratio and a stopping rule were studied. Results showed high sensitivity and specificity of all three procedures to detect conductive, sensorineural and mixed hearing loss > 30 dB HL. Additionally, the data collected from different countries were consistent, and there were no clinically relevant differences observed between countries. Therefore, the Sound Ear Check can offer an international hearing screening test for young children at school entry, solving the current lack of hearing screening services on a global scale