S) score, posterior ethmoid sinus (PES) score, sphenoid sinus (SS) score, ethmoid sinus score/maxillary sinus score (ES/MS) ratio and posterior ethmoid sinus score/anterior ethmoid sinus score (PES/AES) ratio were significantly higher in the B-high subgroup. Logistic regression analyses disclosed that comparing with other sinus CT parameters, OC score was an independent predictor for systemic eosinophilia. There was a moderate correlation between OC score and the level of blood eosinophil (r=0.57, P<0.001). Conclusion: Olfactory cleft opacification shown in paranasal sinus CT may be a marker for the phenotype of CRSwNP with systemic eosinophilia, which appears to be closely related to olfactory dysfunction.

Key Points • CRP reduction at day five of more than 35% from the previous highest concentration post-laryngectomy or laryngopharyngectomy has been proposed to positively predict healing without pharyngocutaneous fistula • Retrospective cohort analysis of 163 patients has not been able to externally validate these findings. • ROC curves and subset analyses have not identified alternative parameters to reach significance • However, there is a non-significant association with decreasing postoperative CRP and healing without fistula. • Multicentre prospective studies to include post-operative procalcitonin could help refine this protocol further.

Introduction Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. Methods We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). Results A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported. Conclusion Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

Objectives: Several studies proposed a loss of neural structures in Menière’s disease (MD). It has also been shown that VIIth and VIIIth cranial nerves are enlarged within MD patients compared to normal controls. We aimed to investigate potential differences in these two nerves in patients with MD. Setting: 71 patients with MD were included, 53 showed clinically unilateral affection. Constructive-interference-in-steady-state(CISS) and 3D-FLAIR-inversion-recovery(IR) sequences with two different slice thicknesses were acquired on a clinical 3T magnetic resonance imaging scanner. We evaluated morphometric properties of the VIIth and VIIIth cranial nerves passing from the cerebellopontine angle to the inner ear modiolus. In patients with clinically unilateral MD, we compared the unaffected to the clinically affected side. In addition, we evaluated the morphology of the nerves in correlation to symptom duration. Results: The clinically unilateral MD-patients showed no significant differences after Bonferroni correction when comparing the affected side to the non-affected side of VIIth and VIIIth cranial nerves. There was no significant difference between patients with different symptom durations. Conclusions: Our data showed no differences in nerve morphometry between the clinically non-affected and the clinically affected side in patients with clinically unilateral MD. There was also no correlation to duration of symptoms, in contrast to previously demonstrated correlations between clinical features and the extent of endolymphatic hydrops. A disease process starting before onset of clinical symptoms could be a potential explanation.

Objective. To discuss the presentation, evaluation, and management of congenital laryngeal web. Methods.: The Institutional Board of Ethics of shanghai Children’s Hospital approved this retrospective review of all patients who were diagnosed with laryngeal web at our institution within the past 10 years. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. Results.: Ten patients were included (6 male, 4female). There were 3 type I、II webs, 7 type III、IV webs; Children with type I and II laryngeal web were mainly presented with hoarseness and discomfort without any obvious respiratory distress（P＜0.05）. Children were usually older when they were presented to the hospital（p<0.05）, All the 3 children with type I and II laryngeal web recovered after a single endoscopic procedure. While children with laryngeal web type III and IV usually had a record of multiple visits to the hospital with multiple treatments（p<0.05） All of these 7 type III、IV webs , the tracheotomy was performed early, The ultimate treatment required for such patients was open laryngoplasty. Conclusions：There is a need for alertness regarding the neonatus exhibiting hoarseness and weak crying. To achieve a satisfactory outcome, it is essential to perform accurate preoperative staging and assessment along with an appropriate choice of treatment and placement of the laryngeal stent.

Abstract OBJECTIVES Given its rarity and the lack of clear clinical markers, amyotrophic lateral sclerosis (ALS) remains a diagnostic challenge. Since bulbar-onset ALS (buALS) presents with impaired speech or swallowing, patients are often primarily referred to an otolaryngologist (ORL) or phoniatrician. We analyzed the role of such specialists in ALS diagnostics and treatment. PARTICIPANTS We reviewed data for all 327 patients treated for ALS through the Hospital District of Helsinki and Uusimaa (HUS) between 2010 and 2014, focusing specifically on 110 (34%) patients presenting with bulbar nerve onset (buALS). MAIN OUTCOME MEASURES The presenting symptoms, referral to specialized care, and to a neurology clinic were assessed. Indications and findings from swallowing studies were reviewed as well as the incidence of percutaneous endoscopic gastrostomy (PEG) and tracheostomy. RESULTS Among the 110 patients with buALS, 64 (58%) were primarily referred to a neurologist, 28 (25%) to an ORL, and 5 (5%) to a phoniatrician. The most common presenting symptom was dysarthria in 89 patients, (81%), followed by dysphagia in 26 (24%). In most cases, an ORL or phoniatrician suspected a neuromuscular disease; however, in 8 (24%) cases, the neurological etiology of symptoms was missed. Overall, 49 (45%) patients underwent a swallowing study and 86 (78%) patients underwent PEG placement. CONCLUSIONS Among buALS patients, 30% initially consulted an ORL or phoniatrician and 45% underwent a swallowing study. Based on our results, swallowing studies rarely lead to immediate PEG placement. An initial visit to other specialists had no impact on diagnostic delays or survival. Five keypoints Amyotrophic lateral sclerosis (or ALS) Motor neuron disease Dysphagia Fiberoptic Endoscopic Examination of Swallowing (or FEES) Percutaneous Endoscopic Gastrostomy (or PEG) Level of Evidence: 3

Objectives: Previously, we used a nasal cavity model to analyze the intranasal airflow dynamics and numerically calculate the nasal resistance value. Here, we created a nasal sinus model that is closer to the real human body and calculated the nasal resistance value. Moreover, we performed comparisons of the measured and simulation data. Setting: The models were healthy adult volunteers: a 35-year-old man (model 1) and a 25-year-old man (model 2), who were used as nasal cavity and paranasal sinus models. A 1.0-mm slice computed tomography (CT) was performed and a nasal sinus model was created. We compared the nasal resistance of the simulation value with that of the measured value obtained using rhinomanometry. Results: In model 1, the measured (simulation) value was 0.69 (0.48) on the right, 1.10 (0.41) on the left, and 0.42 (0.22) on both sides. In model 2, the measured (simulation) value was 0.72 (0.21) on the right, 0.32 (0.09) on the left, and 0.22 (0.06) on both sides. Conclusion: We observed a difference between the simulation and measured values, possibly because of the length of the inferior turbinate and the cross-sectional area of the choana and nasopharynx. Further experiments using additional nasal cavity and paranasal sinus models are warranted.

Abstract Person-specific three-dimensional computational modelling plays a vital role in modern day research of cochlear implants to assist in understanding the neural interface of the cochlea and implanted electrode array. Further improvements are made to these models as more parameters are included. Landmark assessment provides information and is frequently used to register co-ordinates for model generation as it captures small variations. Objectives: The objective of this study is to identify and define landmarks to describe the internal auditory canal adequately for inclusion in the three-dimensional computational models of the cochlea and its surrounding structures. Participants: Retrospectively collected computer tomography scans of live human cochleae were collected. Descriptive and comparative statistics were used to describe the data obtained from the scans. Results: The mean anterior-posterior (AP) diameter at the base on the basal turn, the AP diameter at the midpoint of the IAC, the anterior and posterior length of the internal acoustic canal were measured. 57.14% of the internal acoustic canals observed presented with a cylindrical, 40.48% was funnel-shaped and 2.38 % was bud-shaped. A statistically significant difference was found between the diameters of the male and female internal acoustic meatii. Conclusion: This paper serves as a reference providing a landmark set for the description of the internal acoustic canal for inclusion in three-dimensional computational reconstruction of the cochlea and surrounding structures.

Abstract Objective: To appraise the added benefit of refixation saccades (RS) towards the improvement of the video head-impulse test (vHIT) diagnostic accuracy in cases of suspected left horizontal semicircular canal dysfunction. Study Design: Case-control. Setting: Tertiary referral center. Participants: Twenty patients with a final diagnosis of left horizontal semicircular canal dysfunction and 20 patients for whom vestibular dysfunction was ruled out. Intervention: vHIT recordings of 40 patients with left horizontal semicircular canal (LHSCC) vestibulo-ocular reflex (VOR) gain <0.8. Main outcome measures: LHSCC VOR gain; Presence of RS and their frequency, latency, and velocity characteristics. Results: Gain values > 0.72 were found in all patients with no vestibular disease and in 4 (20%) patients having vestibulopathy. Significantly higher average left-sided RS velocity and frequency were found among the vestibular patients. VOR gain < 0.72 was found to be highly specific for the diagnosis of vestibular dysfunction. However, for gain values in the range of 0.72-0.79 the presence of RS with frequency > 80% largely improved vHIT diagnostic accuracy. CONCLUSIONS: Although VOR gain<0.8 is considered to reflect dysfunction a significant false positive rate for left-sided horizontal vHIT was found for gains in the range of 0.72-0.79. The presence of RS with frequency >80% could improve vHIT diagnostic ability in these patients. Key words: video head impulse test, re-fixation saccades, peripheral vestibular pathology, gain asymmetry in vHIT, lateral semicircular canal hypofunction, saccadic frequency, corrective saccade velocity

Previous studies have shown that patients with acoustic neuroma (AN) sometimes present with sudden sensorineural hearing loss (SSNHL) as an initial symptom. The purpose of this research was to investigate the clinical characteristics, diagnosis and treatment of AN in patients diagnosed as SSNHL initially. A total of 10 patients presented with SSNHL as the initial symptom and diagnosed as AN by magnetic resonance imaging (MRI) finally were enrolled in this study. Patient demographics, associated complaints (mostly tinnitus and vertigo), severity of hearing loss, audiogram configurations, auditory brainstem response (ABR) and MRI examination were reviewed and analyzed. Treatment outcome and management protocols were also included in this study. These patients exhibited varying severity of hearing loss and a variety of audiogram configurations. All patients showed an abnormal ABR. According to the Koos grading standard, there were 5 grade I (intracanalicular) tumors, 3 grade II tumors and 2 grade III tumors. The treatment outcome revealed that 2 patients exhibited recovery of the average hearing of impaired frequency by more than 15 dB, and 6 patients showed no recovery. Four patients were referred to undergo surgical treatment after being diagnosed with AN, 1 patient accepted stereotactic radiation therapy, and the remaining 5 patients were taken “waiting and scan” strategy. The findings of this study show that hearing recovery after corticosteroid treatment for SSNHL does not exclude the presence of AN and all patients diagnosed as SSNHL initially should undergo MRI and ABR to prevent misdiagnosis and delays in potential treatment.

Keypoints: • The presence of a pharyngeal mucosal space abscesses (PMA), being confined between the pharyngeal mucosa and the pharyngeal constrictor muscle, is considered rare. However, in our series represented 14,3% of deep neck infections (DNIs), suggesting that they may not be so rare as they are considered to be. • PMAs’ symptoms and clinical findings are similar to those of other DNIs, but trismus and neck swelling seem to be significant lower in PMAs. • Imaging studies will set PMA diagnosis, while CT with contrast is the modality of choice. • PMAs seems to be less dangerous than their deep-seated counterparts, since its superficial location renders them amenable to spontaneous drainage, aspiration, incision and drainage intraorally obviating spread to deeper structures.

Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.

Introduction With the COVID-19 pandemic, a “new normal” on how surgeons and intensivists perform tracheotomy in COVID-19 patients is essential. We aim to summarize the recommendations and present the supporting evidence of these recommendations. Methods A search of published works on tracheotomy, tracheostomy, COVID-19, novel coronavirus, SARS-CoV-2 was performed on PubMed/MEDLINE/Cochrane Library. Articles relevant to the practice of tracheotomy on patients with COVID-19 were selected. The articles were then reviewed and divided into 4 key categories: 1) Personal protective equipment (PPE) in COVID-19 positive patients, 2) Adjunctive measures of airway management before definitive intervention in COVID-19 positive patients; 3) Timing of tracheotomy in COVID-19 positive patients; and 4) Perioperative considerations in performing tracheotomy in COVID-19 positive patients. Results and key points Firstly, enhanced PPE is recommended during tracheotomy of COVID-19 positive patients. Secondly, adjunctive airway management before definitive intervention includes the use of high flow nasal cannulas (HFNC). Thirdly, non-invasive ventilation via continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) machines are not recommended. Fourth, the general consensus suggests that timing of tracheotomy should be at least 10 days after intubation. Finally, percutaneous dilatational tracheotomy (PDT) is likely to be associated with a lower risk of transmission of the virus to healthcare workers (HCW) than a surgical tracheotomy (ST). Other key precautions would include minimizing the use of diathermy. Conclusions The “new normal” workflow summarizes the ideal recommendations across published societal guidelines. Enhanced PPE should be recommended whenever possible. Adjunctive measures before definitive intervention of COVID-19 patients should be limited to the use of HFNC, and CPAP/BiPAP should be avoided. Tracheotomy should be performed after 10 days, although the long term sequelae of tracheal stenosis and pulmonary fibrosis should be ascertained with this approach.

Tracheostomy related tracheal tear is a serious complication that may follows surgical or percutaneous tracheostomy. Pediatric populations carry higher risk because of the anatomical differences. It needs immediate diagnosis as may leads to life threatening outcomes such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. The best way to diagnose and discover tracheal tear is by tracheobronchoscopy. If the diagnosis established prompt management and treatment should be performed. Objective The aim of this article is to review tracheal tears and to help in their diagnosis and management with assistance of clinical and radiological findings. Methods and Materials A literature review of PubMed , ovid Medline and cochrane collaboration databases was done using the terms pediatric , tracheostomy , tracheal tear. Discussion Tracheostomy related tracheal tear occurs infrequently and less commonly than intubation related tracheal tear. Mostly it is related to tracheostomy placement, using cuffed tubes and overinflation of the cuff or the tear directly follows traumatizing tracheostomy tube introducer insertion. The tear due to tracheostomy mostly located proximal to carina and distal to insertion of point of tracheostomy. Symptoms and complications of the tear may occur intraopertivly or postoperatively(5). Gold standard method for diagnosis will be established by flexible or rigid tracheobronchoscopy which helps in determining the site, size, extension of the tear and its location with respect to the carina that are essential to document. Imaging studies like CT scan which also helps in establishing the diagnosis of tear and some of it is complications such as pneumothorax, pneumonia, pneumomediastinum and mediastinitis. Treatment can be conservative for small uncomplicated wound in stable patient. For larger complicated tears and unstable patient surgical treatment is the gold standard. Conclusion Treatment choices depend on tear site , size, extension of the tear and the status of the patient. Conservative management is sufficient for stable patients with small tears . On the other hand , surgical management is essential for unstable patients and large complicated wounds.

Abstract Background The use of telehealth during the COVID-19 pandemic has emerged as both a necessary and significant tool in the provision of safe and timely healthcare in the field of otolaryngology. Increased access to specialist care in a regional setting is an additional benefit. Variation in diagnostic accuracy of telehealth consultations may affect diagnosis and management. Therefore, our aim is to determine the diagnostic accuracy of telemedicine for otolaryngology in an Australian regional setting. Methods Retrospective review was conducted for all patients who received an initial telemedicine appointment over a 7 month period during the COVID-19 pandemic in regional Victoria, Australia. Data was collected regarding initial diagnosis and management from telemedicine consultations, subsequent physical appointment findings and management and intraoperative findings. Statistical analysis was performed using Prism (version 8.0, GraphPad). Results Two hundred and fifty-nine patients were included. The most common conditions referred were for consideration of tonsillectomy with or without adenoidectomy (44.0%). Overall diagnostic accuracy of the initial referrer was 63.3% and for telephone appointments it was 81.9%. Concordance of recommended treatment plans between telephone and physical appointments was 96.9%. Conclusion There are significant benefits of phone only telemedicine within the context of a global pandemic which were compounded by a regional setting. Paediatric patients were found to be of highest benefit for telemedicine with high diagnostic accuracy and concordance of treatment plans.

Abstract Objectives: This study aimed to determine success rate of tympanoplasty in CSOM patients & its prognosticating factors. Design and setting; A facility based retrospective cross sectional study design was employed to assess the characteristics of chronic suppurative otitis media patients and the success rate of tympanoplasty of patient who underwent surgery at ORL-HNS of SPHMMC, Addis Ababa, Ethiopia. Methods: Ninety patients who had undergone tympanoplasty in the year 2019 from a retrospective database were studied. Data was collected using a structured checklist and analysed using SPSS 25. Baseline profiles of participants were computed using descriptive statistics. Paired t-test was used to compare preoperative and postoperative ABG results. Multiple regression analyses of potential factors (intra-& pre-operative characteristics) were used to identify predictors for success of tympanoplasty while the level of significance was set at p<0.05. Anatomical success was defined as a complete integration of the graft and functional success as an ABG closure of ≤20dB after 6 months postoperatvely. Results: The postoperative anatomical & functional success rates for tympanoplasty were 81.1% and 60%, respectively. According to the statistical results of the study, neither the anatomic success nor the functional was found to be prognosticated by the potential factors analyzed. Conclusion: Tympanoplasty is an effective surgical procedure that can result in improved auditory function in patients and prevents complications satisfactorily irrespective of baseline characteristics. With tympanoplasty, the ear heals and the patient hears. Keywords: Tympanoplasty; CSOM; success rate; SPHMMC Succinct points: Endaural Tympanoplasty; temporalis fascia graft; air bone gap in dB; endoscopic tympanoplasty; 6months follow up period

Objectives: Numerous tasks carried out in the otolaryngology clinic increase the chances of developing injury among practitioners. To mitigate this, we aim to observe the risk of musculoskeletal injury in practitioners when carrying out common procedures. We observe the performance of the Dix-Hallpike manoeuvre, deducing whether technique has an impact on the likelihood of developing injury. Design: Participants were asked to perform the Dix-Hallpike manoeuvre as they normally would in clinic, on departmental colleagues. Data that was collected included chosen preference of position when carrying out manoeuvre, level of seniority of practitioner and risk of musculoskeletal injury to practitioner. Setting: Simulated outpatient department; St John’s Hospital, Edinburgh. Participants: Otolaryngology consultants and trainees with clinic commitments, having regularly performed the Dix-Hallpike manoeuvre. Main outcome measures: Risk of musculoskeletal injury was measured using the validated Rapid Upper Limb Assessment (RULA) tool. Results: 3 consultants and 7 trainees were included in this study performing on average 4 Dix-Hallpike’s during the study period – totalling 40 attempts. The median RULA score was 4 for the sitting position, compared to 6 for standing (p<0.0001). There was similar statistical significance when consultants and trainees were evaluated separately. Conclusions: A doctor’s wellness is of great importance to facilitate long-term job satisfaction and productivity. It is important to improve conditions for the practitioner in the otology clinic, and one factor is procedural technique. Further work is needed to raise ergonomic awareness amongst otolaryngology surgeons.

Objectives: This study aimed to ascertain current practices prevalent among medical students using electroacoustic devices. We also aimed to determine pattern and frequency of hearing loss among medical students. Design: Cross-sectional Participants: Students of 3rd year and 4th year MBBS at Jinnah Sindh Medical University, Karachi, Pakistan were included. Data collection dated from December 2019 till February 2020 using convenience sampling technique. Setting: Students were invited to ENT OPD, Jinnah Postgraduate Medical Centre, Karachi. Through a structured proforma, we recorded practices regarding electroacoustic devices. We investigated hearing of medical students by tuning fork tests and Pure Tone Audiometry. Main Outcome Measures: Using SPSS software version 23 we applied Chi square test, Pearson correlation and independent t test at 95% CI and p=<0.05 as significance level. Results: A total of 221 students fulfilled inclusion criteria. 96.4%(n=213) regularly used electroacoustic devices. Students mostly used insert type earphones connected with a smartphone. More than 30% of medical students demonstrated low frequency (0.25-0.5kHz) sensorineural hearing loss (SNHL). Pearson correlation yielded strong positive correlation with hearing loss and years of exposure(p=<0.001). Male students used electroacoustic devices more frequently than female students(p=0.01). However, we did not observe significant difference between their mean thresholds. Conclusion: Acoustic trauma has been conventionally described to affect higher frequencies. We found low frequency SNHL among majority of students. This indicates that specific type of acoustic trauma can affect particular frequencies on audiogram. KEY WORDS: Low frequency hearing loss, medical students, Pure Tone Audiometry, personal listening devices, hearing thresholds, noise induced hearing loss, sensorineural hearing loss

Objectives: This study aims to compare the graft success and hearing results of the palisade and island cartilage graft, with a new wheel-shaped composite cartilage graft for type 1 tympanoplasty. Design: The study was designed retrospectively. Setting: The study was conducted at Katip Celebi University, Ataturk Training and Research Hospital, Otolaryngology-Head & Neck Surgery Clinic. Participants: Only patients with conductive hearing loss and simple pars tensa perforation of the tympanic membrane were included in the study. Main outcome measures: Pure tone average (PTA), air-bone gap gain (ABG), word recognition score (WRS), ABG closure and grafts success were compared between the graft groups. Results: Records of 111 patients were analyzed. The graft success rate was 89.7% for palisade cartilage graft (PCG, n= 39), 86.1% for island cartilage graft (ICG, n=36), and 97.2% for wheel-shaped composite cartilage graft (WsCCG, n= 36) (p=0.244). Average postoperative PTA and ABG values were significantly affected by the cartilage graft type, but WRS was not affected. (p = 0.005, 0.019, 0.306, respectively, One Way-Anova test). Post-Hoc LSD test showed a statistically significant decrease in PTA and ABG averages for WsCCG group compared to the ICG group (p= 0.004; CI%95= 15.1-2.2 dB and p= 0.023; CI%95= 8.2-0.4 dB, respectively). Postoperative PTA and ABG averages for WsCCG and PCG groups were similar (p= 0.069 and p=0.053, respectively). In addition, while there were 2 (5.1%) retractions in the PCG group and 1 (2.7%)in the ICG group, there was no retraction in the WsCCG group. Conclusion: The WsCCG provided comparable results with classical reliable graft techniques (PCG and ICG) and may recommend as a more suitable graft due to hearing results and resistance against retraction.

Objectives: Pulsatile tinnitus (PT) is usually caused by vascular pulsation, its pathogenic mechanism is still unclear. We conducted a retrospective analysis of some patients diagnosed with PT, aiming to provide clinical reference for future studies on PT. Design: Retrospective study. Setting: Single institution. Participants: Surgical treatment of PT in 52 patients. Methods: We counted basic characteristics of all patients, analyzed the prognostic factors and the treatment results, classified the etiology according to the imaging findings. Results: The gender difference was statistically significant in PT（2=44.308, P＜0.001). The analysis results found a correlation between duration of tinnitus and the prognosis of surgery (P<0.05). we found 19 conditions can lead to PT. We reported the first case in the world that the mirror man suffers from PT in our study. Conclusions: Our study suggests that we attribute the cause of PT to the superposition of the degree and number of risk factors over time. The duration of tinnitus is related to prognosis. The hearing loss of PT is mainly low frequency hearing loss. A total of 19 imaging conditions can cause PT were found. PT caused by sigmoid sinus diverticulum had the best surgical effect, while high jugular bulb had the worst. PT in mirror person is reported for the first time, which provides clinical reference for the diagnosis and treatment of PT in mirror person. At the same time, we raised some new questions for the study of PT.

Background: Paediatric acute myeloid leukaemia (AML) is heterogeneous. Frequency of cytogenetic abnormalities varies from adults. Methods: Children with de novo AML were included. Peripheral blood was analysed for complete blood counts and bone marrow was analysed by fluorescence in situ hybridisation for genetic abnormalities. Results: 53.6% patients had cytogenetic abnormalities. Recurrent genetic abnormalities were seen in 34.7%. Commonest recurrent genetic abnormality was RUNX1-RUNX1T1 rearrangement seen in 14.4%, followed by PML-RARA rearrangement seen in 8.6%, MLL gene rearrangement in 8.6% and CBFB-MYH11 rearrangement in 2.8% patients. In children aged more than five years, PML-RARA and RUNX1-RUNX1T1 were commonest whereas, in children aged five and less, RUNX1-RUNX1T1 and MLL rearrangements were the only recurrent genetic abnormalities. Patients with cytogenetic abnormalities differed significantly with respect to hemoglobin, total leucocyte count and platelet count. Conclusion: FISH alone can classify patients into AML with common recurrent genetic abnormalities. However, other methods are required for complete classification.

Abstract Objectives; to evaluate the quality of life among patients with chronic rhino sinusitis and the risk of developing depression. Design; An observation cross section study. Setting; the quality of life was assessed using 2-item sinonasal outcome test (SNOT-22) while Patient Health Questionnaire-2 (PHQ-2) used for screen of depression and Stress was analyzed using the Kessler Psychological Distress Scale (10 items representing five psychological distress traits were assessed with a five-point scale) Participants; 1072 patients with chronic rhino sinusitis. Main outcome measures; Influence of Chronic Rhino sinusitis on Quality of Life and Risk of Depression and Lost Productivity. Results; the level of quality of life affection was moderate in 159 (24.77%) and severe in 483 (75.23%) of participants with CRS. The mean score of PHQ-2 for assessing the risk of major depression was 4.17 + 1.74 in participants with CRS. 135 (21.03%) were normal (not at risk of major depression) and 507 (78.97%) were at risk of major depression. According to the Kessler Psychological Distress Scale: 759 patients (70.8%) were positive with a mean total perceived stress score of 16.92 ± 7.34, whereas 313(29.2%) were negative with a mean total perceived stress score of 6.08 ± 2.7. The difference was statistically significant Conclusions; Patients with CRS are at risk of depression, poor quality of life and bad work performance. Despite the supportive treatment that used to provide to such patients, a clinical comprehensive approach should be considered to relief the impact on patients’ quality of life.

Objectives: In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). Design, Setting, Participants: A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. Questionnaires on sinonasal symptoms and nasality were recorded. Main outcome measures: The change in the nasalance score and symptoms were measured preoperatively, 6 months, and 12 months after the operation. Results: Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p=0.01) following FESS. In the wide opening surgery group, the change in nasalance was significant, but not in the limited surgery group. Conclusion: Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the nasalance score may represent a return to a normal status since the self-reported nasality assessment was significantly improved postoperatively.

Objective: The utilization of the International Classification of Functioning, Disability and Health (ICF) Brief Core Set for Hearing Loss (BCS-HL) seems to be a promising tool to assess the factors underlying SHL. This study aimed to assess categories underlying SHL in older adults using the ICF-BCS-HL tool. Design: A cross-sectional study. One-hundred and thirty-one independent-living older adults (Mage=72.32, SD=6.83), who completed the speech, spatial, and quality of hearing (SSQ) scale and a set of clinically accepted outcome measurements linked with selected categories listed in the ICF BCS-HL. Results: A linear regression analysis model was fitted with the outcome measurements after controlling for age, sex, education, multimorbidity, and hearing aid use. The model showed 5 significant predictors underlying the SSQ-total score: HL, dizziness handicap, cognitive decline, multimorbidity, and individuals’ ability to accept the noise level. Predictors varied across the SSQ-subscales scores, however. While predictors underlying the SSQ-Quality subscale scores were like the SSQ-total score, individuals’ ability to accept noise level was not one of the predictors underlying the SSQ-Speech subscale scores. Whereas PTA, dizziness handicap and multimorbidity were the predictors underlying the SSQ-Spatial subscale scores. Conclusion: SHL, measured by SSQ, in older adults is a multi-layer structure in nature and is associated with a range of adverse health outcomes. A link of SHL with HL, cognitive deficits, reduced ability to accept background noise level, and multimorbidity, collectively or individually, were well-established. So far, little attention has been paid to the impact of dizziness handicap of elderly patients when evaluating their SHL.