Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t-test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = −1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.

Background: A rescue treatment is needed in cases of Sudden Sensorineural Hearing Loss (SSNHL)which fail to obtain complete hearing restoration after conservative steroid therapy. In order to acquirebetter access of steroid to the cochlea, sealing the round window with a sponge soaked in steroid couldbe considered as an alternative delivery strategy. Purpose: To review the evidence about the impact ofround window sealing in SSNHL patients whose hearing failed to recover completely after treated withsystemic and/or intratympanic steroid. Cases: Seven patients with SSNHL, who had experienced either noor slight response to previous systemic and/or intratympanic steroid administration, underwent transcanalround window sealing with steroid-soaked sponge. Pure Tone Audiometry (PTA) results and symptoms(hearing loss, tinnitus, vertigo) were compared pre- and post-operatively. Five patients reported betterhearing and tinnitus symptom. Method: A scoping review was made by conducting literature searchingat Cochrane, Pubmed, and Google Scholar using keywords “sudden sensorineural hearing loss”, AND“round window sealing”, and their relevant synonymous terms, employing Boolean operators. Result: Atotal of 8 observational studies with 430 subjects met the inclusion criteria. Time measurement of hearingimprovement range from 6 days until 1 year. Most of the studies agreed that the procedure of sealingthe round window had a positive impact on hearing improvement. Conclusion: This study revealed thatround window sealing with steroid-soaked sponged could be considered as an alternative approach forpatients with SSNHL who failed in conservative therapy. Keywords: “round window sealing; sudden sensorineural hearing loss; transtympanic steroid”

Diffusion tensor imaging (DTI) metrics provide insights into neural pathways, which can be pivotal in differentiating congenital and acquired hearing loss to support diagnosis, especially for those diagnosed late. In this study, we analyzed DTI parameters and developed machine learning to classify these two patient groups. The study included 29 patients with congenital hearing loss and 6 with acquired hearing loss. DTI scans were performed to obtain metrics, such as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Statistical analyses based on p-values highlighted the cortical auditory system’s prominence in differentiating between groups, with FA and RD emerging as pivotal metrics. Three machine learning models were trained to classify hearing loss types for each of five dataset scenarios. Random forest (RF) trained on a dataset consisting of significant features demonstrated superior performance, achieving a specificity of 87.12% and F1 score of 96.88%. This finding highlights the critical role of DTI metrics in the classification of hearing loss. The experimental results also emphasized the critical role of FA in distinguishing between the two types of hearing loss, underscoring its potential clinical utility. DTI parameters, combined with machine learning, can effectively distinguish between congenital and acquired hearing loss, offering a robust tool for clinical diagnosis and treatment planning. Further research with larger and balanced cohorts is warranted to validate these findings.