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Objective: The aim of this study was to describe our experience with intratympanic (IT) steroid treatment of sudden sensorineural hearing loss (SSNHL) after the failure of intravenous (IV) steroid treatment and to examine the efficacy of this treatment. Methods: We recruited 65 patients with SSNHL who did not respond to IV treatment with prednisolone. These patients were randomized into 3 groups: treatment with IT steroid, treatment with steroid in ear drops, and blank control. The 24 patients in the IT group received an IT injection of methylprednisolone and the 21 patients in the ear drop group received methylprednisolone that was directly dropped onto the tympanic membrane through the ear canal. The 20 patients in the blank control group did not receive any treatment after the completion of the IV prednisolone injection. Audiograms were performed at the beginning of the study and 2 months after the end of the study. Results: In the IT treatment group, audiogram results showed that the average of the pure tone speech frequencies (500–4000 Hz) was 64.8 (range 40–101 dB) at baseline, 60.7 (range 35–92 dB) at the end of systemic treatment, and 52.9 (range 35–73 dB) at the end of IT treatment. The improvement in the IT group was significantly better than that in the other two groups, with 37% of the IT patients having significant improvement in their hearing (baseline to after systemic treatment). During IT treatment, only 1 patient developed a persistent tympanic membrane perforation, and no serious complications such as chronic otitis media, disequilibrium, and dysgeusia developed. Conclusions: IT steroid therapy can improve hearing function in patients with SSNHL after the failure of systemic steroid treatment.

Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis. Results A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

Our results indicated that poor sleep was common in middle-aged and older adults. It was associated with identity of migrant worker, education level, exercise, illness within 2 weeks and number of chronic disease. Being ill within 2 weeks and having more chronic diseases were the major physical health-related factors contributing to poor sleep in the middle-aged and older people. Physical health may be a major determinant in sleep quality.

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