Clinical and Experimental Otorhinolaryngology最新文献

Objectives: Balloon eustachian tuboplasty (BET) is an emerging treatment for dilatory eustachian tube (ET) dysfunction. However, its efficacy in patients with both chronic suppurative otitis media (COM) and ET dysfunction remains unclear. The objective of the trial was to assess the efficacy and safety of BET versus medical management (MM) alone in adult patients with COM and chronic dilatory ET dysfunction, which was defined by a failed Valsalva maneuver.

Methods: In this prospective, multicenter, randomized controlled trial, a total of 116 participants (121 ears) treated between January 2021 and June 2023 were randomly assigned (1:1) to receive either BET with MM or MM alone (fluticasone furoate nasal steroid spray). The short-term primary outcome was the normalization of the Valsalva maneuver at the 8-week follow-up. Secondary outcomes were improved Eustachian Tube Dysfunction Questionnaire- 7 (ETDQ-7) scores and decreased air-bone gap (ABG) analyzed at 8 weeks. Adverse events were monitored in both groups during the follow-up period.

Results: Among the 116 participants (121 ears), 60 participants (62 ears) received BET and 56 participants (59 ears) received MM alone. Demographics, baseline characteristics, ETDQ-7 scores, bone conduction thresholds, and ABG did not differ significantly between the groups. In the BET group, 46.8% (29/62, ears) achieved a successful Valsalva maneuver compared with 15.3% (9/59, ears) in the MM-only group (p<0.001). BET group (-6.2±9.4) showed greater subjective symptom improvement than the MM-only group (-2.6±8.6) regarding ETDQ-7 scores (p=0.028). ABG decreased more in the BET group (-5.8±11.4 dB) compared with the MM-only group (-1.2±10.5 dB) (p=0.023). No serious procedure-related or device-related adverse events occurred in either group during the 8-week follow-up.

Conclusion: Our trial suggests that BET, combined with MM, demonstrated superiority over MM alone, along with its safety, in treating dilatory ET dysfunction in patients with COM.

Objectives: Branchio-oto syndrome (BOS) is a group of autosomal dominant genetic diseases, multisystem disorders excluding renal anomalies. There are clinical heterogeneity and ethnic diversity in BOS, which reported in more studies in European populations than in Asian populations, with a prevalence rate of approximately 1/40000. As the most common disease-causing gene, the mutation types of EYA1 range from missense to various frameshift, splicing and nonsense variants. Although splicing mutations are one of the important factors in the disease, existed research has paid less attention to the novel mutations causing aberrant RNA splicing and their pathogenic mechanisms. Reproductive interventions that actively block the transmission of the disease to future generations have also not been reported.

Methods: We had collected research samples from a three-generation Chinese family with BOS. Whole exome sequencing was applied for the screening of candidate causing gene. Minigene assay was performed to identify the aberrant splicing products, and molecular biology techniques were used to analyze the pathogenicity of potentially mistranslated proteins. pre-implantation genetic testing (PGT) has been employed to prevent hearing loss in this family based on SNP analysis.

Results: A novel mutation EYA1:c.1598-2AG>TA was identified by whole-exome sequencing and classified as harmful refer to ACMG's evidence. An aberrant RNA splicing was verified and suggested that might prematurely terminates the translation of EYA1 protein, through the minigene assay. The EYA1 truncated protein presented unstable and difficultly translocated to the nucleus, also impaired EYA1-SIX1 interactions in cytological experiments. PGT helped the proband give birth to a healthy boy.

Conclusion: A novel splicing variant of EYA1 gene was identified in this study, and the potential molecular pathogenic mechanism was elucidated by several functional experiments. On basis above findings, we successfully implemented the first instance of using PGT to ensure the birth of a healthy offspring free from this genetic disorder.

Objectives: We aimed to calculate the age-adjusted incidence rate of head and neck cancer (HNC) in South Korea from 1999 to 2020 and investigate the incidence trend of HNC excluding the effect of population aging.

Methods: Data were obtained from the Cancer Registration Statistics Program. All 12 types of HNCs were analyzed. For each HNC type, the crude incidence rate and number of new cases during 1999-2020 are presented according to sex and age group. Age-adjusted incidence rates were calculated based on the World Standard Population (WHO 2000-2025), and its trends were also measured.

Results: Although the crude incidence rates of all HNCs have been steadily increasing from 1999 to 2020, the absolute values were very low in most cases, less than 2/100,000. The male-to-female ratio was 1 or higher for all HNCs except thyroid cancer, and 10 or higher for laryngeal cancer and hypopharyngeal cancer. The trend of age-adjusted incidence was a gradual increase for tongue cancer, tonsil cancer, major salivary gland cancer, and thyroid cancer, a decrease for laryngeal cancer, and no significant change for the remaining HNCs.

Conclusion: Excluding the population aging effect, tongue cancer, tonsil cancer, major salivary gland cancer, and thyroid cancer among HNCs have been increasing in South Korea over the past 20 years, while laryngeal cancer has been decreasing.

Objectives: This study evaluated the cost-effectiveness of using hearing aids among individuals aged 50 and older with varying levels of hearing loss in South Korea.

Methods: A state-transition Markov model was employed to assess the cost-effectiveness of hearing aid utilization from a societal perspective. We simulated a cohort of patients aged 50, tracking their progression through normal, mild, moderate, and severe stages of hearing loss until death or age 80. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year gained was determined using both published and calculated data on the costs and effectiveness of hearing aids.

Results: The respective ICERs were $8,571 for men and $10,635 for women. These figures are significantly below the willingness-to-pay (WTP) threshold of $31,721, which corresponds to the per capita gross domestic product in 2020. The probabilities of cost-effectiveness were 83.6% for men and 73.4% for women at this WTP threshold. The lower ICERs observed in men can likely be attributed to the earlier onset of hearing loss and the rapid progression from normal, mild, moderate, and severe stages of hearing loss to death.

Conclusion: Hearing aids represent a highly cost-effective intervention for adults aged 50 and older in Korea, regardless of the degree of hearing loss, even in mild cases. In light of the rapidly aging population, it would be prudent for government policymakers to consider the costeffectiveness of hearing aids in their decision-making processes.

Background: The septal swell body (SSB), a distinct anatomical structure located in the anterior nasal septum, has been recognized as a significant contributor to nasal obstruction, impacting airflow dynamics and nasal resistance. This meta-analysis evaluated the impact of septal swell body volume reduction (SSBVR).

Methods: A systematic review of studies from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases was conducted through October 2024. Outcomes included changes in nasal obstruction scores, cross-sectional area, and nasal airway resistance pre- and post-SSBVR. Standardized mean differences (SMDs) were calculated, and the effectiveness of SSBVR combined with turbinate surgery was compared to turbinate surgery alone.

Results: Seven studies involving 232 patients were analyzed. SSBVR significantly improved crosssectional area (SMD = -1.05, 95% CI [-1.88; -0.21]) and nasal airway resistance (SMD = -0.67, 95% CI [-0.89; -0.45]), while nasal obstruction scores demonstrated significant improvements over up to 12 months (SMD = 2.54, 95% CI [1.81; 3.26]). The addition of SSBVR to turbinate surgery resulted in greater improvement in nasal obstruction scores (SMD = 0.47, 95% CI [0.24; 0.70]) compared to turbinate surgery alone, though no significant differences were observed in crosssectional area or nasal airway resistance. Subgroup analyses revealed time-dependent improvements in nasal obstruction scores and variability in effectiveness based on treatment modality.

Conclusion: : SSBVR significantly improves nasal obstruction and airflow metrics, with added benefits when combined with turbinate surgery. Further randomized trials are warranted to validate these findings and optimize treatment strategies.

Objective: High recurrence rates in head and neck squamous cell carcinoma (HNSCC) significantly affect prognosis, especially in radioresistant HNSCC (RR-HNSCC). Nonthermal plasma (NTP) therapy can effectively suppress the progression of HNSCC; however, the therapeutic mechanism of NTP therapy for RR-HNSCC remains unclear. In this study, we investigated the regulatory role of NTP in the RR-HNSCC signaling pathway and identified its signature genes.

Methods: After constructing two RR-HNSCC cell lines, we prepared cell lysates from cells treated or not treated with non-thermal plasma-activated media (NTPAM) and performed RNA sequencing to determine their mRNA expression profiles. Based on the RNA sequencing.

Results: we identified differentially expressed genes, followed by bioinformatics analysis to identify candidate molecules potentially associated with NTPAM therapy for RR-HNSCC.

Results: NTPAM decreased RR-HNSCC cell viability in vitro. The RNA sequencing results indicated that NTPAM treatment activated the reactive oxygen species pathway and induced ferroptosis in RR-HNSCC cell lines. Among the 1924 genes correlated with radiation treatment, eight showed statistical significance in both the cell lines and The Cancer Genome Atlas (TCGA) cohort. Only five genes, ABCC3, DUSP16, PDGFB, RAF1, and THBS1, showed consistent results between the NTPAM data sequencing and TCGA data. LASSO regression analysis revealed that five genes were associated with cancer prognosis, with a hazard ratio (HR) of 2.26. In RR-HNSCC cells, NTPAM affected DUSP16, PDGFB, and THBS1 as the activated marker within 6 h and persisted for 12 h. Furthermore, enrichment analysis indicated that these three differential genes were associated with ECM, TGF-β, PI3K-AKT, and MET pathways.

Conclusion: NTPAM therapy enhances cytotoxicity in RR-HNSCC cell lines by inducing specific ROS-mediated ferroptosis. DUSP16, PDGFB, and THBS1 were identified as crucial targets for reversing radiation resistance induced by NTPAM therapy, providing insights into the mechanisms and clinical applications of NTPAM treatment in RR-HNSCC.

Objectives: Endotype-based intervention has shown promise in treatment for patients with obstructive sleep apnea, and upper airway surgery is an important therapeutic option. However, the response to surgery varies among patients with obstructive sleep apnea. This study aims to examine changes in endotypic traits following upper airway surgery and their association with surgical outcome.

Methods: We prospectively recruited 25 patients with obstructive sleep apnea who visited a single sleep center for upper airway surgery and completed polysomnographic studies both before and following surgery. Endotypic traits during non-rapid eye movement and rapid eye movement sleep - including collapsibility (Vpassive), arousal threshold, loop gain, and upper airway compensation - were estimated using the Phenotyping Using Polysomnography method. Patients were classified as responders or non-responders based on improvements in the apnea-hypopnea index, and we compared pre-surgery endotypic traits between them using Mann-Whitney tests. Changes in pre- and post-surgery endotypic traits between responders and non-responders were compared using generalized linear mixed models.

Results: We identified 12 responders and 13 non-responders. Compared to non-responders, collapsibility during rapid eye movement sleep improved in responders (22.3 vs. - 8.2 %eupnea Vpassive, p = 0.01), and the arousal threshold decreased during non-rapid eye movement sleep in responders (-22.4 %eupnea, p = 0.02). No endotypic trait predicted surgical response, but AHI during rapid eye movement sleep was higher among responders than non-responders (51.8 vs. 34.4/h, p = 0.05).

Conclusion: Upper airway surgery significantly reduced collapsibility during rapid eye movement sleep among responders. The target pathology for upper airway surgery is a compromised upper airway during rapid eye movement sleep.

Background: Lateral semicircular canal BPPV (LC-BPPV) is diagnosed by the head roll test (HRT), in which the head is rotated to move particles in the lateral canal, causing nystagmus. The body roll test (BRT) is performed in a rolling position with the body and head together, which has the advantage of safely rotating the head at the correct angle in both directions. This study aims to assess the diagnostic utility of the body roll test (BRT).

Methods: A randomized controlled study was conducted. A total of 43 enrolled patients with LCBPPV symptoms were randomly divided into two groups. In group A (n=21), the HRT was performed first followed by the BRT after 5 minutes. Conversely, the BRT was performed first in group B followed by the HRT after 5 minutes (n=22). Participants were fitted with Freznel glasses and observed for nystagmus in the sitting, bow, and lying down position. The direction, latency, and duration of nystagmus were recorded.

Results: The type of nystagmus was 18:25 (geotropic: apogeotropic). No significant difference was found in age, sex, and nystagmus type between the two groups. The results of the HRT were consistent with those of the BRT for 32 (74.4%) participants. No statistical differences were observed in the diagnosis of the affected side and nystagmus type (geotropic vs. apogeotropic) between the HRT (n=32) and BRT (n=32) (P>0.05). The diagnosis rate in the first (n=31) and second tests (n=33) showed no significant difference and yielded similar results including the type of LC-BPPV. Moreover, no significant difference was found in postural discomfort and pain scores between these groups.

Conclusion: BRT and HRT show similar diagnostic efficacy for LC-BPPV. BRT provides a practical alternative, particularly for patients with limitations that prevent HRT, and may enhance diagnostic accuracy when used together with HRT.

Objectives: This experimental study compares the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation.

Methods: Conducted on formalin-fixed cadaveric heads, the study involved nine senior neurotologists performing both manual and robotic insertions.

Results: The results showed no statistically significant difference between the two methods in insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/s) than manual insertion (0.66 ± 0.31 mm/s), crucial for minimizing intra-cochlear force and pressures. While robotic insertions had fewer complications, such as tip fold-over or scala deviation, there were instances of incomplete insertion.

Conclusion: The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant surgeries and mitigating outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgeries.

Photobiomodulation (PBM), a noninvasive phototherapy using wavelengths ranging between red and near-infrared light, has emerged as a promising approach for controlling inflammation by modulating macrophage polarization. This review investigates the therapeutic potential of PBM in treating ear, neck, and throat (ENT)-specific inflammatory conditions, such as chronic rhinosinusitis and otitis media, focusing on its effects on macrophage phenotypes and evidence from preclinical studies. By promoting mitochondrial activity, increasing ATP production, and modulating reactive oxygen species, PBM has been shown to shift macrophages from a proinflammatory to an anti-inflammatory phenotype. Studies demonstrate that PBM enhances tissue repair, reduces inflammatory markers, and promotes wound healing. Moreover, PBM facilitates the polarization of M2 macrophages, a crucial factor in resolving mucosal inflammation in the nasal, pharyngeal, and middle ear cavities, and restoring tissue homeostasis. The antiinflammatory effects of PBM are attributed to its ability to influence several molecular mechanisms involved in inflammation regulation, particularly in ENT organ tissues, where recurrent inflammation can lead to chronic conditions such as otitis media or sinusitis. Furthermore, this review compares PBM to competing methods for reprogramming macrophages and treating inflammation, highlighting PBM's advantages of minimal toxicity, simplicity, and precision in controlling ENT immune responses.