Clinical and Experimental Otorhinolaryngology最新文献

>background.: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder strongly influenced by obesity, the most significant modifiable risk factor. Effective weight management is therefore essential for optimal OSA care. This guideline aims to provide updated, evidence-based recommendations for the evaluation and management of obesity in adults with obstructive sleep apnea (OSA), incorporating recent advances in lifestyle, pharmacologic, and surgical interventions.

Methods.: The Korean Society of Sleep and Breathing convened a multidisciplinary panel. A systematic literature search was performed across major databases through 2025. Evidence was appraised using GRADE, and recommendations were formulated through consensus using the Evidence-to-Decision framework.

Results.: Eight statements were developed. Key recommendations include recognizing obesity as a major risk factor, routinely assessing overweight and obesity, and implementing structured weight reduction through diet, exercise, and behavioral therapy. Glucagon-like peptide-1 receptor agonists are recommended when lifestyle interventions are insufficient, and bariatric/metabolic surgery is advised for severe obesity unresponsive to nonsurgical treatment. Weight loss improves apnea-hypopnea index, symptoms, and cardiometabolic markers and may reduce positive airway pressure needs. Continued follow-up is recommended even after clinical improvement.

Conclusion.: Weight management is a core component of OSA treatment. This guideline offers practical, evidence-based strategies to support clinicians in delivering effective obesity-focused care for adults with OSA.

Objectives.: Rhinosinusitis disrupts the neuroepithelium, promotes inflammatory cell infiltration, and ultimately leads to olfactory dysfunction. Celecoxib, a selective cyclooxygenase 2 (COX-2) inhibitor, reduces neuroinflammation through its antiinflammatory effects. We hypothesize that celecoxib can mitigate sensorineural olfactory impairment by reducing inflammation, preserving neuroepithelial structure, and exerting neuroprotective effects.

Methods.: Male C57BL/6 mice were intranasally administered lipopolysaccharide (LPS) for three weeks to induce rhinosinusitis. Celecoxib treatment was also administered via subcutaneous injection. The mice then underwent histological staining in sinonasal tissue, olfactory function test, and quantitative genomic expression patterns in the olfactory bulb.

Results.: Following intranasal administration of LPS, mice exhibited impaired olfactory function, increased neutrophil infiltration, an elevated number of goblet cells in the sinonasal mucosa, and upregulated mRNA expression of inflammatory markers indicative of neuroinflammation in the olfactory bulb. Celecoxib treatment resulted in improved olfactory function, reduced neutrophil infiltration, decreased goblet cells number, and attenuated neuroinflammation in the olfactory bulb.

Conclusion.: These findings suggest that celecoxib alleviates sensorineural olfactory dysfunction by reducing sinonasal neuroinflammation, highlighting its therapeutic potential in rhinosinusitis-associated olfactory loss.

Objectives: Particulate matter (PM) is well established as an environmental hazard linked to an increased risk of disease. Although numerous studies have explored PM-induced cellular responses, a comprehensive understanding of PM toxicity requires integrating advanced imaging techniques with quantitative biochemical assays.

Methods: Herein, we address this gap by combining these techniques with quantitative and functional assays to investigate the cellular effects of PM. PM collected from South Korea was used to assess toxicity in macrophages exposed to PM-containing medium. Three-dimensional (3D) holotomography revealed PM distribution and microstructural changes in cells following exposure.

Results: Cell viability and inflammation analyses across PM concentrations highlighted its harmful effects. Lipid metabolism and mitochondrial dysfunction assays helped elucidate the underlying mechanisms, whereas a comparative study of oxidative potential between PM and gold nanoparticles (AuNPs) further demonstrates PM-induced hazards. Oxidative stress drove PM-induced physicochemical changes in macrophages. The oxidative potential of PM is a measurable factor that determines its oxidative stress properties. In addition, PM contains several components including transition metals and organic chemicals. Metallic components in PM particularly exhibited redox activity associated with oxidative stress and inflammation.

Conclusion: Overall, our findings advance the mechanistic understanding of PM-cell interactions and introduce a novel methodological paradigm for studying the toxicological effects of environmental pollutants.

Objectives: Temporal bone squamous cell carcinoma (TBSCC) is the most common subtype of the temporal bone malignancies. Due to its low incidence, high rates of misdiagnosis, and challenges in conducting large-scale studies and clinical trials, its mechanisms of occurrence and progression remain unclear, and both diagnostic and therapeutic biomarkers are lacking. These challenges largely depend on our understanding of the tumor heterogeneity and microenvironment of TBSCC. Our study is aiming at revealing the tumor heterogeneity and microenvironment characteristics of TBSCC.

Methods: Since single-cell RNA sequencing (scRNA-seq) is an effective tool for studying tumor heterogeneity, we here first reported the scRNA-seq data of TBSCC in this study. We collected and sequenced a total of 113,344 cells from 9 samples (i.e., 5 cancer and 4 histologically verified adjacent normal temporal-bone tissues) of 6 TBSCC patients.

Results: We found the proportion of S-phase cancer cells was higher in samples with tumor invasion, and the pseudo-time trajectory of cancer cells closely corresponded with TBSCC differentiation level. We also detected higher communication intensity between some immune cell pairs in cancer tissues than in histologically verified adjacent normal temporal-bone tissues. Additionally, some cancer-related genes are identified as potential diagnostic markers of TBSCC.

Conclusion: This study is the first to unveil the complex heterogeneity and tumor microenvironment characteristics of TBSCC using scRNA-seq technology, offering new avenues for diagnosing, classifying, and treating this rare carcinoma.

Objectives: Obturator and free flap reconstruction differ in their postoperative visibility, potentially affecting cancer surveillance. This study compared clinicopathologic and survival outcomes after maxillectomy in patients with maxillary sinus malignancies and evaluated overall survival (OS) and disease-free survival (DFS) in both the overall cohort and a squamous cell carcinoma (SCC) subgroup.

Methods: A retrospective review of 61 patients (41 obturator, 20 free flap) who underwent maxillectomy between 2002 and 2021 was performed. Clinicopathologic features, resection margin status (clear, close, positive), recurrence patterns, and survival outcomes were analyzed. OS and DFS were estimated using Kaplan-Meier methods, and multivariable Cox models included reconstruction method, overall stage, resection margin status, and postoperative adjuvant therapy in the entire cohort and the SCC subgroup.

Results: Patients in the obturator group were older (63.7 vs. 54.1 years, P=0.046) and more often underwent total maxillectomy (80.5% vs. 50.0%, P=0.039). SCC was the most frequent histology (80.5% vs. 65%). OS and DFS did not differ significantly between groups: 2- and 5-year DFS were 56.1% and 44.1% (obturator) vs. 44.1% and 33.1% (free flap; P=0.931); 2- and 5-year OS were 68.0% and 50.0% vs. 77.1% and 44.1%, respectively (P=0.990). Among 46 patients with SCC (33 obturator, 13 free flap), survival outcomes were comparable. In multivariable analyses, close and positive margins and absence of postoperative adjuvant therapy were independently associated with poorer OS and DFS, whereas reconstruction method was not. Local recurrence was the most common failure pattern in both groups.

Conclusion: Obturator and free flap reconstruction showed comparable survival after maxillectomy for maxillary sinus malignancies. Resection margin status and postoperative adjuvant therapy were the major prognostic factors, underscoring individualized reconstruction and the importance of adequate margins, appropriate adjuvant treatment, and consistent follow-up.

Objectives: A markedly decreased speech intelligibility is reported to be a major feature of vestibular schwannoma (VS); however, details such as the relationship between speech intelligibility and hearing levels have not yet been adequately clarified.

Methods: Among 473 patients with sporadic unilateral vestibular schwannoma, scatter plots of pure tone audiometry (PTA) thresholds and speech discrimination scores were created. Simple regression analysis was conducted, and the Pearson correlation coefficient was calculated. The results were compared with those of 173 patients with asymmetric cochlear hearing loss, including the percentage of patients with unserviceable speech intelligibility.

Results: In patients with vestibular schwannoma, a strong correlation was found between the speech discrimination score and PTA threshold on the affected side, regardless of Koos grade or audiogram shape. In most patients, there was no significant difference in distribution compared with patients with asymmetric cochlear hearing loss. Although the proportion of patients with unserviceable speech discrimination was higher for vestibular schwannoma than asymmetric cochlear hearing loss across all hearing levels, the condition was limited to a small number of cases; a significant difference was only observed in cases with severe hearing loss.

Conclusion: Considering its relationship with hearing level, a markedly decreased speech discrimination score is no longer a major feature of vestibular schwannoma.

Objectives: Spatial mapping of sound frequencies along the auditory pathway is refined by sound-evoked activity during early development. However, the extent to which neonatal auditory deprivation alters this organization remains unclear. This study uniquely examined frequency-specific spatial representations in the inferior colliculus (IC) using targeted low-frequency (apical) and high-frequency (basal) cochlear stimulation, enabling the direct evaluation of low-frequency pathway integrity after neonatal deafness.

Methods: Sixteen Sprague-Dawley rats (8 normal-hearing [NH] and 8 neonatally deafened [ND] rats) were studied. Neonatal deafness was induced by daily kanamycin injections from postnatal days 4 to 17. At 8-10 weeks of age, the animals underwent unilateral cochlear implantation with bipolar electrode pairs positioned in the apical and basal cochlear regions to activate low- and high-frequency pathways. Multiunit responses were recorded from the contralateral IC using a multichannel linear electrode array. Spatial tuning curves (STCs) based on cumulative discriminability were used to assess the thresholds, spread of excitation, and tonotopic precision. Spiral ganglion neuron (SGN) density was histologically assessed.

Results: Despite 48-67 % SGN loss across cochlear turns, electrically evoked auditory brainstem response and IC thresholds were comparable between groups, indicating preserved peripheral excitability. However, ND rats showed significantly broader STCs (p = 0.002) and reduced dorsoventral separation of apical and basal best sites (1.18 ± 0.24 mm vs 1.80 ± 0.30 mm, p = 0.039), reflecting degraded central tonotopic precision. These effects were most pronounced for apical (low-frequency) stimulation, consistent with the selective vulnerability of lowfrequency pathways to early auditory deprivation.

Conclusion: These findings provide direct physiological evidence that early auditory experience is critical for refining the frequency-organized connectivity in the auditory midbrain. The preferential degradation of apical (low-frequency) spatial tuning offers translational insights for optimizing stimulation strategies in early-onset deafness.

Objective: In this study, we aimed to investigate the effects of preoperative auditory rehabilitation using hearing aids in patients with prolonged hearing deprivation.

Design: We retrospectively enrolled 204 patients who underwent cochlear implantation (CI) surgery at age >60 years using a single university hospital database. A total of 135 patients with a duration of deafness (DOD) > 10 years were divided into 3 groups according to perioperative hearing aids: unaided (n=22, 16.3%), aided (n=92, 68.1%, comprising 22 ipsilateral hearing aid and 70 bilateral hearing aids patients), and aided on the contralateral side groups (n=21, 15.5%). We analyzed the highest score on the postoperative sentence recognition test (Max_S) for each group.

Results: Max_S was significantly higher in the DoD < 10 years group (72.38 ± 25.74 vs. 64.09 ± 32.29, p = 0.048). Among the patients whose DoD was ≥ 10 years, the aided group showed significantly better Max_S than the unaided group, (69.84 ± 28.72 vs. 47.86 ± 37.14, p = 0.015). After one-to-two propensity score matching, Max_S was significantly better in the aided group than in the unaided group (73.64±29.10 vs 47.86±37.14, p=0.007).

Conclusion: Our study demonstrated the necessity of hearing rehabilitation, including for the surgical side ear regardless of whether it was beneficial to the hearing level, during the hearing deprivation period.

Objectives: Empty nose syndrome (ENS) is a rare postoperative complication that can develop following turbinate surgery. Here, we present our clinical experience and a comprehensive analysis of the inferior meatus augmentation procedure with autologous costal cartilage (IMAP-ACC) as a treatment for ENS.

Methods: We retrospectively reviewed the medical records of patients diagnosed with ENS who underwent IMAP-ACC at a tertiary referral center between November 2015 and November 2023. Symptom improvement was evaluated using the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score before and after the procedure. In addition, perioperative complications and instances of revision surgery were systematically examined.

Results: Of the 32 patients who underwent IMAP-ACC, clinical analysis included 20 patients (16 men, 4 women) with a mean age of 39.1±11.5 years and a mean follow-up duration of 61.2±28.8 months. The mean ENS6Q score significantly improved from 17.5±5.3 preoperatively to 9.1±6.0 at the final follow-up (P<0.001). In a subgroup analysis of 16 patients with available early follow-up data, significant reductions in ENS6Q scores were observed both at early follow-up (7.8±5.7) and long-term follow-up (8.6±6.5), compared to the preoperative value (18.2±5.6). Across all 32 patients, nasal obstruction was the most common perioperative complication (34.4%), necessitating reoperation in four patients (12.5%). The majority of complications were effectively managed with a conservative approach.

Conclusion: IMAP-ACC has proven to be a valuable and durable treatment option for patients with ENS, demonstrating sustained symptom improvement over extended follow-up periods.

Objectives: The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC.

Methods: A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients.

Results: Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected.

Conclusion: Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.