Clinical and Experimental Otorhinolaryngology最新文献

Objectives: The primary objective was to determine which of the following angular insertion depth (AID) estimation methods showed the strongest correlation with the postoperative AID (AIDpostop) of a lateral wall (LW) electrode: the Escudé formula, based on the largest distance from the round window (RW) to the LW (distance A); the elliptic-circular approximation (ECA) method, based on both distance A and the perpendicular distance (distance B); and a three-dimensional (3D) reconstruction method. The secondary objective was to assess the impact of using the actual electrode insertion length on the evaluation of AID estimation methods.

Methods: This study included 45 cochleae implanted with the Advanced Bionics SlimJ electrode, with all 16 active electrode contacts positioned intracochlear. Distance A, distance B, and a 3D reconstruction along the LW were evaluated on preoperative magnetic resonance imaging using 3D Slicer. The AIDpostop and insertion length were assessed using cone-beam computed tomography. Two sets of estimated AID values were obtained: assuming a perfect 23-mm insertion length with the reference electrode at the RW (AID23mm); and using the actual insertion length (AIDinsertionlength). Spearman's rank correlation coefficient was used to assess the association between the estimated AID values and AIDpostop.

Results: A moderately positive correlation was observed between AID23mm and AIDpostop for all three approaches, with no statistically significant differences among them (rs=0.410-0.579). When the analysis was repeated using AIDinsertionlength, the strength of the correlation with AIDpostop increased significantly for all three methods, with the 3D reconstruction method showing a stronger correlation (rs=0.952) than the Escudé formula (rs=0.734) or the ECA method (rs=0.787) (P<0.001).

Conclusion: The 3D reconstruction approach has the potential to improve prediction of the AID for LW electrode arrays compared to spiral formulae based on 2D cochlear dimensions. Accurate assessment of the actual insertion length is important for the proper evaluation of AID estimation methods.

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of upper airway obstruction during sleep, resulting in apnea and hypopnea. While anatomical factors, such as increased upper airway collapsibility, significantly contribute to OSA, emerging evidence highlights the importance of non-anatomical mechanisms, including impaired pharyngeal muscle responsiveness, low arousal threshold, and elevated ventilatory loop gain. The interplay of these factors leads to respiratory instability, fragmented sleep, and systemic complications. Additional pathophysiological influences such as obesity, aging, sex differences, and central nervous system dysfunction exacerbate cardiovascular and metabolic comorbidities. Advancements in diagnostic methods, including cephalometry and polysomnography, along with therapies such as continuous positive airway pressure, mandibular advancement devices, and hypoglossal nerve stimulation, underscore the necessity for personalized treatment approaches. Although surgical interventions targeting multi-level airway obstructions show potential for successful treatment, they remain limited by variability in long-term efficacy. A thorough understanding of the multifactorial mechanisms underlying OSA is crucial for improving diagnostic accuracy and tailoring patient-specific management strategies. This review summarizes recent findings, clarifying the complex pathophysiology of OSA and highlighting a multidimensional approach to optimize patient outcomes.

Objectives: This study evaluated behavioral test results and histological findings in murine models of allergic rhinitis (AR), chronic rhinosinusitis (CRS), and drug-induced anosmia, comparing outcomes among groups.

Methods: This study established a total of six animal model groups (n=5 per group): control; ovalbumin (OVA)-induced AR; OVA/polyinosinic-polycytidylic acid (poly[I:C])-induced neutrophil-dominant rhinitis; OVA/Staphylococcus enterotoxin B-induced CRS; and two anosmia models induced by chronic intranasal administration of ZnSO4 and intraperitoneal injection of 3-methylindole (3-MI). Olfactory function was evaluated using an open-field food-finding test and a T-maze test one week after model induction. Behavioral test results were analyzed with video analysis software (EthoVision XT). Immunofluorescent staining was conducted to assess histological changes in olfactory sensory neurons (OSNs) and olfactory basal cells.

Results: In the T-maze test, the OVA and OVA/poly(I:C)-induced rhinitis groups showed increased food-finding time compared with the control and CRS groups. The two anosmia mouse models demonstrated statistically significant differences from all other groups. Food-finding time showed significant positive correlations with two novel variables evaluated in this study: total distance moved and average velocity, in both the open-field and T-maze tests. Histologically, the CRS and two anosmia models exhibited a significant decrease in mature and immature OSNs. Additionally, the two rhinitis groups and the CRS group displayed significant changes in the number of immature OSNs. Changes in the basal cell marker cytokeratin-5 were observed specifically in the 3-MI model.

Conclusion: This study demonstrated significant differences in olfactory function and histological changes among various mouse models of upper airway inflammation and drug-induced anosmia, as assessed by histological analysis and behavioral tests. These findings can serve as a reference for future studies on olfaction using mouse models.

Since the release of ChatGPT, large language models (LLMs) have rapidly expanded into professional domains, including medicine. These models, trained on extensive text corpora, including the medical literature, have demonstrated remarkable capabilities in tasks such as clinical decision support, research assistance, and education. This review focuses on LLM applications in otolaryngology-head and neck surgery (Ear, Nose, and Throat [ENT]). We analyzed 25 studies published between January 2022 and March 2025 in ENT journals ranked in the top 25% (Q1) according to the 2023 Journal Citation Reports. Furthermore, we categorized these studies by use case and systematically examined the models, datasets, and evaluation methods employed. Despite increasing adoption of LLMs in the ENT field, several challenges remain, including limited model diversity, inconsistent evaluation standards, and ongoing issues with accuracy and fairness. We also contextualized LLM research trends within the broader medical domain. Five key areas were identified for advancing clinical-grade LLMs: robust evaluation frameworks, external source-based generation, multimodal integration, agent-based reasoning, and model explainability. Our findings provide ENT clinicians and researchers with a practical foundation for understanding, evaluating, and implementing LLMs or their advanced successors (e.g., large multimodal models, agents) in clinical and research settings.

Objectives.: Sleep apnea surgery is effective only for selecting patients, making it crucial to identify those who will benefit. This study aimed to introduce a novel anatomical index for selecting patients with favorable surgical outcomes.

Methods.: A retrospective review was conducted on patients with obstructive sleep apnea who underwent multilevel surgery by a single surgeon at a tertiary medical institution between 2012 and 2021. Anatomical parameters, endoscopic images, and pre- and postoperative polysomnography reports were analyzed. Some patients exhibited posterior pillar hypertrophy (PPH), where the palatopharyngeal muscle is thicker than normal. To assess the effects of PPH exclusively, patients were randomly selected and subjected to propensity matching.

Results.: Logistic regression analysis identified tonsil grade, body mass index, and posterior pillar thickness as significant predictors of surgical success. The success rates were significantly different between the PPH(+) and normal control PPH(-) groups, with 51.9% success in the PPH(+) group compared to 40.7% in the PPH(-) group. Additionally, the PPH(+) group showed a significant increase in the apnea-hypopnea index and oxygen desaturation index postoperatively.

Conclusion.: The presence of posterior pillar hypertrophy serves as an important anatomical predictor of surgical success in obstructive sleep apnea treatment. This index helps in choosing patients and planning surgeries, potentially enhancing treatment.

Results.:

Chronic rhinosinusitis (CRS) and asthma are often comorbid and represent heterogeneous inflammatory disorders in the upper and lower airways, respectively. Type 2 inflammation driven by eosinophils and CD4 T cells has been recognized as central mediators in CRS with nasal polyp (CRSwNP) and asthma pathogenesis. However, recent evidence has highlighted the critical involvement of innate T cells, such as invariant natural killer T (iNKT), mucosal-associated invariant T (MAIT), and γδ T cells in airway inflammatory disorders. Innate T cells were enriched in sinonasal tissues and contributed to mucosal inflammation through cytokine production, exhibiting functional polarization influenced by local inflammatory cues. In particular, MAIT17 and Vγ1+ γδ T cells have been associated with tissue eosinophilia and disease severity in eosinophilic CRSwNP (E-NP) patients, whereas iNKT cells displayed subset-specific distribution across eosinophilic and neutrophilic endotypes. In asthma, iNKT cells consistently contributed to disease development in murine models, whereas the roles of MAIT and γδ T cells were controversial, demonstrating both pro- and anti-inflammatory roles depending on anatomical location and disease context. This review summarizes current findings on the contribution of innate T cells to the immunopathology of CRSwNP and asthma and discusses the challenges and future directions in resolving discrepancies arising from methodological and biological variability.

Objective: Allergic rhinitis (AR) impairs quality of life, and combination therapy is often required for comprehensive symptom control. This study aimed to evaluate the efficacy of montelukast-antihistamine combination therapy compared with antihistamine monotherapy in improving AR symptoms and quality of life.

Methods: PubMed, Embase, MEDLINE, Scopus, the Cochrane Library, and Google Scholar were searched up to April 2025. Eligible studies compared combination therapy with montelukast plus an antihistamine against antihistamine monotherapy and reported nasal symptoms or rhinoconjunctivitis quality of life questionnaire (RQLQ) scores. Standardized mean differences (SMDs) were calculated, and subgroup analyses were conducted according to antihistamine type.

Results: Fifteen studies including 2,882 subjects were analyzed. Combination therapy significantly improved daytime nasal symptoms (SMD [95% CI] = 0.44 [0.21-0.67]), nighttime nasal symptoms (SMD [95% CI] = 0.12 [0.01-0.23]), and RQLQ scores (SMD [95% CI] = 0.14 [0.00-0.27]) compared with monotherapy. Sneezing, nasal obstruction, and rhinorrhea improved significantly, while nasal itching and ocular symptoms did not. Combinations with desloratadine and levocetirizine showed greater benefits than those with loratadine or fexofenadine.

Conclusion: Montelukast-antihistamine combination therapy improves overall symptoms and quality of life compared with antihistamine monotherapy. The magnitude of benefit appears to vary depending on the specific antihistamine used, highlighting the potential value of individualized treatment strategies in the management of AR.

Objectives: Allergic rhinitis (AR) is a chronic nasal mucosal inflammation triggered by environmental allergens. Although its pathophysiology has been well studied, the effects of environmental aggravating factors-especially combined pollutant exposure-are not fully understood. This study aimed to evaluate the impact of coexposure to PM2.5, formaldehyde, and zinc on allergic inflammation in a murine model of AR and to characterize the associated immunological and histopathological responses.

Methods: Female BALB/c mice were sensitized with ovalbumin (OVA) and challenged intranasally to induce allergic rhinitis. On days 21-24, mice were exposed to PM2.5, formaldehyde, and zinc either individually or in combination with OVA. Allergic symptoms were assessed through behavioral observation, and immune responses were evaluated by analyzing nasal and bronchoalveolar lavage fluids (NALF and BALF), serum immunoglobulin levels, nasal histology, and cytokine profiles.

Results: Combined exposure to PM2.5, formaldehyde, and zinc significantly enhanced allergic inflammation compared to single exposures. Coexposure to PM2.5 and zinc resulted in synergistic increases in total and OVA-specific immunoglobulin E(IgE) levels, eosinophilic infiltration, nasal rubbing, and Th2/Th17 cytokines in NALF and BALF. Histological analysis revealed increased mucosal remodeling and goblet cell hyperplasia following combined exposure. Other combinations, such as PM2.5 with formaldehyde, also induced additive or modestly enhanced inflammatory responses.

Conclusion: Coexposure to PM2.5, formaldehyde, and zinc aggravated allergic inflammation in an OVA-induced murine model, with PM2.5 + zinc showing the strongest synergistic effects. These findings highlight the importance of pollutant-pollutant interactions in allergic airway diseases and underscore the need for further studies to elucidate longterm health impacts and human relevance.