Clinical and Experimental Otorhinolaryngology最新文献

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.

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: Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of vertigo. This study analyzes the risk factors involved in the occurrence and recurrence of BPPV.

Methods: A database maintained by the Korean National Health Insurance Service (NHIS) was used to enroll 434,552 patients diagnosed with BPPV from 2011 to 2017. A propensity score was used to match participants with an equal number of control patients without BPPV by age, sex, residential status, and socioeconomic status. Recurrence of BPPV was defined as an occurrence of BPPV more than 90 days after treatment. Logistic regression was used to analyze the occurrence of BPPV, and Cox proportional hazards models were applied to analyze the risk factors for recurrence.

Results: BPPV was 2.2 times more common in females, peaking between the ages of 50 and 59 years. The five-year BPPV recurrence rate was 39.8%, with a significant portion recurring within the first year. The incidence of BPPV was statistically significantly associated with several underlying medical conditions, including vitamin D deficiency, thyroid hormone abnormalities, head trauma, and disorders of the inner ear. Advanced age, female gender, rural residence, low socioeconomic status, and the presence of inner-ear diseases were notable risk factors for the recurrence of BPPV.

Conclusion: Our study provides significant insight into the risk factors associated with both the occurrence and recurrence of BPPV, which appears to be linked to vitamin D levels, thyroid hormones, and estrogen. Conditions such as inner-ear disorders, head trauma, and otologic surgery were strongly associated with both the occurrence and recurrence of BPPV.

Objectives: A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time.

Methods: Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death.

Results: Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively).

Conclusion: . This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.

Objectives: Labyrinthitis significantly reduces quality of life due to prolonged vestibular symptoms in patients experiencing sudden sensorineural hearing loss with vertigo (SSNHLV). This study employed a novel coherence analysis in the video head impulse test (vHIT) to explore vertigo outcomes in SSNHLV patients.

Methods: A retrospective review was conducted on 48 SSNHLV patients who completed high-dose steroid treatment between December 2016 and April 2023. Additionally, 38 healthy volunteers were prospectively enrolled from November 2022 to April 2023 at our academic tertiary referral center. The magnitude-squared wavelet coherence between eye and head velocities during the vHIT was measured to assess correlations across frequency bands. Recovery from vertigo, determined by a visual analog scale (VAS) score of 0 at both 2 weeks and 2 months, was analyzed using multivariable Cox regression.

Results: The mean VAS for patients with SSNHLV was 5.73±2.45. Higher coherent frequencies in the horizontal semicircular canal (SCC), posterior SCC, and the mean and minimal coherent frequencies of all three SCCs combined were significantly associated with early complete remission of vertigo 2 weeks posttreatment. In the multivariate analysis, the minimal coherent frequency among the three SCCs emerged as an independent factor (hazard ratio, 2.040; 95% CI, 1.776-2.304). Two months posttreatment, in addition to the previously significant parameters, abnormalities in the vestibulo-ocular reflex (VOR) in the posterior SCC, gains in the horizontal and posterior SCCs, total and overt saccades in the horizontal SCC, coherent frequency in the anterior SCC, and mean VOR gain of all three SCCs combined were also statistically significantly related to total relief from vertigo.

Conclusion: The highest minimal coherent frequency among the three SCCs significantly contributed to earlier vertigo relief in patients with SSNHLV. Coherence analysis in vHIT may offer greater sensitivity than time series analysis for predicting the prognosis of vertigo.

Objectives: The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size.

Methods: Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted.

Results: Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis.

Conclusion: gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.

Objectives: This study evaluates the enduring efficacy and patient satisfaction of dupilumab with interdose interval adjustments based on the Sino-Nasal Outcome Test (SNOT-22) in chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods: A retrospective analysis was conducted on 44 patients who had been treated with dupilumab for over 6 months. This study targeted individuals diagnosed with CRSwNP according to the 2020 edition of the European Position Paper on Rhinosinusitis and Nasal Polyps Criteria. The treatment involved an add-on dupilumab regimen, where the interdose interval was adjusted based on the SNOT-22 scores. Dosage adjustments were made such that patients with initial SNOT-22 scores greater than 40 were tapered to a target level of 20 or less. Similarly, for patients with initial scores of 40 or less, the treatment aimed for an improvement of 50% or more. At each visit, the effectiveness of the treatment was evaluated using SNOT-22, nasal polyp scores (NPS), and a subjective satisfaction questionnaire adapted from the Treatment Satisfaction Questionnaire for Medication (TSQM v.1.4).

Results: The adjustment of the interdose interval for dupilumab based on SNOT-22 scores demonstrated sustained improvements in patients' subjective symptoms, satisfaction, and NPS. The mean (standard deviation) SNOT-22 scores significantly decreased from 46.04 (22.30) to 14.72 (13.66) over 6 months (P<0.001). Similarly, NPS scores improved from 3.20 (2.24) to 1.72 (1.46) within the same period (P<0.001). Satisfaction scores, ranging from 0 to 5, consistently remained above 3.5 for up to 6 months (P=0.166). Additionally, there was a significant correlation between the improvement in the nasal symptom domain of the SNOT-22 scores and higher satisfaction scores.

Conclusion: Adjusting dupilumab dosing intervals based on SNOT-22 scores from the outset resulted in sustained efficacy and patient satisfaction in Korean patients with CRSwNP. This approach will meaningfully assist clinicians in determining the optimal dupilumab dosing interval.

Objectives: Our study aimed to explore the role of the potassium channel KCNK1 in head and neck squamous cell carcinoma, focusing on its impact on tumor growth, invasion, and metastasis. We also investigated the therapeutic potential of quinidine, a known KCNK1 inhibitor, in both in vitro cell lines and a zebrafish patient-derived xenograft (PDX) model.

Methods: We established primary cell cultures from head and neck cancer tissues and employed the FaDu cell line for in vitro studies, modulating KCNK1 expression through overexpression and knockdown techniques. We evaluated cell migration, invasion, and proliferation. Additionally, we developed a zebrafish PDX model to assess the impact of quinidine on tumor growth and metastasis in vivo. RNA sequencing and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted to elucidate the molecular mechanisms underlying the role of KCNK1 in cancer progression.

Results: Overexpression of KCNK1 in FaDu cells resulted in enhanced cell migration and invasion, whereas its knockdown diminished these processes. In the zebrafish PDX model, quinidine markedly inhibited tumor growth and metastasis, demonstrating a significant reduction in tumor volume and micrometastasis rates compared to the control groups. The molecular analyses indicated that KCNK1 plays a role in critical signaling pathways associated with tumor growth, such as the Ras and MAPK pathways.

Conclusion: Our findings highlight the critical role of KCNK1 in promoting tumor growth and metastasis in head and neck cancer. The inhibitory effect of quinidine on tumor progression in the zebrafish PDX model highlights the therapeutic potential of targeting KCNK1. These results suggest that KCNK1 could serve as a valuable therapeutic target for head and neck cancer, warranting further investigation into treatments that target KCNK1.

Objectives: Microorganisms are likely present in continuous positive airway pressure (CPAP) devices in daily use. Given the potential risk of infection among CPAP users, we aimed to compare the microbiomes of CPAP devices with those of nasal mucosa samples obtained from patients using these devices.

Methods: We conducted a prospective cohort study at multiple tertiary medical institutions. Samples were collected from the tubes and filters of CPAP devices and the nasal mucosa of device users. Microbiomes and mycobiomes were analyzed using 16S ribosomal RNA and internal transcribed spacer region sequencing. The results were compared according to sampling site and usage duration for each patient.

Results: Overall, 27 paired samples of human nasal mucosa and CPAP components were analyzed. Bacteria were detected in 7 of the 27 tubes (25.9%) and in 22 of the 27 filters (81.5%). Fungi were found in 2 tubes (7.4%) and 16 filters (59.3%). The most prevalent bacterial phyla across all samples were Actinobacteria and Firmicutes. Fungi were not detected in any nasal mucosa samples. However, fungi were identified in the CPAP filters and tubes, with the Basidiomycota and Ascomycota phyla predominating. No significant associations were identified according to sampling site or duration of CPAP use.

Conclusion: Some bacteria or fungi are detectable in CPAP samples, even after a short period of CPAP usage. However, the association between respiratory infections and these microbiomes or mycobiomes was not investigated. Further research is required to clarify the risk posed by CPAP devices as a microbial contamination source.