Clinical and Experimental Otorhinolaryngology最新文献

Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrates a high recurrence rate following endoscopic sinus surgery (ESS). The role of adjunctive biologic therapy remains incompletely understood. This study aims to assess the efficacy of dupilumab when used in conjunction with ESS for patients with CRSwNP.

Methods: We conducted a retrospective cohort study of type 2 CRSwNP patients who underwent ESS. The study compared patients receiving postoperative dupilumab with those receiving standard care. Changes in the Lund-Kennedy endoscopic score (LKES) and nasal polyp score (NPS) were recorded, and linear mixed models (LMMs) were employed for the primary outcome analysis.

Results: The study enrolled 49 CRSwNP patients, with 22 patients in the dupilumab group. Postoperative LKES and NPS decreased in both groups. LMM analysis revealed a significant improvement in LKES (B=-0.61; 95% CI, -0.90 to -0.31; P<0.001) and a more pronounced improvement in NPS (B=-0.14; 95% CI, -0.25 to -0.02; P=0.025) in the dupilumab group compared to controls from preoperative to postoperative measurements.

Conclusion: Compared to ESS alone, the adjunctive use of dupilumab in the postoperative period was associated with greater reductions in both NPS and endoscopic scores.

Objectives: Balloon eustachian tuboplasty (BET) is an emerging treatment for dilatory eustachian tube (ET) dysfunction, yet its efficacy in patients with chronic suppurative otitis media (COM) combined with ET dysfunction remains unclear. This trial aimed to evaluate the efficacy and safety of BET versus medical management (MM) alone in adult patients with COM and chronic dilatory ET dysfunction, as defined by a failed Valsalva maneuver.

Methods: This prospective, multicenter, randomized controlled trial enrolled 116 participants (121 ears) between January 2021 and June 2023. Participants were randomly assigned (1:1) to receive either BET combined with MM or MM alone (fluticasone furoate nasal steroid spray). The primary short-term outcome was the normalization of the Valsalva maneuver at 8 weeks, while secondary outcomes included improvements in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores and reductions in the air-bone gap (ABG) measured at 8 weeks. Adverse events were monitored in both groups throughout the follow-up period.

Results: Of the 116 participants (121 ears), 60 participants (62 ears) received BET and 56 participants (59 ears) received MM alone. There were no significant differences in demographics, baseline characteristics, ETDQ-7 scores, bone conduction thresholds, or ABG between the groups. In the BET group, 46.8% of ears (29/62) achieved a successful Valsalva maneuver compared with 15.3% of ears (9/59) in the MM-only group (P<0.001). The BET group exhibited greater subjective symptom improvement, with an average ETDQ-7 score reduction of -6.2±9.4 compared to -2.6±8.6 in the MM-only group (P=0.028). Additionally, the ABG decreased more significantly in the BET group (-5.8±11.4 dB HL) than in the MM-only group (-1.2±10.5 dB HL) (P=0.023). No serious procedure- or device-related adverse events were observed during the 8-week follow-up.

Conclusion: This trial demonstrates that BET combined with MM is superior to MM alone in treating dilatory ET dysfunction in patients with COM, while also maintaining a favorable safety profile.

Objectives: Many studies have reported that patients with anosmia exhibit an increased incidence of dementia later in life. However, most of these studies have focused exclusively on individuals aged 65 or older, leaving a gap in research on middle-aged subjects (40-65 years).

Methods: We conducted a retrospective cohort study using Korea's National Health Insurance claims data. The study targeted participants aged 40 years and above by randomly selecting 40% of individuals who underwent the 2009 national health check-up. The cohort was divided into two groups: the anosmia group (n=8,023), comprising individuals diagnosed with anosmia between 2006 and 2008, and the control group (n=2,680,534), consisting of the remaining participants. Subsequently, we followed the participants to monitor the occurrence of Alzheimer and vascular dementia from 2011 to 2020.

Results: After adjusting for various factors, the incidence of Alzheimer dementia was significantly higher in the anosmia group compared to the control group (hazard ratio [HR], 1.15; 95% CI, 1.04-1.28). Stratification by age revealed that the risk of developing dementia was significantly elevated in anosmia patients under 65 years (HR, 1.28; 95% CI, 1.07-1.54), whereas no significant increase was observed in those over 65 years (HR, 1.10; 95% CI, 0.97-1.24). Vascular dementia was not statistically associated with anosmia.

Conclusion: A diagnosis of anosmia in middle age increases the risk of developing Alzheimer dementia, while no such increase is observed in older individuals.

Olfactory loss affects more than 12% of the population, with prevalence increasing in aging individuals. Multiple conditions can lead to a loss of smell (hyposmia or anosmia), including post-viral damage from coronavirus disease 2019 (COVID-19) or influenza, head injuries, sinusitis, or neurodegenerative conditions such as Alzheimer or Parkinson disease. Although treatments like surgery, anti-inflammatory medications, or olfactory training can be beneficial in certain cases, there remains an unmet need for effective therapies addressing many common causes of olfactory dysfunction. This is particularly true for cases attributed to damage of olfactory neurons that fail to spontaneously recover. Regenerative medicine approaches, aimed at either stimulating the regrowth of sensory neural structures or replacing them through cell-based therapies, have attracted considerable interest for treating various neurological disorders, including olfactory loss. Here, we summarize the intrinsic regenerative capabilities of the peripheral olfactory system, focusing on current research strategies and the existing barriers that must be overcome for successful translational applications. A major unmet need in this field involves the establishment of reliable and widely accepted culture models for expanding and differentiating olfactory stem or progenitor cells from rodents and humans, both for use in vitro assays and as potential material for cell-based therapies.

The prognostic value of pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains controversial. This meta-analysis investigated AAPR's predictive potential for survival outcomes in HNC patients. We conducted a comprehensive literature search across EMBASE, Cochrane Library, and PubMed databases through July 30, 2024. Eight studies comprising 1737 HNC patients were analyzed using random-effects models. The analysis revealed that lower AAPR values were significantly correlated with worse overall survival (HR = 2.08), progression-free survival (HR = 2.00), and disease-free survival (HR = 2.18). Sensitivity analyses confirmed result robustness, with no significant publication bias detected. These 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.

Objective: This study aimed to investigate the regulatory functions of gamma-aminobutyric acid (GABA)ergic neural circuits from the inferior colliculus (IC) to the medial geniculate body (MGB) in salicylate-induced tinnitus.

Methods.: Mice were treated with salicylate to induce tinnitus, and tinnitus-like behaviors were evaluated via gap prepulse inhibition of acoustic startle. Using combined viral tracing methodologies, we identified and mapped the pathways and connections from the IC to the MGB. Moreover, we used Gq-coupled human M3 designer receptors exclusively activated by designer drugs (DREADDs) and Gi-coupled human M4 DREADDs, allowing targeted control of GABAergic neurons through excitation or suppression in the IC and MGB regions. Following the administration of Clozapine N-oxide, which can bind to the abovementioned specific receptors, we modulated these neural circuits to assess their impact on tinnitus severity in a mouse model.

Results.: Our results indicated that mice exposed to salicylate exhibited tinnitus-like behavior. GABAergic neurons projecting retrogradely from the MGB to the IC are mainly concentrated in the external nucleus of the IC. After the administration of Clozapine N-oxide, the chemogenetic activation of IC-MGB GABAergic neurons aggravated salicylate-induced tinnitus. Our study revealed that activation of GABAergic neurons between the IC and MGB was effective in inducing tinnitus perception, even in the absence of salicylate. However, chemogenetic inhibition of the IC-MGB GABAergic circuit did not reverse salicylate-induced tinnitus.

Conclusion.: This finding suggests that activation of the IC-MGB GABAergic neural circuit may contribute to tinnitus generation, but through a mechanism that is distinct from salicylate-induced tinnitus. This study provided novel insights into the mechanisms underlying tinnitus.

Objective: Empty nose syndrome (ENS) is a rare postoperative complication arising from turbinate surgery. Here, we report our clinical experience and comprehensive analysis of the inferior meatus augmentation procedure with autologous costal cartilage (IMAP-ACC) for ENS.

Methods: We conducted a retrospective review of medical records of patients diagnosed with ENS and underwent IMAP-ACC at a tertiary referral center between November 2015 and November 2023. Symptom improvement was assessed by the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score before and after the IMAP. Additionally, perioperative complications and revision surgery cases were investigated.

Results: Out of the 32 patients that underwent IMAP-ACC, the clinical analysis included 20 patients (16 males, 4 females) with a mean age of 39.1 ± 11.5 years and mean follow-up of 61.2 ± 28.8 months. The mean ENS6Q score improved significantly from 17.5 ± 5.3 preoperatively to 9.1 ± 6.0 at the last follow-up (p<0.001). In the subgroup analysis of 16 patients whose early follow-up data were available, significant improvements were observed in the ENS6Q scores at both the early (7.8 ± 5.7) and long-term follow-up (8.6 ± 6.5) compared to the preoperative value (18.2 ± 5.6). Among 32 patients, nasal obstruction was the most common perioperative complication (34.4%), necessitating reoperation in four patients (12.5%). Most complications were managed well with a conservative approach.

Conclusion: IMAP-ACC demonstrated its role as a valuable treatment option for patients with ENS, showing sustained effectiveness over a long-term follow-up period.

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 (GDP) 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 cost-effectiveness of hearing aids in their decision-making processes.