Clinical and Experimental Otorhinolaryngology最新文献

Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of vertigo. This study aims to analyze the risk factors associated with the occurrence and recurrence of BPPV.

Methods: A database maintained by the Korean National Health Insurance Service was used to analyze 434,552 patients diagnosed with BPPV from 2011 to 2017. The propensity score matching technique was employed to pair each participant with a control patient who did not have BPPV, ensuring equivalence in age, sex, residential status, and socioeconomic status. BPPV recurrence was defined as a new episode occurring more than 90 days after the initial treatment. Logistic regression analysis was conducted to examine the incidence of BPPV, while Cox proportional hazards models were used to investigate the risk factors associated with its recurrence.

Results: BPPV was found to be 2.2 times more prevalent in women, particularly peaking between the ages of 50 and 59. The 5-year recurrence rate for BPPV stood at 39.8%, with a significant number of cases reoccurring within the first year. The incidence of BPPV was statistically significantly linked to several underlying medical conditions, including vitamin D deficiency, thyroid hormone abnormalities, head trauma, and inner ear disorders. Notable risk factors for BPPV recurrence included advanced age, female sex, rural residence, low socioeconomic status, and the presence of inner ear diseases.

Conclusion: Our study provides significant insights into the risk factors linked to both the occurrence and recurrence of BPPV. Notably, there appears to be a connection with vitamin D levels, thyroid hormones, and estrogen. Additionally, conditions such as inner-ear disorders, head trauma, and otologic surgery were found to be strongly associated with both the initial onset and subsequent recurrence of BPPV.

Objectives: The vestibular aqueduct (VA) exhibits significant anatomical variability. These variations and their spatial relationships with neighboring structures may pose technical challenges during endolymphatic sac surgery. We aimed to characterize the anatomical features of the VA and its relationship with surrounding structures in patients with severe Meniere disease compared to controls using high-resolution computed tomography (CT).

Methods: This retrospective study included 65 patients (126 ears) who underwent temporal bone CT. The Meniere group comprised 26 patients (26 affected ears) meeting the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria for intractable disease; the contralateral ear group included 24 ears, and the control group comprised 39 patients (76 ears) with unrelated conditions. Measurements included VA thickness (A), width (B/B´), the distance between the posterior semicircular canal (PSCC) and posterior fossa (C), PSCC depth (D/D´), and operculum depth (E/E´). Correlations were analyzed, and k-means clustering was applied to classify anatomical variations. Reliability was assessed using intra- and inter-observer tests.

Results: VA width (B) correlated positively with the PSCC-meningeal distance (C) (r=0.683, P<0.001) and negatively with PSCC depth (D´) (r=-0.290, P<0.01) and operculum depth (E´) (r=-0.520, P<0.001). Patients with a narrower VA exhibited a reduced PSCC-meningeal distance and a deeper operculum position. The Meniere group demonstrated significantly narrower VA and shorter PSCC-dura distances compared to controls (P<0.001). Cluster analysis identified three anatomical patterns, with 61.5% of intractable Meniere ears versus 14.5% of controls and 41.6% of contralateral ears falling into the cluster characterized by smaller VA dimensions, shorter PSCC-dura distances, and deeper operculum positions.

Conclusion: A narrow VA correlates with a reduced PSCC-meningeal distance and a deeper operculum position, potentially complicating endolymphatic sac surgery. These anatomical variations are more prevalent in patients with severe Meniere disease, highlighting the need for tailored surgical approaches.

The sphenoid sinus presents significant challenges during endoscopic sinus surgery. It is essential that surgeons employ strategies that effectively address sphenoid pathology while minimizing surgical risks and optimizing outcomes. Although nomenclature for maxillary and frontal sinus surgery is well established, there is currently no standardized nomenclature for sphenoid sinus surgery. We present a comprehensive review of techniques for accessing the sphenoid sinus and propose a common surgical classification system to better define and categorize these approaches. Each technique is classified based on surgical extent, anticipated operation time, complexity, potential complications, and expected wound healing, aligning with established standards in the literature. The proposed sphenoidotomy types are as follows: type I, sphenoid ostial dilation; type IIa, transnasal sphenoidotomy (sphenoidotomy without ethmoidectomy); type IIb, transethmoidal sphenoidotomy (sphenoidotomy with ethmoidectomy); type III, bilateral, common cavity sphenoidotomy, or "sphenoid drill-out;" type IV, transpterygoid approach, to expose the lateral sphenoid sinus recess; and type V, sphenoid nasalization, completely removing the sphenoid sinus floor. By standardizing the nomenclature for these techniques, we aim to enhance consistency in terminology for teaching, surgical planning, clinical research, and interdisciplinary communication in sphenoid sinus surgery.

Objectives: This study aimed to calculate the age-adjusted incidence rate of head and neck cancer (HNC) in South Korea from 1999 to 2020 and to analyze HNC incidence trends while excluding the effects of population aging.

Methods: Data were obtained from the Cancer Registration Statistics Program. All 12 types of HNCs were analyzed. Crude incidence rates and the number of new cases from 1999 to 2020 were presented by sex and age group. Age-adjusted incidence rates were calculated using the World Standard Population (World Health Organization [WHO] 2000-2025), and trends were assessed.

Results: Although the crude incidence rates of all HNCs increased steadily from 1999 to 2020, the absolute values remained low in most cases, at less than 2 per 100,000. The male-to-female ratio was 1 or higher for all HNCs except thyroid cancer, and 10 or higher for laryngeal and hypopharyngeal cancers. Age-adjusted incidence trends showed 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 effects of population aging, tongue cancer, tonsil cancer, major salivary gland cancer, and thyroid cancer have increased in South Korea over the past 20 years, while laryngeal cancer has decreased.

Objectives: Effective treatment of laryngeal cancer requires clinical decision-making that balances survival outcomes with the preservation of essential functions, such as voice and swallowing. This study, led by the Clinical Practice Guideline Committee of the Korean Society of Head and Neck Surgery, aims to establish evidence-based recommendations to guide surgeons in optimizing treatment decisions for patients with laryngeal cancer.

Methods: A literature search was performed in the PubMed, Embase, Cochrane Library, and KoreaMed databases by a literature search expert and subsequently reviewed by a panel of 39 committee experts. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method was employed to assess the quality of evidence and develop and report the recommendations. The strength of each recommendation reflects the guideline panel's confidence that the benefits of an intervention outweigh its risks for the target population. After drafting the guidelines, Delphi questionnaires were distributed to members of the Korean Society of Head and Neck Surgery and an external reviewer panel.

Results: In total, 15 evidence-based recommendations are provided, addressing six critical aspects of laryngeal cancer treatment: early-stage treatment, treatment of locally advanced cancer, neck management, adjuvant therapy, swallowing rehabilitation, and salvage treatment for recurrent tumors.

Conclusion: The guidelines provide evidence-based, validated recommendations to support clinicians in making optimal treatment decisions for laryngeal cancer.

Objectives: Lateral canal benign paroxysmal positional vertigo (LC-BPPV) is diagnosed using the head roll test (HRT), which involves rotating the head to mobilize particles within the lateral canal, inducing nystagmus. The body roll test (BRT) is conducted by rolling both the body and head simultaneously, offering the advantage of safely achieving the correct rotational angle in both directions. This study evaluates the diagnostic utility of the BRT.

Methods: A randomized controlled study was conducted. In total, 43 patients with LC-BPPV symptoms were enrolled and randomly divided into two groups. In group A (n=21), the HRT was administered first, followed by the BRT after a 5-minute interval. In contrast, group B (n=22) received the BRT first, followed by the HRT after 5 minutes. Participants wore Fresnel glasses, which allowed for the observation of nystagmus in sitting, bowing, and lying down positions. We recorded the direction, latency, and duration of the nystagmus.

Results: The distribution of nystagmus types was 18:25 (geotropic: apogeotropic). There was no significant difference in age, sex, or type of nystagmus between the two groups. The findings from the HRT aligned with those from the BRT for 32 (74.4%) of the participants. No statistical differences were noted in the diagnosis of the affected side or in the type of nystagmus (geotropic vs. apogeotropic) between the HRT (n=32) and BRT (n=32) (P>0.05). The diagnostic rates in the first (n=31) and second tests (n=33) were similar, showing no significant difference and consistent results regarding the type of LC-BPPV. Additionally, there were no significant differences in postural discomfort and pain scores between these groups.

Conclusion: BRT and HRT demonstrate comparable diagnostic efficacy for LC-BPPV. BRT offers a viable alternative, especially for patients whose conditions preclude the use of HRT, and may improve diagnostic accuracy when combined with HRT.

Objectives: State-run newborn hearing screening (NBHS) programs have limitations in identifying children with mild or late-onset sensorineural hearing impairment (SNHI). Given that over 50% of pediatric SNHI cases are linked to genetic causes, the increasing accessibility of high-throughput, low-cost genomic sequencing may help address these shortcomings. This study investigates the feasibility of integrating a next-generation sequencing (NGS)-based genomic screening protocol into conventional NBHS and examines its potential benefits and challenges.

Methods: A total of 8,261 newborns underwent simultaneous NBHS and NGS-based genomic screening targeting 46 deafness genes in this prospective study. The subjects' genotypes were determined, and those with conclusive genetic diagnoses received audiological assessments.

Results: Conclusive genetic diagnoses were confirmed in 164 subjects, with 112 carrying variants in GJB2 and MTRNR1 and 52 carrying variants in other deafness genes. Notably, 126 of these subjects passed the NBHS, suggesting that an additional 1.5% (126/8,261) of children at risk for SNHI, who would have been missed by conventional physiological screening, can be identified through targeted genomic screening in the general population. Furthermore, one subject's father, who carried a COL4A5 variant, and three paternal relatives of another subject carrying an EDNRB variant (previously undiagnosed) were identified with Alport and Waardenburg syndromes, respectively, underscoring the familial benefits of this approach.

Conclusion: Targeted genomic sequencing in newborns may serve as a valuable complement to conventional NBHS by identifying children at risk for SNHI and enabling early diagnosis in families with non-syndromic mimics.

Introduction: Chronic rhinosinusitis (CRS) presents a challenge for otolaryngologists due to its complex management and high recurrence rates. Glucocorticoids (GCs) are extensively utilized for their potent anti-inflammatory effects in managing various inflammatory conditions and also play a pivotal role in treating CRS. Certain patients exhibit insensitivity to GC therapy, leading to GC resistance (GCR). Oxidative stress is one causative factor for GCR development, while the Nrf2 signaling pathway emerges as a critical cellular defense mechanism against oxidative stress-induced damage. Exploring the Nrf2 signaling pathway is promising for advancing our understanding of GC sensitivity and its application in treating CRS. This article overviews the relationship between GC sensitivity and the Nrf2 signaling pathway and potential Nrf2-related drugs. Studies have shown that Nrf2 activators, used alone or in combination with GCs, more effectively inhibit the release of inflammatory factors and oxidative stress damage than GC monotherapy, making them a promising new target for CRS treatment.

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

Methods: The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions.

Results: The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in 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 operations and reducing 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 surgery.

Objectives: Congenital aural atresia (CAA) is a complex condition that manifests in various forms, including Schuknecht type B stenosis, which is characterized by a congenitally narrow bony external auditory canal (EAC). This study aims to evaluate the long-term surgical outcomes of canal-tympanoplasty in patients with Schuknecht type B CAA.

Methods: The study included 21 ears diagnosed with Schuknecht type B CAA, all of which underwent canal-tympanoplasty. Reconstruction of the large EAC and tympanic membrane involved conchal flap meatoplasty, bony EAC drilling, ossicular reconstruction, and overlay tympanoplasty. Standard pure-tone audiometry was analyzed at multiple post-surgery time points: 3, 6, 12, and 24-60 months. Additionally, the incidence of postoperative complications was assessed.

Results: The hearing outcomes of canal-tympanoplasty in this case series were satisfactory. Serviceable hearing was achieved in all patients after 3 months and was maintained in 85% of patients for 1 year. The air-bone gap improved from a preoperative average of 39.3±15.1 dB to 13.7±7.4 dB at 3 months, 16.4±10.5 dB at 6 months, 19.1±11.7 dB at 12 months, and 21.5±16.1 dB at 2-5 years postoperatively. Three patients required revision canal-tympanoplasty due to hearing deterioration, representing 14.3% of the cases. There were no instances of postoperative infection, facial nerve weakness, vertigo, deterioration of bone conduction thresholds, or complete restenosis of the EAC.

Conclusion: Canal-tympanoplasty proved to be a satisfactory surgical intervention for patients with Schuknecht type B CAA. This procedure led to significant improvements in hearing outcomes, providing serviceable hearing that lasted for several years. Moreover, the risk of postoperative hearing deterioration and/or the need for revision surgery within 1 year was considered acceptable.