Clinical and Experimental Otorhinolaryngology最新文献

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.

Objectives: The septal swell body, a distinct anatomical structure in the anterior nasal septum, is a significant contributor to nasal obstruction and affects airflow dynamics and nasal resistance. This meta-analysis evaluated the impact of septal swell body volume reduction (SSBVR).

Methods: A systematic review was conducted using PubMed, Scopus, Embase, Web of Science, and Cochrane databases through October 2024. Outcomes included changes in nasal obstruction scores, cross-sectional area, and nasal airway resistance before and after 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 cross-sectional area (SMD, -1.05; 95% CI, -1.88 to -0.21) and nasal airway resistance (SMD, -0.67; 95% CI, -0.89 to -0.45). Nasal obstruction scores showed significant improvements up to 12 months (SMD, 2.54; 95% CI, 1.81 to 3.26). When SSBVR was added to turbinate surgery, nasal obstruction scores improved further (SMD, 0.47; 95% CI, 0.24 to 0.70) compared to turbinate surgery alone, though no significant differences were found in cross-sectional area or nasal airway resistance. Subgroup analyses demonstrated time-dependent improvements in nasal obstruction scores and varied effectiveness based on treatment modality.

Conclusion: SSBVR significantly improves nasal obstruction and airflow metrics, with additional benefits when combined with turbinate surgery. Further randomized trials are warranted to validate these findings and guide optimal treatment strategies.

Objectives: Hypopharyngeal cancer (HPC), originating from the hypopharyngeal mucosa, is associated with a poor prognosis. Extracellular matrix (ECM) stiffness is closely linked to tumor progression and patient outcomes. This study aimed to investigate the effects of matrix stiffness and to identify molecular markers relevant to HPC prognosis, with the goal of improving clinical outcomes.

Methods: Immunohistochemical analysis and cervical enhanced computed tomography (CT) data were used to evaluate correlations among CT values, matrix stiffness, and prognosis, and to develop a prognostic model for HPC. Cell culture models with varying matrix stiffness were established using polypropylene hydrogel. Western blotting, colony formation, EDU incorporation, and Transwell assays were employed to assess the effects of matrix stiffness on proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT). High-throughput sequencing identified differentially expressed genes in HPC cells cultured on matrices of differing stiffness. Gene editing, in vivo subcutaneous tumorigenesis studies, and Western blotting were performed to elucidate the molecular mechanisms by which high matrix stiffness influences HPC progression and the role of ephrin A2 (EFNA2) in proliferation, migration, and EMT.

Results: Arterial phase CT values were positively correlated with matrix stiffness. Increased matrix stiffness was associated with lymph node metastasis, diminished therapeutic response, and poorer prognosis. Furthermore, metastatic lymph nodes in HPC patients exhibited higher CT values than those in patients with nasopharyngeal carcinoma. A high-stiffness ECM promoted proliferation, migration, and EMT in HPC cells. Mechanistically, a stiff ECM enhanced EFNA2 expression, thereby promoting proliferation, migration, EMT, and tumor growth in vivo.

Conclusion: EFNA2 and elevated matrix stiffness jointly contribute to the malignant phenotype in HPC. EFNA2 may represent a potential therapeutic target for managing HPC progression induced by high matrix stiffness.

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.