Clinical and Experimental Otorhinolaryngology最新文献

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.

Objectives: Allergic rhinitis (AR) significantly impacts quality of life and incurs socioeconomic costs. The influence of smoking habits, including the use of conventional cigarettes (CCs) and electronic cigarettes (ECs), on the prevalence and management of AR remains a subject of debate. This study aims to explore the association between smoking status (CC and EC use) and the prevalence and management of AR among Koreans by analyzing data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2018) and VIII (2019-2021).

Methods: This cross-sectional study involved 22,290 participants aged 19 years and older from the KNHANES. Participants self-reported their smoking status, and urinary cotinine levels were measured to assess nicotine exposure. We employed statistical analyses, including logistic regression, to examine the relationships between smoking status, cotinine levels, and the prevalence and management of AR.

Results: In univariable logistic regression analysis, EC users exhibited a 35.8% increased risk of AR compared to non-smokers, whereas CC users experienced a 27.7% reduced risk. Multivariable logistic regression analysis showed a 20.3% lower risk of AR among CC users; however, no significant association was observed for EC users. Higher cotinine levels (>500 ng/mL) were associated with a lower prevalence of AR. Specifically, heavy CC users with high cotinine levels demonstrated a 35% reduced risk of AR. Nonetheless, after adjusting for confounders, this association was no longer significant, indicating that other variables might influence this relationship.

Conclusion: Smoking status is associated with the prevalence of AR in Koreans. Notably, heavy use of CCs is negatively correlated with the prevalence of AR.

Objectives: Head and neck squamous cell carcinoma (HNSCC) exhibits high recurrence rates, particularly in cases of radioresistant HNSCC (RR-HNSCC). Non-thermal plasma (NTP) therapy effectively suppresses the progression of HNSCC. However, the therapeutic mechanisms of NTP therapy in treating RR-HNSCC are not well understood. In this study, we explored the regulatory role of NTP in the RR-HNSCC signaling pathway and identified its signature genes.

Methods: After constructing two RR-HNSCC cell lines, we prepared cell lysates from cells treated or not treated with NTP-activated media (NTPAM) and performed RNA sequencing to determine their mRNA expression profiles. Based on the RNA sequencing results, we identified differentially expressed genes (DEGs), followed by a bioinformatics analysis to identify candidate molecules potentially associated with NTPAM therapy for RR-HNSCC.

Results: NTPAM reduced RR-HNSCC cell viability in vitro. RNA sequencing results indicated that NTPAM treatment activated the reactive oxygen species (ROS) pathway and induced ferroptosis in RR-HNSCC cell lines. Among the 1,924 genes correlated with radiation treatment, eight showed statistical significance in both the cell lines and The Cancer Genome Atlas (TCGA) cohort. Only five genes-ABCC3, DUSP16, PDGFB, RAF1, and THBS1-showed consistent results between the NTPAM data sequencing and TCGA data. LASSO regression analysis revealed that five genes were associated with cancer prognosis, with a hazard ratio of 2.26. In RR-HNSCC cells, NTPAM affected DUSP16, PDGFB, and THBS1 as activated markers within 6 hours, and this effect persisted for 12 hours. Furthermore, enrichment analysis indicated that these three DEGs were associated with the extracellular matrix, transforming growth factor-beta, phosphoinositide 3-kinase/protein kinase B, and mesenchymal-epithelial transition factor pathways.

Conclusion: NTPAM therapy exerts cytotoxic effects in RR-HNSCC cell lines by inducing specific ROS-mediated ferroptosis. DUSP16, PDGFB, and THBS1 were identified as crucial targets for reversing the radiation resistance induced by NTPAM therapy, providing insights into the mechanisms and clinical applications of NTPAM treatment in RR-HNSCC.