Clinical Otolaryngology最新文献

Background: The association between serum uric acid levels and peripheral vertigo diseases, namely Benign Paroxysmal Positional Vertigo (BPPV), Meniere's Disease (MD), and Vestibular Neuritis (VN), remains a subject of controversy. This study utilises the Mendelian Randomization (MR) approach to investigate the potential link between uric acid levels and these peripheral vertigo diseases, with the goal of informing preventative measures and early intervention strategies.

Methods: Datasets pertaining to uric acid levels (sample size = 343 836) and BPPV (ncase = 3834, ncontrol = 209 582), MD (ncase = 1511, ncontrol = 209 582), and VN (ncase = 1224, ncontrol = 209 582) were selected from Genome-Wide Association Studies (GWAS). Two-sample MR was employed to analyse the correlation between the exposure (uric acid levels) and outcomes (BPPV, MD, VN). The MR analysis methods encompassed Inverse Variance Weighting (IVW), MR-Egger, Simple Mode, Weighted Mode, and Weighted Median methods. The results derived from the IVW analysis were considered as the primary analytical outcomes.

Result: The findings indicated no significant correlation between uric acid levels and BPPV (IVW: OR = 1.152, 95% CI: 0.971-1.367, p = 0.103), MD (IVW: OR = 1.010, 95% CI: 0.757-1.348, p = 0.943), and VN (IVW: OR = 1.005, 95% CI: 0.744-1.358, p = 0.969).

Conclusion: This study employed a two-sample Mendelian randomization approach to conduct an in-depth analysis of the relationship between serum uric acid levels and peripheral vestibular diseases (BPPV, MD, and VN). Our findings indicate that no significant association was found between serum uric acid levels and these diseases. The results of the study do not support the hypothesis that uric acid is an independent risk factor for these conditions.

Introduction: The nasoseptal flap (NSF) has become a widely favoured choice for reconstructing skull base defects following the endoscopic endonasal approach (EEA). However, the exposed septal cartilage and bone at the donor site often require an extended duration for secondary healing. This study investigated whether the free middle turbinate (MT) mucosa grafting at the septal donor site could mitigate post-operative nasal morbidity.

Methods: We retrospectively reviewed patients with sellar and parasellar lesions who underwent NSF harvesting in EEA between 2015 and 2023. In most cases, the MT mucosa was harvested as a free mucosal graft and placed on the exposed nasal septal donor site. The degree of septal mucosalisation and the presence of nasal crusting were assessed during follow-up appointments.

Results: A total of 104 patients were included in this study, comprising 41 males and 63 females. All patients underwent NSF harvesting for skull base defect reconstruction and 99 patients received MT mucosa grafting at the septal donor site. The average duration for complete mucosalisation of the exposed septal cartilage with the MT graft was 38.7 days, significantly different from 59.6 days for patients without the MT graft (p < 0.0001). At the 3-month post-operative follow-up, 34% of the patients with MT graft displayed no crusting compared to 20% of patients without MT graft.

Conclusions: The use of free MT mucosal grafting represents a promising technique for improving mucosalization and minimising crusting at the nasal septal donor site following the harvest of the NSF in EEA for sellar and parasellar lesions.

Objective: To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data.

Design: Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines.

Outcome measures: Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate.

Results: Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0% ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/h (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (p < 0.00001). LSAT improved from 87.8 ± 5.7 to 90.1% ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (p < 0.0001).

Conclusion: Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective; limitations include heterogeneity in reported outcomes influenced by confounding factors.

Introduction: Obstructive sleep apnoea (OSA) in children is associated with numerous adverse outcomes, including elevated blood pressure. While the associations between OSA, obesity, and autonomic dysfunction are recognised, the precise mechanisms linking these factors and their relationship with elevated blood pressure in children remain unclear.

Methods: This retrospective case series included 76 children with OSA. The relationships between night-time systolic and diastolic blood pressures, body mass index, and clinical, polysomnographic, and sleep heart rate variability variables were investigated. Mediation and moderation analyses were performed.

Results: Correlation analyses revealed significant associations between both systolic and diastolic blood pressures with body mass index, age, sex, adenoidal-nasopharyngeal ratio, apnoea-hypopnoea index, and sleep low frequency/high frequency (LF/HF) ratio. In multivariable linear regression models, body mass index, adenoidal-nasopharyngeal ratio, and LF/HF ratio were independently associated with systolic blood pressure, while body mass index and adenoidal-nasopharyngeal ratio were independently associated with diastolic blood pressure. Mediation and moderation analyses identified a conceptual mediation with a moderated direct path model in which body mass index mediated, and the LF/HF ratio moderated, the relationship between apnoea-hypopnoea index and systolic blood pressure. Additionally, children with concomitant OSA and attention deficit hyperactivity disorder had a significantly higher LF/HF ratio than those with OSA alone.

Conclusion: In children with OSA, the relationship between apnoea-hypopnoea index and systolic blood pressure was mediated by weight status and modulated by sleep sympathovagal balance. Children with OSA and attention deficit hyperactivity disorder exhibited greater disturbances in sympathovagal balance. Further research is warranted to explore these associations.

Objectives: To gain insight into the integrity of research in Otolaryngology-Head & Neck Surgery (OHNS) literature through characterising retracted articles, analysing the reason for their retraction, and the trends in the collected data.

Methods: Pubmed, Embase, and Retraction Watch Database were queried for retracted articles published between the dates of 1/31/92 and 9/30/22. Articles with titles relating to OHNS subjects and published in OHNS journals, as determined by Scimago Journal and Country Ranking, were selected for further analysis. Variables recorded included journal name, journal impact factor, article type, article subspecialty subject, reason for retraction, whether re-published, number of authors, time to retraction, and article citations.

Results: Based on title and article content, 245 articles related to the field of OHNS were identified, of which 68 were published in OHNS journals and analysed for reason of retraction. Of those, 16 (23.5%) were replaced due to erratum concerns (spelling, formatting, etc.) rather than content or data-related issues and were excluded. Among the 52 (76.5%) permanent retractions the most common reasons for retraction include article duplication (n = 26), concerns/issues/errors with data (n = 7), and plagiarism (n = 5). The median time between publication and retraction was 2 years (range, 0-19). The median impact factor was 1.64 (range, 0.08-4.68). The median number of citations per article was 7 (range, 0-86).

Conclusion: Retractions continue to occur in the field of OHNS despite increasing education in ethical publication standards and safeguards. There are, however, improved time intervals to retraction indicating improved surveillance of published articles.

Introduction: It is unknown whether prodromal dizziness (PD) before an attack of vestibular neuritis (VN) has an association with peripheral vestibular lesions. The purpose of this study was to investigate whether the severity of vestibular dysfunction has an association with the presence of PD.

Methods: We reviewed the medical records of 88 consecutive unilateral VN patients with unilateral canal paresis in caloric testing. Caloric test, cervical vestibular evoked myogenic potential test to air-conducted sound (ACS cVEMP), ocular vestibular evoked myogenic potential test to bone-conducted vibration (BCV oVEMP) and video head impulse test (vHIT) were used as vestibular function tests. Binomial logistic regression analyses were performed to see whether the subjects' age, sex, disease duration or the presence of PD is associated with the presence of vestibular dysfunction.

Results: Seventeen (19%) experienced an episode of PD. There was no significant association between the presence of PD and abnormality in ACS cVEMPs, BCV oVEMPs, vHIT for the posterior semicircular canal (SCC) or vHIT for the lateral SCC. The presence of PD had a significant positive association with abnormality in vHIT for the anterior SCC (ASCC) (p = 0.0248).

Conclusions: The presence of PD in VN may be associated with the peripheral vestibular lesion.

Objective: Currently, there is no adult-specific decision aid (DA) to support decision-making regarding recurrent tonsillitis. This study intends to address this gap by piloting a prototype DA.

Design: Randomised clinical trial.

Setting: Single centre trial at a tertiary otolaryngology department.

Participants: Forty-three patients were randomised to either the DA or Treatment as Usual (TAU) group.

Main outcome measures: Primary objective: To measure how patients rate the quality of their decision-making experience at the time of the decision and at follow-up (SURE scale).

Secondary objective: The level of decisional satisfaction at the time of the decision and follow-up, as well as to explore the numbers of people opting for surgery for each study condition (Shared tool and patient feedback).

Results: Quality: This study demonstrates no statistically significant difference in how patients rate the quality of their treatment decision between DA and TAU, both at baseline (p = 0.553) and follow-up (p = 0.062). Satisfaction: This study showed a statistically significant level of decisional satisfaction at the time the decision was made for Qu2 of the Shared tool (U = 113, p = 0.026). No other significant difference was found between participants who received the DA and TAU.

Conclusion: The DA is an acceptable and useful tool that could be incorporated into the pathway for recurrent tonsillitis, helping to eliminate physician implicit bias. However, preliminary qualitative evidence from this pilot study does not suggest that including the DA improves the quality of decision-making.

Trial registration: IRAS ID - 230 362.

Objectives: The aim of this study is to evaluate the factors influencing balance and fear of falling (FOF) in patients with benign paroxysmal positional vertigo (BPPV).

Design: A controlled cross-sectional study.

Setting: Single center study.

Methods: A total of 31 patients with BPPV and 30 controls were included in this cross-sectional study. The handgrip strength (HGS) was measured using the Jamar hydraulic hand dynamometer. Ultrasound measurements of muscle thickness (MT) of the biceps brachii, medial head of gastrocnemius, and lateral head of gastrocnemius were recorded. MT/body mass index was calculated. FOF was assessed using the Falls Efficacy Scale (FES). The Berg Balance Scale (BBS) was used to assess the participants' balance. The timed up and go test (TUG) was used to evaluate physical function. The video head impulse test (VHIT) was used to evaluate the semicircular canals.

Results: The FES scores and TUG duration were higher and the BBS scores were lower in patients with BPPV compared with the control group (p < 0.001). Univariate analysis showed that dominant HGS (B = -1.380, p = 0.012), BMI (B = 2.391, p = 0.011), and female gender (B = 18.369, p = 0.036) were associated factors for the FES in patients with BPPV. Age (B = -0.239, p < 0.001), dominant HGS (B = 0.441, p < 0.001), BMI (B = -0.503, p = 0.032) and R ASC (B = -12.601, p = 0.006) were associated variables for the BBS. Age was an associated factor for the TUG (B = 0.158, p = 0.017).

Conclusion: Lower HGS, higher BMI and female gender were associated factors for greater FOF in patients with BPPV. Clinicians should be aware of risk factors and educate patients regarding balance and FOF.