Clinical Otolaryngology最新文献

Objective: This study aimed to evaluate the long-term effects of upper airway surgery on olfactory (orthonasal and retronasal) and gustatory functions in patients with obstructive sleep apnoea syndrome (OSAS). Sensory outcomes were compared between surgically treated patients and newly diagnosed OSAS patients who had not received surgery or Positive Airway Pressure (PAP) therapy. In addition, the influence of surgical technique on investigated parameters was analyzed.

Materials and methods: This prospective study included 49 patients aged 18-75 years with OSAS, divided into a surgical group (n = 25) and a control group (n = 24). The surgical group had undergone at least one of the following procedures more than 1 year prior: anterior palatoplasty, expansion sphincter pharyngoplasty, lateral pharyngoplasty, tongue base coblation, or epiglottopexy. Orthonasal olfaction was assessed using the Connecticut Chemosensory Clinical Research Centre (CCCRC) test; retronasal olfaction using a validated 20-item powder-based test; and gustatory function with taste strips for sweet, salty, sour, and bitter.

Results: There were no significant differences between the surgery and control groups in terms of age, apnoea-hypopnoea index (AHI), retronasal olfactory scores, orthonasal threshold, identification, mean CCCRC scores, or gustatory scores (p = 0.218, 0.912, 0.464, 0.111, 0.952, 0.423, and 0.738, respectively). In contrast, a strong and statistically significant correlation was found between retronasal and mean CCCRC scores (Spearman's r = 0.653, p < 0.001).

Conclusion: Upper airway surgery does not appear to adversely affect long-term olfactory or gustatory function in OSAS patients. The high correlation between orthonasal and retronasal scores supports their combined use in sensory evaluation. These findings suggest that surgery is safe with regard to smell and taste perception.

Objective: The role of elective neck dissection (END) in clinically node negative (cN0) locally advanced cutaneous squamous cell carcinoma (cSCC) of the head and neck on survival outcomes is not well elucidated. To date, there is no systematic review performed on the role of END in cN0 disease for advanced cSCC. This study aims to determine if END affects survival outcomes compared to observation.

Design: Systematic review from inception to 22 June 2025 of three peer-reviewed databases (MEDLINE, Embase, Scopus), two clinical trial registries (Clinicaltrials.gov, ANZCTR) and grey literature (Scopus), for MeSH terms pertaining to 'elective neck dissection', 'cutaneous squamous cell carcinoma' and 'head and neck'. This review was registered prospectively on PROSPERO (CRD42024537410).

Participants: END in patients with cN0 locally advanced head and neck cSCC.

Main outcome measures: Overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS).

Results: Of 983 unique studies, 119 studies underwent full-text screening. Six studies underwent systematic review and meta-analysis. Of 522 included patients, 197 (37.7%) underwent END and 325 (62.3%) underwent observation. Six studies reported on OS, four studies on DSS and three on DFS. Meta-analysis for OS at 5 years did not provide a conclusion for or against END (log risk-ratio 0.09, 95% CI -0.57 to 0.76). Meta-analysis could not be performed for DSS. The meta-analysed occult cervical nodal rate was 17.34% (95% CI 10.57 to 25.14). Studies were of low to moderate risk of bias.

Conclusion: In locally advanced cSCC, END cannot be conclusively stated to improve OS or DSS.

Background: Head trauma is a major cause of chemosensory deficit, with olfactory loss occurring in approximately 22% of cases. Following head injury, olfactory and gustatory loss are often unassessed; patients are often unaware of the problem, thus presenting late to specialist clinics.

Primary aim: To determine the role of screening olfactory and gustatory testing in patients following head trauma.

Methods: This prospective cohort study, conducted at three secondary hospitals, included patients with head injury aged ≥ 18 years, with capacity to consent within 30 days of injury. Patients with previous head injury requiring admission or with pre-existing olfactory/gustatory loss were excluded. Participants underwent screening chemosensory assessment using Burghart Sniffin' Sticks and Taste Strips. If significant loss was identified, patients were referred to Smell & Taste clinic to be seen within 3 months of injury for extended testing.

Results: A total of 121 participants took part in the study (65 male, 56 female); 71% experienced olfactory dysfunction and 62% gustatory dysfunction post head injury. There was no statistically significant association between gender and olfactory/gustatory dysfunction (p > 0.05). Older participants experienced a higher prevalence of olfactory and gustatory dysfunction. Seven participants progressed to a follow-up consultation in the Smell & Taste Clinic, all of whom had persistent olfactory dysfunction.

Conclusion: Our study highlights that a significant proportion of mild head injuries result in olfactory/gustatory dysfunction, thus reinforcing the use of psychophysical testing in this patient cohort. Improvements should be made to ensure they receive suitable follow-up in a Smell & Taste clinic.

Objectives: Smell and taste disorders (SATDs) are frequently overlooked despite growing prevalence. They profoundly impact quality of life. Effective therapies for SATDs remain scarce. This survey aimed to assess patient views surrounding the support available at the time of onset of SATDs, and what further support is needed.

Design and setting: This was a cross-sectional study consisting of an online survey circulated via the UK charity SmellTaste (known as Fifth Sense until a rebrand in May 2025), exploring features and impacts of SATDs, and opinions surrounding support available, and any further support felt to be necessary by those formally diagnosed or self-identifying with SATDs.

Main outcomes: Survey questions were grouped largely into the domains of demographics, features of olfactory issues, impact of disorder, and support network.

Results: A total of 410 participants completed the questionnaire, with the majority being women. When asked how olfactory dysfunction made participants feel, common responses included: 'sad', 'devastated', 'angry', 'anxious', 'depressed', 'isolated' and 'grief'. Family was reported as the greatest source of support when diagnosed with SATDs (partner/spouse, 36.4%; other family member, 15.1%) followed closely by SmellTaste (34%). Only 2.5% reported General Practitioners as their greatest source of support, with many participants reporting that primary care providers could not provide adequate help, leaving them to seek advice elsewhere (support groups, family, friends and self-investigation). Further support, covering medical, psychological and social interventions, was considered important.

Conclusion: Given the complexity of issues experienced and the lack of formal support available for people with SATDs, there is a clear need for an intervention addressing unmet support needs.

Background: Middle ear surgery is a common procedure addressing various pathologies. Postoperative head bandaging has traditionally been used to provide support and prevent complications. However, its necessity remains controversial, with limited empirical evidence supporting its routine use.

Objective: This randomised controlled trial (RCT) evaluated the necessity of head bandaging in middle ear surgery by comparing postoperative complications between a mastoid head bandage and a simple gauze dressing.

Methods: Eighty patients scheduled for middle ear surgery were randomly assigned to two groups: the Pressure Bandage group, where a crepe bandage was wrapped around the head, and the No Pressure Bandage group, where a gauze dressing was secured with Mefix tape. All surgeries were performed by a single otolaryngologist using standardised techniques, with the surgeon blinded to the dressing type. Postoperative complications, including hematoma, erythema, skin abrasion and wound infection, were recorded and compared.

Results: The mastoid bandage group had a significantly higher incidence of forehead skin abrasions (6/40 vs. 0/40, p = 0.026). No significant differences were observed in hematoma or seroma formation, as neither group developed these complications.

Conclusion: Routine mastoid head bandaging does not appear necessary, as it does not reduce postoperative complications and may increase patient discomfort due to skin abrasions. Larger studies with longer follow-ups are recommended to strengthen these findings and guide clinical practice.

Introduction: Pinnaplasty is a widely performed procedure to correct prominent ears. A known complication is suture extrusion, which may delay recovery and require revision surgery.

Objective: To assess whether the placement of Biodesign Otologic Repair Graft over Mustardé sutures reduces the rate of suture extrusion.

Methods: This was a retrospective single-centre clinical audit of 54 consecutive patients (aged ≤ 18 years) who underwent pinnaplasty by a single surgeon between 2011 and 2024. Patients were grouped according to whether Biodesign Otologic Repair Graft was used, and all were followed for up to 12 months post-operatively. The primary outcome was suture extrusion; secondary outcomes included revision surgery and other complications.

Results: Suture extrusion occurred in 7/216 sutures (3.24%) in the non-Biodesign group and 0/126 sutures (0%) in the Biodesign group (p = 0.047). One patient in the Biodesign group developed a keloid requiring revision.

Conclusion: The use of Biodesign Otologic Repair Graft was associated with a reduced rate of suture extrusion in this single-centre audit, with minimal complications. Larger prospective studies are needed to assess cost-effectiveness, long-term safety and generalisability.

Introduction: Pleomorphic adenoma and Warthin tumour are the two most common benign parotid gland tumours with distinct histological and clinical profiles. Recent studies suggest a potential link between metabolic disturbances-particularly insulin resistance-and the development of Warthin tumours. The triglyceride-glucose (TyG) index has emerged as a simple, cost-effective biomarker of insulin resistance. This study aimed to investigate the potential role of the TyG index in differentiating between pleomorphic adenoma and Warthin tumour.

Methods: A retrospective cross-sectional study was conducted on patients histopathologically diagnosed with pleomorphic adenoma (n = 31) or Warthin tumour (n = 22), and compared with healthy controls (n = 58). Fasting glucose and triglyceride levels were used to calculate the TyG index. Statistical analyses included t-tests, ANOVA, and Bonferroni-corrected post hoc comparisons, with a significance threshold of p < 0.05.

Results: No significant differences were observed in age, sex, BMI or TyG index between the tumour group and controls. However, the TyG index was significantly higher in the Warthin tumour group (4.91 ± 0.28) compared to the pleomorphic adenoma (4.68 ± 0.31, p = 0.006) and control groups (4.72 ± 0.23, p = 0.033). No difference was found between the pleomorphic adenoma and control groups.

Conclusion: The TyG index is significantly elevated in patients with Warthin tumours, supporting its potential role as a simple, non-invasive biomarker to aid in the differential diagnosis of benign parotid tumours.

Introduction: Frontal sinusitis is influenced by anatomical variations that impact sinus drainage pathways. Among these, frontal recess cells classified by the International Frontal Sinus Anatomy Classification (IFAC) and uncinate process variations play a key role. This study aimed to investigate the relationship between these anatomical structures and the development of frontal sinusitis.

Methods: This retrospective study included 144 patients (70 with frontal sinusitis, 74 controls) who underwent paranasal sinus computed tomography (PNSCT). Frontal recess cells were evaluated according to the IFAC, and uncinate process variations were assessed using the Landsberg and Friedman classification. Frontal sinusitis severity was determined by the Lund-Mackay scoring system.

Results: The prevalence of supra-agger (SAC) and supra-bullar cells (SBC) was significantly higher in the frontal sinusitis group (p < 0.001). A positive correlation was found between the presence of SAC, SBC and supra-bullar frontal cells and frontal sinus Lund-Mackay scores (p < 0.001, p < 0.001 and p = 0.002, respectively). No significant association was observed between uncinate process variations and frontal sinusitis (p = 0.167).

Conclusion: Frontal recess cells, particularly SAC and SBC, appear to increase susceptibility to frontal sinusitis, likely by impairing drainage. Recognition of these anatomical variations may improve surgical planning and management outcomes in patients with frontal sinusitis.

Objective: To assess if surgery for Obstructive Sleep Apnea Disorder (OSAD) is safe for infants and toddlers.

Methods: Retrospective cohort study of paediatric patients undergoing OSA surgery; partial or complete tonsillectomy with adenoidectomy, tonsillectomy without adenoidectomy and adenoidectomy. Patients were divided into three groups: infants (≤ 1 year), toddlers (1-2 years) and control (children ≥ 2 years). The study measured outcomes such as paediatric intensive care unit (PICU) admissions, length of hospital stay (LOS), emergency room (ER) visits within 2 weeks of surgery, fever, dehydration, bleeding and the need for reoperation.

Results: A total of 419 paediatric patients were included: 61 infants (14.5%), 147 toddlers (35.1%) and 211 controls (50.4%). Adenoidectomy was the most common procedure for infants (75%), followed by toddlers (52%) and controls (27%). The LOS was significantly longer in the infant group (p < 0.001). PICU admissions were higher in infants compared to the control group (p < 0.001). However, after adjusting for the type of surgery, no statistical difference was found. Additionally, there were no significant differences in the relative risk of ER visits, fever, or bleeding between the groups. A total of 60 patients (14.3%) in the cohort underwent reoperations, with higher rates in toddlers compared to infants and controls (25.2%, 16.4% and 6.2%, respectively, p < 0.001). The most common revision surgery for the control group was adenoidectomy (8/13, 61.5%), while for toddlers and infants, the most common revision surgery was adenoidectomy + tonsillectomy (22/37, 59.45% and 5/10, 50%, respectively). However, after adjusting for the type of surgery, no statistical difference was found.

Conclusion: OSA surgery in children aged ≤ 2 years is generally safe but carries risks, including longer hospital stays. The higher rate of reoperations in this age group highlights the need for longer follow-up and parental education about the recurrence of clinical symptoms.