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.

Introduction: Sleep-disordered breathing (SDB) affects up to 5% of children and is associated with multiple systemic complications. Recent concerns over rare but fatal choking incidents in children with untreated obstructive SDB (oSDB) have developed interest in whether swallowing dysfunction is a contributing factor. This systematic review investigates whether there is evidence linking paediatric oSDB with swallowing disorders, excluding children with known neurological or craniofacial comorbidities.

Methods: A systematic literature search was conducted across Embase, PubMed, CINAHL, and Cochrane databases (11th November 2024), using PRISMA 2020 guidelines. Studies were included if they involved children with oSDB and reported swallowing assessments. Exclusion criteria included non-English publications, patients with syndromic or craniofacial conditions, and studies lacking primary data. The risk of bias was assessed using ROBINS-I.

Results: Nine studies met the inclusion criteria. Reported prevalence of swallowing dysfunction ranged from 4% to 70%, with evidence of both oral-phase (e.g., atypical deglutition, reduced mastication) and pharyngeal-phase (e.g., choking, prolonged feeding) abnormalities. Outcome measures varied widely, with only two studies employing a validated swallowing tool. Three studies indicated that treatment of oSDB (adenotonsillectomy or myofunctional therapy) may improve swallowing symptoms. The quality of evidence was low, with most studies showing moderate to serious risk of bias.

Conclusion: There is limited, low-quality evidence suggestive that children with oSDB are at increased risk of swallowing dysfunction. However, heterogeneity in definitions, assessment tools, and study design limits the ability to draw firm conclusions. Episodes of severe swallowing-related complications such as fatal aspiration or choking are rare but clinicians should consider swallowing issues in these patients. Further research with standardised, objective assessments is required to understand better the relationship between SDB and swallowing in children. Early evidence indicates that treated oSDB may improve swallow-related symptoms, but more studies are required before official practice recommendations. Overall, this systematic review highlights a possible link between oSDB and swallowing dysfunction emphasising the need for further objective research to guide clinical care for these patients.

Objective: This study aimed to evaluate the effect of postoperative oral antihistamine (clemastine) use on the incidence of salivary fistula and sialocele in patients undergoing superficial parotidectomy.

Materials and methods: A retrospective analysis was conducted on 202 patients who underwent superficial parotidectomy for benign parotid tumours at the Department of Otolaryngology-Head and Neck Surgery, Necmettin Erbakan University, between 2020 and 2024. All patients were prescribed clemastine-containing antihistamines postoperatively; however, they were divided into two groups based on their access to and use of the medication. The development of salivary fistula and sialocele was assessed clinically. Data were analysed using Fisher's exact test, and p < 0.05 was considered statistically significant.

Results: Salivary fistula was observed in 5 of 164 patients (3.0%) in the antihistamine group and in 5 of 38 patients (13.2%) in the non-user group. This difference was statistically significant (p = 0.022). The incidence of sialocele was three (1.8%) in the antihistamine group and two (5.3%) in the non-user group, with no significant difference between the groups (p = 0.237). The most common side effects in patients receiving antihistamines were drowsiness (12.1%), accommodation disorders (9.1%) and other mild anticholinergic symptoms.

Conclusion: Oral antihistamine use following superficial parotidectomy may significantly reduce the incidence of salivary fistula. Most adverse effects were mild and tolerable. These findings suggest a potential benefit of antihistamines in the prevention of postoperative complications.

Objective: This study aimed to evaluate the efficacy of platelet-rich plasma (PRP), a biologic agent that facilitates tissue regeneration and wound healing, in improving postoperative outcomes of frontal sinus ostium (FSO) and need for postoperative intervention.

Materials and methods: A prospective, randomised controlled trial included chronic rhinosinusitis (CRS) patients undergoing bilateral endoscopic frontal sinus surgery. PRP-soaked absorbable hemostat was applied to the frontal sinus ostium on the randomised side, while a plain absorbable hemostat was used on the control side. Endoscopic evaluations were conducted intraoperatively (baseline), and at 30 and 90 days postoperatively to assess the FSO area, FSO patency, inflammatory visual analog scale (VAS) score, presence of polypoid edema, adhesion/scarring grade, and the need for postoperative interventions.

Results: Thirty participants were enrolled and PRP was applied to 30 frontal sinus ostia on randomised side. On 30-day post-ESS PRP significantly improved inflammatory VAS score (p = 0.041), reduced polypoid edema (odds ratio (OR) 0.49; 95% CI: 0.24, 0.98) and adhesion scarring (OR 0.33; 95% CI: 0.15, 0.74), and improved the need of postoperative intervention compared to the control (risk ratio (RR) 0.25; 95% CI: 0.11, 0.58). On 90-day post-ESS, PRP significantly reduced polypoid edema (OR 0.35; 95% CI: 0.17, 0.67), and adhesion scarring (OR 0.20; 95% CI 0.07, 0.52) compared to the control. The FSO area changes and patency grade were not significantly different between groups.

Conclusion: The PRP application following frontal sinusotomy improved the inflammatory VAS score, polypoid edema and adhesion scarring grades, and reduces the need for oral steroid intervention.

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.