Clinical Otolaryngology最新文献

Introduction: House dust mite (HDM) allergy significantly impacts quality of life. Allergen immunotherapy (AIT), specifically sublingual immunotherapy (SLIT), is an effective treatment for HDM allergy, but adherence to SLIT remains a challenge. This study aimed to evaluate the impact of adherence to SLIT on the use of allergy medications, including antihistamines, nasal corticosteroids, and inhaled corticosteroids (ICS) in a real-world setting.

Methods: We conducted a nationwide cohort study using data from Denmark's comprehensive registries. Patients who initiated HDM SLIT between 2015 and 2020 were included, with follow-up through 2022. Adherent patients, defined as those obtaining at least 80% of the prescribed Defined Daily Dose (DDD) of SLIT, were compared to non-adherent patients. Medication use was tracked for antihistamines, nasal corticosteroids, and ICS. Statistical analyses, including Probit and generalised linear models, assessed the likelihood of obtaining medications and the quantity dispensed, adjusted for age and sex.

Results: Of 950 patients, 456 (48%) were classified as adherent. Adherent patients showed significantly reduced usage of antihistamines (p < 0.001) and nasal corticosteroids (p < 0.001) compared to non-adherent patients. No significant differences were found in ICS use or dosage. Additionally, adherent patients were more likely to have higher education levels and be married or cohabiting.

Conclusion: Adherence to SLIT for HDM allergy is associated with reduced use of antihistamines and nasal corticosteroids. These findings emphasise the importance of SLIT adherence in managing HDM allergy and suggest that improving adherence could further reduce medication usage, improving patient outcomes in real-world settings.

Introduction: Frontal beak reduction is a critical and challenging step in endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Traditional high-speed drills can risk thermal injury and soft tissue trauma, whereas piezoelectric surgery uses ultrasonic vibrations for selective bone cutting and may improve surgical precision. This study compared piezoelectric devices with conventional drills for frontal beaks reduction.

Methods: A double-blind exploratory study with randomisation was conducted during the years 2019-2022. Adult CRS patients (n = 43) with prominent nasofrontal beak undergoing ESS were randomised to piezoelectric knife (n = 22) or high-speed drill (n = 21). Exclusion criteria included prior sinus surgery, septoplasty, neoplasms or systemic contraindications. Outcomes included Lund-Kennedy, Lund-Mackay, Sino-Nasal Outcomes Test (SNOT-22), Visual Analogue Scale (VAS) scores and frontal sinus ostium dilatation, measured pre-operatively and at 1, 4 and 24 weeks post-operatively.

Results: Both groups showed significant post-operative improvements in Lund-Mackay and SNOT-22 scores (p < 0.05). At 1 week, the piezo group had significantly lower Lund-Kennedy scores (p = 0.022), suggesting better mucosal healing. Correlations in the piezo group were observed between ostium dilatation and improved Lund-Mackay (R = -0.527; p = 0.008) and SNOT-22 (R = -0.405; p = 0.049) at 24 weeks. No significant differences were found in ostium width gain, VAS scores or complications. With piezo devices, the median time of surgery was increased.

Conclusion: Piezoelectric surgery is a safe, effective alternative to drills for frontal beak reduction in ESS, with potential benefits for early mucosal healing. Further studies are warranted to confirm long-term advantages.

Objectives: To evaluate the viability of different anatomical targets within the olfactory system for electrical stimulation by an olfactory implant aimed at restoring smell.

Design: Narrative review of research relevant to olfactory implant development, with emphasis on stimulation feasibility and elicitation of olfactory percepts.

Main outcome measures: Surgical accessibility, functional specificity, interindividual structural variability and olfactory perception responses to electrical stimulation across different sites within the olfactory system.

Results: The olfactory epithelium is the most surgically accessible target but is limited by factors including age-related degeneration and interindividual variability. The olfactory bulb, a major site of convergence in olfactory processing, has shown spatially specific percepts in animal models and reproducible percepts in early human studies. Recent studies have explored multiple surgical approaches varying in invasiveness and safety. Stimulation of structures in the central olfactory system, such as the piriform complex and orbitofrontal cortex, has produced occasional and non-specific olfactory or chemosensory percepts in epilepsy monitoring and deep brain stimulation. Non-invasive and extracranial stimulation strategies remain experimental with minimal validation in living humans.

Conclusion: Current evidence suggests that the olfactory bulb is the best-suited target for future olfactory implant development. Its role in early olfactory processing, emerging surgical approaches, and early human feasibility make it the most viable candidate for restoring olfactory percepts.

Objectives: There are limited data on the incidence of postoperative fever in children undergoing tonsillectomy and whether the surgical technique has an influence on it. This study aimed to examine the association between surgical technique-cold adenotonsillectomy versus powered intracapsular tonsillectomy and adenoidectomy(PITA)-and the incidence of postoperative fever in children.

Design: Prospective cohort study conducted between June 1, 2023, and November 30, 2024.

Setting: Tertiary referral center.

Participants: Children who underwent tonsillectomy with or without adenoidectomy.

Main outcome measures: The primary outcome was the incidence of high postoperative fever (> 37.9°C/100.2°F) within 1-week postoperatively. Secondary outcomes included haemorrhage rates, pain levels, days to normal diet, halitosis, referral to treating physician, and readmissions within 1-week postoperatively.

Results: Of the 82 children (46[56%] males, mean age:5.1 years interquartile range: [3-5]), 40(48.8%) underwent cold adenotonsillectomy, while the other 42(51.2%) underwent PITA (22 with coblation and 20 with microdebrider). One-week postoperative fever rate was 24.4%. Compared to cold adenotonsillectomy, PITA was associated with higher rates of fever 1-week postoperatively (odds ratio: 4.81, 95% confidence interval:1.29-22.02) and referrals to treating physician (15/42[35.7%] vs. 6/40[15%], p = 0.023). However, PITA showed lower pain levels (mean 1-week daily visual analogue scale: 3.4 ± 0.05 vs. 4.13 ± 0.82, p = 0.001) and shorter time to resuming a normal diet (mean 3.4 ± 0.77 vs. 4.07 ± 0.69 days, p = 0.001). No significant differences were observed in haemorrhage, readmission, or halitosis rates between the different surgical techniques.

Conclusions: PITA was associated with higher rates of fever 1-week postoperatively. Parents should be informed about the possibility of fever and educated on how to manage it.

Introduction: Recurrent paediatric epistaxis is a common condition that is often distressing for children and their caregivers. Although treatments such as Naseptin or silver nitrate cautery are widely used, a recurrence of epistaxis after an initial symptom-free period is frequent. Yet, there is a lack of robust, long-term studies comparing treatment modalities and sustained success rates. This study aims to address that gap by evaluating long-term outcomes in a previously established paediatric cohort.

Methods: We performed a follow-up analysis of a 2020 cohort at a tertiary paediatric otolaryngology centre. Patients were contacted by letter and SMS to schedule a telephone appointment. Anonymised data, including age, sex, healthcare attendances, interventions and epistaxis frequency, were collected using a standardised proforma. Statistical analysis was performed using R Statistical Software (v4.5.1; R Core Team 2025).

Results: Two hundred and ten patients were scheduled for a telephone appointment and 145 (69.0%) were successfully contacted. Mean age was 13.08 years, with 125 males and 85 females. Median follow-up was 48 months. Among the 75 patients (51.7%) who reported persistent epistaxis, 65.3% (n = 49) had not sought any further medical care. Persistent epistaxis was reported in 44.1% (n = 30) of patients treated with Naseptin alone, compared to 57.6% (n = 30) of those who also received silver nitrate cautery. There was no significant difference in the rate of recurrence between Naseptin and added cautery.

Conclusion: Persistent epistaxis was common, with no significant difference between treatment with Naseptin alone and those who also received silver nitrate cautery. Patient/parent education is essential to explain the aetiology of recurrent paediatric epistaxis, its natural history and appropriate first aid.