Clinical Otolaryngology最新文献

Objective: The objective of this study is to characterise available clinical trial information for paediatric obstructive sleep apnea (OSA) and identify opportunities for future research to better treat children with this condition.

Methods: A cross-sectional analysis of paediatric OSA clinical trials was conducted using the International Clinical Trials Registry. Criteria for inclusion included sleep apnea trials with participants < 18 years old and an interventional design. We assessed the information available on the database to identify recent trends in research. We used PubMed to examine publication rate. NIH RePORTER was used to characterise funding patterns for trials conducted in the United States.

Results: Of 91 trials analysed, 54% of trials were conducted in the United States. The number of paediatric OSA clinical trials has been increasing since 2005. Patients aged 6, 7 and/or 8 were enrolled in 70% of trials, whereas infants under 12 months of age were only represented in approximately 9%. Overall, 31.9% had results reported directly on the registry, while 57% had results published. Median time to trial completion by sponsor for US trials was 3.04 years for NIH-sponsored trials, 1.29 years for industry-sponsored trials, and 1.96 years for non-funded sources. The NIH funded 56% of US trials.

Conclusion: Despite a growing interest in paediatric OSA, continued focus on reporting and publishing results in a timely manner is essential to further advance the care of children with OSA. Future research should aim to address the gaps in age representation and focus on early intervention to treat age groups with higher prevalence.

Objective: Evaluate the role of surgery as the sole treatment modality for patients with cervical head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

Design: Systematic review of observational cohort studies with qualitative synthesis.

Setting: PubMed, Ovid EMBASE, and Cochrane Controlled register of Trials (CENTRAL) were screened from January 2000 up to October 2021.

Participants: Patients with HNSCCUP after completing diagnostic workup subsequently treated with single-modality surgery.

Main outcome measures: The primary outcome was 3-year overall survival (OS). Secondary outcomes included disease-free survival (DFS), primary emergence, regional recurrence, and distant metastasis.

Results: Fourteen eligible studies were identified, including 1780 patients, of whom 294 received surgery as their sole treatment (seven studies) with 3-year OS ranging from 43.9% to 100%. 3-year DFS was reported in four studies (n = 62) ranging from 42.8% to 67.0%. 5-year OS and DFS were available in three studies (n = 31), ranging from 36.6% to 75.0%, and 43.6% to 67.0%, respectively. The rate of primary emergence ranged from 11.1% to 33.3% (seven studies, n = 157), regional relapse from 0.0% to 50.0% (five studies, n = 60) and distant metastasis from 0.0% to 3.3% (three studies, n = 45). Patients undergoing surgery as a sole treatment had predominantly p16/HPV positive N1 (TNM7) disease without ECS.

Conclusion: Outcomes for HNSCCUP patients undergoing surgery alone range widely in the literature but may be reasonable in a subset of patients with early-stage p16/HPV positive disease. Data is lacking for p16/HPV negative disease where the potential primary site is more varied and primary emergence appears more common.

Objectives: This descriptive epidemiological study aims to investigate trends in head and neck cancer (HNC) within the anatomical divisions of laryngeal, oropharyngeal, and oral cavity cancers over the past two decades.

Design: Retrospective population-based observational study.

Setting: Scotland, a constituent country of the United Kingdom, with a population of 5.5 million.

Participants: Newly diagnosed HNC patients in Scotland registered in the Scottish Cancer Registry from 2001 to 2020.

Main outcome measures: Trends in age-standardised incidence rates from 2001 to 2020 for each HNC subsite, anatomical division, and individual sociodemographic using joinpoint regression analysis and Poisson regression analysis.

Results: Overall, HNC incidence rates have remained stable, with an average annual percentage change (AAPC) of 0.29% (p = 0.34). However, oropharyngeal cancer showed a significant increase in incidence rates with an AAPC of 3.76% (p < 0.001); the tonsils (C09) and the base of the tongue (C01) experienced the greatest increases in AAPC of 4.63% (p = 0.001) and 4.79% (p < 0.001), respectively. Conversely, laryngeal cancer rates declined significantly, with an AAPC of -2.56% (p < 0.001). This decline was primarily influenced by annual reductions of -2.40% (p = 0.09) in cancers affecting the glottis (C32.0). Incidence rates for oral cavity cancer remained mostly stable, with an AAPC of -0.60% (p = 0.08).

Conclusion: This analysis highlights that behind a stable HNC incidence rate over the past 20 years, there are differential trends among various anatomical divisions with an overall increasing burden of oropharyngeal cancer and declining rates of laryngeal cancer.

Objectives: Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom.

Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT (PET-CT) within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients with no primary site on examination and no previous head and neck cancer were eligible.

Results: Data for 965 patients were received from 57 centres; 68.5% were HPV-related disease. Three investigation cycles were observed: ultrasound with biopsy, cross-sectional imaging (MRI and/or CT) and PET-CT, at median times of 17, 29.5 and 46 days from referral. No primary was identified on PET-CT in 49.8% (n = 478/960). Diagnostic tonsillectomy was performed in 58.2% (n = 278/478) and tongue base mucosectomy (TBM) in 21.7% (n = 104/479). Ipsilateral tonsillectomy carried the highest diagnostic yield (18.7%, n = 52/278), followed by TBM (15.4%, n = 16/104). Contralateral tonsillectomy, performed in 49.0% (n = 234/478), carried the lowest yield (0.9%, n = 2/234). PET-CT with concurrent MRI was associated with higher primary site detection than PET-CT with concurrent CT (p = 0.003). A minority of patients undergoing treatment with curative intent received first-definitive-treatment within 62 days of referral (15.2%, n = 77/505, median 92 days, IQR: 71-117).

Conclusions: Most patients experienced a protracted diagnostic pathway and waited over 3 months for definitive treatment. Earlier PET-CT with concurrent MRI may expedite diagnosis. TBM appears more productive than contralateral tonsillectomy for primary site detection.

Introduction: Artificial intelligence (AI) based chat robots are increasingly used by users for patient education about common diseases in the health field, as in every field. This study aims to evaluate and compare patient education materials on rhinosinusitis created by two frequently used chat robots, ChatGPT-4 and Google Gemini.

Method: One hundred nine questions taken from patient information websites were divided into 4 different categories: general knowledge, diagnosis, treatment, surgery and complications, then asked to chat robots. The answers given were evaluated by two different expert otolaryngologists, and on questions where the scores were different, a third, more experienced otolaryngologist finalised the evaluation. Questions were scored from 1 to 4: (1) comprehensive/correct, (2) incomplete/partially correct, (3) accurate and inaccurate data, potentially misleading and (4) completely inaccurate/irrelevant.

Results: In evaluating the answers given by ChatGPT-4, all answers in the Diagnosis category were evaluated as comprehensive/correct. In the evaluation of the answers given by Google Gemini, the answers evaluated as completely inaccurate/irrelevant in the treatment category were found to be statistically significantly higher, and the answers evaluated as incomplete/partially correct in the surgery and complications category were found to be statistically significantly higher. In the comparison between the two chat robots, in the treatment category, ChatGPT-4 had a higher correct evaluation rate than Google Gemini and was found to be statistically significant.

Conclusion: The answers given by ChatGPT-4 and Google Gemini chat robots regarding rhinosinusitis were evaluated as sufficient and informative.

Background: This study investigates the effect of locally applied honey on pain intensity, analgesia consumption, pain relief and nighttime awakenings in children following tonsillectomy, addressing conflicting evidence and the lack of differentiation between adult and paediatric populations in previous reviews.

Methods: A systematic search was conducted across multiple databases, including Cochrane Library, ClinicalTrials.gov, MEDLINE, Web of Science and Google Scholar. Randomised controlled trials (RCTs) comparing pain outcomes in children receiving honey in addition to standard treatments versus those receiving standard treatments alone were included. Pain intensity was measured with the VAS tool. Meta-analysis was performed using STATA version 14 software. Also, risk of bias and certainty of evidence were evaluated.

Results: Out of 537 articles, seven studies (n = 710) with RCT design met the inclusion criteria. The average duration for measuring pain intensity was 7.37 days. Pooled effect size showed a statistically significant reduction in pain intensity in the honey intervention group compared to the control group (WMD: -0.90, 95% CI [-1.32, -0.48], p < 0.001, I²: 92.5%; certainty of evidence: low). Also, the results demonstrated that honey significantly decreased the average time required for pain relief and analgesic consumption in the intervention group compared to the control group. One study was deemed low risk of bias, four studies were of intermediate quality and two studies were evaluated as high.

Conclusion: While honey shows promise in reducing post-tonsillectomy pain, cautious use is advised due to the limited quality of evidence. More robust RCTs are needed to address biases and reinforce confidence in the findings.

Objectives: A recent paper by Moore, Lowe and Cox has proposed guidelines for diagnosing noise-induced hearing loss (NIHL). It is referred to here as the MLC guidelines. Our aim was to assess the specificity of those guidelines (i.e., freedom from false-positive outcomes) and compare with pre-existing guidelines.

Design: We applied the MLC guidelines and pre-existing guidelines to three data sets composed of adults who do not have a history of material noise exposure and therefore cannot have NIHL.

Setting: National Health Service (NHS) ENT clinic.

Participants: Five hundred thirty-six patients with hearing difficulty and/or tinnitus who denied material noise exposure. Two large archival population studies of hearing were also assessed, which included 3250 participants without material noise exposure.

Main outcome measure: False-positive outcome from guidelines.

Results: The MLC guidelines demonstrated moderate or high false-positive rates overall, the magnitude depending on the noise exposure scenario and whether clinical or population samples were considered. For the procedure applicable to steady broadband noise exposure, the false-positive rate averaged 56% in the population samples, compared to 31% for previous guidelines. For exposure to intense impulse sounds, the MLC guidelines take a different approach and the false-positive rate was about 70% in the population samples and even higher in the clinic sample. For exposure to intense tones, the MLC guidelines take yet another approach and the false-positive rate reached 80%.

Conclusions: The MLC guidelines demonstrate poorer specificity than previous guidelines. Medical experts should be aware of their poor specificity and consequential likelihood of false-positive diagnoses of NIHL.