Clinical Otolaryngology最新文献

Background

In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well-differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low-risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines.

Methods

A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta-analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines.

Results

We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology.

Conclusions

Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre-ATA 2015 era.

Objectives

Although many studies have assessed the clinical features and the factors affecting treatment outcomes of Bell's palsy, few have analysed differences between men and women. This study therefore evaluated whether the clinical features and treatment results, and the factors affecting them, differ between men and women with Bell's palsy.

Methods

This retrospective study included 1708 patients (791 men and 917 women) who presented with facial palsy to the otolaryngology department between January 1986 and December 2022. Clinical features and treatment outcomes were compared in men and women diagnosed with Bell's palsy.

Results

Age distribution, side affected by facial palsy, House-Brackmann (HB) Grade, underlying disease such as diabetes and hypertension, electroneuronography (ENoG) results, electromyography (EMG) results, and treatment methods did not differ significantly between men and women with Bell's palsy (p > 0.05 each). Factors significantly associated with better prognosis in men included milder initial facial palsy and better electromyography (EMG) results (p < 0.05). Factors significantly associated with better prognosis in women included younger age, milder initial facial palsy, and better EMG results (p < 0.05). Women had significantly better prognosis than men when treated with steroids within 3 days of the onset of paralysis (p < 0.05).

Conclusion

Milder initial facial palsy and better EMG results were associated with better prognosis in both men and women with Bell's palsy. Younger age at onset and early stage treatment with steroids were associated with a higher recovery rate in women, but not in men.

Introduction

In Australia, older Aboriginal and Torres Strait Islander people have the highest prevalence of hearing loss, for which dedicated audiological services are available.

However, there is limited research on the experiences older Aboriginal and Torres Strait Islander people have with hearing loss and audiological services. Therefore, this study aimed to consolidate existing literature with a scoping review, specifically on the above to identify gaps and guide future research.

Method

Ten databases, including electronic journal databases and government databases, were systematically searched. Additional studies were sought from article reference lists, review articles, conference abstracts and Google Scholar. We identified 540 records and 22 of them met our inclusion criteria. Our inclusion criteria constituted research of any design on the experiences of older Aboriginal and Torres Strait Islander people (aged 45+ years) with hearing loss and audiological services.

Results

Seventeen studies reported on experiences with hearing loss, four studies reported on experiences with audiological services and one study reported on both experiences. Prevalence of hearing loss was estimated to be 20%–34% in older Aboriginal and Torres Strait Islander people; a discrepancy between self-reported and objective hearing difficulties was also identified. Audiological services currently available to older Aboriginal and Torres Strait Islander people were also underutilised.

Conclusions

Future research on older Aboriginal and Torres Strait Islander people is required to uncover: (1) the reasons for underreported hearing loss; (2) types of hearing loss experienced; (3) barriers to accessing audiological services; and (4) best hearing-loss management and rehabilitation practices.

Objective

Apparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients.

Design

Retrospective observational study.

Setting

Quaternary care referral centre.

Participants

A retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done.

Main Outcome Measure

Chi-square or Fisher's exact test was used to compare ADC values of bacterial and fungal SBO.

Results

The most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10⁻³ mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10⁻³ mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142).

Conclusion

This study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.

Objective

It is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low.

Methods

Retrospective case note review of children attending the nurse-led epistaxis clinic between 2019 and 2022.

Results

Nine hundred and twenty children were seen in the nurse-led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery.

Conclusion

To the author's knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service.

Objectives

We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM).

Study Design

It was a prospective randomised comparative study.

Settings

It was held in tertiary referral institutions between May 2020 and April 2022.

Participants

We included 100 patients with a large-sized eardrum perforation (50%–75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients.

Main Outcome Measures

We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation.

Results

Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference.

Conclusions

Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.

Introduction

Observational studies have shown a bidirectional association between gastroesophageal reflux (GER) and chronic rhinosinusitis (CRS) or chronic rhinitis (CR), but it is not clear whether this association is causal.

Objectives

This study was to investigate the causality between GER and CRS or CR using bidirectional two-sample Mendelian randomization (MR) analysis.

Methods

Using pooled data from large genome-wide association studies (GWAS), genetic loci independently associated with GER, CRS and CR in populations of European and American ancestry were selected as instrumental variables (IVs). The inverse variance weighted (IVW) method was used to analyse the random effects model of MR, and the odds ratio (OR) was used as the evaluation index to explore the bidirectional causality between GER and CRS or CR. Single nucleotide polymorphism (SNP) outliers were detected using MR-pleiotropy Residual Sum and Outliers (MR-PRESSO). The MR–Egger intercept test examined the horizontal pleiotropy of SNPs. The “leave-one-out” sensitivity analysis examined whether MR results were affected by a single SNP.

Results

The main results of IVW showed that GER increased the risk of CRS (OR = 1.3795, 95% CI = 1.188–1.603, p < 0.0500) and CR (OR = 1.3941, 95% CI = 1.1671–1.6652, p < 0.0500). The obtained SNPs as IVs for GER, CRS and CR had no significant horizontal pleiotropy, heterogeneity or bias. Regarding the reverse directions, no notable associations could be found.

Conclusion

This MR analysis revealed that genetically predicted GER had a causal effect on an increased risk of CRS or CR, but not vice versa. These results have great implications for the management of CRS (especially for refractory CRS) or CR in clinical practice.