Clinical Otolaryngology最新文献_第4页

Influence of Multiple Prior Endoscopic Sinus Surgeries on Dupilumab Efficacy Including Smell Function in the DUPIREAL Population 既往多次鼻窦内镜手术对DUPIREAL人群Dupilumab疗效包括嗅觉功能的影响

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-11-19 DOI: 10.1111/coa.70060

Eugenio De Corso, Claudio Montuori, Elena Cantone, Giorgia Carlotta Pipolo, Daniela Lucidi, Ernesto Pasquini, Ignazio La Mantia, Rodolfo Francesco Mastrapasqua, Gabriele De Maio, Gian Luca Fadda, Giancarlo Ottaviano, Cecilia Rosso, Matteo Alicandri-Ciufelli, Veronica Seccia, Angelo Ghidini, Russo Paolo, Giulia Dané, Fabio Pagella, Fabio Sovardi, Marco Corbo, Serena Pisciottano, Leandro Maria D'Auria, Francesco Bussu, Jacopo Galli, Dupireal Italian Study Group

Introduction

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that significantly reduces the quality of life due to nasal obstruction, loss of smell and rhinorrhea. Although endoscopic sinus surgery offers relief of symptoms and improvement of quality of life, recurrences are common and multiple surgeries are often required. The aim of this post hoc analysis is to verify the hypothesis that previous multiple surgeries may be associated with poor outcomes with dupilumab in a real-life setting in terms of quality of life, reduction in nasal polyps and improvement of olfaction.

Methods

This is a post hoc analysis of the Phase IV real-life multicentre DUPIREAL study in patients with severe uncontrolled CRSwNP treated with dupilumab 300 mg every 2 weeks for 12 months. Inclusion criteria included adherence to treatment and olfactory evaluation measured by Sniffin' Sticks Identification Test 16 (SSIT-16). Statistical analyses included multivariate regression, evaluating correlations between baseline factors and poor outcomes in terms of NPS ≥ 4, SNOT-22 ≥ 30 and SSIT-16 ≤ 12.

Results

Higher NPS at baseline was associated with an increased risk of NPS > 4 at 12 months, whereas a higher number of previous surgeries is associated with a higher probability of lower NPS. Notably, a greater number of previous surgeries was independently associated with incomplete recovery of smell, and surgery-naïve patients had a higher likelihood of achieving complete olfactory recovery. Dupilumab treatment led to a remarkable improvement in olfactory function, with anosmia rates decreasing from 60.2% to 3.3% after 1 year, although in our series, nearly half of the patients still exhibited residual olfactory impairment.

Conclusions

This post hoc analysis highlights the efficacy of dupilumab for the treatment of CRSwNP in real life. Multivariate analysis revealed that multiple prior surgeries negatively impact outcomes with dupilumab during the first year of treatment, especially in terms of olfactory recovery.

慢性鼻窦炎伴鼻息肉（CRSwNP）是一种持续性炎症，由于鼻塞、嗅觉丧失和鼻漏而显著降低生活质量。虽然内窥镜鼻窦手术可以缓解症状和改善生活质量，但复发是常见的，经常需要多次手术。本事后分析的目的是验证先前多次手术可能与杜匹单抗在生活质量、鼻息肉减少和嗅觉改善方面的不良结果相关的假设。方法：这是一项IV期现实多中心DUPIREAL研究的后期分析，该研究在每2周使用dupilumab 300 mg治疗12个月的严重不受控制的CRSwNP患者中进行。纳入标准包括治疗依从性和嗅探棒识别测试16 （SSIT-16）测量的嗅觉评估。统计分析采用多变量回归，以NPS≥4、ssit -22≥30、SSIT-16≤12为标准，评价基线因素与不良结局的相关性。结果：基线时较高的NPS与12个月时NPS bb0 4的风险增加相关，而先前手术次数较多则与较低NPS的可能性较高相关。值得注意的是，更多的先前手术与嗅觉不完全恢复独立相关，surgery-naïve患者实现嗅觉完全恢复的可能性更高。Dupilumab治疗导致嗅觉功能的显著改善，嗅觉缺失率在1年后从60.2%下降到3.3%，尽管在我们的研究中，近一半的患者仍然表现出残留的嗅觉障碍。结论：这一事后分析强调了杜匹单抗在现实生活中治疗CRSwNP的有效性。多变量分析显示，在治疗的第一年，多次手术会对dupilumab的治疗结果产生负面影响，特别是在嗅觉恢复方面。

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引用次数: 0

Polidocanol Sclerotherapy in Hereditary Hemorrhagic Telangiectasia Patients Does Not Seem to Decrease Epistaxis-Related Outpatient and Emergency Visits—A Retrospective View Polidocanol硬化治疗遗传性出血性毛细血管扩张患者似乎不会减少出血相关的门诊和急诊就诊：回顾性分析

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-11-12 DOI: 10.1111/coa.70059

Elsa-Leea Kotola, Johanna Wikstén, Eeva Castrén

<p>Hereditary hemorrhagic telangiectasia (HHT) is a rare inherited disease characterised by the presence of telangiectasia in the nasal and gastric mucosa and arteriovenous malformations (AVM) in the lungs, brain, and liver [<span>1</span>]. All known gene defects underlying the disease are related to the endothelial transforming growth factor beta family. These mutations in HHT patients lead to unregulated vessel wall regeneration in mucous membranes and internal organs leading to activation of angiogenesis. This results in dilated and tortuous postcapillary veins that eventually join the dilated arteries via capillaries. Subsequently, the capillary segments disappear and direct arteriovenous connections are formed [<span>2, 3</span>].</p><p>The diagnosis of HHT is based on the Curaco criteria, which include recurrent epistaxis, telangiectasias of the skin and mucosa, visceral AVMs and a positive family history for HHT [<span>4</span>]. Troublesome epistaxis is the most common symptom of HHT impairing the most the patients' quality of life. The nosebleeds are caused by ruptured intranasal telangiectasia, which can lead to frequent emergency room visits, hospital stays, anaemia and blood transfusions. Symptoms often aggravate with age [<span>5</span>].</p><p>Different treatments have been applied to control HHT-related epistaxis and to improve the patients' quality of life. No curative treatment for HHT exists. The options to control epistaxis are topical agents, systemic medical treatment or locally invasive procedures on the nasal mucosa. Traditional procedures include cauterization, laser, septodermoplasty, or even nasal closure. Arterial embolization has also been used [<span>6</span>]. More invasive procedures require an operating room (OR), as do severe bleedings, which may unfortunately occur outside of office hours.</p><p>Currently, sclerotherapy has shown promising results to control epistaxis in HHT patients [<span>7, 8</span>]. Polidocanol, also known as lauromacrogol 400 or aethoxysklerol is the most used sclerosing agent. Polidocanol is stable at room temperature and can be applied under local anaesthesia [<span>8</span>]. This treatment technique to control epistaxis in HHT patients was first reported by Ramírez et al. in 2000 [<span>9</span>], followed by a larger study by Morais et al. in 2012 [<span>8</span>]. Polidocanol sclerotherapy has been shown to relieve the frequency and severity of epistaxis, reduce anaemia and blood transfusions, and improve the quality of life. Serious sclerotherapy complications, such as unilateral blindness are extremely rare [<span>7, 8</span>].</p><p>However, the impact of sclerotherapy for HHT patients on the number of hospital visits is not known. Our objective was to study whether polidocanol sclerotherapy influences the number of epistaxis-related emergency room and outpatient visits, and on the need for emergency OR procedures.</p><p>We conducted a database search from our institution's electr

遗传性出血性毛细血管扩张症（HHT）是一种罕见的遗传性疾病，其特征是鼻和胃粘膜毛细血管扩张以及肺、脑和肝脏的动静脉畸形（AVM）。所有已知的潜在疾病的基因缺陷都与内皮转化生长因子β家族有关。HHT患者的这些突变导致粘膜和内脏的血管壁再生不受调节，从而激活血管生成。这导致扩张和弯曲的毛细血管后静脉最终通过毛细血管加入扩张的动脉。随后，毛细血管段消失，形成直接动静脉连接[2,3]。HHT的诊断基于Curaco标准，包括复发性鼻出血、皮肤和粘膜毛细血管扩张、内脏AVMs和HHT[4]阳性家族史。头痛性鼻出血是HHT最常见的症状，严重影响患者的生活质量。流鼻血是由鼻内毛细血管扩张破裂引起的，这可能导致频繁的急诊室就诊、住院、贫血和输血。症状常随年龄增长而加重。不同的治疗方法已被应用于控制hht相关的鼻出血和改善患者的生活质量。目前尚无治疗HHT的有效方法。控制鼻出血的选择是局部用药，全身药物治疗或局部侵入性鼻黏膜手术。传统的治疗方法包括烧灼、激光、鼻中隔皮成形术，甚至是鼻塞。动脉栓塞也已被采用。更多的侵入性手术需要手术室（OR），严重的出血也需要手术室（OR），不幸的是，出血可能在办公时间之外发生。目前，硬化疗法在控制HHT患者鼻出血方面显示出良好的效果[7,8]。聚烷醇，又称月桂醇400或乙氧基醇，是最常用的硬化剂。poly - canol在室温下是稳定的，可以在局部麻醉下使用。这种控制HHT患者鼻出血的治疗技术最早由Ramírez等人于2000年报道，随后由Morais等人于2012年进行了更大规模的研究。Polidocanol硬化疗法已被证明可以减轻鼻出血的频率和严重程度，减少贫血和输血，并提高生活质量。严重的硬化治疗并发症，如单侧失明极为罕见[7,8]。然而，HHT患者硬化治疗对医院就诊次数的影响尚不清楚。我们的目的是研究多元醇硬化疗法是否会影响与鼻出血相关的急诊室和门诊就诊数量，以及是否需要急诊或手术。我们使用ICD-10 HHT代码（I78.0）从我院的电子患者登记处进行了数据库检索，并利用我院2003年至2021年的罕见病登记处，以确定我们集水区的所有HHT患者。收集了人口统计和html相关数据。我们选择了那些在我们耳鼻喉科接受了poly - canol硬化治疗的HHT患者，并在硬化治疗开始前和开始后的一年进行了至少3年的随访。对于这些患者，我们登记了所有急诊、门诊和手术室就诊以及控制鼻出血的所有程序。由于回顾性研究设置，生活质量或鼻出血严重程度评分（ESS）数据不充分。使用SPSS社会科学统计软件包28.0版本对数据进行分析。研究方案已被当地伦理委员会接受。我们的研究队列共包括145名HHT患者；根据图1所示的纳入标准，116例被排除在研究之外。因资料不足而排除的患者主要在本院区外治疗。最后，该研究纳入了29名患者。所选患者的人口学和hht相关信息见表1。平均年龄65岁（28 ~ 90岁）。每年平均有30次注射就诊。患者平均接受7.45次硬化治疗（范围1-35次）。在研究期间，poly - canol硬化治疗的总次数为216次。治疗HHT患者鼻出血的要求很高，对最佳方法没有明确的共识。在这里，我们首次研究了聚多卡因硬化治疗对HHT患者鼻出血相关就诊的影响。我们的研究并没有证明在开始polidocanol硬化治疗前后急诊科访问量、门诊访问量或不同程序的数量有显著变化。然而，目前的国际HHT指南以及先前的研究和临床经验都支持在保守方法不足的情况下使用消融疗法（如硬化疗法）来治疗HHT相关的鼻出血。多元醇硬化治疗的优点是局部麻醉下可用于门诊，耐受性好。Polidocanol硬化治疗被认为是经济有效的，因为通常不需要手术室或全身麻醉。先前的研究表明，聚多卡因可降低HHT患者鼻出血的频率和严重程度，并改善其生活质量。Morais等首次对聚多坎醇硬化疗法治疗hht相关性鼻出血进行了重大研究，在45例患者中，95%的患者鼻出血频率和严重程度降低，且无明显的副作用[8]。在Marcos等人的研究中，多元醇硬化疗法显著降低了ESS[7]评估的流鼻血的频率和严重程度。这两项研究也证明了生活质量的改善。最近的一项系统综述显示，硬化疗法治疗hht相关鼻衄的疗效积极但数据有限。所有的研究都报告了鼻出血的改善，但缺乏统一的报告措施，因此无法进行分析。然而，这些研究没有报告对急诊就诊的影响。这是第一个研究poly - canol硬化治疗对HHT患者鼻出血相关急诊就诊影响的研究。这些访问和紧急OR程序会给我们的医疗保健系统带来很大的压力，因此这是评估治疗效果的一个重要因素。总的来说，我们的研究中急诊科的访问量和门诊的访问量有所增加，但结果都没有统计学意义。因此，先前研究中显示的鼻出血严重程度和频率的降低并没有在我们的结果中得到清楚的反映。然而，我们的临床观察是，许多HHT患者倾向于与流鼻血作斗争而不寻求医疗帮助。在开始硬化治疗和持续的护理关系后，HHT患者在急性鼻出血时也可能更容易寻求帮助。此外，hht相关的鼻出血随着年龄的增长而加剧，这可能会影响我们的结果。我们还发现，在紧急情况下，双极烧灼主要用于控制鼻出血。然而，HHT患者应避免使用，因为它可以刺激新的毛细血管扩张的形成。这一发现呼吁急诊科医生在治疗与hht相关的鼻出血时提高认识。我们的研究有一些局限性。首先，我们的患者数量相对较少，由于随访资料不足，许多HHT患者被排除在外。其次，由于技术原因，我们无法获得HHT队列中与鼻出血相关的初级卫生保健急诊访问。由于回顾性研究设置，没有足够的ESS数据，尽管这样的评估有利于更全面地评估治疗结果。根据我们的临床经验，HHT患者对polidocanol硬化治疗普遍满意。在未来的研究中，标准化的工具，如ESS和生活质量问卷将有助于分析治疗效果。为了确定多元醇硬化治疗对鼻出血相关急诊科就诊的影响，需要更大规模的研究和更长时间的随访。在紧急情况下，与hht相关的鼻出血总是需要治疗的，因此找到最好的方法来预防这些紧急情况至关重要。E.C.设计了作品；e.l.k., j.w.， E.C.获取和分析数据；e.l.k、j.w.、E.C.起草、修改、审定稿件；e.l.k., j.w.， E.C.同意对工作的各个方面负责。这项回顾性研究得到了赫尔辛基大学医院伦理委员会的批准。由于该研究使用了来自现有医疗记录的匿名数据，因此不需要知情同意。删除了所有个人标识符，以保持参与者的机密性，并根据机构数据保护协议安全地存储数据。这项研究遵循了《赫尔辛基宣言》所规定的伦理准则。该研究对参与者的风险最小，因为数据是为临床目的收集的，并且所有的努力都是为了保护隐私和保密。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。本文的同行评审历史可在https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/coa.70059上获得。

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引用次数: 0

Modifiable Risk Factors for Symptom Burden in Chronic Rhinosinusitis With Nasal Polyps: The Role of Obesity and Sleep Apnoea 慢性鼻窦炎伴鼻息肉症状负担的可改变危险因素：肥胖和睡眠呼吸暂停的作用。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-11-05 DOI: 10.1111/coa.70058

Javier Modesto García-Fernández, María Soledad Sánchez-Torices, María Pilar Gómez-Gallego, Miguel Ángel Feliz-Fernández, María Alharilla Montilla-Ibáñez, Rafael Lomas-Vega

Objective

To identify sociodemographic and clinical predictors of symptom severity and quality of life (QoL) impairment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), diagnosed according to the latest EPOS 2020 criteria.

Study Design

Cross-sectional analytical study.

Setting

Tertiary Care Center (University Hospital of Jaén, Spain).

Methods

A total of 188 patients diagnosed with CRSwNP were evaluated. Symptom severity and QoL were assessed using the Nasal Obstruction Symptom Evaluation (NOSE-E) and the Sino-Nasal Outcome Test (SNOT-22). Multiple linear regression analysis was used to identify predictors of symptom burden.

Results

Higher body mass index (BMI) and the presence of sleep apnoea were independently associated with increased symptom severity, as measured by both the NOSE-E (adj. R ² = 0.224, p = 0.002) and the SNOT-22 (adj. R ² = 0.242, p = 0.005). Smoking was associated in the bivariate analysis but was not retained in the multivariate models.

Conclusion

BMI and sleep apnoea are independent predictors of greater symptom burden and poorer QoL in CRSwNP. These findings highlight the importance of incorporating weight management and sleep apnoea screening into the multidisciplinary management of CRSwNP to improve patient outcomes.

目的：确定慢性鼻窦炎合并鼻息肉（CRSwNP）患者的症状严重程度和生活质量（QoL）损害的社会人口学和临床预测因素，根据最新的EPOS 2020标准诊断。研究设计：横断面分析研究。地点：三级保健中心（西班牙贾文森大学医院）。方法：对188例诊断为CRSwNP的患者进行评估。采用鼻塞症状评估（NOSE-E）和鼻-鼻结局测试（SNOT-22）评估症状严重程度和生活质量。采用多元线性回归分析确定症状负担的预测因素。结果：较高的身体质量指数（BMI）和睡眠呼吸暂停的存在与症状严重程度的增加独立相关，通过NOSE-E （adj. R2 = 0.224, p = 0.002）和SNOT-22 （adj. R2 = 0.242, p = 0.005）测量。吸烟在双变量分析中是相关的，但在多变量模型中没有保留。结论：BMI和睡眠呼吸暂停是CRSwNP患者症状负担加重和生活质量下降的独立预测因素。这些发现强调了将体重管理和睡眠呼吸暂停筛查纳入CRSwNP多学科管理以改善患者预后的重要性。

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引用次数: 0

Role of Xylitol Nasal Irrigation in the Management of Chronic Sinusitis: A Systematic Review and Meta-Analysis 木糖醇鼻腔冲洗在慢性鼻窦炎治疗中的作用：系统综述和荟萃分析。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-11-04 DOI: 10.1111/coa.70057

Yun Jin Kang, Gulnaz Stybayeva, Se Hwan Hwang

Objectives

Xylitol, a low-permeability sugar alcohol, is recommended for treating chronic rhinosinusitis (CRS) due to its ability to decrease liquid salt concentration at the airway surface. This study investigated the efficacy of xylitol nasal irrigation for the management of CRS and its postoperative care.

Methods

We analysed 7 studies with 263 participants after reviewing the studies that were retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to December 2024. Those comparing changes in endoscopic score, Sinonasal Outcome Test (SNOT), Nasal Obstruction Symptom Evaluation (NOSE), olfactory dysfunction, and CRS-related visual analogue scale from baseline to post-treatment between xylitol and normal saline nasal irrigation groups were analysed.

Results

Nasal irrigation with xylitol significantly improved sinonasal well-being in CRS patients compared to irrigation with saline (SMD 0.6253, 95% CI [0.0067; 1.2438]; I² = 0.0%). Patients who underwent endoscopic sinus surgery showed substantial SNOT improvement (SMD 3.1284, 95% CI [0.5229; 5.7338]; I² = 86.1%), while no significant changes were observed in non-ESS patients (SMD 0.2571, 95% CI [−0.4872; 1.0014]). The xylitol group also showed significant improvements in NOSE (SMD 0.5976, 95% CI [0.2297; 0.9656]; I² = 49.3%) and SNOT scores (SMD 0.3608, 95% CI [0.0724; 0.6493]; I² = 49.1%). However, there were no significant changes in endoscopic scoring (SMD 0.1309, 95% CI [−0.1777; 0.4396]; I² = 0.0%), olfaction (SMD −0.0292, 95% CI [−0.3633; 0.3050]; I² = 0.0%), or saccharine clearance time (SMD 0.3816, 95% CI [−0.3816; 1.1449]; I² = 61.6%). Xylitol irrigation was well tolerated, with minimal, transient side effects and no significant adverse events.

Conclusion

Nasal irrigation with xylitol significantly improves the subjective management of CRS and postoperative care compared to saline irrigation but does not alter objective outcomes.

目的：木糖醇是一种低渗透性糖醇，因其能够降低气道表面液盐浓度而被推荐用于治疗慢性鼻窦炎。本研究探讨木糖醇鼻腔冲洗治疗CRS的疗效及术后护理。方法：在回顾了PubMed， SCOPUS, Embase， Web of Science和Cochrane数据库中截至2024年12月的研究后，我们分析了7项研究，共263名参与者。比较木糖醇组和生理盐水组从治疗前到治疗后内窥镜评分、鼻窦结局测试（SNOT）、鼻塞症状评估（NOSE）、嗅觉功能障碍和crs相关视觉模拟量表的变化。结果：与生理盐水冲洗相比，木糖醇鼻冲洗可显著改善CRS患者的鼻腔健康（SMD = 0.6253, 95% CI [0.0067; 1.2438]; I2 = 0.0%）。接受鼻窦内窥镜手术的患者鼻窦功能明显改善（SMD为3.1284,95% CI [0.5229; 5.7338]; I2 = 86.1%），而非ess患者鼻窦功能无明显变化（SMD为0.2571,95% CI[-0.4872; 1.0014]）。木糖醇组鼻鼻部（SMD = 0.5976, 95% CI [0.2297; 0.9656], I2 = 49.3%）和鼻鼻部（SMD = 0.3608, 95% CI [0.0724; 0.6493], I2 = 49.1%）评分也有显著改善。然而，内镜评分（SMD 0.1309, 95% CI [-0.1777; 0.4396]; I2 = 0.0%）、嗅觉（SMD -0.0292, 95% CI [-0.3633; 0.3050]; I2 = 0.0%）或糖精清除时间（SMD 0.3816, 95% CI [-0.3816; 1.1449]; I2 = 61.6%）均无显著变化。木糖醇灌洗耐受性良好，有最小的，短暂的副作用，没有显著的不良事件。结论：与生理盐水冲洗相比，木糖醇鼻冲洗可显著改善CRS的主观管理和术后护理，但不改变客观结果。

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引用次数: 0

Long-Term Outcomes of Orthonasal, Retronasal Olfactory and Gustatory Functions in Patients Undergoing Surgery for Obstructive Sleep Apnea Syndrome 阻塞性睡眠呼吸暂停综合征手术患者的鼻、后鼻嗅觉和味觉功能的长期预后。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-11-02 DOI: 10.1111/coa.70055

İrem Damla Güver Çalapkulu, Zehra Betul Paksoy, İbrahim Sevim, Süleyman Boynueğri

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.

目的：本研究旨在评价上呼吸道手术对阻塞性睡眠呼吸暂停综合征（OSAS）患者嗅觉（正鼻和后鼻）和味觉功能的长期影响。比较手术治疗患者和未接受手术或气道正压（PAP）治疗的新诊断OSAS患者的感觉结果。此外，还分析了手术技术对研究参数的影响。材料与方法：本前瞻性研究纳入49例18-75岁的OSAS患者，分为手术组（n = 25）和对照组（n = 24）。手术组在1年前至少接受过以下手术之一：前腭成形术、扩张括约肌咽成形术、侧咽成形术、舌底消融或会音固定术。使用康涅狄格化学感觉临床研究中心（CCCRC）测试评估正交鼻嗅觉；使用经过验证的20项粉末测试进行后鼻嗅觉；还有味觉功能，有甜、咸、酸、苦的味觉条。结果：手术组与对照组在年龄、呼吸暂停低通气指数（AHI）、后鼻嗅觉评分、正鼻阈值、鉴别、CCCRC平均评分、味觉评分方面差异均无统计学意义（p分别为0.218、0.912、0.464、0.111、0.952、0.423、0.738）。相比之下，后鼻和平均CCCRC评分之间存在显著的相关性（Spearman’s r = 0.653, p）。结论：上呼吸道手术对OSAS患者的长期嗅觉或味觉功能没有不良影响。正鼻和后鼻评分之间的高度相关性支持它们在感觉评估中的联合使用。这些发现表明手术对于嗅觉和味觉感知是安全的。

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引用次数: 0

Vocal Fold Paralysis in Paediatric Patients With Arnold-Chiari Malformations: A Systematic Review and Meta-Analysis 小儿Arnold-Chiari畸形患者声带麻痹：系统回顾和荟萃分析。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-10-30 DOI: 10.1111/coa.70054

Jad Hosri, Vanessa Helou, Jonathan Abou Chaar, Zahi Hamdan, Randa Barazi

Objective

To highlight risk factors affecting outcomes of vocal fold paralysis (VFP) in patients with Arnold-Chiari malformations (ACM).

Methods

A systematic review was conducted according to the 2020 PRISMA checklist. The authors comprehensively searched multiple databases from inception till August 2023 for both keywords and medical subject headings pertinent to ACM and VFP. Data from 33 studies was obtained by applying predetermined inclusion and exclusion criteria and quality assessment of the chosen articles. Meta-analysis using Chi-squared test and binary logistic regression was performed to determine the association between age and other variables.

Results

The 33 studies included a total of 165 patients with a mean age of 15.31 months. The predominant type of Chiari malformation was type 2, observed in 120 cases. Bilateral vocal fold paralysis was confirmed in 103 patients while 12 patients had unilateral disease. The most common treatment modality was ventriculoperitoneal shunt placement in 108 patients (65.45%), followed by posterior fossa decompression surgery in 86 patients (52.12%). Regarding airway status, most patients were not intubated (65.45%); however more than one third of patients underwent tracheostomy (38.79%) following VFP. There was a significant association between the age of VFP onset and both recovery and survival in both the overall cohort and the ACM II cohort.

Conclusion

Age at onset of VFP is a critical factor associated with both recovery and survival rates in paediatric patients, with younger ages linked to incomplete symptom resolution and worse survival.

目的：探讨影响Arnold-Chiari畸形（ACM）患者声带麻痹（VFP）预后的危险因素。方法：根据2020年PRISMA检查表进行系统评价。作者综合检索了从成立到2023年8月的多个数据库，检索了与ACM和VFP相关的关键词和医学主题词。通过应用预定的纳入和排除标准以及对所选文章的质量评估，获得了33项研究的数据。采用卡方检验和二元logistic回归进行meta分析，以确定年龄与其他变量之间的相关性。结果：33项研究共纳入165例患者，平均年龄15.31个月。Chiari畸形的主要类型为2型，共120例。确诊双侧声带麻痹103例，单侧声带麻痹12例。最常见的治疗方式是放置脑室-腹膜分流器（108例，占65.45%），其次是后颅窝减压术（86例，占52.12%）。关于气道状况，大多数患者未插管（65.45%）；然而，超过三分之一的患者在VFP后接受了气管切开术（38.79%）。在整体队列和ACM II队列中，VFP发病年龄与恢复和生存之间存在显著关联。结论：VFP发病年龄是影响儿科患者恢复和生存率的关键因素，年龄越小，症状解决不完全和生存率越差。

{"title":"Vocal Fold Paralysis in Paediatric Patients With Arnold-Chiari Malformations: A Systematic Review and Meta-Analysis","authors":"Jad Hosri, Vanessa Helou, Jonathan Abou Chaar, Zahi Hamdan, Randa Barazi","doi":"10.1111/coa.70054","DOIUrl":"10.1111/coa.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To highlight risk factors affecting outcomes of vocal fold paralysis (VFP) in patients with Arnold-Chiari malformations (ACM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted according to the 2020 PRISMA checklist. The authors comprehensively searched multiple databases from inception till August 2023 for both keywords and medical subject headings pertinent to ACM and VFP. Data from 33 studies was obtained by applying predetermined inclusion and exclusion criteria and quality assessment of the chosen articles. Meta-analysis using Chi-squared test and binary logistic regression was performed to determine the association between age and other variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 33 studies included a total of 165 patients with a mean age of 15.31 months. The predominant type of Chiari malformation was type 2, observed in 120 cases. Bilateral vocal fold paralysis was confirmed in 103 patients while 12 patients had unilateral disease. The most common treatment modality was ventriculoperitoneal shunt placement in 108 patients (65.45%), followed by posterior fossa decompression surgery in 86 patients (52.12%). Regarding airway status, most patients were not intubated (65.45%); however more than one third of patients underwent tracheostomy (38.79%) following VFP. There was a significant association between the age of VFP onset and both recovery and survival in both the overall cohort and the ACM II cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age at onset of VFP is a critical factor associated with both recovery and survival rates in paediatric patients, with younger ages linked to incomplete symptom resolution and worse survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"51 2","pages":"194-202"},"PeriodicalIF":1.5,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Post-COVID-19 Pandemic Growth of National Hearing Aid Utilisation: A Population-Based Study covid -19大流行后全国助听器使用率的增长：一项基于人群的研究

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-10-24 DOI: 10.1111/coa.70048

Keren Oren, Itai Hazan, Stave Edri Abikasis, Tomer Kerman, Liron Kariv, Oded Cohen, Oren Ziv

Introduction

Hearing loss affects 538 million people globally. Untreated hearing loss may be compensated through speech reading. The COVID-19 pandemic prompted face coverings, causing communication challenges. We aim to investigate the possible impact of the COVID-19 outbreak era on hearing aid demand.

Study Design

Ecological time-series study.

Settings

A health organisation with five million members.

Methods

We examined the number of patients referred for hearing aid fitting by an otolaryngologist from March 2018 to February 2024. The data were stratified into three main groups: pre-pandemic (control group, 2018–2020), COVID-19 pandemic (study group 1, 2020–2022) and post-pandemic group (study group 2, 2022–2024).

Results

A total of 97 149 patients were included in the study. The yearly incidence rate of referrals for hearing aid fitting (per 100 000 patients) in all age groups increased in all study groups (during and post-COVID) compared to the average incidence of the control group, with a notable increase in the second year of the COVID-19 pandemic onward. The incidence rate ratio (IRR) for the 18–49 age group showed the largest and most significant increase 3.16 (95% CI: 2.74, 3.65) in the second post-COVID year compared to the pre-COVID period (p < 0.001). Significant increases were also observed in the 50–75 age group IRR: 2.10 (95% CI: 1.87, 2.36) and the 75–120 age group IRR: 1.53 (95% CI: 1.35, 1.74) (p < 0.001).

Conclusion

There is a significant increase in the demand for hearing aids following the COVID-19 outbreak. Considering the possibility of future outbreaks and the everyday increase in face masking usage, health providers and patients should be further encouraged to pursue hearing rehabilitation.

Level of Evidence

Level 3.

导读：听力损失影响着全球5.38亿人。未经治疗的听力损失可以通过言语阅读得到补偿。COVID-19大流行促使人们捂脸，给沟通带来了挑战。我们旨在调查新冠肺炎疫情对助听器需求的可能影响。研究设计：生态时序研究。环境：一个拥有500万会员的卫生组织。方法：我们调查了2018年3月至2024年2月由耳鼻喉科医生转诊的助听器配戴患者的数量。数据被分为三个主要组：大流行前（对照组，2018-2020）、COVID-19大流行（研究1组，2020-2022）和大流行后组（研究2组，2022-2024）。结果：共纳入97 149例患者。与对照组的平均发病率相比，所有研究组（在covid期间和之后）中所有年龄组的助听器配套件年发病率（每10万名患者）均有所增加，在COVID-19大流行的第二年显着增加。18-49岁年龄组的发病率比（IRR）在冠状病毒感染后第2年与冠状病毒感染前相比，增幅最大、最显著（3.16,95% CI: 2.74, 3.65） (p)。考虑到未来爆发的可能性和每天使用口罩的增加，应进一步鼓励卫生服务提供者和患者进行听力康复。证据等级：三级。

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引用次数: 0

Paediatric Obstructive Sleep Apnoea-We Have to Work Together! 小儿阻塞性睡眠呼吸暂停——我们必须共同努力！

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-10-23 DOI: 10.1111/coa.70036

May M C Yaneza

引用次数: 0

Methods of Lateral Osteotomy in Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomised Controlled Trials 鼻整形术中侧骨切开术的方法：随机对照试验的最新系统评价和荟萃分析。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-10-23 DOI: 10.1111/coa.70053

Ebraheem Albazee, Ayman Khatib, Abdulrahman Makhseed, Hamad Alajmi, Ali Aldoukhi, Mohannad Al-Qudah

Objective

To provide an up-to-date systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the postoperative outcomes of two lateral osteotomy techniques (external vs. internal) in patients undergoing rhinoplasty.

Methods

We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and the CENTRAL from their inception until January 2025. Eligible RCTs were assessed for risk of bias using Cochrane's risk of bias tool. The specific outcomes included clinically relevant measures, such as eyelid edema, ecchymosis, and step-off deformity. Standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CIs) were used to combine the data. STATA software was used for statistical analysis.

Results

A total of 13 RCTs involving 1008 patients were included. Five RCTs demonstrated a low risk of bias, six had some concerns, and two exhibited a high risk of bias. The pooled analysis showed no significant difference in eyelid edema between the external and internal osteotomy groups at 2 days (SMD = −0.13, 95% CI [−0.49, 0.22]), 3 days (SMD = −0.14, 95% CI [−0.77, 0.48]), and 7 days (SMD = −0.08, 95% CI [−0.27, 0.12]). Similarly, no significant difference was observed in ecchymosis between the two groups at 2 days (SMD = −0.12, 95% CI [−0.51, 0.27]), 3 days (SMD = −0.21, 95% CI [−1.11, 0.70]), and 7 days (SMD = −0.10, 95% CI [−0.33, 0.12]). The mean score of step-off deformity was significantly higher in the external osteotomy group compared to the internal osteotomy group (SMD = 0.54, 95% CI [0.19, 0.89]), whereas the rate of step-off deformity did not differ significantly between the groups (RR = 0.79, 95% CI [0.43, 1.44]).

Conclusion

This updated systematic review and meta-analysis of 13 RCTs involving 1008 patients demonstrated comparable outcomes between external and internal lateral osteotomy in terms of postoperative eyelid edema, ecchymosis, and step-off deformity in patients undergoing rhinoplasty.

Trial Registration: PROSPERO: CRD420251003922

目的：提供随机对照试验（rct）的最新系统综述和荟萃分析，以评估鼻整形患者采用两种外侧截骨技术（外部与内部）的术后结果。方法：我们对PubMed、Scopus、Web of Science、Embase和CENTRAL从成立到2025年1月进行了全面的检索。使用Cochrane偏倚风险工具评估符合条件的随机对照试验的偏倚风险。具体结果包括临床相关指标，如眼睑水肿、瘀斑和台阶畸形。采用95%置信区间（ci）的标准化平均差（SMD）和风险比（RR）合并数据。采用STATA软件进行统计分析。结果：共纳入13项rct，共1008例患者。5项随机对照试验显示低偏倚风险，6项有一些担忧，2项显示高偏倚风险。合并分析显示，在2天（SMD = -0.13, 95% CI[-0.49, 0.22]）、3天（SMD = -0.14, 95% CI[-0.77, 0.48]）和7天（SMD = -0.08, 95% CI[-0.27, 0.12]）时，外切骨组和内切骨组的眼睑水肿无显著差异。同样，两组在第2天（SMD = -0.12, 95% CI[-0.51, 0.27]）、第3天（SMD = -0.21, 95% CI[-1.11, 0.70]）和第7天（SMD = -0.10, 95% CI[-0.33, 0.12]）时的瘀斑无显著差异。外截骨组的断步畸形平均评分明显高于内截骨组（SMD = 0.54, 95% CI[0.19, 0.89]），而两组间断步畸形发生率无显著差异（RR = 0.79, 95% CI[0.43, 1.44]）。结论：这项更新的系统综述和荟萃分析了13项随机对照试验，涉及1008例患者，结果表明，在鼻整形患者术后眼睑水肿、瘀斑和步进畸形方面，外部和内部外侧截骨术的结果相当。试验注册：PROSPERO: CRD420251003922。

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引用次数: 0

Paediatric Sleep-Disordered Breathing Special Issue Introductory Editorial 儿科睡眠呼吸障碍特刊导论社论。

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology

Pub Date : 2025-10-23 DOI: 10.1111/coa.70049

Carlos Flores-Mir, Hong He

引用次数: 0