Clinical Otolaryngology最新文献

Objectives

This study aimed to evaluate the olfactory and gustatory functions of patients with nasal septal deviation (NSD) and identify the factors associated with olfactory loss (OL) and gustatory loss (GL).

Design and Setting

Retrospective data analysis of cohort group.

Participants

Two-hundred fourteen adult patients with NSD at a tertiary hospital.

Main Outcome Measures

Olfactory and gustatory functions were assessed using the psychophysical olfactory and gustatory function tests. The association of various demographic and clinical factors, including age, sex, NSD type, allergic sensitization status, presence of concha bullosa (CB), total serum immunoglobulin E (IgE) level, blood eosinophil count, and acoustic rhinometry parameters, with OL and GL was analysed.

Results

Among the patients, 20.6% (44/214) and 16.4% (35/213) had OL and GL, respectively. Patients with CB showed a significantly lower threshold, discrimination, and identification (TDI) score than those without CB (p = 0.012). Conversely, the TDI score did not differ according to age group, sex, NSD type, or allergic sensitization status. Blood eosinophil count was inversely correlated with the TDI score (p = 0.003), whereas nasal cavity volume, minimal cross-sectional area, and serum IgE level were not correlated with the TDI score. In the multivariable analysis, the presence of CB (p = 0.029, odds ratio [OR] = 2.281) and a blood eosinophil count ≥ 190 (p = 0.030, OR = 2.155) were identified as significant factors associated with OL. No factors were significantly associated with GL.

Conclusion

The presence of CB and a high blood eosinophil count are significant predictors of OL in patients with NSD.

Objectives

Obstructive sleep apnea (OSA) is currently viewed as a chronic, multisystem condition associated with an increased risk of cognitive impairment, especially mild cognitive impairment (MCI). As biomarkers of neurodegeneration, we evaluated whether neurofilament light (NfL), amyloid-β 42(Aβ-42) and amyloid-β 40 (Aβ-40) can be used to indicate MCI in OSA.

Design

A cross-sectional study.

Setting

Single-centre trial at tertiary medical institutions.

Participants

A total of 153 newly diagnosed subjects with OSA.

Main Outcomes Measures

All participants completed polysomnography, neuropsychological assessments, and plasma biomarkers of neurodegeneration detection, including NfL, Aβ-42 and Aβ-40.

Results

Compared to the cognitively normal group, only the levels of plasma NfL were increased in the MCI group. The plasma NfL levels were associated with an increased risk of cognitive impairment in OSA patients after adjusting for age, gender, body mass index, and education year. Plasma NfL outperformed other biomarkers in differentiating MCI from normal cognition (area under the ROC curve [AUC] = 0.829). Plasma NfL, in combination with conventional factors (age, body mass index, smoking, alcohol consumption, diabetes mellitus, hypertension, history of snoring, history of apneic episodes and time ratio of SaO₂ < 90%) yielded an AUC of 0.907 for differentiating between MCI and normal cognition.

Conclusions

These findings indicate that the plasma NfL was increased in OSA patients with cognitive impairment. Furthermore, plasma NfL appears to be superior to plasma Aβ for identifying MCI in OSA and holds potential as an objective biomarker associated with MCI in these patients.

Background

Early laryngeal cancer is effectively treated with transoral laser microsurgery (TLM) or radiotherapy, both offering comparable oncological outcomes. The impact on voice and swallowing remains unclear.

Objectives

To evaluate voice and swallowing outcomes following treatment with TLM or radiotherapy for early laryngeal cancer in a UK multi-centre prospective study.

Methods

A total of 137 patients with T1 or T2 laryngeal cancer were recruited from five UK head and neck cancer centres. Patients received either TLM or radiotherapy (up to 55 Gy). Voice and swallowing function were assessed at baseline, 3 months and 6 months post-treatment using a multidimensional protocol: Voice Handicap Index (VHI-10), maximum phonation time (MPT), GRBAS perceptual voice scale, 100 mL timed water swallow test and Normalcy of Diet (NoD).

Results

VHI scores improved significantly following radiotherapy at 3 months (MD 8.66, SD 11.46, 95% CI 5.5, 11.8, p < 0.001). MPT was also significantly longer in the radiotherapy group (MD 2.47, SD 6.2, 95% CI 0.7–4.2, p = 0.007). Perceptual voice ratings showed reduced hoarseness post-radiotherapy at 3 months (MD 0.71, SD 1.11, 95% CI 0.43, 0.98, p < 0.001). No significant differences were found between treatments for swallowing function or NoD, which remains stable up to 6 months.

Conclusion

Radiotherapy is associated with better short-term voice outcomes compared to TLM. Swallowing function remains largely unaffected by treatment type. This study highlights the need to include functional outcomes in treatment decisions and is the first UK multicentre prospective study to use standardised, multidimensional assessments of early recovery following treatment for early laryngeal cancer.

Background

Paediatric airway diseases such as asthma, allergies, rhinitis, upper respiratory tract infections and acute otitis media are major health challenges for children globally. The prevalence of these conditions has been increasing, impacting children's quality of life, educational attainment and imposing a substantial economic burden.

Objectives

This longitudinal prospective study investigated the prevalence rates and environmental links associated with paediatric airway diseases in the first 3 years of life in 241 newborns, with the goal of contributing to early detection, prevention and management strategies.

Methods

Structured questionnaires were administered to parents at birth, 1 year and 3 years of age. Data on socioeconomic factors, pregnancy and delivery characteristics, parental smoking, breastfeeding, childcare attendance and children's health history were collected. Skin prick tests were conducted in year 3 to assess allergic sensitisation.

Results

Two hundred seven patients completed three-year follow-up. Factors such as having siblings, exclusive breastfeeding and attending kindergarten were associated with increased risks of certain diseases at 1 and 3 years. Smoking exposure appeared protective against wheezing in the first year. Breastfeeding showed mixed results, with protective effects against URTIs at 1 year but a potential risk factor for asthma at 1 year. Kindergarten attendance was associated with increased risks of URTIs and AOM at 3 years but appeared protective against inhalant allergies.

Conclusion

The study highlighted the complex interplay of various factors in the development of paediatric airway diseases. Further research is needed to refine our understanding of these factors and their impact on paediatric diseases.

Objectives

This study aimed to investigate whether the Systematic Coronary Risk Estimation 2 and Systematic Coronary Risk Estimation 2-Older Persons (SCORE 2 and SCORE 2-OP) cardiovascular disease (CVD) risk scales can be used as prognostic factor for sudden sensorineural hearing loss (SSHL).

Design

Prospective observational study.

Setting

Single-center study.

Methods

The study included 62 patients diagnosed with SSHL. SCORE 2 and SCORE 2-OP risks were calculated using the data collected from each participant. Patients were categorised into Green (low–moderate) and Non-Green (Yellow and Red, containing high and very high) risk groups. Recovery was categorised based on changes in pure-tone average (PTA). Statistical analyses included Pearson's correlation, univariate and multivariate logistic regression and ROC curve analysis.

Results

A significantly higher proportion of patients in the Complete Recovery group had a Green SCORE risk classification (63.6%) than in the non-complete recovery group (32.5%, p = 0.018). The Green SCORE classification and lower pre-treatment PTA levels were significantly associated with better recovery outcomes. In multivariate analysis, Green SCORE remained an independent predictor of complete recovery (OR = 4.052, 95% CI: 1.218–13.487, p = 0.023). ROC analysis revealed moderate discriminative ability (AUC = 0.656, p = 0.044; sensitivity, 63.6%; specificity, 67.5%), with a negative predictive value of 77.1%.

Conclusion

The SCORE2 and SCORE2-OP cardiovascular risk scores, particularly the Green risk category, are valuable predictors of hearing recovery in SSHL. This finding has the potential to serve as a guide for clinicians, informing the adaptation of treatment intensity or the investigation of adjunctive therapies within populations characterised by elevated risk.

Introduction

Radiomics offers the potential to predict oncological outcomes from pre-operative imaging, aiding in the identification of ‘high risk’ patients with sinonasal cancer who are at an increased risk of recurrence. This study aims to comprehensively review the current literature on the role of radiomics as a predictor of disease recurrence in sinonasal squamous cell carcinoma.

Methods

A systematic search was conducted in Medline, EMBASE and Web of Science databases. Retrospective and prospective studies examining the use of radiomics to predict post-operative recurrence in sinonasal cancer that met the inclusion criteria were included. Study quality was assessed using the QUADAS-2 and Radiomics Quality Score (RQS) tools.

Results

Five studies met the inclusion criteria, encompassing 638 participants. All studies were single-centre and utilised MRI-based radiomics in the construction of their models. Radiomic models demonstrated excellent predictive performance. The median AUC, sensitivity and specificity were 0.947, 0.86 and 0.923 in the training set, and 0.914, 0.833 and 0.878 in the validation set. A pooled meta-analysis estimated the combined AUC across training sets as 0.931 (95% CI, 0.898–0.963) and 0.922 (95% CI, 0.880–0.964) for validation sets.

Conclusion

Our systematic review provides evidence supporting the role of radiomics in predicting post-operative disease recurrence in sinonasal cancer. Radiomics shows promise in enhancing personalised treatment strategies by improving prognostic accuracy. However, further research is needed to standardise methodologies and validate these findings in larger, multicentre cohorts.

Objectives

The expression and functionality of bitter taste receptors (T2Rs) in the sinonasal mucosa have been linked to variations in chronic rhinosinusitis (CRS) severity and susceptibility, suggesting a potential therapeutic target for managing this chronic condition. This study is an initial proof-of-concept study to explore the potential of nasal bitter taste testing as a screening tool for CRS, aiming at developing a screening method to detect the bitter taste receptor in the nose and its sensitivity between healthy individuals and those with CRS using available bitter ligands; therefore, coming up with a suitable titration of this ligand for future use.

Methods

A cross-sectional study of 84 adults (42 with CRS and 42 healthy controls) evaluated nasal glucose levels and phenylthiocarbamide (PTC) taste sensitivity. Colorimetric and statistical tests were used to analyse PTC threshold values and nasal glucose levels.

Results

Based on 0.13% as the most suitable dilution for intranasal testing of PTC, there is an association between nasal bitter taste testing among CRS and control groups with a p value of < 0.001.

Conclusions

The bitter taste testing on the nose seems to be a simple and inexpensive way for screening patients with CRS. The titration and intranasal sites suggested in this study can be used as a basis for further prospective studies to view the outcome of patients with CRS. Targeting these receptors in diagnostics could open a new window of opportunity in the management of patients with CRS.

Objective

To evaluate the prognostic significance of preoperative inflammatory markers including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) in patients with laryngeal squamous cell carcinoma (LSCC) undergoing total laryngectomy (TL).

Methods

Patients were stratified by preoperative inflammatory markers: NLR > 3, PLR > 109.54, and AGR < 1.29; values were obtained from blood tests within 6 months prior to surgery. The primary outcome was overall survival (OS). Secondary outcomes included postoperative complications, emergency department (ED) visits, and length of hospitalisation. Multivariable analyses adjusted for age, sex, comorbidity burden, socioeconomic status, and prior radiation exposure.

Results

A total of 616 patients included (mean age 67 years; 85% male). Low AGR was significantly associated with longer hospital stays, higher ED visit rates at 3, 6, and 12 months (p < 0.001), and reduced 1, 2, and 5-year survival (p = 0.01, 0.02, 0.003). NLR > 3 predicted longer hospitalisation (p = 0.019) and more frequent ED visits (p < 0.01), and PLR > 109.54 was associated with increased ED visits and lower 5-year survival.

In multivariable models, only AGR < 1.29 remained a strong independent predictor of ED visits and mortality. Stratified analysis showed that this association persisted in patients without prior radiation (HR: 3.32; p = 0.002), but not in those who underwent salvage TL.

Conclusion

Low preoperative albumin-to-globulin ratio (AGR) is an independent predictor of reduced OS in patients undergoing TL for LSCC. Incorporating AGR into preoperative risk assessment may help identify high-risk patients and inform clinical decision-making.