European Archives of Oto-Rhino-Laryngology最新文献

Introduction: Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared.

Methods: Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3 months, 6 months, 12 months, 18 months and at the last follow up (more than 18 months) are compared.

Results: 153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6 months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3 months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6 months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6 months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations.

Discussion/conclution: MF was associated to initial superior results, presenting significant facial recovery at 3 months, and significantly better functional outcomes at 6 months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure.

Purpose: Tinnitus is a condition that causes people to hear sounds without an external source. One significant issue arising from this condition is the difficulty in communicating, especially in the presence of noisy backgrounds. The process of understanding speech in challenging situations requires both cognitive and auditory abilities. Since tinnitus presents unique challenges, it is important to investigate how it affects speech perception in noise.

Method: In this review, 32 articles were investigated to determine the effect of tinnitus on the effect of speech in noise perception performance. Based on the meta-analysis performed using a random-effects model, meta-regression was used to explore the moderating effects of age and hearing acuity.

Results: A total of 32 studies were reviewed, and the results of the meta-analysis revealed that tinnitus significantly impacts speech in terms of noise perception performance. Additionally, the regression analysis revealed that age and hearing acuity are not significant predictors of speech in noise perception.

Conclusion: Our findings suggest that tinnitus affects speech perception in noisy environments due to cognitive impairments and central auditory processing deficits. Hearing loss and aging also contribute to reduced speech in noise performance. Interventions and further research are necessary to address individual challenges associated with continuous subjective tinnitus.

Purpose: Middle turbinate (MT) surgery is extremely common during endoscopic sinus surgery procedures, though no agreement exists on which techniques provide the best outcomes. This PRISMA-compliant systematic review aims to assess which MT surgery technique yields the least postoperative adverse effects and the best objective and subjective outcomes.

Methods: A comprehensive search criteria was conducted in multiple databases up to July 3, 2023, to identify studies reporting surgical treatments of the MT. After screening and quality assessment, 14 articles were included for analysis. Data on patients demographics, surgical approaches, postoperative treatment and follow-up, objective and subjective outcomes were extracted and reviewed.

Results: Out of 173 unique papers identified, 14 articles met the inclusion criteria, predominantly randomized controlled trials (n = 9). Antero-inferior middle turbinectomy was the predominant surgical approach. Most studies evaluated results with postoperative endoscopy, a superior outcome was documented in the intervention group (ten out of eleven cases). In four out five studies using the SNOT-22, the treatment group was associated with a statistically significant improvement. Olfactory questionnaires highlighted superior olfactory outcome in two out of three studies. The UPSIT score revealed no significant difference between groups. Objective olfactory assessments favored treatment groups in both studies utilizing olfactometry.

Conclusions: It seems that a partial MT surgical approach consistently yields subjective and objective improvements compared to conservative measures, also suggesting a positive impact on smell function. Despite it appears that better outcomes with fewer complications are consistently achieved with partial techniques, it remains challenging identifying which partial technique surpasses the others, due to significant heterogeneity among the studies.

Introduction: Facial nerve palsies may develop during the postoperative period of microsurgical removal of vestibular schwannomas (VSs), even after normal facial function for days or weeks after surgery. The aim of this study was to identify the pathomechanism and predictive factors of delayed palsy.

Material and method: The clinical data of 193 patients who underwent vestibular schwannoma surgery between 2012 and 2021 were retrospectively analyzed. A total of 134 patients were included. The patients showed intact facial nerve function up to 24 h after surgery. All patients (n = 20) with palsy from postoperative day 4 were included and collectively referred to as delayed facial nerve palsy (DFNP). Various factors were checked using a binomial regression analysis.

Results: The mean age of patients with DFNP was 57.8 years (55% female, 45% male). 70% had VS with KOOS ≥ 3, and 60% underwent surgery via a translabyrinthine approach Among the 16 patients with DFNP-related neurotropic pathogens, 25% were seropositive for herpes simplex virus. Most patients (n = 9/20) experienced onset of palsy between postoperative days 6 and 10. Of the four variables included in the significance test, three were significant: KOOS ≥ 3 (p < .04), ipsilateral vestibular organ failure (p < .05), and age group (p < .03). After therapy, 100% of patients recovered almost complete facial nerve function. The parameters mentioned above (KOOS classification and ipsilateral vestibular dysfunction) could be proven risk factors for the occurrence of DFNP.

Purpose: There are many specific instruments for assessing the quality of life (QoL) in patients with chronic rhinosinusitis. Of all these tests, the Sino-Nasal Outcome Test-22 (SNOT-22) is the most widely used internationally. The purpose of the study was linguistic adaptation and validation of the SNOT-22 scale in the Polish language.

Methods: The SNOT-22 was adapted into Polish and was administered to 148 subjects (108 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and 40 asymptomatic controls. Seventy-one patients completed the SNOT-22 a second time to evaluate test-retest reliability. The Polish SNOT-22 was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity.

Results: The Polish SNOT-22 exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient (α = 0.89) was obtained. Significantly higher scores (p < 0.01) were revealed in the Study Group with a median score of 32 (range 15-53) points in comparison with controls: 5 (range 0-20). A moderate correlation was found between SNOT-22 and the Lund-Kennedy test score (r = 0.334; p < 0.001) and a strong correlation between SNOT-22 and the Lund-Macay test score (r = 0.469; p < 0.001). The best cut-off point was set at a 16 score with a sensitivity of 0.981 and a specificity of 0.995. The determined Area Under Curve (AUC = 0.997; p < 0.001) confirms the diagnostic accuracy of the Polish SNOT-22.

Conclusions: The Polish version of the SNOT-22 is a valid and reliable tool for measuring health-related quality of life in patients with CRSwNP in the Polish-speaking population.

Purpose: Assessing olfactory function is highly significant in clinical practice, particularly in the context of the recent COVID-19 pandemic. Recent approaches in this field emphasize the importance of reducing the time and cost devoted to olfactory testing procedures. Hence, the aim of the present study was to examine the reliability and basic characteristics of Digital Scent Device 20 (DSD-20), an innovative olfactory test consisting of 20 "universal odors", in a European population.

Methods: A total of 88 participants (mean age = 45.1, SD = 20.3) volunteered for the study. The sample consisted of 37 normosmic controls and 51 dysosmic patients.

Results: The correlation between DSD-20 and the total score in Sniffin' Sticks was high (TDI; R = .80, p < .001), and the test correlated with the individual components of the Sniffin' Sticks test. Furthermore, the correlation coefficient between DSD-20 test and retest was very high (R = .88, p < .001), which was additionally confirmed by a Bland-Altman plot. Essential characteristics of the DSD-20 are its simplicity in self-administration, speed of application, portability, and the fact that it can be reused.

Conclusion: Overall, the present study confirms previous notions on DSD-20 by demonstrating its high reliability and usefulness in separating patients with hyposmia/anosmia and normosmic controls.

Background:  Olfactory training (OT) is commonly used for the treatment of olfactory disorders. Nevertheless, there is an ongoing debate about the most effective OT regimen. We aimed to compare the effects of OT with 7 items (rose, lemon, eucalyptus, cloves, stewed apple, balm, mint) to 4-item-OT (rose, lemon, eucalyptus, cloves) over 3 months. Methods: Participants were 40 patients with olfactory dysfunction receiving 4-item-OT or 7-item-OT and 60 gender- and age-matched individuals with normal sense of smell receiving no OT, 4-item-OT, or 7-item-OT. Before and after the OT we assessed n-butanol odor thresholds, discrimination, and identification (TDI score), additionalthresholds for (R)-(-)-carvone, β-damascenone, salicyclic acid benzylester, the degree of phantosmia and parosmia, cognitive function, and ratings of olfactory function. Results: In both patient groups, the TDI score increased with the use of OT, regardless of the number of odors used (p < 0.001; 3.48 ± 4.21 and lower than control groups). The clinically significant increase of 5.5 points in TDI score correlated with change of ratings of parosmia (r 0.62; p < 0.01) and with ratings of olfactory dysfunction (r = 0.51; p < 0.05).

Conclusion:  Concluding, OT over a 3-months period with 4 or 7 odors appears to produce similar results, although the sample size has to be considered.

Objectives: To analyze the overall long-term outcome of surgically treated skull base and temporal bone chondrosarcomas.

Methods: The medical records of patients with surgically treated skull base and temporal bone chondrosarcomas between 1983 and 2024 were thoroughly evaluated.

Results: Out of a total of over 5000 skull base surgeries performed at our center, only 29 patients had histopathologically confirmed chondrosarcomas of the skull base and temporal bone. The mean of patients age was 45.6, and the male-to-female ratio was 1.9:1. The most common symptoms included hearing loss (58.6%), tinnitus (41.4%), diplopia (31%), dysphonia (24.1%), dysphagia (20.7%), vertigo (10.3%), and dizziness (10.3%). The most frequent locations of lesions among the 29 patients are as follows: petroclival region (34.5%), jugular foramen (27.6%), petrous apex (17.2%), middle ear (13.8%), others (3.4%). TO, IFTA, IFTB, IFTC, POTS, and combined surgical approaches were commonly used. The rate of gross total removal and recurrence was 82.6% and 13.8% respectively. The follow-up duration of 6 patients was more than five years and less than ten years whereas ten patients had more than ten years of follow-up.

Conclusions: Chondrosarcoma of the skull base and temporal bone is a very rare pathology. Due to its multiple potential sites of origin and histological specificity, it presents us with significant challenges. Gross total removal is the primary treatment for chondrosarcoma of the skull base and temporal bone. Personalized decision-making should be considered based on the following aspects: tumor, patient, and surgeon's factors. Postoperative radiation therapy is complementary to surgical treatment in grades II and III lesions to achieve long-term survival.

Purpose: The survival benefit with higher body mass index (BMI) of patients suffering from head and neck squamous cell carcinoma (HNSCC) is documented as BMI paradox. As the early re-nourishment of high-risk patients determine survival, we searched for a nutritional status marker suitable for everyday screening. Grouping patients based on the 8th Edition of TNM Classification, we investigated for the first time the candidate nutritional status markers among TNM8 subgroups, including the newly introduced p16 positive oropharyngeal squamous cell cancer (OPSCC) patients.

Methods: We conducted a retrospective cohort study enrolling 661 patients and collecting anthropometric indices, laboratory parameters, clinical scores, nutritional risk scores. To discover the best one for screening survival analyses and correlation tests were executed.

Results: By performing univariate Cox regression, we found three nutritional markers significantly correlating with overall survival (OS) and cancer specific survival (CSS): BMI at diagnosis, percent of weight loss over six months and prognostic nutritional index (PNI). The latter proved to be independent of tumor stage. p16 negative OPSCC patient's OS and CSS did not correlate with BMI, but it did correlate with PNI and percent of weight loss. BMI was the only marker correlating with OS, only in stage 4 hypopharyngeal cancer patients. All three markers significantly correlated with survival among p16 positive oropharyngeal and glottic cancer patients.

Conclusion: We found BMI, percent of weight loss and PNI good candidate markers for malnutrition. PNI proved to be superior in every aspect, enabling the treating physicians to discover high-risk patients in need of aggressive re-nourishment. The survival of supraglottic laryngeal squamous cancer patients seemed to be independent of these nutritional status markers, which observation should be a subject of further investigations.

Background: Chronic rhinosinusitis (CRS) is prevalent in cystic fibrosis (CF), significantly affecting quality of life. The introduction of CFTR modulators, including elexacaftor-tezacaftor-ivacaftor (ETI), offers promise for improving sinonasal outcomes.

Methods: We conducted a retrospective cohort multicenter study analyzing electronic medical records of 45 adult CF patients with CRS, predominantly heterozygous for the ΔF508 mutation, treated with ETI between January 2018 and December 2023. Assessments included Sinonasal Outcome Test 22 (SNOT-22), Nasal Polyp Score (NPS), modified Lund-Kennedy Score (mLKS), Lund-Mackay Score (LMS), and olfactory function using smell loss visual analog scale (VAS) and Sniffin' Sticks identification test (SSIT).

Results: After 12 months of ETI therapy, significant improvements were observed in pulmonary function parameters (FEV1, FVC), CRS severity scores (SNOT-22, NPS, mLKS), radiological findings (LMS), and olfactory function. Subgroup analysis suggested enhanced efficacy in patients with prior endoscopic sinonasal surgery.

Conclusions: ETI therapy demonstrates comprehensive improvements in CRS and olfactory function in CF patients, highlighting the potential of CFTR modulators in managing sinonasal manifestations.