European Archives of Oto-Rhino-Laryngology最新文献

Purpose: This study aimed to investigate the factors affecting laryngeal cancer survival.

Methods: This study retrospectively analysed laryngeal cancer types, treatment options, and potential factors influencing survival.

Results: 77 patients (26.27%) had supraglottic laryngeal cancer, 209 (70.13%) had glottic laryngeal cancer, and 7 (3.6%) had subglottic laryngeal cancer. Common comorbidities such as type 2 diabetes mellitus, chronic obstructive pulmonary disease, and coronary disease were observed in 13.65%, 11.9%, and 22.18% of the patients, respectively. Smoking was detected in 88.05% of the patients, while 56.3% reported regular alcohol consumption. The study found that hemilaryngectomy and supraglottic horizontal resection led to significantly longer survival compared to other treatment options (i.e., total laryngectomy, supracricoid horizontal partial laryngectomy, transoral laser cordectomy, chemoradiation, chemotherapy, and radiotherapy), p = 0.000*. Glottic cancers tend to have longer survival when considering laryngeal cancer locations; however, this difference was statistically insignificant (p = 0.640). Statistical comparisons showed significantly longer survival rates for surgical treatments in stages 1 (p = 0.007*) and 4 (p = 0.007*). Factors such as coronary artery disease, higher ECOG performance status, advanced 'N' stages, and higher tumour grades were found to significantly worsen survival, as determined by a Cox proportional hazards model.

Conclusion: The study revealed that factors such as coronary disease, patients' functionality, 'N' stages, and tumour grade significantly impacted survival rates. Furthermore, the study found that supraglottic horizontal resection and hemilaryngectomy resulted in the longest survival. Surgical methods were associated with significantly longer survival rates in disease stages 1 and 4.

Objective: Our study focused on the development and evaluation of the SAPIENS (Specific Anatomical Printed-3D-model In Education and New Surgical Simulations) as a valid tool for otologic surgical education.

Methods: Twenty junior otolaryngologist surgeons in training were enrolled in the study. Each participant was invited to perform dissection of three different temporal bones. 1)Transparent 3-D printed model; 2)Opaque 3-D model; 3)fresh frozen human temporal bone. Following their drilling experience, participants answered to two specific questionnaires. The first was a questionnaire developed by Mowry et al. to evaluate 3D models in its general characteristics of anatomy and dissection, while the second one was a questionnaire specifically designed to compare the 3-D printed models with the human fresh frozen temporal bone.

Results: The average total score of the questionnaire was calculated as 53.2/61 in transparent 3-D model and 55.4/61 in the opaque 3-D model. These values indicate that the 3D printed models closely resemble the human TB in terms of anatomy and dissection. Comparisons of the 3D model and human TB were rated as very similar in all surgical steps. The total score was 4/5 in the transparent 3-D model and 4.2/5 in the opaque 3-D model.

Conclusion: We have designed and developed a 3D-printed model of the temporal bone that closely resembles the human temporal bone. The SAPIENS 3-D printed temporal bone model could be considered a valuable tool for advancing oto-surgical education due to its similarity to the human temporal bone in terms of anatomy and dissection.

Objective: To re-evaluate the published systematic reviews and meta-analyses on the efficacy and safety of intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss (SSNHL).

Methods: Systematic reviews and meta-analyses related to intratympanic steroid therapy for SSNHL were identified by searching both English and Chinese language databases, including OVID, The Cochrane Library, PubMed, Web of Science, Embase, CBM, WanFang, CNKI, and CSTJ. For each included study, the AMSTAR 2 appraisal tool was used to assess methodological quality, the PRISMA statement evaluated reporting quality, and the GRADE system was applied to assess the strength of evidence for primary study outcomes.

Results: A total of 16 studies that met the inclusion criteria were included in the analysis. The AMSTAR 2 evaluation identified 2 studies as having low credibility and 14 as having very low credibility. The PRISMA statement ratings for the studies ranged from 10 to 23 (mean score: 17.6), with 4 studies classified as high quality, 8 as medium quality, and 4 as low quality. The GRADE assessment included 53 outcome indicators, with 2 considered as having intermediate evidence, 12 as low-level evidence, and 39 as very low-level evidence.

Conclusion: Based on the AMSTAR 2, PRISMA, and GRADE evaluations, this study provides evidence in favor of intratympanic steroid therapy as a salvage treatment for sudden deafness. However, the systematic reviews and meta-analyses included in this study generally exhibit low methodological quality and inconsistent reporting. Future clinical trials and systematic reviews/meta-analyses should aim to improve the quality of their design, execution, and reporting to provide more reliable evidence that can guide clinical decision-making.

Background: Nasal dermoid cysts are rare congenital anomalies that can present with intracranial extension in approximately 10% of cases. Traditional surgical approaches require frontal craniotomy, which is invasive and may lead to significant morbidity.

Objective: We describe a novel, minimally invasive, endoscopic-assisted surgical approach for the removal of a nasofrontal dermoid cyst with intracranial extradural extension.

Methods: A 2-year-old girl with a nasal dermoid cyst extending intracranially was treated using an endoscopicassisted technique through a small skin incision. Surgical steps, intraoperative findings, and postoperative outcomes were recorded.

Results: The procedure allowed complete resection with excellent visualization, reduced morbidity, and satisfactory cosmetic outcomes. No cerebrospinal fluid leakage or recurrence was noted at 6-month follow-up.

Conclusion: Endoscopic-assisted removal is a safe and effective alternative to traditional approaches, providing excellent tumor visualization and better cosmetic results while minimizing surgical morbidity.

Purpose: The article provides an intriguing overview with tangible historical references, accompanied by photographic material, delving into the historical context of Eagle syndrome.. It ambitiously aims to shed light on the origins of the surgeon's reflections regarding the anatomy of the styloid process. Indeed, ever since the first original article by Watt Weems Eagle, these reflections have been attributed to Pietro Marchetti (Padua, 1589-1673), an Italian surgeon, anatomist, and physician. However, it appears they should be attributed to his son, Domenico De Marchetti (Padua, 1626 - 1688).

Methods: The original book "ANATOMIA-cui responsiones ad Riolanum anatomicum Parisiensem in ipsius animaduersionibus contra Veslingium additae sunt", (Padua-ed. 1654, first edition in 1652),written by Domenico De Marchetti was examined.The Latin text was analyzed adopting a philologico-clinical approach and related to contemporary medical and anatomical knowledge [18,19].

Results: The study highlights Marchetti's meticulous analysis of the hyoid bone and its associated structures, revealing the multifaceted nature of the styloid process. Noteworthy is Marchetti's observation regarding the styloid process's connection with the hyoid bone's horns during cadaver dissections, hinting at the calcification of the stylohyoid ligament, a key factor in Eagle syndrome. Marchetti's insights during cadaver dissection are evocative both regarding the hypothesis of stylohyoid ligament calcification and concerning the concept of styloid process growth throughout a person's life.

Conclusions: Marchetti's observations provide the first evidence of the continuous evolution of the styloid process throughout life and represent a valuable contribution to understanding the etiology of Eagle's Syndrome.

Purpose: This clinical trial examined how the articifial intelligence (AI)-based diagnostics system S-Detect for Thyroid influences the ultrasound diagnostic work-up of thyroid ultrasound (US) performed by different US users in clinical practice and how different US users influences the diagnostic accuracy of S-Detect.

Methods: We conducted a clinical trial with 20 participants, including medical students, US novice physicians, and US experienced physicians. Five patients with thyroid nodules (one malignant and four benign) volunteered to undergo a thyroid US scan performed by all 20 participants using the same US systems with S-Detect installed. Participants performed a focused thyroid US on each patient case and made a nodule classification according to the European Thyroid Imaging Reporting And Data System (EU-TIRADS). They then performed a S-Detect analysis of the same nodule and were asked to re-evaluate their EU-TIRADS reporting. From the EU-TIRADS assessments by participants, we derived a biopsy recommendation outcome of whether fine needle aspiration biopsy (FNAB) was recommended.

Results: The mean diagnostic accuracy for S-Detect was 71.3% (range 40-100%) among all participants, with no significant difference between the groups (p = 0.31). The accuracy of our biopsy recommendation outcome was 69.8% before and 69.2% after AI for all participants (p = 0.75).

Conclusion: In this trial, we did not find S-Detect to improve the thyroid diagnostic work-up in clinical practice among novice and intermediate ultrasound operators. However, the operator had a substantial impact on the AI-generated ultrasound diagnosis, with a variation in diagnostic accuracy from 40 to 100%, despite the same patients and ultrasound machines being used in the trial.

Authors' Response to Letter to Editor from Kuan-Fu Liao and Shih-Wei Lai.

Objective: Detailed pre-operative HRCT scan-based measurement of the distance between surgical landmarks with lateral or sigmoid sinus (SS) and classification of its relations with surgical landmarks.

Study design: Observational Study.

Setting: Tertiary care center.

Patients: Patient volunteers above 18 years of age undergoing scans for various reasons.

Interventions: Axial Sections of HRCT of 260 temporal bones obtained from patient volunteers were studied with the help of RadiAnt DICOM Viewer (version 2023.1).

Main outcome measures: Closest distance of the SS from the posterior wall of the external auditory canal wall (CW), the vertical portion of the facial nerve (VPFN), the short process of incus (SPI), lateral (LC), and posterior semi-circular canal (PC), was measured. The SS relation with the mastoid was classified as type 1-4 depending upon the shortest distance of the sinus from the posterior canal wall millimeters.

Results: The mean distance of the SS from surgical landmarks was 14.6 ± 2.7 mm for SPI, 11.1 ± 3.1 for CW, 11.4 ± 2.9 for VPFN, 10.1 ± 2.8 for PC, and 11.9 ± 2.7 LC. All measured distances were significantly more on the left side (p < 0.05, Z test), except the difference in distance from LC. The greatest range of variation (5.2 to 21.8 mm) was seen in the distance between SS and VPFN. The most common type of relationship between SS and CW was type 3, present in 64% of subjects, while the least common group was type 1, with nearly 1% of subjects.

Conclusion: The assessment of distances and relations of various surgical landmarks with SS, with the proposed novel classification based on SS-CW distance, can be essential for preoperative planning and risk mitigation.

Level of evidence: 3: