European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Obstructive sleep apnea (OSA), a sleep-related disorder, reports significant clinical consequences, apart from its socioeconomic burden globally. Among the physiotherapeutic treatment options, exercise training is primarily preferred for these patients. In the current systematic review and meta-analysis, we hypothesize that aerobic exercise training could be beneficial in reducing the severity of OSA.

Methods: A thorough literature search was carried out from Scopus, PubMed, CINAHL, Cochrane, and Embase databases following the PRISMA guidelines, and eight studies were included. The primary outcome was the apnea hypopnea index (AHI) and secondary outcomes were maximal oxygen consumption, oxygen desaturation index, mean oxygen saturation during sleep, Epworth sleepiness scale, body mass index, and neck circumference. RevMan version 5.4.1 was utilized for analysis.

Results: Meta-analysis involved seven studies that showed that aerobic training significantly improved the AHI with a mean difference of -5.24 and an overall effect of p < 0.00001; and VO_2max with a mean difference of 5.84 and an overall effect of p = 0.03. The other secondary outcomes reported improvement but were not significant.

Conclusion: The current review concludes that there is supporting evidence for the beneficial effects of aerobic exercise training in reducing the severity of obstructive sleep apnea.

Prospero registration: CRD42023453316.

Background and aim: Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder linked to increased risks of cardiovascular and metabolic disorders, significantly raising overall mortality rates. This study explores the associations between OSA and mortality in adults with and without Metabolic Syndrome (MetS) using data from the National Health and Nutrition Examination Survey (NHANES).

Methods and results: Data from NHANES (2005-2008) were analyzed, including 11,759 participants. OSA and MetS were identified based on survey responses and standard clinical criteria. Cox proportional hazards regression models were used to assess the relationship between OSA and mortality, adjusting for covariates. OSA was associated with significantly higher all-cause and cardiovascular mortality in the general population. In individuals without MetS, OSA was linked to higher all-cause and cardiovascular mortality. However, in individuals with MetS, OSA did not significantly affect mortality rates after adjusting for covariates.

Conclusion: OSA increases the risk of all-cause and cardiovascular mortality in individuals without MetS, emphasizing the need for early identification and management, particularly in those without metabolic comorbidities. In contrast, the impact of OSA on mortality in individuals with MetS may be mitigated by medical monitoring and treatment. These findings highlight the importance of individualized clinical strategies and call for further research to explore the underlying mechanisms of OSA-MetS interactions.

Purpose: Instagram ranks among the most used social media platforms worldwide. An increasing number of posts are dedicated to specific medical topics, such as sleep medicine. The educational content of these posts is largely unknown. Therefore, a structured content analysis of posts linked to the hashtag "obstructivesleepapnea" was conducted, as obstructive sleep apnea (OSA) represents the most common sleep-related breathing disorder.

Methods: The hashtag "obstructivesleepapnea" was entered into Instagram's search field. The first linked post was selected and then subdivided into visual content and text content for systematic analysis with a focus on educational information on OSA. Demographic factors of the post such as likes, hashtags and the posting account were also included in the analysis. The data collection was completed for N = 150 consecutive posts.

Results: 37.3% of the visual content and 32.7% of the text content addressed educational information on OSA. In both subgroups, the most frequently discussed aspects were OSA symptoms, comorbidities, and therapy (visual content: 50.0%, 39.3, and 41.1%, respectively; text content: 42.9%, 44.9%, and 24.9%, respectively). The most common (professional) background of the account, as self-stated by the holder, was dentists (29.5%). Additional sleep medicine content was posted by 34.3% of all accounts.

Conclusion: Instagram offers informative content about OSA and is therefore a potential source for patient education. However, the content available is often poorly organized and in most cases incomplete. Patients may have difficulty categorizing the information provided to benefit from it.

PURPOSE  : Periodic hypopnea or apnea during sleep, along with episodes of hypoxia and sleep fragmentation caused by frequent awakenings to restore the upper airway are the characteristics of Pediatric obstructive sleep apnea (P-OSA). While extensive literature evaluates biomarkers in the diagnosis of OSA in adults, no systematic review summaries their diagnostic accuracy in P-OSA. This systematic review evaluates the diagnostic accuracy of biomarkers in assessing the P-OSA compared to Polysomnography in children.

Method: The research question was established in PECO format. The study protocol was registered in PROSPERO. A literature search was conducted in various database upto January 2025, including studies that assessed various biomarkers in comparison with polysomnography. Screening was done with Distiller SR and the risk of bias was assessed with Newcastle-Ottawa Scale. Meta-analysis was performed with the pooled sensitivity and specificity values using RevMan software.

Results: Eighteen studies were included, that assessed transfer-ribonucleic acid, C-reactive protein, inflammatory markers, leukotrienes, salivary amylase, salivary cortisol, isoprostane and hydrogen peroxide. Meta-analysis revealed that urine-based biomarkers had highest diagnostic accuracy with a sensitivity of 89.75%, compared to 77.87% for serum-based biomarkers. The pooled Odds ratio was 10.31 (95% CI: 8.48-12.54), indicating a strong diagnostic association.

Conclusion: Biomarkers offer a non- invasive and reliable diagnostic tool for P-OSA. Urine-based leukotriene biomarkers are a promising biomarkers for screening P-OSA in conjunction with other diagnostic aids, due to its high sensitivity. However, the diagnostic accuracy can be influenced by various factors, necessitating further studies to identify biomarkers with high precision in the diagnosis of P-OSA.

Objective: To propose a European consensus for managing and treating laryngopharyngeal reflux disease (LPRD) to guide primary care and specialist physicians.

Methods: Twenty-three European experts (otolaryngologists, gastroenterologists, surgeons) participated in a modified Delphi process to revise 38 statements about the definition, clinical management, and treatment of LPRD. Three voting rounds were conducted on a 5-point scale and a consensus was defined a priori as agreement by 80% of the experts.

Results: After the third round, 36 statements composed the first European Consensus Report on the definition, diagnosis, and treatment of LPRD. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring is the gold standard for diagnosing LPRD (> 1 pharyngeal reflux event) and treating the LPRD with personalized therapy. The empirical treatment needs to be based on diet, stress reduction, and alginates or antiacids to address the acidic and alkaline reflux events. Proton pump inhibitors are kept for patients with acidic LPRD and gastroesophageal reflux disease (GERD) findings. The treatment needs to be as short as possible (minimum two months). The medication can be progressively reduced for patients with relief of symptoms. Changing medication class can be considered for refractory LPRD rather than an increase in drug doses.

Conclusion: A consensus endorsed by the Confederation of European Otorhinolaryngology-Head and Neck Surgery Societies is presented to improve the management and treatment of LPRD. The approved statements could improve collaborative research through the adoption of common management approaches to LPRD.

Objective: To investigate the association between laryngopharyngeal reflux disease (LPRD) and Empty Nose Syndrome (ENS).

Methods: Nasal and laryngopharyngeal reflux symptoms were investigated in patients with ENS. Symptoms were evaluated with reflux symptom score-12 (RSS-12), nasal obstruction symptom evaluation (NOSE), empty nose syndrome 6-item questionnaire (ENS6Q), empty nose syndrome index (ENSI), and sinonasal outcome tool-22 (SNOT-22). The anxiety and depression were assessed with the general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). A study of association was conducted between demographics and patient-reported outcome questionnaires.

Results: Forty-one ENS patients were included (20 females (48.8%)). The control groups included 27 patients with rhinitis/rhinosinusitis and 36 asymptomatic individuals. The ENSI and ENS6Q detected ENS in 97.6% and 90.2% of cases, respectively. The mean scores of ENSI, ENS6Q, RSS-12, NOSE, and SNOT-22 were significantly higher in the ENS group compared to controls. The prevalence of suspected LPRD was 90.2% in the ENS group, which was significantly higher compared to controls. The prevalence of mild, moderate, moderately severe, and severe depression in ENS patients was 7.3% (n = 3), 4.9% (n = 2), 39.0% (n = 16), and 46.3% (n = 19), respectively. RSS-12 reported significant and high associations with the ENS6Q (r_s=0.939; p = .001) and ENSI (r_s=0.699; p = .001).

Conclusion: LPRD symptoms and prevalence were significantly higher in ENS patients compared to controls. Future controlled studies are needed to investigate the prevalence of LPRD in ENS patients through objective approaches (impedance-pH monitoring, nasal digestive enzyme measurements).

Objective: To investigate the impact of physician unawareness towards laryngopharyngeal reflux (LPR) on healthcare costs.

Methods: Patients with a confirmed LPR diagnosis were consecutively recruited from Belgian Hospitals. Demographics and clinical outcomes (impedance-pH testing features, reflux symptom score, and reflux sign assessment) were extracted. The past consultations and additional examinations dedicated to the investigation of laryngopharyngeal symptoms and findings without suspicion of LPR were collected. The estimated costs of consultations and procedures were those indicated in the National Health Insurance Institute's Charges for 2022. Part was reimbursed by the social security system, and the rest was paid by patients.

Results: Seventy-six patients were recruited. Seventeen patients (22.4%) had no previous consultation or additional examination for their LPR-symptoms. The estimated mean (standard deviation) costs related to the unawareness of LPR for the healthcare system and patient, were 310.06 ± 370.49 €, and 54.05 ± 46.28 €, respectively. The highest estimated costs were related to gastroenterology consultations and procedures, which did not lead to a confirmation of LPR diagnosis. The total estimated cost for the Belgian healthcare system and patients (11,590,000 million), could range from 359 359 540 € to 1 078 078 620 €; and 62 643 950 € to 187 931 850 €, respectively. The estimated costs related to gastroenterology practice of patients with severe disease were significantly higher than patients with mild disease.

Conclusion: The unawareness of practitioners toward LPR leads to significant costs for healthcare system and patients. The teaching and awareness towards LPR need to be improved in medical schools and clinical practice.

Background: The prevalence, role, and clinical relevance of Helicobacter Pylori (HP) in sinonasal tissues of patients with chronic rhinosinusitis remain unclear.

Objective: To investigate the prevalence and clinical relevance of Helicobacter Pylori (HP) in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSSNP).

Methods: Three investigators conducted a PubMed, Scopus, and Cochrane Library systematic review of the prevalence and clinical relevance of HP infection in CRS patients through the PRISMA framework. A bias analysis was conducted to identify potential heterogeneity and biases across studies.

Results: Of the 42 identified studies, 20 met the inclusion criteria, accounting for 741 CRS patients and 368 controls. HP was detected in 37.1% (n = 127/342) of polyps of CRSwNP patients with the polymerase chain reaction (PCR) and 32.7% (n = 37/113) of polyp tissue with the immunohistochemistry (IHC). Controls reported a nasal PCR and IHC detection rates of 14.8% (n = 36/243) and 3.6% (n = 3/84), respectively. The HP rate did not differ between CRSwNP and CRSsNP. Among patients with CRS, the enzyme-linked immunosorbent assay testing detected blood HP antigens in 48.7% (n = 74/152) of CRS patients and 41.6% (n = 37/89) of controls. The detection of HP in polyps was associated with the severity of gastroesophageal reflux disease (GERD). There was an important heterogeneity between studies for the inclusion criteria, methods of HP detection, and reflux outcomes.

Conclusion: Helicobacter Pylori can be detected in one-third of sinonasal tissues from patients with CRS and can be considered a biomarker of GERD. The potential role of HP in the development of CRS remains unclear. The heterogeneity between studies limits the drawing of valid conclusions.