European Archives of Oto-Rhino-Laryngology最新文献

Background: Vocal fold leukoplakia (VFL), a precancerous lesion of the larynx, is characterized by white plaques on the vocal fold mucous membrane. Currently, there are no reliable biomarkers to predict the recurrence and malignant transformation of VFL. Considering chondroitin sulfate proteoglycan 4 (CSPG4) as a biomarker for malignant tumors such as laryngeal squamous cell carcinoma (LSCC), we conducted this cohort study to evaluate the prognostic influence of CSPG4 expression on VFL patients.

Methods: This study included 44 patients with surgical intervention of VFL. CSPG4 expression in VFL were observed using immunohistochemistry, and the relationship between the prognosis of VFL patients and CSPG4 expression were investigated using Spearman correlation analysis and multiple Cox regression models.

Results: During a median follow-up of 89.3 months, recurrence occurred in 19 postsurgical VFL patients, and malignant transformation occurred in 10 patients. The recurrence and malignant transformation group showed significant differences in the H-SCORE of CSPG4 (P = 0.005 and P = 0.045) compared to the the non-recurrence group and the non-malignant transformation group. And the CSPG4 expression level was positive correlation with recurrence and malignant transformation (0.306 or 0.416, spearman correlation confident). Receiver operating characteristic curve analysis indicated that CSPG4 H-SCORE has predictive value for poor prognosis (areas under the curve, 0.742 and 0.710; cut-off points, 82.5 and 177.5, respectively). Multiple Cox regression analysis revealed a statistically significant effect of lesion size (P = 0.014) and CSPG4 H-SCORE (P = 0.005) on recurrence as well as pathological type (P = 0.001) and CSPG4 H-SCORE stratified by 177.5 (P = 0.039). Our survival data indicated that higher CSPG4 expression was associated with a shorter time of recurrence (P = 0.003) and tumorigenesis (P<0.001).

Conclusion: CSPG4 overexpression indicates higher risks and shorter time of postoperative VFL recurrence and tumorigenesis. Detection of CSPG4 expression in VFL may be a novel approach to assess the outcome of VFL patients.

Objectives: we evaluated the hypothesis that level of ctHPVDNA on the first postoperative day (POD-1); and at 15 days (POD-15) could be associated with the need for adjuvant therapy and the presence of recurrence.

Materials and methods: this is a prospective observational study on biomarkers, focusing on the longitudinal monitoring of ctHPVDNA in a cohort of HPV-OPSCC patients undergoing TORS. Blood samples were collected according to the following schema: (1) pretreatment; (2) on first postoperative day (POD 1); and (3) at 15 days (POD 15). Plasma samples were analyzed with ddPCR assay comprising E6 of HPV16, HPV 33 and HPV 35.

Results: Present study was conducted on 44 OPSCC patients and revealed a ctHPVDNA sensitivity of 100% (95%CI: 89-100%) in blood samples at first diagnosis. Data demonstrated a significant different of ctHPVDNA levels at POD-1 among patients who received observation vs. adjuvant treatment and among patients who remained disease-free at the last follow-up, compared to those who experienced recurrence. In the next years, studies on larger patients' surgical cohorts focused on ctHPVDNA levels at POD-1 and continued improvements in assay methodology could allow the implementation of ctHPVDNA in routine clinical use.

Conclusion: Liquid biopsy could identify residual molecular disease after surgery and guide clinicians choosing adjuvant treatment.

Purpose: Tympanoplasty is a surgical procedure performed to cure middle ear infections and restore normal middle ear function. It is one of the most common procedures in otological surgery. Since Wullstein described tympanoplasty, the microscope has been a widely used surgical tool in otological surgery. Transcanal endoscopic ear surgery (TEES) has come to the forefront as an alternative option due to the various limitations of microscopic surgery and the development of otological surgical techniques. When reviewing the types and tecniques of grafts used in tympanoplasty in the current literature, it is clear that the ideal graft material and tecnique to meet all needs has not yet been found. The objective of this study is to describe a novel graft technique, a modification of the cartilage-perichondrium graft obtained from tragal cartilage, which is believed to represent an optimal solution for the desired graft technique at the highest level.

Material&method: The study included 40 patients who underwent endoscopic annular chondroperichondrial tympanoplasty at Hatay Mustafa Kemal University Hospital between 2015 and 2022. All patients underwent clinical otological examination and pure tone audiometry before and after surgery. Hearing results were expressed as pure tone mean air-bone gap (ABG) at 4 frequencies (500,1000,2000,4000 Hz). For all operations, the primary surgeon was the second author. Patients with inadequate follow-up, revision surgery, inflammatory middle ear mucosa, perforation etiology other than chronic otitis media were not included in the study.

Results: No complications were observed in the patients included in the study. Accordingly, the graft was intact at the end of the 6th month in 38 of the 40 patients operated on. The graft success rate was 95%. The mean preoperative PTA-ABG was 22.1. The mean post-operative PTA-ABG was 5.7. Mean closed PTA-ABG was 16.4.

Conclusion: In parallel with the development of otological surgical technologies, endoscopy is becoming increasingly important in tympanoplasty. We believe that our technique, endoscopic annular chondroperichondrial tympanoplasty, will be an important step in the search for the ideal grafting technique.

Purpose: The escalating number of endoscopic skull base procedures necessitates exploring additional materials to reduce postoperative cerebrospinal fluid (CSF) leaks in revision or staged surgeries. This study evaluates the effectiveness of reused nasoseptal flaps (NSFs) in such clinical scenarios.

Methods: A retrospective review was conducted on patients who previously underwent surgery involving NSFs and later had revision or secondary skull base surgeries via endoscopic endonasal approaches (EEAs) at a tertiary medical center. Patients were divided into two groups: one with reused NSFs and the other without. Demographics, intraoperative CSF leaks, reconstruction materials, postoperative morbidity, and time to complete mucoepithelialization of the defect were analyzed.

Results: The study included 20 patients with prior NSF usage who underwent secondary EEAs. Thirteen cases utilized reused NSFs alone or with inlay fat or fascia lata, while the remaining seven employed other materials. Pathology type disparity was significant (p = 0.031). Reused NSF demonstrated a 100% success rate in reducing CSF leaks. The average time for mucoepithelization was 61 days (SD = 34 days).

Conclusions: Reusing NSF in revision or staged surgeries is a reliable technique for skull base repair, potentially reducing nasal morbidity and obviating the need for harvesting other vascular flaps.

Purpose: To evaluate the efficacy of tonsillectomy and/or adenoidectomy for the treatment of nocturnal enuresis (NE) in children with obstructive sleep apnea (OSA).

Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to December 2023. We included all studies of children with OSA and NE who underwent adenoidectomy and/or tonsillectomy. Risk of bias assessment and meta-analyses of included studies were performed. The sources of heterogeneity were explored through subgroup analyses.

Results: The combined overall remission (OR), complete remission (CR), and partial remission (PR) were 67%, 57%, and 4%, respectively, in NE children who underwent adenoidectomy and/or tonsillectomy. Therein, the pooled OR and CR of primary nocturnal enuresis in children with OSA were 67% and 59%, respectively. The pooled OR and CR of children who were treated with adenotonsillectomy (T&A) were 72% and 65%, respectively. The pooled OR and CR of children with OSA aged > 5 years were 67% and 58%, respectively. The pooled OR and CR of postoperative follow-up of ≤ 3 months were 64% and 52%, respectively. The pooled OR and CR of NE based on RCT studies were 37.3%.

Conclusion: The remission rate of NE children who underwent adenoidectomy and/or tonsillectomy was more than half. While the remission rate was significantly lower when RCT studies were included. This suggested that the actual NE remission rate may be lower than expected. Further studies with large sample sizes and control groups are expected to confirm the position of adenoidectomy and/or tonsillectomy in NE treatment.

Purpose: This study examined the effects of individualized dietary modifications based on the volume-viscosity swallow test (V-VST) on functional oral intake, incidence of pneumonia, and swallowing-related quality of life in individuals with intracerebral hemorrhage.

Methods: One hundred and seven participants with signs of dysphagia in the acute and early subacute phases of stroke following intracerebral hemorrhage were randomly assigned into an experimental group for individualized dietary modifications based on V-VST plus routine standard care (n = 53), and a control group for routine care alone (n = 54). Incidence of pneumonia, functional oral intake scale (FOIS) ratings and Eating Assessment Tool (EAT-10) scores before and after intervention were evaluated.

Results: A significantly lower incidence of pneumonia was found in the experimental group than in the control group (p < 0.05). Significant group differences were found in functional oral intake and in quality of life, with significantly higher FOIS ratings and significantly lower EAT-10 scores in the experimental group post-intervention (p < 0.001).

Conclusion: These findings suggested that despite being a noninstrumental screening tool, V-VST could facilitate individualized dietary modifications and could be an effective clinical option for reducing the risk of pneumonia, improving functional oral intake and enhancing quality of life in individuals with dysphagia following intracerebral hemorrhage. Future studies should explore how dietary modifications could be more precisely implemented based on the International Dysphagia Diet Standardization Initiative framework.

Purpose: Acute acoustic trauma (AAT) is a sudden sensorineural hearing loss (SNHL) due to exposure to high intensity impulse noise. There are no acceptable treatment guidelines, although several studies showed steroids could be effective in restoring hearing levels. A recent report suggested that steroids combined with hyperbaric oxygen therapy (HBOT) are a superior regiment for AAT. The purpose of the current study is to investigate the effectiveness of steroids and HBOT for AAT treatment.

Methods: the medical records 90 patients (118 ears) afflicted with AAT and treated with steroids and HBOT were retrospectively reviewed. Inclusion criteria were sensorineural hearing loss of at least 30 dB at the high frequency range (> 3,000 Hz) following exposure to intense sound. Patients who started treatment within 7 days were classified as "Early treatment" group whereas patients who started treatment ≥ 8 days after AAT were classified as "Late treatment".

Results: The high frequency (3-8 kHz) Pure Tone Average (hPTA) of the entire study population (n = 118) was 40.26 ± 15.42 dB pretreatment vs. 24.99 ± 15.83 dB post treatment (Wilcoxon matched-pairs test, P < 0.0001). Pre-treatment hPTA was not statistically different between early and late study groups, 39.87 ± 16.00 vs. 40.86 ± 14.35 dB in the early vs. late group, respectively (ANOVA, F[3,232] = 22.574, P > 0.05). The post-treatment hPTA on the other hand, was significantly lower in the early vs. late treatment groups (21.93 ± 15.38 vs.31.19 ± 15.09 dB, respectively; ANOVA, F[3,232] = 22.574, P < 0.05).

Conclusion: Combination treatment with corticosteroids and HBOT is highly beneficial in improving hearing outcomes following AAT, when initiated within 7 days. This study was retrospectively registered on July 19th 2020 and assigned the identifier number NCT04482998.

Purpose: Vestibular neuritis (VN) is a common cause of vertigo with significant impact on patients' quality of life. This study aimed to analyze global research trends in VN using bibliometric methods to identify key themes, influential authors, institutions, and countries contributing to the field.

Methods: We conducted a comprehensive search of the Web of Science Core Collection database for publications related to VN from 1980 to 2024. Bibliometric data including publication year, keywords, citations, authors, journals, institutions, and countries were extracted and analyzed using VOSviewer software.

Results: A total of 624 publications were identified, showing a steady increase in VN research output, particularly after 2003. South Korea and the USA were the most prolific countries, while Acta Oto-Laryngologica and Otology & Neurotology were the leading journals in terms of publication count. Michael Strupp emerged as the most productive author. Keyword analysis revealed prominent research themes including diagnosis, treatment (vestibular rehabilitation, pharmacological interventions), pathophysiology, and the impact of VN on vestibular function.

Conclusions: This bibliometric analysis provides a comprehensive overview of global VN research. The findings highlight the growing research interest in VN, with a focus on improving diagnostic accuracy, optimizing treatment strategies, and understanding the underlying mechanisms. This study can serve as a valuable resource for researchers, clinicians, and policymakers interested in the field of VN.

Background and purpose: To evaluate various anatomical parameters and their relationship to chorda tympani nerve (CTN) injury and round window (RW) access during cochlear implantation.

Materials and methods: Ultra-high-resolution CT images of 66 patients were retrospectively reviewed and compared with operative reports. The facial recess and the round window were analyzed, mainly using the chorda-facial angle (CFA), the width of the facial recess, the CTN-tympanic annulus distance, the RW-mastoid portion of the facial nerve angle, and the type of RW.

Results: Surgical management of the CTN was uneventful in 59 patients, whereas surgical difficulty occurred in 7, with significant differences only between the CTN-tympanic annulus distance and the RW-mastoid portion of the facial nerve angle (P ≤ 0.04). The optimal cut-off values for predicting surgical difficulty were 0.95 mm and 19°, respectively, with sensitivity, specificity, positive, and negative predictive values of 0.71, 0.67, 0.2 and 0.95 for the distance, and 0.57, 0.95, 0.57 and 0.94 for the angle, respectively. The RW was accessible in 51 patients and cochleostomy was performed in 15 patients, without significant difference between radiological parameters, especially concerning the CFA.

Conclusion: A CTN-tympanic annulus distance greater than 0.95 mm may help to predict a non-negligible risk of CTN surgical damage, and a RW thinner than 1.85 mm may require exploring the possibility of a cochleostomy approach.