European Archives of Oto-Rhino-Laryngology最新文献

Background: Laryngeal cancer (LC) is among the most prevalent tumors of the respiratory tract. In recent years, the implementation of non-surgical treatments like radiotherapy and chemotherapy has significantly enhanced the therapeutic outcomes for LC. Nevertheless, the underlying therapeutic mechanisms remain unclear, posing a hindrance to the progression of subsequent treatment strategies.

Objectives: To explore the potential mechanisms from existing effective treatments for LC and identify relevant targets, thereby providing guidance for subsequent therapeutic research on LC.

Methods: This study focuses on ferroptosis, a common type of non-apoptotic cell death that is closely linked to various malignancies. It examines the relationship between ferroptosis and LC by analyzing how regulating ferroptosis-related targets in LC cells can influence the development of the cancer.

Results: There is a strong association between ferroptosis and LC. Regulating the targets related to ferroptosis in LC cells can effectively counteract the progression of LC.

Conclusions: Taking ferroptosis as an entry point, analyzing its potential mechanism in inhibiting LC can provide a direction for the treatment of laryngeal cancer, which may contribute to the improvement of therapeutic strategies for this disease.

Purpose: The study's objective was to evaluate the safety and outcomes of stapes surgery in patients with Bellucci type 1 chronic otitis media.

Methods: The study group was composed of Bellucci type 1 chronic otitis media patients who were found to have stapedial footplate fixation during surgery for chronic otitis media. Stapedotomy and prosthesis insertion were performed during the same operation. The control group consisted of patients with an intact tympanic membrane who underwent stapedotomy for primary otosclerosis. The study and control groups comprised 11 and 16 patients, respectively. No preoperative or intraoperative perforation was present in the control group. We recorded the pre-and post-operative air conduction thresholds, the presence and degree of any air-bone gap (ABG) and documented any postoperative complications. A comparison was then made between the two groups.

Results: The mean preoperative air conduction threshold for patients in the study group was 51.73 dBHL, which improved to 33.27 dBHL after surgery. In the control group, the preoperative mean air conduction threshold was 50.13 dB HL, which also demonstrated significant improvement postoperatively, with a threshold of 29.5 dB HL. Preoperative ABG was 31.36 dBHL and 29.88 dBHL, respectively, in the study and control group. Postoperatively, ABG was reduced to 14.82 dBHL and 10.06dBHL in the study and control groups, respectively (p < 0.001).

Conclusion: The preliminary findings of the present study indicated that concurrent tympanoplasty and stapedotomy in Bellucci type 1 chronic otitis media patients could yield safe and effective outcomes. Further investigations should be conducted to set forth the benefits of a single-stage surgery over a series of staged surgeries.

Purpose: Optical magnification is crucial in ear surgery, ensuring the precise identification of anatomical structures. Traditionally, microscopes have been the standard due to their magnification and stereoscopic capabilities. However, the introduction of exoscopes has introduced new possibilities, particularly in ergonomics, teaching, collaboration, and surgical training. This cadaveric study aimed to evaluate the feasibility, effectiveness, and trainee performance when using the exoscope in ear dissection and to compare it with the traditional microscope.

Methods: This study involved 10 non-expert medical trainees who undertook a series of surgical tasks on cadaveric specimens using both the microscope and exoscope. The tasks included different surgical approach simulations and exercises. NASA Task Load Index and a Visual Analog Scale questionnaires were administered to assess participants' subjective experiences with each instrument.

Results: All participants successfully completed the assigned tasks with both the microscope and exoscope. While there were no significant differences in the timing of surgical steps between the two instruments, participants perceived the microscope as less physically demanding and temporally taxing, while the exoscope excelled in structural identification and offered benefits for teaching and collaboration.

Conclusions: The choice between microscope and exoscope should be guided by the specific surgical demands, educational context, and preferences of the team. While the microscope excels in flexibility, the exoscope provides advantages in structural identification and collaborative learning, making it a valuable tool in ear surgery. This study contributes valuable insights for otological surgeons and educators to optimize surgical outcomes and learning experiences of trainees.

Purpose: The purpose of this study is to examine the influence of allergic rhinitis (AR) and asthma on the incidence of otitis media (OM), which in turn serves as a mediator for the need for tympanostomy tube placement (TTP).

Methods: A comprehensive logistic regression analysis was performed, incorporating multiple variables to assess the relationship between AR, asthma, and the likelihood of TTP. OM was considered the mediating variable in this relationship. The analysis adjusted for a range of demographic and health-related covariates to ascertain the independent effects of the allergic conditions. Mediation analysis was utilized to evaluate the extent to which otitis media influences the association between AR and asthma and the need for TTP. Additionally, sensitivity analyses were conducted to assess the robustness of the findings against potential missing data.

Results: The study revealed significant associations between AR and asthma with the prevalence of OM, which in turn significantly increased the odds of TTP. Specifically, the odds ratios (ORs) for AR were 2.46, 2.44, and 2.19 across models 1, 2, and 3, respectively, indicating a robust correlation with TTP. Asthma also showed a consistent positive relationship with TTP, with ORs of 1.95, 1.94, and 1.56 for the respective models. Mediation analysis provided evidence that OM significantly mediated the relationship between AR and TTP, with an Average Causal Mediation Effect (ACME) of 0.02219, translating to 2.22% of the total effect being mediated through OM. For asthma, the ACME was 0.01395, indicating a 1.4% mediation effect. The Average Direct Effects (ADE) for AR and asthma were 0.03151 and 0.02084, respectively, suggesting substantial direct and indirect effects on TTP. Sensitivity analyses, accounting for missing data, further substantiated the robustness of these associations, with adjusted ORs for AR and asthma remaining highly significant.

Conclusion: The study concludes that AR and asthma are key drivers of OM, which acts as a mediator for TTP. The significant mediation effects highlight the importance of managing these allergic conditions to potentially reduce the incidence of ear infections and the necessity for TT surgery. Further research is encouraged to explore the intricate links between allergic conditions and otological health, facilitating the development of more effective clinical interventions.

Objective: To evaluate the impact of the COVID-19 pandemic on acute otitis media (AOM) and acute mastoiditis (AM) by analyzing longitudinal changes in disease incidence, clinical presentations, complications, and microbial patterns across pre-pandemic, pandemic, and post-pandemic periods.

Methods: A retrospective cohort study examining pediatric AOM and AM cases (age ≤ 15 years) at a tertiary medical center between March 2015 and February 2024. Cases were categorized into three periods: pre-COVID (March 2015-February 2020), lockdown (March 2020-February 2021), and post-lockdown (March 2021-February 2024). We assessed disease incidence, microbiology, complications, and clinical outcomes.

Results: Among 6,673 patients (6,221 AOM, 452 AM), AOM cases significantly decreased during lockdown (301/year) vs. pre-COVID (658/year) (p = 0.041) but returned to baseline in post-lockdown (758/year). AM showed similar trends without statistical significance. Complications of AM per case were highest during lockdown (0.52) vs. pre-COVID (0.39), with increased mastoidectomy rates (28% vs. 18.4%). Positive culture rates increased post-COVID (52.7-73.7%), and mean hospitalization duration was longest during lockdown (8.56 days vs. 7.96 pre-COVID, p = 0.005).

Conclusions: The COVID-19 pandemic induced a significant temporary reduction in acute otitis media and acute mastoiditis cases, primarily during lockdown periods. Despite the initial decrease, disease incidence returned to pre-pandemic baseline levels post-lockdown. Notably, the lockdown period showed higher complication rates and longer hospitalization durations, suggesting potential delays in medical care, but overall disease patterns remained fundamentally unchanged.

Purpose: To evaluate the ototoxicity of povidone iodine (PVP-I) at concentrations of 5% and 10% during tympanoplasty by assessing frequency-specific audiometric outcomes and graft success rates in a large cohort of patients.

Methods: This prospective, triple-blinded, randomized clinical trial enrolled 542 patients undergoing primary tympanoplasty. After excluding patients for inadequate follow-up, 204 ears received 10% PVP-I and 199 ears received 5% PVP-I. Audiometric evaluations, including bone conduction (BC), air conduction (AC), air-bone gap (ABG), and speech reception threshold (SRT), were conducted preoperatively and 12 months postoperatively. The primary outcome was the incidence of sensorineural hearing loss (SNHL), defined as an increase in BC threshold of more than 10 dB. Secondary outcomes included graft success rate and audiometric gains.

Results: The overall incidence of SNHL was 1.5% in the 10% PVP-I group and 1.0% in the 5% PVP-I group, with no significant difference (P = 1.000). In ears with preoperative mixed hearing loss, SNHL at 0.25 kHz was significantly higher in the 10% PVP-I group (28.9%) compared to the 5% PVP-I group (6.7%) (P = 0.002). Graft success rates were 94.1% and 97.0% in the 10% and 5% PVP-I groups, respectively (P = 0.164). No clinically significant differences in audiometric gains were observed between the groups.

Conclusion: Both 5% and 10% PVP-I concentrations are safe for antiseptic preparation in tympanoplasty, as evidenced by low rates of SNHL and high graft success rates. These findings support the use of PVP-I in human otologic surgery without significant ototoxic risk.

Purpose: Tall cell papillary thyroid cancer (tcPTC) is traditionally considered to be an aggressive subtype of differentiated thyroid cancer, although its independent prognostic value is unclear. To investigate the independent prognostic value of tall cell morphology a tcPTC cohort was compared with a classical PTC (cPTC) cohort.

Methods: A retrospective longitudinal study was performed using a cohort of tcPTC patients treated at Royal North Shore Hospital and Westmead Hospital in Sydney, Australia, and a cohort of cPTC patients treated at Westmead Hospital. Clinicopathological tumour characteristics and treatment pathways were analysed. Thyroglobulin and thyroglobulin antibody levels and further neck surgeries in the two years post thyroidectomy were used as a surrogate marker for early disease recurrence.

Results: Presentation and treatment were analysed for 51 tcPTC patients and a comparator group of 365 cPTC patients. On univariate analysis, tcPTC was found to present at an older age (53.6 years v 46.4 years, p < 0.01), with greater rates of positive surgical margins (31.37% v 16.44%, p < 0.05), and greater rates of microscopic (47.06% v 22.74%, p < 0.001) and gross extrathyroidal extension (15.69% v 6.30%, p < 0.05). Longitudinal analysis was conducted for 236 patients (n = 24 for tcPTC, n = 212 for cPTC). Multivariate analysis found no difference in the odds of developing early recurrence between the tcPTC cohort and the cPTC cohort (OR = 0.65, p > 0.1).

Conclusion: tcPTC is associated with more aggressive features compared with cPTC. Tall cell morphology was not found to be an independent predictor of early recurrence.

Objective: Intraoperative systems for monitoring facial nerve function, in which temporal electrical stimulation is applied to the facial nerve through electrodes, are used in many surgeries requiring facial nerve preservation; however, continuous stimulation or quantitative evaluation of facial nerve function is difficult with this approach. We examined the usefulness of a continuous and quantitative facial nerve-monitoring system for temporal bone lesions by using our experience to modify the existing methods used for cases involving vestibular schwannomas.

Study design: Retrospective observational study.

Setting: Department of Otorhinolaryngology-Head and Neck Surgery at our hospital.

Methods: We modified the electrode placement and examined the usefulness of the modified system under several conditions. The study population consisted of patients who were operated on for temporal bone lesions at our department and underwent continuous nerve monitoring using the modified system. Case details, electrode-placement sites, and facial nerve function data before and after the surgery were obtained and retrospectively evaluated.

Results: Electrodes were placed safely during surgery in all cases. No obvious deterioration in facial nerve function was observed, except in one case.

Conclusion: The advantages of this system include its ability to perform quantitative intraoperative evaluations and prevent unexpected nerve damage in cases where the facial nerve shows complicated pathways. This monitoring system is useful, even in complex temporal bone surgeries.