European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Volume injected for glottic insufficiency is paramount in achieving desired outcome. Factors that determine the required volume have not been thoroughly investigated and may correlate with outcome. The first objective of this investigation was to evaluate the association between injectable volume and various parameters, including lifestyle characteristics, pre-procedural factors, and voice measures, while the second aim assessed the correlation of volume to clinical outcomes in patients who underwent injection laryngoplasty.

Methods: For the first objective, a one-way ANOVA and univariate linear regression were used to analyze data from 124 patients (injected material, pre-operative diagnosis, previous voice therapy, age etc.). One-sample t-tests and Pearson correlational coefficients were employed for statistical analysis of aim 2 in a subgroup of 28 patients that had pre- and post-injection voice evaluations (e.g., acoustic and aerodynamic analysis, perceptual assessment, questionnaires).

Results: Average injection volume was 0.39 ± 0.062 mL (range: 0.1-1.6mL). No pre-procedural or lifestyle factor significantly affected injection volume (p > 0.05). There was no relationship between pre-procedural voice outcomes and injection volume (p > 0.05). Of the factors that were significantly improved post-injection laryngoplasty (GFI, VHI, and GRBAS), there were no significant correlations between the magnitude of improvement in these measures and injection volume (p > 0.05).

Conclusion: Injection volume does not appear to be affected by pre-procedural or lifestyle factors. In addition, injection volume does not significantly impact clinical outcomes assessed through voice analysis or patient-reported questionnaires. Our results underscore the complexity of factors at play in injection laryngoplasty for glottic insufficiency.

Purpose: As online health information-seeking surges, concerns mount over the quality and safety of accessible content, potentially leading to patient harm through misinformation. On one hand, the emergence of Artificial Intelligence (AI) in healthcare could prevent it; on the other hand, questions raise regarding the quality and safety of the medical information provided. As laryngeal cancer is a prevalent head and neck malignancy, this study aims to evaluate the utility and safety of three large language models (LLMs) as sources of patient information about laryngeal cancer.

Methods: A cross-sectional study was conducted using three LLMs (ChatGPT 3.5, ChatGPT 4.0, and Bard). A questionnaire comprising 36 inquiries about laryngeal cancer was categorised into diagnosis (11 questions), treatment (9 questions), novelties and upcoming treatments (4 questions), controversies (8 questions), and sources of information (4 questions). The population of reviewers consisted of 3 groups, including ENT specialists, junior physicians, and non-medicals, who graded the responses. Each physician evaluated each question twice for each model, while non-medicals only once. Everyone was blinded to the model type, and the question order was shuffled. Outcome evaluations were based on a safety score (1-3) and a Global Quality Score (GQS, 1-5). Results were compared between LLMs. The study included iterative assessments and statistical validations.

Results: Analysis revealed that ChatGPT 3.5 scored highest in both safety (mean: 2.70) and GQS (mean: 3.95). ChatGPT 4.0 and Bard had lower safety scores of 2.56 and 2.42, respectively, with corresponding quality scores of 3.65 and 3.38. Inter-rater reliability was consistent, with less than 3% discrepancy. About 4.2% of responses fell into the lowest safety category (1), particularly in the novelty category. Non-medical reviewers' quality assessments correlated moderately (r = 0.67) with response length.

Conclusions: LLMs can be valuable resources for patients seeking information on laryngeal cancer. ChatGPT 3.5 provided the most reliable and safe responses among the models evaluated.

Purpose: Large language models continue to dramatically change the medical landscape. We aimed to explore the utility of ChatGPT in providing accurate, actionable, and understandable generative medical translations in English, Spanish, and Mandarin pertaining to Otolaryngology.

Methods: Responses of GPT-4 to commonly asked patient questions listed on official otolaryngology clinical practice guidelines (CPG) were evaluated with the Patient Education materials Assessment Tool-printable (PEMAT-P.) Additional critical elements were identified a priori to evaluate ChatGPT's accuracy and thoroughness in its responses. Multiple fluent speakers of English, Mandarin, and Spanish evaluated each response generated by ChatGPT.

Results: Total PEMAT-P scores differed between English, Mandarin, and Spanish GPT-4 generated responses depicting a moderate effect size of language, Eta-Square 0.07 with scores ranging from 73 to 77 (P-value = 0.03). Overall understandability scores did not differ between English, Mandarin, and Spanish depicting a small effect size of language, Eta-Square 0.02 scores ranging from 76 to 79 (P-value = 0.17), nor did overall actionability scores Eta-Square 0 score ranging 66-73 (P-value = 0.44). Overall a priori procedure-specific responses similarly did not differ between English, Spanish, and Mandarin Eta-Square 0.02 scores ranging 61-78 (P-value = 0.22).

Conclusion: GPT-4 produces accurate, understandable, and actionable outputs in English, Spanish, and Mandarin. Responses generated by GPT-4 in Spanish and Mandarin are comparable to English counterparts indicating a novel use for these models within Otolaryngology, and implications for bridging healthcare access and literacy gaps.

Level of evidence: IV.

Purpose: This study aimed to investigate the hearing outcomes in patients with sudden sensorineural hearing loss without vertigo (SSNHLwoV).

Methods: Patients with SSNHLwoV managed from December 2016 to March 2020 were prospectively enrolled in an academic tertiary referral center. Fifty-one patients with SSNHLwoV who completed high-dose steroid treatment. The hearing prognosis was analyzed using a multivariate Cox regression model.

Results: The rates of complete, partial, and no hearing recovery were 52.9%, 17.6%, and 29.4% in patients with SSNHLwoV, respectively. The video head impulse test (vHIT) of the posterior semicircular canal (PSC), high-tone hearing loss (4-8 kHz) ≥ 30 dB, and average hearing threshold (0.5-1-2-4 kHz) were significantly associated with incomplete recovery of hearing after treatment. In multivariate analysis, the vHIT of the PSC (hazard ratio [HR], 14.502; 95% confidence interval [CI], 1.371-153.355) and high-tone hearing loss ≥ 30 dB (HR, 9.170; 95% CI, 2.283-36.830) remained robust.

Conclusions: Abnormal vestibular function tests were performed in 80.4% of the patients with SSNHLwoV. Abnormal vHIT of the PSC and high-tone hearing loss ≥ 30 dB were independent factors resulting in incomplete recovery of hearing in patients with SSNHLwoV. In the SSNHLwoV cohort, the caloric test was not significantly associated with hearing prognosis, and vHIT was a feasible predictor of treatment outcome.

Purpose: The retrolabyrinthine approach is a surgical method designed to preserve hearing after surgery. When paired with intraoperative monitoring and an endoscope, this approach has demonstrated high rates of postoperative hearing preservation. However, the long-term prognosis of hearing preservation after utilizing this approach for vestibular schwannomas remains unexplored. This study aimed to examine the long-term outcomes of preserved hearing, providing insights into the suitability of the retrolabyrinthine approach for hearing preservation surgery.

Methods: This study included 34 patients with preserved hearing after vestibular schwannoma surgery using the retrolabyrinthine approach at a single center. Long-term hearing prognosis and requirement for additional interventions were retrospectively examined.

Results: Immediate after post-operative hearing preservation rate was 71.7%. Among the 34 patients with preserved hearing post-vestibular schwannoma surgery, four (11.8%) required additional interventions. Other patients experienced a gradual deterioration in their hearing status, with an approximate 10 dB decline during the 5-year follow-up; however, a serviceable hearing level persisted long after the surgery in these individuals.

Conclusions: This study indicated the rationale for the retrolabyrinthine approach as a hearing preservation surgery for vestibular schwannomas, emphasizing its long-term hearing prognosis.

Objective: The aim of this study was to conduct a bibliometric and visualization analysis of research on cochlear implantation (CI) for inner ear malformations (IEMs) from 1986 to 2024.

Methods: A comprehensive literature search was performed using the Web of Science Core Collection Database, resulting in the identification of 431 relevant publications. Various data analysis and visualization tools, including VOSviewer, CiteSpace, and Bibliometrix, were utilized to analyze annual publication outputs, countries/regions and institutions, authors, journals and studies, keywords, and theme evolution.

Results: The study revealed an overall increasing trend in research output on CI for IEMs, with significant contributions from countries such as the United States, China, Turkey, Germany, and Italy. The analysis also identified key authors, research teams, journals, and studies that have made substantial contributions to the field. Furthermore, the study highlighted important research hotspots and trends, such as the classification of IEMs, outcomes of CI for IEMs, and the management of pediatric patients with IEMs.

Conclusion: The findings of this study provide a comprehensive overview of the research landscape surrounding CI for IEMs. The results serve as a basis for future research topic selection and emphasize the need for enhanced international collaboration and the publication of high-impact research to further advance this field.

Introduction: A cupulolithiasis of the lateral semicircular canal is an accumulation of otolithic debris at the level of the cupula of the same canal. Its pathophysiology generally generates a specific clinical presentation. This situation can be very disabling for the patient and tricky to treat for the clinician.

Case report: The patient was a 70-year-old man with cupulolithiasis of the right lateral semicircular canal. We present here the conversion of cupulolithiasis to canalolithiasis using the Thomas Richard Vitton (TRV) repositioning chair, as well as the treatment of this canalolithiasis through a mechanical liberation maneuver.

Conclusion: The results of manual therapeutic maneuvers for Benign Paroxysmal Positional Vertigo (BPPV) are generally good regardless of the type of BPPV. It can sometimes be more challenging to resolve an ageotropic-type BPPV of the lateral semicircular canal and mechanically-assisted maneuvers using a repositioning chair may be required. Faced with symptom resistance despite attempts at multiple liberatory maneuvers, clinicians must be able to reconsider their initial diagnosis and investigate other potentially more serious origins of these symptoms. The TRV chair can be a treatment option in the management of cupulolithiasis, especially in cases where classic reduction maneuvers do not always yield good results.

Purpose: Our study aims to assess the open-fitting capabilities and vent properties of traditional open-fitting behind-the-ear (open BTE) hearing aids to instant-fit open-fitting completely-in-the-canal (open CIC) systems.

Methods: The study analysed data from 40 patients grouped in two groups based on the used hearing aids. Free field pure tone and speech audiometry were performed to obtain the free-field pure tone average and free-field word recognition score (WRS). The matrix sentence test was employed to evaluate the auditory performance and functional outcomes of patients. The Satisfaction with Amplification in Daily Life (SADL) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire were used to assess the personal satisfaction and benefit provided by the hearing aid. Real ear measurements were conducted to objectively evaluate the Real-Ear Unaided Gain (REUG) and Real-Ear Occluded Gain (REOG) of the two groups. For this purpose, six frequency bands (band 1 from 125 to 200 Hz, band 2 from 250 to 400 Hz, band 3 from 500 to 800 Hz, band 4 from 1000 to 1600 Hz, band 5 from 2000 to 3150 Hz, and band 6 from 4000 to 6300 Hz) were defined and compared.

Results: Free-field WRS exhibited a significant difference (p-value = 0.004) between open BTE and open CIC, with better results for the open BTE. Matrix test speech reception threshold scores did not differ significantly between groups. No statistical significant difference were observed between APHAB and SADL total scores. Correlation tests revealed a negative correlation between SRT and APHAB scores in the open BTE group, not seen in the open CIC. No statistically significant difference was observed for all bands of REUG values, demonstrating comparability in terms of acoustic resonance of the external auditory canal. Comparing the REOG recorded in the two groups a significant difference was observed for bands 2 through 6. While the average REOG values for bands 5 and 6 were higher in patients with traditional open BTE aids, in contrast, for bands 2, 3, and 4, the REOG values for the open CIC group were higher and statistically significant compared to patients wearing traditional open-fitting BTE hearing aids.

Conclusion: Patients with open CIC seem to perform worse in quiet environments compared to noisy ones, as indicated by the free field WRS score. However, the absence of differences in functional performance assessed with the matrix sentence test, and in the psychosocial aspects, makes these devices a good solution for individuals who reject hearing aids due to aesthetic concerns. The differences in terms of real ear measurements, while statistically significant, do not negatively impact overall performance.

Purpose: In Japan, two types of tests for diagnosing olfactory disorders, T and T (T&T) olfactometry and intravenous olfactory tests, are covered by insurance and performed on patients with olfactory disorders. This study examined the validity of these olfactory tests and whether psychophysical or morphological tests are more helpful in evaluating olfactory disorders.

Methods: We evaluated patients who visited our department and underwent two types of olfaction tests and sinus computed tomography (CT). Data regarding the age, sex, peripheral blood eosinophil percentage, presence of bronchial asthma, diagnoses, olfactory symptom score, results of the two olfactory tests, and CT findings in eligible patients were extracted from medical records and retrospectively reviewed.

Results: One hundred and sixty-three patients underwent all tests during the study period. The results of the T&T olfactometry and intravenous olfactory tests were significantly correlated. However, only the results of T&T olfactometry and olfactory cleft opacification on CT were statistically significant predictors of the olfactory symptom scores.

Conclusion: T&T olfactometry and CT evaluations of olfactory cleft opacification helped evaluate olfactory dysfunction. It is important to note that intravenous olfactory tests are best performed with careful control and not blindly to assess olfactory disorders.

Puropse: The aim of this study was to evaluate the sensory processing skills, quality of life and balance performance in adult cochlear implant users.

Methods: A sample of 40 individuals was studied in two groups; 20 normal hearing individuals (37.84 ± 15.39 years old) and 20 cochlear implant users (35.58 ± 11.22 year old). Balance performance was assessed by Computerized Dynamic Posturography. The Adolescent/Adult Sensory Profile completed by the individual was used to assess sensory processing skills. Finally, quality of life was assessed with the Short Form-36.

Results: Among the different sensory processing parameters in the adolescent/adult sensory profile, a significant difference was found between the two groups in the parameters of low registration, sensory sensitivity and sensory avoidance (p < .05). Visual, vestibular and composite scores were found to be lower in cochlear implant users by Computerised Dynamic Posturography assessment (p < .05). When assessing quality of life, emotional well-being and social functioning parameters were found to be lower in cochlear implant users (p < .05).

Conclusion: Factors such as the inability to reach sufficient auditory stimuli due to hearing loss and the occurrence of vestibular problems after cochlear implant surgery limit the quantity and quality of sensory stimuli from the environment. Individuals with cochlear implants may prefer to live isolated from society because they cannot adequately process incoming sensory stimuli due to hearing/balance problems, and this may negatively affect the quality of life of individuals. Our findings revealed the necessity of multisensory assessment and therapy protocols when rehabilitating individuals with cochlear implants.