European Archives of Oto-Rhino-Laryngology最新文献

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:

Purpose: Listening effort increases as background noise levels rise, affecting both children and adults. Understanding the impact of increased listening effort and identifying effective methods to estimate it in children is crucial, as higher listening effort can hinder learning. This systematic review and meta-analysis examined the effects of noise on listening effort, as measured using various methods, in children aged 5 to 13 years with normal hearing.

Methods: Four scientific databases, PubMed, Scopus, Cochrane Library, and Web of Science, were searched to retrieve 23 eligible articles. The methodological quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Meta-analysis was performed according to different methods of listening effort [behavioral (single-task paradigm and dual-task paradigm), subjective ratings, and physiological (pupillometry)].

Results: Single-task paradigm and subjective ratings showed a medium effect of noise on listening effort, which was significant. Dual-task paradigm and pupillometry did not show statistically significant effects of noise on listening effort. Further, speech perception tasks show a greater effect of noise on listening effort as compared to listening comprehension.

Conclusions: Single-task paradigm and subjective rating methods revealed the negative effect of noise on listening effort during spoken language processing in children between 5-13 years of age. Thus, a combination of these two methods might provide useful information regarding the effect of noise on this population. The heterogeneity in the findings could be due to the multidimensional nature of listening effort and lack of construct validity of the methods used to assess listening effort.

Purpose: The aim of this study was to investigate the effects of prognostic nutritional index (PNI), systemic immune inflammation index (SII) and hemoglobin, albumin, lymphocyte, platelet (HALP) score on fistula formation, recurrence and mortality in patients with laryngeal cancer.

Method: The study included 77 patients who underwent total laryngectomy operation between 2018 and 2021. 66 (85.7%) patients underwent primary and 11 (14.3%) patients underwent salvage total laryngectomy. PNI, SII and HALP scores and cutt-off values of all patients were determined and the relationships between pharyngocutaneous fistula (PCF) formation, recurrence and mortality were statistically analysed. The patients with a score less than the cut-off value were divided into two groups as Group 1, and the patients with a score equal to or greater than the cut-off value were divided into two groups as Group 2.

Results: The effect of PNI, SII and HALP on the development of FKF was not significant (P = 0.110, P = 0.135, P = 0.358). The effect of high SII and low HALP score on the development of recurrence was statistically significant (P = 0.001, P = 0.012). Low PNI increased the development of recurrence, but this increase was not statistically significant (P = 0.075). Overall survival rate was 68.8%. The effect of low PNI and HALP on survival was statistically significant (P = 0.011, P = 0.021). The effect of high SII on survival was not significant (P = 0.533).

Conclusion: Low PNI index and HALP score and high SII index are cost-effective simple prognostic biomarkers that are significant in the development of FCF, as well as in the evaluation of recurrence and overall survival in the long-term follow-up of these patients.

Introduction: This study aimed to investigate the relationship between DOI (Depth of Invasion) and metastasis to the neck lymph nodes in patients with laryngeal squamous cell carcinoma (LSCC).

Methods: This cross-sectional observational study was conducted on all patients diagnosed with LSCC who underwent total laryngectomy and neck dissection between 2014 and 2021. DOI was measured in millimeters by a pathologist who examined the patients' specimens. Demographic information and tumor characteristics were collected and analyzed.

Results: The study included 62 patients with LSCC, of whom 23 (37%) had cervical lymph node metastasis. There were 54 (87%) male. The mean DOI was (9.91 ± 1.60) mm in the metastatic group and (7.56 ± 1.42) mm in the non-metastatic group. The results showed that tumors with a higher DOI had a higher probability of cervical lymph node metastasis ( p < 0.001), but there was no significant correlation between DOI and the number of involved lymph nodes (p = 0.318). The analysis also revealed that poorly differentiated tumors (p. value < 0.001), male patients (p. value < 0.001), and older patients (p. value < 0.001) had a higher DOI.

Conclusion: According to our results, DOI can be an important predictive factor in predicting cervical lymph node metastasis in LSCC. Therefore, measuring DOI can assist surgeons in decision-making for neck dissection. It is recommended that DOI be determined during surgery using frozen sections or pre-operatively with deep biopsy samples. Considering that laryngeal cancer with cervical lymph node metastasis has a worse prognosis, it could be concluded that greater DOI predicts worse prognosis.

Purpose: To investigate how endolymphatic hydrops (EH) affects the entry of intratympanic gadolinium in the inner ear of patients with Meniere's disease (MD).

Materials and methods: This study included 166 MD patients. MRI was performed 24 h after intratympanic injection of dexamethasone and 20-fold diluted Gd-DTPA. The region of interest with the strongest enhancement in the cochlea and vestibule was selected to calculate the signal intensity ratio (SIR), representing transport speed. The enhancement area in the vestibular perilymph, indicating the distribution volume of Gd-DTPA, was measured.

Results: EH was detected in 77.7% of patients, specifically in 60 out of 63 definite MD cases and 51 out of 103 probable MD cases. Vestibular EH with various grades was present in 76.1% of patients, whereas 17.5% exhibited impaired barriers of endolymph. Cochlear EH with various grades was observed in 68.7% of patients, and 34.9% located at the apex; 12.7% had impaired barriers of endolymph. The severity of cochlear symptoms and the stage of MD significantly correlated with the presence of EH. The vestibular SIR inversely correlated with vestibular EH. The enhancement area of the vestibular perilymph inversely correlated with EH and the stage of MD.

Conclusions: Gadolinium transport from the middle ear into the inner ear and the distribution volume in the inner ear inversely correlated with EH, which is compromised in more advanced stages MD patients.

Objective: To characterize research on inflammation in CRS over the past 23 years, and analyze trends in hotspots, and collaboration networks.

Methods: We conducted a methodological, objective, and extensive analysis of inflammation in CRS to track research trends and hotspots. Original research literature published between 2000 and 2023 was obtained from The Web of Science Core Collection (WoSCC) database. Data on country/region, institution, author, journal, keywords, and references were extracted using VOSviewer and CiteSpace for analysis.

Results: The number of publications on inflammation in CRS has significantly increased over the past 23 years. The United States has been the most prolific contributor in terms of publications and collaborations. The top 10 high-frequency keywords were "chronic rhinosinusitis," "nasal polyps," "asthma," "inflammation," "sinusitis," "rhinosinusitis," "eosinophils," "nasal polyposis," "chronic rhinosinusitis with nasal polyps," and "allergic rhinitis." The timeline view revealed changes in keywords over time, with endotype and biologics emerging as recent hotspots.

Conclusions: Substantial improvement has been made in the study of inflammation in CRS. The United States leads with the most published articles, productive institutions, and influential journals. Strengthening collaborations between institutions and countries is recommended. The current focus is primarily on immunotherapy, and inflammation in CRS is likely to continue being a prominent topic.

Purpose: To introduce a novel technique utilizing a pedicled ventricular mucosal flap (PVMF) following one-stage, radical resection of T1b glottic cancer with anterior commissure involvement by transoral laser surgery, and to explore the oncological and functional outcomes, as well as its efficacy in preventing postoperative anterior glottic web formation.

Methods: Twelve patients diagnosed with T1bN0M0 glottic cancer involving anterior commissure underwent one-stage, radical resection of tumor by transoral laser surgery combined with PVMF between January 2021 and June 2023. The relative vocal fold length and Voice Handicap Index-10(VHI-10) scores at 6 months postoperatively were measured. The 1-year local control rate was measured.

Results: The median age was 64.5 years (range, 50-85). The median follow-up time was 19.5 months (range, 12-37 months). The 1-year local control rate was 100%. The healed pedicled ventricular mucosal flap exhibited the appearance of a mucosal eminence with smooth surface at the anterior part of the glottic region. The mean relative vocal fold length was 0.80 ± 0.23. At 6 months postoperatively, 50% (6/12) had no anterior glottic web formation. The median VHI-10 scores preoperatively and at 6 months postoperatively was 19.3 ± 3.9 (range, 11-24) and 10.0 ± 7.3 (range, 3-28) respectively, showing a significant difference (P < 0.05).

Conclusion: Transoral laser surgery combined with PVMF is an effective, stent-less, one-stage surgical approach for selective T1bN0M0 glottic cancer with anterior commissure involvement, effectively reducing the risk of anterior glottic web formation. The oncological outcomes in the cohort are promising, with 1-year local control rate of 100%; however, long-term follow up is still necessary.

Objective: Patients with recurrent head and neck carcinoma are considered for salvage surgery if resectability with clear margins is achievable. However, postoperative complications such as wound healing disorders and pharyngocutaneous fistulas remain significant challenges. While various reconstructive surgical techniques exist, supportive vacuum therapy-both external and endoluminal-has been explored as an alternative treatment modality.

Type of study: We present a case report of a 60-year-old male patient with recurrent laryngeal cancer who underwent salvage laryngopharyngectomy following multiple previous surgical procedures and definitive radiochemotherapy. Due to persistent pharyngocutaneous fistula formation despite multiple reconstructions using pectoralis major flaps, an anterolateral thigh flap, and a fasciocutaneous deltopectoral flap, a novel approach combining endopharyngeal and external vacuum therapy was implemented.

Results: Over six weeks, with vacuum system changes performed twice weekly, the pharyngocutaneous fistula successfully closed, leading to complete wound healing.

Conclusion: This case demonstrates the potential effectiveness of a combined endopharyngeal and external vacuum therapy approach for treating persistent pharyngocutaneous fistulas when conventional surgical options are exhausted. Notably, the patient was able to resume oral food consumption following therapy, highlighting the functional benefits of this novel treatment strategy.