European Archives of Oto-Rhino-Laryngology最新文献

Purpose: The COVID-19 pandemic has resulted in significant global morbidity and mortality. The disease presents a broad clinical spectrum, significantly influenced by underlying comorbidities. While certain conditions are known to exacerbate COVID-19 outcomes, the role of chronic inflammatory airway diseases such as asthma and rhinitis in influencing disease severity remains controversial. This study investigates the association between asthma and allergic rhinitis and the severity of COVID-19 outcomes in a specific geographical region prior to widespread vaccine deployment.

Methods: We conducted a case-control study with unvaccinated adult patients who had laboratory-confirmed COVID-19 by polymerase chain reaction (PCR). Cases were defined as severe or critical COVID-19 patients requiring intensive care unit (ICU) admission, and controls were non-severe patients without signs of viral pneumonia or hypoxia. We utilized the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to assess the presence of asthma and allergic rhinitis. The association between these chronic inflammatory airway diseases and the severity of COVID-19 was evaluated using multivariate logistic regression analysis.

Results: A total of 122 patients were analyzed, with 61 in each group. The presence of asthma (9 patients) was associated with an increased likelihood of severe COVID-19 (OR = 13.0; 95% CI 1.27-133.74), while rhinitis (39 patients) was associated with a protective effect against severe outcomes (OR = 0.36; 95% CI 0.13-0.99). No significant association was found between the frequency of asthmatic episodes or the severity of rhinitis and the severity of COVID-19 outcomes.

Conclusion: This study underscores the divergent effects of chronic inflammatory airway diseases on COVID-19 severity, with asthma associated with a higher likelihood of severe outcomes and rhinitis potentially offering protective effects. These findings enhance our understanding of the complex interactions between respiratory allergies and COVID-19, emphasizing the importance of targeted clinical management and public health strategies.

Purpose: The control of epistaxis has always posed a significant challenge for otolaryngologists. One of the most viable options to address refractory cases is the ligation or cauterization of the sphenopalatine artery. The objective of this study was to assess the efficacy, safety, and long-term outcomes of these interventions.

Materials and methods: Two independent otolaryngologists conducted a comprehensive search for studies dealing with management of uncontrolled/recurrent epistaxis by consulting the main scientific databases on the web, including PubMed, Google Scholar, Medline, EMBASE, Web of Science, and the Cochrane Library. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.

Results: Sixteen studies were included in the systematic review, comprising a total of 454 patients. Among these, 289 individuals underwent ligation of the sphenopalatine artery, while 100 underwent cauterization of the same artery. Additionally, 56 patients underwent both ligation and cauterization of the sphenopalatine artery during the same surgery. The incidence of rebleeding and complications was respectively 12.1% (55/454) and 3% (14/454), resulting in relatively low rates in both cases.

Conclusions: Our review emphasizes the increasing importance of surgical approaches, specifically ligation or cauterization of the sphenopalatine artery, in addressing refractory cases. The low incidence of complications, predominantly temporary decreased lacrimation in patients undergoing ligation of the sphenopalatine artery, highlights the safety and feasibility of these interventions.

Purpose: Olfactory training (OT) is an effective and affordable option in the treatment of olfactory dysfunction. Despite significant progress in the field in recent years, some factors influencing OT participation remain unclear.

Methods: Based on an anonymous online survey orchestrated by AbScent.org the present study enrolled 450 participants and divided them into OT (n = 161) and No OT (n = 289) groups based on their OT participation. Participants also provided information on demographics, medical history, quality of life, OT duration for those who engaged in OT, and the reasons for non-participation in OT among those who did not.

Results: Patients who had greater loss of quality of life participated more in OT. Similarly, more participation was observed in patients who noticed an improvement in their ability to smell. Notably, most of the sample engaged in OT trained less than four weeks (73%). In the No OT group, the primary barrier to OT participation was the unawareness of OT treatment (37%) and these barriers differed by age, where older people expressed interest but were unaware of OT treatment, while younger individuals exhibited more cautiousness about its effectiveness.

Conclusion: Lower quality of life drives active OT participation. Limited training periods and unawareness of OT serve as potential barriers to olfactory recovery. Clinicians should actively promote the background of OT and underscore the significance of adhering to the "prescribed" training regimen.

Introduction: Reviewing the literature, Osia 2 system implantation is predominantly performed under general anesthesia (GA). Although in the pediatric population GA is inevitable, in adult cases, especially with high anesthesiological risks, local anesthesia (LA) is an obvious solution.

Method: The aim of this article is to provide a detailed demonstration of Osia 2 implantation under LA. In our case series of five adult implant recipients, the surgical procedure was carried out without encountering any difficulties during or after the operation.

Conclusion: Based on our experiences, implantation of the Osia® 2 System under local anesthesia is an easy and safe method for patients.

Purpose: While some OVEMP recordings are morphologically straightforward, some are poor in appearance, which can create a challenge, as they often require a "second look" by another experienced assessor. Even OVEMPs in normal subjects are sometimes poorly formed, but we wondered if the morphological assessment of the OVEMP response might provide some additional diagnostic information.

Methods: A single experienced assessor evaluated the OVEMP recordings of 60 patients referred sequentially to a tertiary care centre, and categorized them as "easy to assess" (i.e. obvious to a minimally trained assessor) or "difficult to assess", often requiring a second look by another experienced assessor.

Results: In 48 patients, the results were easy to assess (regardless of the actual clinical results) while 12 were classified as "difficult". This figure reflected the rate of morphologically poor responses we found in our population of normative data.

Conclusion: Our clinical concern is that many centres have given up relying on OVEMP assessment because the morphology of the wave may be challenging to interpret. OVEMP assessment often calls for a "second look", requiring a collaboration between two experienced assessors. It seems that this feature may not be diagnostically useful and poor OVEMP morphology may present a challenge in interpretation, but this should not be used as a reason to defer OVEMP testing.

Background: Diagnosing and treating tonsillitis pose no significant challenge for otolaryngologists; however, it can increase the infection risk for healthcare professionals amidst the coronavirus pandemic. In recent years, with the advancement of artificial intelligence (AI), its application in medical imaging has also thrived. This research is to identify the optimal convolutional neural network (CNN) algorithm for accurate diagnosis of tonsillitis and early precision treatment.

Methods: Semi-supervised learning with pseudo-labels used for self-training was adopted to train our CNN, with the algorithm including UNet, PSPNet, and FPN. A total of 485 pharyngoscopic images from 485 participants were included, comprising healthy individuals (133 cases), patients with the common cold (295 cases), and patients with tonsillitis (57 cases). Both color and texture features from 485 images are extracted for analysis.

Results: UNet outperformed PSPNet and FPN in accurately segmenting oropharyngeal anatomy automatically, with average Dice coefficient of 97.74% and a pixel accuracy of 98.12%, making it suitable for enhancing the diagnosis of tonsillitis. The normal tonsils generally have more uniform and smooth textures and have pinkish color, similar to the surrounding mucosal tissues, while tonsillitis, particularly the antibiotic-required type, shows white or yellowish pus-filled spots or patches, and shows more granular or lumpy texture in contrast, indicating inflammation and changes in tissue structure. After training with 485 cases, our algorithm with UNet achieved accuracy rates of 93.75%, 97.1%, and 91.67% in differentiating the three tonsil groups, demonstrating excellent results.

Conclusion: Our research highlights the potential of using UNet for fully automated semantic segmentation of oropharyngeal structures, which aids in subsequent feature extraction, machine learning, and enables accurate AI diagnosis of tonsillitis. This innovation shows promise for enhancing both the accuracy and speed of tonsillitis assessments.

Objective: Peritonsillar abscess (PTA) is the most common deep soft tissue infection necessitating surgical intervention in the head and neck region. Potential causes include infections of the palatine tonsils, palatine glands, or branchiogenic rudiments ("acute tonsillitis hypothesis" vs. "Weber's gland hypothesis"). Understanding the currently still unknown predominant cause is crucial for guiding therapeutic strategies, such as abscess tonsillectomy versus incision and drainage alone. This study aims to investigate the pre-diagnoses associated with subsequent PTA using a nationally representative practice database in Germany.

Methods: Data were collected from 195 ENT practices across Germany utilizing the nationally representative practice database IQVIA™ Disease Analyzer. Included were patients aged 18 years and older with a first diagnosis of PTA (index date) between January 2005 and December 2022 and a minimum observation period of 12 months preceding the index date. These patients were matched (1:5) with controls without PTA, based on age, sex, and index year. Frequencies of prior diagnoses coded according to ICD-10 in the 12 months preceding the index date were computed. The association between prior diagnoses and PTA was evaluated using multivariable logistic regression (MLR) and sensitivity analysis (SA).

Results: A total of 5,325 cases were compared with 26,725 controls in the multivariable logistic regression (MLR) analysis, and 16,251 cases were compared with 81,255 controls in the sensitivity analysis (SA). Mean age was 45.3 ± 18.3 years (MLR) and 41.9 ± 16.7 years (SA). The proportion of female patients was 51.8% (MLR) and 46.9% (SA), respectively. MLR showed the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (odds ratio, OR: 6.71; 95% CI: 5.81-7.74), "chronic tonsillitis" (OR: 2.00; 95% CI: 1.58-2.52), and "acute pharyngitis" (OR: 1.74; 95% CI: 1.50-2.03). SA similarly indicated the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (OR: 5.02; 95% CI: 4.60-5.47), "chronic tonsillitis" (OR: 1.87; 95% CI: 1.64-2.12), and "acute pharyngitis" (OR: 1.27; 95% CI: 1.14-1.41).

Conclusion: The most prevalent prior diagnosis associated with PTA was acute tonsillitis, followed by chronic tonsillitis and acute pharyngitis. The association with acute pharyngitis suggests possible non-tonsillogenic causes. Other specific causes of PTA, such as inflammation of the palatine gland or branchiogenic remnants, are not captured by the ICD system or the database utilized in this study.

Purpose: Cisplatin-induced hearing loss is a common side effect in patients treated with cisplatin-based chemoradiation (CRT) for head and neck squamous cell carcinoma. The extent of hearing loss after concurrent CRT was compared between triweekly (3 × 100 mg/m²) and weekly (7 × 40 mg/m²) cisplatin CRT.

Method: This retrospective cohort study was conducted in the Antoni van Leeuwenhoek Hospital and included 129 patients with cisplatin-based CRT for head and neck cancer (72 treated in the triweekly and 57 in the weekly regimen). Baseline and follow-up pure tone audiometry was conducted to assess hearing loss. Clinically relevant hearing loss was defined as a decline upon treatment of ≥ 10 decibel at a pure tone average 1-2-4 kHz and/or 8-10-12.5 kHz.

Results: The incidence of clinically relevant cisplatin CRT induced hearing loss was 42% in the triweekly versus 19% in the weekly group (p < 0.01). The mean threshold shift at a pure tone average (PTA) 1-2-4 kHz was 9.0 decibel in the triweekly compared to 4.3 decibel in the weekly CRT group (p < 0.01). At PTA 8-10-12.5 kHz, the incidence of clinically relevant hearing loss was 75% in the triweekly compared to 74% in the weekly CRT group (p = 0.87). The mean threshold shift at PTA 8-10-12.5 kHz was 20.2 decibel versus 15.6 decibel, respectively (p = 0.07).

Conclusion: Cisplatin-dose reduction to a weekly cisplatin CRT regimen for head and neck cancer may reduce the incidence of clinically relevant hearing loss at frequencies vital for speech perception.

Purposes: To evaluate whether mandibular advancement device therapy is recommended in patients affected by obstructive sleep apnea.

Methods: In order to predict oral appliances therapy response, drug induced sleep endoscopy with cardio-respiratory polygraphy and mandibular advancement device simulator was carried out. Patients in which upper airway obstruction was resolved on all levels and AHI was normalized (< 5/h), were referred for oral appliance therapy. At 5 months follow up, a cardio-respiratory polygraphy with MAD was performed.

Results: 36 patients who have evidence of resolution of UA collapse and AHI below 5 events per hour, were referred for MAD therapy. At follow up, the mean AHI decreased from 29.1 ± 13.1 to 3.3/h ± 1.9 (p < 0.001). All the patients were responders.

Conclusion: Combining the evaluation of drug induced sleep endoscopy and cardio-respiratory polygraphy data simultaneously during mandibular protrusion, has the potential to be a useful tool for prediction of MAD therapy response.