European Archives of Oto-Rhino-Laryngology最新文献

Objective: The use of the endoscope has brought major changes in skull base surgery in the last decades. In the cerebellopontine angle (CPA), it has shown few advantages over microscopic surgery alone, evolving towards a full-endoscopic surgery for neurovascular conflicts and tumors. This review aims to systematically analyze the literature about the use of the endoscope in the cerebellopontine angle tumors.

Methods: Pubmed/Medline and Embase databases were investigated applying PRISMA guidelines without time restrictions to find all adult patients affected by an extra-axial cerebellopontine angle tumor (vestibular schwannoma, meningioma, epidermoid tumor, or other extra-axial lesions) treated using only the endoscope (full-endoscopic, FE or endoscopic-controlled, EC) or with endoscopic assistance (EA).

Results: After article selection, a total of 2489 patients have been treated for a CPA lesion using the endoscope: 2054 vestibular schwannomas (VS), 368 epidermoid tumors (ET), 41 meningiomas and 26 among other pathologies. The retrosigmoid approach was the most frequently employed surgical corridor, irrespective of lesion type, for both full-endoscopic and endoscopic-assisted procedures. Although a great heterogeneity should be highlighted among the selected series of VS (1539), a weighted average of 92.5% of gross total resection (GTR) was obtained and 90% out of 1332 showed a good facial nerve outcome when comparable. Advantages in term of recognition of residuals have been described for the CPA meningiomas and multicompartmental epidermoid tumors with origin from CPA cistern, without increasing the risk of complications.

Conclusions: Despite different accepted advantages, the number of tumors in which the endoscope has been included among the surgical armamentarium is still limited compared to the number of the full-microscopic resections. After almost 30 years since its value was recognized, the number of prospective and case-control studies is still scarce to affirm a real benefit leading to its routinary use.

Objective: This systematic review aims to determine whether patients with obstructive sleep apnea (OSA) undergoing Ear, Nose, and Throat (ENT) surgery have an increased risk of postoperative complications.

Methods: The review followed the Preferred Reporting Items of Systematic Reviews guidelines. A comprehensive search was conducted in Medline, EMBASE, Cochrane CENTRAL, CINAHL, and Google Scholar. The search was performed and updated the on 27th of August 2024 and included all studies involving adults diagnosed with obstructive sleep apnea (OSA) undergoing ENT surgery. Studies focused on OSA-specific surgeries were excluded. The ROBINS-I tool was used to assess the risk of bias for the included studies. The primary outcome was all reported postoperative complications.

Results: The search identified 18,487 articles, with 88 full-text articles reviewed. Three studies, encompassing 1,071 patients, were finally included. The complications reported were desaturation, postoperative hypertension, and infections. All three studies had a serious risk of bias.

Conclusion: This review finds an increased risk of specific complications, including desaturation, hypertension, and infection, in OSA patients undergoing ENT surgery. However, the current body of evidence is significantly limited by the small sample sizes, heterogeneity in study design, variability in diagnostic methods, and inconsistent outcome reporting across the included studies. These limitations hinder the ability to draw definitive conclusions or establish clear recommendations regarding the perioperative management of OSA patients in ENT settings, including whether routine postoperative admission is warranted. The findings emphasize the urgent need for more rigorous, high-quality research to guide clinical decision-making.

Purpose: Obtaining negative margins in primary tumor resection is essential to decreasing recurrence and mortality. Fluorescence imaging may aid in complete tumor removal. As fluorescent agents are still under clinical trial investigation for use in head and neck cancer (HNC), their effectiveness in intraoperative margin assessment (IMA) remains unclear. This scoping review examines the use of fluorescent-guided surgery (FGS) in the treatment of HNC, highlighting significant opportunities in this nascent field.

Methods: PubMed, Scopus, CINAHL, and Cochrane Library were searched from inception through March 22, 2024. This study was conducted under PRISMA-ScR guidelines. Data on study characteristics, fluorescence and imaging techniques, imaging efficacy, and diagnostic accuracy were extracted.

Results: Twenty-seven prospective studies from 2013 to 2024 on intraoperative FGS in HNC, involving 455 patients from six countries, were included. Studies ranged from preclinical to phase II trials, applying various fluorescent techniques, predominantly indocyanine green and IRDye800CW, to enhance surgical precision. Imaging assessments were conducted in-vivo, ex-vivo, or both, using a wide range of devices and taking an additional 0 to 30 min intraoperatively. Quantitative measures like signal-to-background ratio and mean fluorescent intensity suggested variable diagnostic accuracy across studies. FGS shows great potential in improving IMA, although standardization in methodologies and reporting is needed.

Conclusion: This scoping review highlights the potential of intraoperative FGS to enhance treatment accuracy in solid HNC, though variability in diagnostic efficacy and a lack of standardized methodologies persist. Advancements in fluorophore technology and uniform procedural protocols are essential to optimize surgical outcomes and move towards personalized HNC interventions.

Purpose: This article aims to review techniques and applications for using double flaps (both free and pedicled, and their combinations) in reconstructing defects from total pharyngolaryngectomies (TPL) or pharyngolaryngo-esophagectomies.

Methods: This systematic review followed PRISMA 2020 guidelines. Three authors screened articles, selecting and extracting data on malignancy characteristics, reconstructive techniques, outcomes and complications.

Results: Eleven articles were reviewed, involving 176 oncologic patients. Most patients (39.8%) had defects in the larynx, hypopharynx and cervical skin, while in 31.8% the double flaps were used to restore the pharynx and protect the visceral anastomosis. In most studies included, preoperative treatments were administered, including radiotherapy (RT), concurrent chemoradiotherapy (CRT), and surgery, either alone or in combination. A wide variety of pedicled and free flaps were described. The most common pedicled flap is the pectoralis flap (81 patients, 46%), while the most used free flap is the jejunum flap (124 patients, 70%). 19 patients (10.8%) manifested partial necrosis or encountered minor complications postoperatively. 5 patients necessitated a surgical revision of the flap.

Conclusion: The literature on surgical reconstructions following TPL or pharyngolaryngo-esophagectomies using double flaps is limited. The use of double flap is indicated in cases of TPL with extensive skin defect but is also recommended in case of salvage TPL without skin defect.

Purpose: To evaluate the aesthetic outcomes of primary closure of auricle lacerations in the emergency department.

Methods: In this prospective case study in our tertiary referral center we included all patients with an auricular laceration without complete avulsion. Wound treatment involved thorough cleaning and primary closure. Photos of the auricle were taken at various stages for evaluation. To evaluate the achieved results after 3 months, a success classification system with four classes was developed: (1) full success, no irregularities, (2) partial success, only minor irregularities, (3a) unsuccessful, major irregularities or (3b) unsuccessful, (partial) necrosis.

Results: Most patients demonstrated successful outcomes (60.7% full success and 32.1% partial success), with helical involvement being associated with inferior results. The interobserver percent agreement of the classification system was 88%. The Fleiss' kappa coefficient was 0.570, p < 0.001.

Conclusion: Primary closure of ear lacerations results in a high success rate. We have introduced a revised classification system to qualify the success of treatment of the auricle laceration. Involvement of the helix is correlated with inferior surgical results three months after surgical closure. Trial registration number and date of registration: reference number W21_387 # 21.432, September 9, 2021.

Purpose: Otoacoustic emission (OAE) is a widely utilized method for screening newborns for congenital hearing loss. While OAE-based screening has high sensitivity, it is associated with high false-positive rates when conducted shortly after birth. Previous studies found that infants delivered by cesarean section show higher false-positive rates. Nonetheless, other modes of delivery have not been investigated to date. This study aims to evaluate the impact of maternal, neonatal, and perinatal factors on hearing screening false-positive results.

Methods: This retrospective study included 5,621 infants with normal hearing. Infants were divided into two groups: those who failed the initial OAE hearing screening were assigned to the study group, and those who passed were assigned to the control group. Maternal, neonatal, and perinatal factors were extracted from medical records and analyzed to assess possible associations with failing the initial OAE screening.

Results: A total of 365 out of 5621 (6.5%) neonates failed the initial OAE hearing screening. The study group had a higher prevalence of infants delivered by elective or emergency cesarean section, as well as by vacuum-assisted delivery, compared to the control group. Multivariate analysis showed that the mode of delivery had a significant effect on false-positive results, with odds ratios of 15.5, 7.2, and 8.6 for infants born by elective cesarean section, emergency cesarean section, and vacuum delivery, respectively, compared to vaginal delivery.

Conclusion: Infants delivered by cesarean section or vacuum extraction have higher odds of failing the initial OAE screening when conducted within 48-72 h after birth. Further research is needed to determine the optimal timing for hearing screening.

Purpose: Recently, the indications for Cochlear Implant (CI) have also been extended to subjects with Single Sided Deafness (SSD) in order to restore binaural hearing. The primary objective of this study was to investigate the advantages of CI following one year of usage in SSD subjects. Secondarily we want to assess the long-term stability of the CI.

Methods: 57 participants performed speech audiometry in noise and localization test. For each was also evaluated subjective hearing profile (with Speech Spatial and Qualities_SSQ questionnaire) and the impact of tinnitus (with the Tinnitus Handicap Inventory_THI questionnaire).

Results: After one year of CI usage, we observed a significant improvement in speech in noise, in sound localization abilities, in the Speech (p-value 0.001) and Spatial (p-value 0.001) subscales of the SSQ questionnaire and in THI questionnaire (p-value 0.001). The improvements in speech in noise and localization abilities and the reduction of the SSQ and THI questionnaires scores were maintained over time. Only eight participants did not fully utilize the CI.

Conclusion: CI in SSD represents an effective method for improving speech recognition in noisy environments, restoring sound localization abilities, reducing tinnitus and improve subjective listening skills.

Purpose: The development of delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) injection has allowed the identification of endolymphatic hydrops (EH). We aimed to investigate the correlations between EH and auditory-vestibular clinical symptoms in patients with unilateral Ménière's disease (MD).

Methods: In this retrospective study, 91 patients with definite MD (DMD) and 20 patients with probable MD (PMD) underwent intratympanic injection Gd-enhanced MRI of the inner ear. Pure tone audiometry (PTA), speech discrimination score (SRS), electrocochleography (ECochG), and caloric tests were performed. Clinical features were analysed and compared between the DMD and PMD groups, and the relationships between EH and auditory-vestibular results were investigated.

Results: Cochlear endolymphatic hydrops (C-EH) and vestibular endolymphatic hydrops (V-EH) were more common and more severe in the DMD group than in the PMD group (P < 0.001). EH in both DMD and PMD patients was inconsistent with the results of auditory-vestibular tests. However, in the DMD group, the PTA average in the affected ear was significantly correlated with the severity of both C-EH (ρ = 0.376, P < 0.001) and V-EH (ρ = 0.404, P < 0.001). In the PMD group, C-EH was positively correlated with the 125 Hz PTA result (ρ = 0.449, P = 0.047). Furthermore, the severities of both C-EH (ρ = 0.210, P = 0.047) and V-EH (ρ = 0.266, P = 0.011) were significantly correlated with the disease course in the DMD group. In the PMD group, the severity of V-EH (ρ = -0.494, P = 0.027) was negatively correlated with the course of MD.

Conclusion: Gd-enhanced MRI of the inner ear is a clinically available and effective auxiliary examination that can provide a direct basis for the diagnosis of DMD and PMD.

Purpose: Eustachian tube dysfunction plays a crucial role in the pathophysiology of chronic otitis media and impacts surgical outcomes of tympanoplasty. We aimed to assess the outcomes of combined tympanoplasty with eustachian tuboplasty compared to tympanoplasty alone with respect totes graft success rate, hearing outcome, tympanometry measures, and improvement of eustachian tube function.

Methods: This review has been registered in the Prospective Register of Systematic Reviews. (CRD42024614970) and was conducted according to the PRISMA guidelines. Four major databases-PubMed, ScienceDirect, Web of Science, and Google Scholar-were used for the electronic search to identify relevant studies.

Results: Seven studies involving 386 patients were included; 195 (50.5%) and 191 patients (49.5%) were assigned to the tympanoplasty plus eustachian tuboplasty and tympanoplasty alone groups, respectively. The meta-analysis revealed significant improvements in graft success rates (Odds Ratio = 1.90, 95% CI: 1.02 to 3.54, p = 0.042), air-bone gap (MD = -2.07, 95% CI: -3.78 to -0.36, p = 0.018), and eustachian tube scores (Mean difference = 2.00, 95% CI: 0.02 to 3.98, p = 0.048) in the combined group compared to in the control group. Only minor complications were observed in some studies, such as mild tympanic membrane retraction, graft myringitis, and temporary patulous eustachian tubes.

Conclusion: Combining tuboplasty with tympanoplasty is an effective procedure with significant improvements in graft success rates, hearing outcomes, and eustachian tube function scores. Eustachian tuboplasty is a safe and successful procedure with very few potential complications.

Background: Adenotonsillar hypertrophy is the leading cause of obstructive sleep apnea (OSA) in children, with adenotonsillectomy (AT) being the most common surgical treatment. Although AT is widely performed, its efficacy in treating mild OSA remains uncertain. Current literature suggests that children with mild OSA might benefit from non-surgical management, but there is a lack of evidence ND studies evaluating the outcomes of AT specifically for mild OSA. The aim of this systematic review and meta-analysis is to provide conclusive insights into the effectiveness of adenotonsillectomy in improving health outcomes and quality of life for children with mild obstructive sleep apnea.

Methods: PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. We included original studies that evaluated the safety or effectiveness of AT in the management of mild OSA among pediatric patients. For quantitative analysis, data were synthesized using a random-effects model in R (version 4.3.3), and heterogeneity was assessed using statistical methods including the restricted maximum-likelihood estimator and the I2 statistic. We also conducted analyses of change scores and covariance to estimate the effect of AT on the severity of mild OSAS.

Results: Our review included 27 studies after screening 1851 citations. The meta-analysis demonstrated significant improvements with AT for mild OSA. The Pediatric Sleep Questionnaire scores improved with a mean difference (MD) of -0.32 (95% CI [-0.39; -0.25], p < 0.001). AHI decreased significantly with an MD of -1.45 (95% CI [-2.11; -0.80], p < 0.001). Comparison with watchful waiting revealed AT to be more effective: AHI showed an MD of -1.22 (95% CI [-1.92; -0.53], p < 0.001), and the arousal index had an MD of -1.73 (95% CI [-2.95; -0.51], p = 0.005). Safety data indicated that while AT is generally safe, it is associated with minor complications such as postoperative desaturation and occasional bleeding. Long-term serious adverse events were rare.

Conclusion: AT effectively improves symptoms in children with mild OSA, outperforming watchful waiting in several key metrics. This review supports AT as a viable option but underscores the importance of considering individual patient factors in treatment decisions.