European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To investigate effectiveness of Virtual Reality (VR) on tinnitus burden in adult patients, and which improvements can be implemented. Literature review focuses on VR's usability as a tinnitus management tool, and on comparison with standard care.

Methods: Systematic search of PubMed and Google Scholar databases, covering articles from 2000 to 2024. We used MeSH terms "VR," "Virtual Reality," and "3D immersion" combined with "tinnitus," applying filters for clinical trials and randomized controlled trials. In Google Scholar, the advanced search function was used. Only English peer reviewed articles were included. Studies were selected based on PICOS (Patient Intervention Comparison Outcome Study) criteria, including adult patients receiving VR therapy with outcomes measured by questionnaires.

Results: Of the 17 initially identified articles, 10 remained after removing duplicates, and 2 studies were ultimately included for detailed review. Data extraction followed the PRISMA-ScR guidelines, with independent reviewers charting data. Primary outcomes included change in functional limitations, mood and distress. Results suggest beneficial findings of VR immersion equivalent to standard care. However, the clinical significance remains unclear due to small sample and effect sizes and short follow-up periods.

Conclusions: VR therapy shows promise as a potential tool for managing tinnitus, particularly due to its independence from therapists and shorter treatment duration, while being as effective as usual care. Further research with larger sample sizes, extended follow-up periods and incorporation of minimal clinically important differences (MCID) is necessary to validate effectiveness and scalability as an intervention for tinnitus resilience enhancement. Suggestions are given for content optimization.

Purpose: The gold standard diagnostic modality of Obstructive Sleep Apnea (OSA) is polysomnography (PSG), which is resource-intensive, requires specialized facilities, and may not be accessible to all patients. There is a growing body of research exploring the potential of artificial intelligence (AI) to offer more accessible, efficient, and cost-effective alternatives for the diagnosis of OSA.

Methods: We conducted a scoping review of studies applying AI techniques to diagnose and assess OSA in adult populations. A comprehensive search was performed in the Web of Science database using terms related to "obstructive sleep apnea," "artificial intelligence," "machine learning," and related approaches.

Results: A total of 344 articles met the inclusion criteria. The findings highlight various methodologies of disease evaluation, including binary classification distinguishing between OSA-positive and OSA-negative individuals in 118 articles, OSA event detection in 211 articles, severity evaluation in 38 articles, topographic diagnostic evaluation in 8 articles, and apnea-hypopnea index (AHI) estimation in 26 articles. 40 distinct types of data sources were identified. The three most prevalent data types were electrocardiography (ECG), used in 108 articles, photoplethysmography (PPG) in 62 articles, and respiratory effort and body movement in 44 articles. The AI techniques most frequently applied were convolutional neural networks (CNNs) in 104 articles, support vector machines (SVMs) in 91 articles, and K-Nearest Neighbors (KNN) in 57 articles. Of these studies, 229 used direct patient recruitment, and 115 utilized existing datasets.

Conclusion: While AI demonstrates substantial potential with high accuracy rates in certain studies, challenges remain such as model transparency, validation across diverse populations, and seamless integration into clinical practice. These challenges may stem from factors such as overfitting to specific datasets, limited generalizability, and the need for standardized protocols in clinical settings.

Objective: To discuss indications (unfavorable conditions), surgical steps, complications, and follow-up of subtotal petrosectomy (STP) in cochlear implantation based on our experience of 348 cases. Anatomical variations associated with or without cochlear malformations and differences between electrode insertions were included in our analysis.

Materials and methods: A retrospective case study was done in Gruppo Otologico (Piacenza, Italy), a quaternary referral center. Among 1002 cases that underwent subtotal petrosectomy, 348 were selected for cochlear implantation in the same setting. The study period was from 2004 to 2019. These patients' clinical and radiological follow-up ranged from 2 months to 180 months. Data were inspected, cleaned, and analyzed by SPSS software.

Results: The selected group's mean age was 57.236 years, including 178 male and 170 female patients. The follow-up period lasted up to 108.65 months. Out of 348 cases, 8 were children (under the age of 18 years old). Inclusion criteria to be eligible for cochlear implantation in the same setting of subtotal petrosectomy was a preoperative pure tone average (PTA) of more than 90 decibels associated with low speech discrimination ranging from 0% in most cases up to 50% in the minority. 329 patients had a complete electrode insertion intra-operatively. Minor complications were observed in 6 cases. These include one case of implant extrusion due to a middle ear infection leading to labyrinthitis, three cases of post-auricular fistula causing one device failure, one subcutaneous CSF collection, and one subcutaneous seroma collection.

Conclusion: Although in most cases, standardized trans mastoid facial recess technique for cochlear implantation is ideal as the surgical risks are minimal, in complicated cases such as concomitant chronic otitis media, prior canal wall-down cases, radical cavities, or inner ear abnormalities with high risk of cerebrospinal fluid leak subtotal petrosectomy should be the first choice of management with complete disease clearance. Close clinical and radiological follow-up is therefore mandatory. Single-stage implantation is preferred to staging the procedure unless one is unsure of disease clearance.

Purpose: To evaluate long-term hearing outcomes, healthcare utilization, and health-related quality of life (HRQoL) in adults with chronic otitis media (COM) who underwent primary tympanoplasty (PT) but were left with a significant air-bone gap (25-30 dB).

Methods: A retrospective medical chart review was conducted to assess the standard of care for COM patients across three European countries, analyzing hearing data, healthcare utilization, and demographics. Additionally, HRQoL and hearing disability were assessed prospectively using questionnaires. Sixty-nine adults diagnosed with COM who underwent PT between 2010 and 2016 were included.

Results: Average hearing outcomes showed minimal to no improvement, with a substantial number of patients experiencing moderate to severe hearing loss post-PT. Many continued to rely on rehabilitative technologies, with bone conduction hearing device (BCHD) users reporting higher consistent use compared to conventional hearing aid users. Participants required an average of 7.6 healthcare visits with a mean follow-up time of 7.64 years after PT, underscoring the ongoing burden on healthcare systems. Impaired hearing negatively impacted both general and disease-specific HRQoL.

Conclusion: Managing COM remains challenging due to the variability in surgical outcomes, particularly regarding hearing restoration. The high post-PT healthcare utilization and persistent HRQoL impairments caused by impaired hearing highlight the need for more effective rehabilitative strategies such as conventional hearing aids and BCHD.

Purpose: This study evaluates the role and effectiveness of indocyanine green (ICG) angiography in conventional thyroidectomy, comparing its outcomes with those of the naked-eye (NE) technique.

Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library databases through November 2024. Meta-analyses were performed on the selected studies. We compared the rates of parathyroid gland (PG) identification, autotransplantation, hypoparathyroidism, hypocalcemia, and postoperative levels of intact parathyroid hormone (iPTH) and calcium between the ICG and NE groups.

Results: We analyzed 29 studies involving 2,393 thyroidectomies. The PG identification rate was significantly higher in the ICG group at 84.7% (95% CI: 77.5-90.0%) than in the NE group (OR = 1.49, 95% CI: 1.26-1.79). Additionally, the rate of parathyroid autotransplantation was higher in the ICG group (OR = 2.18, 95% CI: 1.56-3.03). The transient hypoparathyroidism rate in the ICG group was 11.0% (95% CI: 5.3-21.5%), which was slightly lower than that in the NE group, although the difference was not statistically significant. Conversely, the transient hypocalcemia rate was significantly lower in the ICG group at 13.2% (95% CI: 8.6-19.6%) than in the NE group (OR = 0.50, 95% CI: 0.30-0.85). No significant differences were observed between the two groups in 1-day postoperative iPTH or calcium levels.

Conclusion: This meta-analysis demonstrates the superior efficacy of ICG angiography over the NE technique during thyroidectomy. ICG angiography resulted in a higher PG identification rate and significantly reduced postoperative transient hypocalcemia compared to those in the NE approach.

Purpose: To integrate the results from multiple electrophysiological tests, which has the potential to significantly improve outcome predictions in patients with Bell's palsy.

Methods: This retrospective study analyzed 193 patients who were diagnosed with Bell's palsy at our Department of Physical Medicine & Rehabilitation, from January 2020 to December 2022. All patients were followed for at least 6 months, with a mean follow-up duration of 6.8 months (range: 6-9 months). Clinical data, including House-Brackmann (H-B) grade and electrophysiological data from five tests, were analyzed using multiple logistic regression analysis and decision tree analysis to predict outcome at 6 months. The five electrophysiological tests were: electroneurography degeneration index (ENoG DI), compound muscle action potential (CMAP) latency, blink reflex (BR), nerve excitability test (NET), and needle electromyography (nEMG).

Results: The decision tree model identified five key predictors of recovery: ENoG DI in the orbicularis oculi, initial H-B grade, interference pattern in orbicularis oculi, NET difference, and CMAP latency in the frontalis. Patients with an ENoG DI < 71.72% and initial H-B grade ≤ 3 had a high probability of complete recovery. For higher ENoG DI values, a NET difference ≥ 4.50 mA and CMAP latency > 3.80 ms predicted incomplete recovery. This analysis led to an overall accuracy of 86.01%.

Conclusion: This study demonstrated that the combined use of initial H-B grade with the results from multiple electrophysiological results provided reliable outcome predictions in patients with Bell's palsy.

Objective: To describe the baseline vestibular function in cochlear implant candidates and identify demographic and audiologic risk factors for vestibular dysfunction.

Study design: Retrospective cohort study (2012-2022) of the CI candidate population.

Setting: Neurotology practice at large academic hospital.

Methods: All patients evaluated for CI underwent routine preoperative vestibular evaluation, irrespective of symptoms. Preoperative audiologic data was also analyzed.

Results: Of a total of 180 preoperative VNGs obtained, 39.4% demonstrated preoperative vestibular weakness as determined on caloric testing. Of these, 26.8% had evidence of bilateral weakness, 60.5% unilateral weakness ipsilateral to the worse hearing ear and 12.7% contralateral weakness. Demographic variables such as age, gender, BMI and medical comorbidities including diabetes, hypertension, hyperlipidemia were not found to be associated with a higher risk of vestibular weakness. Patients with vestibular weakness had significantly poorer low tone hearing. Hearing loss at 250 Hz was the strongest prognostic factor for risk of vestibular weakness. Using a cutoff of 45dB at 250 Hz as an indicator for obtaining preoperative VNG was found to have a sensitivity of 92.9% and specificity of 37.9% for identifying vestibular weakness.

Conclusions: Traditional CI candidates have a high prevalence of preoperative vestibular weakness. Audiologic data and specifically severity of hearing loss in the low frequencies may be a useful indicator of vestibular weakness and thus help guide which patients should undergo preoperative VNG. We propose the cutoff point of 45dB at 250 Hz as an indicator of higher risk for vestibular weakness and recommend preoperative VNG testing for this population prior to surgery.

Background: Laryngotracheal stenosis (LTS) results from abnormal airway narrowing, primarily caused by iatrogenic injuries like prolonged intubation. It leads to respiratory distress and vocal complications, requiring interventions ranging from endoscopic procedures to open surgeries like laryngotracheal reconstruction (LTR) with autologous grafts. Pediatric patients pose unique challenges due to smaller airways but may have better healing outcomes. This review aims to synthesize evidence on the success and operative parameters of different grafts in pediatric LTR to guide clinical decision-making and improve patient outcomes.

Methods: We retrieved relevant articles from PubMed, Scopus, Web of Science, and the Cochrane Library up to August 2024. Two independent authors extracted data from eligible studies, including baseline information, success rate, need for extra procedures, time to stent removal, and time to decannulation. All analyses were undertaken using RevMan v5.4.

Results: We collected 1,201 records from four databases after excluding 788 duplicates. After screening titles and abstracts, 108 records were assessed for eligibility, resulting in 86 included articles. Of these, 64 had enough data for analysis. The overall success rate for LTR was 89% for costal grafts, 86% for thyroid grafts, and 85% for auricular grafts, with no significant differences between graft types. A third of cases required additional procedures. Time to stent removal averaged 7.85 days for single-stage LTR and 62.86 days for double-stage LTR. Decannulation took 198.29 days. Complications included respiratory issues like atelectasis and pneumonia, graft-related problems, infections, and wound complications. Donor site complications and deaths were rare but occurred due to respiratory arrest, pneumothorax, and tracheotomy tube obstruction.

Conclusion: Costal, thyroid, and auricular grafts are comparable and show similar success rates in pediatric LTR. Optimizing perioperative management is crucial for reducing complications. Future research should standardize postoperative care and address patient pathology heterogeneity to improve outcomes.

Purpose: Dizziness and vertigo are among the most frequently reported complaints among patients across various medical and healthcare specialties. Studies have revealed that they are associated with cognitive impairments, particularly in older adults. While vestibular rehabilitation therapy (VRT) alleviates physical symptoms, its effects on cognitive function remain underexplored. Hence, this study aims to assess the impact of VRT on the quality of life and cognitive performance of individuals with chronic dizziness or vertigo.

Methods: This was a randomized control trial in which 60 participants experienced chronic dizziness or vertigo. The participants were assigned to either the medication-only group receiving betahistine or the VRT + medication group receiving VRT combined with betahistine. Quality of life was measured via the Dizziness Handicap Inventory (DHI). Cognitive performance was assessed via a digit span test, task-switching test, and recording of P300 response.

Results: The VRT + Medication group showed significant improvements in cognitive performance, particularly in the digit span and task-switching tests, with reduced P300 response latency and increased amplitude. No significant cognitive changes were observed in the medication-only group. Both groups showed improvement in quality of life, with a greater reduction in DHI scores observed in the VRT + Medication group.

Conclusion: VRT combined with medication significantly improves cognitive function and quality of life in individuals with chronic dizziness or vertigo. These findings suggest that VRT not only addresses physical symptoms but also enhances cognitive performance, highlighting its potential as a comprehensive therapeutic approach.

Trial registration: The study protocol was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2020/03/023934).

Purpose: To investigate the efficacy of topical sucralfate on postoperative recovery following oropharyngeal surgery in adults using pain scales, analgesic use, and various self-reported measures.

Methods: CINAHL, Cochrane Library, PubMed, and SCOPUS databases were searched from inception through July 3, 2024. Randomized controlled trials related to topical sucralfate following oropharyngeal surgery in patients at least 18 years old were included. Study protocols for clinical trials, abstracts, and non-English language articles were excluded. Two authors extracted data, and disagreements were resolved with a third party if needed. Risk of bias was assessed according to Risk of Bias 2 (RoB 2) tool. Results of included studies and a narrative summary of our findings are presented through descriptive statistics (frequency (%) for categorical variables and mean (range) for continuous variables).

Results: Four studies (n = 185) pertaining to topical sucralfate and post-operative outcomes in an adult population were included. The sucralfate group had a mean age of 40.08 vs. 37.50 for the control group. The sucralfate group had a significantly higher reduction in pain scores than the control group. The sucralfate group also had statistically significant improvements in otalgia, strength, diet tolerance, and reduction in analgesic use compared to the control group in two of the four studies.

Conclusions: Oropharyngeal surgery is commonly performed in adults despite having a morbid recovery process. The literature shows promising results with the use of sucralfate in the reduction of post-operative pain in adults; however, further investigation is warranted given the limited scope of the literature.