European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To compare the temperature of thermoanatomic points and areas of the upper and lower lips between mouth-breathing and nasal-breathing children.

Methods: This cross-sectional observational study had a sample of 30 nasal-breathing and 30 mouth-breathing children aged 4 to 11 years. One front-view, one left-view, and one right-view infrared thermogram of the face were acquired from each participant. A total of 14 thermoanatomic points plus the upper lip and lower lip areas were marked on the front-view thermograms, while on the side-view thermograms, six thermoanatomic points were marked. The research also calculated the difference between the temperature of the upper and lower lip areas (∆T area) and between the temperature of the points on the upper and lower lips (∆T points). The normalized mean temperatures of points and areas and temperature differences were compared between groups with the t-test and Mann-Whitney test.

Results: The temperature of the thermoanatomic points closest to the lip (nasolabial, Labial Commissure, and lower labial), areas of the lips, and external acoustic meatus was lower in mouth breathers than in nasal breathers, which did not happen for most other points. ∆T area and ∆T points were not different between the groups.

Conclusion: Thermography is a promising complementary diagnostic tool, since showed mouth-breathing children had lower temperatures in the region of the lips than nasal breathers.

Purpose: Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications.

Methods: An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap.

Results: Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases.

Conclusions: Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation.

Purpose: To perform a systematic review and meta-analysis exploring the effectiveness of porcine small intestinal submucosa (pSIS) compared with autologous grafts for tympanic membrane perforation repair.

Methods: A prospective meta-analysis protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) on June 5th, 2024, under protocol CRD42024551979. PubMed, Embase/Ovid and Cochrane Central databases were searched from inception to 28/05/2024 for studies comparing the use of pSIS versus autologous grafts (perichondrium, cartilage, temporalis fascia or cartilage-perichondrium) for tympanic membrane perforation repair. The outcomes evaluated were persistent perforation after surgery, operative time and hearing outcome. Statistical analyses were performed using the online Review Manager (Cochrane Collaboration). A subgroup analyses were carried out for the paediatric population.

Results: We included 1,407 patients (1447 ears) from seven records; six retrospective cohort studies and one randomised controlled trial (RCT). pSIS graft was used in 563 ear surgeries (38.1%). Four studies included children with a mean age ranging from 7.3 to 11.7 years and the other 3 studies included adults with a mean age ranging from 30.8 to 48.4 years. Follow-up ranged from 2 to 132 months. There was no statistically significant difference in the failure rate (persistent perforation) between pSIS graft and autologous graft (RR 0.95; 95% CI 0.67-1.33; p = 0.76). However, reduced operative time was associated with using pSIS grafts (MD -16.12 min; 95% CI -22.94-9.31; p = < 0.00001).

Conclusion: Tympanic membrane perforation repair with pSIS grafts had a similar failure rate and hearing outcome compared to autologous grafts and demonstrated an association with reduced operative time.

Purpose: Nasal breathing (NB) is a fundamental physiological process, and emerging research indicates its potential role in modulating resting metabolism, impacting energy expenditure and metabolic efficiency. This study investigates the impact of NB on resting metabolic rate (RMR), offering novel insights into metabolic regulation.

Methods: A prospective study was conducted on patients undergoing nasal surgery, with measurements taken before and 3 months after surgery. Metabolic rate assessments, anthropometric dimensions, and peak nasal inspiratory flow (PNIF) were recorded. Factors like age, sex, and health status were considered to control for confounding variables.

Results: A total of 83 patients were initially enrolled: 17 underwent septorhinoplasty (SRP), 61 septoplasty (ST) and 5 inferior turbinate reduction alone. 72 patients completed the follow-up. SRP patients exhibited significantly higher pre- and post-operative RMR compared to ST patients (p = 0.005), and this association was not observed when PNIF was included in the analysis (p > 0.05). Pre-operative and post-operative PNIF values significantly correlated with pre-operative and post-operative RMR (p = 0.049 and p = 0.005, respectively). Post-operative PNIF predicted post-operative RMR after confoundment adjustment in linear regression (β = - 0.043, p = 0.017). Importantly, total body weight increased after surgery (pre-op: 74 ± 14.6 kg versus post-op: 75.6 ± 15.5 kg, p < 0.001) due to an increment in muscle mass (pre-op: 52.3 ± 12 versus post-op: 55.5 ± 14, p < 0.01).

Conclusion: Preliminary analysis suggests a potential link between NB and RMR, emphasizing the overlooked role of nasal respiratory physiology in energy homeostasis. Surgery also elicited body composition alterations. Further research is needed to uncover the underlying mechanisms of this association. Understanding the impact of NB on RMR could underscore its significance in metabolic regulation, reinforcing the importance of nasal surgery on overall health. This study provides foundation for future investigations.

Introduction: Cholesteatoma, a challenging entity in otologic surgery, necessitates a standardized classification system for effective communication among healthcare providers and consistent reporting of surgical outcomes. The ChOLE Classification System, introduced by Linder et al., stages cholesteatoma based on extension (Ch), ossicular chain status (O), life-threatening complications (L), and Eustachian tube function and mastoid pneumatization (E).

Methods: We classified 199 patients who underwent cholesteatoma surgery between 2019 and 2023 in our University Hospital to assess the distribution of the ChOLE stages and to examine the relationship between the ChOLE stages and the duration of surgery.

Results: This study revealed significant correlations between the ChOLE stage and respective subgroups of the classification and duration of surgery and thus complexity of procedure.

Conclusion: Despite limitations, the ChOLE classification proves valuable in predicting surgical complexity and optimizing patient care. Further research is warranted to validate these findings and enhance cholesteatoma management strategies.

Autoimmune inner ear disorder (AIED) diagnosis is based on the onset of bilateral sensorineural hearing loss (SNHL) that progresses over 3 to 90 days and responds to steroid treatment. Among autoimmune conditions, Cogan's syndrome (CS) is a rare disorder characterized by the onset of inflammation in both eyes and in the inner ear, leading to progressive sensorineural hearing loss, particularly at high frequencies, often with vestibular symptoms. If left untreated, CS can cause profound bilateral hearing loss. The disease is believed to have an autoimmune etiology, although a common biomarker has not been clearly identified. Early-stage inner ear involvement in CS can mimic Menière's Disease (MD), although key differences between phenotypes, such as the pattern and speed of progression, characterized by a pousseè evolution of bilateral high frequencies hearing loss rather than low frequencies fluctuating, help distinguish the two conditions. Few is known about imaging of the inner ear in patients with CS, and most of the insight into the radiological manifestation in the inner ear of this rare pathology came from the '90s. Recent advances in imaging, particularly with 3D-FLAIR MRI sequences after gadolinium administration, have shown promise in detecting endolymphatic hydrops (EH) in MD patients. Our study reports findings in five CS patients on whom we performed a 3 Tesla MRI, revealing EH in three of them. This is the first report of such a correlation in vivo, contributing valuable new insights into the radiological manifestations of CS.

Purpose: The aim of this study is to compare the results of auditory perception tests and speech sound evaluations with electrode array length in patients with Mondini deformity.

Methods: The study included 14 patients who underwent cochlear implantation and radiologically confirmed Mondini deformity between 2007 and 2021 in our clinic. While 7 patients received standard electrode arrays from the MED-EL brand, the remaining 7 received shortened electrode arrays from the MED-EL brand. Differences in auditory perception, articulation, and speech intelligibility between the two groups were examined. Auditory perception tests were administered to these patients preoperatively and at least 2 years after cochlear implant surgery. The patients' auditory perception performance was evaluated using single, double, and triple closed-set word tests (MTP-3, MTP-6, MTP-12), two-syllable open-set word test, Glendonald Auditory Screening Procedure (GASP) tests for articulation, Phonemic Synthesis Test (SST) for phonemic knowledge, and Speech Intelligibility Rating (SIR) test for speech intelligibility.

Results: Both groups did not show statistically significant differences in auditory perception tests (MTP-3, MTP-6, MTP-12, two-syllable open-set word test), speech sound tests (SST), and speech intelligibility test (SIR). Significant improvement was observed in all tests in both groups when compared preoperatively and postoperatively.

Conclusion: No significant difference was observed in auditory perception and speech sound tests between groups with short and standard electrode arrays in patients with Mondini deformity. The option of using short electrode arrays during implantation in patients with Mondini deformity can be preferred without doubt in terms of outcomes.

Purpose: Over the last 40 years, there has been an unusual trend where, even though there are more varied treatments, survival rates have not improved much. Our study used survival analysis and machine learning (ML) to investigate this odd situation and to improve prediction methods for treating non-metastatic LSCC.

Methods: The surveillance, epidemiology and end results (SEER) database provided the data used for this study's analysis. To identify the prognostic variables for patients with non-metastatic LSCC, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict 5-year survival. A method of validation that incorporated the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was employed to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using Kaplan Meier (K-M) survival analysis.

Results: The study included 63,324 patients, of whom 40,824 were diagnosed with glottic cancer (GC), 21,774 with supraglottic (SuGC) and 726 with subglottic (SC). ML models identified age, stage, and tumor size as the most important factors that affect survival. For SuGC, age, stage, and sex and stage and race for SC. In terms of treatment, best survival therapeutic options for GC and SC were surgery and radiotherapy (RT), whereas SuGC surgery only.

Conclusion: This study underscores the critical role of individualized factors in non-metastatic LSCC management, with surgery often combined with radiotherapy as the optimal treatment for early stage tumors. Despite advancements, stable prognosis highlights the need for continuous refinement of therapeutic strategies to balance tumor control and quality of life.

Purpose: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS).

Methods: We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373).

Results: Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group.

Conclusions: This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Purpose: This study proposes the Lamella Ostium Extent Mucosa (LOEM) system as a compact and user-friendly classification for endoscopic sinus surgery (ESS), based on surgical bone extension and mucosal management, aiming to resolve inconsistencies in describing surgical techniques and extension levels, and to enhance comparability of outcomes in chronic rhinosinusitis (CRS).

Methods: LOEM uses a lettering system representing a specific topographical level: L identifies the lamellae, O the ostia, E the opening of the sinus walls, and M the mucosal approach. Eleven CRS surgical cases were independently evaluated by seven rhinologists following a Delphi method in two consecutive rounds. Consensus was assessed using Cohen's kappa.

Results: A substantial agreement was found among the experts (κ = 0.77) in the first round, although the M item only showed fair agreement (κ = 0.37). Clarifications for this item were given in the second round, after which, the overall agreement increased to κ = 0.81 and to κ = 0.79 for the M item. A decrease in agreement from substantial to moderate for O and E items in the second round was found. Test-retest analysis showed an almost perfect agreement (92.96%, κ = 0.82). In this study, a web-based app is provided to assist with the regular use of the LOEM system.

Conclusions: The LOEM system provides a compact, comprehensive code for ESS, integrating anatomical and functional aspects to represent surgical techniques described so far. This system may be suitable for facilitating communication between surgeons and collecting robust labeled data, hopefully leading to further standardization and validation of surgical approaches in future CRS studies.