European Archives of Oto-Rhino-Laryngology最新文献

Background: Tympanostomy tube insertion is a standard surgical procedure in children to address middle ear infections and effusion-related hearing and speech development issues. Perioperative treatments like ear drops containing antibiotics, steroids, and tube irrigation with saline aim to prevent complications, yet no universal gold standard treatment exists. Despite guidelines, practice preferences among ENT specialists vary, motivating this study to investigate perioperative management practices in Israel.

Method: A survey was distributed among ENT surgeons, collecting data on their main workplace, sub-specialty, preoperative hearing test requirements, tube irrigation practices, tube selection criteria, and timing of tube removal. Distribution and association with main workplaces were examined.

Results: The survey achieved a response rate of 27.33%. Most participants routinely required preoperative hearing tests, with a preference for conducting them within three months prior to surgery (62.2%). Tube irrigation during the procedure was less common among surgeons in the public system (p = 0.007). In response to the COVID-19 pandemic, the majority of respondents maintained their established practices (96.3%), while a small proportion (3.7%) adapted by replacing two in-person meetings with one virtual session. Variations in tube removal timing based on the main workplace were noted, with private practitioners opting for earlier removal (p = 0.002) and were less permissive in water deprivation practices (p = 0.053).

Conclusion: This study provides insights into the practices and preferences of ENT surgeons in tympanostomy tube insertion procedures in Israel. Adherence to standardized practices was observed, with variations influenced by the primary workplace. Despite the COVID-19 pandemic, minimal changes were made to established practices. Further research and consensus are necessary to optimize patient outcomes and develop tailored guidelines in this field.

Purpose: Tongue base mucosectomy (TBM) is a well-established procedure in investigating cervical squamous cell carcinoma of occult primary. However, its risks have not been balanced against its benefits with validated tools.

Methods: A systematic literature review was conducted for reported complications and quality-of-life outcomes following TBM. The complications and quality-of-life outcomes following TBM at our institution are then reported using objective metrics and validated assessment tools, including Performance Status Scale for Head and Neck Cancer Patients (PSS-HNS), University of Washington Quality-of-life Questionnaire (UW-QOL) and M. D. Anderson Dysphagia Inventory (MDADI).

Results: Eighteen studies met the criteria for inclusion in the systematic review. Of these, 9 addressed swallowing outcomes described in text, without using validated assessment tools. No studies reported taste, speech and pain outcomes after TBM. Post-operative bleeding was not consistently reported. 20 patients underwent robotic TBM at our institution between 2017 and 2023. The primary tumour was identified in 50% (10/20) of cases. The median time to commencing soft diet and median time of NG feeding was 0 days. The median return to normalcy of diet score was 95. Median post-treatment UW-QOL pain and swallowing scores were 100 and 70 respectively. The median speech score was 100, saliva 70, and taste 70. The median normalised MDADI scores were: global 80; emotional 67; functional 80 and physical 65.

Conclusions: Validated assessment tools better inform patients about treatment options and can help compare post-TBM results across institutions. Our data demonstrates that TBM patients have a functional post-operative swallow, are pain and gastrostomy free, even after adjuvant treatment. Routine post-operative insertion of NG tube is not necessary.

Purpose: Patients with oral squamous cell carcinoma (OSCC) often have difficulties in obtaining sufficient nutrition and may develop refeeding syndrome (RFS) during hospitalization. RFS may be fatal if not treated properly. This study clarified changes in perioperative phosphate levels and occurrence of RFS symptoms in OSCC patients to identify clinically notable predisposing factors for RFS in this specific patient population.

Methods: A retrospective analysis included primary OSCC patients with microvascular free flap reconstruction. Patients with treatment for additional malignancy, hypoparathyroidism, and missing values of preoperative and/or postoperative plasma phosphate (P-Pi) concentration were excluded. The outcome variable was severe postoperative hypophosphataemia (mmol/l) during the postoperative period (P-Pi < 0.50 mmol/l). Predictor variables were age, sex, smoking, heavy alcohol use, diabetes, body mass index (BMI), weight, height, tumour site, tumour size, tracheostomy, nutritional route, and preoperative P-Pi concentration.

Results: Of the 189 patients with primary OSCC, 21 (11%) developed severe hypophosphataemia. Of these patients, 17 (81%) developed RFS symptoms. Higher age (p = 0.01), lower patient height (p = 0.05), and no current smoking (p = 0.04) were significantly associated with postoperative hypophosphataemia. In multivariable regression analyses, higher age (OR 1.06 per year) and age over 70 years (OR 3.77) were independently associated with development of severe hypophosphataemia.

Conclusion: Restoration of nutritional balance and close follow-up of electrolyte balance in the perioperative phase are necessary to prevent RFS, especially in patients with oral cancer requiring extensive reconstructions. Special attention should be focused on elderly patients since they are prone to this unnoticeable but potentially life-threatening electrolyte disturbance.

Background: Despites a tripling of recognised occupational sinonasal adenocarcinomas in the past three decades, no comprehensive publications of the epidemiological development and histological distribution of sinonasal malignancies exist in Germany. Therefore, this study aims to analyse population-related data and address gaps in the nationwide cancer registry.

Methodology: The German Center for Cancer Registry Data (ZfKD) provided a dataset covering the period from 2003 to 2015. 8332 cases were extracted, morphologically clustered and underwent descriptive analysis. Incidence and mortality rates were standardised, and overall survival (OS) probability was estimated.

Results: Standardised incidence rates increased, averaging 1.8 for men and 1.0 for women per 100,000 inhabitants. Sinonasal cancer manifested mostly in the nasal cavity with a 5-year OS of 63%. In contrast, malignancies in the frontal sinus had a less favourable survival probability (p < 0.001). Morphologically, the tumour entities comprised 55% squamous cell carcinomas, 18% adenocarcinomas, 8% mucosal melanomas, 4% esthesioneuroblastomas and 2% sinonasal undifferentiated carcinomas (SNUC). The highest 5-year OS rate was observed in esthesioneuroblastomas (59%), while SNUC (38%) and mucosal melanoma (29%) had the lowest (p < 0.001).

Conclusions: This study provides a comprehensive epidemiological analysis of sinonasal morphologies based on a unique dataset. Findings reveal a higher incidence and lower survival probability among men. The topographical distribution varies by sex and tumour entity. The mortality rate for patients with sinonasal cancer is moderate to high, particularly for SNUC and mucosal melanoma, with incidences of 8.4% and 2%, respectively. Hence, there is an urgent need for an optimised screening for early-stage malignancies.

Aim: To evaluate (1) Audiological and surgical outcomes in patients with otosclerosis following cochlear implantation. (2) surgical difficulties and outcomes between both groups. (3) Audiological outcomes between both groups.

Study design and setting: Retrospective study conducted at Otology and Skull Base Surgery Center.

Subjects and methods: Data were analyzed from 111 patients with otosclerosis (114 ears) who underwent cochlear implant surgery using the cochlear implant database. Demographic characteristics (age, sex, and operated ear), auditory outcomes, and operative details (extent of cochlear ossification, surgical approach [posterior tympanotomy or subtotal petrosectomy], electrode insertion [partial/complete, scala tympani or vestibuli], and complications) were analyzed Auditory outcomes were assessed over at least one year follow-up period using pure tone audiometry and speech discrimination scores. Patients were divided into two groups (with and without cochlear ossification) to compare auditory outcomes and surgical outcomes.

Results: The mean age of patients with ossified and non-ossified cochlea was 60.04 and 62.22 years respectively. Sixty-five of 114 ears had cochlear ossification, with complete round window involvement in 75.4% of these patients, while the rest had partial or complete basal turn ossification. Subtotal petrosectomy was performed in 63.1% and 28.6% of ossified and non-ossified cochlea respectively while the rest underwent cochlear implantation through posterior tympanotomy. Only one case had scala vestibuli insertion and four had incomplete electrode insertion. Six patients underwent re-implantation due to infection, device failure, and erosion of the posterior canal wall. Auditory outcomes among patients with ossified otosclerosis were slightly better than those without ossification but this difference was not statistically significant.

Conclusion: Cochlear implantation for otosclerosis yields excellent auditory outcomes with a low rate of surgical complications, despite the high incidence of cochlear ossification.

Objectives: The diagnosis of tuberculosis otitis media (TBOM) remains a great challenge. This study aims to suggest potential diagnostic clues and proper management of TBOM.

Methods: The study is a retrospective review of TBOM cases that were treated at our department, between January 2015 and June 2023. Summarizing their clinical characteristics, diagnosis, and treatment. Additionally, a literature review is conducted.

Results: Eight cases of TBOM, 6 female and 2 male patients, median age was 32 years old, were included in the study. TBOM mainly presents with symptoms of otorrhea, hearing loss, and occasional early-onset facial palsy. One case had a positive Purified Protein Derivative (PPD) before the operation. Middle ear tissue was pathologically biopsied in 7 cases, with 3 cases testing positive for Acid Fast Bacillus and 6 cases testing positive for Mycobacterium tuberculosis PCR. Middle ear surgery and Anti-tubercular treatment (ATT) were completed in all cases. The median follow-up was 11 months. No cases of TB relapse were observed.

Conclusions: Proper suspicion and confirmation of TBOM is the primary clinical orientation. Middle ear surgery combination with ATT results in satisfactory outcomes. Hearing reconstruction should be performed after ATT is completed.

Background: As the global population ages, hearing loss becomes increasingly prevalent, and is associated with neurocognitive and psychiatric comorbidities, impacting quality of life. Early screening and timely intervention might prevent or delay cognitive decline, a gap in care that can potentially be addressed by self-administered smartphone hearing tests.

Objective: This study aims to evaluate the accuracy of Mimi™ (Berlin, Germany), a commercially available self-administered smartphone hearing test compared to pure tone audiogram (PTA) in terms of both hearing levels and hearing thresholds in our local geriatric population > 65 years-old.

Method: Fifty-two participants above 65 years of age requiring conventional audiograms were recruited from a National Referral University Hospital Otolaryngology clinic from March to June 2022. All participants were administered the conventional PTA tests in a sound-proof booth conducted by audiology technicians followed by Mimi™ Hearing Test in a quiet clinic room. Comparisons between the hearing levels of both tests were analyzed using Spearman's rank correlation coefficient, Bland-Altman plots and Gwet's Kappa which looked at concordance. Hearing thresholds were then analysed using the Wilcoxon signed rank (SR) test.

Results: Mimi™ showed strong to very strong correlation with good agreement compared to readings obtained from formal PTA. Concordance in determining hearing loss also showed substantial to almost perfect agreement at each individual frequency, with values of kappa falling between 0.735-0.857. In terms of thresholds, there were no significant differences in thresholds given by both tests except for 2.0 kHz, HFPTA and 4FPTA (p < 0.05).

Conclusion: Mimi™ serves as a good screening tool for detection of moderate hearing loss for early pickup and treatment except at higher frequencies. The smartphone hearing test is also less accurate in determining the extent of hearing loss and formal PTA after hearing loss is detected on screening should still be standard of care.

Objective: Maintenance therapy following first-line chemotherapy is of particular significance in patients diagnosed with recurrent or metastatic nasopharyngeal carcinoma (NPC). We conducted a meta-analysis to investigate the impact of maintenance therapy (MT) on the survival prognosis of individuals with recurrent or metastatic NPC.

Methods: The databases Embase, PubMed, and the Cochrane Library were thoroughly searched in a comprehensive manner. Prospective studies of MT for recurrent or metastatic NPC are required. Study endpoints included progression-free survival (PFS) and overall survival (OS).

Results: Two randomized controlled clinical trials, with a total of 294 participants, were analyzed. The maintenance therapy group consisted of 140 participants, while the remaining participants were in the non-maintenance therapy (non-MT) group. The MT group showed a notable enhancement in PFS compared to the non-MT group, with a hazard ratio(HR) of 0.44 and a 95% Confidence interval [CI] of 0.34-0.58 (p < 0.0001). Overall survival was also significantly improved (HR0.42, 95% CI 0.30-0.58; p < 0.0001). The incidence of grade 3 or 4 side effects in the MT group was leukopenia (2.9%), thrombocytopenia (0.7%), and anemia (4.3%), hand-foot syndrome (5.8%), and thrombocytopenia (0.7%). oral mucositis (1.5%), and nausea and vomiting (2.2%).

Conclusions: Maintenance therapy with S-1 (tegafur/gimeracil/oltiracetam) or capecitabine following first-line chemotherapy significantly enhanced OS and PFS in patients with recurrent or metastatic nasopharyngeal carcinoma, while exhibiting minimal incidence of grade 3-4 side effects.

Purpose: The purpose of this study was to evaluate the efficacy and safety of combining platelet-rich fibrin (PRF) with diced cartilage (DC) in patients undergoing rhinoplasty.

Methods: A systematic search of MEDLINE/PubMed, Cochrane Library, Web of Science, and Scopus was conducted, including studies published through August 9, 2024. We included observational studies and clinical trials of rhinoplasty using the DC technique with PRF. Primary outcomes were cartilage resorption, nasal dorsum/tip irregularity, and patient satisfaction. Secondary outcomes included postoperative complications such as edema, hematoma, infection, erythema, displacement, and extrusion. Risk of bias (ROB) was assessed using the ROB2 tool for randomized trials and the MINORS checklist for observational studies.

Results: Seven studies with 286 participants were included. Results showed minimal cartilage resorption in five studies. The pooled incidences of nasal dorsum/tip irregularity, erythema, and displacement were 0.43% [95% CI: 0.00-1.95%], 1.63% [95% CI: 0.00-4.99%], and 0.63% [95% CI: 0.00-2.22%], respectively. Patient satisfaction was high, with a pooled rate of 94.33% [95% CI: 89.28-99.38%].

Conclusion: The addition of PRF to DC in rhinoplasty was associated with favorable postoperative outcomes and high patient satisfaction, with a low incidence of complications. However, the lack of comparative studies makes it difficult to determine whether PRF provides significant benefits over DC alone. Larger randomized controlled trials with longer follow-up are needed to further validate these findings.