European Archives of Oto-Rhino-Laryngology最新文献

Objective: To analyze independent risk factors for distant metastasis of columnar cell subtype of papillary thyroid carcinoma (CCS-PTC) and to construct and validate a nomogram to help clinicians make more individualized clinical decisions.

Study design: Retrospective population-based cohort study.

Setting: Surveillance, Epidemiology, and End Results (SEER) database.

Methods: Patient data were downloaded from the SEER database. Chi-square test and Logistic regression analysis were used to determine independent risk factors for distant metastasis of CCS-PTC. A nomogram based on significant independent risk factors was established using the rms package of R software (version 4.3.3). The performance of the nomograms was evaluated using subject work characteristic curves (ROC), calibration curves, and decision curve analysis (DCA).

Results: A total of 1712 patients with CCS-PTC were included, of which 79 patients developed distant metastasis, accounting for 4.61% of the entire cohort. The results of chi-square test showed that age, gender, race, tumor size, and lymph node metastasis were significantly associated with distant metastasis of CCS-PTC. Multifactorial logistic regression analysis showed that age, race, tumor size, and lymph node metastasis were independent risk factors for distant metastasis of CCS-PTC, and this was used to draw the nomogram. the results of ROC, calibration curves, and DCA showed that the predictive performance of the nomogram was good.

Conclusion: We successfully constructed and validated a nomogram for CCS-PTC distant metastases, which is important for clinicians to identify patients at high risk of distant metastases in a timely manner and make more individualized clinical decisions.

Introduction and purpose: In this prospective study, we performed neck morphological measurements and the relationship between the nerve and important anatomical structures in the neck to prevent spinal accessory nerve (SAN) damage in patients who underwent neck dissection.

Methods: This study was conducted prospectively between October 2021 and September 2023 in 80 patients who underwent neck dissection due to head and neck malignancy.

Results: The mean age of 59.2 ± 17.07 years (18-90 years) of the 80 patients, 54 were men and 26 were women. There was a positive correlation between the distance between the NAM-SAN and the sternocleidomastoid (Scm) muscle thickness(r = 0.242, p = 0.03). There was a positive correlation between the distance between the NAM-SAN and the distance between the mastoid apex and the clavicle midline (r = 0.235, p = 0.036). There was a statistically significant negative correlation between the distance between the NAM-SAN and age (r = - 0.324 p = 0.003). There was a positive correlation between the trapezius-SAN and the distance between the mandibula angulus-clavicle midline (r = -0.243 p = 0.03).

Conclusion: The spinal accessory nerve must be sought for higher than the estimated point In patients which with more scm thickness. It should be considered that as the preoperatively measured mastoid apex-clavicle distance increases, the distance between the NAM and the SAN increases. It should be taken into consideration that the course of the SAN in the posterior triangle will be longer in patients with longer necks. It should be noted that as age increases, the distance between the SAN and NAM decreases.

Background: Bone conduction devices are hearing assistive devices that are used in many children who have conductive hearing loss, mixed hearing loss or single sided deafness. The aim of this study is to assess long-term outcomes of children who underwent piezoelectric bone conductive device implantation.

Method: A prospective cohort of children who underwent Osia system implantation (OSI200) between the period of Jan 2021 and December 2022. The main Outcome measures were; Long-term complications, hearing thresholds, speech discrimination, sound localization and quality of life.

Results: 25 children were implanted with 27 devices. The median surgical time 39 min. 6 children had single sided deafness, 21 ears had conductive hearing loss due to microtia/canal atresia (20 ears) or chronic ear disease (1 ear). None of the patients had any major adverse events. In children with conductive hearing loss, the median threshold of improvement was 37.5 dB. All patients reported significant improvement of their auditory function. Aided thresholds were best at 1 kHz (median 20 dB HL). Recorded gains were measured up 8000 Hz reflecting good auditory performance even at high frequencies. Speech Discrimination when using the Osia was 89% and self-reported hearing and quality of life by participants improved in all domains assessed.

Conclusion: Osia system is a safe and effective solution to restore hearing without any major long term complications. It provides auditory benefits that covers a wide range of frequencies. Children had significant improvement in their ability to sound localize as well as QoL. Osia surgery can be performed in a routine day surgery setting safely in children.

Purpose: We present a case of dysphagia caused by an aberrant internal carotid artery (ICA). By reporting this rare occurrence, we hope to highlight the anomaly as a differential in cases of persistent, progressive dysphagia.

Results: Even though the symptomatic mass effect of the ICA warranted the option of surgical intervention, due to a patient-centered approach with an emphasis on personal preference, the patient was instead referred for specialized ergotherapy.

Conclusion: This case characterizes a rare yet significant cause of dysphagia, in addition, it illustrates the necessity of a multidisciplinary approach when dealing with complex cases of dysphagia.

Purpose: The management of unilateral Menière's disease (MD) in adult patients remains contentious, with various therapeutic options proposed but no established gold standard. This scoping review aims to evaluate the current treatment options for unilateral MD, identifying challenges in management and providing guidance for ENT physicians in selecting effective therapies.

Methods: A comprehensive literature search of the MEDLINE and Embase databases was conducted without date restrictions, assessing various treatment modalities for MD. Randomized controlled trials (RCTs) were selected to ensure the highest quality of evidence was reviewed.

Results: Thirty-four RCTs met the inclusion criteria. The current evidence base encompasses dietary interventions, systemic drug therapy, intratympanic treatments, positive pressure therapy, low-level laser therapy, and non-destructive surgical techniques. However, the evidence supporting these treatments is limited and inconsistent. Notably, none of the RCTs considered the heterogeneity of MD patient populations, which may explain the variability in study results.

Conclusion: This review highlights the limited evidence supporting current treatments for unilateral MD, emphasizing the need for high-quality, placebo-controlled trials. Future research should incorporate biomarker-based stratification, large patient cohorts, standardized outcome measures, and long follow-up periods to enhance the consistency and comparability of findings.

Purpose: Currently, free-flap surgery with double innervation is considered a reliable and effective treatment in case of long standing facial paralysis. This study aimed to provide a current review of the literature (the "current state of the art") on lower third of the facial reanimation in restoring the voluntary and spontaneous smile in adult population using dual innervation free flap surgery.

Methods: We conducted a comprehensive literature review of all relevant papers by searching the electronic databases MEDLINE, Embase, Scopus, and the Cochrane Library.

Results: We included 12 retrospective studies involving 147 patients, five of which used the latissimus dorsi double innervation technique (42 patients) and seven of which investigated double innervation with a gracilis free flap (105 patients). In this review, we summarised the available data on smile recovery after free flap double innervation surgery. In half of the included studies, smiling was completely recovered.

Conclusions: Our study confirms that free flap surgery with dual innervation for long-term paralysis of the lower third of the face can guarantee comparable results using latissimus dorsi or gracilis free flaps. The best option depends on the case, taking into account the surgeon's skills and experience, as well as the patient's wishes and expectations.

Objectives: To evaluate the performance of machine learning models in predicting the 5-year overall survival of patients with Hurthle cell carcinoma, and to identify significant prognostic factors influencing survival.

Methods: A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results database, encompassing patients treated between 2010 and 2015. Key variables included demographic information (age, sex, race), clinical characteristics (tumor size, T, N, M stages, and overall stage), and survival outcomes. Patients were included if they had complete data, were not censored before 60 months of follow-up, and had undergone thyroid surgery.

Results: The study included 1,143 patients with a mean age of 57.7 years (standard deviation = 15.8). The cohort consisted of 770 females (67.4%) and was predominantly White (83.0%). Tumor classifications were varied, with T2 being most common (37.2%). The majority had no nodal involvement (94.1%) or distant metastasis (97.6%). The support vector model achieved the highest area under receiver characteristics operating curve of 0.8402 (95% CI: 0.7915 to 0.8847), indicating good predictive performance. Sensitivity and specificity were 81.16% and 73.72%, respectively. The Brier score for the model was 0.1223, demonstrating adequate calibration. Higher age and T classification were the most significant predictors of decreased survival, while being female was associated with increased survival.

Conclusion: Machine learning models, particularly the support vector model, effectively predicted 5-year overall survival in patients with Hurthle cell carcinoma. The study highlights age and tumor extent as critical prognostic factors.

Purpose: To evaluate the reliability and accuracy of Large Language Models in answering patient Frequently Asked Questions about adult neck masses.

Methods: Twenty-four questions from the American Academy of Otolaryngology-Head and Neck Surgery were presented to ChatGPT, Claude, and Gemini. Five independent otolaryngologists evaluated responses using six criteria: accuracy, extensiveness, misleading information, resource quality, guideline citations, and overall reliability. Statistical analysis used Fisher's exact tests and Fleiss' Kappa.

Results: All models showed high reliability (91.7-100%). Paid GPT and Gemini achieved highest accuracy (95.8%). Extensiveness varied significantly (p = 0.012), with Gemini scoring lowest (62.5%). Resource quality ranged from 58.3% (Claude) to 100% (Paid GPT). Guideline citations were highest for GPT models (50%) and lowest for Gemini (16.7%). Misleading information was rare (0-16.7%). Inter-rater reliability was near-perfect across five reviewers (κ = 0.95).

Conclusion: Large Language Models demonstrate high reliability and accuracy for neck mass patient education, with paid versions showing marginally better performance. While promising as educational tools, variable guideline adherence and occasional misinformation suggest they should complement rather than replace professional medical advice.

Background: Voice disorders (VD) are often linked to vocal fold structural pathologies (VFSP). Laryngeal imaging plays a vital role in assessing VFSPs and VD in clinical and research settings, but challenges like scarce and imbalanced datasets can limit the generalizability of findings. Denoising Diffusion Probabilistic Models (DDPMs), a subtype of Generative AI, has gained attention for its ability to generate high-quality and realistic synthetic images to address these challenges.

Purpose: This study explores the feasibility of improving VFSP image classification by generating synthetic images using DDPMs.

Methods: 404 laryngoscopic images depicting VF without and with VFSP were included. DDPMs were used to generate synthetic images to augment the original dataset. Two convolutional neural network architectures, VGG16 and ResNet50, were applied for model training. The models were initially trained only on the original dataset. Then, they were trained on the augmented datasets. Evaluation metrics were analyzed to assess the performance of the models for both binary classification (with/without VFSPs) and multi-class classification (seven specific VFSPs).

Results: Realistic and high-quality synthetic images were generated for dataset augmentation. The model first failed to converge when trained only on the original dataset, but they successfully converged and achieved low loss and high accuracy when trained on the augmented datasets. The best performance was gained for both binary and multi-class classification when the models were trained on an augmented dataset.

Conclusion: Generating realistic images of VFSP using DDPMs is feasible and can enhance the classification of VFSPs by an AI model and may support VD screening and diagnosis.

Purpose: This review aims to investigate the effects of the Barbecue roll maneuver on horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) recovery.

Methods: Multiple databases, including "PubMed, PEDro, REHABDATA, MEDLINE, SCOPUS, EMBASE, and Web of Science" were searched from inception to October 2024". Experimental studies that included patients with HC-BPPV that performed the Barbecue roll maneuver independently or in combination with other treatments, compared with active, passive, or no controls, assessed HC-BPPV symptoms, were included in this analysis. The "Physiotherapy Evidence Database (PEDro)" scale was used to investigate the methodological quality of the included studies.

Results: Nine studies met the inclusion criteria with 768 HC-BPPV patients (mean age = 56.16 years; 64% female; 52% right-side HC-BPPV; 90% geotropic HC-BPPV). The PEDro scores ranged from 3 to 8, with a median of 6. The findings showed that the Barbecue roll maneuver is not superior in reducing HC-BPPV symptoms compared to other maneuvers, such as the Gufoni, the Gufoni-Appiani and the Li repositioning.

Conclusions: The initial findings indicated that the Barbecue roll maneuver is considered a treatment option for treating geotropic HC-BPPV. Performing Barbecue roll maneuver for 1 to 3 times can yield meaningful effects. Accurate diagnosis of HC-BPPV is essential for optimal treatment outcomes. The success rate of recovery depends on patient characteristics and therapist proficiency. Additional studies are recommended.