European Archives of Oto-Rhino-Laryngology最新文献

Purpose: The aim of this study is to propose a classification for patients with recurrent head and neck squamous cell carcinoma (HNSCC) treated with salvage surgery based on the location of the primary tumor and data commonly found in the pathological report of the resection.

Methods: Retrospective study of 665 patients with HNSCC treated with a salvage surgery after a local and/or regional recurrence of the tumor.

Results: We propose a new postoperative classification for patients with recurrent HNSCC treated with salvage surgery. PATH classification stratifies patients into 4 stages based on the glottic or non-glottic location of the primary tumor, the local and regional pathologic extension of the tumor, the status of the surgical margins, and the presence of lymph node metastases with extracapsular spread. The PATH classification was more homogeneous in the prognosis of patients included in each of its stages, and it had a better prognostic discrimination capacity between stages than the rpTNM classification. According to the PATH classification, the 5-year disease-specific survival was: PATH I (n = 306) 82.8%; PATH II (n = 119) 47.1%; PATH III (n = 202) 24.4%; PATH IV (n = 38) 3.7%. For the rpTNM classification, the 5-year disease-specific survival was: stage I (n = 119) 85.1%; stage II (n = 134) 68.4%; stage III (n = 111) 59.5%; stage IV (n = 301) 33.3%.

Conclusion: The PATH classification for HNSCC patients with local and/or regional recurrence treated with salvage surgery had a better prognostic capacity than the rpTNM classification.

Level of evidence: Level IV.

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.

Purpose: Sigmoid sinus anomalies such as dehiscence or diverticula may present with pulsatile tinnitus (PT) and low-frequency hearing loss. Occasionally, these symptoms are severe, necessitating resurfacing of the affected area to restore a normal-appearing sinus wall. This study describes three cases wherein we managed PT attributed to sigmoid sinus anomalies using polymethylmethacrylate (PMMA) bone cement, a novel material.

Methods: Three patients with PT without any history of illnesses initially underwent cortical mastoidectomy to expose the affected area and resurface the sinus wall. Subsequently, PMMA bone cement was used to reconstruct any bony defects causing PT symptoms. Viscosity of the bone cement was altered based on specific characteristics and causes of the affected area. Additionally, we performed the water occlusion test (WOT), audiological assessment, the Tinnitus Handicap Inventory score (THI), and temporal computed tomography, both pre- and postoperatively, to assess the extent of PT.

Results: Preoperatively, all three patients had tinnitus that dissipated with pressure on the neck and the water occlusion test (WOT), with no reported vertigo, trauma, or ear infections. Moreover, all three cases had a severe handicap according to the THI. In contrast, all cases had reduced PT and a significantly decreased THI score postoperatively, as well as no recurrence or complications and no instances of increased intracranial hypertension at the 12-month follow-up.

Conclusion: All cases showed promising results, emphasizing the sustained benefits of this novel intervention for the management of PT.

Purpose: Anaplastic thyroid carcinoma (ATC) is a highly aggressive and lethal thyroid cancer subtype with a poor prognosis. Recent advancements in machine learning (ML) have the potential to improve survival predictions. This study aimed to develop and validate ML models using the SEER database to predict 3-month, 6-month, and 12-month (overall survival) OS in ATC patients.

Methods: Clinical and demographic data for patients with ATC from the SEER database (2004-2015) were utilized. Five ML algorithms-AdaBoost, support vector machines, gradient boosting classifiers, random forests, and naive Bayes-were evaluated. The data were split into training and testing sets (7:3 ratio), and the models were tuned using fivefold cross-validation. Model performance was assessed using the concordance index (C-index) and Brier score, with 95% confidence intervals reported.

Results: The gradient boosting model achieved the greatest performance for 3-month survival (C-index: 0.8197, 95% CI 0.7682-0.8689; Brier score: 0.1802), and the AdaBoost model achieved the greatest performance in 6-month survival (C-index: 0.8473, 95% CI 0.7979-0.8933; Brier score: 0.1775). The SVC model showed superior performance for 12-month survival (C-index: 0.8347, 95% CI 0.7866-0.8816; Brier score: 0.1476). Using SHAP with a gradient boosting model, the top five features affecting 6-month OS were identified: surgery, the presence of stage IVC, radiation, chemotherapy, and tumor size. Treatment improved survival, while higher stages reduced survival, with smaller tumors generally linked to better outcomes.

Conclusion: ML algorithms can accurately predict short-term survival in ATC patients. These models can potentially guide clinical decision-making and individualized treatment strategies.

Purpose: The auricular fillet flap (AFF) is also used to reconstruct defects of the periauricular region and scalp.The aim of this study was to evaluate patients in whom the total AFF was used to reconstruct defects formed after the resection the skin of the auricular and parotid regions.

Methods: Seven patients, who presented at the researchers' hospital between January 2017 and July 2020 with masses involving, to different degrees, the parotid region, the periauricular region, the external auditory canal, or the auricular anterior surface skin were retrospectively evaluated.

Results: The study retrospectively analyzed seven patients aged 71 to 92 (mean: 80.3 years), including two females (28.5%) and five males (71.5%). The defective region, formed as a result of surgery, was reconstructed with the TAFF in all patients. One patient developed a blood circulation deficiency at first but recovered within a week, while there were no problems with blood circulation or compatibility of the flaps in the other six patients.

Conclusion: The researchers recommend using the TAFF as an alternative flap for reconstructing defects of the skin of the auricular and parotid regions. This reconstruction method can be achieved in one session and offers acceptable aesthetic results.

Background: The alignment between objective scores and patient-reported outcome measures (PROMs) is underexplored. This study aimed to assess changes in Nasal Polyp Score (NPS) and Sino-Nasal Outcome Test (SNOT) scores in chronic rhinosinusitis with nasal polyps (CRSwNP) patients undergoing dupilumab treatment and explore correlations between these scores.

Methods: CRSwNP patients received dupilumab therapy for six months. SNOT-20 German Adapted Version (GAV)/SNOT-22 scores were assessed weekly, and NPS was measured at baseline and after one, three, and six months. Correlations were analyzed using Spearman's rank correlation and regression analysis.

Results: 69 patients were included. After one, three and six months of dupilumab therapy, SNOT and NPS scores improved significantly. Correlation analysis of SNOT and NPS showed significant correlations only within the nasal subscores, along with a weak trend for SNOT-20. Absolute changes over time lacked significance. However, correlation analysis revealed significant associations between relative changes in SNOT score and NPS, irrespective of timing, and when stratified by baseline NPS of 8, 6, and 4 (r = -0.54, p = 0.01; r = -0.44, p < 0.001; r = -0.7, p < 0.001). This was supported by linear regression modeling, suggesting potential predictive capability of NPS reduction on relative SNOT score improvement.

Conclusion: Dupilumab therapy significantly improved subjective and objective CRSwNP scores, exhibiting weak correlations in absolute values for nasal subscores. Furthermore, evidence indicated a correlation between relative changes in SNOT score and NPS, substantiated by predictive capability. This might be due to subjective perception variability, highlighting the suitability of relative change correlation analysis.

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.

Purpose: This non-randomized clinical study aims to identify polysomnographic phenotypic characteristics that differentiate responders from non-responders to mandibular advancement devices (MAD) treatment for obstructive sleep apnea (OSA) and to establish a predictive model of treatment response for OSA using oral devices based on the set of anthropometric, demographic, and polysomnographic phenotypic characteristics.

Methods: This study was registered under the identifier number: NCT02724865. It prospectively analyzed patients receiving MAD treatment for six years. The MADs used were two-piece adjustable appliances following a standardized protocol. Treatment response was defined according to the latest International Consensus Statement on OSA severity. The study analyzed polysomnographic phenotypes, categorizing them into positional phenotype, sleep-stage phenotype (REM/NREM-OSA), and airway collapsibility phenotype. A logistic regression model and a classification and regression tree were implemented.

Results: A total of 112 patients completed the study (64 responders and 48 non-responders). Positional-OSA patients had higher response rates than non-positional (64.1% vs. 35.9; p 0.032). REM-OSA and apnea-predominant phenotype showed a lower response (p < 0.001). In these phenotypes, most patients were women, with higher body mass index, higher scores in the Epworth Sleepiness Scale, lower minSaO2 in REM-OSA phenotype, and higher T90% in apnea-predominant phenotype.

Conclusion: This study underscores the importance of hypoxic burden in the severity of OSA. The parameters T90% and POSA formed predictive model. Additionally, MAD appears to be less effective in the REM-OSA phenotype. Moreover, although patients with an apnea-predominant phenotype responded less favorably, there was a conversion from apneas to hypopneas, reducing severity.

The human microbiome has garnered tremendous interest in the field of oncology, and microbiota studies in head and neck oncology has also flourished. Given the increasing incidence and mortality of HNSCC, as well as the suboptimal outcomes of available treatments, there is an urgent need for innovative approaches involving the microbiome. This review evaluates the intricate relationship between the microbiome and HNSCC, highlighting the potential of the microbiome as a marker for cancer detection, its role in malignancy, and its impact on the efficacy of conventional treatments like chemotherapy and radiotherapy. The review also explores the effects of treatment modalities on the microbiome and discusses the potential of microbiome alterations to predict and influence treatment toxicities such as mucositis and xerostomia. Further research is warranted to characterize the microbiome-HNSCC association, which holds promise for advancing early diagnosis, enhancing prognostic accuracy, and personalizing treatment strategies to improve patient outcomes. The exploration of the microbiome in clinical trials indicates a burgeoning subject of microbiome-focused therapies, heralding a new frontier in most cancer care.

Purpose: Anterolateral thigh free flap (ALTFF) is a versatile option for tongue reconstruction after cancer resection. Compartmental tongue surgery (CTS) is a surgical technique whose purpose is to remove the entire oncological compartment with the pathways of tumor spread. Extended glossectomies (EG) follow the same surgical steps and anatomical concepts as CTS but extend beyond hemiglossectomy. The surgical defect following such resections often necessitates the use of a large free flap, with the ALTFF being the most commonly used.

Methods: The CTS and EG are anatomically-based approaches tailored to the lesion rather than the tumor margins. Leaving a predictable defect, the reconstructive phase can, in most cases, be planned in a standardized way, assuming certain scenarios based on the surgical approach.

Results: After CTS and EG, the residual volumetric defect is large. Therefore, the reconstructive flap of choice is the ALTFF. The ALTFF offers sufficient tissue volume to cover the functional defect and is a versatile flap. It can be harvested as a simple fasciocutaneous flap, as a chimeric flap, or as a muscle-fasciocutaneous flap, depending on the reconstruction requirements. We demonstrated the constant design of ALTFF based on the predictable defect after CTS and EG, aiming for a more precise and standardized reconstruction.

Conclusion: We propose a flap design based on the anatomy of the tongue and oral cavity after CTS or EG for a more precise and standardized reconstruction. Additionally, a standard template is particularly useful for less experienced surgeons who are approaching this technique for the first time.