European Archives of Oto-Rhino-Laryngology最新文献

Purpose: Vibrant Soundbridge (VSB) is an active middle ear implant that serves as a solution for people unable to use conventional hearing aids properly. Surgical techniques for VSB implantation have progressively advanced, improving its outcomes. Traditionally, VSB processor activation transpires around four weeks after the surgery to provide enough healing; however, contemporary practices in cochlear implant and bone-anchored hearing device activations indicate reduced waiting times. The purpose of this research is to explore the feasibility, safety, and advantages of early VSB activation.

Methods: This prospective study was conducted in two phases. In phase one, the patients only attempt using the device on the first business day after surgery and then return in 4 weeks for a complete and standard fitting and device use. In the second phase, participants had a thorough fitting and began using the device on a regular basis the first working day after surgery. Feasibility, safety, and audiological results were assessed throughout both phases.

Results: Early activation was successfully achieved in all patients in the early group without significant complications. When comparing the audiological examination and fitting parameters between the initial session the day after surgery and the one-month follow-up, there was no statistically significant change.

Conclusion: The study emphasizes the possibility for early VSB activation, which might minimize wait times and enhance patient satisfaction without compromising device function. Further study is required to validate these results in broader groups and investigate long-term consequences.

Purpose: Detection of complications during rehabilitation and postoperative follow-up after cochlear implantation is essential, especially in children and cognitively impaired patients. Electrode array migration can affect outcomes and must be detected early. Traditional radiographic methods, although effective, are costly and expose patients to radiation. This case report discusses the use of a previously published impedance-based model for cochlear implant array localization in a child with Aymé-Gripp syndrome.

Methods: Impedance telemetry data and X-ray images were collected at the time of initial surgery and before and after the required revision surgery. The impedance-based model was used to estimate the insertion depth of the most basal cochlear implant electrode within the cochlea. The resulting estimates were compared with the electrode positions from radiographs to assess the accuracy and applicability of the model.

Results: 20 months after implantation, the patient suddenly stopped tolerating the CI audio processor. Retrospectively, the impedance-based model revealed substantial electrode migration, which was confirmed by postoperative radiography.

Conclusion: The proposed model, which uses routine impedance telemetry data without radiation exposure, offers a cost-effective alternative to radiography. Early detection and intervention, particularly in complex cases, improves outcomes and reduces costs, highlighting the importance of objective monitoring.

Objective: Research on age and prognosis for oral cavity squamous cell carcinomas (OSCCs) has shown inconsistent results. We aimed to establish age as an independent prognostic factor and determine an age cutoff for staging in OSCC.

Methods: Electronic records were reviewed for all OSCC patients treated between 2000 and 2020.

Results: The study involved 250 patients, identifying a mortality cutoff age of 65 through Receiver Operating Characteristic curve analysis (sensitivity 77%, specificity 49%). Patients ≥ 65 had lower survival rates for early-stage (TNM I-II; 63.5% vs. 96%, p < 0.001) and advanced-stage (TNM III-IV; 37.5% vs. 62%, p = 0.011) diseases. A proposed age-based TNM staging system categorized ≥ 65 as Stage III/IV, with comparable survival rates confirmed in a revised analysis.

Conclusion: The study identifies age, with a 65-year cutoff, as an independent prognostic factor in OSCC and highlights its role in improving current staging systems.

Level of evidence: III.

Purpose: Cholesteatoma is characterized by the abnormal growth of keratinizing squamous epithelium in the middle ear. Although both pediatric and adult populations are affected, differences in the molecular mechanisms underlying cholesteatoma between these age groups are not fully understood. miRNA-21 and IL-6 have been implicated in various inflammatory and proliferative processes, and their roles in cholesteatoma pathogenesis among different age groups warrant detailed investigation. Research objective -Compare the expression levels of miRNA-21 and IL-6 genes in pediatric versus adult cholesteatoma tissues to elucidate potential age-related molecular differences.

Methods: Tissue samples were collected from 30 patients (15 in Pediatric group and 15 in Adult group) undergoing surgical treatment for cholesteatoma. Preoperative MERI scores and Quantitative real-time PCR (qRT-PCR) was employed to measure the expression levels of miRNA-21 and IL-6. Statistical analyses were conducted to compare the expression profiles between the two groups.

Results: The results revealed a significantly higher expression of miRNA-21 and IL-6 in pediatric cholesteatoma compared to adult cholesteatoma. These findings suggest distinct molecular pathways may be involved in the pathogenesis of cholesteatoma in different age groups.

Conclusion: The differential expression of miRNA-21 and IL-6 between pediatric and adult cholesteatoma underscores the potential for age-specific therapeutic targets. Increased miRNA-21 and IL-6 gene expression in pediatric cases may indicate a more pronounced role in tissue proliferation and inflammation. Further research is necessary to explore the clinical implications and potential for targeted treatments based on these molecular differences.

Level of evidence: 3:

Purpose: Obstructive sleep apnea syndrome is a common condition that can have serious consequences if left untreated. Many patients are intolerant of treatment by continuous positive airway pressure or a mandibular advancement splint. Tonsillopharyngeal surgery may be a viable therapeutic alternative. The objective of this study was to compare clinical assessments of tonsillar obstruction in awake patients with findings from drug-induced sleep endoscopy (DISE). A secondary objective was to evaluate its impact on therapeutic success.

Methods: A retrospective cohort study was conducted on 270 patients, of whom 128 were selected for the study. Patients were evaluated both clinically and via DISE.

Results: Significant differences were found between tonsillar obstruction pattern observed under sedation with those seen in awake patients. DISE led to the cancellation of surgeries planned in nearly half of the cases. Interestingly, size 2 tonsils, generally considered non-obstructive, were found to be obstructive in 58% of cases. Tonsillectomy and/or pharyngoplasty when performed on patients selected throught DISE was successful in 75% of cases.

Conclusion: DISE appears to be a valuable tool for assessing tonsillar obstructions and may allow more patients to benefit from appropriate surgical interventions.

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.