European Archives of Oto-Rhino-Laryngology最新文献

Purpose: To assess the inter-rater agreement of the Cribriform plate, Lamina papyracea, Onodi cell, Sphenoid sinus pneumatization, and Ethmoidal artery (CLOSE) checklist results among rhinology & skull-base surgeons and a head and neck-neuroradiology specialist for pre-operative computed tomography (CT) sinus assessment.

Methods: This retrospective cross-sectional study reviewed 50 patients who underwent endoscopic sinus surgery (ESS) in the period between January 2013 and March 2014 at the Royal Victoria Hospital in Montreal, Canada. According to the CLOSE checklist, the CT scans were evaluated independently by one surgeon and one radiologist using the InteleRadiology Picture Archiving and Communication System (IntelePACS).

Results: Two experts reviewed fifty ESS patients' pre-surgical CT scans. Kappa scores indicated almost perfect agreement for the anterior ethmoidal artery, substantial for Onodi cells, moderate for lamina papyracea dehiscence and anterior clinoid pneumatization, and fair to none/slight agreement for other components. No cases of maxillary fat herniation or ICA aneurysm were observed.

Conclusion: The CLOSE checklist is a reliable preoperative CT examination for paranasal sinuses that requires surgical and radiological expertise to identify anatomical variances, with updated definitions for accurate identification.

Vernet syndrome is a neurological disorder rarely seen in association with varicella-zoster virus (VZV) infection in ear. This report presents a 61-year-old man demonstrating neuropathy of cranial nerve XI, X, and XI. Subsequent serological and radiological examinations revealed Vernet syndrome due to VZV infection, a rare complication of a common infection. Notably, the current report features in the resolutions of inflammatory processes around the right jugular foramen evidenced by serial magnetic resonance (MR) images. This report highlights the potential values of radiological assessment in VZV-induced Vernet syndrome regarding the diagnosis and clinical follow-up. In addition, prompt clinical intervention can lead to favorable outcomes in VZV-induced Vernet syndrome.

Background: Adenotonsillar hypertrophy is the most frequent cause for obstructive sleep apnea (OSAS) in children. In patients with small tonsils and where adenoid size cannot be assessed, the indication for adenoidectomy often relies on clinical symptoms. However, data on the association of clinical parameters and adenoid hypertrophy with OSAS severity in children undergoing an adenoidectomy is sparse.

Aim: To investigate the correlation of patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity in pediatric patients indicated for an adenoidectomy.

Methods: We performed a retrospective chart review of all pediatric patients at our tertiary referral center between 2018 and 2023 who underwent polygraphy (PG) for OSAS diagnostics. Adenoid hypertrophy was assessed as adenoid-choanal ratio (AC-ratio) via nasal endoscopy and clinical symptom score (CS) via physical examination and parental survey. We included all symptomatic children with mild to severe OSAS (apnea-hypopnea index (AHI) ≥ 1). Exclusion criteria were obesity according to BMI and/or the presence of systemic diseases. The patients were divided according to age in a preschool and school cohort. Patient characteristics and PG data were compared between both groups. Linear regression analysis was used to investigate the association of AC-ratio, CS and BMI with the AHI.

Results: A total of 121 patients were identified of which 81 were included in our study, resulting in 42 and 39 patients from 3-5 and 6-14 years of age, respectively. We observed a significant correlation between CS and BMI (p = 0.026) and the CS and AC-ratio (p < 0.001). Univariable regression analysis showed significant association of the AC-ratio and CS with AHI-score for the total (p < 0.001), the preschool (p < 0.001), and the school cohort (p < 0.001). In multivariable regression analysis, the significant association of AC-ratio and CS remained in the total (p = 0.014; p < 0.001), and the preschool cohort (p = 0.029; p = 0.002). However, only the CS remained as positive predictor in the school cohort.

Conclusion: AC-ratio and clinical symptoms seem to be reliable predictors for OSAS severity in patients between 3-14 years of age. Moreover, only clinical symptoms were associated with OSAS severity in schoolchildren. Future investigation should contribute to the validation of our results.

Background: Treating options for vocal fold cysts became more diversified with office-based laryngological surgery advances, offering new soft interventions, promising a good vocal outcome within a shorter healing period.

Methods: We proposed two types of in-office surgeries, performed in the outpatient setting: a cyst punction-aspiration emptying the cyst, relieving its tension and improving the mucosal wave, with 4 cases showing no refilling within one year of follow-up, and a cyst marsupialization with Blue Laser, with 3 reported cases showing good vocal fold healing within three months.

Conclusion: Both techniques showed promising results in improving vocal function and minimizing recovery time.

Purpose: To analyze the correlation between pharyngeal residue and penetration/aspiration in post-stroke individuals.

Methods: Cross-sectional, descriptive, retrospective, clinical study with 157 post-stroke individuals, 71 females and 86 males, aged 26 to 92 years (mean age: 67.2 years), all diagnosed by neurological assessment and imaging exams (computed tomography or magnetic resonance imaging), who underwent fiberoptic endoscopic evaluation of swallowing (FEES) in a rehabilitation center. They were served 5 mL of moderately thick liquid (level 3 in the International Dysphagia Diet Standardization Initiative [IDDSI]) in a spoon three times. Two expert raters in dysphagia assessed them with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) and Penetration Aspiration Scale (PAS). Their interrater sensitivity agreement was analyzed with the Kappa test, and Spearman's rank correlation (r) verified the correlation between pharyngeal residue and the PAS and calculated the effect size (r²).

Results: YPRSRS in vallecula was positively correlated with PAS (r = 0.43; r² = 0.18; p ≤ 0.000); YPRSRS in pyriform sinus, with PAS (r = 0.54; r² = 0.29; p ≤ 0.000); and YPRSRS in both vallecula/pyriform sinus with PAS (r = 0.57; r² = 0.32; p ≤ 0.000).

Conclusion: The severity of pharyngeal residue in post-stroke individuals with dysphagia is correlated with the level of penetration-aspiration.

Purpose: To report the intraoperative observations and hearing outcomes in patients undergoing endoscopic revision ossiculoplasty.

Methods: A retrospective cohort of patients who had undergone revision ossiculoplasty were enrolled in this study. Intraoperative findings were documented. Follow-up visits were scheduled from 3 to 12 months post-surgery to assess hearing levels and record any potential complications.

Results: Between April 2020 and May 2023, a total of 26 cases were enrolled, with 11 male patients represented. The mean age of the patients was 40.5 ± 9.4 years, ranging from 18 to 66 years. During the revision surgeries, various intraoperative findings were noted, including adhesive tissues affecting the activity of ossicular chain (observed in 37.0% of cases), tympanosclerosis of the ossicular chain (also in 37.0% of cases), dislocation of ossicular prosthesis (33.3%), erosion of the ossicular chain (33.3%), and identified cholesteatoma (11.1%). In terms of hearing outcomes, a significant improvement was observed. Overall, only 37.0% of patients achieved an air-bone gap of 20 dB or less, indicating the inferior outcome in revision ossiculoplasty.

Conclusions: This study highlight the role of inflammatory responses (adhesion, tympanosclerosis), stapes erosion, and prosthesis dislocation, as contributing factors to the failure of primary tympanoplasty. Endoscopic revision ossiculoplasty emerges as a reliable and effective approach.

Background: Systemic chemotherapy is the primary treatment strategy for recurrent or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN). Therapeutic strategies are changing considerably with the introduction of molecular-targeted and immune checkpoint inhibitor (ICI) therapies in addition to conventional cytotoxic therapy. The CheckMate-141 and KEYNOTE-048 trials have enabled the use of ICIs as first-line treatment to improve the overall prognosis of RM-SCCHN. However, background factors affecting treatment responses, including performance status (PS), remain poorly defined. Therefore, we investigated the effect of PS in patients treated with nivolumab.

Methods: We retrospectively reviewed the treatment outcomes and backgrounds of 31 patients with RM-SCCHN who received nivolumab monotherapy between April 2017 and March 2023.

Results: The patient background was male/female = 29/2, median age was 68 years (range 39-85), PS0/1/2 = 14/15/2, and oral/oropharynx/hypopharynx/larynx = 2/12/12/5. Median overall survival was 8.0 months (95% confidence interval [CI]: 4.3-30.6 months), median progression-free survival was 3.0 months (95% CI 1.7-9.1 months), and objective response rate was 22.6% (95% CI 11.1-40.1%). Immune-related adverse events of grade 3 or higher were observed in three patients (9.7%). Eight (29.6%) of the 27 patients (excluding four patients who maintained complete response for over 2 years) were successfully transferred to post-treatment. In the multivariate analysis, Eastern Cooperative Oncology Group (ECOG) PS (Hazard Ratio: 9.87, 95% CI 1.79-54.56) was associated with poor survival.

Conclusion: The efficacy of nivolumab is reduced in patients with poor PS.

Introduction: Mucins are glycoproteins with a significant molecular weight that have a diverse range of biological functions. MUC1 & MUC4 are transmembrane mucin family members that are expressed in airway epithelial cells and body fluids. It is expressed excessively in numerous carcinomas in addition to their altered expression. A thorough review of the literature reveals very limited research about MUC1 & 4 expressions in oral malignancies and oral premalignant disorders. The aim of the research is to assess the pattern and quantity of gene expression in MUC1 & MUC4 individually in various grades of oral squamous cell carcinoma (OSCC), oral premalignant disorders (OPMDs)- oral epithelial dysplasia (OED), oral submucous fibrosis (OSF), oral lichen planus (OLP), and compared with normal oral mucosa (NOM).

Materials and methods: Immunohistochemistry and qRTPCR evaluation of MUC1 & 4 on sixty-three cases of OSCC, OPMD, and NOM was accomplished. The one-way ANOVA test and Chi-square test were done for statistical analysis.

Results: The overall immunoexpression of MUC1 & 4 increased significantly from NOM to OPMDs to OSCC. In the subgrades of OSCC and OPMDs, the staining intensity varied. For MUC4, the intensity was strongest in well-differentiated grades and MUC1, exhibiting a higher expression in poorly differentiated grades of OSCC and OPMDs.

Conclusion: The study's results indicate that MUC1 & 4 individually are crucial for monitoring OSCC and OPMD pathogenesis as the former gives an idea of highly undifferentiated grades while the latter indicated more differentiated tumors and perhaps a better prognosis. Therefore, the two can be useful tumor markers for determining the severity and eliminating it in its early phases.