European Archives of Oto-Rhino-Laryngology最新文献

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.

Purpose: Unilateral vestibular dysfunction leads to significant asymmetry in the horizontal vestibulo-ocular reflex (VOR) during swift head movements. This reflex can be enhanced through rehabilitation exercises and visual-vestibular adaptation techniques. This systematic review aims to evaluate the current evidence on the effectiveness of unidirectional rotation treatments for improving symptoms and function in patients with vestibular disorders.

Methods: A systematic review was conducted following the PRISMA 2020 guidelines, using databases such as PubMed, Cochrane Library, EMBASE, and Scopus. Included were experimental studies, randomized controlled trials (RCTs), or pilot RCTs. Meta-analysis was performed based on the findings of these studies.

Results: Among 24 articles identified, three addressed the systematic review's question, two observational studies (one retrospective and one prospective) and a RCT. Studies included data from a total of 200 participants with vestibular disorders (n = 96; 48% males) for the meta-analysis. A meta-analysis, including a subgroup analysis, was conducted to assess the improvement in VOR asymmetry following vestibular rehabilitation. The analysis compared pre- and post-rehabilitation directional preponderance (DP) across three studies. Results showed a significant improvement in VOR asymmetry, with a mean difference of 18.72% in favour of rehabilitation.

Conclusion: Our findings substantiate the efficacy of unilateral vestibular stimulation in reducing asymmetry in the VOR among patients with vestibular dysfunction. This modality represents a promising rehabilitation strategy, significantly enhancing vestibular function and patient outcomes.

Purpose: Positional obstructive sleep apnea (POSA) is common among obstructive sleep apnea (OSA) patients and exhibits distinct clinical features. This study aimed to analyze the clinical characteristics and associated factors of POSA, as well as compare the outcomes between POSA and non-POSA (NPOSA).

Methods: OSA subjects aged over 40 years from the Sleep Heart Health Study were included in this study. OSA was classified into POSA and NPOSA according to the Cartwright criteria. Univariate and multivariable logistic regression analyses were conducted to identify predictors of POSA. The incidence of outcome events across the two groups was assessed using cumulative hazard curves and compared with the log-rank test.

Results: A total of 1,080 OSA subjects were included, with 412 in the NPOSA group and 668 in the POSA group. In the univariate analysis, body mass index, diabetes, apnea-hypopnea index (AHI), the percentage of sleep time with oxygen saturation below 90% (CT90) and arousal index were inversely associated with POSA, average oxygen saturation during sleep and minimum oxygen saturation during sleep were positively associated with POSA. In the multivariate analysis, AHI (OR 0.98, 95% CI 0.97 to 0.99, p = 0.006) and CT90 (OR 0.98, 95% CI 0.96 to 1.00, p = 0.027) remained significantly inversely associated with POSA after adjusting for other variables. There was no significant difference in the cumulative hazard of myocardial infarction, stroke, congestive heart failure, or all-cause mortality between the two groups during the mean follow-up period of 11 years.

Conclusions: This study identified AHI and CT90 as independent predictive factors for POSA. There was no significant difference in the incidence of myocardial infarction, stroke, congestive heart failure, or all-cause mortality between POSA and NPOSA.

Background: A new endoscopic tympanoplasty technique for large and medium-sized central perforations via a transcanal approach, without tympanomeatal flap elevation compared the preliminary postoperative graft success and hearing outcomes with other techniques in the literature.

Methods: The study involved 75 patients aged 12 to 44 who underwent tympanoplasty with the lateral malleolar flap technique from 2014 to 2017. Pre-operative otoscopy recorded perforation sizes, and pure tone averages were calculated at 500, 1000, 2000, and 4000 Hz. The procedure was performed under general anesthesia via a transcanal approach using tragal cartilage, without tympanomeatal flap elevation. A control otoscopy was conducted six months post-operation to assess reperforation and graft position. Pure tone averages were measured, and pre-operative and post-operative audiological values were compared.

Results: Post-operative six-month graft success rate was 94.6%. Reperforation was observed in one patient (1.3%), while another patient (1.3%) exhibited lateralization, and two patients (2.6%) demonstrated medialization. The pre-operative mean hearing level was recorded at 33.3 ± 7.0 dB, accompanied by an Air-Bone Gap (ABG) of 24.0 ± 6.6 dB. Post-operative measurements indicated an improvement in these values, with the mean hearing level decreasing to 18.0 ± 4.8 dB and the ABG reducing to 16.3 ± 5.3 dB (p < 0.05).

Conclusion: The endoscopic underlay cartilage tympanoplasty with lateral malleolar flap is a safe technique that avoids elevating the tympanomeatal flap. It offers shorter operation time, easier postoperative dressing, and high graft success rates similar to other tympanoplasty techniques.

Purpose: The persistent and recurring nature of Menière's Disease may pose psychological challenges for patients. The association between Menière's Disease and depression and anxiety remains inconclusive among pre-existing studies. This study seeks to review and synthesise existing evidence regarding the association between Menière's Disease and depression and anxiety.

Methods: Two authors independently searched PubMed, Embase and The Cochrane Library for observational or randomized studies investigating the association between Menière's Disease with depression or anxiety. Using a random-effects model, the prevalence of depression and anxiety among Menière's Disease patients were pooled using proportions, the standardized mean difference of depression and anxiety test scores between Menière's Disease patients and controls were compared, and maximally-adjusted risk ratios were pooled to determine the risk of depression and anxiety. Heterogeneity was assessed using the I² test. The bias of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the overall quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Results: We included 35 observational studies with 15,890 patients. The prevalence of depression and anxiety among Menière's Disease patients were 34% (95% CI 18%-54%) and 23% (95% CI 16%-32%) respectively. Patients with Menière's Disease exhibited significantly elevated scores in both depression (SMD: 0.73, 95% CI 0.22-1.25) and anxiety (SMD: 0.687, 95% CI 0.228-1.146) assessments in comparison to healthy controls. However, no significant correlation was observed between Menière's Disease and the long-term risk of developing depression or anxiety.

Conclusion: There may be an association between Menière's Disease and depression and anxiety, but further studies are required to confirm these findings.

Purpose: To evaluate the diameter of the facial nerve (FN) and facial canal (FC) at different segments in Bell's palsy (BP) patients and compare the facial nerve/facial canal width ratio (FN/FC) of the the affected and healthy sides to determine the entrapped sites.

Methods: This retrospective study enrolled 47 patients with BP that were referred to a tertiary referral hospital. From patients' records, initial House-Brackmann grades, cranial computurized tomography (CT) and contrast enhanced temporal magnetic resonance imaging (MRI) scans were revieved. FC and FN diameter measurements were performed at the midpoint of labyrinthine segment, geniculate ganglion and tympanic segment in the axial plane, and mastoid segment in the sagittal plane. Contrast-enhanced segments on MRI were evaluated.

Results: There was no statistically significant difference between the FC diameters of the affected and the healthy sides on CT at any measured segments. FN diameter was increased significantly for all segments except mastoid segment on the affected side compared to the healthy side. FN/FC ratio was significantly greater on the affected side than the healthy side in all measured segments. Evident contrast enhancement was observed in all affected FNs, with geniculate ganglion and labyrinthine segment being the most common sites with contrast enhancement on MRI.

Conclusion: Anatomical differences in FC may not be the main predisposing factor in BP. As the geniculate ganglion and labyrinthine segments had the highest FN/FC ratio and showed clear contrast enhancement on MRI, these findings may indicate a higher risk of inflammation and entrapment in these segments.