European Archives of Oto-Rhino-Laryngology最新文献

Purpose

Although tonsillectomy is a common otolaryngological procedure renowned for its ease and safety, it is associated with various complications such as hemorrhage, dysphagia, pain, and infection. Post-tonsillectomy bleeding, especially secondary bleeding, poses a significant risk, with mortality rates reported as 5% of cases. Various techniques have been proposed to mitigate these risks, including the closure of the tonsillar fossa to prevent hemorrhage. Suturing of tonsil pillars has been suggested to enhance healing by reducing exposed surfaces. However, complications such as arterial injury and infection have been reported. This study aimed to investigate the efficacy of barbed sutures for reducing post-tonsillectomy complications compared to standard techniques.

Methods

This prospective case-control study included 25 patients to receive a tonsillectomy with silk sutures (n = 11) or a tonsillectomy with barbed sutures (n = 14). Patients underwent either Barbed Tonsillectomy (BT) or standard tonsillectomy with external silk sutures. Pain scores were assessed using a visual analogue scale (VAS), while oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT-10) at two weeks and one month post-operation.

Results

BT showed significantly lower postoperative pain scores than standard tonsillectomy at 24 hours (VAS: 2.9 vs. 7.0) and after two weeks (VAS: 0.1 vs. 3.4). Similarly, BT demonstrated lower EAT-10 scores at two weeks (0.6 vs. 8.2) and one month (0.9 vs. 5.3), thus indicating reduced dysphagia. Only one patient in the control group required surgical revision due to bleeding, and none in the BT group. Comparison of all variables showed always a statistically significant (p<0.05).

Conclusions

This study showed that barbed sutures in tonsillectomy may be a safe technique with reduced complications and a faster recovery. Initial findings regarding hemorrhage, pain management, and recovery outcomes are highly promising, warranting further investigation with larger sample sizes to endorse these results.

Purpose

This study aimed to evaluate the feasibility, safety, and patient satisfaction of outpatient partial parotidectomies in a French university hospital, addressing the lack of national data on such procedures amidst a push for increased ambulatory surgeries.

Methods

A prospective cohort study was conducted, involving patients undergoing partial parotidectomy for non-malignant tumors from March 2021 to May 2023. Inclusion was based on surgical, medical, and social criteria. A control group was also reviewed for comparison. The study followed a standardized surgical and anesthesia protocol, with patient satisfaction assessment.

Results

From an initial pool of 104, 64 patients passed surgical screening, and 45 remained after anesthesia and social considerations, marking a 70% inclusion rate for outpatient care. The success rate of outpatient procedures stood at 98%, with complication incidences mirroring those of inpatient counterparts. 91% of participants expressed high satisfaction, scoring their experiences 7/10 or above.

Conclusion

Outpatient partial parotidectomies within the French health infrastructure are both viable and align with patient expectations, reinforcing the shift towards ambulatory surgery.

Purpose

To assess whether the duration of disease may influence the surgical success of Endonasal Endoscopic DCR (EE-DCR) in patients affected by nasolacrimal duct obstruction (NLDO).

Methods

Single-center observational retrospective analysis on EE-DCR via posterior trans-ethmoidal approach. Consecutive patients were enrolled in 2021–2024 and evaluated with proper questionnaires; resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Also, patients were asked to complete the Hospital Anxiety and Depression Scale (HADS) at each timepoint. The sample was divided based on the duration of disease (group A: ≤ 24 months, group B: > 24 months).

Results

Ninety-one patients were included. At baseline no differences were observed between the two groups. At both timepoints, Munk score was significantly lower in Group A compared to Group B, while a difference in dacryocystitis rate was observed only at T2. Anxiety scores differed significantly at T2, although no differences were observed for depression. At paired analysis, all groups improved significantly at T1 compared to baseline, whereas no further improvement was observed between T2 and T1. A significantly higher improvement was observed in group A for the Munk and HADS-A scores over timepoints, whereas there was no significance for dacryocystitis rate and HADS-D. Also, group A showed a higher complete success rate compared to group B (p = 0.041). Finally, linear regression confirmed a positive relationship between Munk and anxiety scores and the duration of disease at T2.

Conclusions

Our findings showed that long-lasting NLDO symptoms may be associated with worse EE-DCR surgical outcomes.

Background

Although endoscopic dacryocystorhinostomy (EDCR) has been performed successfully in primary and revision cases, there has yet to be a consensus on the best surgical approach.

Methods

Excessive granulation, adhesion, and fibrosis, the main causes of unsuccessful EDCR, should be expected more frequently in revision surgery. Anastomosis by ligating the nasal mucoperiosteum and lacrimal sac flaps with clips can minimise the surface of exposed bone, therefore, the possibility of stenosis and failure of the dacryocystorhinostomy.

Conclusions

In 12 revision EDSR patients, ligating clips ensured an anatomical overlap of the mucoperiosteum and sac flap, providing a wider rhinostomy opening and straight epithelial lining.

Purpose

This study assessed whether the Fazekas score could account for the variability in cochlear implantation (CI) outcomes among individuals with DFNA9 and evaluated signal loss in the semicircular canals (SCCs) on magnetic resonance imaging (MRI) among individuals with DFNA9.

Method

This retrospective cross-sectional study included CI recipients with DFNA9. Pre-implantation MRI-scans were reviewed to determine the Fazekas score, localizing and grading cerebral white matter lesions (WML), and identify abnormalities in the SCCs. CI performance was assessed by evaluating phoneme scores one year post-implantation. The function of the SCCs was evaluated using rotatory chair testing with electronystagmography (ENG) and the video Head Impulse Test (vHIT).

Results

Forty-five subjects (49 ears) were enrolled. The phoneme scores significantly improved from 35% (IQR 11–50) pre-implantation to 84% (IQR 76–90) one year post-implantation. No correlation was observed between the Fazekas score and the one-year post-implantation phoneme score (r_sp=0.003, p = 0.986). Signal loss in at least one SCCs was detected in 97.7% of subjects and 77.8% of ears. There was no correlation between vestibular test results and fluid signal loss in the SCCs on MRI.

Conclusion

Most individuals with DFNA9 show improved speech recognition with CI. The observed variability in CI outcomes was not linked to the Fazekas score. Additionally, our study confirms a high prevalence of focal sclerosis in DFNA9. Recognizing the limitations of this study, further research is needed to explore the predictive role of the Fazekas score on CI outcomes and its relationship with vestibular function.

Purpose

To investigate the short-term efficacy of third-generation bisphosphonate in the management of tinnitus associated with otosclerosis.

Methods

A prospective case–control study included 100 patients with otosclerosis-associated bothersome tinnitus. Patients were assigned to two groups: group A (control): 25 patients who planned to receive only complementary supplements, oral vitamin D plus calcium, and group B (case): 75 patients who planned to receive oral bisphosphonate plus routine vitamin D and calcium supplements. Group B was subdivided into B₁: 25 patients without any previous intervention, B₂: 25 patients with persistent tinnitus for more than 6 months after a previous uncomplicated stapedotomy in the same ear, and B₃: 25 patients with persistent tinnitus for more than 6 months after hearing aid fitting. The outcome was tinnitus assessment both subjectively (tinnitus intensity, frequency, and questionnaire) and objectively (tinnitus intensity and frequency).

Results

The female-to-male ratio was 1.6:1 with ages ranging from 40 to 61 years. The baseline revealed no statistically significant differences between the groups. After 6 months, there were statistically significant differences, both objectively and subjectively. The tinnitus questionnaire median (IQR) for group B was 16 (30), whereas control group A had 52 (24). The tinnitus severity median (IQR) for group B was 20 (30), compared to group A’s 52 (42). After 6 months, 40% of the cases in group B demonstrated complete improvement, compared to 0% in control group A.

Conclusion

We demonstrated significant tinnitus improvement in cases treated with bisphosphonate compared to the control group.

Introduction

Multidisciplinary tumor boards are meetings where a team of medical specialists, including medical oncologists, radiation oncologists, radiologists, surgeons, and pathologists, collaborate to determine the best treatment plan for cancer patients. While decision-making in this context is logistically and cost-intensive, it has a significant positive effect on overall cancer survival.

Methods 

We evaluated the quality and accuracy of predictions by several large language models for recommending procedures by a Head and Neck Oncology tumor board, which we adapted for the task using parameter-efficient fine-tuning or in-context learning. Records were divided into two sets: n=229 used for training and n=100 records for validation of our approaches. Randomized, blinded, manual human expert classification was used to evaluate the different models.

Results 

Treatment line congruence varied depending on the model, reaching up to 86%, with medically justifiable recommendations up to 98%. Parameter-efficient fine-tuning yielded better outcomes than in-context learning, and larger/commercial models tend to perform better.

Conclusion

Providing precise, medically justifiable procedural recommendations for complex oncology patients is feasible. Extending the data corpus to a larger patient cohort and incorporating the latest guidelines, assuming the model can handle sufficient context length, could result in more factual and guideline-aligned responses and is anticipated to enhance model performance. We, therefore, encourage further research in this direction to improve the efficacy and reliability of large language models as support in medical decision-making processes.

Purpose

Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media characterized by eosinophilic accumulation in the middle ear mucosa and effusion. It is refractory to conventional treatments and is strongly associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The diagnostic criteria for EOM were established by IINO in 2011. With the recognition of type 2 inflammatory diseases, the gold standard of treatment is the systemic and topical administration of corticosteroids. Recently, several retrospective studies have demonstrated the efficacy of biologic treatments in EOM. We aimed to share our experience regarding the response of EOM after the use of biologics.

Methods

This is a retrospective observational analysis including patients with refractory EOM treated with different biologics (benralizumab, omalizumab, mepolizumab, dupilumab) for concomitant severe asthma, urticaria and/or severe uncontrolled CRSwNP from 2011 to 2023. Treatment effectiveness in terms of EOM severity was measured using medical Global Evaluation of Treatment Effectiveness (GETE).

Results

We illustrated 4 clinical cases of uncontrolled comorbid EOM and demonstrated the complexity of multidisciplinary medical pathway with good response to biologics. We also observed that response to EOM and CRSwNP does not always follow that of asthma.

Conclusions

The results of our small sample were consistent with those found in the literature and showed control of EOM with biologics. We need a larger multicentric sample and methodology to confirm these results and to compare the efficacy of different biologics.

Purpose

To analyse diagnostic accuracy of MRI-DWI in detecting residual disease after cholesteatoma surgery and propose an optimum follow-up (FU) scheme.

Method

A retrospective chart review of patients who had cholesteatoma surgery in a tertiary referral centre. 3.0 T non-echo planar diffusion weighted imaging was performed as part of routine FU or indicated on the basis of clinical suspicion of disease. Imaging outcome was verified per-operatively during a second-look procedure or ossicular chain reconstruction. Diagnostic parameters were calculated and stratified by FU length.

Results

For the FU of 664 cholesteatoma surgeries, 1208 MRI-DWI were obtained and 235 second-look procedures were performed. Most MRI-DWI were obtained within 1.5 yrs of surgery. In this period, significantly less true positive MRI-DWI and significantly more false negative MRI-DWI for residual disease were found compared to other FU periods. Scanning after approximately 3 yrs yielded a significantly higher rate of true positive MRI-DWI, while sensitivity surpassed 80%. Younger patients had a higher risk of developing residual disease. Patients undergoing canal wall up surgery, as well as patients < 12 yrs, were at risk for false negative MRI-DWI. Obliteration reduces the risk of residual disease, while leading to less false negative MRI-DWI.

Conclusion

A novel radiologic FU scheme for detecting residual disease is suggested for stable ears after cholesteatoma surgery: standard MRI-DWI approximately 3 and 5 yrs after primary surgery, as well as MRI-DWI after approximately 9 yrs for patients with specific risk factors (i.e., patients < 12 yrs or patients undergoing canal wall up surgery without obliteration).

Purpose

Access the importance of visualizing the pterygomandibular raphae (PMR) while fixing palatopharyngeous (PPM) muscle to the pterygomandibular raphae (PMR).

Methods

Randomized controlled trial. First group, forty-two OSA patients performed either Anterolateral advancement pharyngoplasty (ALA) or Barbed reposition pharyngoplasty (BRP) while visualizing the PMR according to the following criteria: age between 21 and 60 years, body mass index (BMI) < 35, and patients with lateral pharyngeal collapse diagnosed with drug induced sleep endoscopy (DISE). The results were compared to the second control group of 42 patients performed the same procedures without exposing the PMR.

Results

PMR was bilaterally present in 27 (64.28%) patients and bilaterally absent in 5 (11.8%) patients while unilateral in 10 (23.9%) patients. PSG findings in group 1: Apnea hypopnea index (AHI) decreased from 40.84 ± 26.93 to 14.81 ± 7.43 (P < 0.001), mean Lowest oxygen saturation (LOS) significantly increased from 79.25 ± 14.93 to 89.92 ± 10.7 (P < 0.001) and Epworth sleepiness scale (ESS) significantly dropped from 13.25 ± 4.65 to 6.1 ± 2.06 (P < 0.001). Group 2 results showed AHI decrease from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ 0.001), LOS increased from 81.86 ± 6.41 to 90.21 ± 3.70 and ESS dropped from 14.95 ± 3.72 to 7.91 ± 3.05. The difference between both groups was not statistically significant (P > 0.001).

Conclusion

Fixation of PPM to the PMR under direct vision doesn’t significantly affect the surgical outcomes but can increase the procedure efficiency and reduce complication rate keeping in mind that PMR may be absent in some patients.