European Archives of Oto-Rhino-Laryngology最新文献

Purpose: By synthesizing and analyzing existing research data, this study evaluates the clinical efficacy and safety of corticosteroids in the treatment of pediatric retropharyngeal abscess (RPA) and parapharyngeal abscess (PPA).

Data sources: Two authors independently searched PubMed, EMBASE, Cochrane Library, and Web of Science, for studies relating to corticosteroids-assisted antibiotic therapy for pediatric RPA and PPA.

Review methods: Literature was meticulously screened against predefined inclusion and exclusion criteria, and relevant data were extracted. Meta-analysis and systematic review methodologies were employed to synthesize and analyze existing research comprehensively, evaluating clinical efficacy and safety.

Results: Five studies were included (2 retrospective case series, 3 retrospective cohort studies), involving a total of 2560 subjects. The cohort studies demonstrated robust methodological quality. Meta-analysis results indicated significantly lower surgical drainage rates in the steroid group (OR = 0.28; 95% CI: 0.23-0.34; p < 0.01) and reduced hospitalization duration (OR=-0.14; 95% CI: -0.23 to -0.06; p < 0.01) compared to the non-steroid group. Systematic evaluation revealed lower hospitalization costs in the steroid group. Predominantly, studies favored intravenous dexamethasone (82.76%). No adverse reactions to corticosteroids were reported.

Conclusion: Current evidence suggests a beneficial role for corticosteroids in the treatment of pediatric RPA and PPA, emphasizing their importance in symptom improvement, decreased surgical intervention, shortened hospital stays, and reduced hospital costs. However, caution is warranted regarding potential side effects, particularly with long-term use. Future research should further elucidate specific dosages, durations, and optimal types of glucocorticoid therapy to better guide clinical practice.

Objective: Cochlear Implantation by classical Trans-mastoid Posterior tympanotomy approach for Round window insertion using microscope is often difficult due to limited visualization of Round window membrane niche. Our study aims to use Endoscope as an adjunct to classical microscopic technique to overcome this difficulty.

Methods: Our study is a Double blinded Randomised controlled trial with patients undergoing Cochlear implantation & having St Thomas Hospital classification IIb and III intraoperatively included in study. They were divided into two groups. Group A underwent Microscopic Cochlear Implantation while Group B underwent Endoscope assisted Cochlear Implantation. Based on visibility Round window niche structural visibility index (RSVI) score was recorded using both microscope and Endoscope.

Results: In Endoscope assisted group mean RSVI score was 8.44 ± 1.37 as compared to microscopic group was 5.47 ± 2.56 and it was Statistically significant with p < 0.05. Intraoperative mean electrically evoked compound action potentials(ECAP) for electrodes 1 to 8 was 187.9 ± 2.84 in microscopic group as compared to 179.44 ± 2.30 in Endoscopic group and the same for electrode 9 to 15 was 178.69 ± 3.16 & 175.3 ± 3.65 respectively but ECAP for electrode 16-22 was statistically insignificant between the groups considering p-value < 0.001. Endoscope assisted Cochlear Implantation was found to be associated with Statistically significant(p < 0.05) chances of Round window insertion with Chi square value of 15.45.

Conclusion: Microscope is the tool of choice for Cochlear Implantation but in cases with difficult visualization Endoscope can adjunct microscope in better visualization thus increasing chances of Round window insertion and promoting hearing preservation.

Objective: Endoscopic ear surgery (EES) is engaged nearly in all otology procedures in this era. The widespread application is faced by raised drawbacks that EES can induce thermal injury to the inner ear structures.

Methods: This retrospective study investigates the effect of endoscopic tympanoplasty on the postoperative sensorineural element of hearing and other inner ear functions. Cases of endoscopic tympanoplasty admitted to the tertiary referral center in the period of the study were included. Important audiologic data were collected including the preoperative and postoperative bone conduction threshold and air bone gap. The total endoscopic usage time during surgery was collected. Appropriate statistical testing was performed using SPSS 20.

Results: The study included 51 patients who had endoscopic tympanoplasty. The mean age was (33.65 ± 10.840) years. The study showed no statistically significant difference between the preoperative and postoperative bone conduction threshold. In addition, Pearson correlation test showed no statistical association between the total endoscopic usage time and the postoperative bone conduction threshold. No significant vertigo nor facial nerve affection were observed in the postoperative period.

Conclusion: Endoscopic tympanoplasty as an example of EES does not affect the inner ear structures, clinically described as it does not affect the postoperative sensorineural hearing, facial nerve function nor the balance.

Objective: We aimed to compare the success rate of the inner-ear visualization and actual endolymphatic hydrops (EH) detection rate of gadolinium-enhanced MRI in ears with definite Meniere's disease (dMD) with intratympanic versus intravenous injection.

Methods: 122 ears with dMD were included and divided into the intratympanic (IT) administration and intravenous (IV) groups. 38 ears in the IT group were evaluated by 3D-real IR and 3D-FLAIR sequence scans 24 h after injection of 8-fold diluted gadolinium. 84 ears in IV group were evaluated by i3D-real IR sequence scans 4 h after intravenous gadolinium administration. The success rate and the detection rate of EH were evaluated and analysed.

Results: The i3D-real IR sequence in the IV group had a higher success rate (100%) than did the 3D-real IR (76.32%) and 3D-FLAIR (84.21%) sequences in the IT group. The actual EH detection rate in the IV group (98.81%) was significantly higher than that for the 3D-real IR (76.32%), 3D-FLAIR (78.95%) or 3D-real IR + 3D-FLAIR (84.21%) sequences in the IT group. The presence of EH could not accurately be assessed in 15.79% of ears in the IT group due to weak perilymph enhancement. After exclusion of these ears, the IT and IV groups showed similar EH detection rates.

Conclusion: The insufficient success rate of IT method reduced its actual EH detection rate. Using i3D-real IR, the IV method offers the higher success and actual EH detection rates, which provides a reference to the individualized choice of gadolinium-enhanced MRI.

Background: Laryngeal cancer is one of the most common head and neck tumors, with 75% affecting the vocal cords. The 8th edition of the TNM staging system defines T1 glottic tumors as those limited to the vocal cords with preserved mobility. Since the publication of the third edition in 1998, this category has been divided into T1a (tumor limited to one vocal cord) and T1b (both vocal cords involved). However, these tumors can also involve the anterior commissure. The anterior commissure is considered a sublocation by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control, but it is not accounted for in the current T staging system. Although the anterior commissure is rarely the primary site of glottic tumors (1%), 20% of glottic tumors show involvement of the anterior commissure, with its impact on prognosis still controversial.

Methods: A global and specific survival analysis was performed using the Kaplan-Meier method, comparing survival curves with the Log Rank test. A Cox regression model was constructed, including confounding variables and examining possible interaction terms, evaluating the proportionality assumption through graphical methods. Confounding variables were controlled using the Propensity Score (PS), estimating the effect with different PS methods.

Results: The variable "Anterior Commissure" showed a significant effect on the recurrence of glottic cancer, consistent across the different propensity score adjustment methods. The Inverse Probability of Treatment Weighting (IPTW) method was particularly effective in adjusting for covariate differences between groups, maintaining the full sample size, and providing a robust and clinically relevant analysis.

Conclusions: The anterior commissure is a significant risk factor for the recurrence of glottic cancer. Integrating propensity score methods enhances the precision and validity of survival studies. It is recommended to continue exploring these methods in larger and more diverse cohorts.

Background: Laryngeal cancer (LC) is among the most prevalent tumors of the respiratory tract. In recent years, the implementation of non-surgical treatments like radiotherapy and chemotherapy has significantly enhanced the therapeutic outcomes for LC. Nevertheless, the underlying therapeutic mechanisms remain unclear, posing a hindrance to the progression of subsequent treatment strategies.

Objectives: To explore the potential mechanisms from existing effective treatments for LC and identify relevant targets, thereby providing guidance for subsequent therapeutic research on LC.

Methods: This study focuses on ferroptosis, a common type of non-apoptotic cell death that is closely linked to various malignancies. It examines the relationship between ferroptosis and LC by analyzing how regulating ferroptosis-related targets in LC cells can influence the development of the cancer.

Results: There is a strong association between ferroptosis and LC. Regulating the targets related to ferroptosis in LC cells can effectively counteract the progression of LC.

Conclusions: Taking ferroptosis as an entry point, analyzing its potential mechanism in inhibiting LC can provide a direction for the treatment of laryngeal cancer, which may contribute to the improvement of therapeutic strategies for this disease.

Purpose: The study's objective was to evaluate the safety and outcomes of stapes surgery in patients with Bellucci type 1 chronic otitis media.

Methods: The study group was composed of Bellucci type 1 chronic otitis media patients who were found to have stapedial footplate fixation during surgery for chronic otitis media. Stapedotomy and prosthesis insertion were performed during the same operation. The control group consisted of patients with an intact tympanic membrane who underwent stapedotomy for primary otosclerosis. The study and control groups comprised 11 and 16 patients, respectively. No preoperative or intraoperative perforation was present in the control group. We recorded the pre-and post-operative air conduction thresholds, the presence and degree of any air-bone gap (ABG) and documented any postoperative complications. A comparison was then made between the two groups.

Results: The mean preoperative air conduction threshold for patients in the study group was 51.73 dBHL, which improved to 33.27 dBHL after surgery. In the control group, the preoperative mean air conduction threshold was 50.13 dB HL, which also demonstrated significant improvement postoperatively, with a threshold of 29.5 dB HL. Preoperative ABG was 31.36 dBHL and 29.88 dBHL, respectively, in the study and control group. Postoperatively, ABG was reduced to 14.82 dBHL and 10.06dBHL in the study and control groups, respectively (p < 0.001).

Conclusion: The preliminary findings of the present study indicated that concurrent tympanoplasty and stapedotomy in Bellucci type 1 chronic otitis media patients could yield safe and effective outcomes. Further investigations should be conducted to set forth the benefits of a single-stage surgery over a series of staged surgeries.

Purpose: Optical magnification is crucial in ear surgery, ensuring the precise identification of anatomical structures. Traditionally, microscopes have been the standard due to their magnification and stereoscopic capabilities. However, the introduction of exoscopes has introduced new possibilities, particularly in ergonomics, teaching, collaboration, and surgical training. This cadaveric study aimed to evaluate the feasibility, effectiveness, and trainee performance when using the exoscope in ear dissection and to compare it with the traditional microscope.

Methods: This study involved 10 non-expert medical trainees who undertook a series of surgical tasks on cadaveric specimens using both the microscope and exoscope. The tasks included different surgical approach simulations and exercises. NASA Task Load Index and a Visual Analog Scale questionnaires were administered to assess participants' subjective experiences with each instrument.

Results: All participants successfully completed the assigned tasks with both the microscope and exoscope. While there were no significant differences in the timing of surgical steps between the two instruments, participants perceived the microscope as less physically demanding and temporally taxing, while the exoscope excelled in structural identification and offered benefits for teaching and collaboration.

Conclusions: The choice between microscope and exoscope should be guided by the specific surgical demands, educational context, and preferences of the team. While the microscope excels in flexibility, the exoscope provides advantages in structural identification and collaborative learning, making it a valuable tool in ear surgery. This study contributes valuable insights for otological surgeons and educators to optimize surgical outcomes and learning experiences of trainees.