European Archives of Oto-Rhino-Laryngology最新文献

A 53 year old female presented with a six-year history of right-sided slow deterioration in hearing and a feeling of pressure in the right ear. The patient had not experienced any pain but reported some paresthesia of the right half of the tongue, whereas no further other cranial nerve deficits were evident. The otoscopy was unremarkable as well as the rest of the clinical ENT examination except for a slight asymptomatic swelling of the right cheek. Imaging findings showed an expansive tumor infiltrating and destroying the right lateral skull base. The tumor was partially composed of cystic/regressive lesions with high contrast media uptake. The tumor had high-signal intensity with water-sensitive sequences (T2w) and was hypointense on T1w images. We performed a tumor resection via a transparotideal-infratemporal approach. Histologically, the tumor was composed of granular variably calcified chondroid matrix with extensive regressive changes and granulation-like tissue reaction associated with calcinosis and crystal deposition. Molecular analysis of the tumor via the TruSight- RNA-Fusion panel detected a fusion involving FN1::FGFR2, consistent with "calcified chondroid mesenchymal neoplasm" (CCMN), a rare tumor entity recently defined by Liu et al 2021. In regular follow-up care no residual tumor has been detected in imaging studies (MRI and CT) within 2 years and 4 months. The biology and consequently the radio sensitivity cannot be defined precisely since long term results are missing due to the first description of this entity in 2021. As a consequence, surgical resection is recommended as the treatment of choice. Thorough clinical and radiological follow-up is mandatory as local recurrences are to be expected due to the infiltrative behavior. In case of a loco regional recurrence the fusion with FGFR2 may represent a therapeutic option for a targeted therapy on molecular level.

Purpose: Modern facial surgery can improve eye closure and address facial functional and emotional expression disabilities in case of severe acute facial paralysis with low probability of recovery and in cases of chronic flaccid facial paralysis. Reports on outcome typically originate from specialized tertiary care centers, whereas population-based data from routine care beyond specialized centers is sparse.

Methods: Therefore, patients' characteristics, surgical techniques, postoperative complications, and patients' satisfaction with the final outcome were analyzed for all inpatients with facial paralysis undergoing facial surgery in Thuringia, a federal state in Germany, between 2006 and 2022. 260 patients (female 41.5%; median age 65 years) were included.

Results: On average, the surgery rate was higher for men than for women (0.83 ± 0.39 versus 0.58 ± 0.24 per 100,000 population per year). For first surgery, static procedures were dominating (67.3%), followed by dynamic reconstruction (13.8%), and combined static and dynamic reconstructions (13.5%). The most frequent type of surgery was upper lid weight loading (38.5%), hypoglossal-facial jump nerve suture (17.3%), and facial-facial interpositional graft suture (16.9%). Bleeding/hematoma formation needing revision surgery was the most frequent complication (6.2%). Overall, 70.4% of the patients were satisfied with the final result. The satisfaction was higher if the target was to improve eye closure (65.2%) or to improve upper face function (65.3%) than to improve the lower face function (53.3%).

Conclusions: If facial nerve reconstruction surgery and/or upper lid weight placement was performed, the satisfaction was significantly higher. If revision surgery was needed to improve the result, the satisfaction was significantly lower.

The human microbiome has garnered tremendous interest in the field of oncology, and microbiota studies in head and neck oncology has also flourished. Given the increasing incidence and mortality of HNSCC, as well as the suboptimal outcomes of available treatments, there is an urgent need for innovative approaches involving the microbiome. This review evaluates the intricate relationship between the microbiome and HNSCC, highlighting the potential of the microbiome as a marker for cancer detection, its role in malignancy, and its impact on the efficacy of conventional treatments like chemotherapy and radiotherapy. The review also explores the effects of treatment modalities on the microbiome and discusses the potential of microbiome alterations to predict and influence treatment toxicities such as mucositis and xerostomia. Further research is warranted to characterize the microbiome-HNSCC association, which holds promise for advancing early diagnosis, enhancing prognostic accuracy, and personalizing treatment strategies to improve patient outcomes. The exploration of the microbiome in clinical trials indicates a burgeoning subject of microbiome-focused therapies, heralding a new frontier in most cancer care.

Introduction: First branchial cleft anomalies (FBCA) are rare congenital head and neck malformations, often subject to incorrect diagnosis and treatment. We present our experience with FBCA, focusing on clinical presentation, diagnosis, perioperative relation to the facial nerve, surgical approach, complications and patient satisfaction.

Methods: A consecutive cohort of 16 patients undergoing surgical treatment for FBCA between 1999 and 2021 was analyzed. Demographic and clinical information was extracted from their medical records. Additionally 14 patients were interviewed by telephone to assess postoperative outcomes and patient satisfaction using a Likert scale.

Results: Sixteen patients (11 females, 5 males) were surgically treated at an age ranging from 7 months to 13 years. Type I and type II FBCA were evenly distributed. Lesions presented as cysts (n = 4), sinuses (n = 7) or fistulas (n = 5). The main symptoms were swelling, inflammation and discharge. Otologic symptoms were present in 31%. In 80% of patients, magnetic resonance imaging was needed to reach the correct diagnosis. Ten patients (63%) had a history of a surgical attempt in another center before definitive surgical treatment in our center. Complete excision was accomplished in all patients. Postoperative complications included limited Frey syndrome (n = 4), temporary hypertrophic scarring (n = 4), minimal paresis of the marginal mandibular branch of the facial nerve (n = 1) and limited external auditory canal stenosis (n = 1). One patient experienced a recurrence at the level of the external auditory canal, that required minor revision surgery. The average patient satisfaction score was 13.64 out of 15.

Conclusion: Thorough clinical examination, awareness of the different entities and awareness of expert head and neck radiological advice are crucial for correct FBCA diagnosis and typing, determining the correct surgical approach. It is crucial that patients diagnosed with FBCA undergo surgery in specialized centers. Despite the challenging surgery and its potential complications, the overall patient satisfaction remains high post- treatment.

Purpose: Balance problems in the elderly are a major social concern, primarily due to the risk of falls. One of the reasons of fast worsening of stability and therefore falling is represented by acute BPPV. Treatment through repositioning maneuvers could significantly reduce the risk of further falls of the patients treated with. The physical ability of older individuals to be treated with maneuvers is a topic of debate due to possible joint stiffness and less compliance with movements. There are few previous studies focusing on the practicality and effectiveness of physical therapy for BPPV in people over 80 years.

Methods: We conducted a retrospective study collecting data on 517 patients to assess the feasibility, effectiveness, safety and the number of therapeutic maneuvers necessary to get therapeutic success when treating individuals over 80 years compared to those aged between 18 and 64.

Results: We found no difference in terms of number of maneuvers needed to get therapeutic success between the two groups. As for the therapeutic maneuver no difference in success and feasibility of execution was found between Semont and Epley maneuvers which proved equally effective in the two groups.

Conclusion: Our data are not inconsistent with the hypothesis that repositioning maneuvers for posterior canal BPPV are feasible and demonstrated a good efficacy in all elderly people. This could encourage the diagnosis and treatment of BPPV also for the purpose of reducing the risk of falls in the elderly.

Purpose: It is hypothesized that a vestibular implant should re-establish baseline activity of the ampullary nerves. Use of a constant baseline stimulation potentially allows encoding of bi-directional head movements, through the addition of signal modulations. Effective stimulation of the vestibular nerves depends on the ability to acclimate to this baseline signal. This study aims to measure eye movement responses and evaluate patient perception after turning ON and OFF single-canal and multi-canal baseline stimulation with a vestibulocochlear implant.

Methods: Nine subjects with a multi-canal vestibulocochlear implant were investigated by turning baseline stimulation ON and OFF. Eye movements were recorded at fixed time points. To quantify acclimatization, both the relative time constant (time until the nystagmus decreases to 37% of its initial maximum value) and the absolute time constant (time until the velocity drops below 5°/s) were calculated. Following each recording, patients' perceptions were collected.

Results: A rapid logarithmic decay in response dynamics was observed in all subjects after turning baseline stimulation ON and OFF. Full acclimatization was typically achieved within one minute. The response dynamics were reproducible when tested twice and were comparable when using a stimulation rate of either 100% or 50%. In general, turning baseline stimulation OFF resulted in lower response dynamics compared to ON.

Conclusion: The ability to quickly acclimate to step changes in stimulation amplitude level is beneficial and suggests the presence of efficient neuronal processes that aid in the process of dual-state adaptation. Rapid acclimatization paves the way for safe and convenient use of the implant.

Trial registration number and date: ClinicalTrials.gov: NCT04918745. Registered 28 April 2021.

Purpose: The study aimed to evaluate the long-term efficacy and safety of superior laryngeal nerve (SLN) block for treating chronic neurogenic cough (CNC) in a large patient cohort.

Methods: A retrospective review was conducted on patients treated between January 2019 and October 2023. Data collected included patient demographics, number of injections, follow-up times, subjective cough severity, and Leicester Cough Questionnaire (LCQ) scores.

Results: Among 117 patients (76.1% female; mean age 66.1), the median number of injections was 3, with a median follow-up duration of 4 weeks. Subjective improvement was reported in 74.4% of cases, with mild adverse events occurring in 8.4% of injections. Regression analysis showed a strong correlation between decreased subjective severity and time. LCQ scores improved slightly within 1-3 months and 25-40 months.

Conclusion: The findings suggest that SLN blocks effectively reduce subjective severity and improve LCQ scores long-term, with sequential injections potentially reducing chronic steroid use risks. Further prospective studies are recommended to optimize dosing intervals.

Purpose: The aim of this study is to obtain the anatomical limits of the parapharyngeal space by transoral surgical approach, in order to objectively determine the types of lesions according to location, where this type of approach is more indicated.

Methods: A prospective, experimental, radio-anatomical study was performed on 10 cryopreserved human heads(20 sides). A transoral approach of the parapharyngeal space was performed determining its anatomical limits by CT navigation. A statistical analysis of the registered variables was carried out.

Results: Intraoral endoscopic dissection of the parapharyngeal space was possible in all anatomical pieces (10 heads, 20 sides). The surgical technique was started by placing a laryngopharyngoscopic retractor. The scalpel incision was made from the posterior border of the hard palate, extending along the lateral border of the soft palate, following the glossopalatine arch and ending at the base of the tongue, in its posterolateral region. Under direct vision with a 0º rigid endoscope, we proceeded to the dissection by planes, identifying all the relevant vasculonervous, osseous and muscular structures. Once all the anatomical references were located, the planned measurements were taken using the surgical navigator.

Conclusions: The endoscopic intraoral approach constitutes a feasible, safe and direct access route to the parapharyngeal space. This approach would be especially indicated in lesions of the parapharyngeal space (PPS) that do not exceed the styloid and pterygoid processes cranially, do not have significant retrostylial extension and do not substantially reach the lower area of the PPS.

Objective: This study aims to compare the outcomes of balloon-assisted rib graft placement with traditional graft placement in Endoscopic Posterior Cricoid Split with Rib Graft Placement (EPCS/RG).

Methods: We conducted a retrospective analysis of 23 patients who underwent EPCS/RG by a single senior surgeon at King Saud University Medical City from 2017 to 2024. Data were collected on demographics, surgical approach, and operative time. Statistical analyses included Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, with significance set at p-value < 0.05. Univariate binary regression was reported as Odds Ratio (OR) with 95% Confidence Interval (CI).

Results: Of the 23 cases, 16 (69.5%) utilized the balloon-assisted technique. Age ranged from 8 months to 19 years (median age 10 years). Older age was significantly associated with the balloon-assisted technique (OR 1.627, p-value 0.022). Balloon-assisted cases demonstrated longer split lengths and graft widths, though data limitations hindered definitive conclusions. Tracheostomy was avoided in 65.2% of cases. The operative duration averaged 240 min, showing no significant difference between balloon-assisted or the standard techniques (OR 1.015, CI 0.993-1.038, p-value 0.177).

Conclusion: Balloon-assisted rib graft placement in EPCS/RG facilitates surgical approach, particularly in older patients. It does not extend operative duration, offering a promising advancement in airway surgery.

Level of evidence: Level 3.

Objective: Intraoperative systems for monitoring facial nerve function, in which temporal electrical stimulation is applied to the facial nerve through electrodes, are used in many surgeries requiring facial nerve preservation; however, continuous stimulation or quantitative evaluation of facial nerve function is difficult with this approach. We examined the usefulness of a continuous and quantitative facial nerve-monitoring system for temporal bone lesions by using our experience to modify the existing methods used for cases involving vestibular schwannomas.

Study design: Retrospective observational study.

Setting: Department of Otorhinolaryngology-Head and Neck Surgery at our hospital.

Methods: We modified the electrode placement and examined the usefulness of the modified system under several conditions. The study population consisted of patients who were operated on for temporal bone lesions at our department and underwent continuous nerve monitoring using the modified system. Case details, electrode-placement sites, and facial nerve function data before and after the surgery were obtained and retrospectively evaluated.

Results: Electrodes were placed safely during surgery in all cases. No obvious deterioration in facial nerve function was observed, except in one case.

Conclusion: The advantages of this system include its ability to perform quantitative intraoperative evaluations and prevent unexpected nerve damage in cases where the facial nerve shows complicated pathways. This monitoring system is useful, even in complex temporal bone surgeries.