Journal of Laryngology and Otology最新文献

Objectives: The present review aims at an insight into the pathophysiology of chronic rhinosinusitis with nasal polyposis through the combination of three tissue sources: (1) nasal polyp, (2) neighboring non-polypoid mucosa (MS) and (3) healthy controls.

Methods: The primary outcomes included three lists of molecules (1) those significantly different between nasal polyp, neighboring non-polypoid mucosa and controls (2) those up/downregulated in nasal polyp, but comparable between MS and controls and (3) those comparable between nasal polyp and neighboring non-polypoid mucosa, but different between NP and controls.

Results: Ten studies investigating a large variety of 68 molecules presented comparisons between nasal polyp and neighboring non-polypoid mucosa in endotype-specified populations. Comparisons between nasal polyp and neighboring non-polypoid mucosa are approached separately for eosinophilic/non-eosinophilic chronic rhinosinusitis with nasal polyposis . The small number of studies prohibits a meta-analysis.

Conclusion: Inclusion of neighboring non-polypoid mucosa in future studies may provide a bias-free list of the molecules that contribute to the actual pathogenesis and preservation of nasal polyps within the chronic rhinosinusitis inflammatory environment.

Objectives: The aim of this study is to systematically review and analyse the literature regarding clinical application of picrotoxin for vertigo caused by peripheral vestibular disorders.

Methods: We conducted a search in PubMed/MEDLINE and Google Scholar in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. The primary selection included all studies exploring the effect of this phytopharmacological substance on the vestibular system and vertigo. The secondary selection included only reports on its clinical use for treatment of Ménière's disease and other peripheral vestibular disorders.

Results: From the 398 identified studies, 18 were included from the primary selection and 6 from the secondary selection. In total, 203 patients received picrotoxin; 85 of them were treated for vertigo with 1-mg picrotoxin suppositories. In this subgroup vertigo was reduced in 74.9 per cent.

Conclusion: Picrotoxin is a non-invasive treatment option worth considering, especially in cochlear-implanted patients with recurring disabling vertigo.

Objectives: Otolaryngology/ear, nose and throat conditions are common in clinical practice, yet undergraduate exposure in UK medical schools remains limited. The coronavirus disease 2019 pandemic created opportunities to innovate medical education. This review explores the scope of advance in otolaryngology undergraduate education following the coronavirus disease 2019 pandemic.

Methods: A search of MEDLINE, Embase, Cochrane, and Education Resources Information Center databases was conducted. Studies that met inclusion criteria were subject to risk-of-bias assessment and narrative analysis.

Results: Interventions such as mixed reality, cadaveric teaching, and anatomical models improved short-term performance and student satisfaction. Surveys limited advancement in clinical exposure to otolaryngology/ear, nose and throat, when compared to pre-coronavirus-disease literature.

Conclusion: Despite the potential for reform following the pandemic, there has been no significant advancement in the provision of undergraduate medical education in the post-coronavirus-disease era. Standardisation of undergraduate education is needed to mirror recent changes to assessment in undergraduate education in the UK.

Objectives: To investigate socio-economic and clinical disparities in the utilisation of robotic surgery for head and neck cancer.

Methods: Using the National Cancer Database (2010-2020), 212 449 surgically treated patients were analysed. Multivariate logistic regression identified predictors of robotic versus non-robotic surgery (p < 0.05).

Results: Robotic surgery utilisation increased over time during the study period. The following characteristics positively correlated with the use of robotic surgery: male, aged 41-80 years, White race, insured (with private insurance, Medicaid and Medicare) and treatment at an Academic/Research centre. Metropolitan residency, higher income/education levels, lower comorbidity (Charlson-Deyo score of 0) and Stage I disease were also associated with increased robotic surgery utilisation.

Conclusion: Significant socio-economic disparities exist in robotic surgery access, potentially exacerbating outcome inequities. Targeted interventions are needed to improve equity in treatment access and standardise care protocols. Further research should validate trends and address systemic barriers.

Objective: To explore the treatment options and prognostic factors of vocal fold leukoplakia.

Methods: The study examined conservative and surgical treatment approaches, and analysed prognostic factors influencing vocal fold leukoplakia outcomes.

Results: In the conservative treatment group, lesion size (p = 0.035) and smoking (p < 0.001) were identified as independent factors influencing treatment outcomes. In the surgical treatment group, lesion size (p = 0.018) was identified as an independent factor affecting recurrence. There was no statistically significant difference in the effectiveness of conservative versus surgical treatment for patients with hyperplasia (p = 0.223), mild dysplasia (p = 0.634) and moderate dysplasia (p = 0.758).

Conclusion: Smoking and lesion size are key factors influencing the outcome of conservative treatment, while lesion size is a significant factor affecting recurrence in surgically treated patients. More importantly, conservative treatment should be prioritised for patients with moderate dysplasia and milder vocal fold leukoplakia.

Objectives: The primary aim of this study was to investigate qualitative themes contributing to a successful ENT induction.

Methods: Responses were gathered as part of "RecENT SHO", a multi-centre retrospective cross-sectional survey. Qualitative data were analysed thematically, with key themes supported by direct quotations.

Results: A total of 380 eligible responses identified four major themes: induction methodology, induction duration, senior clinician involvement and post-induction support. Respondents strongly favoured face-to-face, simulation-based training and practical skill development under senior supervision.

Conclusion: This study highlights the critical components of successful ENT inductions, emphasising the necessity of practical skill training and senior clinician involvement. Future induction programmes should incorporate these findings to improve resident doctor preparedness and patient safety.

Objectives: To investigate the stapes superstructure removed during surgical procedure under a light microscope, see whether the stapes superstructure was directly or indirectly affected by otosclerosis, and evaluate the results using the audiometric data.

Methods: Histologic section of the stapes superstructures of 30 patients operated for otosclerosis were retrospectively analysed.

Results: There were no obvious active/inactive otosclerotic foci in the investigated stapes superstructures. Nevertheless, stapes superstructures had certain histopathologic findings that were not normally expected. Patients with otosclerotic alterations (Group 1) and without otosclerotic alterations (Group 2) were compared by pre-operative and post-operative air conduction, bone conduction, and air-bone gap.

Conclusion: The stapes superstructure contained degenerative findings similar to osteoarthritis of long bones and histopathologic changes that might be considered significant in terms of otosclerosis. Nevertheless, these changes did not significantly affect pre-operative and post-operative pure tone audiometry data. This is the first study known to us that investigated the stapes superstructure from the otosclerosis perspective, and the cases were assessed in combination with audiometric data.

Background: Adenoid hypertrophy contributes to nasal obstruction and obstructive sleep disorders in children, but can be difficult to assess. This study examines whether inferior turbinate hypertrophy can predict adenoid hypertrophy severity in children with obstructive sleep disorders.

Methods: This retrospective cohort study included children (0-18 years) with a diagnosis of obstructive sleep-disordered breathing or obstructive sleep apnoea who underwent drug-induced sleep endoscopy. Analyses explored demographic, clinical and endoscopic associations with adenoid hypertrophy.

Results: A total of 269 children were included. Separate univariate analyses showed that older age and greater inferior turbinate hypertrophy predicted greater adenoid hypertrophy (p < 0.05). However, in multivariate ordered logistic regression, only inferior turbinate hypertrophy remained significant (p < 0.01), while age did not (p = 0.11).

Conclusion: These findings suggest inferior turbinate hypertrophy may serve as a proxy for adenoid hypertrophy, aiding clinicians in assessment and guiding further evaluation or intervention.

Objectives: Few studies have investigated stapedotomy using 1470 nm diode laser, and the present article contributes with clinical experience.

Methods: A retrospective analysis was conducted to investigate hearing performance of 22 patients undergoing 1470 nm diode laser-assisted primary stapedotomy.

Results: In 8/22 cases, accidental breaches to the inner ear by the laser and in 14/22 cases the stapedotomy was performed as planned only by drill. Air-bone gap and loss of sensorineural hearing were low and with no significant differences for groups at follow-up. No patients with breaches by laser reported new or worse tinnitus.

Conclusion: Accidental breaches in the stapes footplate using this diode laser did not appear to equate with inner ear damage within this limited cohort. Hearing outcomes were not significantly affected. These findings should be interpreted with caution. Further studies evaluating this laser wavelength in stapedotomy is required.