Journal of Laryngology and Otology最新文献

Objectives: This study aimed to describe a one-stage technique for nasal skin defect reconstruction using an oxidised regenerated cellulose/collagen matrix (Promogran™) to enhance contour and graft survival.

Methods: Following excision of a skin lesion, Promogran™ is cut to size, placed in the wound bed to restore contour and provide bulk, saturated with blood and covered with a full-thickness skin graft.

Results: The technique improves cosmesis and enables graft survival over avascular structures, including exposed bone and cartilage. Promogran™ exerts wound-healing effects such as matrix metalloprotease inhibition, regulation of growth factors and cytokines, free-radical scavenging and fibroblast proliferation.

Conclusion: This simple, one-stage approach offers an alternative to complex or multistage reconstruction for patients unsuitable for, or preferring to avoid, more invasive procedures.

Objective: We evaluated the olfactory fossa and Keros classification in patients with unilateral mucosal contact points in septal deviation.

Methods: Paranasal sinus computed tomography images of 60 patients with mucosal contact points on the septum were compared with those of the control group (N = 60). The Keros types, septal deviation angles, mucosal contact point angles, olfactory fossa widths and depths, crista galli lengths, widths and pneumatisations, as well as the presence of anatomical variations, were analysed.

Results: The depth of the olfactory fossa contralateral to the mucosal contact point was greater in patients with septal deviation compared to those without (p < 0.05). A significant correlation was found between increased crista galli height and a higher Keros degree on the right side (p < 0.05).

Conclusion: The presence and differences of mucosal contact points should alert surgeons both before and during the surgical procedure, and further studies on this topic are of great importance.

Background: Dengue fever, a mosquito-borne viral illness, has varied systemic manifestations, but its auditory effects remain underexplored. The objective of this study was to assess the association between dengue infection and hearing loss.

Methods: A prospective case-control study was conducted on 79 patients-40 dengue-positive (NS1 antigen confirmed) and 39 with other febrile illnesses. All participants underwent otological examination and pure tone audiometry.

Results: Hearing loss was observed in 15.2 per cent of dengue patients, with none in controls (p < 0.001). The odds ratio for hearing loss in dengue was 34.6 (95 per cent confidence interval: 1.97-610). Dengue patients exhibited significantly elevated air and bone conduction thresholds (p < 0.001). Lower platelet counts and higher C-reactive protein levels correlated with hearing loss, suggesting vascular and inflammatory mechanisms.

Conclusion: Dengue fever may be associated with reversible sensorineural hearing loss, likely due to microvascular and inflammatory injury to the cochlea. Early audiological screening is recommended in dengue cases.

Background: Pierre Robin Sequence is characterised by a small lower jaw, tongue displacement and, often, a U-shaped cleft palate, leading to breathing and feeding problems. Orthodontic airway plates have been developed as a non-invasive treatment option. A systematic review was conducted to evaluate the outcomes of orthodontic airway plates in children with Pierre Robin Sequence.

Methods: Databases were searched for studies published up to December 2024, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Ten clinical studies with a total of 598 patients were included, among which 483 had isolated Pierre Robin Sequence, and 115 had syndromic Pierre Robin Sequence. Orthodontic airway plates improved airway obstruction and helped avoid tracheostomy in most patients. A small proportion of syndromic cases still required surgery. Feeding outcomes improved, with fewer children needing tube feeding. Speech development was good, though hypernasality persisted in some.

Conclusion: Orthodontic airway plates are a minimally invasive yet effective way to manage airway complications in Pierre Robin Sequence patients.

Problem: Eustachian tube balloon dilation is increasingly recognised as a minimally invasive option for middle ear effusion. However, its role in children with cleft lip and palate remains under-explored.

Methods: We prospectively evaluated 14 cleft lip and palate children (28 ears) with middle ear effusion. Group 1 (intervention) comprised 14 ears that underwent Eustachian tube balloon dilation with intranasal corticosteroids, while Group 2 (control) included 14 ears treated with intranasal corticosteroids alone. Tympanometry, pure-tone audiometry and Eustachian Tube Dysfunction Questionnaire-7 were administered before and six weeks after intervention.

Results: Eustachian tube balloon dilation significantly improved hearing thresholds (p = 0.03) and air-bone gap (p = 0.04), with favourable tympanometric changes (p < 0.05) and a significant reduction in Eustachian Tube Dysfunction Questionnaire-7 scores, indicating symptom improvement. No major complications occurred.

Conclusion: Eustachian tube balloon dilation is a safe, well-tolerated and potentially effective adjunctive procedure for cleft lip and palate children with middle ear effusion. Larger randomised controlled trials are needed to validate these findings.

Objectives: This study aimed to investigate whether seasonal epistaxis patterns differ between cases manageable in emergency departments versus those requiring hospital admission and to examine weather parameter correlations by severity category.

Methods: A retrospective severity-stratified analysis of 2,201 epistaxis presentations across two UK hospitals (January 2023-December 2024) with comprehensive weather correlation analysis was used.

Results: Emergency department cases (1,762 presentations, 80.1 per cent) peaked in winter (475 cases, 27.0 per cent), while hospital admissions (439 cases, 19.9 per cent) peaked in spring (130 cases, 29.6 per cent). A critical 10°C temperature threshold effectively separated severity categories with high predictive accuracy.

Conclusion: Epistaxis demonstrates opposing seasonal patterns by clinical severity with distinct weather correlation profiles. Emergency departments should prepare for winter volume surges during cold, humid periods, whilst specialist ENT services require enhanced spring capacity during moderate temperature conditions.

Objective: This study aimed to estimate the prevalence of Eustachian tube dysfunction and identify associated risk factors in a consecutive cohort of children undergoing adenotonsillectomy for sleep-disordered breathing.

Methods: This was a retrospective study of children with sleep-disordered breathing admitted for adenotonsillectomy in two tertiary public hospitals in South China from January 2019 to November 2023. The prevalence of Eustachian tube dysfunction was assessed based on tympanograms. Demographic information and clinical characteristics were collected for risk factors analysis.

Results: A total of 1,044 children aged 3 to 14 years were enrolled in the present study, 375 (35.92%) of whom had Eustachian tube dysfunction. Risk factors for Eustachian tube dysfunction included age less than or equal to six years, allergic rhinitis, sinusitis, adenoid hypertrophy and hypoxemia. No significant association was found between Eustachian tube dysfunction and gender, disease duration, tonsillar hypertrophy, obesity or obstructive sleep apnoea.

Conclusion: Eustachian tube dysfunction is highly prevalent in children undergoing adenotonsillectomy for sleep-disordered breathing and, therefore, warrants further attention and intervention.

Objectives: This study aimed to evaluate the diagnostic and surveillance performance of circulating tumour human papillomavirus DNA for post-treatment monitoring of human papilloma virus-positive oropharyngeal squamous cell carcinoma.

Methods: Systematic review and meta-analysis of prospective studies (2019-2024) identified from PubMed, Web of Science and Scopus. Random-effects models were used to pool circulating tumour human papillomavirus DNA detectability and summarise lead-times to recurrence.

Results: Fifteen studies (n=1,447) were included; 10 cohorts (n=731) entered the quantitative meta-analysis. Pooled baseline detectability was 85.5 per cent (95 per cent confidence interval 78.2-90.6). Circulating tumour human papillomavirus DNA positivity preceded clinical recurrence by a mean of 76.8 days (median 87.5). Specificity and negative predictive value were consistently high, whereas sensitivity varied by assay platform and sampling frequency.

Conclusion: Serial circulating tumour human papilloma virus DNA testing is a reliable adjunct to post-treatment surveillance in HPV-positive oropharyngeal squamous cell carcinoma, offering a clinically meaningful lead-time to recurrence. Standardised assays and multicentre validation are warranted.

Objectives: This study aimed to explore the efficacy of tramadol for neurogenic cough and describe the longitudinal treatment experience.

Methods: A retrospective case series of adults with chronic cough who were treated with tramadol for neurogenic cough. A complete response was defined as no pathologic coughing, and a partial response was defined as 50 per cent or greater reduction in severity or frequency.

Results: Sixty-nine patients were included: 38 per cent of patients reported a complete response with an additional 33 per cent reporting a partial response. The most common successful dosing regimen was 50 mg twice a day. Age, gender and body mass index did not impact treatment response. Patients with a history of laryngeal surgery were less likely to respond (p = 0.04). Sedation (10 per cent) was the most common side effect. Fifty per cent of complete responders (n = 13) were weaned off tramadol after a mean of 39 weeks of treatment.

Conclusion: Tramadol may be effective and is well tolerated in patients with neurogenic cough.

Objectives: This study aimed to determine the prevalence of undiagnosed diabetes and prediabetes in patients presenting with recurrent otomycosis and to evaluate associated risk factors, fungal profiles and cerumen pH variations.

Methods: This cross-sectional study included 213 adults with greater than or equal to two episodes of otomycosis. Glycaemic status was assessed using fasting blood sugar, post-prandial blood sugar and glycated haemoglobin. Fungal identification and cerumen pH measurement were performed. Multivariate analysis identified predictors of recurrence.

Results: Undiagnosed diabetes and prediabetes were found in 30 per cent and 13 per cent of patients, respectively. Candida albicans predominated in diabetics, while Aspergillus niger was common in normoglycaemics. Cerumen pH was significantly higher in diabetics (6.6) compared to normoglycaemics (5.3). Glycated haemoglobin greater than or equal to 6.5 per cent, Candida infection and steroid ear drop use were independent predictors of recurrence.

Conclusion: A substantial proportion of patients with recurrent otomycosis harbour unrecognised glycaemic abnormalities. Routine diabetes screening in ENT clinics may aid in early metabolic disease detection and reduce recurrence rates.