Journal of Laryngology and Otology最新文献

Objective: To evaluate clinical characteristics, complications and survival outcomes in patients undergoing lateral temporal bone resection for malignancy at a tertiary skull base centre.

Methods: This retrospective cohort study analysed patients treated between 2004 and 2023 at a UK tertiary referral centre. Data collected included demographics, histological diagnosis, stage, surgical approach, reconstruction and adjuvant therapy. Complications and survival were examined using descriptive statistics, Kaplan-Meier survival curves and Cox proportional hazards modelling.

Results: Eighty-nine patients were included (mean age, 67.2 years; 69.7 per cent male). Squamous cell carcinoma (SCC) was the most frequent diagnosis (58.4 per cent) and lateral temporal bone resection was the predominant procedure (73.0 per cent). Post-operative complications occurred in 25.8 per cent of patients, with haematoma the most common complication. Median follow up was 19 months. The 5-year overall survival rate was 50 per cent, with significant differences by cancer stage and patient age.

Conclusion: Surgical management of lateral temporal bone malignancies, predominantly SCC, carries significant morbidity, while survival and complication rates mirror published literature, with outcomes chiefly influenced by age and cancer stage rather than nodal status.

Objectives: This study aimed to determine the incidence, location and outcome of incidental avid lesions on positron emission tomography-computed tomography scans for head and neck cancer.

Methods: A retrospective study reviewing digital case notes, performed from a single centre. Clinicopathological information was collected and incidental avid lesions on positron emission tomography-computed tomography reports were recorded. Further investigations were followed up to determine the outcome of the lesions.

Results: A total of 281 patients undergoing staging positron emission tomography-computed tomography (stages T4, N3 or unknown primary) and/or treatment response positron emission tomography-computed tomography scans for head and neck cancer were identified, with 363 incidental avid lesions reported in 369 scans. The most common location was the abdomen (30.0 per cent), followed by thorax (28.9 per cent). A total of 33.1 per cent of lesions had further investigation. The rate of incidental synchronous primary was 3.6 per cent.

Conclusion: The benefit of investigating carefully selected incidental avid lesions outweighs the harm of investigation, as it may alter management. There is a need for a standardised pathway for investigating these lesions in head and neck cancer services.

Objective: Difficulty visualising the round window is occasionally encountered during cochlear implant surgery. This paper presents a novel method for predicting difficult round window accessibility using pre-operative computed tomography (CT) imaging.

Methods: This is a retrospective multicentre study of all cochlear implantation surgical procedures conducted in two Singaporean tertiary hospitals between 2018 and 2021. Pre-operative CT temporal bone scans were reviewed and two lines were drawn on a single axial cut. Where both lines intersect medially, difficult round window visualisation is predicted. Computed tomography predictions were compared with intra-operative findings, and statistical analysis was performed.

Results: In 9 of 89 cases (10.1 per cent) difficult round window access was noted intra-operatively and 8 cases (88.9 per cent) were correctly predicted by the novel method (p < 0.001; sensitivity, 89 per cent; specificity, 100 per cent).

Conclusion: This study describes a simple, effective method to predict difficult round window access on axial CT temporal bone images, without reconstructed images or complex calculations.

Objectives: Pharyngo-oesophageal spasm is a common reason behind the failure of tracheo-oesophageal voice production. This study aims to describe the feasibility of high-resolution ultrasound for localisation of the spasmodic segment for botulinum toxin injection.

Methods: The pharyngo-oesophageal segment was localised using a 6-13 Hz linear probe. It was visualised as a concentric muscular area between the great vessels of the neck. The spasmodic segment was identified as the narrowest region when the patient was asked to attempt phonation and swallow.

Results: This technique was utilised in one patient who had pharyngo-oesophageal spasm following total laryngectomy. Following botulinum toxin injection, the patient was able to attempt phonation after one week.

Conclusion: High-resolution ultrasound is an effective modality to guide botulinum toxin injection into the spasmodic pharyngo-oesophageal segment. It allows intervention to be performed at the bedside or outpatient setting without associated radiation exposure.

Objectives: This study aimed to evaluate physical simulation models for endoscopic ear surgery including model types, validation methodology and educational outcomes.

Methods: A Preferred Reporting Items for Systematic reviews and Meta-Analyses compliant search of PubMed, Embase and the Cochrane Library was conducted to June 2025. Studies describing physical endoscopic ear surgery simulators with reported validation or educational outcomes were included.

Results: Fourteen studies met inclusion criteria. Simulators comprised cadaveric animal heads, synthetic task trainers and single- and multi-material three-dimensional-printed models. Face validity was consistently high. Construct validity, assessed using Objective Structured Assessment of Technical Skills scores or timed tasks, was demonstrated in five studies. Content validity was reported in three studies. No study evaluated transfer validity. Educational outcomes included improvements in confidence, anatomical knowledge and task completion time.

Conclusion: Physical endoscopic ear surgery simulators show strong face validity and emerging construct validity, but evidence is limited by small, single-centre studies and methodological variability. Standardised validation and assessment of clinical transfer are needed to support integration into training pathways.

Objective: To assess the relationship between vitamin D and post-operative hypocalcaemia in patients undergoing total thyroidectomy in our population.

Methods: A prospective cohort of 210 patients meeting inclusion criteria from March 2020 to September 2023 at Sultan Qaboos University Hospital was analysed. Pre-operative serum 25-hydroxy vitamin D was measured, with calcium and parathyroid hormone assessed post-operatively, and symptoms recorded.

Results: Univariate and logistic regression analyses showed no significant association between pre-operative vitamin D levels and post-operative hypocalcaemia (p = 0.254 and 0.52, respectively). Receiver operating characteristic analysis showed an area under the curve of 0.6 (p = 0.012), indicating limited predictive ability.

Conclusion: In our population, pre-operative vitamin D level was not a reliable predictor of post-thyroidectomy hypocalcaemia. Because of population-based differences in vitamin D metabolism and assay variability, universal cut-off values remain impractical. These findings highlight the need for further research to establish population-specific thresholds for vitamin D in predicting hypocalcaemia risk.

Objective: This study aimed to explore clinical characteristics and treatment efficacy in patients with posterior canal benign paroxysmal positional vertigo and different sleep qualities.

Methods: Patients with posterior canal benign paroxysmal positional vertigo were divided into high and low sleep quality groups based on Pittsburgh Sleep Quality Index scores.

Results: No significant baseline differences existed between low (n = 53) and high (n = 39) sleep quality groups. However, the proportion of cupulolithiasis was higher in the low sleep quality group (60.38 per cent vs. 35.90 per cent; p < 0.05). Additionally, the low sleep quality group had a longer median duration of upbeat nystagmus during the Dix-Hallpike test (63.50 seconds vs. 26.80 seconds; p < 0.05) and a lower cured rate in initial repositioning (9.43 per cent vs. 56.41 per cent) compared to high sleep quality group. Repositioning therapy significantly improved depressive and anxiety symptoms in all patients with posterior canal benign paroxysmal positional vertigo, with a more pronounced improvement in depressive symptoms in the low sleep quality group.

Conclusion: Poor sleep quality is associated with higher cupulolithiasis prevalence and treatment resistance, with residual symptoms mainly affecting social functioning.

Objectives: This study aimed to assess the efficacy of core needle biopsy in the diagnostic workup of thyroid.

Methods: All patients referred to the thyroid multidisciplinary team who underwent core needle biopsy as part of their diagnostic workup were identified for analysis. Data was collected from initial fine needle aspiration cytology to final multidisciplinary team outcome for patients assessed between December 2022 and April 2024.

Results: Data on 50 patients with thyroid nodules who underwent core needle biopsy was collected. A definitive diagnosis of malignancy was reached in 6.0 per cent (n = 3) of cases through core needle biopsy. Most patients (n = 39, 79.6 per cent) were offered diagnostic hemithyroidectomy after having had core needle biopsy. There was an average of 40 days between multidisciplinary team decision to offer core needle biopsy and decision to offer diagnostic surgery.

Conclusion: The value of offering core needle biopsy in all initially graded Thy3a fine needle aspiration biopsies is limited. Its potential benefit in progressing patient management requires further evaluation and its ongoing use should be determined on a case-by-case basis following multidisciplinary team discussion.

Objective: To validate a subgroup classification tool designed to support clinical decision-making in vestibular physiotherapy.

Methods: A structured instrument was developed based on the main vestibular disorders commonly treated by physiotherapists. The tool was applied by professionals to simulated clinical cases. Content validation was performed by expert judges using the Delphi technique. The Content Validity Index was calculated for each item.

Results: The tool obtained a Content Validity Index of 0.78 or more across all domains in the first round and reached 100 per cent agreement among experts in the second round, confirming its content validity. The tool demonstrated clarity, coherence and clinical relevance for decision-making in vestibular rehabilitation.

Conclusion: The validated tool presents evidence of content validity and clinical applicability, offering support for physiotherapists in the classification and management of vestibular disorders.