Journal of Laryngology and Otology最新文献

Introduction: The inner ear is a complex sensory organ with finely balanced physiology; disrupting this may cause hearing changes or vestibular symptoms. Pregnancy involves multiple significant reversible alterations in physiological state. This study reviews literature on the inner ear in pregnancy.

Methods: The review was pre-registered on the PROSPERO database CRD42023446898. Robust searches were conducted by two independent researchers according to the PRISMA 2020 guideline.

Results: A total of 69 studies were filtered into the final analysis. Consistent evidence of subclinical hearing loss in pregnancy was identified, which resolved following childbirth. Auditory processing is affected by pregnancy. Vestibular dysfunction may contribute to pregnancy nausea. Sudden sensorineural hearing loss does not occur more frequently in pregnancy.

Conclusion: This review summarises evidence for reversible and irreversible changes to hearing and vestibular function in pregnancy and pregnancy-related conditions, reviewing aetiological theories and offering insight to audiovestibular physiology and explaining audiovestibular symptoms in the pregnant patient.

Objectives: To introduce refinements to the original single-stage technique published in 2018, described for delayed reconstruction of partial subtotal defect of the helical rim and antihelix.

Methods: Cases performed by the senior author (MA) were included, with important tips introduced to refine and standardise the technique to improve outcomes. These refinements extend the use of the technique to the reconstruction of larger defects than previously described, the use of contralateral conchal cartilage and carved rib cartilage graft, and the use of quilting sutures with the dental bolsters to support the post-auricular sulcus.

Results: The refinements used contralateral conchal cartilage grafts for defects up to 4 cm and autologous rib cartilage graft for defects more than 4 cm.

Conclusion: This versatile and reliable technique should be considered the standard technique for patients presenting with delayed helical rim defects. It produces satisfactory aesthetic results in terms of size and shape.

Objective: Cochlear implantation has transformed management of children with severe to profound hearing loss but the influence of residual hearing on outcomes remains debatable.

Methods: This ambispective study analysed 48 prelingually deaf children aged 3-8 years to evaluate auditory, speech and language outcomes following unilateral cochlear implantation. Participants were grouped based on presence of residual hearing and tracked up to 3 years post implantation.

Results: Early improvements in auditory and speech perception were significantly higher in candidates with residual hearing but equalised by 12 months. Language outcomes initially favoured RH group with no significant difference beyond 18 months. Owing to gradual development of language, it remained below age-appropriate levels. Parental satisfaction scores were consistently better in RH group, driven by early post-implantation gains.

Conclusion: Residual hearing positively impacts early outcomes in cochlear implant recipients but influence diminishes over time.

Objective: This study aimed to compare long-term audiological outcomes of diode laser stapedotomy, microdrill stapedotomy and combined potassium titanyl phosphate laser-microdrill stapedotomy, and to identify predictors of surgical success.

Methods: Surgical, audiological and complications data were collected. Surgical success was analysed via the measurement of post-operative air-bone gap, air conduction gain.

Results: A total of 615 patients were included; median follow-up was 16 months (range 1-1319). Overall, the 94.3 per cent achieved surgical success (air-bone gap < 15 dB). Median air-bone gap closure was 5 dB (interquartile range: 2.50-8.12), and median air conduction gain was 27.5dB (interquartile range: 19.37-36.25).Compared across techniques, success rates were similar; however, post-operative air-bone gap was significantly better with laser techniques than with microdrill alone (p = 0.016). Longer prostheses were associated with improved outcomes.

Conclusion: All the examined techniques showed excellent audiological results. Laser use was associated with better post-operative air-bone gap than stapedotomy with microdrill only.

Background: This study examines changes in supportive care needs, quality of life and social support among laryngeal cancer patients following total laryngectomy.

Methods: Ninety-nine patients were assessed pre-operatively (T0), one (T1), three (T2) and six months (T3) post-total laryngectomy using SCNS-SF34, FACT-H&N and PSSS. Statistical analysis included repeated-measures analysis of variance and paired t-tests.

Results: Unmet needs increased significantly over time in physical/daily (46.46 per cent →86.87 per cent), psychological (60.61 per cent →93.94 per cent), patient care (83.84 per cent →97.98 per cent) and health system domains (85.86 per cent →96.97 per cent), while sexual needs remained low. SCNS-SF34 scores rose (113.03→145.25; p < 0.001), FACT-H&N declined (97.17→75.19; p < 0.001) and PSSS decreased (55.48→41.99; p < 0.001), with family support most affected. All scales showed significant timepoint differences (p < 0.05). Notably, none of the patients underwent voice function restoration surgery during the study follow-up period, which may have amplified voice-related impacts on these outcomes.

Conclusion: Following total laryngectomy, laryngeal cancer patients experience escalating supportive care needs, alongside significant declines in quality of life and social support-with family support particularly affected by caregiving burdens.

Objectives: To evaluate the evidence for superior laryngeal nerve block in neurogenic cough and outline practical considerations for clinical use.

Methods: A systematic review was conducted in May 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies reported validated cough-specific quality-of-life outcomes and safety data.

Results: Nine studies (1 randomised trial, 8 case series; n = 490) were included. All studies reported subjective improvement: eight conducted statistical testing and seven showed significant benefit, with the Leicester Cough Questionnaire exceeding the minimal clinically important difference and the Cough Severity Index showing reductions post treatment. Patients received an average of 2 to 3 injections, with follow-up of up to 22 months. Adverse effects were mild and transient. Neuromodulator use and behavioural therapy were inconsistently reported.

Conclusion: Superior laryngeal nerve block appears safe and effective as a short-term intervention, with long-term efficacy remaining uncertain. This review highlights procedural gaps and introduces a structured pathway to guide patient selection, injection and follow up. Robust multicentred trials and consensus guidelines are needed to define long-term benefit and standardise practice.

Objectives: This study investigated the impact of residual dizziness after successful canalith repositioning manoeuvre on cognitive functions and dual-task performance in patients with benign paroxysmal positional vertigo (BPPV).

Methods: Forty-four patients with posterior canal BPPV were assessed 1 week after successful treatment and divided into 2 groups: with residual dizziness (n = 22) and without residual dizziness (n = 22). Cognitive function was evaluated using the Stroop test and digit span test. Dual-task performance was assessed with a combination of the timed up and go test and the digit span test.

Results: Residual dizziness was associated with longer BPPV duration, and higher anxiety and disability levels (p < 0.05). Patients with residual dizziness performed worse on the Stroop test (p < 0.05), while no significant differences were found in digit span or dual-task performance (p > 0.05).

Conclusion: The results highlight a dynamic interplay between cognitive and vestibular systems. Residual dizziness may impair cognitive performance, while baseline cognitive deficits may also increase vulnerability to residual dizziness.

Objective: Artificial intelligence (AI) has the potential to revolutionise medical communication. Our aim was to investigate whether AI can be used to adapt patient information leaflets and compare their acceptability with human-generated patient information leaflets.

Methods: ChatGPT was instructed to refine four ENT-related patient information leaflets originally written by clinicians. Pairs of human-generated and AI-adapted patient information leaflets were distributed to patients alongside a questionnaire asking them to assess presentation, condition explanation, ease of understanding, and when to seek medical attention and overall preference. Readability was evaluated using the Flesch-Kincaid Readability Ease Score and Grade Level.

Results: Of 111 responses, 39.6 per cent expressed no overall preference between the AI-adapted and human-generated patient information leaflets, 27.9 per cent preferred the AI-adapted leaflet and 32.4 per cent preferred the human-generated patient information leaflet. There was a slight reduction in the readability of the AI-adapted patient information leaflets.

Conclusion: Artificial intelligence- and human-generated patient information leaflets were broadly comparable in their acceptability to patients. However, clinician oversight is essential to safeguard the quality and readability of AI-produced materials.

Objectives: To characterize treatment trends and facial weakness outcomes in vestibular schwannoma management using real-world data from a large US patient cohort.

Methods: This retrospective cohort analysis utilized the TriNetX US Collaborative Network. The study included 72,496 patients diagnosed with vestibular schwannoma, managed with observation, stereotactic radiosurgery or surgical treatments. Main outcome measures were demographic profiles, treatment modality utilization, facial weakness incidence and historical (2022-2025) and predicted (2025-2026) treatment trends.

Results: It showed a slight female predominance (54.35 per cent) and underrepresentation of Black and Asian patients. Observation was most common (87.6 per cent), followed by surgery (65.3 per cent) and stereotactic radiosurgery (34.7 per cent). Facial weakness rates: 4.7 per cent (observation), 9.1 per cent (stereotactic radiosurgery), 24.4 per cent (surgery). Combined treatments had higher facial weakness rates. Stereotactic radiosurgery use was stable; translabyrinthine surgery declined; posterior fossa approaches increased.

Conclusion: This comprehensive analysis highlights varying facial weakness risks across treatment modalities, disparities in the treatments and evolving treatment preferences.