Chinese journal of otorhinolaryngology head and neck surgery最新文献

Objective: To develop a deep learning-assisted diagnostic model based on white light imaging (WLI) and narrow band imaging (NBI) endoscopic images for nasopharyngeal carcinoma (NPC), and to further explore its potential clinical application in remote diagnostic systems. Methods: Endoscopic image data were retrospectively collected from 1 262 subjects who underwent nasopharyngeal screening at the Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University between July 2018 and September 2021. A total of 9 370 WLI and 5 558 NBI images were included. NPC recognition models were developed and validated separately for WLI and NBI using the InceptionResNetV2 deep neural network architecture. Results: An artificial intelligence-based diagnostic model for NPC (NPC-CAD) was successfully established, achieving diagnostic accuracies of 96.03% and 91.16% in the WLI and NBI test sets, with AUC of 0.99 and 0.96 respectively. A cloud-based intelligent diagnostic platform was subsequently developed and demonstrated preliminary feasibility and performance in remote healthcare scenarios. Conclusion: This study presents a novel AI-assisted diagnostic model for NPC that integrates deep learning with nasal endoscopic image analysis and introduces a prototype cloud-based diagnostic platform. The model shows strong potential to improve early screening efficiency and to reduce missed diagnoses, particularly in resource-limited settings.

Objective: To investigate the frequency characteristics of utricular damage and pathological ultrastructural features in patients with unilateral Ménière's disease (MD). Methods: This cross-sectional study included 104 patients with unilateral MD admitted to Shandong Provincial ENT Hospital between July 2019 and September 2021. There were 50 males and 54 females, aged 21-72 years (mean 46.4 years). Disease duration ranged from 1 month to 40 years (median duration 4.5 years). All patients underwent pure-tone audiometry and vestibular function tests, including caloric test, video head impulse test (v-HIT), vestibular evoked myogenic potentials (VEMP), and unilateral centrifugation subjective visual vertical (UC-SVV). Utricular maculae from 4 patients who underwent labyrinthectomy for intractable vertigo were observed under light microscopy and transmission electron microscopy (TEM). Type Ⅰ and Type Ⅱ hair cells were counted and compared, and common pathological changes of the utricular macula were observed. SPSS 19.0 software was used for statistical analysis. Results: According to pure-tone average, patients were clinically staged as follows: stage Ⅰ, 26 cases; stage Ⅱ, 26 cases; stage Ⅲ, 39 cases; and stage Ⅳ, 13 cases. The abnormality rates of vestibular function tests were as follows: 63.5% by caloric test (66/104), 32.7% by v-HIT (34/104), 65.4% by cervical VEMP (cVEMP) (68/104), 68.3% by ocular VEMP (oVEMP) (71/104), and 58.7% by UC-SVV (61/104). There was a statistically significant difference in the abnormality rates between the caloric test and v-HIT, which assessed low-frequency and high-frequency semicircular canal function, respectively (χ²=7.775, P=0.005). However, there was no statistically significant difference in the abnormality rates between oVEMP and UC-SVV, which assessed high-frequency and low-frequency utricular function, respectively (χ²=0.495, P=0.482). Pathological examination under light microscopy revealed monolayer degeneration of the sensory epithelium in the utricular macula, with varying degrees of reduction in the number of both Type Ⅰ and Type Ⅱ hair cells and absence of cilia. No significant difference was observed in the quantity between Type Ⅰ and Type Ⅱ hair cells. TEM examination showed numerous vacuoles formed by swollen endoplasmic reticulum in the hair cells, dilated perinuclear cisternae, edema, scattered lipid droplets, and lysosome distribution within the cells. Occasional mitochondrial swelling was also observed. Conclusions: No frequency-specific characteristics were found in the oVEMP and UC-SVV test results of patients with unilateral MD. Damage was commonly observed in both Type Ⅰ and Type Ⅱ hair cells of the utricular macula, with no significant differences noted in cell count or the degree of damage between the two types.

Objective: To investigate the efficacy and safety of non-surgical comprehensive treatment methods for patients with locally advanced oropharyngeal squamous cell carcinoma (OPSCC) and to analyze the impact of HPV (human papilloma virus) status on the patients' prognoses. Methods: A retrospective analysis was conducted on 152 patients with advanced OPSCC treated with non-surgical comprehensive treatment methods at the Department of Otolaryngology Head and Neck Surgery of the PLA General Hospital from October 2010 to October 2024. There were 114 males and 38 females, aged from 38 to 70 years, with a median age of 55.5 years. The treatments included induction chemotherapy (IC)+concurrent chemoradiotherapy (CCRT)±epidermal growth factor receptor (EGFR) molecular targeted therapy, including 126 patients treated with EGFR molecular targeted drugs during CCRT (124 with nimotuzumab+2 with cetuximab) and 32 patients with PD-1 immunotherapy during induction chemotherapy. Helical tomotherapy (HT) and intensity-modulated radiotherapy (IMRT) techniques were used in radiotherapy. The adverse reactions of chemoradiotherapy were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5. survival rates were analyzed using the Kaplan-Meier method and Cox regression analysis. Results: The patients were followed up for 3 to 120 months, with an average follow-up time of 34.4 months. All 152 patients completed the planned radiotherapy and chemotherapy cycles. The 2-year and 3-year overall survival (OS) rates for all patients were 86.8% and 74.6%, respectively, and the progression-free survival (PFS) rates were 83.5% and 73.3%, respectively. In the p16+ patients (n=71), the 2-year and 3-year OS rates were 98.9% and 93.2% respectively, and the PFS rates were 97.6% and 91.1% respectively. For p16- patients (n=33), the 2-year and 3-year OS rates were 77.2% and 61.4% respectively, and the PFS rates were 74.6% and 58.5% respectively. The p16+ patients showed the higher OS and PFS than p16- patients (χ² values were 7.27 and 6.64 respectively, and both P values were <0.05). After treatment, 127 cases (83.3%) developed grade 3 oropharyngeal mucositis, and 7 cases (4.6%) required nasogastric feeding or parenteral nutrition. No patients underwent gastrostomy, and all patients were able to tolerate the adverse reactions. Conclusion: Non-surgical comprehensive therapy (IC+CCRT±EGFR inhibitors) is an effective treatment modality for advanced OPSSC, and patients can generally tolerate the associated adverse reactions. Moreover, p16+ patients exhibit a higher survival rate compared to p16- patients.