World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Objective: The aim of this study is to develop a multimodal MRI radiomics-based model for predicting long-term overall survival in hypopharyngeal cancer patients undergoing definitive radiotherapy.

Methods: We enrolled 207 hypopharyngeal cancer patients who underwent definitive radiotherapy and had 5-year overall survival outcomes from two major cancer centers in China. Pretreatment MRI images and clinical features were collected. Regions of interest (ROIs) for primary tumors and lymph node metastases (LNM) were delineated on T2 and contrast-enhanced T1 (CE-T1) sequences. Principal component analysis (PCA), support vector machine (SVM), and 5-fold cross-validation were used to develop and evaluate the models.

Results: Multivariate Cox regression analysis identified age under 50 years, advanced T stage, and N stage as risk factors for overall survival. Predictive models based solely on clinical features (Model A), single radiomics features (Model B), and their combination (Model C) performed poorly, with mean AUC values in the validation set of 0.663, 0.772, and 0.779, respectively. The addition of multimodal LNM and CE-T1 radiomics features significantly improved prediction accuracy (Models D and E), with AUC values of 0.831 and 0.837 in the validation set.

Conclusion: We developed a well-discriminating overall survival prediction model based on multimodal MRI radiomics, applicable to patients receiving definitive radiotherapy, which may contribute to personalized treatment strategies.

Objective: The aim of this study is to compare the clinical characteristics and surgical outcomes of patients with traumatic and nontraumatic cerebrospinal fluid (CSF) rhinorrhea.

Methods: CSF rhinorrhea patients admitted between January 2007 and December 2022 were recruited and categorized into traumatic and nontraumatic groups. The clinical characteristics and surgical outcomes of the two groups were compared.

Results: A total of 94 patients with traumatic and 49 patients with nontraumatic CSF rhinorrhea were included. The prevalence of meningitis was significantly higher in traumatic CSF rhinorrhea patients (p = 0.012). Multifocal defects were more frequent in the traumatic group, while sphenoidal defects were significantly correlated with nontraumatic CSF rhinorrhea. Frontal defects were commonly identified in CSF rhinorrhea patients with meningitis than in those without, though no statistical significance was reported. Multivariate logistic regression revealed that male sex, iatrogenic traumatic CSF leak, and pneumonitis are independent factors for development of meningitis. An endoscopic approach combined with an external incision was performed in one patient and 24 patients in nontraumatic and traumatic groups, respectively (p = 0.001). Combined vascularized grafts were more commonly used in patients with traumatic CSF rhinorrhea (p < 0.05). No statistical difference in the success rate (100% vs. 97.9%) was documented between the two groups.

Conclusions: Multifocal defects and meningitis were more prevalent in traumatic CSF rhinorrhea patients, leading to increased complexity in treatment management. Iatrogenic rather than accidental traumatic CSF rhinorrhea is an independent risk factor for development of meningitis. The endoscopic combined coronal extradural approach, in conjunction with various vascularized flaps, can effectively supplement skull base reconstruction, especially for complex traumatic CSF rhinorrhea.

Objectives: To gain a comprehensive understanding of the vocal repercussions experienced by mild COVID-19 infection, as well as the duration and underlying factors contributing to these effects.

Methods: Ten participants with mild COVID-19 infection were included as the experimental group to evaluate the voice metrics changes at 15 days (D15), 30 days (D30), and 60 days (D60) after mild COVID-19 infection, and 10 healthy people were taken as the normal control group. Self-assessment and objective measures were taken at each time point, including questionnaires for voice handicap index (VHI) and reflux symptom index (RSI), as well as acoustic and aerodynamic indicators such as fundamental frequency (F0), Jitter, Shimmer, noise-to-harmonics ratio, sound pressure level (SPL), phonation threshold pressure (PTP), phonation threshold flow, aerodynamic resistance(AR), aerodynamic efficiency, mean expiration airflow, maximum phonation time, and maximum loudest phonation time.

Results: Notable elevations in RSI and VHI were observed during the D15 assessment, but by D60, these levels had returned to normal. At D60, Shimmer, PTP, and PTF significantly increased compared to the control group, while HNR and AR significantly decreased (p < 0.05). F0, SPL, and PTP significantly increased compared to 15 days (p < 0.05), while other acoustic and aerodynamic indicators showed no significant changes in intra-group and inter-group comparisons.

Conclusions: Our study demonstrated that COVID-19 infection has a detrimental effect on voice production. Although subjective discomfort may gradually subside within 2 months after onset, alterations in phonation mode can be delayed. It is essential for healthcare professionals to remain vigilant in preventing any organic changes that may arise due to COVID-19-related voice disorders, such as muscle tension dysphonia.

The incidence of juvenile-onset recurrent respiratory papillomatosis (JORRP) varies worldwide, and the lack of well-adopted guidelines for use in China suggests that patients with JORRP do not receive optimal care. In America, where data are available, pediatric patients undergo an average of 4 surgeries annually and a total of >40 surgeries in their lifetimes primarily due to this condition. It is widely accepted that timely diagnosis and implementation of scientifically sound and effective interventions can prevent JORRP progression and mitigate serious complications. Notably, evidence-based guidelines to coordinate care are lacking, and there is a need to standardize clinical practice to improve outcomes for patients. The International Pediatric Otolaryngology Group issued guidelines in 2020 to improve care for patients with JORRP. However, this guideline was majorly tailored to the healthcare system in Europe and America, posing a challenge to its adoption in China. To this effect, we assembled a guideline development working group to formulate guidelines for the diagnosis and treatment of JORRP tailored to the Chinese context. The working group consisting of multidisciplinary experts with experience in managing patients with JORRP undertook qualitative and quantitative studies, conducted two rounds of Delphi consensus, and carried out multiple systematic reviews/meta-analyses to provide 24 key recommendations to 12 questions of clinical interest. We anticipate that healthcare workers, including primary care physicians and specialists managing JORRP, will find the guidelines useful, and their utilization will translate to improved outcomes for patients with the disease.