World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Endoscopic ear surgery has been widely performed in China since 2015 due to the development and rapid popularization of endoscopic technology. Due to the relative shortness of the auditory meatus, only a fixed endoscope is required in many cases, rather than a motion similar to a nasal endoscope, and uncontrollable bleeding is virtually non-existent. Compared to microscopy, endoscopy allows for rapid and flexible changes in the field of view, eliminating the need for bone grinding. On these grounds, the advantages of endoscopy in ear surgery have been largely recognized. At the same time, physicians have become more rational about expanding indications for endoscopic ear surgery due to limitations such as single-handed surgery. The debate and standardization surrounding endoscopic ear surgery is ongoing. This review focuses on the current status and development of endoscopic ear surgery in China, discusses the advantages, limitations, and prospects of endoscopic ear surgery.

Auditory neuropathy (AN) is an auditory disorder that affects the function of the auditory pathway. An increasing number of AN cases have been identified with the revelation of the underlying mechanisms, the advancements of diagnostic and detecting techniques. The precise assessment, intervention, and effective rehabilitation of AN, which are crucial for AN patients and their families, have become challenging and significant topics in the field of otology. To discuss and lead the development of the "Chinese Clinical Practice Guideline for AN," more than 200 experts from China and other countries were invited to the "the International Advanced Forum on Auditory Neuropathy," which was hosted by the Chinese PLA General Hospital from 2016 to 2020, basing on the global research progress on AN and the clinical practice achievements in China. This guideline was jointly launched by the "Chinese Multi-center Research Collaborative Group on Clinical Diagnosis and Intervention of Auditory Neuropathy," the "Editorial Board of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery," the "Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association," the "China Division, International Association of Physician in Audiology," and the "Society of Audiology and Vestibular Medicine, China International Exchange and Promotion Association for Medical and Health Care." This guideline aims to embody the characteristics and contributions of Chinese research in terms of disease diagnosis consistency, operational procedure standardization, disease subtype classification, lesion location classification, precise genetic diagnosis, personalized intervention, and follow-up of the natural course. It aims to establish and improve the Chinese Clinical Practice Guidelines for AN (gCAN) that conform to Chinese medical conditions.

Objectives: Insulin-like growth factor 1 receptor (IGF-1R) is crucial for immunological control and the development of different types of cancer. It is still uncertain how the expression of IGF-1R impacts hypopharyngeal squamous cell carcinoma (HPSCC) and whether it has any predictive value for prognosis. Therefore, this study aimed to investigate the prognostic value of IGF-1R in HPSCC and its connection to tumor immunity.

Methods: Correlation between IGF-1R, p16, and tumor-infiltrating immune cells from the TCGA HNSCC data set was analyzed. The expressions of IGF-1R and programmed death ligand (PD-L1) and immune cell density were analyzed using immunohistochemistry (IHC) and multiplex immunohistochemistry (mIHC) in p16+/p16- HPSCC. Overall, 114 surgical specimens from 51 p16+ patients and 63 p16- patients with a bioptic diagnosis of HPSCC who underwent surgical resection at the Second Affiliated Hospital of Harbin Medical University were analyzed.

Results: IGF-1R and PD-L1 were expressed in tumor cells and invasion-front immune cells. Expression of IGF-1R and PD-L1 was related to tumor grade and lymph node status. In patients with p16- HPSCC, IGF-1R and PD-L1 expression were significantly higher than those with p16+ HPSCC, as were CD68+ or CD163+ cell densities. PD-L1 expression and CD68+ macrophage density were positively correlated with IGF-1R expression in p16+ HSPCC. In the p16+ HPSCC group, the co-expression rate of IGF-1R/PD-L1 was significantly increased.

Conclusion: IGF-1R expression could potentially serve as a better predictor of PD-1/PD-L1 inhibitor response rate in patients with HPSCC compared to p16 status. Combination therapy using IGF-1R inhibitors and PD-1/PD-L1 blockade may prove to be an effective treatment approach for patients with p16+ HPSCC.

The COVID-19 pandemic had profound effects on vocal health, impacting both infected individuals, professional voice users and essential workers. The objective of this paper was to explore the multifaceted nature of dysphonia associated with COVID-19, arising from both direct and indirect consequences of the pandemic. Prevalence rates of dysphonia among COVID-19 patients range widely from 25% to 79%, with significant underreporting. Factors contributing to voice changes include laryngeal inflammation, respiratory function impairment, treatment-related interventions, and increased vocal strain from masking and virtual communication. Professional voice users, such as teachers and singers, experienced unique challenges, including increased voice fatigue and apprehension regarding aerosol transmission during singing. For the voice clinician, videolaryngoscopic examination remains the critical tool for capturing the broad landscape of diagnoses that can range from inflammation to surgically emergent airway stenoses. Innovations with voice also emerged, utilizing artificial intelligence voice analysis for COVID-19 detection. Overall, understanding the relationship between COVID-19 and voice health is crucial for appropriate diagnosis and treatment of dysphonic patients. Continued research is necessary to further delineate the long-term implications and optimal treatment approaches for those affected.

Objective: This study aimed to explore the prognostic relevance of the age-adjusted Charlson Comorbidity Index (ACCI) in laryngeal squamous cell carcinoma (LSCC) survival.

Methods: This retrospective analysis was conducted on the medical records of 367 LSCC patients admitted to the First Hospital of Shanxi Medical University, China, from January 2012 to December 2015. The cohort (n = 367) comprised 351 males and 16 females aged 40-88 years. ACCI scores were categorized into three groups: high (7-12), moderate (5-6), and low (2-4). Prognostic factors were analyzed using the multivariable Cox proportional hazards regression model, and dynamic prognostic nomograms and calibration curves were generated based on the results. Model performance was evaluated using the C-index.

Results: In this cohort of 367 LSCC patients, the 5-year overall survival (OS) rate was 58.6%. Meanwhile, the 5-year progression-free survival (PFS) rate was 64.3%, and the cancer-specific survival (CSS) rate was 61.9%. Cox regression analysis identified ACCI, T stage, distant metastasis, and degree of differentiation as independent risk factors for both OS and CSS (p < 0.05). Additionally, a dynamic prognostic nomogram was established and validated, with a C-index of 0.75 (95% CI: 0.711-0.788) and 0.753 (95% CI: 0.714-0.792) for OS and CSS, respectively. High ACCI emerged as a pivotal survival prognosticator for LSCC patients. Thus, a more convenient and precise dynamic predictive model for formulating treatment strategies can be formulated by incorporating ACCI, T stage, metastasis, and differentiation.

Conclusions: Overall, this study advances our understanding of ACCI's prognostic significance and its role in guiding LSCC management to improve clinical outcomes.

Spasmodic dysphonia is a laryngeal dystonia that can present as adductor, abductor, or mixed types, with or without tremor. The etiology is not understood fully. Comprehensive evaluation is required to establish the diagnosis. Treatments include voice therapy, medications, botulinum toxin injection, laryngeal surgery, deep brain stimulation, and others. In most patients, it is possible to improve fluency.

Vocal fold leukoplakia (VFL) is a descriptive term for a white plaque in the true vocal folds (TVF). It is estimated at 10.2 cases per 100,000 males and 2.1 per 100,000 females. The most critical aspect of managing a VLF is achieving an accurate pathological diagnosis, since a white plaque in the TVF can have numerous differential diagnoses. Patients with VFL usually complain of hoarseness and vocal strain. The common cause of VFL is premalignant lesions with primary risk factors of tobacco and alcohol consumption. Inflammatory aggressors such as laryngopharyngeal reflux disease are proven to affect directly the incidence of VFL. Infectious agents such as human papilloma virus and Helicobacter pylori may also play a role in the development of VFL. Frequent differential diagnosis includes laryngeal candidiasis, prolonged ulcerative laryngitis, previous head and neck radiotherapy, and, more rarely, lichen planus. The clinical investigation for a VLF includes laryngeal exam through a rigid or a flexible laryngoscope; videochromoendoscopy is a useful tool. Biopsy is mandatory so a pathological diagnosis is made. The most accepted classification for VFL and premalignant lesions is the fifth edition of the World Health Organization, and it uses a two-tiered system. The treatment for VFL and premalignant lesions can be done by cold knife surgery, KTP laser, or CO₂ laser.

Neurological voice disorders, such as Parkinson's disease, laryngeal dystonia, and stroke-induced dysarthria, significantly impact speech production and communication. Traditional diagnostic methods rely on subjective assessment, whereas artificial intelligence (AI) offers objective, noninvasive, and scalable solutions for voice analysis. This review examines the applications, advancements, challenges, and future prospects of AI-driven methods in diagnosing, monitoring, and treating neurological voice disorders. We analyze recent advances in AI-based voice analysis, including machine learning, deep learning and signal processing techniques, and evaluate their effectiveness based on existing literature. AI models have demonstrated high accuracy in detecting subtle voice impairments, enabling early diagnosis of voice disorders, and predicting treatment response. Deep learning methods, particularly convolutional and transformer-based networks, have been effective in extracting meaningful biomarkers from acoustic or other modality data. Despite these promising advances, challenges remain, including limited high-quality data sets on some rare neurological voice disorders, ethical concerns regarding patient privacy, and the need for broad clinical validation. Further research should focus on developing standardized data sets, improving the ability of the AI model to learn representations, and enhancing its generalizability. With further development, AI-driven data analysis has the potential to transform the early detection and management of neurological voice disorders.

This overview serves as a foundational resource for clinicians caring for neurologically complex patients presenting with voice complaints. Neurogenic voice disorders are diverse in their clinical presentations and therapeutic approaches. A thorough medical history, including family history, detailed laryngeal examination, voice assessments, and neuroimaging, are imperative, as well as a multidisciplinary, collaborative approach with neurologists, speech language pathologists, and patient caregivers. Disorders such as amyotrophic lateral sclerosis (ALS), cerebrovascular accidents (strokes), Huntington's disease, myasthenia gravis (MG), Parkinson's disease (PD), and voice tremor should be understood by otolaryngologists. Each condition presents unique challenges and requires tailored treatment strategies ranging from supportive therapies and pharmacological interventions to surgery. Voice management techniques, including the use of botulinum toxin for hyperkinetic disorders and deep brain stimulation for refractory cases, are highlighted as promising interventions.