World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Objective: Automated air-conduction pure-tone audiograms through Bayesian estimation and machine learning (ML) classification have recently been proposed in the literature. Although such ML-based audiometry approaches represent a significant addition to the field, they remain unsuited for daily clinical settings, in particular for listeners with asymmetric or conductive hearing loss, severe hearing loss, or cochlear dead zones. The goal here is to expand on previously proposed ML approaches and assess the performance of this improved ML audiometry for a large sample of listeners with a wide range of hearing status.

Methods: First, we describe the changes made to the ML method through the addition of: (1) safety limits to test listeners with a wide range of hearing status, (2) transient responses to cater for cochlear dead zones or nonmeasurable thresholds, and importantly, (3) automated contralateral masking to test listeners with asymmetric or conductive hearing loss. Next, we compared the performance of this improved ML audiometry with conventional and manual audiometry in a large cohort (n = 109 subjects) of both normal-hearing and hearing-impaired listeners.

Results: Our results showed that for all audiometric frequencies tested, no significant difference was found between hearing thresholds obtained using manual audiometry on a clinical audiometer as compared to both the manual and automated improved ML methods. Furthermore, the test-retest difference was not significant with the automated improved ML method for each audiometric frequency tested. Finally, when examining cross-clinic reliability measures, significant differences were found for most audiometric frequencies tested.

Conclusions: Together, our results validate the use of this improved ML-based method in adult clinical tests for air-conduction audiometry.

Introduction: Unilateral vocal fold paralysis (ULVP) is characterized by the complete immobility of a single vocal fold which can cause significant health challenges, including voice impairment, difficulty swallowing, and a high risk of aspiration due to glottic incompetency. The aim of this study is to systematically review the effectiveness of laryngeal reinnervation (LR) and medialization thyroplasty (MT) in the treatment of ULVP.

Materials and methods: Medline, PubMed, Cochrane Library, OVID, Scopus, Springer Nature Journals, ScienceDirect, and Directory of Open Access Journals databases were searched. Restriction to non-English studies were applied. Studies were excluded if subjects had previous treatment for ULVP, if they had co-existing neuromuscular disease affecting the larynx, and if they had significant non-laryngeal speech abnormalities.

Results: Fifteen articles were reviewed, all conducted between 2003 and 2023. Among the 864 participants included, 48 underwent LR, 348 underwent MT, and the remaining 432 were in the comparison group, which involved injection laryngoplasty (IL), voice therapy (VT), placebo, and medialization with arytenoid adduction. Meta-analyses compared LR to MT and MT to alternative treatments, revealing a preference for MT. The comparison between LR and MT in the network meta-analysis yielded a mean difference of 0.33 (95% CI: -11.79, 12.6) favoring the MT group, ranking using SUCRA values highlighted that MT is the best treatment modality followed by LR.

Discussion: The results of the network meta-analysis and the subgroup meta-analysis showed that MT is better than alternative treatments that were included in this study. Moreover, management modalities should be individualized to each patient as many factors are important and may affect the final outcomes.

Conclusions: While the network meta-analysis indicates that MT may be more effective than alternative treatments for managing ULVP, the results should be interpreted with caution due to potential confounding factors. One notable limitation is the small sample size in the LR group. Despite these limitations, the findings contribute to the existing literature and can help guide future research on optimal interventions for the treatment of ULVP.

Objectives: Sinonasal inverted papilloma (SNIP) is a benign tumor type that has been subject to growing levels of research interest owing to its potential for malignant transformation. However, there have been no studies to date of ferroptosis or related proteins in SNIP. Accordingly, this study was designed to examine correlative relationships between SNIP pathogenesis and the expression of proteins associated with ferroptotic activity, including p53, SAT1, and ALOX15.

Methods: Samples were collected from 44 total SNIP patients, and control middle turbinate samples were obtained from 28 patients with deviated septums. The RNA and protein levels of p53, SAT1, and ALOX15 were compared between these samples via quantitative real-time PCR (qRT-PCR), Western blot analysis (WB), and immunohistochemistry (IHC). The expression of mRNA was further validated by interrogating the GSE193016 data set. The correlations among the expression levels of these three genes were also assessed. Then, the Krouse stage system was used to grade these patients and to explore differences in p53, SAT1, and ALOX15 expression among different stages of the disease. Lastly, we compared the differences in the expression of these genes in inverted papilloma and squamous cell carcinoma by qRT-PCR and IHC.

Results: SNIP samples exhibited significantly higher p53, SAT1, and ALOX15 mRNA and protein levels than control samples, and strong correlations were observed between the levels of these three proteins. Furthermore, the expression levels of p53, SAT1, and ALOX15 were significantly higher in stage T4 compared to T2 in SNIP. p53 and SAT1 were significantly elevated in squamous carcinomas compared to inverted papilloma. However, the expression of ALOX15 tended to decrease in squamous carcinoma.

Conclusion: These results support a potential role for the p53/SAT1/ALOX15 ferroptotic pathway proteins in SNIP pathogenesis, although future molecular biology-based studies will be essential to test this hypothesis.

Objectives: Augmentation laryngoplasty represents a therapeutic choice for patients who suffer from glottic insufficiency of different etiologies. There have been multiple injectables that have been proven effective. The present study examines the short-term effects of vocal fold augmentation on phonation, swallowing, and breathing in individuals with glottic insufficiency. In addition, a decision plan is also proposed.

Methods: Data from medical records and operative notes were used to conduct a retrospective cohort study on patients with glottic insufficiency who underwent vocal fold augmentation from 2016 to 2023. Hyaluronic acid, calcium hydroxyapatite, and polydimethylsiloxane were the injectable materials that were used. An analysis was conducted on phonation, breathing, swallowing, and laryngoscopy findings both before and after vocal folds' augmentation.

Results: Seventy-nine patients were included, which represents 97 injections. The median (IQR) preoperative Voice Handicap Index-10 (VHI-10) score improved from 21 (15-28) to 16 (9-25) postoperatively (p < 0.001). The GRBAS scale also significantly decreased (p < 0.001). The median (IQR) preoperative Dyspnea Index score improved from 6 (0-17) to 2 (0-10) postoperatively (p < 0.05). Laryngoscopic findings showed significant improvement in the bulk of the vocal folds. There was no significant change in swallowing.

Conclusions: In case of dysphonia secondary to glottic insufficiency, augmentation laryngoplasty using various injectable materials has proven to be an effective option across a range of different etiologies, as it results in significant improvements in voice quality. The choice of the injectable material depends upon the severity and the etiology of glottic insufficiency.

Objectives: Bilateral recurrent nerve damage still represents one of the main complications following thyroid surgery, even though the nerve intraoperative monitoring has allowed the decrease of this injury. This observational retrospective study aims to define the onset modalities and the recovery time of different clinical conditions that may occurs after thyroidectomy.

Methods: From a total of 1417 patients who underwent total thyroidectomy for benign tumors between 2017 and 2022 in ENT Unit of University of Campania "L. Vanvitelli," this study involved 30 patients with bilateral vocal folds motility deficit. These patients (28 F, 2 M), aged from 24 to 78 years old (average age 51.7), presented a bilateral vocal fold motility deficit. Five patients of the study developed an acute respiratory failure upon the awakening that required a nasotracheal prolonged safe extubation. The other 25 patients underwent 9 months diagnostic and therapeutic process, which started approximately 30 days after thyroid surgery.

Results: Indeed, there are several outcomes of these complications, like functional laryngeal defects, which are mainly related to respiratory and phonatory activities. These clinical manifestations can evolve in different ways within a context of a wide range of possibilities, from the spontaneous bilateral or monolateral recovery to the necessity of a functional or surgical restoration.

Conclusion: This study allowed the acquisition of useful information about prognostic indications and an adequate therapeutic process, based on the specific clinical characteristics.

Objective: The objective if this study was to investigate phenotypic differences in airway obstruction, as determined by VOTE score, in a cohort of patients with obstructive sleep apnea (OSA) undergoing drug-induced sleep endoscopy (DISE).

Methods: Patients older than 18 years of age scheduled for DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included in a single-center retrospective cohort study. Patient demographics, body mass index (BMI), apnea-hypopnea index (AHI), and VOTE scores were extracted. Spearman correlation tests were utilized to determine the relationship between variables, and statistical analyses were performed using R.

Results: The study included 165 patients (61.24 years, SD 11.57; BMI 31.04 kg/m², SD 6.05). Due to several significant relationships between VOTE scores and patient demographics, a cluster analysis was performed, in which two distinct clusters (phenotype 1 and phenotype 2) arose. Phenotype 1 patients had lower overall VOTE scores (p < 0.001), less obstruction at the velum (p < 0.001) and oropharynx (p < 0.001), significantly more tongue obstruction (p = 0.031), and a significantly lower BMI (p = 0.001). Though not reaching significance, phenotype 1 patients also had more epiglottic obstruction (p = 0.0841) and were older (p = 0.2775).

Conclusions: Patients suffering from OSA may be categorized into one of two distinct phenotypes of clinical significance. Phenotype 1 patients who are nonobese and have less significant obstruction overall, with increased obstruction at the tongue, may benefit greatly from targeted surgical modalities. Conversely, phenotype 2 patients with worse obstruction on DISE and increased velum and oropharynx obstruction may represent a phenotype of OSA that is increasingly difficult to treat surgically, due to body habitus and severe, multi-level obstruction.

Introduction: Choanal atresia (CA) is a congenital narrowing or obliteration of the posterior nasal aperture. The condition is rare with an incidence of approximately 1 in 5000 to 9000 live births.

Objective: The aim of this work was to assess the results of treating this condition at the Otolaryngology Department in Oslo University Hospital-Rikshospitalet.

Methods: Retrospective review of patients treated at Oslo University Hospital-Rikshospitalet between 2005 and 2015 were performed. The review consisted of surgical techniques and outcomes, types of atresia, uses of stent and mitomycin C, age at operation, laterality of atresia, and associated anomalies.

Results: Thirty-one patients with CA were referred to Oslo University Hospital-Rikshospitalet during the mentioned observation period. Nine (29%) of the cases had bilateral CA and 22 (71%) had unilateral CA. Ten patients (32%) had bony atresia, 12 (39%) had membranous and eight (26%) had mixed type of atresia. Twenty-one patients (68%) needed revision surgery because of complete or partial restenosis after primary surgery. Stents were applied in 16 cases (52%) of patients and Mitomycin C was only used in the primary surgery of three patients. In the bilateral group, eight of the nine patients were operated on within the first 9 days of life. Sixteen patients (45%) had associated anomalies.

Conclusions: According to the observations in our sample, the restenosis problem is expected more and may need more revisions in bilateral CA than the unilateral type. The presence of other anomalies is associated with higher incidence of restenosis. Stenting is not essential in preventing restenosis.