European Annals of Otorhinolaryngology-Head and Neck Diseases最新文献

Nasal septal perforations (SP) are common yet challenging conditions encountered in otorhinolaryngology. Endoscopic repair of nasal septal perforations using nasal pedicle mucosal flaps has become an important treatment method. However, there are no established guidelines for selecting the appropriate mucosal flaps for repair, and the choice largely depends on the surgeon's experience. This study outlines the procedure and benefits of utilizing a unilateral inverted mucosal flap from the nasal septum, along with criteria for selecting suitable cases for this surgical approach. The technique is best suited for moderate-sized perforations located in the anterior nasal septum, with a diameter of less than 2cm. The mucosa around the perforation is thicker. It is essential that the nasal mucosa is healthy and that the perforation edges have sufficient bony and cartilaginous support to prevent mucosal adhesion on both sides of the septum, which could hinder the complete separation of the inverted mucosal flap. Our findings suggest that, with careful case selection, the repair technique involving a unilateral inverted mucosal flap combined with stitching methods is a feasible option. This approach not only simplifies the surgical procedure but also significantly reduces its complexity, making it more accessible to those new to the field.

Aim: This study aimed to investigate the impact of residual ethmoidal laminae after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Materials and methods: This retrospective cohort included 66 patients with CRSwNP who received 300mg of dupilumab every 2weeks for 16weeks between August 2020 and March 2022. Patients were categorized into the no-lamina or residual-lamina groups based on postoperative sinus computed tomography scans. Clinical parameters, including the Lund-Mackay score (primary endpoint), nasal polyp score, T&T olfactometer threshold, and SNOT-22 scores (secondary endpoints), were assessed at baseline and 16weeks posttreatment.

Results: Of 66 patients who received dupilumab, 51 met the inclusion criteria. The no-lamina (n=23) and residual-lamina (n=28) groups exhibited similar baseline characteristics. At 16weeks, the Lund-Mackay Score significant improved in the no-lamina group compared with the residual-lamina group (5±4 vs. 9±4; P=0.004). Non-significant differences were observed in nasal polyp score (2.6±1.6 vs. 3.3±2.0; P=0.22), T&T olfactometer threshold test score, (3.2±1.8 vs. 3.3±1.4; P=0.78) SNOT-22 score, (18±11 vs. 24±13; P=0.15).

Conclusion: This study suggests an association between the absence of residual ethmoidal laminae and an enhanced dupilumab response in CRSwNP. Residual laminae in the anterior ethmoid affect the effectiveness of dupilumab in targeting inflammatory pathways. Meticulous clearance, particularly in the anterior ethmoidal region, optimizes the efficacy of dupilumab. Understanding the influence of residual ethmoidal laminae on dupilumab outcomes is crucial for refining post-ESS treatment strategies for patients with CRSwNP.

Purpose: User-friendly artificial intelligence (AI) chatbots are increasingly being explored to assist healthcare teams in their decision-making processes. As accurate diagnosis in all medical fields is vital in treatment planning, this research seeks to explore the function of two specific AI chatbots, ChatGPT and Perplexity AI, in distinguishing the various types of dysphonia (organic, functional, and neurological).

Material and methods: In experiment 1, a script combining voice self-assessments plus the acoustic analysis, and in experiment 2, only the acoustic analysis of 37 dysphonic patients was fed into the ChatGPT and Perplexity AI chatbots specifying the type and asked to develop a complex AI-based model to determine dysphonia type. Then, the same process was redone with data from a sample of 27 other patients as a test.

Results: Although ChatGPT could not analyze the data and only provided guidance, the Cohen's Kappa agreement between experts' diagnoses and Perplexity AI diagnoses in experiment 1 (P=0.773) and experiment 2 (P=0.067) lacked statistically significance.

Conclusion: Regarding the preliminary poor performance of AI chatbots in differential diagnosis of dysphonia type, it is not currently recommended to use them in clinical settings. However, modifications in AI chatbots in the future might provide more promising results in determining the dysphonia type. Further research is needed to shed light on AI chatbots ability in voice clinics.

Aim: The treatment of salivary gland cancers with clinically negative neck is controversial, with divergent guidelines about elective neck dissection (END). Even though these guidelines are widely used, they mostly rely on retrospective research that are subject to methodological flaws and selection bias.

Methods: A critical narrative review. Problem description, identification of likely clinical scenarios, appraisal of previous recommendations, critical examination of available data, and presentation of clinical decision-making options comprised the article creation.

Results: One of the most important factors is the rate of occult lymph node metastases, which ranges from 2-30% and varies greatly depending on the kind and grade of tumor. The use of risk classification according to preoperative findings, such as tumor size, grade, and clinical signs such involvement of the facial nerve, offers some guidance. Nevertheless, unanticipated cancers are frequently discovered by intraoperative and postoperative histological results, which makes decision-making even more difficult. Alternatives to END, including elective neck irradiation, have similar effectiveness in reducing regional recurrence in high-risk scenarios. Although END may enhance regional control, it carries risks of surgical complications, such as injury to nerves and functional impairment. No prospective randomized studies have definitively demonstrated the advantage of END regarding survival or recurrence.

Conclusion: END may be appropriate in certain high-risk situations, but its regular use in cN0 salivary gland cancers is still up for debate. A personalized strategy that accounts for tumor-specific and patient-related variables, together with careful use of adjuvant treatments, is advised until substantial prospective data is available.

Objective: Conducting a prospective pilot study to investigate the effect of temperature-controlled radiofrequency treatment of the nasal valve in endurance athletes with internal nasal valve collapse.

Material and methods: Twenty-five endurance athletes with nasal valve collapse were recruited from 2018 to 2020. Eight of the 25 patients dropped out of the study due to different reasons (injured due to non-nasal causes before postoperative measurement, refusal of surgery in the short term, termination due to corona pandemic), so that 17 study participants completed the study. We investigated NOSE questionnaire and rhinomanometry before and after radiofrequency treatment of the internal nasal valve (Vivaer radiofrequency probe). In addition, an exhaustive treadmill test before and after radiofrequency treatment was performed. The collected measurements were registered and compared with paired t-test. A Cohen's dz was performed for significant results. The normal distribution was confirmed by using the Kolmogorov-Smirnov test and Q-Q plots.

Results: There was a significant improvement in the NOSE score (P<0.001, Cohen's dz=1.03) and no serious side effects. No significant differences were seen before and after the treatment in rhinomanometry and spiroergometry.

Conclusion: Due to the low side effects and the subjective improvement in nasal breathing according to the NOSE score, the technique could perhaps represent a promising non-invasive therapy for improving nasal breathing in endurance athletes. However, no significant improvement was observed in the objective parameters. Larger study cohorts are required to investigate the effect in more detail.