Laryngoscope最新文献

Objective: Otitis media with effusion (OME) is frequently observed in patients with severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)-yet it remains underrecognized. Both conditions are debilitating and may share type 2 inflammatory mechanisms. This study investigates the prevalence of OME (measured by tympanometry) in patients with CRSwNP and evaluates the effect of biologic treatment with mepolizumab, with or without combined FESS, on hearing outcomes as well as otologic symptoms.

Methods: Secondary analysis of a randomized controlled trial (RCT) (n = 58) comparing FESS and mepolizumab versus mepolizumab alone in patients suffering from severe CRSwNP. Tympanometry, audiometry, and patient-reported outcomes (SNOT-22 and COMOT-15) were assessed at baseline and after 6 months.

Results: At baseline, 22.8% (13/57) of patients had pathological tympanometry (OME), consistent with previous prevalence estimates. After 6 months, the proportion decreased to 14% (p = 0.07). No significant changes were observed in pure tone averages (PTA). In contrast, self-reported outcomes improved significantly, with reductions in both COMOT-15 and SNOT-22 scores (p < 0.05), independent of baseline tympanometry status.

Conclusion: Mepolizumab treatment was associated with a trend toward reduced middle ear symptoms and significant improvement in self-reported otologic symptoms, supporting the concept of global type 2 airway inflammation and the clinical relevance of assessing ear disease in CRSwNP.

Level of evidence: 2:

Objective: To develop and evaluate a deep learning object detection system for identifying vocal fold polyps in stroboscopic video frames using You Only Look Once (YOLO), and to assess the added benefit of temporal tracking on detection performance.

Methods: A retrospective dataset of 12,742 annotated frames from 55 laryngoscopy video recordings was annotated with bounding boxes identifying vocal fold polyps. Pretrained YOLO11 and YOLO12 models were fine-tuned to detect the polyps in the frames. A temporal tracking algorithm was further developed to propagate missed detections across adjacent frames.

Results: YOLO12 outperformed YOLO11 across all metrics. On the hold-out test set, YOLO12 reached a precision of 83.1% and an F1 score of 67.6%, with a mean average precision at 0.5 (mAP@0.5) of 64.1%. By comparison, YOLO11 achieved a precision of 67.3% and an F1 score of 56.2%, with a mAP@0.5 of 56.0%. Incorporating temporal tracking increased mAP@0.5 to 70.4% with YOLO 12, while maintaining a detection speed of 21.4 frames per second (fps), close to real time (30 fps).

Conclusions: Using YOLO 12 for vocal fold polyp detection in stroboscopy was enhanced with temporal tracking, achieving a mAP@0.5 of 70.4% with near real time performance. These results demonstrate the potential of real-time AI-assisted detection of vocal fold lesions.

Level of evidence: 4:

Introduction: The most common genes responsible for autosomal recessive nonsyndromic hearing loss (AR-NSHL) are GJB2 and STRC. STRC mutations are associated with mild-to-moderate sensorineural (SNHL) hearing loss and a lack of progression. However, our institutional experience suggested otherwise, prompting this review.

Methods: A 10-year retrospective chart review was performed at a tertiary children's hospital after the University of Iowa added STRC to its OtoSCOPE^R panel in 2013. Subjects with positive OtoSCOPE^R results underwent audiologic review. Hearing progression was defined based on pure-tone average changes, and mutation subtypes were categorized.

Results: Of 354 subjects undergoing OtoSCOPE^R testing, 181 (51.1%) carried a pathogenic mutation; GJB2 (28.7%) and STRC (16.6%) were most common. The STRC cohort included 30 subjects (21 males, 9 females) with hearing loss severity classifiable in 26 subjects and the highest proportion in the mild-to-moderate range (n = 46 ears; 88.5%). Hearing progression was observed in 12/24 subjects (20 ears: 8 bilateral, 4 unilateral). Median annual progression was 1.1 dB (range -3.5 to 18.7 dB). Two STRC subjects had substantial progression requiring cochlear implantation (one performed, one recommended). Genetic subtyping revealed seven categories, including six males with STRC/CATSPER2 deletions (deafness-infertility syndrome). No association between subtype and severity or progression was identified.

Discussion: STRC is the second most common cause of childhood NSHL and the leading contributor to mild-to-moderate SNHL. Unlike most published literature, 50% of our STRC cohort exhibited progression, and 17.6% of progressing subjects had substantial unilateral loss. We recommend long-term audiometric monitoring and standardized genomic reporting for this population.

Level of evidence: 4:

Objectives: Urbanization-related air pollution may be associated with olfactory dysfunction (OD) in China, yet population studies are lacking.

Methods: We conducted a cross-sectional study of 1500 participants in urbanizing Yancheng, China (2023-2025). Olfactory function was assessed via Sniffin' Sticks. Machine learning (XGBoost, k-means clustering) was used to analyze risk factors and phenotypes.

Results: Head trauma (OR = 163.04) and chronic rhinosinusitis (CRS, OR = 161.39) were the dominant risk factors for OD (p < 0.001). Rural residence was associated with a 99% lower OD risk compared to urban residence (OR = 0.011, p < 0.0001). Four OD subtypes emerged: (1) sinusitis-linked generalized impairment; (2) age-related threshold deficit; (3) neurological disorder-associated identification loss; (4) child-specific mild dysfunction. Olfactory ability peaked at the age of 23 years, remained stable among individuals aged 40-60 years, and declined sharply in those aged over 63 years. Anosmia quadrupled from childhood to elderly (7.1% → 28.2%, p < 0.0001).

Conclusion: In urbanizing China, head trauma and sinusitis are the most potent risk factors for olfactory dysfunction (OD). Additionally, long-term exposure to air pollution-proxied by urban residence-and the natural aging process are significant contributing factors. Phenotypic stratification enables targeted interventions, thereby urging reforms in environmental policies and enhanced clinical management of high-risk conditions (e.g., head trauma, sinusitis).

Level of evidence: 3:

Background: Management of mandibular osteoradionecrosis (ORN) is challenging and often requires large surgical resection. Alternatively, mandibular preservation and wrapping with a periosteal free flap may achieve healing in selected patients. Our objective was to assess the success rate and morbidity of revascularization of mandibular ORN using a humeral periosteal free flap.

Methods: A retrospective study was performed using medical records of patients who had undergone humeral periosteal free flap reconstruction for mandibular ORN. Clinical data, including age, gender, ORN site, ORN grade according to the Notani classification, clinical and radiological outcomes and complications were analyzed. The primary endpoint was ORN healing, defined as complete resolution of the main symptom (exposure, chronic infection, fistula, or fracture) at 6 months postoperatively.

Results: A total of 36 lesions in 34 patients with mandibular ORN associated with bone exposure and/or infection and/or pathologic fracture were included. ORN healing at 6 months was achieved in 64.7% (n = 22/34) of treated sites in the overall cohort and in 91.6% (n = 22/24) of patients with a viable flap.

Conclusion: The humeral periosteal free flap can be considered a reasonable surgical option for advanced mandibular ORN to avoid segmental mandibulectomy.

Level of evidence: 4:

Objectives: Abnormal nasal mucosal function has been frequently implicated in the symptomatology of empty nose syndrome (ENS), yet with limited evidence. This prospective pilot study aims to compare nasal mucosal sensitivity to air-jet stimuli between ENS patients and patients who underwent septoplasty/turbinate reduction (septo-turb) surgery, but without ENS symptoms.

Methods: Seven ENS and seven septo-turb subjects were recruited through a sample of convenience (from 06/2023 to 09/2024) due to the rarity of ENS. A precise, 0.25 s air jet ranging from 0.5 to 5 L/min was delivered via a 25-gage microcannula, with a 0.4 × 1.6 mm side opening placed 2 mm from the mucosal surface at predetermined sites that include the medial and lateral side of the nasal valve, the head and the center of inferior turbinate and their opposing septum. Detection thresholds were determined using a single-staircase method in 0.5 L/min steps.

Results: The ENS group had a significantly higher (less sensitive) threshold than the septo-turb group for the septum opposing the center of the inferior turbinate (ENS: 2.43 ± 1.37 L/min; septoplasty: 1.39 ± 1.27 L/min, p = 0.016); however, not for other sites. This regional threshold significantly correlated with all self-reported symptom scores (NOSE, SNOT-22, ENS6Q, VAS) (r = 0.45-0.54, all p < 0.05).

Conclusion: Significant regional differences in air-jet stimulus sensitivity between ENS and septoplasty patients were found that significantly correlated with symptom scores. A future larger sample size would make a more definitive conclusion.

Level of evidence: 3:

The expanded endonasal approach (EEA) to resect skull base lesions has classically included the resection of one or both middle turbinates (MT). Here, we describe for the first time a technique that spares the MT entitled middle turbinate release with preservation (MTRP) that can give an alternative and feasible approach to skull base surgeons that wish to maintain this endonasal landmark.

Objective: To determine the prevalence and characteristics of objectively confirmed laryngopharyngeal reflux (LPR) in patients with laryngeal contact granuloma (LCG) using 24-h hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring, and to compare patient and disease features by reflux status.

Methods: This retrospective study included patients diagnosed with LCG who underwent 24-h HEMII-pH monitoring. Reflux episodes were classified by acidity (acid, weakly acidic, weakly alkaline) and posture (upright, recumbent). Clinical characteristics, reflux episode profiles, lesion laterality, and Reflux Symptom Index (RSI) scores were compared between reflux-positive and reflux-negative patients.

Results: Among 41 patients, 25 (61.0%) were reflux-positive and 16 (39.0%) were reflux-negative, with no hypopharyngeal reflux event detected. The pH-based classification of reflux events identified a predominance of weakly acidic (46.2%) and weakly alkaline (44.3%) episodes; acidic events were uncommon (9.5%). Most reflux events occurred during upright periods (94.8%), with only 5.2% during recumbent position. Among unilateral lesions, a higher proportion of hypopharyngeal reflux-positive cases involved the left side (76.2% left, 23.8% right), while reflux-negative cases showed no lateral preference (60.0% left, 40.0% right). Symptom screening with the RSI had limited discrimination for hypopharyngeal reflux status (sensitivity 50.0%, specificity 46.7%, PPV 60.0%, NPV 36.8%).

Conclusion: Our findings highlight the limitations of symptom-based diagnosis and empiric acid suppression in patients with LCG. Pre-treatment 24-h HEMII-pH monitoring can provide a more evidence-based initial approach than routine empiric therapy and supports individualized behavioral interventions.

Level of evidence: 4: