Auris Nasus Larynx最新文献

{"title":"Effectiveness of CI as an alternative to ABI for hearing loss in patients with vestibular schwannomas: A multicenter study in Japan","authors":"Mitsuyoshi Imaizumi ,&nbsp;Hidehiko Takeda ,&nbsp;Shujiro Minami ,&nbsp;Naoki Oishi ,&nbsp;Daisuke Yamauchi ,&nbsp;Shigeyuki Murono ,&nbsp;Hirofumi Nakatomi ,&nbsp;Kiyoshi Saito ,&nbsp;Akio Morita ,&nbsp;Masazumi Fujii","doi":"10.1016/j.anl.2024.10.010","DOIUrl":"10.1016/j.anl.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS), often causing severe damage to the bilateral auditory function. Auditory brainstem implantation (ABI) provides hearing-impaired patients with an opportunity to reacquire auditory sensation through electrical stimulation of auditory neurons in the cochlear nucleus. However, ABI is not covered by public health insurance in Japan, leading to a large difference in financial burden compared to cochlear implantation (CI). The aim of the present study was to demonstrate the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.</div></div><div><h3>Methods</h3><div>To investigate the current situation of ABI and CI for hearing reconstruction in VS patients, we conducted a questionnaire survey of 102 facilities in Japan. Based on the responses to the questionnaire, a multicenter research group consisting of otolaryngologists and neurosurgeons was established. We collected detailed data on patients with VS who underwent ABI (<em>n</em> = 7, all NF2) and CI (<em>n</em> = 14 [nine NF2, and five non-NF2]).</div></div><div><h3>Results</h3><div>Some sense of hearing was obtained in all patients but one with CI indicating the efficacy of CI and ABI for profound hearing loss caused by VS. The mean hearing levels were 45.4 dB HL in the ABI patients and 32.7 dB HL in the CI patients, indicating that CI was effective as an alternative to ABI.</div></div><div><h3>Conclusion</h3><div>The results of the present study suggest the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1009-1015"},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination therapy with BRAF and MEK inhibitors for anaplastic thyroid cancer: A report of two cases","authors":"Mayu Yamauchi,&nbsp;Akihiro Sakai,&nbsp;Koji Ebisumoto,&nbsp;Hiroaki Iijima,&nbsp;Takanobu Teramura,&nbsp;Aritomo Yamazaki,&nbsp;Ryoko Yanagiya,&nbsp;Ai Yamamoto,&nbsp;Yoshiyuki Ota,&nbsp;Hiroshi Ashida,&nbsp;Naoya Kobayashi,&nbsp;Kenji Okami","doi":"10.1016/j.anl.2024.10.002","DOIUrl":"10.1016/j.anl.2024.10.002","url":null,"abstract":"<div><div>Anaplastic thyroid cancer (ATC) is an aggressive malignancy with a poor prognosis and limited treatment options. Herein, we report two cases of unresectable ATC treated with a combination of BRAF and MEK inhibitors. The patients were initially treated with other therapies but were switched to BRAF and MEK inhibitors after testing positive for <em>BRAF</em> mutations. This resulted in a partial response, tumor shrinkage, and conversion to resectability in one case. The patient experienced manageable adverse events. <em>BRAF</em> mutations are common in thyroid cancers, and studies have demonstrated the efficacy of combining BRAF and MEK inhibitors for treating advanced or recurrent differentiated thyroid cancer or ATC with <em>BRAF</em> mutations. These cases emphasize the importance of <em>BRAF</em> gene testing at the initial diagnosis and the potential of BRAF and MEK inhibitors as treatment options for unresectable ATC with <em>BRAF</em> mutations. The oral administration and manageable adverse event profiles of these medications make them suitable for outpatient treatment. In conclusion, <em>BRAF</em> gene testing should be performed at the initial diagnosis, and the use of BRAF and MEK inhibitors should be considered in patients with ATC.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1003-1008"},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic surgery for squamous cell carcinoma in the nasal cavity and ethmoid sinus: A retrospective observational study","authors":"Yukio Nishiya ,&nbsp;Teru Ebihara ,&nbsp;Kazuhiro Omura ,&nbsp;Teppei Takeda ,&nbsp;Kazuto Matsuura ,&nbsp;Nobuyoshi Otori","doi":"10.1016/j.anl.2024.10.006","DOIUrl":"10.1016/j.anl.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>Reports of endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus are limited. Herein, we present a comprehensive account of the results obtained from performing endoscopic surgery based on the concept of en bloc resection.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study of patients who underwent nasal endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus at a hospital between July 2018 and December 2021. Primary endpoints were overall survival, relapse-free survival, and local recurrence-free survival. Data on tumor stage, tumor site of origin, postoperative treatment, and papilloma-related status were reviewed. Statistical analyses included the Kaplan–Meier method, Cox regression analysis, and Fisher's exact test.</div></div><div><h3>Results</h3><div>Twenty-two patients with a median age of 62 (range 27–84) years, comprising 15 male and 7 female, were included in this study, and the median duration of observation was 2.1 (range 0.6–4.3) years. The 2-year overall survival, relapse-free survival, and recurrence-free survival rates were 91.0%, 69.9%, and 79.0%, respectively. Cancer of the nasal cavity was significantly superior to that of the ethmoid sinus in terms of local recurrence-free survival (<em>p</em> = 0.03). The patients who underwent postoperative treatment had significantly worse recurrence-free survival rates than those who did not receive postoperative treatment (<em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>This study examined the results of the endoscopic treatment for squamous cell carcinoma of the nasal cavity and ethmoid sinus with the concept of en bloc resection. Patients with ethmoid sinus carcinoma had a greater risk for local recurrence, and the prognosis for patients requiring postoperative treatment was poor.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 996-1002"},"PeriodicalIF":1.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge destination following elective and emergency surgical tracheostomies in head and neck cancer patients","authors":"Seraphina Key ,&nbsp;Clemente Chia ,&nbsp;Marcus Del Rio ,&nbsp;Debra Phyland ,&nbsp;Charles Giddings","doi":"10.1016/j.anl.2024.10.007","DOIUrl":"10.1016/j.anl.2024.10.007","url":null,"abstract":"<div><h3>Objectives</h3><div>Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies.</div></div><div><h3>Methods</h3><div>Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing.</div></div><div><h3>Results</h3><div>Of 188 patients (47 emergency, 141 elective), 83.0 % returned to their pre-morbid accommodation, either directly home (54.6 %), or with additional community-based services (27.7 %). There was a significant difference in post-discharge destination (<em>p</em> = 0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95 % CI 0.32–1.79), and more likely to require additional supports on discharge(67.6 %) compared to elective(41.9 %) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation.</div></div><div><h3>Conclusion</h3><div>Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 990-995"},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early injection laryngoplasty for acute unilateral vocal fold paralysis after thoracic aortic surgery","authors":"Hanju Lee ,&nbsp;Hyoung Woo Chang ,&nbsp;Jeong-Yeon Ji ,&nbsp;Jae Hang Lee ,&nbsp;Kay-Hyun Park ,&nbsp;Woo-Jin Jeong ,&nbsp;Wonjae Cha","doi":"10.1016/j.anl.2024.09.006","DOIUrl":"10.1016/j.anl.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>Unilateral vocal fold paralysis (UVFP) following open thoracic aortic surgery increases pulmonary complications and hospital stays. An intervention protocol with early injection laryngoplasty (IL) and swallowing maneuvers was developed for acute UVFP following thoracic aortic surgery. This study aimed to compare the incidence of complications and length of medical care between the non-VFP and the IL-UVFP group managed under this protocol.</div></div><div><h3>Methods</h3><div>Patients who underwent open thoracic aortic surgery from March 2020 to February 2023 were included, excluding those with preoperative VFP or postoperative bilateral VFP. Under the protocol, patients with UVFP and incomplete glottic closure received IL and swallowing maneuvers within one week after diagnosis, while those without a glottic gap started a soft diet along with swallowing maneuvers. Postoperative complications, including reintubation, ICU re-transfer, pneumonia, stroke, delirium, wound infection, and bleeding, as well as hospital and ICU stay, were assessed.</div></div><div><h3>Results</h3><div>Of the 355 patients included in the study, 51 (14.4%) developed postoperative UVFP, while 304 (85.6%) had normal VF function. In the UVFP group, 42 patients underwent IL, while 9 patients without a glottic gap did not undergo IL. The incidence of complications and length of medical care were analyzed in the non-VFP and the IL-UVFP groups. The IL-UVFP group had a longer median hospital stay compared to the non-VFP group (20.5 vs. 16.0 days), though this difference was not statistically significant (<em>P</em> = .0681). ICU stay (<em>P</em> = .5396) and ICU re-transfer rates (<em>P</em> = 1.00) were also comparable between the groups. There was no significant difference in the incidence of pneumonia between the IL-UVFP group (4.8%) and the non-VFP group (9.5%) (<em>P</em> = .4003). Additionally, no significant differences were observed in the incidence of stroke, delirium, wound infection, or bleeding between the groups. No IL-related complications were reported.</div></div><div><h3>Conclusions</h3><div>The protocol with early IL appears to help reduce complication rates in acute UVFP patients following thoracic aortic surgery to levels comparable to those in patients without VFP. This protocol could serve as a guideline for otolaryngologists in managing UVFP patients.</div></div><div><h3>Level of evidence</h3><div>2b/Individual cohort study.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 984-989"},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia as a predictive factor for febrile neutropenia during induction chemotherapy in head and neck squamous cell cancer","authors":"Ken Kasahara ,&nbsp;Seiji Shigetomi ,&nbsp;Yoichiro Sato ,&nbsp;Yorihisa Imanishi ,&nbsp;Yuichi Ikari ,&nbsp;Takanori Nishiyama ,&nbsp;Yuki Matsui ,&nbsp;Seiichi Shinden ,&nbsp;Hiroyuki Ozawa ,&nbsp;Takeyuki Kono","doi":"10.1016/j.anl.2024.09.010","DOIUrl":"10.1016/j.anl.2024.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>Febrile neutropenia (FN) is the most serious toxicity in patients with head and neck squamous cell carcinoma (HNSCC) treated with induction chemotherapy (IC). Although it is well-known that sarcopenia is a risk factor for severe toxicity of (chemo)radiotherapy, the data on the association between sarcopenia and FN during IC in HNSCC patients is rare. This study determined the impact of sarcopenia on FN during IC.</div></div><div><h3>Methods</h3><div>IC-treated patients with HNSCC were enrolled in this study. Skeletal muscle mass (SMM) at the C3 vertebral body was used to define sarcopenia from computed tomography (CT) scans. To determine the predictive effect of low SMM on FN, logistic regression analysis was performed.</div></div><div><h3>Results</h3><div>In this study, 71 patients were included, of whom 28 had low SMM and 14 experienced FN. In multivariate analysis, low SMM and high CRP were the independent predictive factors for FN. The combination index of sarcopenia and CRP showed a greater odds ratio than sarcopenia alone suggesting a more significant predicting indicator.</div></div><div><h3>Conclusions</h3><div>Sarcopenia defined by CT imaging is associated with FN in patients with HNSCC treated with IC. The combination of sarcopenia and high CRP is a more significant risk factor, and it helps determine patients at risk of FN during IC.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 971-975"},"PeriodicalIF":1.6,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pathological findings and prognosis of early laryngeal and pharyngeal cancer treated with transoral surgery","authors":"Masashi Kuroki ,&nbsp;Hirofumi Shibata ,&nbsp;Kazuhiro Kobayashi ,&nbsp;Manato Matsubara ,&nbsp;Saki Akita ,&nbsp;Tatsuhiko Yamada ,&nbsp;Rina Kato ,&nbsp;Ryota Iinuma ,&nbsp;Ryo Kawaura ,&nbsp;Hiroshi Okuda ,&nbsp;Kenichi Mori ,&nbsp;Natsuko Ueda ,&nbsp;Tatsuhiko Miyazaki ,&nbsp;Takenori Ogawa","doi":"10.1016/j.anl.2024.10.003","DOIUrl":"10.1016/j.anl.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Transoral surgery for early-stage pharyngeal and laryngeal cancer provides good local control and is less invasive than external incisions. Postoperative pathological findings are considered the most important indicators for determining postoperative treatment, but detailed criteria have not been established. In this study, we evaluated the impact of postoperative pathological findings on prognosis of patients undergoing transoral surgery.</div></div><div><h3>Methods</h3><div>This study included patients with oropharyngeal, hypopharyngeal, and supraglottic cancer who underwent transoral surgery at Gifu University Hospital from April 2016 to December 2023. Resection margins were pathologically evaluated with horizontal and vertical margins, and vascular invasion was evaluated in three categories: lymphatic invasion, venous invasion, and perineural invasion. The correlation between each postoperative pathological finding and prognosis was evaluated.</div></div><div><h3>Results</h3><div>A total of 70 cases were assessed in this study. Cases of horizontal margin positive were 38.6 %, and cases of vertical margin positive were 27.1 %. Prognoses were comparable to previous reports. Despite the high margin positive rate, the 5-year overall survival rate was 77.1 %. The 5-year disease-specific survival rate was 89.7 %, and the 5-year local control rate was 85.3 %. Notably, when evaluated by margin direction, cases with positive horizontal margins had significantly worse prognoses. Although no significant correlation was found between vascular invasion and prognosis, cases of venous invasion tended to have a higher local recurrence rate.</div></div><div><h3>Conclusion</h3><div>This study suggests that transoral surgery has good prognosis despite a high positive-margin rate. However, detailed criteria for additional treatment have not been developed, and further case accumulation is required. Intriguingly, positive horizontal margins are correlated with significantly worse prognosis. This result may be related to a high risk of multiple cancers, and careful follow-up after surgery is recommended.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 976-983"},"PeriodicalIF":1.6,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter retrospective study on neck dissection and adjuvant radiotherapy with transoral surgery for hypopharyngeal squamous cell carcinoma","authors":"Koji Ushiro ,&nbsp;Yoshiki Watanabe ,&nbsp;Yo Kishimoto ,&nbsp;Yoshitaka Kawai ,&nbsp;Shintaro Fujimura ,&nbsp;Ryo Asato ,&nbsp;Takashi Tsujimura ,&nbsp;Ryusuke Hori ,&nbsp;Yohei Kumabe ,&nbsp;Kaori Yasuda ,&nbsp;Hisanobu Tamaki ,&nbsp;Takehiro Iki ,&nbsp;Yoshiharu Kitani ,&nbsp;Keisuke Kurata ,&nbsp;Tsuyoshi Kojima ,&nbsp;Kuniaki Takata ,&nbsp;Shinpei Kada ,&nbsp;Shinji Takebayashi ,&nbsp;Shogo Shinohara ,&nbsp;Kiyomi Hamaguchi ,&nbsp;Koichi Omori","doi":"10.1016/j.anl.2024.10.004","DOIUrl":"10.1016/j.anl.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer.</div></div><div><h3>Methods</h3><div>We compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021.</div></div><div><h3>Results</h3><div>Two hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (<em>p</em> = 0.007) and distant metastasis (<em>p</em> &lt; 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (<em>p</em> = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival.</div></div><div><h3>Conclusion</h3><div>In cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 956-963"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined local flap placement and negative-pressure wound therapy for the management of critical peritracheostomal pharyngocutaneous fistula","authors":"Hideki Kadota ,&nbsp;Chikafumi Oryoji ,&nbsp;Seita Fukushima ,&nbsp;Ryo Shimamoto ,&nbsp;Kenichi Kamizono ,&nbsp;Sei Yoshida","doi":"10.1016/j.anl.2024.09.008","DOIUrl":"10.1016/j.anl.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>Peritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5–125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings.</div></div><div><h3>Results</h3><div>We enrolled six patients [male, <em>n</em> = 6; mean age, 66.5 years (range, 57–80 years)]. NPWT was applied for an average of 18.2 days (range, 2–28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15–55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment.</div></div><div><h3>Conclusion</h3><div>Our method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 964-970"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of patulous Eustachian tube","authors":"Ryoukichi Ikeda","doi":"10.1016/j.anl.2024.09.007","DOIUrl":"10.1016/j.anl.2024.09.007","url":null,"abstract":"<div><div>Symptoms of patulous Eustachian Tube (PET) were first described by Jago in 1858 and reported by Schwartze in 1864, recognizing PET as a clinical entity. This review summarizes the causes, epidemiology, diagnosis, and treatment of PET, with a particular emphasis on diagnosis and treatment, detailing the diagnostic criteria and silicone plug (Kobayashi plug) surgery proposed or developed in Japan. PET is often linked to weight loss from chronic illnesses, dieting, anorexia nervosa, hemodialysis, and bariatric surgery. It is also associated with pregnancy, oral contraceptive use, nasopharyngeal and muscular atrophy or scarring, and neuromuscular diseases. Interestingly, many PET cases lack an identifiable cause. The prevalence of PET ranges from 0.3 % to 7.0 %, with a higher incidence in females and typically occurring in adolescents and adults. Diagnosis relies on a combination of clinical history, physical examination, ET function test, and imaging. The Japan Otological Society (JOS) proposed standardized diagnostic criteria, where a “definite PET” diagnosis requires all three criteria (aural symptoms, tubal obstruction procedures, and objective findings), while “possible PET” requires two. Treatment includes conservative and surgical interventions. For persistent and severe cases that do not improve with conservative treatments, surgical options are explored. These surgical procedures are classified by the type of intervention, which includes tympanic membrane manipulation (such as tympanostomy tube insertion and mass loading of the tympanic membrane), plug surgery, ET injection, shim surgery, tuboplasty, and ET closure. The Kobayashi plug, a 23 mm long silicone plug, is specifically designed for PET treatment. Indications for its use include “definite PET,” a PHI-10 score of 26 or higher, and lack of improvement after six months of conservative treatment. Preoperative evaluations include CT scans to assess ET patency and confirm the bony portion. Surgery, mostly performed under local anesthesia, involves inserting the plug into the ET via a myringotomy, ensuring the correct size and position with endoscopic guidance. In conclusion, PET is a challenging condition with diverse etiologies and symptoms. Effective management requires a comprehensive diagnostic approach and tailored treatment plans, with the Kobayashi plug offering a promising solution for refractory cases. Further research and advancements in diagnostic techniques and therapeutic interventions will continue to enhance the management of PET.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 947-955"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}