The aim of the ‘Summary of Japanese Clinical Practice Guidelines 2025 for the Management of Olfactory Dysfunction’ is to review the latest evidence regarding olfactory dysfunction and to present the current standard approaches for diagnosis and treatment. For the present guidelines, the Clinical Practice Guideline Committee, which is composed of otorhinolaryngologists, neurologists and oncologists with extensive experience treating patients with olfactory dysfunction, was formed by the Japanese Rhinologic Society. The Committee revised and updated the ‘Clinical Practice Guidelines for the Management of Olfactory Dysfunction 2019 Edition’. Following a public comment period, the guidelines underwent external evaluation through peer review by the Scientific Committee of the Japanese Society of Otorhinolaryngology-Head and Neck Surgery. A total of 16 clinical questions consisting of three categories (diagnosis, treatment, and neurodegenerative diseases associated with dementia), are comprehensively described. These evidence-based recommendations were compiled with the consensus of the Guideline Committee.
{"title":"Summary of Japanese clinical practice guidelines 2025 for the management of olfactory dysfunction","authors":"Kenzo Tsuzuki , Masakazu Hamamoto , Mutsumi Iijima , Masayoshi Kobayashi , Kenji Kondo , Eri Mori , Yoshiharu Motoo , Keigo Nakamura , Fumino Okutani , Minori Shibata , Hideaki Shiga , Kumiko Suzuki , Motohiko Suzuki , Shohei Horii , Ayako Inoshita , Yui Kawai , Shu Kikuta , Shunichi Miyazaki , Hiroyuki Morishita , Hironobu Nishijima , Takaki Miwa","doi":"10.1016/j.anl.2025.11.004","DOIUrl":"10.1016/j.anl.2025.11.004","url":null,"abstract":"<div><div>The aim of the ‘Summary of Japanese Clinical Practice Guidelines 2025 for the Management of Olfactory Dysfunction’ is to review the latest evidence regarding olfactory dysfunction and to present the current standard approaches for diagnosis and treatment. For the present guidelines, the Clinical Practice Guideline Committee, which is composed of otorhinolaryngologists, neurologists and oncologists with extensive experience treating patients with olfactory dysfunction, was formed by the Japanese Rhinologic Society. The Committee revised and updated the ‘Clinical Practice Guidelines for the Management of Olfactory Dysfunction 2019 Edition’. Following a public comment period, the guidelines underwent external evaluation through peer review by the Scientific Committee of the Japanese Society of Otorhinolaryngology-Head and Neck Surgery. A total of 16 clinical questions consisting of three categories (diagnosis, treatment, and neurodegenerative diseases associated with dementia), are comprehensively described. These evidence-based recommendations were compiled with the consensus of the Guideline Committee.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 111-127"},"PeriodicalIF":1.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967861","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}
Vocal demands in opera singers vary not only by vocal range but also by voice type subcategories (e.g., lyric vs. dramatic), which shapes technique and repertoire. Despite this, little is known about how these voice subcategories influence vocal fold pathology. To address this gap, we investigate the three-dimensional characteristics of vocal fold nodules in professional soprano opera singers and to clarify morphological differences based on voice type subcategories (lyric vs. dramatic).
Methods
This retrospective study included 19 professional soprano singers who underwent microlaryngeal surgery for bilateral vocal fold nodules between January 2018 and May 2023. Voice type subcategories, based on self-reported repertoire, was categorized as either lyric or dramatic. Nodules were classified as edematous or fibrous. Vertical location, estimated area, estimated contact area, and estimated volume of the nodules were calculated using intraoperative measurements and surgical video review. Statistical comparisons were performed between the lyric and dramatic groups.
Results
A total of 38 nodules were analyzed: 26 from lyric sopranos and 12 from dramatic sopranos. Lyric sopranos predominantly exhibited edematous nodules (24/26), while dramatic sopranos had a higher proportion of fibrous nodules (6/12). In both groups, nodules were more frequently located in the upper part of the vocal folds. Lyric sopranos showed significantly greater width, estimated area, estimated contact area, and estimated volume of vocal fold nodules compared to dramatic sopranos.
Conclusion
Voice-type subcategories may influence the morphological characteristics of vocal fold nodules in professional soprano singers. Lyric sopranos tend to develop larger, edematous nodules, likely due to repetitive high-frequency phonation, while dramatic sopranos are more prone to smaller, fibrotic nodules, potentially resulting from greater horizontal mechanical stress.
{"title":"Three-dimensional analysis of vocal fold nodules in operatic soprano singers undergoing microlaryngeal surgery: Differences according to voice type subcategories (Lyric vs. Dramatic)","authors":"Nobuaki Honda , Yusuke Watanabe , Daigo Komazawa , Mayu Hirosaki , Michihiko Sone","doi":"10.1016/j.anl.2025.12.006","DOIUrl":"10.1016/j.anl.2025.12.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Vocal demands in opera singers vary not only by vocal range but also by voice type subcategories (e.g., lyric vs. dramatic), which shapes technique and repertoire. Despite this, little is known about how these voice subcategories influence vocal fold pathology. To address this gap, we investigate the three-dimensional characteristics of vocal fold nodules in professional soprano opera singers and to clarify morphological differences based on voice type subcategories (lyric vs. dramatic).</div></div><div><h3>Methods</h3><div>This retrospective study included 19 professional soprano singers who underwent microlaryngeal surgery for bilateral vocal fold nodules between January 2018 and May 2023. Voice type subcategories, based on self-reported repertoire, was categorized as either lyric or dramatic. Nodules were classified as edematous or fibrous. Vertical location, estimated area, estimated contact area, and estimated volume of the nodules were calculated using intraoperative measurements and surgical video review. Statistical comparisons were performed between the lyric and dramatic groups.</div></div><div><h3>Results</h3><div>A total of 38 nodules were analyzed: 26 from lyric sopranos and 12 from dramatic sopranos. Lyric sopranos predominantly exhibited edematous nodules (24/26), while dramatic sopranos had a higher proportion of fibrous nodules (6/12). In both groups, nodules were more frequently located in the upper part of the vocal folds. Lyric sopranos showed significantly greater width, estimated area, estimated contact area, and estimated volume of vocal fold nodules compared to dramatic sopranos.</div></div><div><h3>Conclusion</h3><div>Voice-type subcategories may influence the morphological characteristics of vocal fold nodules in professional soprano singers. Lyric sopranos tend to develop larger, edematous nodules, likely due to repetitive high-frequency phonation, while dramatic sopranos are more prone to smaller, fibrotic nodules, potentially resulting from greater horizontal mechanical stress.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 99-106"},"PeriodicalIF":1.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938764","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}
Pub Date : 2026-01-08DOI: 10.1016/j.anl.2025.12.016
Go Omura , Kohtaro Eguchi , Toshihiko Sakai , Tatsuya Ito , Akihisa Tanaka , Mitsuhiko Katoh , Sorane Maezumi , Yoko Murayama , Hiroki Kuroyanagi , Paulina Maria Angela C. Villar , Azusa Sakai , Hideaki Takahashi , Chihiro Fushimi , Taisuke Mori , Seiichi Yoshimoto
Objective
This study aimed to elucidate the utility of transoral robotic surgery (TORS) for lateral oropharyngectomy in patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) by comparing its treatment outcomes with those of conventional non-robotic procedures.
Methods
The clinical charts of patients with newly diagnosed p16-positive OPSCC from the lateral wall who underwent lateral oropharyngectomy at our institution between 2016 and 2025 were retrospectively reviewed. The patients were divided into two groups according to the surgical approach: the non-robotic procedure group, treated via direct visualization or transoral videolaryngoscopic surgery, and the TORS group, treated using the da Vinci Surgical System. Clinicopathological data were compared between the groups.
Results
This study included 105 patients, 80 of whom underwent non-robotic procedures, and 25 underwent TORS. The TORS group exhibited a significantly lower rate of positive surgical margins (36% vs. 4%, P < .001). Logistic regression analysis revealed that TORS is an independent predictor of negative margins (odds ratio, 0.15; 95% confidence interval, 0.03–0.70; P = .02).
Conclusions
TORS was associated with superior margin control, supporting its utility as a primary treatment modality for p16-positive OPSCC.
目的：本研究旨在通过比较经口机器人手术（TORS）与传统非机器人手术的治疗效果，阐明经口机器人手术（TORS）在hpv相关口咽鳞状细胞癌（OPSCC）患者侧口咽切除术中的应用。方法回顾性分析我院2016 - 2025年新诊断p16阳性外侧壁OPSCC行侧口咽切除术患者的临床资料。根据手术方式将患者分为两组：非机器人手术组，通过直接可视化或经口视频喉镜手术治疗；TORS组，使用达芬奇手术系统治疗。比较两组临床病理资料。结果本研究纳入105例患者，其中80例接受了非机器人手术，25例接受了TORS。TORS组的手术切缘阳性率明显较低（36% vs. 4%, P < 001）。Logistic回归分析显示，TORS是负边际的独立预测因子（优势比为0.15；95%可信区间为0.03-0.70;P = 0.02）。结论stors与良好的切缘控制相关，支持其作为p16阳性OPSCC的主要治疗方式。
{"title":"Feasibility of ensuring surgical margins of transoral robotic surgery for lateral oropharyngectomy for p16-positive oropharyngeal squamous cell carcinoma patients compared with non-robotic surgery: A single-center, retrospective study","authors":"Go Omura , Kohtaro Eguchi , Toshihiko Sakai , Tatsuya Ito , Akihisa Tanaka , Mitsuhiko Katoh , Sorane Maezumi , Yoko Murayama , Hiroki Kuroyanagi , Paulina Maria Angela C. Villar , Azusa Sakai , Hideaki Takahashi , Chihiro Fushimi , Taisuke Mori , Seiichi Yoshimoto","doi":"10.1016/j.anl.2025.12.016","DOIUrl":"10.1016/j.anl.2025.12.016","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to elucidate the utility of transoral robotic surgery (TORS) for lateral oropharyngectomy in patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) by comparing its treatment outcomes with those of conventional non-robotic procedures.</div></div><div><h3>Methods</h3><div>The clinical charts of patients with newly diagnosed p16-positive OPSCC from the lateral wall who underwent lateral oropharyngectomy at our institution between 2016 and 2025 were retrospectively reviewed. The patients were divided into two groups according to the surgical approach: the non-robotic procedure group, treated via direct visualization or transoral videolaryngoscopic surgery, and the TORS group, treated using the da Vinci Surgical System. Clinicopathological data were compared between the groups.</div></div><div><h3>Results</h3><div>This study included 105 patients, 80 of whom underwent non-robotic procedures, and 25 underwent TORS. The TORS group exhibited a significantly lower rate of positive surgical margins (36% vs. 4%, <em>P</em> < .001). Logistic regression analysis revealed that TORS is an independent predictor of negative margins (odds ratio, 0.15; 95% confidence interval, 0.03–0.70; <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>TORS was associated with superior margin control, supporting its utility as a primary treatment modality for p16-positive OPSCC.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 107-110"},"PeriodicalIF":1.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938595","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}
Pub Date : 2025-12-30DOI: 10.1016/j.anl.2025.12.002
Jia Ji Ng , Hui Yan Ong , Ziyad Al Harrasi , Nik Fariza Husna Nik Hassan , Sherin Sokmun , Farah Liana Lokman , Nadhirah Mohd Shakri , Mawaddah Azman , Mohd Razif Mohamad Yunus , Marina Mat Baki
Objective
This study aimed to investigate the validity and reliability of the Bahasa Malaysia version of the Eating Assessment Tool-10 (mEAT-10) and determine the cutoff point for abnormal swallowing.
Methods
This prospective convenience sampling study was conducted at a tertiary center between December 2019 and May 2022. The mEAT-10 was produced following rigorous forward and backward translations. One hundred and thirty-eight participants, including 70 healthy volunteers and 68 patients with dysphagia, were recruited to complete the test–retest mEAT-10 assessment and the 3-ounce water test. The mEAT-10 was repeated within four weeks via telephone interviews or clinic visits. Patients in the dysphagia group underwent flexible endoscopic evaluation of swallowing (FEES). The FEES results were evaluated independently by four different raters to determine the reliability of the penetration-aspiration score (PAS) scoring, which categorizes them into safe and unsafe swallowing for data analysis. Internal consistency and test–retest agreement were assessed using Cronbach alpha and intraclass correlation coefficient (ICC). The mEAT-10 comparison between the normal and dysphagia groups was performed using the Mann–Whitney U test. The association between PAS and mEAT-10, gag reflex,3-ounce water test and the other risk factors were evaluated using chi-square and Fisher exact test, with univariable and multivariable logistic regression.
Results
The mEAT-10 test–retest showed a Cronbach alpha of >0.90 and an ICC of >0.85. The mEAT-10 cutoff score indicating abnormal swallowing is seven, with sensitivity and specificity of 0.82 and 0.54, respectively. In univariable analysis, higher mEAT-10 scores (≥7), absence of gag reflex, and failure of the 3-ounce water test were all significantly associated with unsafe swallowing (PAS ≥3). In multivariable logistic regression, however, failure of the 3-ounce water test was the only independent predictor of unsafe swallowing (PAS ≥3; adjusted odds ratio 4.24, 95% confidence interval 1.53–11.77; p=0.006).
Conclusion
mEAT-10 is a reliable tool for screening and assessing patients with dysphagia. A cutoff score of 7 or more indicates abnormal swallowing and maybe associated with unsafe swallowing (PAS ≥3).
{"title":"Validity and reliability of Bahasa Malaysia eating assessment tool (mEAT-10): A good screening tool for safe swallowing","authors":"Jia Ji Ng , Hui Yan Ong , Ziyad Al Harrasi , Nik Fariza Husna Nik Hassan , Sherin Sokmun , Farah Liana Lokman , Nadhirah Mohd Shakri , Mawaddah Azman , Mohd Razif Mohamad Yunus , Marina Mat Baki","doi":"10.1016/j.anl.2025.12.002","DOIUrl":"10.1016/j.anl.2025.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the validity and reliability of the Bahasa Malaysia version of the Eating Assessment Tool-10 (mEAT-10) and determine the cutoff point for abnormal swallowing.</div></div><div><h3>Methods</h3><div>This prospective convenience sampling study was conducted at a tertiary center between December 2019 and May 2022. The mEAT-10 was produced following rigorous forward and backward translations. One hundred and thirty-eight participants, including 70 healthy volunteers and 68 patients with dysphagia, were recruited to complete the test–retest mEAT-10 assessment and the 3-ounce water test. The mEAT-10 was repeated within four weeks via telephone interviews or clinic visits. Patients in the dysphagia group underwent flexible endoscopic evaluation of swallowing (FEES). The FEES results were evaluated independently by four different raters to determine the reliability of the penetration-aspiration score (PAS) scoring, which categorizes them into safe and unsafe swallowing for data analysis. Internal consistency and test–retest agreement were assessed using Cronbach alpha and intraclass correlation coefficient (ICC). The mEAT-10 comparison between the normal and dysphagia groups was performed using the Mann–Whitney U test. The association between PAS and mEAT-10, gag reflex,3-ounce water test and the other risk factors were evaluated using chi-square and Fisher exact test, with univariable and multivariable logistic regression.</div></div><div><h3>Results</h3><div>The mEAT-10 test–retest showed a Cronbach alpha of >0.90 and an ICC of >0.85. The mEAT-10 cutoff score indicating abnormal swallowing is seven, with sensitivity and specificity of 0.82 and 0.54, respectively. In univariable analysis, higher mEAT-10 scores (≥7), absence of gag reflex, and failure of the 3-ounce water test were all significantly associated with unsafe swallowing (PAS ≥3). In multivariable logistic regression, however, failure of the 3-ounce water test was the only independent predictor of unsafe swallowing (PAS ≥3; adjusted odds ratio 4.24, 95% confidence interval 1.53–11.77; p=0.006).</div></div><div><h3>Conclusion</h3><div>mEAT-10 is a reliable tool for screening and assessing patients with dysphagia. A cutoff score of 7 or more indicates abnormal swallowing and maybe associated with unsafe swallowing (PAS ≥3).</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 91-98"},"PeriodicalIF":1.5,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866647","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}
Since 2022, transoral robotic surgery (TORS) for pharyngeal and laryngeal cancers has been covered under Japan’s national health insurance system. Despite its technical advantages, such as improved access and functional preservation, its adoption remains limited. One of the barriers may be that TORS is reimbursed at the same level as conventional endoscopic surgery, despite requiring substantial initial investment and operational costs. This raises concerns about the underutilization of a potentially valuable technology. Therefore, an economic evaluation of TORS is warranted to inform reimbursement policy.
Methods
We used data from Japan’s national Diagnosis Procedure Combination (DPC) database to identify patients with T1–2N0–1M0 pharyngeal or laryngeal cancers who received either TORS or intensity-modulated radiation therapy (IMRT) in 2022. Total medical costs during the treatment period were compared.
Results
Among 447 patients identified, 40 received TORS and 407 underwent IMRT. The TORS group had significantly shorter hospital stays (mean 16.3 vs. 55.5 days) and lower mean costs (1.26 vs. 3.45 million yen; P < 0.01) than those who underwent IMRT. Using a generalised linear model with a gamma distribution and log link, and adjusting for sex, age, tumour site, tumour size and nodal status, TORS was associated with significantly lower costs than IMRT (adjusted cost ratio 0.39; 95 % confidence interval 0.35–0.43; P < 0.01). A similar result was observed even when the analysis was limited to patients with oropharyngeal cancer and N0.
Conclusions
TORS demonstrated a significant reduction in medical costs for treating patients with T1–2N0–1M0 pharyngeal or laryngeal cancer. However, this result should be interpreted with caution, as the observed cost advantage is probably due to the current Japanese reimbursement pricing. Nevertheless, the shortened treatment period associated with TORS offers meaningful benefits from the patient perspective. Even with moderate adjustments in reimbursement, the cost-effectiveness of TORS is expected to remain robust.
{"title":"Cost and clinical outcomes of transoral robotic surgery versus radiation therapy for T1–2N0–1M0 pharyngeal and laryngeal cancers","authors":"Susumu Kunisawa , Ichiro Tateya , Hisayuki Kato , Koichi Omori , Kiyohide Fushimi , Yuichi Imanaka","doi":"10.1016/j.anl.2025.12.012","DOIUrl":"10.1016/j.anl.2025.12.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Since 2022, transoral robotic surgery (TORS) for pharyngeal and laryngeal cancers has been covered under Japan’s national health insurance system. Despite its technical advantages, such as improved access and functional preservation, its adoption remains limited. One of the barriers may be that TORS is reimbursed at the same level as conventional endoscopic surgery, despite requiring substantial initial investment and operational costs. This raises concerns about the underutilization of a potentially valuable technology. Therefore, an economic evaluation of TORS is warranted to inform reimbursement policy.</div></div><div><h3>Methods</h3><div>We used data from Japan’s national Diagnosis Procedure Combination (DPC) database to identify patients with T1–2N0–1M0 pharyngeal or laryngeal cancers who received either TORS or intensity-modulated radiation therapy (IMRT) in 2022. Total medical costs during the treatment period were compared.</div></div><div><h3>Results</h3><div>Among 447 patients identified, 40 received TORS and 407 underwent IMRT. The TORS group had significantly shorter hospital stays (mean 16.3 vs. 55.5 days) and lower mean costs (1.26 vs. 3.45 million yen; <em>P</em> < 0.01) than those who underwent IMRT. Using a generalised linear model with a gamma distribution and log link, and adjusting for sex, age, tumour site, tumour size and nodal status, TORS was associated with significantly lower costs than IMRT (adjusted cost ratio 0.39; 95 % confidence interval 0.35–0.43; <em>P</em> < 0.01). A similar result was observed even when the analysis was limited to patients with oropharyngeal cancer and N0.</div></div><div><h3>Conclusions</h3><div>TORS demonstrated a significant reduction in medical costs for treating patients with T1–2N0–1M0 pharyngeal or laryngeal cancer. However, this result should be interpreted with caution, as the observed cost advantage is probably due to the current Japanese reimbursement pricing. Nevertheless, the shortened treatment period associated with TORS offers meaningful benefits from the patient perspective. Even with moderate adjustments in reimbursement, the cost-effectiveness of TORS is expected to remain robust.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 86-90"},"PeriodicalIF":1.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866650","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}
Pharyngo-laryngeal herpes zoster (HZ) is a rare but clinically important manifestation of varicella-zoster virus (VZV) reactivation. Unlike the well-described Ramsay Hunt syndrome, its neurological spectrum and outcomes remain poorly characterized. This study aimed to clarify patterns of cranial nerve involvement, recovery outcomes, and diagnostic challenges in pharyngo-laryngeal HZ, representing the largest single-center series to date.
Methods
We retrospectively reviewed 34 patients diagnosed with pharyngo-laryngeal HZ at a tertiary referral hospital in Japan between July 2007 and June 2025. VZV reactivation was confirmed serologically in all cases. Clinical features, affected cranial nerves, treatments, and recovery outcomes were analyzed. Neurological recovery was defined as complete resolution of paralysis, and swallowing recovery as tolerance of the pre-onset diet.
Results
The cohort comprised 24 men and 10 women (mean age, 61.7 years). Herpetic lesions were identified in 23 patients, while 11 (32 %) presented without rash and were diagnosed with zoster sine herpete, underscoring the diagnostic value of serology. The glossopharyngeal (IX) and vagus (X) nerves were most frequently affected (59 % each), followed by the facial nerve (24 %). Dysphagia occurred in 22 patients (65 %), with 5 requiring nutritional support and 2 developing aspiration pneumonia. Among 25 patients with cranial nerve paralysis, only 14 (56 %) achieved complete recovery. Laryngeal paralysis resulting from the X nerve impairment demonstrated the poorest prognosis, with a recovery rate of 50 %, although none required surgical intervention. In contrast, all cases of facial paralysis recovered fully, often after delayed onset following IX/X nerve symptoms. Incomplete recovery was more common in older patients and those who did not receive combined antiviral and corticosteroid therapy, though differences were not statistically significant. Overall, dysphagia resolved in 21 of 22 patients (95 %), but recovery was frequently prolonged, with most requiring >2 weeks of swallowing rehabilitation before resuming oral intake.
Conclusions
Pharyngo-laryngeal HZ is a distinct clinical entity typically manifesting as cranial polyneuropathy. The IX and X nerves are most often involved, with laryngeal paralysis associated with poorer outcomes. A substantial proportion of patients experience severe or prolonged dysphagia, necessitating nutritional support and rehabilitation. The frequent occurrence of zoster sine herpete highlights the critical role of serological testing in diagnosis. These findings emphasize that pharyngo-laryngeal HZ can cause severe, lasting morbidity, warranting early recognition, aggressive treatment, and preventive strategies, including zoster vaccination.
{"title":"Outcomes of cranial nerve disorders in pharyngo-laryngeal herpes zoster: A retrospective study of 34 cases at a single institution","authors":"Kanoko Minoshima , Hiroko Yanagi , Hiroki Sato , Michiya Matsumura , Yasushi Furuta","doi":"10.1016/j.anl.2025.12.014","DOIUrl":"10.1016/j.anl.2025.12.014","url":null,"abstract":"<div><h3>Objective</h3><div>Pharyngo-laryngeal herpes zoster (HZ) is a rare but clinically important manifestation of varicella-zoster virus (VZV) reactivation. Unlike the well-described Ramsay Hunt syndrome, its neurological spectrum and outcomes remain poorly characterized. This study aimed to clarify patterns of cranial nerve involvement, recovery outcomes, and diagnostic challenges in pharyngo-laryngeal HZ, representing the largest single-center series to date.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 34 patients diagnosed with pharyngo-laryngeal HZ at a tertiary referral hospital in Japan between July 2007 and June 2025. VZV reactivation was confirmed serologically in all cases. Clinical features, affected cranial nerves, treatments, and recovery outcomes were analyzed. Neurological recovery was defined as complete resolution of paralysis, and swallowing recovery as tolerance of the pre-onset diet.</div></div><div><h3>Results</h3><div>The cohort comprised 24 men and 10 women (mean age, 61.7 years). Herpetic lesions were identified in 23 patients, while 11 (32 %) presented without rash and were diagnosed with zoster sine herpete, underscoring the diagnostic value of serology. The glossopharyngeal (IX) and vagus (X) nerves were most frequently affected (59 % each), followed by the facial nerve (24 %). Dysphagia occurred in 22 patients (65 %), with 5 requiring nutritional support and 2 developing aspiration pneumonia. Among 25 patients with cranial nerve paralysis, only 14 (56 %) achieved complete recovery. Laryngeal paralysis resulting from the X nerve impairment demonstrated the poorest prognosis, with a recovery rate of 50 %, although none required surgical intervention. In contrast, all cases of facial paralysis recovered fully, often after delayed onset following IX/X nerve symptoms. Incomplete recovery was more common in older patients and those who did not receive combined antiviral and corticosteroid therapy, though differences were not statistically significant. Overall, dysphagia resolved in 21 of 22 patients (95 %), but recovery was frequently prolonged, with most requiring >2 weeks of swallowing rehabilitation before resuming oral intake.</div></div><div><h3>Conclusions</h3><div>Pharyngo-laryngeal HZ is a distinct clinical entity typically manifesting as cranial polyneuropathy. The IX and X nerves are most often involved, with laryngeal paralysis associated with poorer outcomes. A substantial proportion of patients experience severe or prolonged dysphagia, necessitating nutritional support and rehabilitation. The frequent occurrence of zoster sine herpete highlights the critical role of serological testing in diagnosis. These findings emphasize that pharyngo-laryngeal HZ can cause severe, lasting morbidity, warranting early recognition, aggressive treatment, and preventive strategies, including zoster vaccination.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 80-85"},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859009","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}
We report a rare case of thyroid cancer with tumor embolism of the internal jugular vein (IJV) that progressed cranially into the skull base and caused multiple cranial neuropathies. An 80-year-old woman presented with a progressively enlarging right cervical mass, which had been neglected for 10 years. Ultrasonography and magnetic resonance imaging revealed a cystic cervical lesion with a tumor embolism within the IJV extending to the jugular foramen and hypoglossal and facial canals. Fine-needle aspiration cytology yielded inconclusive results on two occasions, likely because of cystic degeneration. The patient developed facial paralysis, tongue deviation, and vocal cord paralysis. Biopsy confirmed papillary thyroid carcinoma with poorly differentiated areas. The patient elected the best supportive care and passed away four months after diagnosis. Cranial progression was likely facilitated by venous stasis due to an intraluminal tumor thrombus combined with the biological aggressiveness of dedifferentiation. To the best of our knowledge, this is the first documented case of thyroid cancer with retrograde IJV tumor embolism that led to skull base invasion and jugular foramen syndrome. This case highlights the variability in thyroid cancer extension patterns, which can occasionally result in highly atypical and clinically significant manifestations.
{"title":"Thyroid cancer with internal jugular vein tumor embolism and skull base invasion causing polyneuropathy","authors":"Hiroki Matsushita , Gaku Omura , Sumiyo Saburi , Takahiro Tsujikawa , Shigeru Hirano","doi":"10.1016/j.anl.2025.12.009","DOIUrl":"10.1016/j.anl.2025.12.009","url":null,"abstract":"<div><div>We report a rare case of thyroid cancer with tumor embolism of the internal jugular vein (IJV) that progressed cranially into the skull base and caused multiple cranial neuropathies. An 80-year-old woman presented with a progressively enlarging right cervical mass, which had been neglected for 10 years. Ultrasonography and magnetic resonance imaging revealed a cystic cervical lesion with a tumor embolism within the IJV extending to the jugular foramen and hypoglossal and facial canals. Fine-needle aspiration cytology yielded inconclusive results on two occasions, likely because of cystic degeneration. The patient developed facial paralysis, tongue deviation, and vocal cord paralysis. Biopsy confirmed papillary thyroid carcinoma with poorly differentiated areas. The patient elected the best supportive care and passed away four months after diagnosis. Cranial progression was likely facilitated by venous stasis due to an intraluminal tumor thrombus combined with the biological aggressiveness of dedifferentiation. To the best of our knowledge, this is the first documented case of thyroid cancer with retrograde IJV tumor embolism that led to skull base invasion and jugular foramen syndrome. This case highlights the variability in thyroid cancer extension patterns, which can occasionally result in highly atypical and clinically significant manifestations.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 76-79"},"PeriodicalIF":1.5,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797297","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}
We report a case of VEXAS syndrome in a 71-year-old man presenting with auricular chondritis, scleritis, hearing loss, and vestibular dysfunction. Although the clinical picture initially suggested relapsing polychondritis, hematologic findings and UBA1 variant confirmed VEXAS syndrome. Comprehensive audiovestibular testing revealed bilateral sensorineural hearing loss and global vestibular impairment. Steroid therapy led to partial improvement. This case highlights the potential for inner ear involvement in VEXAS syndrome, underscoring the importance of systematic audiovestibular evaluation and clinical awareness to differentiate it from similar conditions such as relapsing polychondritis.
{"title":"VEXAS syndrome with cochleovestibular involvement","authors":"Keishi Fujiwara , Shinya Morita , Kimiko Hoshino , Hideaki Takeda , Kento Komatsuda , Kaoru Kahata , Yuji Nakamaru , Akihiro Homma","doi":"10.1016/j.anl.2025.12.010","DOIUrl":"10.1016/j.anl.2025.12.010","url":null,"abstract":"<div><div>We report a case of VEXAS syndrome in a 71-year-old man presenting with auricular chondritis, scleritis, hearing loss, and vestibular dysfunction. Although the clinical picture initially suggested relapsing polychondritis, hematologic findings and <em>UBA1</em> variant confirmed VEXAS syndrome. Comprehensive audiovestibular testing revealed bilateral sensorineural hearing loss and global vestibular impairment. Steroid therapy led to partial improvement. This case highlights the potential for inner ear involvement in VEXAS syndrome, underscoring the importance of systematic audiovestibular evaluation and clinical awareness to differentiate it from similar conditions such as relapsing polychondritis.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 70-75"},"PeriodicalIF":1.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795757","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}
Pub Date : 2025-12-16DOI: 10.1016/j.anl.2025.12.008
Jun Suzuki , Yuta Kobayashi , Yoshihisa Fujino , Takahiro Tabuchi , Yukio Katori
Objective
Olfactory dysfunction (OD) compromises safety and well-being in humans; however, large-scale Japanese data are lacking. We quantified the prevalence of subjective chronic OD (self-reported olfactory impairment persisting ≥3 months), identified associated health and occupational factors, and evaluated determinants for severity using data from a nationwide web-based survey in Japan.
Methods
We analyzed data from the Japan coronavirus disease 2019 and Society Internet Survey 2023, a stratified, nationwide, cross-sectional survey of community-dwelling residents in Japan. From the initial 33,000 participants, we used the data of 25,569 participants (12,323 men, 13,246 women), after excluding those with implausible responses and missing data, to calculate prevalence. Inverse probability weighting was used to align the sample with the 2019 National Living Conditions Survey. Group differences concerning the presence and severity of OD were tested with χ² or Wilcoxon tests after excluding participants with additional missing data; independent associations were examined using weighted multivariable logistic regression analyses.
Results
The weighted prevalence for chronic subjective OD was 1.3 % (95 % confidence interval [CI] 1.1–1.4); age-specific rates ranged from 0.6 % (40–49 years) to 2.1 % (60–69 years). Independent OD correlates included the factors current smoking (odds ratio [OR] 2.09, p = 0.016), homeworking (OR 2.75, p = 0.004), somatic symptoms (Somatic Symptom Scale-8 score ≥ 12; OR 2.66, p = 0.009), dysgeusia (OR 193.2, p < 0.001), current hypertension (OR 3.69, p = 0.005), current bronchial asthma (OR 6.09, p < 0.001), current allergic rhinitis (OR 1.97, p = 0.012), and moderate-severe presenteeism (Work Functioning Impairment Scale score ≥ 21; OR 3.04, p < 0.020). Being a woman was associated with lower OD severity (OR 0.34, p = 0.035, for moderate-severe vs mild), whereas having ≥ 1 day of sick absences in the previous month was associated with higher OD severity (OR 3.17, p = 0.044).
Conclusion
Subjective OD prevalence in Japan was 1.3 %. Presenteeism was associated with OD and absenteeism was associated with moderate-severe OD. Further studies on the relationship between OD and work productivity are warranted.
目的：嗅觉功能障碍（OD）危及人类的安全和福祉；然而，日本缺乏大规模的数据。我们量化了主观慢性吸毒过量（自我报告的嗅觉障碍持续≥3个月）的患病率，确定了相关的健康和职业因素，并利用日本全国网络调查的数据评估了严重程度的决定因素。方法：我们分析了2019年日本冠状病毒病和2023年社会互联网调查的数据，这是一项针对日本社区居民的分层、全国性、横断面调查。从最初的33,000名参与者中，我们使用了25,569名参与者（12,323名男性，13,246名女性）的数据，在排除了那些不可信的回答和缺失数据后，计算患病率。使用逆概率加权使样本与2019年全国生活条件调查保持一致。在排除额外缺失数据的参与者后，用χ 2或Wilcoxon检验检验OD存在和严重程度的组间差异；使用加权多变量逻辑回归分析检验独立关联。结果：慢性主观性吸毒过量的加权患病率为1.3%(95%可信区间[CI] 1.1-1.4)；特定年龄的发病率从0.6%（40-49岁）到2.1%（60-69岁）不等。独立的OD相关因素包括当前吸烟（比值比[OR] 2.09, p = 0.016）、在家工作（OR 2.75, p = 0.004）、躯体症状（躯体症状量表-8评分≥12；OR 2.66, p = 0.009）、语言障碍（OR 193.2, p < 0.001）、当前高血压（OR 3.69, p = 0.005）、当前支气管哮喘（OR 6.09, p < 0.001）、当前过敏性鼻炎（OR 1.97, p = 0.012）和中重度出勤（工作功能障碍量表评分≥21；OR 3.04, p < 0.020）。女性与较低的用药过量严重程度相关（OR 0.34, p = 0.035，中重度vs轻度），而上个月病假天数≥1天与较高的用药过量严重程度相关（OR 3.17, p = 0.044）。结论：日本的主观OD患病率为1.3%。出勤与吸毒过量有关，旷工与中重度吸毒过量有关。有必要进一步研究OD与工作效率之间的关系。
{"title":"Prevalence and associated factors of self-reported olfactory dysfunction in Japan: Findings from a nationwide web-based cross-sectional survey","authors":"Jun Suzuki , Yuta Kobayashi , Yoshihisa Fujino , Takahiro Tabuchi , Yukio Katori","doi":"10.1016/j.anl.2025.12.008","DOIUrl":"10.1016/j.anl.2025.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>Olfactory dysfunction (OD) compromises safety and well-being in humans; however, large-scale Japanese data are lacking. We quantified the prevalence of subjective chronic OD (self-reported olfactory impairment persisting ≥3 months), identified associated health and occupational factors, and evaluated determinants for severity using data from a nationwide web-based survey in Japan.</div></div><div><h3>Methods</h3><div>We analyzed data from the Japan coronavirus disease 2019 and Society Internet Survey 2023, a stratified, nationwide, cross-sectional survey of community-dwelling residents in Japan. From the initial 33,000 participants, we used the data of 25,569 participants (12,323 men, 13,246 women), after excluding those with implausible responses and missing data, to calculate prevalence. Inverse probability weighting was used to align the sample with the 2019 National Living Conditions Survey. Group differences concerning the presence and severity of OD were tested with χ² or Wilcoxon tests after excluding participants with additional missing data; independent associations were examined using weighted multivariable logistic regression analyses.</div></div><div><h3>Results</h3><div>The weighted prevalence for chronic subjective OD was 1.3 % (95 % confidence interval [CI] 1.1–1.4); age-specific rates ranged from 0.6 % (40–49 years) to 2.1 % (60–69 years). Independent OD correlates included the factors current smoking (odds ratio [OR] 2.09, <em>p</em> = 0.016), homeworking (OR 2.75, <em>p</em> = 0.004), somatic symptoms (Somatic Symptom Scale-8 score ≥ 12; OR 2.66, <em>p</em> = 0.009), dysgeusia (OR 193.2, <em>p</em> < 0.001), current hypertension (OR 3.69, <em>p</em> = 0.005), current bronchial asthma (OR 6.09, <em>p</em> < 0.001), current allergic rhinitis (OR 1.97, <em>p</em> = 0.012), and moderate-severe presenteeism (Work Functioning Impairment Scale score ≥ 21; OR 3.04, <em>p</em> < 0.020). Being a woman was associated with lower OD severity (OR 0.34, <em>p</em> = 0.035, for moderate-severe vs mild), whereas having ≥ 1 day of sick absences in the previous month was associated with higher OD severity (OR 3.17, <em>p</em> = 0.044).</div></div><div><h3>Conclusion</h3><div>Subjective OD prevalence in Japan was 1.3 %. Presenteeism was associated with OD and absenteeism was associated with moderate-severe OD. Further studies on the relationship between OD and work productivity are warranted.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 61-69"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776704","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}
The 2016 diagnostic criteria for patulous Eustachian tube (PET) proposed by the Japan Otological Society classify cases as “definite” or “possible.” However, the clinical characteristics and natural course of possible cases remain unclear. This study aimed to clarify the clinical profiles and diagnostic transition of possible PET by subclassifying them into two groups.
Methods
We retrospectively reviewed the records of 292 patients diagnosed as possible PET at their first visit to our specialized outpatient clinic between June 2019 and May 2025. Patients were categorized as group A (symptom relief with Eustachian tube–closing maneuvers but lacking objective findings) or group B (objective findings present but without symptom relief). Clinical features, symptom profiles, and diagnostic transitions were analyzed. Survival analyses using the Kaplan–Meier method, Cox proportional hazards model, Weibull parametric model, and restricted mean survival time (RMST) were conducted to evaluate transition to definite PET.
Results
Voice autophony (81.8%¦vs. 59.9%) and breathing autophony (47.1%¦vs. 35.3%) were significantly more frequent in group A, whereas hearing loss was more common in group B (34.1%¦vs. 16.5%, p < 0.001). During follow-up, 30 patients (25 in group A, 5 in group B) progressed to definite PET. Kaplan–Meier analysis showed a significantly higher transition rate in group A (log-rank, p < 0.0001). Cox regression demonstrated a nearly five-fold higher hazard of progression in group A (HR = 4.95, 95% CI: 1.89–12.95, p = 0.001). RMST analysis indicated that group B required on average 1.5 more visits to reach diagnosis. Weibull analysis revealed that most group A patients were diagnosed by the third visit, whereas group B patients frequently remained undiagnosed.
Conclusion
Possible PET cases comprise heterogeneous conditions, with group A containing a higher proportion of true PET and group B including more non-PET cases with hearing loss. Careful follow-up and additional testing are warranted for group A, while differential diagnosis should be prioritized in group B. Subgroup-based evaluation may contribute to a more precise and practical diagnostic process for PET.
目的：日本耳科学会提出的2016年扩张性咽鼓管（PET）诊断标准将病例分为“确定”和“可能”两类。然而，临床特征和可能病例的自然病程尚不清楚。本研究旨在通过将可能的PET分为两组来阐明其临床特征和诊断转变。方法：回顾性分析2019年6月至2025年5月在我院专科门诊首次就诊时诊断为PET的292例患者的记录。患者分为A组（症状缓解，有咽鼓管闭合术，但无客观结果）和B组（有客观结果，但无症状缓解）。分析临床特征、症状概况和诊断转变。使用Kaplan-Meier法、Cox比例风险模型、威布尔参数模型和限制平均生存时间（RMST）进行生存分析，以评估向确定PET的过渡。结果：语音自动应答率为81.8%。59.9%)和呼吸自动语音（47.1%）。（35.3%），而听力损失在B组中更为常见（34.1%）。16.5%, p < 0.001)。随访期间，30例患者（A组25例，B组5例）发展为明确的PET。Kaplan-Meier分析显示，a组的转移率显著高于对照组（log-rank, p < 0.0001）。Cox回归显示a组的进展风险高出近5倍（HR = 4.95, 95% CI: 1.89-12.95, p = 0.001）。RMST分析表明，B组平均需要多1.5次就诊才能得到诊断。Weibull分析显示，大多数A组患者在第三次就诊时被诊断出来，而B组患者经常未被诊断出来。结论：可能的PET病例具有异质性，A组真PET比例较高，B组非PET患者听力损失较多。A组需要仔细的随访和额外的检测，而b组应优先进行鉴别诊断。基于亚组的评估可能有助于PET的更精确和实用的诊断过程。
{"title":"Possible patulous Eustachian tube: Clinical characteristics and diagnostic transition according to the Japan Otological Society criteria","authors":"Marin Yoshida , Hidetoshi Oshima , Hideshi Shindo , Ryoji Hirai , Takeshi Oshima","doi":"10.1016/j.anl.2025.11.005","DOIUrl":"10.1016/j.anl.2025.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>The 2016 diagnostic criteria for patulous Eustachian tube (PET) proposed by the Japan Otological Society classify cases as “definite” or “possible.” However, the clinical characteristics and natural course of possible cases remain unclear. This study aimed to clarify the clinical profiles and diagnostic transition of possible PET by subclassifying them into two groups.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the records of 292 patients diagnosed as possible PET at their first visit to our specialized outpatient clinic between June 2019 and May 2025. Patients were categorized as group A (symptom relief with Eustachian tube–closing maneuvers but lacking objective findings) or group B (objective findings present but without symptom relief). Clinical features, symptom profiles, and diagnostic transitions were analyzed. Survival analyses using the Kaplan–Meier method, Cox proportional hazards model, Weibull parametric model, and restricted mean survival time (RMST) were conducted to evaluate transition to definite PET.</div></div><div><h3>Results</h3><div>Voice autophony (81.8%¦vs. 59.9%) and breathing autophony (47.1%¦vs. 35.3%) were significantly more frequent in group A, whereas hearing loss was more common in group B (34.1%¦vs. 16.5%, p < 0.001). During follow-up, 30 patients (25 in group A, 5 in group B) progressed to definite PET. Kaplan–Meier analysis showed a significantly higher transition rate in group A (log-rank, p < 0.0001). Cox regression demonstrated a nearly five-fold higher hazard of progression in group A (HR = 4.95, 95% CI: 1.89–12.95, p = 0.001). RMST analysis indicated that group B required on average 1.5 more visits to reach diagnosis. Weibull analysis revealed that most group A patients were diagnosed by the third visit, whereas group B patients frequently remained undiagnosed.</div></div><div><h3>Conclusion</h3><div>Possible PET cases comprise heterogeneous conditions, with group A containing a higher proportion of true PET and group B including more non-PET cases with hearing loss. Careful follow-up and additional testing are warranted for group A, while differential diagnosis should be prioritized in group B. Subgroup-based evaluation may contribute to a more precise and practical diagnostic process for PET.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"53 1","pages":"Pages 55-60"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769814","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}
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