<div><h3>Objective</h3><div>To elucidate the clinical characteristics of vocal fold polyps (VFPs) and evaluate the efficacy of phonosurgery using a comprehensive analysis of multidimensional voice parameters.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 201 patients with VFPs treated at Kurume University Hospital between 1996 and 2022. All patients underwent either endolaryngeal microsurgery (LMS) under general anesthesia or forceps excision (FE) under local anesthesia. Lesions were categorized as pedunculated or sessile and as hemorrhagic or non-hemorrhagic based on coloration. Polyp size was calculated as the ratio of the lesion diameter to the distance from the anterior commissure to the vocal process. Pre- and postoperative values and postoperative differences (Δ) were analyzed for voice parameters: maximum phonation time (MPT), mean flow rate (MFR), fundamental frequency (<em>F</em><sub>o</sub>), <em>F</em><sub>o</sub> range, sound pressure level (SPL), SPL range, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), jitter, shimmer, normalized noise energy (NNEa), noise-to-harmonic ratio, Voice Handicap Index-10 (VHI-10), Voice-Related Quality of Life (V-RQOL), and GRB scale (G = grade, R = roughness, B = breathiness). Outcomes between LMS and FE were compared using adjusted analyses to control for baseline differences.</div></div><div><h3>Results</h3><div>Men were significantly older than women (<em>p</em> = 0.034) and had larger polyps (<em>p</em> = 0.005) that were more often pedunculated (<em>p</em> = 0.006) and hemorrhagic (<em>p</em> = 0.031); bilateral lesions were more common in women (<em>p</em> = 0.040). Except for <em>F</em><sub>o</sub> and SPL, all multidimensional voice parameters improved significantly after surgery. Comparing surgical approaches, the LMS group (<em>n</em> = 166) was younger (<em>p</em> = 0.003) and had larger polyps (<em>p</em> < 0.001) than the FE group (<em>n</em> = 35). After adjusting for age and polyp size, most voice parameters showed no significant difference between LMS and FE. Polyp size was weakly to moderately correlated with multiple preoperative parameters; it correlated positively with MFR in men (<em>p</em> = 0.025), PPQ (<em>p</em> = 0.032), APQ (<em>p</em> = 0.003), jitter (<em>p</em> = 0.027), shimmer (<em>p</em> = 0.001), NNEa (<em>p</em> = 0.004), VHI‑10 (<em>p</em> = 0.030), G (<em>p</em> = 0.001), R (<em>p</em> = 0.006), and B (<em>p</em> = 0.006) and negatively with MPT (<em>p</em> = 0.012) and <em>F</em><sub>o</sub> range in men (<em>p</em> = 0.015). Larger polyps also showed weak negative correlations with ΔAPQ (<em>p</em> = 0.029), Δjitter (<em>p</em> = 0.009), Δshimmer (<em>p</em> = 0.047), ΔVHI-10 (<em>p</em> = 0.037), ΔG (<em>p</em> = 0.005), ΔR (<em>p</em> = 0.031), and ΔB (<em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>Phonosurgery for VFPs significantly improves multidimensional voice outcomes. Polyp size is a
{"title":"Phonosurgery for vocal fold polyps: A comprehensive analysis of multidimensional voice outcomes in 201 cases and the impact of polyp size","authors":"Toshiyuki Mitsuhashi , Hirohito Umeno , Shun-ichi Chitose , Takashi Kurita , Kyoji Furukawa , Fumihiko Sato , Kiminobu Sato , Mioko Fukahori , Takeharu Ono , Shintaro Sueyoshi , Sachiyo Hamakawa","doi":"10.1016/j.anl.2025.08.012","DOIUrl":"10.1016/j.anl.2025.08.012","url":null,"abstract":"<div><h3>Objective</h3><div>To elucidate the clinical characteristics of vocal fold polyps (VFPs) and evaluate the efficacy of phonosurgery using a comprehensive analysis of multidimensional voice parameters.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 201 patients with VFPs treated at Kurume University Hospital between 1996 and 2022. All patients underwent either endolaryngeal microsurgery (LMS) under general anesthesia or forceps excision (FE) under local anesthesia. Lesions were categorized as pedunculated or sessile and as hemorrhagic or non-hemorrhagic based on coloration. Polyp size was calculated as the ratio of the lesion diameter to the distance from the anterior commissure to the vocal process. Pre- and postoperative values and postoperative differences (Δ) were analyzed for voice parameters: maximum phonation time (MPT), mean flow rate (MFR), fundamental frequency (<em>F</em><sub>o</sub>), <em>F</em><sub>o</sub> range, sound pressure level (SPL), SPL range, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), jitter, shimmer, normalized noise energy (NNEa), noise-to-harmonic ratio, Voice Handicap Index-10 (VHI-10), Voice-Related Quality of Life (V-RQOL), and GRB scale (G = grade, R = roughness, B = breathiness). Outcomes between LMS and FE were compared using adjusted analyses to control for baseline differences.</div></div><div><h3>Results</h3><div>Men were significantly older than women (<em>p</em> = 0.034) and had larger polyps (<em>p</em> = 0.005) that were more often pedunculated (<em>p</em> = 0.006) and hemorrhagic (<em>p</em> = 0.031); bilateral lesions were more common in women (<em>p</em> = 0.040). Except for <em>F</em><sub>o</sub> and SPL, all multidimensional voice parameters improved significantly after surgery. Comparing surgical approaches, the LMS group (<em>n</em> = 166) was younger (<em>p</em> = 0.003) and had larger polyps (<em>p</em> < 0.001) than the FE group (<em>n</em> = 35). After adjusting for age and polyp size, most voice parameters showed no significant difference between LMS and FE. Polyp size was weakly to moderately correlated with multiple preoperative parameters; it correlated positively with MFR in men (<em>p</em> = 0.025), PPQ (<em>p</em> = 0.032), APQ (<em>p</em> = 0.003), jitter (<em>p</em> = 0.027), shimmer (<em>p</em> = 0.001), NNEa (<em>p</em> = 0.004), VHI‑10 (<em>p</em> = 0.030), G (<em>p</em> = 0.001), R (<em>p</em> = 0.006), and B (<em>p</em> = 0.006) and negatively with MPT (<em>p</em> = 0.012) and <em>F</em><sub>o</sub> range in men (<em>p</em> = 0.015). Larger polyps also showed weak negative correlations with ΔAPQ (<em>p</em> = 0.029), Δjitter (<em>p</em> = 0.009), Δshimmer (<em>p</em> = 0.047), ΔVHI-10 (<em>p</em> = 0.037), ΔG (<em>p</em> = 0.005), ΔR (<em>p</em> = 0.031), and ΔB (<em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>Phonosurgery for VFPs significantly improves multidimensional voice outcomes. Polyp size is a ","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 633-642"},"PeriodicalIF":1.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134872","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 : 2025-09-10DOI: 10.1016/j.anl.2025.06.006
Ken Ito
Objective
To describe the characteristics of the two representative models, Standard Masking Model and Extended Masking Model, which is superior to and including the former, based on the preceding Review Article on the models for pure tone audiometry.
Methods
Computer simulation of the models and numerical confirmation of the outputs.
Results
1: propositions were evaluated by using Practical Judgement Method (PJM), covering a large number of combinations of parameters. 2: characteristics of 4 masking profiles (air/bone, right/left) were described. 3: bending patterns of profiles were explored. 4: relationships between the set of combinations of parameters (Set-C) and the set of masking profiles (Set-M) were elucidated. 5: exemplary evaluation of typical pure tone audiometry procedures was conducted. Method-A (the "ABC" method) was effective but Method-P (an elaborate method searching plateaux) achieved superior results both in Standard and Extended Masking Models.
Conclusion
The findings shown here will form the most fundamental knowledges concerning pure tone audiometry. Preliminary implication on masking methods was also presented.
{"title":"Theoretical characterization of pure tone audiometry models","authors":"Ken Ito","doi":"10.1016/j.anl.2025.06.006","DOIUrl":"10.1016/j.anl.2025.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the characteristics of the two representative models, Standard Masking Model and Extended Masking Model, which is superior to and including the former, based on the preceding Review Article on the models for pure tone audiometry.</div></div><div><h3>Methods</h3><div>Computer simulation of the models and numerical confirmation of the outputs.</div></div><div><h3>Results</h3><div>1: propositions were evaluated by using Practical Judgement Method (PJM), covering a large number of combinations of parameters. 2: characteristics of 4 masking profiles (air/bone, right/left) were described. 3: bending patterns of profiles were explored. 4: relationships between the set of combinations of parameters (Set-C) and the set of masking profiles (Set-M) were elucidated. 5: exemplary evaluation of typical pure tone audiometry procedures was conducted. Method-A (the \"ABC\" method) was effective but Method-P (an elaborate method searching plateaux) achieved superior results both in Standard and Extended Masking Models.</div></div><div><h3>Conclusion</h3><div>The findings shown here will form the most fundamental knowledges concerning pure tone audiometry. Preliminary implication on masking methods was also presented.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 615-629"},"PeriodicalIF":1.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042280","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}
To investigate whether sublingual immunotherapy (SLIT) with house dust mite (HDM) extract suppresses new sensitization to Japanese cedar pollen(JCP) in children with HDM-positive allergic rhinitis.
Methods
This retrospective study was conducted at our center and included pediatric patients aged 5–15 years who visited between January 2018 and December 2020. Eligible patients tested positive for HDM-specific immunoglobulin E (IgE), negative for JCP-specific IgE, and had no history of SLIT for cedar pollen. 33 patients who continued HDM SLIT for 3 years were assigned to the SLIT group, while 52 patients with allergic rhinitis who did not receive HDM SLIT formed the non-SLIT group. Patients with severe allergic comorbidities or those undergoing immunosuppressive therapy were excluded. The primary endpoints were the rate of new sensitization to Japanese cedar pollen and the cedar-specific IgE levels after 3 years. We used the chi-square test, t-test, Mann–Whitney U test, and logistic regression analysis to compare the groups.
Result
After 3 years, the rate of new sensitization to JCP was 42.4 % in the SLIT group and 51.9 % in the non-SLIT group (p = 0.383). The JCP-specific IgE level was 4.77 UA/mL in the SLIT group and 7.93 UA/mL in the non-SLIT group (p = 0.207).
Conclusion
The SLIT group showed a slightly lower rate of new sensitization and lower JCP-specific IgE levels; however, the differences were not statistically significant. A larger, multi-center study is needed to confirm these findings and adjust for potential confounders.
{"title":"Retrospective study about suppression of new sensitization to cedar pollen in children who have undergone sublingual immunotherapy for house dust mites","authors":"Yuko Nagai , Sho Obata , Kayoko Kawashima , Takanari Kawabe , Yukiko Hanada , Tomohiro Yamaguchi , Rumi Ueno , Yuki Tsurinaga , Youhei Fukasawa , Yuri Takaoka , Yukinori Yoshida , Makoto Kameda","doi":"10.1016/j.anl.2025.08.002","DOIUrl":"10.1016/j.anl.2025.08.002","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether sublingual immunotherapy (SLIT) with house dust mite (HDM) extract suppresses new sensitization to Japanese cedar pollen(JCP) in children with HDM-positive allergic rhinitis.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at our center and included pediatric patients aged 5–15 years who visited between January 2018 and December 2020. Eligible patients tested positive for HDM-specific immunoglobulin E (IgE), negative for JCP-specific IgE, and had no history of SLIT for cedar pollen. 33 patients who continued HDM SLIT for 3 years were assigned to the SLIT group, while 52 patients with allergic rhinitis who did not receive HDM SLIT formed the non-SLIT group. Patients with severe allergic comorbidities or those undergoing immunosuppressive therapy were excluded. The primary endpoints were the rate of new sensitization to Japanese cedar pollen and the cedar-specific IgE levels after 3 years. We used the chi-square test, <em>t</em>-test, Mann–Whitney U test, and logistic regression analysis to compare the groups.</div></div><div><h3>Result</h3><div>After 3 years, the rate of new sensitization to JCP was 42.4 % in the SLIT group and 51.9 % in the non-SLIT group (<em>p</em> = 0.383). The JCP-specific IgE level was 4.77 UA/mL in the SLIT group and 7.93 UA/mL in the non-SLIT group (<em>p</em> = 0.207).</div></div><div><h3>Conclusion</h3><div>The SLIT group showed a slightly lower rate of new sensitization and lower JCP-specific IgE levels; however, the differences were not statistically significant. A larger, multi-center study is needed to confirm these findings and adjust for potential confounders.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 610-614"},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010351","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 : 2025-09-08DOI: 10.1016/j.anl.2025.08.011
Aiko Shimizu, Seiichiro Makihara
{"title":"Authors’ reply to: “Comment on the article by Dr. Cem Çelik: Endoscopic transpterygoid repair of sphenoid sinus meningocele: A comprehensive case report and literature review”","authors":"Aiko Shimizu, Seiichiro Makihara","doi":"10.1016/j.anl.2025.08.011","DOIUrl":"10.1016/j.anl.2025.08.011","url":null,"abstract":"","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Page 631"},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031258","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}
This study aimed to identify prognostic factors for postoperative hypothyroidism and assess the timing of its onset in patients who underwent hemithyroidectomy for thyroid tumors. Despite normal preoperative thyroid function, some patients develop postoperative hypothyroidism, necessitating lifelong thyroid hormone replacement therapy. Identifying risk factors and establishing appropriate follow-up guidelines are essential for optimizing patient management.
Methods
A retrospective analysis was conducted on 306 patients with normal preoperative thyroid function (thyroid stimulating hormone [TSH]: 0.61–4.23 mIU/L, fT4: 0.93–1.7 ng/dL) who underwent hemithyroidectomy between 2016 and 2021. Patients with prior thyroid surgery or hormone therapy were excluded. Postoperative thyroid function was assessed for at least 2 years.
Results
Postoperative hypothyroidism occurred in 166 patients (54.2 %), with 68.7 % detected within 1 month and 95.2 % within 1 year. Multivariate analysis identified preoperative TSH levels (P = 1.60 × 10⁻¹⁵) and dual positivity for thyroid peroxidase antibody and thyroglobulin antibody (P = 0.0431) as significant predictors of postoperative hypothyroidism. The optimal preoperative TSH cutoff for distinguishing euthyroid and hypothyroid groups was 1.82 mIU/L (area under the receiver operating characteristic curve = 0.875). A clinically applicable threshold of 2.0 mIU/L was determined, with 90.1 % of patients above this level developing hypothyroidism, and 29.7 % requiring thyroid hormone replacement therapy. In contrast, only 3 % of patients with preoperative TSH <2.0 mIU/L required hormone therapy, suggesting the necessity of intensive monitoring in this group.
Conclusion
Preoperative TSH levels and the positivity of both anti-TPO and anti-Tg antibodies were associated with postoperative hypothyroidism, suggesting that they may serve as prognostic predictors for postoperative thyroid dysfunction. Patients with preoperative TSH ≥2.0 mIU/L require careful follow-up, whereas intensive monitoring is unnecessary for those with TSH <2.0 mIU/L. Given that 95.2 % of hypothyroidism cases occur within the first year, thyroid function should be monitored for at least 1 year postoperatively. Additionally, patients developing hypothyroidism within the first year should be followed for up to 3 years to ensure appropriate management.
{"title":"Risk factors and timing of postoperative hypothyroidism onset following hemithyroidectomy","authors":"Kuniaki Takata , Tsuyoshi Kojima , Yusuke Okanoue , Shuya Otsuki , Shiori Oda , Taishi Yasuda , Shiori Matsumaru , Moemi Kinoshita , Harukazu Hiraumi","doi":"10.1016/j.anl.2025.08.008","DOIUrl":"10.1016/j.anl.2025.08.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify prognostic factors for postoperative hypothyroidism and assess the timing of its onset in patients who underwent hemithyroidectomy for thyroid tumors. Despite normal preoperative thyroid function, some patients develop postoperative hypothyroidism, necessitating lifelong thyroid hormone replacement therapy. Identifying risk factors and establishing appropriate follow-up guidelines are essential for optimizing patient management.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 306 patients with normal preoperative thyroid function (thyroid stimulating hormone [TSH]: 0.61–4.23 mIU/L, fT4: 0.93–1.7 ng/dL) who underwent hemithyroidectomy between 2016 and 2021. Patients with prior thyroid surgery or hormone therapy were excluded. Postoperative thyroid function was assessed for at least 2 years.</div></div><div><h3>Results</h3><div>Postoperative hypothyroidism occurred in 166 patients (54.2 %), with 68.7 % detected within 1 month and 95.2 % within 1 year. Multivariate analysis identified preoperative TSH levels (<em>P</em> = 1.60 × 10⁻¹⁵) and dual positivity for thyroid peroxidase antibody and thyroglobulin antibody (<em>P</em> = 0.0431) as significant predictors of postoperative hypothyroidism. The optimal preoperative TSH cutoff for distinguishing euthyroid and hypothyroid groups was 1.82 mIU/L (area under the receiver operating characteristic curve = 0.875). A clinically applicable threshold of 2.0 mIU/L was determined, with 90.1 % of patients above this level developing hypothyroidism, and 29.7 % requiring thyroid hormone replacement therapy. In contrast, only 3 % of patients with preoperative TSH <2.0 mIU/L required hormone therapy, suggesting the necessity of intensive monitoring in this group.</div></div><div><h3>Conclusion</h3><div>Preoperative TSH levels and the positivity of both anti-TPO and anti-Tg antibodies were associated with postoperative hypothyroidism, suggesting that they may serve as prognostic predictors for postoperative thyroid dysfunction. Patients with preoperative TSH ≥2.0 mIU/L require careful follow-up, whereas intensive monitoring is unnecessary for those with TSH <2.0 mIU/L. Given that 95.2 % of hypothyroidism cases occur within the first year, thyroid function should be monitored for at least 1 year postoperatively. Additionally, patients developing hypothyroidism within the first year should be followed for up to 3 years to ensure appropriate management.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 597-604"},"PeriodicalIF":1.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988653","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 : 2025-09-04DOI: 10.1016/j.anl.2025.08.010
Sholem Hack , Rebecca Attal , Armin Farzad , Eran E. Alon , Eran Glikson , Eric Remer , Alberto Maria Saibene , Habib G Zalzal
Objective
To systematically evaluate the diagnostic accuracy, educational utility, and communication potential of generative AI, particularly Large Language Models (LLMs) such as ChatGPT, in otolaryngology.
Data Sources
A comprehensive search of PubMed, Embase, Scopus, Web of Science, and IEEE Xplore identified English-language peer-reviewed studies from January 2022 to March 2025.
Review Methods
Eligible studies evaluated text-based generative AI models used in otolaryngology. Two reviewers screened and assessed studies using JBI and QUADAS-2 tools. A random-effects meta-analysis was conducted on diagnostic accuracy outcomes, with subgroup analyses by task type and model version.
Results
Ninety-one studies were included; 61 reported quantitative outcomes. Of these, 43 provided diagnostic accuracy data across 59 model-task pairs. Pooled diagnostic accuracy was 72.7 % (95 % CI: 67.4–77.6 %; I² = 93.8 %). Accuracy was highest in education (83.0 %) and diagnostic imaging tasks (84.9 %), and lowest in clinical decision support (67.1 %). GPT-4 consistently outperformed GPT-3.5 across both education and CDS domains. Hallucinations and performance variability were noted in complex clinical reasoning tasks.
Conclusion
Generative AI performs well in structured otolaryngology tasks, particularly education and communication. However, its inconsistent performance in clinical reasoning tasks limits standalone use. Future research should focus on hallucination mitigation, standardized evaluation, and prospective validation to guide safe clinical integration.
{"title":"Performance of generative AI across ENT tasks: A systematic review and meta-analysis","authors":"Sholem Hack , Rebecca Attal , Armin Farzad , Eran E. Alon , Eran Glikson , Eric Remer , Alberto Maria Saibene , Habib G Zalzal","doi":"10.1016/j.anl.2025.08.010","DOIUrl":"10.1016/j.anl.2025.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the diagnostic accuracy, educational utility, and communication potential of generative AI, particularly Large Language Models (LLMs) such as ChatGPT, in otolaryngology.</div></div><div><h3>Data Sources</h3><div>A comprehensive search of PubMed, Embase, Scopus, Web of Science, and IEEE Xplore identified English-language peer-reviewed studies from January 2022 to March 2025.</div></div><div><h3>Review Methods</h3><div>Eligible studies evaluated text-based generative AI models used in otolaryngology. Two reviewers screened and assessed studies using JBI and QUADAS-2 tools. A random-effects meta-analysis was conducted on diagnostic accuracy outcomes, with subgroup analyses by task type and model version.</div></div><div><h3>Results</h3><div>Ninety-one studies were included; 61 reported quantitative outcomes. Of these, 43 provided diagnostic accuracy data across 59 model-task pairs. Pooled diagnostic accuracy was 72.7 % (95 % CI: 67.4–77.6 %; I² = 93.8 %). Accuracy was highest in education (83.0 %) and diagnostic imaging tasks (84.9 %), and lowest in clinical decision support (67.1 %). GPT-4 consistently outperformed GPT-3.5 across both education and CDS domains. Hallucinations and performance variability were noted in complex clinical reasoning tasks.</div></div><div><h3>Conclusion</h3><div>Generative AI performs well in structured otolaryngology tasks, particularly education and communication. However, its inconsistent performance in clinical reasoning tasks limits standalone use. Future research should focus on hallucination mitigation, standardized evaluation, and prospective validation to guide safe clinical integration.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 585-596"},"PeriodicalIF":1.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988652","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 : 2025-09-04DOI: 10.1016/j.anl.2025.08.007
Mika Adachi , Masayuki Shirakura , Takeshi Sato , Yukio Katori
A cartilage-conduction hearing aid (CCHA) transmits sound vibrations to the inner ear via the ear cartilage rather than through air or bone. They can be used in patients with meatal atresia and persistent otorrhea. Unlike bone-conduction hearing aid (BCHA), there is no need for pressure between the transducer and the temporal bone. Effective hearing is achieved by simply bringing the cartilage-conduction transducer into contact with the auricular cartilage. Crouzon syndrome is characterized by craniosynostosis and is associated with a high incidence of meatal atresia, which causes conductive hearing loss. Cranial enlargement surgeries are performed repeatedly during infancy and early childhood to reduce the symptoms of intracranial hypertension. Therefore, BCHA can be difficult to use. We report the case of a child with Crouzon syndrome who required multiple cranial surgeries for craniosynostosis, in whom CCHAs were applied. As a result, his vocabulary development progressed, and after 22 months of using the CCHA, he reached the expected developmental level for his age.
{"title":"Use of cartilage-conduction hearing aids in a child with Crouzon syndrome and meatal atresia","authors":"Mika Adachi , Masayuki Shirakura , Takeshi Sato , Yukio Katori","doi":"10.1016/j.anl.2025.08.007","DOIUrl":"10.1016/j.anl.2025.08.007","url":null,"abstract":"<div><div>A cartilage-conduction hearing aid (CCHA) transmits sound vibrations to the inner ear via the ear cartilage rather than through air or bone. They can be used in patients with meatal atresia and persistent otorrhea. Unlike bone-conduction hearing aid (BCHA), there is no need for pressure between the transducer and the temporal bone. Effective hearing is achieved by simply bringing the cartilage-conduction transducer into contact with the auricular cartilage. Crouzon syndrome is characterized by craniosynostosis and is associated with a high incidence of meatal atresia, which causes conductive hearing loss. Cranial enlargement surgeries are performed repeatedly during infancy and early childhood to reduce the symptoms of intracranial hypertension. Therefore, BCHA can be difficult to use. We report the case of a child with Crouzon syndrome who required multiple cranial surgeries for craniosynostosis, in whom CCHAs were applied. As a result, his vocabulary development progressed, and after 22 months of using the CCHA, he reached the expected developmental level for his age.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 581-584"},"PeriodicalIF":1.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988654","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}
: This study aimed to evaluate the effect of age at tympanostomy tube insertion on mastoid air cell development, focusing on whether insertion before 3 years of age is associated with more favorable pneumatization.
Methods
: We retrospectively analyzed 39 children (71 ears) who developed tympanic membrane perforation following tube insertion (tube group), including cases primarily associated with recurrent acute otitis media (rAOM) and otitis media with effusion (OME). The control group consisted of 41 children (41 ears) with congenital cholesteatoma, using their contralateral normal ears as controls. Mastoid air cell area was measured on axial temporal bone CT using two standard slices. Linear mixed-effects models were applied to assess associations with age, sex, laterality, and tube insertion age (<3 vs. ≥3 years). Age-specific comparisons between the tube and control groups were also performed.
Results
: The control group included 112 CT images, and the tube group included 71 images (46 with OME, 25 with rAOM). The average mastoid air cell area was 437.7 ± 181.6 mm² in the control group and 263.8 ± 139.6 mm² in the tube group. In controls, mastoid air cell area increased significantly with age (p < 0.001), while sex and laterality were not significant predictors. In the rAOM subgroup, children who underwent tube insertion before age 3 had mastoid air cell areas most similar to those of controls (e.g., age 1: p = 0.284), whereas insertion at ≥3 years was associated with significantly smaller areas across all groups (p < 0.001). No consistent age-related recovery was observed after age 3.
Conclusion
: Tympanostomy tube insertion before 3 years of age, especially in patients with rAOM, is associated with mastoid air cell development closer to that of healthy controls. Early intervention may play a key role in preserving mastoid pneumatization and preventing chronic middle ear sequelae.
{"title":"Relationship between timing of tympanostomy tube insertion and mastoid air cell development in children with otitis media","authors":"Seiichi Kadowaki , Ryota Ishii , Tomonori Sugiyama , Saori Kikuchi , Yukiko Iino","doi":"10.1016/j.anl.2025.08.006","DOIUrl":"10.1016/j.anl.2025.08.006","url":null,"abstract":"<div><h3>Objective</h3><div><em>:</em> This study aimed to evaluate the effect of age at tympanostomy tube insertion on mastoid air cell development, focusing on whether insertion before 3 years of age is associated with more favorable pneumatization.</div></div><div><h3>Methods</h3><div><em>:</em> We retrospectively analyzed 39 children (71 ears) who developed tympanic membrane perforation following tube insertion (tube group), including cases primarily associated with recurrent acute otitis media (rAOM) and otitis media with effusion (OME). The control group consisted of 41 children (41 ears) with congenital cholesteatoma, using their contralateral normal ears as controls. Mastoid air cell area was measured on axial temporal bone CT using two standard slices. Linear mixed-effects models were applied to assess associations with age, sex, laterality, and tube insertion age (<3 vs. ≥3 years). Age-specific comparisons between the tube and control groups were also performed.</div></div><div><h3>Results</h3><div><em>:</em> The control group included 112 CT images, and the tube group included 71 images (46 with OME, 25 with rAOM). The average mastoid air cell area was 437.7 ± 181.6 mm² in the control group and 263.8 ± 139.6 mm² in the tube group. In controls, mastoid air cell area increased significantly with age (<em>p</em> < 0.001), while sex and laterality were not significant predictors. In the rAOM subgroup, children who underwent tube insertion before age 3 had mastoid air cell areas most similar to those of controls (e.g., age 1: <em>p</em> = 0.284), whereas insertion at ≥3 years was associated with significantly smaller areas across all groups (<em>p</em> < 0.001). No consistent age-related recovery was observed after age 3.</div></div><div><h3>Conclusion</h3><div><em>:</em> Tympanostomy tube insertion before 3 years of age, especially in patients with rAOM, is associated with mastoid air cell development closer to that of healthy controls. Early intervention may play a key role in preserving mastoid pneumatization and preventing chronic middle ear sequelae.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 605-609"},"PeriodicalIF":1.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988651","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 aim of this study was to analyze nationwide patterns of epistaxis treatment in Japan, including temporal trends, demographic distributions, and regional variations. This was a nationwide descriptive observational study using a national administrative database.
Methods
We analyzed open data of the National Database of Health Insurance Claims from fiscal years 2019–2022 to examine two treatment procedures for epistaxis: hemostasis with gauze packing and cauterization. Treatment patterns were evaluated by month, age, sex, and prefecture of residence. The standardized claim ratio was calculated using indirect standardization for regional comparisons
Results
During the study period, 870,819 gauze-packing procedures and 523,591 cauterization procedures were recorded. Both procedures exhibited consistent seasonal patterns, peaking in winter (December to February). Age distribution followed a bimodal pattern, with higher incidence in children and older adult individuals, and a male predominance across all age groups. Pediatric patients were more likely to receive gauze packing. Geographic analysis showed a preference for gauze packing in Western Japan, whereas cauterization was more frequently performed in Northern Japan, suggesting a potential association with higher latitudes.
Conclusion
This is the first nationwide study to identify distinct seasonal, demographic, and regional variations in epistaxis treatment in Japan. These findings suggest that factors beyond climate may influence treatment selection.
{"title":"Nationwide descriptive epidemiological study of epistaxis treatment using the national database of Japan","authors":"Seiichiro Makihara , Kensuke Uraguchi , Shohei Fujimoto , Aiko Shimizu , Shin Kariya , Mitsuhiro Okano , Soshi Takao , Takashi Yorifuji , Mizuo Ando","doi":"10.1016/j.anl.2025.08.001","DOIUrl":"10.1016/j.anl.2025.08.001","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to analyze nationwide patterns of epistaxis treatment in Japan, including temporal trends, demographic distributions, and regional variations. This was a nationwide descriptive observational study using a national administrative database.</div></div><div><h3>Methods</h3><div>We analyzed open data of the National Database of Health Insurance Claims from fiscal years 2019–2022 to examine two treatment procedures for epistaxis: hemostasis with gauze packing and cauterization. Treatment patterns were evaluated by month, age, sex, and prefecture of residence. The standardized claim ratio was calculated using indirect standardization for regional comparisons</div></div><div><h3>Results</h3><div>During the study period, 870,819 gauze-packing procedures and 523,591 cauterization procedures were recorded. Both procedures exhibited consistent seasonal patterns, peaking in winter (December to February). Age distribution followed a bimodal pattern, with higher incidence in children and older adult individuals, and a male predominance across all age groups. Pediatric patients were more likely to receive gauze packing. Geographic analysis showed a preference for gauze packing in Western Japan, whereas cauterization was more frequently performed in Northern Japan, suggesting a potential association with higher latitudes.</div></div><div><h3>Conclusion</h3><div>This is the first nationwide study to identify distinct seasonal, demographic, and regional variations in epistaxis treatment in Japan. These findings suggest that factors beyond climate may influence treatment selection.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 5","pages":"Pages 575-580"},"PeriodicalIF":1.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907005","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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