Acta Oto-Laryngologica最新文献

Background: Inverted papilloma is a benign epithelial tumour located in the sinonasal tract with a high recurrence rate and a potential of malignant transformation. From 2017, patients with IP were included in our fast-track regime similar to head and neck cancer patients, including follow-up at 2, 6, 12, 18 and 24 months after surgery, then yearly for a total of 5 years.

Aims/objectives: This study aims to compare the recurrence rate and malignant transformation of patients with IP treated at a university centre following the implementation of a fast-track regime including a close follow-up.

Methods: A retrospective study was performed on all patients with IP diagnosed between 2018 and 2022.

Results: The study included 125 patients, all surgically treated for IP. Eight patients (6%) also presented with SCC at the time of diagnosis. The recurrence rate of benign IP was 17%. Most tumours originated in the maxillary sinus (48/117, 41%). No cases of metachronous cancer were seen during the follow-up.

Conclusions and significance: The majority of recurrences (90%) occurred within the first 2 years after treatment. No cases of malignant transformation were seen in the follow-up period. The rigorous follow-up program potentially contributed to the detection of recurrence before malignant transformation.

Background: Horizontal semicircular canal benign paroxysmal positional vertigo(HSC-BPPV) is the second most common type of BPPV. It is difficult to diagnose and treat, which has a serious impact on the prognosis of patients.

Objectives: To study the clinical features of HSC-BPPV and the influencing factors of residual dizziness (RD).

Materials and methods: The clinical data of 358 patients with BPPV were retrospectively collected. The differences between HSC-BPPV and posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) were compared, and the influencing factors of RD after HSC-BPPV repositioning were analyzed.

Results: ① Compared with PSC-BPPV, HSC-BPPV had a lower success rate of first repositioning (64.7 vs. 75.0%), a higher incidence of RD (57.3 vs. 43.8%), and a higher DHI score (40.0 vs. 34.0), and the differences were statistically significant (p < .05). ② Logistic regression analysis showed that age ≥60 years, secondary, DHI score, successful first repositioning were the influencing factors for the development of RD after HSC-BPPV repositioning (p < .05).

Conclusions and significance: The diagnosis and treatment of HSC-BPPV is difficult, and RD is prone to occur. Clinicians need to strengthen the training of HSC-BPPV diagnosis and treatment to reduce the occurrence and progression of RD.

Background: Tonsillectomy is an effective treatment option for obstructive sleep apnoea in selected adult patients, but there has been a lack of long-term follow-up data.

Objectives: To analyse the long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults, with the longest follow-up periods to date.

Materials and methods: We recruited adults who had undergone extracapsular tonsillectomy because of obstructive sleep apnoea between 2004 and 2018 in the Hospital District of Southwest Finland. A new home sleep study, questionnaires, and a structured phone interview were conducted on these patients 4-17 years after surgical treatment. The primary outcome was the change in the apnoea-hypopnoea index.

Results: The mean apnoea-hypopnoea index was reduced from 27.1 preoperatively to 14.1 after the long-term follow-up (mean 12 years), and the mean Epworth Sleepiness Scale score decreased from 9.2 to 4.6. The long-term surgical success rate was 38.5%. Four out of five patients would choose the surgery again according to the phone interview.

Conclusions and significance: This study supports the notion that extracapsular tonsillectomy alone can be considered as a surgical treatment option for selected adults with obstructive sleep apnoea and tonsillar hypertrophy. For most of the patients, the obstructive sleep apnoea is alleviated.

Background: Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies but can lead to complications, including ototoxicity.

Aim/objectives: This study aims to explore the relationship between patient-specific factors and ototoxicity in adult HSCT patients.

Material and methods: We conducted a retrospective analysis of 129 adult patients who underwent HSCT between 2003 and 2020. Age, gender, transplant indications, conditioning regimens, and pre- and post-transplant audiometry thresholds data were collected from patient files. A hearing loss of 10 decibels or more at two consecutive frequencies or a hearing loss of 20 decibels or more at a single frequency was considered as significant hearing loss (SHL). Statistical analyses were performed to describe factors associated with SHL.

Results: SHL occurred in 16.3% of patients. Older age was significantly associated with an increased risk of SHL (p = .035). Poorer pretransplant hearing thresholds at 4000 Hz and 6000 Hz were also significant predictors of SHL (p = .039 and p = .014, respectively). There was no significant relationship between the donor type of HSCT (autologous vs. allogeneic) and ototoxicity (p = .45), and between conditioning regimens and ototoxicity (p = .860).

Conclusions: Age and pre-existing hearing levels are significant predictors of ototoxicity post-HSCT. Careful management and monitoring are essential to prevent and address hearing loss in HSCT patients to improve hearing-related quality of life.

Background: Endoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis.

Aims/objectives: To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis.

Material and methods: A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups.

Results: ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP.

Conclusions and significance: Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time.

Background: The presence of Actinomyces can be associated with complications.

Aims: This study aimed to determine the frequency of post-tonsillectomy hemorrhage (PTH), the presence of Actinomyces in palatine tonsils and serum inflammatory biomarker levels in PTH.

Material and methods: The cases who underwent tonsillectomy at a single center were included in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) values were calculated from the complete blood count test. The presence of Actinomyces was recorded from histopathological tonsillectomy material.

Results: A total of 1137 patients were included in the study. Actinomyces was detected in 93 (8.18%) patients. Bleeding complications were encountered in 65 cases (5.72%). No relationship was detected between the presence of Actinomyces and PTH rates (p = 0.433). While a relationship was found between age, NLR, and SIRI values and Actinomyces status (respectively, p < 0.001, p = 0.017, p = 0.038), no statistically significant relationship was found between tonsil size, PLR, and SII (p > 0.05).

Conclusion and significance: According to the data in our study, NLR and SIRI values were elevated in subjects with Actinomyces. Our findings suggest that this entity has a systemic manifestation. Serum inflammatory biomarkers and the presence of Actinomyces were not found to be associated with PTH.

Background: In cases of congenital sensorineural hearing loss, testing for genetic etiologies and congenital cytomegalovirus (cCMV) infection have become common practice.

Aims/objectives: The purpose of this study is to determine which specific testing methodologies should be used and when.

Material and methods: We surveyed 20 practicing otolaryngologists across eighteen institutions in thirteen countries about their approach to cCMV, GJB2, and wider genetic testing.

Results: We found 90% of respondents employ all three tests, either in routine or special cases. cCMV testing is widely used, with 95% of respondents incorporating it into their clinical practice. GJB2 testing was employed by 90%. In cases with negative GJB2 test results, a majority of respondents proceeded to wider genetic screening. Test reimbursement was also examined for each test. For cCMV testing, 63.1% reported reimbursement, 68.4% reported reimbursement for GJB2 variant testing and 52.6% reported reimbursement for wider genetic screening.

Conclusions and significance: A common approach is to perform cCMV and GJB2 testing as the first tests, followed by wider genetic testing. This study offers insight into the prevalence, methodologies, and reimbursement status of these testing methodologies across multiple hearing centers and countries. Current consensus and future directions are described based on the current survey.

Background: The association between objective imaging findings and subjective symptoms remains undefined.

Aims: To investigate the correlation between objective imaging findings and symptom severity in the overall chronic rhinosinusitis with nasal polyps (CRSwNP) population as well as its subendotypes according to the eosinophilic inflammation.

Methods: Patients with CRSwNP undergoing endoscopic sinus surgery were included. All participants completed the Sino-Nasal Outcome Test (SNOT-22) questionnaire. The Lund-Mackay (LM) CT scores was also obtained. Spearman correlation analysis was performed to evaluate the correlation between CT scores and SNOT-22 scores.

Results: Forty-four non-eosinophilic CRSwNP(neCRSwNP) and 93 eosinophilic CRSwNP (eCRSwNP) patients were recruited. There was significant association between LM total score and nasal subdomain of SNOT-22 in the overall CRSwNP patients. The nasal symptom of SNOT-22 was significantly associated with maxillary, frontal, sphenoid, anterior drainage, and posterior drainage in all CRSwNP patients. In eCRSwNP and neCRSwNP patients, the sense of smell/taste was associated with sphenoid and posterior drainage. Thick nasal discharge was positively correlated with maxillary, frontal, and anterior drainage only in eCRSwNP patients.

Conclusions: The high score of sphenoid and posterior drainage may suggest the occurrence of loss of sense of smell/taste, while high score of maxillary sinus may indicate suffering from thick nasal discharge in eCRSwNP patients.

Background: Hearing can be preserved in patients with considerable low-frequency hearing implanted with cochlear implants. However, the most favorable electrode type for hearing preservation and speech perception has been debated.

Objective: The aim was to evaluate hearing preservation and speech discrimination one year post-implantation for all types of cochlear implant electrode used for adult patients implanted between 2014 and 2022.

Methods: The HEARING group formula was used to calculate the degree of hearing preservation, which was defined as minimal (0-25%), partial (25-75%) or complete (≥ 75%). Speech perception was measured by monosyllabic words.

Results: Analysis of hearing preservation for the various electrode types revealed that FLEX 24 preserved hearing statistically significantly better (p < 0.05) than FLEX 28, FLEX soft, and contour advance. Also, FLEX 20 preserved hearing statistically significantly better (p < 0.05) than contour advance. No statistically significant difference was found for the monosyllabic word score for the different electrode types.

Discussion: There was a statistically significant difference between the electrode types in terms of hearing preservation but not for speech perception. The result of this study contributes important information about hearing preservation and speech perception that can be used for pre-surgery patient counselling.

Background: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females.

Objectives: To evaluate the hearing and balance functions in SLE patients.

Materials and methods: Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125-16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT).

Results: A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains.

Conclusions and significance: Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests.