Acta Oto-Laryngologica最新文献

Background: Benign paroxysmal positional vertigo (BPPV) has a characteristic, called BPPV fatigue, in which positional nystagmus (PN) and dizziness symptoms disappear when the patient repeatedly assumes a head position that causes dizziness.

Aims/objectives: We previously developed a new maneuver to restore PN that had disappeared because of BPPV fatigue in posterior-canal-type BPPV (pc-BPPV). This study aimed to demonstrate that the maneuver restores PN from BPPV fatigue to a level sufficient for diagnosing BPPV by macroscopic observation of PN.

Material and methods: Thirty patients with pc-BPPV underwent the Dix-Hallpike test (DHT) three times, and video recordings of PN were made during the DHTs. Twenty patients underwent the maneuver before the third DHT. The videos were shown to six examiners, who judged whether PN had been restored from BPPV fatigue to a level that allowed diagnosis, including on the affected side.

Results: PN was restored from BPPV fatigue in 18 of the 20 patients who underwent the maneuver, although PN was not restored in all 10 patients who did not undergo the maneuver.

Conclusions and significance: When BPPV fatigue occurs, the maneuver can induce sufficiently strong PN to diagnose pc-BPPV by macroscopic observation, including on the affected side, with 90% probability.

Background: A total of 890,000 new cases of head and neck squamous cell carcinoma are diagnosed worldwide annually.

Objectives: To assess whether lymph node density has an impact on the survival of patients undergoing neck dissection for squamous cell carcinoma of the oral cavity (OSCC).

Method: This was a longitudinal and retrospective study conducted with adult patients with OSCC. Clinical and demographic data, variables related to OSCC and surgery were reviewed. For statistical analysis, the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis tests, univariate Cox regression and Kaplan-Meier curve were used.

Results: A total of 96.8% of the patients were male. The mean age was 57.87 ± 8.20 years, and the majority was white as well as smoker and alcoholic. There was a statistical difference between the total number of lymph nodes resected and the types of neck dissection (p = 0.0189) and between the skin color and worse prognosis (p = 0.0227). The mortality rate was 35.5% and the mean overall survival time was 1.25 years.

Conclusions and significance: There was an association between T staging and a worse survival prognosis, and between the number of lymph nodes resected and the type of neck dissection. There was no association between lymph node density and patients' overall survival.

Background: Hypopharyngeal carcinoma often requires extensive surgical resection, making reconstruction challenging.

Objectives: This study aimed to compare the clinical outcomes of hypopharyngeal defect reconstruction using thoracoacromial artery perforator (TAAP) flaps and supraclavicular artery island flap (SCAIF), to provide guidance for clinical practice.

Material and methods: This prospective study included 40 patients with hypopharyngeal carcinoma who underwent surgery at the Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Chongqing Medical University, between October 2021 and April 2023. The patients were randomly assigned to the TAAP and SCAIF groups (n = 20 each). Preoperative Doppler ultrasonography was performed to localize vascular perforators. Postoperative flap survival, complication rates, shoulder function, and scar appearance were compared between the two groups.

Results: The groups did not differ significantly in terms of intraoperative defect size, flap harvesting area, or intraoperative blood loss (p > 0.05). Pedicle length (p = 0.015) and operation time (p < 0.01) were significantly longer in the TAAP group than in the SCAIF group. No necrosis was observed in the TAAP group, whereas two patients in the SCAIF group experienced partial flap necrosis leading to pharyngocutaneous fistula, which healed after dressing changes. The donor-site complication rate was 0% in the TAAP group and 20% in the SCAIF group (p < 0.05). The TAAP group had significantly lower Shoulder Pain and Disability Index scores one, three, and six months postoperatively than those in the SCAIF group (p < 0.05), indicating better shoulder function and less pain. Additionally, the TAAP group showed superior cosmetic outcomes, with significant differences in Vancouver Scar Scale scores three and six months postoperatively (p < 0.05).

Conclusions and significance: The TAAP flap demonstrated significant advantages over the SCAIF in hypopharyngeal reconstruction, including a longer pedicle and better preservation of shoulder function and aesthetic outcomes, despite a longer operative time. The choice of flap should be selected based on patient needs and surgeon experience.

Background: Vestibular dysfunction is prevalent in severe/profound unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) and may influence hearing recovery. This study investigates associations between vestibular function (cVEMP/oVEMP, vHIT, caloric tests) and short-term auditory outcomes.

Aims: To evaluate whether vestibular test abnormalities predict treatment response in severe/profound ISSNHL and identify independent prognostic factors.

Material and methods: Retrospective analysis of 133 patients (mean age 53.58 ± 18.56 years) treated with steroids/hyperbaric oxygen. Vestibular tests (cVEMP, oVEMP, vHIT, caloric) were performed pre-treatment. Outcomes were categorized as effective (complete/marked recovery) or ineffective (mild/no recovery).

Results: The ineffective group had higher vertigo prevalence (65/93 vs 14/40, p < 0.001) and older age (55.98 ± 17.85 vs 48.00 ± 19.22 years, p = 0.022). Univariate analysis showed abnormal vestibular tests (oVEMP/cVEMP/vHIT/caloric) correlated with outcomes (p < 0.05). Multivariate analysis identified three independent predictors of poor outcome: vertigo (OR 0.367), abnormal caloric test (OR 0.339), and abnormal vHIT (OR 0.316). cVEMP/oVEMP abnormalities were not independently associated (p > 0.05).

Conclusions: Vertigo, abnormal caloric/vHIT results predict poorer short-term hearing recovery in severe/profound ISSNHL. Vestibular assessment aids prognosis but should not be used alone. Larger studies are needed for validation.

Background: Vestibular neuritis (VN) is characterized by a sudden spontaneous vertigo without any other associated neurological signs, while the underlying mechanism of VN remains unclear.

Objectives: We aimed to investigate the regulation of the peripheral Th1 and Th2 balance and changes in related cytokines and clarify the possible dominance of immuno-inflammatory reaction in VN.

Material and methods: Patients diagnosed with VN from symptom onset and age-and gender-matched healthy controls were recruited. The peripheral blood levels of cytokines and C-reactive protein (CRP) were determined and analyzed.

Results: A total of participants that included 74 VN patients and 116 controls were included. No statistically significant differences were found in body mass index (BMI), comorbidities between both groups (p > 0.05). The levels of plasma IL-2 and IFN-γ in patients with VN were significantly lower when compared with the healthy control subjects (p < 0.05).

Conclusions and significance: There was an imbalance in the expression of Th1 and Th2 cytokines in patients with VN and it do not support the profound involvement of systemic inflammatory components in VN pathophysiology.

Background: The long-term balance and motor development of infants and children with bilateral aplasia of the labyrinth, known as Michel aplasia is currently unknown.

Objective: To follow up, over a period of twenty years from two months after birth to age twenty, the balance and motor development of a patient with bilateral aplasia of the labyrinth and the VIIIth nerve, Michel aplasia, and offer insight to his remarkable compensation.

Materials and methods: Our patient is a twenty-year-old male who was followed up from the age of two months. CT and MRI scans were performed for imaging of the temporal bones and brain. The balance function and motor development were evaluated.

Results: His CT of temporal bone demonstrated bilateral aplasia of the labyrinth and the VIIIth nerve. His primitive and postural reflexes appeared later than usual. In early childhood, the milestones of his gross motor function were delayed. In adulthood, he has become a professional athlete with no problems observed in balance or motor functions.

Conclusions and significance: Even with bilateral aplasia of the labyrinth and the VIIIth nerve, as long as no other problems are present, the balance and gross motor functions can be acquired with delay through central compensation.

Background: Chronic otitis media and tympanic membrane perforations are common indications for tympanoplasty, where the choice of middle ear packing material critically influences graft survival, hearing restoration, and postoperative complications.

Objective: To systematically compare the efficacy and safety of different middle ear packing materials-including platelet-rich fibrin (PRF), hyaluronic acid (HA), Gelfoam, fat, and ciprofloxacin-soaked packing-on tympanoplasty outcomes.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Embase, and Cochrane Library were searched (2019-2025) for RCTs and cohort studies comparing packing materials in tympanoplasty. Data extraction and quality assessment were performed independently by two reviewers using Covidence, applying the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted using RevMan 5.4.

Results: Fifteen studies met inclusion criteria. PRF achieved the highest graft success (93.7%), with HA offering superior hearing improvement (mean ABG closure: 15.2 dB). Both PRF and HA were associated with significantly fewer complications compared to Gelfoam or fat. Bacterial cellulose showed promise for small perforations. Substantial heterogeneity was observed in studies using traditional materials.

Conclusion: PRF and HA are superior to traditional packing materials in tympanoplasty, optimising graft survival and functional outcomes. Evidence-based selection of biologically active materials is recommended to improve patient care, with further research needed to standardise protocols and confirm long-term benefits.

Background: Fine-needle aspiration cytology (FNAC) is extensively employed in the assessment of neoplastic pathology involving the parotid and submandibular glands.

Aims/objectives: This study assessed the diagnostic value of FNAC in salivary gland tumors using the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).

Materials and methods: 152 patients who underwent surgery for parotid or submandibular gland tumors were included. FNAC results were compared with final histopathology. The risk of malignancy (ROM) and risk of neoplasia (RON) were investigated in all categories.

Results: FNAC showed a sensitivity of 93.3%, specificity of 95.2%, positive predictive value of 70%, negative predictive value of 99.2%, and overall accuracy of 95% for detecting malignancy. Pleomorphic adenoma was the most common benign tumor, while salivary duct carcinoma was the most common malignancy. The risk of malignancy in the Milan categories V and VI was 100%. When the diagnostic value of FNAC in the detection of neoplasia was examined, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92.7%, 62.5%, 95.0%, 52.6%, and 89.3%, respectively.

Conclusions and significance: MSRSGC offers a standardized and effective approach for distinguishing benign from malignant salivary gland tumors.

Background: Hearing loss (HL) is genetically and phenotypically heterogeneous. Variants in GRHL2, which encodes the Grainyhead-like 2 transcription factor, cause autosomal dominant nonsyndromic HL (DFNA28). Only six pathogenic GRHL2 variants have been reported, predominantly associated with high-frequency HL.

Objectives: To elucidate the molecular etiology of ADNSHL presenting with low-to-mid frequency HL in a four-generation Chinese Han family.

Material and methods: Whole exome sequencing was performed to identify the candidate variant, followed by Sanger sequencing for co-segregation analysis. Functional assessments included protein subcellular localization, luciferase assays and co-immunoprecipitation.

Results: A novel nonsense variant, c.648C>G (p.Tyr216Ter), in GRHL2 was identified and co-segregated with the HL phenotype. Contrary to the characteristic high-frequency HL in DFNA28, the 11-year-old proband (IV:4) displayed low-to-mid frequency HL. The variant introduces a premature termination codon, producing a truncated protein missing 409 C-terminal amino acids. Initially classified as likely pathogenic according to the ACMG/AMP guidelines, functional analysis demonstrated cytoplasmic mislocalization and abnormal transcriptional upregulation, potentially via interaction with wild-type GRHL2, prompting reclassification to pathogenic.

Conclusion and significance: Our findings broaden the GRHL2 mutational spectrum, support a gain-of-function mechanism in DFNA28, and establish GRHL2 as a gene associated with low-to-mid frequency HL, expanding known genotype-phenotype correlations.

Background: Aging is characterized by a gradual loss of normal physiological function, culminating in frailty and increased susceptibility to diseases. One plausible candidate for this is the decrease in oxygen supply that occurs with aging.

Aims/objectives: The purpose is to compile a literature review to provide well-founded guidelines for healthy aging.

Material and methods: Based on published literature, the significance of changes in oxygen supply and autonomic regulation in aging is analyzed.

Results: Both oxygen uptake and its delivery to organs decline with age. This induces low-level hypoxia and further oxidative stress (OS) that is thought to cause aging-related disease conditions. Therefore, aging and hypoxia are connected. Hypoxia-induced OS also leads to imbalance of the autonomous nervous system (ANS) that is involved in more than 85% of chronic illnesses. Therefore, targeting hypoxia, OS and ANS imbalance is likely an effective treatment strategy for most age-related neurodegenerative and other diseases. This is best done with a hybrid strategy consisting of hyperbaric air or oxygen and non-invasive vagal nerve stimulation for reversing sympathoexcitation and stress.

Conclusions and significance: In all, two strategies to slow down age-related dysfunctions and diseases are to correct hypoxia and to reduce stress.