Acta Oto-Laryngologica最新文献

Background: The symptoms of chronic rhinosinusitis (CRS) are common. Diagnosis with computed tomography (CT) and endoscopy is not possible in all patients. Nasal nitric oxide (nNO) detects the obstruction of paranasal sinus ostia, but its clinical relevance is unknown.

Aims/objectives: We assessed whether nNO, Sinonasal Outcome Test 22 (SNOT-22) and Zinreich modified Lund-Mackay (ZL-M) CT-scores are associated with subsequent surgery among CRS or recurrent acute rhinosinusitis (RARS) patients.

Material and methods: Sixty-six CRS (with/without nasal polyps) or RARS patients were included in this prospective study. Appropriate medical therapy was used for at least 2 months. Patients were assessed during three consecutive visits: on current prescriptions, after a medication pause, and after intranasal fluticasone propionate. The clinician was unaware of the nNO results during subsequent treatment decisions.

Results: The positive predictive value (PPV) of nNO for the decision to proceed with surgical intervention "after fluticasone" was 76%, and the negative predictive value (NPV) was 80%. These results were not statistically significantly different from those of the ZL-M (PPV 76%; NPV 82%).

Conclusions and significance: Low nNO in patients with CRS symptoms was associated with a later decision for surgery. The applicability of nNO to guide ENT referrals from primary care should be further evaluated.

Background: This study analysed the long-term outcomes of single, first-time radiofrequency ablation of the inferior turbinates (RFAIT) on nasal obstruction and patient satisfaction in chronic inferior turbinate hypertrophy (ITH).

Aims/objectives: The primary aim was to assess RFAIT effectiveness and patient satisfaction; secondary aims included recovery and harms.

Material and methods: The SNOT-22 and a specific questionnaire were sent to 165 patients who underwent their first RFAIT for nasal obstruction between June 2014 and June 2015 at the Department of Otorhinolaryngology-Head and Neck Surgery, Hyvinkää Hospital, Finland. Eligible patients had identifiable ITH and had used intranasal corticosteroids for at least three months without adequate relief. Patients with nasal polyposis, severe septal deviation, or uncorrected bleeding disorders were excluded. A total of 102 patients responded. The median follow-up was 15.2 months (range 8.0-24.2).

Results: Nasal obstruction improved in 58% of patients after one RFAIT, and 75% reported a positive impact on daily life. No major postoperative complications occurred. Temporary increased obstruction, crusting, and minor bleeding were the most common complaints. Smoking and allergies had no significant effect on outcomes.

Conclusions and significance: Single RFAIT appears to be a safe and effective outpatient treatment for chronic ITH with high patient satisfaction.

Background: Soft tissue subglottic stenosis (SGS) progressively reduces the airway dimension below the vocal folds. The cause is unknown. As no cure is available patients face a recurrent need for surgical treatment. Previous research has not established whether the need for repeated interventions diminishes or intensifies as the disease evolves. Our hypothesis is that the number of surgical interventions decrease with disease duration. If true, these findings may have an impact on the surgical setting.

Aims/objectives: To investigate if the number of surgical interventions decreases with disease duration.

Material and methods: Participants were retrospectively included between 1999-2024 using medical records. The primary outcome measure was number of surgical interventions. A piecewise exponential additive mixed model (PAMM) was applied to assess changes in reoperation risk over time.

Results: 217 cases were identified, 60 (93% females) met the criteria for SGS. These 60 cases underwent 147 surgical procedures. There was a significant decrease in the hazard of re-operation along the timeline from the index surgery, corresponding to 7.7% annual reduction in the risk of requiring a new surgical intervention.

Conclusions and significance: The risk of reoperation decreased by 7.7%/yr. (p = 0.008), reflected in increased treatment-free intervals and interpreted as decreasing disease activity.

Background: As anatomical variations influence surgical difficulty, trainees must be exposed to a range of cases to gain mastery. While most surgeons believe they can predict the difficulty of a temporal bone, it is unclear whether these predictions align with trainee performance.

Objective: We hypothesized that expert judgement of temporal bone difficulty would correlate with trainee surgeons' performance in a VR environment.

Material and methods: Ten expert surgeons were recruited to assess the difficulty level of the VR bones using the developed difficulty scale. Thirty participants (10 medical students, 10 ENT trainees, and 10 consultants) performed mastoidectomy on these VR specimens. These dissections were scored by a blinded expert surgeon. We compared the correlation of expert-rated difficulty and surgical performance across experience levels.

Results: Expert ratings of bone difficulty showed high inter-rater reliability. Temporal bone dissection performance reflected experience: consultants performed best, followed by trainees, then medical students. Interestingly, trainees performed well on some expert-perceived difficult anatomical characteristics.

Conclusion: Anatomical variation-based difficulty ratings appear not to predict trainee performance on temporal bone dissection. This suggests difficulty may be better judged by actual surgical performance, which is feasible in VR environments and 3D printed models where standardised anatomy can be replicated.

Background: Patients with smaller vestibular schwannoma (VS) with preserved hearing can be subjected to hearing preservation surgery using the Middle Cranial Fossa (MCF) approach.

Aims/objectives: We aimed to evaluate hearing outcome postoperatively and more than 10 years after MCF surgery.

Materials and methods: Eighty-four patients with sporadic unilateral VS treated with MCF surgery between 1998 and 2020 at a single tertiary centre, were retrospectively studied. Pure tone audiometry and word recognition scores (WRS) preoperatively, postoperatively, and after > 10 years of follow-up, were analysed.

Results: Sixty (71%) patients had preserved hearing function after MCF surgery. Twenty-three of the 60 patients were followed up for >10 years after surgery. Hearing outcomes of the tumour ear after >10 years of follow up were as follows: median pure tone average (PTA): 61 decibel hearing level (dB HL) (range 6-94 dB HL), and median WRS 71% (range: 0-98%). The age-related decline in pure tone audiometry thresholds was not significantly different between the tumour and contralateral ears.

Conclusions and significance: MCF surgery offers the possibility of retaining hearing function even after >10 years of surgery in patients with preserved hearing. Additional hearing loss at the long-term follow-up was bilateral and symmetrical.

Objective: To investigate the prevalence and clinical relevance of endolymphatic hydrops in the contralateral ear of patients with unilateral Meniere's disease.

Material and methods: We analyzed 66 patients with definite unilateral MD. Participants underwent audiological examinations and clinical assessments, including the Tinnitus Handicap Inventory (THI), Dizziness Handicap Inventory (DHI), disease duration, and vertigo characteristics. Besides, bilateral intratympanic gadolinium-enhanced 3D-Real IR magnetic resonance imaging (MRI) was performed.

Results: EH was detected in 24.2% of contralateral ears, predominantly presenting as isolated vestibular or cochlear hydrops. Cochlear hydrops in the contralateral ear showed a positive correlation with hearing loss severity (χ²= 3.95, p < 0.05) and disease duration (t = 3.5, p < 0.001). Conversely, vestibular hydrops in the contralateral ear exhibited no significant associations with hearing loss or disease duration (p > 0.05). Furthermore, no correlations were found between contralateral EH and THI, DHI, or vertigo duration.

Conclusion and significance: Our study confirms that contralateral EH is a prevalent imaging finding in unilateral MD, highlighting the disease's potential for subclinical bilateral involvement.

Background: Radical surgery with free-flap reconstruction for advanced head and neck squamous cell carcinoma (HNSCC) carries a high risk of postoperative complications.

Aims/objectives: To identify the complication most strongly associated with poor oncologic outcomes.

Materials and methods: We retrospectively evaluated 346 patients who underwent free-flap reconstruction between January 2013 and December 2022. Postoperative complications were classified using Clavien-Dindo (CD) grading. Overall survival (OS), recurrence-free survival (RFS), hospital stay, and the surgery-to-postoperative radiotherapy (S-PORT) interval were evaluated.

Results: Surgical site infection (SSI) was the most common complication (n = 56). Patients with CD grade ≥ IIIa SSI showed significantly worse 5-year OS (hazard ratio [HR], 3.075; 95% confidence interval [CI], 1.605-5.892; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.135-3.866; p = 0.018). Multivariate analysis confirmed CD grade ≥ IIIa SSI as an independent prognostic factor for OS (HR, 3.539; 95% CI, 1.786-7.012; p < 0.001) and RFS (HR, 2.095; 95% CI, 1.155-4.053; p = 0.016). These patients had significantly longer hospital stays, whereas S-PORT intervals showed no difference.

Conclusions and significance: CD grade ≥ IIIa SSI independently predicts poor survival after free-flap reconstruction in HNSCC. Preventing and promptly managing SSIs are crucial to improving long-term outcomes.

Background: Nasal vestibular cyst is a common disease in otolaryngology. Traditional surgery via the labiogingival groove approach is invasive, while the rapid development of endoscopic minimally invasive technology may be significant for the improvement of nasal vestibular cyst surgery.

Objectives: To compare the clinical efficacy of endoscopic uncapping surgery and traditional sublabial approach resection in treating nasal vestibular cysts, providing evidence for clinical practice selection.

Methods: A retrospective analysis was performed on 47 patients with nasal vestibular cysts admitted to the Department of Otorhinolaryngology-Head and Neck Surgery from March 2019 to October 2024. They were divided into an endoscopic group (24 cases, undergoing endoscopic uncapping surgery) and a control group (23 cases, receiving traditional sublabial resection). Surgical indicators (operation time, intraoperative blood loss), postoperative recovery indicators (facial compression need, VAS scores at 24/48h, hospital stay), complication incidence, and cyst recurrence during follow-up were compared.

Results: The endoscopic group showed significantly shorter operation time [(20.13 ± 3.15) vs (59.13 ± 13.45) min], less intraoperative blood loss [(5.34 ± 0.67) vs (15.64 ± 2.63) ml], no need for facial compression (vs all controls needing it), lower VAS scores (24h: 2.13 ± 0.52 vs 4.87 ± 0.76; 48h: 1.56 ± 0.41 vs 3.92 ± 0.63), shorter hospital stay [(1.25 ± 0.31) vs (3.76 ± 0.84) days], and lower complication incidence (4.17% vs 13.04%) (all p < 0.05). No recurrence was found in either group during 12-month follow-up.

Conclusion: Endoscopic uncapping surgery for nasal vestibular cysts has advantages of short operation time, less bleeding, mild postoperative pain, rapid recovery, few complications, and low recurrence rate, with significant clinical effect worthy of wide promotion.

Background: Video exergame training shows promise in balance rehabilitation for children, effectively addressing the challenge of poor compliance. However, its application is limited by the need for specialized equipment.

Aims/objectives: To evaluate the effect and safety of smartphone-based video exergame training in children.

Materials and methods: Children with unilateral cochlear implants from the Gansu Hearing-Speech Rehabilitation Centre were recruited. All participants completed exergame training using the ihuman AI Sports app during the school term. Vestibular and balance functions were assessed before and after training, using the Cervical Vestibular Evoked Myogenic Potential (cVEMP) and the balance subset of Bruininks-Oseretsky Test of Motor Proficiency-II (BOT-2).

Results: A total of 37 children aged 4-7 years with balance deficit (BD) were recruited and divided into two groups based on adherence to the exercise. In Group I, one task of BOT-2 showed significant improvement after 9 weeks exercise. In Group II, total scores and 2 tasks improved significantly after 13 weeks training (p < 0.001).

Conclusions and significance: Smartphone-based video exergame training showed significant improvements in postural stability among children with BD. It is effective and safe, suggesting its potential as a valuable tool for balance rehabilitation in young children at home.

Background: Ferritin, a key iron-storage and antioxidant protein, is integral to iron metabolism. Its association with hearing loss remains unclear.

Objectives: This study aimed to investigate the association between serum ferritin levels and hearing loss in U.S. adults and explore potential causal relationships using Mendelian Randomization (MR).

Methods: We analyzed 2,971 participants from NHANES 1999-2002 using weighted multivariable logistic regression to assess associations between serum ferritin levels (high, normal, and low) and different frequencies of hearing loss. Stratified analyses were conducted. Bidirectional MR was performed using GWAS summary statistics to infer causal associations for sensorineural/conductive hearing loss.

Results: After full adjustment, high serum ferritin was associated with a significantly lower risk of high-frequency hearing loss (HFHL) (OR = 0.600 [0.390, 0.922]), especially in younger participants (20-44 years) and males. MR analysis supported a causal protective role of ferritin against sensorineural hearing loss (OR = 0.860 [0.765, 0.968]).

Conclusions: Higher serum ferritin levels are observationally associated with a reduced risk of HFHL. Genetic analyses further suggest a protective causal relationship between ferritin and sensorineural hearing loss.

Significance: These findings suggest ferritin may be a biomarker or potential intervention target for hearing preservation. Further prospective and experimental validation of these associations is warranted.