Acta Oto-Laryngologica最新文献

Background: Post-tonsillectomy pain is one of the most common morbidities in children, markedly affecting comfort and recovery. Although several factors influencing pain have been explored, the role of tonsil volume remains unclear.

Aims/objectives: To investigate the relationship between objectively measured tonsil volume and postoperative pain in pediatric tonsillectomy.

Material and methods: This prospective observational study included 150 children aged 4-12 years who underwent bilateral cold-dissection tonsillectomy. Tonsil volume was measured intraoperatively by the water-displacement method. Patients were divided into three groups by total tonsil volume. Postoperative pain was assessed using the Wong-Baker Faces Pain Rating Scale (WB) and the Parents' Postoperative Pain Measure (PPPM) at 1, 6, and 24 h and on postoperative days 3 and 7. Correlations were analyzed with Spearman's test.

Results: Pain scores differed significantly among groups. The largest-volume group showed the highest PPPM scores at all time points (p < 0.001). The strongest correlation occurred between tonsil volume and PPPM scores at 6 h (r = 0.65, p < 0.001), while WB scores on day 7 correlated moderately (r = 0.41, p < 0.001).

Conclusions: Tonsil volume is positively correlated with postoperative pain after pediatric tonsillectomy.

Significance: Objective volumetric assessment offers greater predictive value than subjective grading and may guide individualized analgesic and counseling strategies.

Background: Partial parotidectomy is the most common surgical approach to treat benign parotid tumours. Studies on recovery from parotidectomy are lacking.

Objectives: To prospectively evaluate recovery and work ability after partial parotidectomy.

Methods: The study group comprised 80 patients who underwent surgery for benign parotid neoplasms. Patient-reported data were collected via the electronic Case Report Form database.

Results: Pain and swelling were the most frequently reported symptoms preventing work ability. A week after surgery, pain and the need for pain medication decreased steadily and at that time point, 56% of patients were already able to work. The predisposing factors for a longer recovery comprised physically demanding work, low education level, and no possibility of remote work. A postoperative complication also prolonged recovery, although no major complications occurred.

Conclusions and significance: Pain was mild thorough the recovery but tightening of the wound, numbness, and tingling last a relatively long time and may be regarded as pain. Over half of the patients were fully or partially able to work after one week. Thus, recovery and work ability are patient- and work-dependant. Remote work, patient counselling about common postoperative symptoms, and signing shorter sick leaves will encourage faster return to everyday life.

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: 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: 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: 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: Chronic rhinosinusitis (CRS) affects all ages, but inflammatory differences between pediatric and adult patients are unclear.

Methods: Nasal secretions from 14 pediatric and 28 adult CRS without nasal polyps (CRSsNP) patients, plus 14 pediatric and 14 adult controls, were analyzed for 27 inflammatory mediators via bio-plex.

Results: Compared to controls, pediatric CRSsNP showed only decreased bFGF. Adult CRSsNP exhibited increased IL-6 and IL-7. Fourteen mediators (including IFN-γ, IL-4, IL-5, IL-9, IL-13, IL-6, TNF-α, IL-8, bFGF, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES) were significantly higher in adult CRSsNP patients than pediatric CRSsNP patients. Comparing control groups, adults had higher IL-5, bFGF, MIP-1α and lower IL-1Ra than children. Age positively correlated with levels of several cytokines, especially IL-5, IL-6, bFGF, and MCP-1.

Conclusion: Pediatric CRSsNP demonstrates a low-inflammatory profile relative to both pediatric controls and adult CRSsNP. Adult CRSsNP presents a significantly heightened inflammatory state. The data indicate that CRSsNP inflammation becomes more pronounced with age in the nasal mucous. This age-dependent increase in inflammatory mediators may explain why a better prognosis is typically observed in pediatric CRSsNP compared to adults.

Background: The use of topical haemostatic agents in head and neck surgery has increased. Although generally considered safe, concerns have arisen about potential associations with postoperative complications.

Aims/objectives: This study aims to evaluate whether haemostatic agent use in parotidectomy and thyroidectomy is associated with increased risk of seroma or postoperative infection.

Material and methods: A retrospective cohort study was conducted on patients who underwent parotidectomy between 2017-2024 and thyroidectomy between 2022-2024.

Results: 82, 31, 35 and 15 patients underwent drainless parotidectomy (DLP), drained parotidectomy (DP), drainless thyroidectomy (DLT) and drained thyroidectomy (DT) respectively. Haemostatic agent use was the only significant factor associated with increased risk of seroma/sialoma in parotidectomy (OR3.58, p = 0.02). No seroma occurred in patients who underwent thyroidectomy. Haemostatic agent use was associated with higher risk of post-parotidectomy infection (OR 6.74, p = 0.01), but this may be confounded since all infections occurred in DLP where these agents were more commonly used. Further analysis found a weak, non-significant association (Cramer's V = 0.20, p = 0.07). Concurrent neck dissection was the only significant predictor of post-thyroidectomy infection (OR6.33, p = 0.04).

Conclusions and significance: Haemostatic agent use in parotidectomy is associated with increased seroma/sialoma risk and potentially infection risk, particularly when drains are omitted.

Background: Choanal atresia (CA) is rare. Unilateral CA (UCA) can be detected late in life. Recurrences following CA repair are challenging.

Objectives: To examine the long-term surgical and subjective outcomes in patients with CA and the reason for recurrences.

Methods: Outcome of transnasal endoscopic repair of congenital CA was examined between 2010 and 2022 in 25 patients with UCA and 31 patients with bilateral CA (BCA). Demographics, surgical data, and postoperative course were investigated. Subjective outcomes with regard to function and quality of life were examined via a visual analogue scale (VAS).

Results: Twelve surgeries were performed in ten patients with BCA due to recurrence. Insufficiently resected posterior vomer, and granulation tissue growth caused recurrences. VAS demonstrated a significant improvement in function (p < 0.0001) and quality of life (p < 0.0001) following surgery in patients with UCA and BCA with the highest levels of postoperative satisfaction (median satisfaction score of 10).

Conclusion: Insufficient vomer resections and granulation tissue cause recurrences. Patients with UCA exhibited substantial impairment in both function and quality of life.

Significance: BCA requires immediate treatment at birth. But also, the treatment of patients with UCA should be timely, contingent on present symptoms, as CA repair significantly increase their quality of life.