Acta Oto-Laryngologica最新文献

Background: Tuberculous otitis media (TOM) is a rare form of chronic otitis media, which presents diagnostic challenges due to nonspecific symptoms.

Aims/objectives: To characterize the clinical features and identify strategies for early diagnosis.

Materials and methods: A retrospective analysis was conducted on 32 patients (40 ears) diagnosed with TOM between 2002 and 2024. Clinical, audiologic, radiologic, and laboratory findings were reviewed.

Results: Mean diagnostic delay was 28.9 months. Persistent otorrhea (90%) and hearing loss (HL) (100%) were predominant. Tympanic membrane findings varied: single perforation (70%), multiple (12.5%), and intact (17.5%). Granulations were universal. Age stratification revealed conductive HL and pneumatized mastoids predominated in patients <40 years, while mixed HL and mixed-type mastoid were more common in patients >40 years (p = 0.016, p = 0.005). Bone destruction was evident in 25% of the cases. Mastoid type correlated with HL patterns in non-destructive cases (p = 0.040). Interferon-gamma release assay (IGRA) and polymerase chain reaction (PCR) showed relatively high detection rates.

Conclusions and significance: Early suspicion of TOM in refractory/recurrent otitis media, combined with IGRA/PCR screening, prompt imaging, and consideration of age-specific patterns, facilitates timely diagnosis. Surgical biopsy remains critical for confirmation. Integration of age-stratified clinical, laboratory, and radiological findings improves detection accuracy and patient outcomes.

Background: The ideal ossiculoplasty technique should effectively restore sound transmission, be surgically feasible, biocompatible, and stable. Currently, no single material fully meets these criteria in a cost-effective manner.

Objectives: To evaluate and compare the long-term audiological outcomes of various ossiculoplasty techniques.

Materials and methods: This retrospective study included 116 patients (aged 11-72) who underwent ossiculoplasty using cortical bone, bone cement, or titanium prostheses between 2013 and 2019. Preoperative and 2-year postoperative air and bone conduction thresholds (500-4000 Hz), air-bone gap (ABG), and hearing gains were analyzed.

Results: Significant postoperative ABG improvement was observed in the malleus-incus, incus-stapes bone cement, TORP, and PORP groups (p < 0.05). Although hearing gain was noted in the malleus-stapes bone cement and cortical bone groups, the improvement was not statistically significant (p = 0.18 and p = 0.95, respectively). Hearing gain >10 dB was achieved in 76.5% of incus-stapes bone cement and 53% of TORP procedures.

Conclusions and significance: Bone cement offers an effective and economical option for ossiculoplasty, particularly in incudostapedial repairs. Despite no statistically significant difference (p = 0.206), the favorable outcomes of TORP suggest it may be superior to cortical bone in patients with non-functional ossicular chains.

Background: While extensive research exists on the efficacy of the Epley maneuver, studies examining nystagmus findings during treatment are limited.

Aims/objectives: This study aimed to examine posterior canal benign paroxysmal positional vertigo (BPPV) to determine whether nystagmus findings during the Epley maneuver can predict efficacy. Additionally, we investigated the occurrence of nystagmus in the sitting position immediately following treatment.

Materials and methods: The participants comprised 50 consecutive cases of posterior canal BPPV. Eye movements during and after the Epley maneuver were observed. Patients were asked to revisit within a week for the Dix-Hallpike test.

Results: A high incidence of torsional nystagmus towards the affected side was observed in the healthy-ear-down 135° position, occurring in 62% of cases. This finding indicates that the treatment was successful. However, not all cases exhibiting this nystagmus achieved complete recovery. Ninety-four % of patients did not exhibit nystagmus in the final position, even though pathological debris was stimulating the utricle.

Conclusions and significance: Nystagmus findings during the Epley maneuver cannot always predict the efficacy. The occurrence of nystagmus in the final position is very low, suggesting that stimulating the utricle may not always induce nystagmus.

Background: Snoring often limits sleep quality and quality of life of the affected person. Effective therapies for snoring are scarce.

Aims/objectives: This prospective, randomized, controlled study aims to investigate the efficacy of an orolingual myofunctional therapy for the treatment of snoring.

Material and methods: In total 125 participants with history of snoring were included in this single center study. Participants were randomized to orolingual (treatment) or finger coordination exercises (control) for 6 weeks. The primary endpoint was a subjective snoring score derived from visual analogue scales for snoring qualities. The secondary endpoints included snoring index, -time and apnea-hypopnea index determined by home sleep apnea test and sleep questionnaires.

Results: 92 patients reached final analysis (51 experimental, 41 controls). In analysis of covariance, the snoring score at follow-up was 2.3 scale points lower in the treatment group, compared to the control group (95% CI 0.6 to 3.9, p = 0.007). Explorative analysis suggested that older participants benefit more than younger. Secondary parameters did not differ significantly.

Results: 92 patients reached final analysis (51 experimental, 41 controls). In analysis of covariance, the snoring score at follow-up was 2.3 scale points lower in the treatment group, compared to the control group (95% CI 0.6 to 3.9, p = 0.007). Explorative analysis suggested that older participants benefit more than younger. Secondary parameters did not differ significantly.

Conclusions and significance: Results of this study indicate that orolingual myofunctional therapy improves subjective snoring score with respect to the bed partner compared to control.

Background: Castleman disease, a rare lymphoproliferative disorder with diverse features, is often misdiagnosed due to rarity and similarity to malignancies.

Aims: The study analyzed the clinicopathological characteristics, diagnostic challenges, and outcomes of head and neck Castleman disease (HNCD) to improve diagnostic accuracy and optimize management strategies.

Material and methods: Retrospective study of 21 HNCD patients treated at Beijing Tongren Hospital (2007-2024). Demographics, presentation, imaging, histopathology, treatment, and outcomes were analyzed using t-tests, Mann-Whitney U, and Fisher's exact tests.

Results: Mean age 36.1; 52.4% female. Mainly painless cervical masses (95.2%). Histology: 85.7% hyaline vascular, 14.3% plasma cell. Imaging showing non-specific hypoechoic nodules (ultrasound) and homogeneous enhancement (CT/MRI). Surgical excision (85.7%) achieved 76.2% complete remission (mean follow-up: 85.2 months). Tumor size (34.6 ± 15.3 mm) didn't correlate with outcome (p = 0.756). One plasma cell patient (4.8%) died of unrelated causes. No recurrences or malignant transformations were observed.

Conclusions and significance: HNCDs are predominantly unicentric and can be cured with complete surgical resection. Due to the lack of specificity of imaging and laboratory findings, diagnosis relies on histopathology. Collaborations among multiple centers and molecular studies are essential to advancing the precision treatment of HNCD.

Purpose: To investigate the associations of the presence, duration, and co-occurrence of chronic inflammatory diseases with age-related hearing loss.

Methods: This cross-sectional investigation included 583 subjects aged over 60 years. The participants were divided into two categories: healthy cohort (Group H, n = 65) and inflammation cohort (Group I, n = 518). Group I was defined by the presence of at least one chronic inflammatory condition. Participants' smoking history was gathered and evaluated as a possible confounding factor. Hearing assessments were conducted using extended high-frequency audiometry, measuring thresholds from 125-18000 Hz. To analyze the association between hearing thresholds and inflammation duration, regression analysis was employed, with age as a controlled variable.

Results: Participants in Group I demonstrated significantly elevated hearing thresholds at extended high frequencies compared to those in Group H (p < 0.05). The duration of chronic inflammatory diseases was significantly associated with elevated hearing thresholds at high frequencies (4000, 8000, 10000, and 12500 Hz) (p < 0.05) regardless of age. The presence of co-occurring inflammatory conditions did not show a significant impact on hearing thresholds.

Conclusion: The impact of aging on hearing thresholds, particularly at higher frequencies, appears to be more pronounced in individuals with longer durations of chronic inflammatory conditions.

Background: ChatGPT and other large language models have emerged as new tools for patient education, yet their clinical safety and reliability remain unclear.

Objective: To assess the accuracy and safety of ChatGPT-4o's responses to common postoperative questions following rhinoplasty.

Methods: Ten consensus-based postoperative questions were identified via a modified Delphi process. ChatGPT-4o responses were generated and evaluated by three independent otolaryngologists using a 10-point Likert scale. Reviewers also assessed the presence of critical errors.

Results: The average Likert score across responses was 8.87 (95% CI, 8.39 to 9.34), No critical errors were detected. Inter-rater reliability was high (ICC(2,k) = 0.876).

Conclusions: ChatGPT-4o provided clinically accurate and safe answers to common rhinoplasty postoperative questions.

Significance: These findings suggest that ChatGPT-4o may serve as a useful adjunct for postoperative patient counseling in structured settings, particularly when physician access is limited.

Background: Temporal bone squamous cell carcinoma (TBSCC) is a clinically rare, yet highly aggressive, malignant tumor of the temporal bone, characterized by a poor prognosis and a high mortality rate.

Aims: The aim of this study was to assess the survival and recurrence rates of TBSCC patients treated at our institution and to identify factors related to postoperative recurrence and prognosis.

Material and methods: This retrospective study evaluated 81 histologically confirmed TBSCC cases (2000-2020) with follow-up through August 2022. Kaplan-Meier analysis assessed recurrence-free and overall survival, while Cox proportional hazards modeling identified independent prognostic risk factors.

Results: Facial nerve paralysis, tumor invasion of the sigmoid sinus/mastoid, advanced MPB-T staging, dural invasion, and facial nerve involvement are associated with high recurrence rates at 3 and 5 years. Furthermore, advanced MPB-T staging and tumor invasion into the sigmoid sinus/mastoid significantly impact the survival prognosis of patients with TBSCC.

Conclusions and significance: Preoperative facial paralysis and facial nerve invasion indicate a high risk of recurrence, while dural invasion is a strong predictor of relapse. In TBSCC, advanced MPB-T stage and sigmoid sinus/mastoid process invasion correlate with poor prognosis. Precise assessment of tumor subsite and invasion extent is critical in clinical management.

Background: Reconstructive surgery with flaps plays a key role in the head and neck region, but the potential toxicity of adjuvant treatment on flap are uncertain.

Aim: to identify possible predictors of acute toxicity and flap failure in patients affected by head and neck cancer (HNC) who underwent surgery with flap reconstruction and adjuvant radiotherapy.

Materials and methods: We retrospectively analyzed clinical data of 46 patients affected by locally advanced HNC, who underwent surgery with major reconstruction, followed by adjuvant treatment (radiotherapy +/- chemotherapy), between December 2005 and December 2022.

Results: pN status and type of flap are the only two independent predictors of severe acute toxicity (p = 0,018 and p = 0,038 respectively) but none of the variables seems influencing per se the viability of the reconstructive flap at multivariate analysis. However, radiation-induced flap fibrosis occurred most commonly in the pedicled flap group.

Conclusions and significance: This study was able to confirm the favorable integration of reconstructive flaps in advanced HNC patients, highlighting the robustness and resilience of the reconstructive flap even after adjuvant treatments. It contributes to the existing literature by identifying pN status and flap type as significant predictors of toxicity in locally advanced HNC patients undergoing adjuvant treatment.

Background: Exposure to high-intensity impulsive noise, such as firearm blasts, can lead to subclinical cochlear and efferent system damage that is not detectable by standard audiometry.

Objective: This study aimed to evaluate the effects of firearm noise exposure on the auditory efferent system in military personnel.

Methods: This prospective study included 45 firearm-using military personnel and 45 non-exposed controls. Participants underwent pure-tone and speech audiometry, DPOAE, and contralateral suppression testing to assess MOCR. Bonferroni correction was applied for multiple comparisons.

Results: After correction (p < 0.0027), thresholds were significantly higher at 4 kHz in the right ear and at 0.25, 2, and 4 kHz in the left ear. Firearm users also had higher pure-tone averages and speech reception thresholds, and lower speech discrimination scores than controls. Among DPOAE and MOCR measures, only the 2 kHz DPOAE amplitude in the left ear remained significant after correction (p = 0.001).

Conclusion and significance: Impulsive noise from firearms may lead to subclinical cochlear dysfunction even in individuals with clinically normal hearing. DPOAE measurements, particularly at mid-frequencies, may serve as early indicators of noise-induced auditory damage. These findings underscore the importance of auditory monitoring and effective hearing protection in noise-exposed populations.