Acta Oto-Laryngologica最新文献

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.

Background: Parotidectomy for benign salivary gland tumours may result in postoperative sequelae affecting health-related quality of life. No validated Swedish disease-specific instrument for postoperative symptom burden after parotid surgery has been previously available.

Aims/objectives: To translate and validate the Parotidectomy Outcome Inventory-8 for Swedish-speaking patients (SwPOI-8).

Material and methods: A total of 108 adults who had undergone parotidectomy for benign disease at least six months previously were included. The SwPOI-8 was developed using forward-backward translation. Psychometric evaluation included internal consistency, test-retest reliability and construct validity assessed against the established patient-reported outcome measures.

Results: All SwPOI-8 items were completed by all respondents. The mean total score was 6.4 ± 5.2 (range 0-31). Internal consistency was acceptable (Cronbach's α = 0.75). Test-retest reliability was good, assessed using the intraclass correlation coefficient (ICC = 0.87), with substantial agreement for the total score based on weighted kappa (κ = 0.74). Moderate correlation was observed with the Postoperative Global Impairment Scale, while correlations with general patient-reported outcome measures were weak.

Conclusions and significance: The SwPOI-8 demonstrates satisfactory reliability and validity as a disease-specific measure of postoperative symptom burden after benign parotid surgery, supporting its use in clinical follow-up, research and quality assessment.

Background: Non-implantable bone conduction (BC) hearing systems are well-established for individuals with conductive or mixed hearing loss.

Objective: To evaluate the audiological performance of two wearing options-an adhesive adapter and headband-worn unilaterally and bilaterally using the same non-implantable BC hearing device Contact Forte (BHM Inc., Grafenschachen, Austria).

Material and methods: Fifteen normal hearing adults with simulated bilateral conductive hearing losses participated in the study. Speech understanding in quiet and in noise were measured unaided and with BC devices worn unilaterally, bilaterally, with adhesive adapters, and mounted on headbands. Sound quality was rated using a questionnaire.

Results: At 50 dB SPL word recognition scores in quiet improved, on average, by 58% (unilateral), and 69% (bilateral) with adhesive adapters and by 65% and 74% with headbands. At 65 dB mean scores were above 95% in all aided conditions. In noise, speech presented speech reception thresholds decreased by 2.3-3.6 dB. With two devices, an additional benefit of 4.4 dB SNR (p<.001) was observed for speech from the side of the second device. Participants favored the bilateral configurations.

Conclusion and significance: Both wearing options showed comparable improvements in speech understanding. Bilateral fittings led to better speech understanding for one configuration and were favored subjectively.

Background: Paediatric laryngeal pathology is common, with laryngomalacia being the leading cause of infant stridor and vocal cord nodules the most frequent cause of dysphonia. Although awake flexible nasopharyngolaryngoscopy (FNPLS) provides definitive diagnosis, it is invasive and uncomfortable. Laryngeal ultrasound (LUS) is a non-invasive, radiation-free, and well-tolerated alternative that allows dynamic assessment in awake children. .

Objective: To compare the reproducibility of FNPLS and LUS findings and to evaluate patient comfort for each procedure.

Methods: A single-blinded prospective cohort study was conducted in a tertiary centre in Klang Valley, Malaysia, involving 32 children aged 0-12 years with stridor or dysphonia. FNPLS was performed by an ENT surgeon, followed by LUS within two weeks by a radiologist blinded to FNPLS findings. Sensitivity and specificity of LUS were calculated using FNPLS as the gold standard. Comfort was assessed using VAS or FLACC scales.

Results: LUS showed the highest sensitivity and specificity for subglottic stenosis, followed by laryngeal mass lesions, vocal cord paresis/paralysis, vocal cord masses, and laryngomalacia. Overall specificity was high with variable sensitivity. LUS was significantly more comfortable than FNPLS (mean difference -5.66, p<0.001).

Conclusion: While FNPLS remains the gold standard, LUS is a valuable, less traumatic adjunct, particularly for subglottic stenosis, laryngeal masses, and follow-up evaluation.

Background: Differentiating Ménière's disease (MD) from vestibular migraine (VM) is clinically significant.

Objective: We aimed to compare the diagnostic performance of two MRI parameters, endolymphatic hydrops (ELH) and endolymphatic drainage system, in distinguishing MD from VM and to explore their correlations.

Material and methods: Fifty-five MD and 34 VM patients underwent 3D-FLAIR sequences after intratympanic gadolinium injection. ELH was evaluated with Nakashima criteria, and endolymphatic drainage system parameters, including the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PPD) and the vestibular aqueduct (MRI-VA) visibility, were assessed.

Results: (1) MD patients had higher cochlear and vestibular ELH grades and vestibular ELH ratio on the affected side compared to VM patients. MD patients showed bilaterally reduced MRI-VA visibility compared to VM patients. (2) Higher cochlear and vestibular ELH grades were associated with reduced MRI-VA visibility, and increased cochlear ELH grade correlated with shorter PPD.

Conclusions and significance: MRI-VA invisibility and short PPD, may be interrelated features of inner ear ELH in vivo. Moreover, the bilaterally symmetrical reduction of VA visibility may be a potential biomarker in differentiating MD from VM, with comparable efficiency as that of ELH.

Background: Surgical management of chronic ear diseases, particularly middle ear cholesteatoma and chronic otitis media, often results in significant skin defects in the external auditory canal (EAC) and auricular region.

Objectives: To evaluate the clinical efficacy and safety of xenogeneic acellular dermal matrix (xeno-ADM) in repairing ear skin defects following surgical resection of middle ear pathologies.

Material and methods: A prospective cohort study was conducted from March 2024 to April 2025 at a single tertiary care center. One hundred and twelve consecutive patients with ear skin defects underwent reconstruction using xeno-ADM. Primary outcomes included epithelialization time, functional recovery (ear canal patency, hearing improvement), and postoperative complications. Secondary outcomes included surgical difficulty, patient satisfaction, and physician evaluation. Air conduction threshold changes were measured pre- and postoperatively. Pain was assessed using Visual Analog Scale.

Results: Mean epithelialization time was 36.0 days. All patients achieved complete epithelialization with 100% ear canal patency. Hearing improved significantly with mean air conduction threshold reduction of -13.32 ± 14.67 dB, with 94% of patients showing improvement or stability. Postoperative pain was minimal. Complications were rare: mild exudate in 75.0%, local infection in 0.9%, partial membrane loss in 13.4% (successfully managed with reapplication). No rejection reactions occurred. Patient satisfaction was 100% for both appearance and function.

Conclusions and significance: Xeno-ADM demonstrates excellent efficacy and safety for ear skin defect repair, offering rapid epithelialization, significant hearing improvement, minimal pain, and high patient satisfaction during the mean follow-up of 6 months. However, the absence of a control group limits the strength of these conclusions, and long-term outcomes remain unknown due to the limited follow-up duration.