Acta Oto-Laryngologica最新文献

Background: Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a prevalent chronic inflammatory disorder of the nasal cavity and paranasal sinus with benign polypoid masses. Recent evidence highlights the immunomodulatory role of Vitamin D (Vit D) in mitigating inflammation associated with CRSwNP.

Aims: The aim of this study is to examine the effect of Vit D on the improvement of CRSwNP.

Material and methods: This randomized, double-blind clinical trial was conducted on 59 patients with CRSwNP. All patients with Vit D deficiency (25OH Vit D level < 20 ng/mL) or insufficiency (<30 ng/mL) underwent endoscopic sinus surgery (ESS). The rate of changes in the patients' symptoms were recorded before and 8 weeks after the surgery.

Result: All patients showed a better postsurgical improvement in terms of Visual Analogue Scale(VAS), Lund-Kennedy (LK), and Questionnaire (SNOT-22) scores. The Vit D supplement group showed better postsurgical improvement in comparison to placebo in terms of VAS and LK scores (p = 0.02, p = 0.03 respectively).

Conclusions and significance: The administration of Vit D after ESS is relatively effective in the improvement of CRSwNP symptoms. This finding highlights the possibility of developing an efficient, safe, and cost-effective therapy for patients with CRSwNP.

Background: In the management of patients with peripheral facial palsy, it is essential to have tools that allow patients to tell what their facial disabilities are.

Objective: This study aimed to translate and validate the FaCE scale into Italian (I-FaCE).

Material and methods: The FaCE scale was translated into Italian using a three-stage process. The draft was reviewed for comprehensibility by SLTs and revised accordingly. The beta version of I-FaCE was administered to 200 patients. Internal consistency was measured using McDonald's omega, while test-retest reliability was assessed with a fifteen-day interval between administrations. Confirmatory factor analysis (CFA) was performed to evaluate construct validity. Concurrent validity was tested by correlating I-FaCE scores with the House-Brackmann Scale, Sunnybrook Scale, and FDI Scale.

Results: The I-FaCE demonstrated excellent internal consistency (McDonald's omega = 0.87) and strong test-retest reliability. CFA indicated a good model fit, with indices such as CFI (0.94), TLI (0.91), RMSEA (0.07), and RMSR (0.06). Concurrent validity showed significant correlations between I-FaCE and other grading systems.

Conclusion and significance: I-FaCE is a valid and reliable tool to assess the impact of facial dysfunction on quality of life. Its adoption will facilitate better patient care and enable meaningful comparisons with international data.

Background: The repair of nasal septal perforations is challenging. Interposition of polydioxanone (PDS) plates combined with fascia graft have been described in the literature with high success rates.

Aims: This study aims to present a case series on the closure of nasal septal perforation using this technique and to evaluate its outcomes.

Material and methods: Retrospective evaluation of patients who underwent surgical repair of nasal septal perforations with interposition fascia graft and PDS plates from 2020 to 2023.

Results: Nine patients were evaluated, 66.7% were male and the mean age was 40.7 years. The perforation size ranged from 0.9 to 4.5 cm (largest diameter). All procedures were performed by an open approach and all patients received interposition grafts of PDS plates - eight cases combined with a temporoparietal fascia graft and one combined with a rectus abdominis muscle fascia graft. Eight patients (88.9%) achieved complete closure of the perforation. No other complications were reported.

Conclusions and significance: Interposition temporoparietal fascia graft combined with PDS plates could be a highly effective technique, demonstrating good functional and anatomic outcomes with low morbidity at the donor site. This composite can be applied to small and large perforations as surgical success does not appear to be affected by the defect size.

Backgrounds: Some studies believe that there is a correlation between larygopharyngeal reflux disease (LPRD) and allergic rhinitis (AR). Salivary pepsin concentration (SPC) test is a gradually accepted objective examination method for LPRD in recent years.

Objectives: To investigate the impact of coexisting LPRD on subjective severity of seasonal AR and the potential role of pepsin.

Material and methods: Adult patients with seasonal AR were prospectively enrolled. Subjective severity of AR was assessed using the Total Nasal Symptom Score (TNSS) and visual analog scale (VAS). Potential LPRD was assessed using the Reflux Symptom Index (RSI) and SPC measurements.

Results: No significant correlation was found between the RSI value and the TNSS and VAS values (both p > .05). In contrast, the SPC value was found to be significantly associated with both of TNSS and VAS values (p < .05). Among the symptoms included in the TNSS, the SPC value was significantly and positively associated with nasal congestion and runny nose (both p < .05), but not with sneezing and nasal itching (both p > .05).

Conclusions and significance: Coexisting LPRD may aggravates seasonal AR symptoms. SPC could be used to examine whether AR patients have combined LPRD and to determine the necessity of anti-reflux treatment.

Background: Current guidelines recommend p16 immunohistochemistry (IHC) for testing human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC). The need for additional HPV-DNA testing is debated.

Aims/objectives: We evaluated the prognostic value of HPV-DNA in situ hybridization (ISH) as an adjunct to p16.

Material and methods: A population-based cohort of 1,033 head and neck squamous cell carcinoma patients was used, to identify 124 OPSCC patients treated with a curative intent.

Results: Of the p16-positive patients, 17.9% did not show evidence for presence of HPV-DNA in ISH. Both p16 and HPV-DNA ISH were significant prognostic factors for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) when used independently. When combining information from p16 IHC and HPV-DNA ISH, survival of the p16+/ISH- discordant patients was intermediate compared to the p16+/ISH+ and p16-/ISH- groups. In the discordant group, smoking was a strong prognostic determinator, with non-smokers having an outstanding prognosis.

Conclusions and significance: Both p16 IHC and HPV-DNA ISH perform well as separate prognostic biomarkers for OS, DSS, and DFS on a population level. However, a discordant group does exist. Limiting HPV-DNA testing for p16-positive patients who smoke by the time of diagnosis may be a cost-efficient and justified solution.

Background: Currently, there is limited knowledge regarding the effects of climate on the lower turbinate morphology.

Objectives: This study evaluated the existence of humidity-related climatically adaptive changes in inferior turbinate.

Methods: Previously taken computed tomography images of the paranasal region were evaluated belonging to a total of 100 patients from two different climates (50 patients each from humid climate and from dry climate). The width, length and height of the lower turbinate, the breadth, length and height of the internal nasal passage, height of the inferior airway, breadth of common and inferior meatus were compared.

Results: The group from dry climate has narrower internal nasal passage breadth (p = .010) with wider inferior meatus width (p = .031). No dimensional difference in the lower turbinates was observed between the two climatic groups. These two findings indicate a more lateralized turbinates in the humid group as opposed to more centralized turbinates in the dry group.

Conclusions: Humidity has an effect as a climatic factor on turbinate positioning in the nasal fossa and contribute to an overall pattern of ecogeographic variation of nose. It may be useful to review surgical interventions to the inferior turbinate in the light of this information.

Backgrounds: It remains unclear whether LVAS pediatric patients experience more severe subjective symptoms after surgery compared to other pediatric patients, whether their objective vestibular function is worse, and the underlying reasons for their poorer subjective experience.

Objectives: To compare vestibular function following CI between pediatric pediatric patients with and without LVAS.

Materials and methods: The study included 11 patients in the LVAS group(18.42 ± 2.4 month) and 24 patients in the NLVAS group(35.73 ± 11.40 month). A comprehensive assessment of vestibular function was conducted both preoperatively and postoperatively. The assessment included vestibular function tests and evaluation of vestibular-related symptoms. The vestibular function test was conducted using cervical vestibular evoked myogenic potentials (cVEMP).

Results: A higher incidence of postoperative dizziness was reported in the LVAS group compared to the NLVAS group (63.63% vs 0.08%, p = 0.001). The LVAS group exhibited a prolonged recovery period for head lifting and sitting compared to the NLVAS group (3.27 ± 0.715 vs 1.42 ± 0.119 days, p = 0.027; 4.09 ± 1.217 vs 1.92 ± 0.219 days, p = 0.022, respectively). The elicitation rate and amplitude of cVEMP in LVAS children showed no significant difference when compared to the NLVAS group preoperatively (p > 0.05). The LVAS group had a more decrease in amplitude 5 days after surgery compared to the NLVAS group (142.09 ± 33.98 vs 81.89 ± 17.13, p = 0.039).

Conclusion: Pediatric patients with LVAS are more prone to experiencing dizziness symptoms post- CI surgery. There is an increased fluctuation in amplitude of cVEMP in LVAS pediatric patients.

Background: The awareness and prevalence of olfactory dysfunction (OD) has increased significantly in recent years, with the SARS-CoV-2 pandemic being a major catalyzer. Consequently, demands for reliable OD tests have also risen.

Aims: This systematic review compares two commonly used tests for olfactory assessment: the University of Pennsylvania Smell Identification Test (UPSIT) and the Threshold, Discrimination, and Identification test (TDI). The correlation between UPSIT, TDI, and the Visual Analogue Scale (VAS) for olfaction is also examined.

Material and methods: A systematic search of PubMed and EMBASE identified articles validating UPSIT or TDI and comparing these to self-reported OD via VAS. The outcome of interest was test-retest validity and correlation.

Results: The search identified 1536 studies, with nine meeting inclusion criteria. UPSIT showed a 'very strong' test-retest correlation, while TDI showed a 'strong' correlation. One study addressed VAS in relation to UPSIT and five for TDI. Correlation coefficients varied between VAS and TDI/UPSIT.

Conclusions and significans: UPSIT and TDI exhibited strong to very strong test-retest reliability. Due to the limited number of studies, a meta-analysis was not feasible, and neither test was found to be superior in reliability. VAS did not correlate significantly with either TDI or UPSIT.

Background: Deviated nasal septum (DNS) changes aerodynamic airflow pattern and increases nasal resistance that may affect paranasal sinus pneumatization.

Objectives: To explore the relationships among DNS, sphenoid bone pneumatization and surrounding neurovascular structures.

Material and methods: The paranasal sinus CT images of DNS patients (n = 100) and patients without DNS (n = 60) between 2020 and 2022 were retrospectively analyzed. Sphenoid bone pneumatization and anterior clinoid processes (ACP) length were measured while surrounding neurovascular structure types were assessed.

Results: In the DNS group, the indicators demonstrating sphenoid bone pneumatization were significantly (p < 0.001) greater than that in the control group. There were no statistically significant differences in the indicators demonstrating the positions of vidian canal (VC) and foramen rotundum (FR) between two groups. Regarding proportion of different neurovascular structure grades, the findings were significant (p < 0.05) between two groups. The corrected sphenoid sinus area also correlated with surrounding neurovascular structure types.

Conclusions and significance: Severe DNS is significantly related to the sphenoid bone pneumatization and surrounding neurovascular structure. This suggests that clinicians should be aware of the anatomical variation of sphenoid bone pneumatization and the cranial base structures in DNS patients.

Background: Pediatric deep neck abscesses (PDNAs) are uncommon but can cause serious complications. Despite advances in diagnostics and antibiotic therapies, effective PDNA management remains challenging, necessitating prompt diagnosis and targeted treatment.

Objectives: This study evaluated the clinical characteristics, treatment approaches, and factors affecting hospital stay in pediatric patients with PDNAs. Associations between laboratory markers (hemoglobin, albumin, inflammatory indices) and abscess characteristics with clinical outcomes were analyzed.

Methods: A retrospective review of 72 PDNA cases at Ankara Bilkent City Hospital (2019-2024) was performed. Clinical presentation, laboratory findings (hemoglobin, albumin), abscess size, and inflammatory indices (SII, NLR, SIRI) were analyzed.

Results: The mean age was 6.69 years, with 51.38% under six. Peritonsillar abscesses were the most common (40.3%), followed by retropharyngeal abscesses. Antibiotic therapy alone was successful in 33.3% of cases, while 66.7% required surgical drainage. Prolonged hospitalization was associated with low hemoglobin (p = .003) and albumin (p = .034), larger abscess size (p = .047), and elevated inflammatory markers (SIRI: p = .007, SII: p = .015).

Conclusions and significance: Prognostic factors such as hemoglobin, albumin, and inflammatory indices is essential in PDNA management. Surgical intervention plays a key role in severe cases, emphasizing the need for standardized protocols.