Acta Oto-Laryngologica最新文献

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.

Background: TMC1 variants cause autosomal dominant (DFNA36) and recessive (DFNB7/11) sensorineural hearing loss. However, the clinical significance of novel missense variants, particularly in East Asian populations, remains unclear.

Objective: Our study aims to clarify the pathogenicity of a novel variant p.S390C by clinical characterization, genetic and molecular model analysis in China.

Material and methods: Auditory features of the hearing loss were characterized in proband. Variant screening of 406 known deafness-associated genes was performed in proband by targeted next-generation sequencing, confirmed by Sanger sequencing. Variant analysis was prediction computational and molecular model analysis.

Results: Consistent with typical DFNB7 phenotype, the proband in this study showed congenital profound hearing loss. Targeted next-generation sequencing identified a compound heterozygous mutation: p. S390C variant and p.R34X variant in TMC1. Prediction computational analysis of protein functional damage and 3D modeling analysis consistently support that the p. S390C in TMC1 is pathogenic.

Conclusions and significance: The p. S390C variant in TMC1 gene is highly likely to be pathogenic and associated with autosomal recessive hearing loss. Our study expanded the mutation spectrum of the TMC1 gene, providing deeper insights into the genotype-phenotype correlations of hereditary deafness, which holds significant implications for genetic diagnosis and counseling in affected families.

Background: Cancer of unknown primary (CUP) is diagnostically challenging. Diagnostic strategy remains controversial.

Aim: The aim of this retrospective study was to evaluate the diagnostic value of FDG-PET/CT and MRI in detecting primary tumours in patients presenting with suspected CUP.

Methods: Patients referred to FDG-PET/CT for suspected CUP were included retrospectively. Data on demographics, diagnostic tests and imaging was collected. Sensitivity and specificity for FDG-PET/CT and MRI were compared using McNemar's test.

Results: In a four year period a total of 329 patients were included, 226 (68.7%) with malignant and 103 (31.3%) with benign pathology. Of the 226 with malignant tumours, 150 (66.4%) had head and neck cancer, the majority of which were with oropharyngeal origin 114 (76.0%).In a subgroup of 80 patients who had both FDG-PET/CT and MRI scans (53.3%), MRI did not significantly increase sensitivity (p = 0.092) in identifying tumour site.

Conclusions and significance: There was no significant difference in the sensitivity between FDG-PET/CT and MRI in patients with head and neck cancer or CUP. Adding MRI to the diagnostic workup in occult cancer did not significantly improve detection of primary tumours. In case of malignant tumours, 50% were oropharyngeal cancer and required MRI for preoperative planning.

Background: A correlation between thyroid function and the occurrence of sudden sensorineural hearing loss (SSNHL) has been reported.

Aims/objectives: This study aims to investigate the treatment outcomes for SSNHL in patients with thyroid dysfunction using TSH as a parameter.

Material and methods: Retrospective review of the medical records of 41 patients who had previously been diagnosed with hypothyroidism and subsequently experienced SSNHL. According to Siegel's criteria, participants who showed complete or partial recovery were classified as the recovery group, and participants who showed slight improvement or no improvement were classified as the non-recovery group.

Results: The final hearing gain and TSH level showed a significant negative correlation. In subgroup analysis, non-recovery group showed significantly higher TSH than recovery group.

Conclusions and significance: This study results showed that TSH level is negatively correlated to hearing gain in SSNHL. Our authors suggest the possibility of TSH being a prognostic factor for SSNHL treatment.

Background: Age-related hearing loss (ARHL) is a condition linked to cochlear degeneration influenced by genetic, environmental, and comorbid factors. Although oxidative stress and inflammation have been implicated in ARHL, their dynamic interplay during aging remains unclear.

Aims/objectives: This study aimed to clarify the temporal progression of oxidative and inflammatory mechanisms in cochlear degeneration using the C57BL/6 mouse model of ARHL.

Material and methods: C57BL/6 mice, characterized by a predictable auditory decline, were examined at 3, 6, and 12 months of age. Auditory brainstem responses (ABRs) were recorded to assess hearing thresholds and neural transmission efficiency. Morphological analyses were performed to evaluate neuronal integrity, while cochlear tissues were analyzed for markers of oxidative stress and inflammation, including 3-nitrotyrosine (3-NT), 4-hydroxynonenal (4-HNE), and tumor necrosis factor-alpha (TNF-α).

Results: With advancing age, mice exhibited a progressive elevation of hearing thresholds, reduced neural transmission efficiency, and loss of spiral ganglion neurons. Molecular analyses revealed increased 3-NT, 4-HNE, and TNF-α expression. Both oxidative stress and inflammation were detectable from 6 months of age, suggesting that these processes synergistically drive cochlear degeneration.

Conclusions and significance: Our findings underscore the role of oxidative stress-inflammation crosstalk in ARHL, suggesting therapeutic targets for preventing presbycusis in aging populations.

Background: Persistent unilateral Otitis Media with Effusion (OME) in adults is a recognised presenting feature of nasopharyngeal carcinoma (NPC). Currently, there is no guideline-driven consensus on the optimal investigation and management for this cohort.

Aim: This study aims to capture current approaches for the management of Persistent unilateral otitis media with effusion (OME) in adults among UK otolaryngologists.

Material and methods: An anonymised survey was developed and piloted locally among consultants at Sheffield Teaching Hospitals (STH) Trust before national distribution to ENT UK members via newsletters in November 2024 and January 2025. Responses from consultant and non-consultant grades were analysed.

Results: A total of 105 clinicians (45 consultants, 60 non-consultants) responded. Initial management varied, with intranasal steroids (48.6%), auto-inflation exercises (43.8%) and expectant management (37.7%) most common. MRI was requested selectively, mainly for abnormal nasendoscopic findings. Examination under anaesthesia was reserved for suspicious cases, and malignancy in a clinically normal nasopharynx was rarely reported.

Conclusions and significance: Significant variation in practice exists, highlighting the need for an evidence-based diagnostic pathway for suspected NPC that balances early disease detection with avoidance of unnecessary investigations.