Acta Oto-Laryngologica最新文献

Aims/objectives: To compare the surgical outcomes in relation to tympanic membrane regeneration therapy and myringoplasty for tympanic membrane perforation.

Material and methods: The present study comprised a total of 23 ears of tympanic membrane regeneration therapy and 8 ears of myringoplasty, as performed at our hospital between January 2022 and December 2024. Gender, age, anesthetic method, operative time, tympanic membrane perforation closure rate, and postoperative hearing improvement in ears with perforation closure were compared between the two groups.Furthermore, in the regenerative therapy group, postoperative satisfaction was subjectively assessed using the Visual Analog Scale (VAS).

Results: In comparison with tympanoplasty, tympanic membrane regeneration therapy demonstrated a statistically significant reduction in operative time. However, no other statistically significant differences were observed. The VAS results indicate an average hearing improvement of 62.7, and an average overall satisfaction with the surgery of 77.5.

Conclusions and significance: Regenerative therapy has the potential to become a new treatment option because it is less invasive than myringoplasty.

Aims/objectives: To identify strategies that minimize adverse tissue reactions, reduce reimplantation difficulty, and maximize success rates.

Material and methods: In a retrospective cohort study of 77 cochlear reimplantations, patients were stratified into packing or non-packing groups based on material presence at reimplantation. Baseline characteristics, intraoperative findings, and prognostic outcomes were analyzed and compared.

Results: Statistically significant differences were observed between the packing and non-packing groups regarding the presence of fibrous adhesion within the mastoid cavity (p = 0.016), facial recess bone hyperplasia (p < 0.001), granulation tissue formation (p < 0.001), cochlear ossification (p < 0.001), and the need for cochleostomy re-expansion (p = 0.001). The mean Categories of Auditory Performance score was lower in the packing group (4.75) compared to the non-packing group (5.16); however, this difference was not statistically significant (p = 0.192).

Conclusions and significance: Residual packing materials from primary CI increase intraoperative complexity during revision surgery, potentially compromising procedural success. Minimizing non-essential packing material use during initial implantation is strongly recommended to facilitate future revisions.

Background: Neoadjuvant chemotherapy (NAC) followed by surgery (NAC + S) may enable treatment de-escalation in HPV-positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC).

Objective: To evaluate oncologic outcomes and the potential to omit adjuvant therapy in patients undergoing NAC + S compared to upfront surgery.

Methods: This retrospective study included 400 HPV+ OPSCC patients treated with surgery between 2005 and 2020. Of these, 121 received NAC prior to surgery, and 279 underwent upfront surgery. Clinical, pathological, and survival outcomes were compared. Propensity score matching (PSM) was used to adjust for baseline differences.

Results: The NAC group had higher negative margin rates (78.5% vs. 68.8%) and lower rates of lymphovascular invasion (19.0% vs. 34.0%) and extranodal extension (25.6% vs. 47.7%). Adjuvant therapy was less frequent in the NAC group (59.5% vs. 78.1%). After PSM, 5-year recurrence-free and disease-specific survival did not differ significantly. Among 62 NAC patients with no adverse pathological features, 43 omitted adjuvant therapy and remained disease-free.

Conclusion: NAC + S achieved comparable survival outcomes to upfront surgery and allowed omission of adjuvant therapy in selected patients, supporting its role in treatment de-intensification for HPV+ OPSCC.

Background: The incidence of symptomatic otosclerosis (SOS) in China is unknown, which is detrimental to the public health policy and physician training.

Aims/objectives: To estimate the incidence and clinicoepidemiological features of SOS in Shanghai.

Material and methods: Outpatient SOS incidence data were derived from hospital records in Shanghai capable of performing otosclerosis surgery. The total number of SOS patients was calculated using the proportion of outpatients in our hospital and other hospitals in Shanghai. Also, the clinic epidemiological features were studied using 1,147 SOS surgical inpatients in our hospital.

Results: The incidence of SOS was 2.5 per 100,000 persons, which appeared to be increasing. The increased severity of the lesion shown by CT is related to several preoperative symptoms including tinnitus and bilateral incidence and pregnancy-related complaints (female only) in SOS patients. Moreover, 72.8% of SOS patients could be accurately diagnosed at their first visit.

Conclusions and significance: Our results estimated the possible incidence of SOS in Shanghai for the first time, providing a conservative incidence in China. Based on our results, stapes surgery remains an important part of advanced ear surgery training in hospital. However, the accuracy of initial SOS diagnosis can be further improved clinically.

Background: Sensorineural hearing loss is the most common sensory disorder, and more than 50% of congenital cases are genetic. For decades, clinical management has relied largely on prosthetic devices such as hearing aids and cochlear implants, which improve audibility but do not restore native cochlear biology.

Aims: To review how advanced biological therapies-especially inner-ear gene therapy-have evolved from animal proof-of-concept to first-in-human trials. To summarize the progression of therapeutic strategies (gene replacement, antisense oligonucleotides, genome/RNA editing) and the technological hurdles that had to be cleared.

Material and methods: We surveyed preclinical studies in rodents and non-human primates and analyzed advances in delivery vectors high-efficiency AAVs for various inner-ear cell types, and surgical administration routes validated in adult and primate models. We also review published clinical data from AAV-mediated OTOF gene therapy trials.

Results: Highly efficient viral vectors can now transduce multiple cell types in the cochlea. Safe, increasingly standardized surgical routes have been established in the primate inner ears. Novel platforms for dominant mutations and oversized genes are maturing. Critically, AAV-OTOF gene therapy has restored hearing in congenitally deaf children with DFNB9.

Conclusions and significance: Inner-ear gene therapy has moved from an experimental concept to a clinically validated treatment. AAV-OTOF success opens the door to extending gene therapy to a broad spectrum of auditory and vestibular disorders, heralding a new era of restorative medicine for deafness.

Background: Children with prelingual profound sensorineural hearing loss (SNHL) and inner ear malformations (IEM), including cochleovestibular nerve anomalies, present complex and challenging cases during cochlear implantation. Intraoperative objective assessments, such as the electric auditory brainstem response (eABR), provide crucial information on auditory pathway integrity during surgery.

Aims/objectives: To evaluate a novel intraoperative eABR paradigm in children with IEM and compare the findings with those from children with normal inner ear anatomy.

Material and methods: Nineteen cochlear implant candidates (11 with IEM, 8 with normal anatomy) underwent implantation following comprehensive preoperative imaging and audiological evaluation. Under general anesthesia, intraoperative eABR was recorded using three stimulation paradigms, namely: external promontory (ePEABR), internal promontory (iPEABR), and intracochlear (iEABR). The presence, latency, amplitude, and threshold of Waves III and V were analyzed.

Results: ePEABR responses were observed in 45.5% of IEM and 37.5% of normal cases, with elevated thresholds and frequent artifacts. iPEABR responses were detected in all patients, showing consistent latency patterns. iEABR elicited robust responses in all pateints . Latencies shortened and amplitudes increased as stimulation approached the cochlear nerve.

Conclusions and significance: Intraoperative iPEABR is feasible and provides valuable objective information on auditory pathway function in children with IEM, supporting surgical decision-making during cochlear implantation.

Background: Supraglottic squamous cell carcinoma (SGSCC) represents the second most prevalent form of laryngeal cancer and carries a poor prognosis.

Aims/objectives: This study aimed to combine clinicopathological and treatment-related factors as integrative inputs to build a machine learning (ML) model to estimate the overall survival (OS) of patients with early-stage SGSCC. Furthermore, we explored the complementary prognostic potential of these input parameters.

Material and methods: A total of 1171 patients with SGSCC were extracted from Surveillance, Epidemiology, and End Results (SEER) public data. We used feature importance analysis to examine the integrative inputs that are associated with OS.

Results: The ML model showed a weighted accuracy of 72.3% in predicting OS. The aggregate feature importance showed that age at diagnosis, marital status, number of malignancies, regional lymph nodes, and radiotherapy are the five most important features for enhancing OS among these patients. We found that as age increases, the chance of OS decreases. Being married, the absence of other primary indicators, surgical treatment, and radiotherapy were associated with improved OS.

Conclusions and significance: Combining clinicopathological and treatment-related factors seems to predict accurately OS in patients with early-stage SGSCC. External independent geographic validation is warranted to evaluate model generalizability.

Background and aims: To investigate the heterogeneity of mental health among patients of chronic rhinosinusitis with nasal polyps (CRSwNP), and further look into the relationship between mental health, disease severity, and quality of life.

Methods: Patients with CRSwNP were investigated using the General information questionnaire, Lund-Mackay score (LMS), 22-item Sino-Nasal Outcomes Test (SNOT-22), 14-item Perceived Stress Scale (PSS-14), as well as Hospital Anxiety and Depression Scale (HADS). Latent profile analysis was applied to investigate the heterogeneity of mental health in CRSwNP patients. Multivariate logistic regression was utilized to analyze the influencing factors of different profiles.

Results: 185 patients with CRSwNP were enrolled, including 105 males (56.8%) and 80 females (43.2%), and mean (SD) age was 46.31 (14.41). Three potential profiles of mental health were identified, including 'positive group' (30.3%), 'stable group' (30.8%), and 'negative group' (38.9%). Disease severity was associated with different groups of mental health. Patients with higher disease severity and having a history of systemic steroid use are more likely to be categorized in the 'stable group' and 'negative group'. The total scores and various domains (rhinology symptoms, extra-nasal rhinologic symptoms, ear/facial symptoms, psychological dysfunction, and sleep dysfunction) scores of quality of life are significantly different among the groups.

Conclusions: Three potential profiles of mental health in patients of CRSwNP were identified. Severity contributes to the heterogeneity of mental health, and quality of life is associated with mental health. Clinical caregivers could give targeted interventions to improve patients' quality of life through characteristics of mental health and severity.

Background: The three-dimensional (3D) exoscope is an emerging alternative to the operating microscope (OM) in otologic surgery.

Aims: To assess its clinical utility in cholesteatoma surgery.

Methods: Retrospective review of 36 primary cases (21 OM, 15 exoscope) comparing setup time, surgical duration, audiological outcomes, and recurrence.

Results: Groups were comparable in background and stage. Setup time was shorter with exoscope (microscope: 20 min, range 18-22, exoscope: 17 min, range 14-20) (p = .002), while other outcomes showed no significant difference.

Conclusions: The 3D exoscope reduced setup time with equivalent surgical and functional outcomes to OM.

Background: Vestibular neuritis (VN) is characterized by a sudden spontaneous vertigo without any other associated neurological signs, while the underlying mechanism of VN remains unclear.

Objectives: We aimed to investigate the regulation of the peripheral Th1 and Th2 balance and changes in related cytokines and clarify the possible dominance of immuno-inflammatory reaction in VN.

Material and methods: Patients diagnosed with VN from symptom onset and age-and gender-matched healthy controls were recruited. The peripheral blood levels of cytokines and C-reactive protein (CRP) were determined and analyzed.

Results: A total of participants that included 74 VN patients and 116 controls were included. No statistically significant differences were found in body mass index (BMI), comorbidities between both groups (p > 0.05). The levels of plasma IL-2 and IFN-γ in patients with VN were significantly lower when compared with the healthy control subjects (p < 0.05).

Conclusions and significance: There was an imbalance in the expression of Th1 and Th2 cytokines in patients with VN and it do not support the profound involvement of systemic inflammatory components in VN pathophysiology.