Acta Oto-Laryngologica最新文献

Background: Recent advances in artificial intelligence have facilitated the automatic diagnosis of middle ear diseases using endoscopic tympanic membrane imaging.

Aim: We aimed to develop an automated diagnostic system for middle ear diseases by applying deep learning techniques to tympanic membrane images obtained during routine clinical practice.

Material and methods: To augment the training dataset, we explored the use of generative adversarial networks (GANs) to produce high-quality synthetic tympanic images that were subsequently added to the training data. Between 2016 and 2021, we collected 472 endoscopic images representing four tympanic membrane conditions: normal, acute otitis media, otitis media with effusion, and chronic suppurative otitis media. These images were utilized for machine learning based on the InceptionV3 model, which was pretrained on ImageNet. Additionally, 200 synthetic images generated using StyleGAN3 and considered appropriate for each disease category were incorporated for retraining.

Results: The inclusion of synthetic images alongside real endoscopic images did not significantly improve the diagnostic accuracy compared to training solely with real images. However, when trained solely on synthetic images, the model achieved a diagnostic accuracy of approximately 70%.

Conclusions and significance: Synthetic images generated by GANs have potential utility in the development of machine-learning models for medical diagnosis.

Background: Recurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease.

Aims: We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome.

Methods: Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics.

Results: Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment.

Conclusion: Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics.

Background: Cochlear implants (CI) help regain perception of sound for patients with sensorineural hearing loss. The ability to recognize music pitch may be crucial for recognizing and producing speech for Mandarin.

Aims/objectives: This study aims to search for possible influencing factors of music perception and correlations between music perception and auditory speech abilities among prelingually deaf pediatric Mandarin-speaking CI users.

Material and methods: Music perception of 24 pediatric CI users and 12 normal hearing children was measured using the MuSIC test. Auditory speech perception of the 24 CI users was also measured and analyzed with their music perception results.

Results: Pediatric CI users performed worse than normal hearing children in pitch, rhythm and melody discrimination tests (p < .05). Significant difference in pitch and melody discrimination tests between age at implantation <5 and >5 groups was found. There were significant correlations between perception of consonants, tones, and speech in a noisy environment and perception of music pitch and melody.

Conclusion and significance: Prelingually deaf pediatric CI users who received implantation before the age of five perform better in music perception tests. Pediatric CI users with better music perception show better auditory speech perception of Mandarin.

Background: There are two types of central auditory disorders due to pathology of the bilateral auditory cortices in adult patients: auditory agnosia with residual hearing; cortical deafness with total hearing loss. However, long-term changes of hearing acuity over physical development time are unknown.

Objective: The aim of this case report was to illustrate the pathophysiology of auditory changes in a 1 year-3 months old child who was diagnosed with auditory agnosia as a sequel of herpes encephalitis and later developed cortical deafness during a 36-year follow-up.

Materials and methods: Brain MRI, hearing tests, ABR, DPOAE and developmental tests of speech/language were periodically performed.

Results: Brain imaging revealed extensive damage in the bilateral auditory cortices. His auditory speech perception was lost and his language development was seriously delayed. His hearing threshold progressively decreased over time from normal at first to profound hearing loss as a teenager. However, at 29 years of age his ABR was normal. He was able to communicate and converse by sign language or writing.

Conclusions and significance: Later developing cortical deafness with profound hearing loss could be caused by retrograde degeneration of the auditory radiation overtime to the bilateral medial geniculate bodies.

Background: Cochlear implants are standard of care for the patients with sensorineural hearing loss not benefited from hearing aids.

Aims: Evaluate qualitatively the impact of cochlear implantation in the long-term.

Materials-methods: Thirty middle-class patients with similar patterns of loss and social environment averaging 20 years post-implantation responded to 52 questions that evaluated psychosocial benefits from cochlear implantation.

Results: All completed secondary education and 93% had postgraduate studies. Educational and workwise they are at the same level as their hearing counterparts. All use their cochlear implants and would recommend one to people who need it. They attribute their success to the implant, the rehabilitation program, their family, and a stimulating social environment. Despite their success, most experience difficulties relating with others (socially and at work) due to their hearing condition. They manage but work much harder than their hearing peers to achieve the same.

Conclusions: We made a difference in the lives of these patients, however, there is more to be done.

Significance: Early intervention, rehabilitation, plus family, and stimulating-environment are crucial in children with sensory deficits.

Background: Currently, there is a ‌paucity of research‌ comparing the clinical characteristics and repositioning efficacy between ‌posterior canal-benign paroxysmal positional vertigo-canalolithiasis (PC-BPPV-ca)‌ and ‌posterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu)‌.

Aims/objectives: To observe the clinical characteristics and compare the efficacy of repositioning maneuvers between PC-BPPV-ca and PC-BPPV-cu patients.

Material and methods: Clinical information of patients was collected. The G-Force BPPV diagnostic apparatus was used to simulate dizziness handicap inventory (DHI) positional test, and the therapeutic effects, DHI, and sentiment indicators of baseline, and 1-week and 1-month treatment were compared.

Results: A total of 92 patients were collected, with 46 cases in each group, and PC-BPPV-cu patients were with the longer disease course and have worse sleep quality than that of PC-BPPV-ca patients. Moreover, the PC-BPPV-cu patients had a shorter latency of nystagmus and a greater intensity of nystagmus (p < .05); however, PC-BPPV-ca patients experienced higher proportion of reverse nystagmus. In terms of repositioning efficacy, the PC-BPPV-cu group had poorer initial efficacy compared to the PC-BPPV-ca group (p < .05).

Conclusions: PC-BPPV-cu patients exhibit more extended disease duration, diminished sleep quality, and pronounced nystagmus. Additionally, they tend to experience less effective initial repositioning treatments and continue to present with more pronounced residual depressive symptoms.

Background: Squamous cell carcinoma (SCC) of the temporal bone (TB) is a rare pathology originating from the external auditory canal (EAC). Surgery remains the gold standard to achieve local control.Aims/Objectives:The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) after surgery of the SCC of EAC.

Material and methods: A retrospective chart review in a tertiary referral center included 26 patients: 23 were operated with lateral temporal bone resection (LTBR, n = 10) and extended temporal bone resection (ETBR, n = 13). The outcomes were OS and DFS.

Results: Adjuvant radiotherapy was performed in 91.3% (n = 21/23). Mean age was 60.8 and sex ratio was 1. Median follow-up was 43 months; The 5-years OS was 90% (± 9.5%) and 47.7% (± 12.9%) for stage I/II and III/IV respectively (p = .033). DFS was 67.6% (IC 95%, 51.4%-88.9%) without statistical difference between early advanced stage. Incomplete margins (p = .004) and Stage IV(p < .001) were associated with poorer DFS. Free margins significantly correlated with better OS (HR = 9.8, p = .04).

Conclusion: En bloc surgical resection with free margins, coupled with postoperative radiotherapy, provides optimal local control. For stage IV tumors, where complete margins are achievable, ETBR is recommended to enhance local control.

Background: The early diagnosis of glottic laryngeal cancer is the key to successful treatment, and machine learning (ML) combined with narrow-band imaging (NBI) laryngoscopy provides a new idea for the early diagnosis of glottic laryngeal cancer.

Objective: To explore the clinical applicability of the diagnosis of early glottic cancer based on ML combined with NBI.

Material and methods: A retrospective study was conducted on 200 patients diagnosed with laryngeal mass, and the general clinical characteristics and pathological results of the patients were collected. Chi-square test and multivariate logistic regression analysis were used to explore clinical and laryngoscopic features that could potentially predict early glottic cancer. Afterward, three classical ML methods, namely random forest (RF), support vector machine (SVM), and decision tree (DT), were combined with NBI endoscopic images to identify risk factors related to glottic cancer and to construct and compare the predictive models.

Results: The RF‑based model was found to predict more accurately than other methods and have a significant predominance over others. The accuracy, precision, recall and F1 index, and AUC value of the RF model were 0.96, 0.90, 1.00, 0.95, and 0.97.

Conclusions and significance: We developed a prediction model for early glottic cancer using RF, which outperformed other models.

Background: Single-nucleotide polymorphisms (SNPs) of the NF-E2-related factor 2 (NRF2) gene might be associated with several diseases. In the animal models, NRF2 has been reported to be associated with the age-related hearing loss (ARHL). However, the effect of NRF2 SNPs on ARHL in the general population has not been reported.

Objectives: This study aimed to evaluate the effect of NRF2 SNP-617 on ARHL in the general Japanese population.

Methods: This study included participants from the Iwaki Health Promotion Project. The genotypes of NRF2 SNP-617 were determined via whole-genome sequencing, and the hearing level of the CC homozygote + CA heterozygote carrier group was compared with that of the AA homozygote carrier group.

Results: Among the 306 CC+CA and 31 AA group male subjects, 22 (7.2%) and six (19.4%), respectively, had hearing loss, with a significant difference. Multiple logistic regression analysis showed that the risk of hearing loss in the male subjects was significantly higher in the AA group than that in the CC+CA group (p = .031, odds ratio = 3.437, 95% confidence interval = 1.116-10.580).

Conclusion: The genotypes of NRF2 SNP-617 AA carriers were significantly associated with the development of ARHL among the males aged 30-59 years.

Background: Infection with human papillomavirus (HPV) low-risk type 6 and 11 in the respiratory tract can cause recurrent benign squamous papillomas in the larynx, in children, juvenile-onset recurrent respiratory papillomatosis (JoRRP).

Objectives: This systematic review investigated the impact of national HPV vaccination programs on JoRRP incidence and prevalence.

Methods: PubMED was systematically searched for publications between 2010 and March 2024 that assessed the incidence and prevalence of JoRRP post-implementation of HPV vaccination programs.

Results: Four studies met the inclusion criteria, comprising 622 patients with JoRRP (range 15-576) from Australia, New Zealand and the Unites States. The majority were girls (F:M ratio 2:1), with a median debut age between three to four years. Two studies (n = 591) showed a significant decline in JoRRP incidence after vaccination from 2,0 per 100,000 < 18 years (2004-2005) to 0,5 per 100,000 < 18 years (2012-2013) in the United States, and 0,16 per 100,000 < 15 years (2012) to 0,02 per 100,000 < 15 years (2016) in Australia. Higher vaccination coverage correlated with a reduced JoRRP burden.

Conclusion: Our findings indicate implementation of HPV-vaccination programs reduced the JoRRP incidence and prevalence emphasizing the importance of large-scale HPV vaccination. Total impact of HPV vaccination will become fully evident when the vaccinated population reach childbearing ages.