Acta Oto-Laryngologica最新文献

Background: Otosclerosis is a primary osteodystrophy of the otic capsule that causes conductive or mixed hearing loss. High-resolution computed tomography (HRCT) is the preferred imaging tool, but its sensitivity varies and depends on radiologist expertise. Artificial intelligence (AI) may improve diagnostic accuracy by identifying subtle features.

Objective: To evaluate the diagnostic accuracy of a convolutional neural network (CNN) in detecting otosclerosis on temporal bone CT scans.

Methods: This retrospective study included CT scans from 53 surgically confirmed otosclerosis patients and 36 healthy controls. After augmentation, the dataset comprised 74 otosclerosis and 74 control images. A CNN with three convolutional layers, dropout, and a fully connected dense layer was developed. Model performance was assessed using accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve (AUC).

Results: The CNN achieved 98% training and 87.5% maximum validation accuracy. In validation, sensitivity was 80.0%, specificity 84.6%, precision 85.7%, F1-score 82.8%, and AUC 0.847. Learning curves showed stable convergence without overfitting.

Conclusion and significance: AI-based CT analysis demonstrated promising diagnostic performance in otosclerosis, especially in cases initially reported as normal. Integration of AI into otologic imaging may enhance diagnostic reliability, surgical planning, and patient management.

Background: No randomized trials confirm the efficacy of concurrent chemoradiotherapy (CCRT) in platinum-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) post-induction chemotherapy (IC).

Objectives: This study evaluates the efficacy of platinum-based versus taxane-based CCRT after IC in LAHNSCC patients, excluding nasopharyngeal carcinoma, to assess the viability of taxanes as a platinum alternative.

Materials and methods: A retrospective analysis was conducted on 215 LAHNSCC patients treated with IC using nab-paclitaxel/docetaxel, cisplatin, and fluorouracil (AP/APF or TP/TPF). During CCRT, patients were divided into platinum and taxane groups. Survival rates, and safety profiles of nab-paclitaxel versus docetaxel were compared. All patients received Helical tomotherapy and Intensity-modulated radiotherapy at 60-70 Gy.

Results: No significant differences were observed in CR rates, 3-year progression-free survival (PFS) (75.2 vs. 84.8%), or overall survival (OS) (72.1 vs. 84.1%) between taxane and platinum groups. Within the taxane group, CR rates and 3-year PFS showed no significant difference. However, the nab-paclitaxel group demonstrated significantly improved 3-year OS (80.9 vs. 67.6%) and disease-specific survival (DSS) (94.09 vs. 70.72%) compared to the docetaxel group.

Conclusions: Taxane-based CCRT after IC is as effective as platinum-based treatment with manageable toxicity. Nab-paclitaxel surpassed docetaxel in 3-year OS and DSS.

Background: Cochlin-tomoprotein (CTP) has recently emerged as a promising diagnostic marker for perilymphatic fistula (PLF), but its utility beyond diagnosis remains unclear.

Aims/objectives: We aim to clarify whether CTP levels could help to predict prognosis, treatment efficacy and initial symptoms for PLF.

Material/methods: This retrospective study included 20 patients with acute sensorineural hearing loss who underwent CTP testing.

Results: Among cases of PLF (CTP levels ≥30 ng/mL), higher CTP levels were significantly associated with poorer improvement of hearing. However, the patients with PLF showed better improvement of hearing than those without PLF. When using a level of CTP <25 ng/mL, the surgical intervention group showed better improvement of hearing than the conservative treatment group. The patients presenting progression of hearing loss (≥10 dB) showed significantly higher levels of CTP. Receiver operating characteristic curve analysis revealed that a cut-off level of CTP 26.9 ng/mL predicted hearing improvement ≥15 dB with an AUC of 0.85 (95% CI: 0.68-1.00, p = 0.0335), yielding a sensitivity of 68.8% and a specificity of 100%.

Conclusion: The current proposal of CTP ≥30 ng/mL or nearby levels can be used not only as a diagnostic marker, but also as an indicator for initial symptoms and prognosis.

Background: Bilateral vestibulopathy (BVP) is a rare disorder that markedly reduces quality of life through impaired vestibulo-ocular reflex and related symptoms.

Aims/objectives: This study aimed to describe the etiological features of BVP and assess functional outcomes using subjective and objective tools.

Material and methods: A retrospective review was conducted in 31 patients with BVP. Demographic data, etiologies, and comorbidities were analyzed. Functional outcomes were evaluated with Dizziness Handicap Inventory (DHI) and video Head Impulse Test (vHIT). Statistical analyses examined correlations between these measures.

Results: The mean age was 55 ± 16 years. Idiopathic cases comprised 19.4%, while ototoxicity was the most frequent cause (41.9%), mainly aminoglycosides (29%). Advanced age and comorbidities were risk factors for ototoxicity. Mean DHI score was 59 ± 21, with highest scores in ototoxic cases. Mean vHIT gains were 0.37 ± 0.17 (right) and 0.36 ± 0.20 (left), with lowest values in ototoxicity. A significant negative correlation existed between vHIT gains and DHI scores (r=-0.616, p < 0.001).

Conclusions and significance: In our retrospective cohort, ototoxic medications appear to be the leading cause of BVP, especially among older patients with comorbidities. The inverse relationship between vHIT and DHI highlights the need to integrate both assessment methods for comprehensive evaluation. These findings emphasize ototoxicity awareness and validate complementary use of objective and subjective assessments.

Background: Tinnitus is a common symptom in patients of chronic otitis media (COM), but data regarding its dynamics after middle ear surgery is limited. Furthermore, the mechanism of new-onset tinnitus post-surgery surgery remains unclear.

Aim: To analyze postoperative tinnitus changes and contributing factors in COM patients.

Materials and methods: Clinical statistics were collected from 55 COM patients. Tinnitus severity was evaluated using the tinnitus handicap inventory (THI) and visual analogue scale (VAS) preoperatively and follow-up points (7 days, 1 month and 6 months postoperatively). Statistical analysis was performed.

Results: Among 28 patients with preexisting tinnitus, 20 cases (71.43%) reported tinnitus improvement 6 months post-surgery. THI scores, along with emotional and catastrophic subscale scores, were significantly reduced (p < 0.05). Among the 27 patients without preoperative tinnitus, 8 (29.6%) developed transient new-onset tinnitus, which resolved completely within 3 months. Patients of new-onset tinnitus showed better preoperative hearing thresholds than those without new-onset tinnitus (p < 0.05). No significant predictors were identified for the improvement of preexisting tinnitus.

Conclusion and significance: Surgery alleviates preexisting tinnitus in most COM patients, especially reducing emotional burden. Patients developing new-onset tinnitus exhibit better preoperative hearing, potentially due to transient conductive hearing loss.

Background: Recently, Hydrops MRI has unexpectedly identified endolymphatic hydrops (EH) in patients presenting with profound sensorineural hearing loss (SNHL), highlighting a discrepancy that prompted further investigation.

Objective: This study aimed to elucidate the mechanism of profound SNHL in ears with EH.

Methods: Six (3%) of 184 patients with positive EH on Hydrops MRI presented with profound SNHL. Three of 6 patients had been previously diagnosed as Meniere's disease, and 4 patients were compromised hosts. All patients underwent an inner ear test battery followed by Hydrops MRI.

Results: The prevalence of EH at the cochlea and vestibule was identified in 67% and 42% of the ears, respectively. Three (50%) out of 6 patients experienced a short interval of 1-2 months between the onset of profound SNHL in both ears, which was associated with superimposed infection. In contrast, another three patients (50%) had a longer interval of 5-8 years, attributed to delayed EH.

Conclusion: Profound SNHL in ears with EH suggests two potential mechanisms: a short interval (1-2 months) between onset in both ears points to a pre-existing hydrops ear further compromised by a superimposed infection, whereas a longer interval (5-8 years) indicates the development of delayed EH.

Background: The clinical influence of COVID-19 on patients with oropharyngeal squamous cell carcinoma (OPSCC) in Denmark is unclear.

Aims: To investigate the impact of COVID-19 on frequency of diagnosed cases, treatment regimens, time to treatment (TTT), and prognosis for OPSCC patients in Eastern Denmark.

Materials and methods: All patients with OPSCC in Eastern Denmark during COVID-19 lockdown periods in 2019 and 2020 were included. Primary outcomes were TTT and changes in treatment regimens. Secondary outcomes were three-year overall survival (OS), three-year recurrence-free interval (RFI), and pattern of recurrence.

Results: Two hundred and ninety-seven patients were included. Most patients received chemoradiotherapy (CRT), with 82% in the COVID-19 period vs. 70% in the non-COVID-19 period, p = 0.06. Primary surgery was allocated to 7% in the COVID-19 period vs. 11% in the non-COVID-19 period, p = 0.06. The TTT was significantly shorter for primary surgery during the pandemic (20 vs. 28 days, p = 0.04). No differences in three-year OS or three-year RFI were observed.

Conclusions and significance: We found a significantly decreased TTT for primary surgery during the pandemic alongside a notable decline in primary surgery and a corresponding increase in CRT. Lockdown periods of the COVID-19 pandemic did not impact the frequency or prognosis of OPSCC in Eastern Denmark.

Background: In patients with clinically non-metastatic (N0) oral tongue squamous cell carcinoma (OTSCC), occult metastases remain a critical determinant of survival.

Aims/objectives: This study evaluates sentinel lymph node biopsy (SLNB) utilizing dual ICG fluorescent and 99mTc radioactive tracers as a less invasive technique to detect lymphatic dissemination, compared to elective neck dissection. The primary objective was to determine the sensitivity and negative predictive value of SLNB. Secondary objectives included characterizing the distribution of sentinel nodes (SNs) and metastases and to assess recurrence rates.

Material and methods: 40 consecutive T1-T3N0 OTSCC (C02.1) patients underwent SLNB followed by ipsilateral modified neck dissection. All patients had a minimum follow-up of 24 months.

Results: The study demonstrated a sensitivity of 92.3% (95% CI: 66.7-98.6%) and a negative predictive value of 96.4% (95% CI: 82.3-99.4%) for SLNB. In 53% of the cases, SNs were identified outside of ipsilateral levels 1-3, with 13% in the contralateral neck. Metastatic involvement of SNs outside ipsilateral levels 1-3 occurred in 42% of cases, and contralateral metastases in 8%. The overall recurrence rate was 13%, with isolated regional recurrence in 2% of patients.

Conclusions and significance: The results suggest that SLNB with combined tracers is an accurate and reliable alternative to neck dissection for evaluating lymphatic spread in early-stage OTSCC.

Background: Chronic otitis media and tympanic membrane perforations are common indications for tympanoplasty, where the choice of middle ear packing material critically influences graft survival, hearing restoration, and postoperative complications.

Objective: To systematically compare the efficacy and safety of different middle ear packing materials-including platelet-rich fibrin (PRF), hyaluronic acid (HA), Gelfoam, fat, and ciprofloxacin-soaked packing-on tympanoplasty outcomes.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Embase, and Cochrane Library were searched (2019-2025) for RCTs and cohort studies comparing packing materials in tympanoplasty. Data extraction and quality assessment were performed independently by two reviewers using Covidence, applying the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted using RevMan 5.4.

Results: Fifteen studies met inclusion criteria. PRF achieved the highest graft success (93.7%), with HA offering superior hearing improvement (mean ABG closure: 15.2 dB). Both PRF and HA were associated with significantly fewer complications compared to Gelfoam or fat. Bacterial cellulose showed promise for small perforations. Substantial heterogeneity was observed in studies using traditional materials.

Conclusion: PRF and HA are superior to traditional packing materials in tympanoplasty, optimising graft survival and functional outcomes. Evidence-based selection of biologically active materials is recommended to improve patient care, with further research needed to standardise protocols and confirm long-term benefits.

Background: Post-tonsillectomy pain is one of the most common morbidities in children, markedly affecting comfort and recovery. Although several factors influencing pain have been explored, the role of tonsil volume remains unclear.

Aims/objectives: To investigate the relationship between objectively measured tonsil volume and postoperative pain in pediatric tonsillectomy.

Material and methods: This prospective observational study included 150 children aged 4-12 years who underwent bilateral cold-dissection tonsillectomy. Tonsil volume was measured intraoperatively by the water-displacement method. Patients were divided into three groups by total tonsil volume. Postoperative pain was assessed using the Wong-Baker Faces Pain Rating Scale (WB) and the Parents' Postoperative Pain Measure (PPPM) at 1, 6, and 24 h and on postoperative days 3 and 7. Correlations were analyzed with Spearman's test.

Results: Pain scores differed significantly among groups. The largest-volume group showed the highest PPPM scores at all time points (p < 0.001). The strongest correlation occurred between tonsil volume and PPPM scores at 6 h (r = 0.65, p < 0.001), while WB scores on day 7 correlated moderately (r = 0.41, p < 0.001).

Conclusions: Tonsil volume is positively correlated with postoperative pain after pediatric tonsillectomy.

Significance: Objective volumetric assessment offers greater predictive value than subjective grading and may guide individualized analgesic and counseling strategies.