Acta Oto-Laryngologica最新文献

Background: MicroRNAs play a critical role in laryngeal carcinogenesis, yet their stage-dependent dysregulation in tumor and peritumoral mucosa remains unclear.

Objectives: To evaluate expression of miR-144 and miR-145 in tumor and peritumoral mucosa of early- and advanced-stage laryngeal carcinoma, and assess their association with stage progression and field cancerization.

Methods: Expression levels of miR-144 and miR-145 were analyzed by qPCR in tumor and matched peritumoral mucosa from 91 patients (26 early-stage glottic and 60 advanced-stage laryngeal carcinomas).

Results: In early-stage tumors, miR-144 was downregulated in 32% and miR-145 in 36% of cases, with a subset showing upregulation. Peritumoral mucosa displayed similar dysregulation. Distinct stage-associated patterns emerged: peritumoral miR-144 was significantly reduced in advanced versus early disease (p = 0.013), whereas tumor miR-145 was significantly lower in advanced tumors (p = 0.004). No stage-related differences were detected for tumor miR-144 or peritumoral miR-145. miR-144 and miR-145 expression correlated moderately in both compartments (ρ = 0.40 tumor; ρ = 0.37 peritumor). ROC analysis revealed modest discriminatory potential (AUC 0.62-0.64).

Conclusions: miR-144 and miR-145 exhibit distinct, stage-dependent dysregulation in laryngeal carcinoma. Tumor miR-145 and peritumoral miR-144 alterations support a dynamic model of field cancerization, suggesting potential biomarker roles in disease progression and risk assessment.

Background: Age-related immunosenescence, also known as 'inflammageing', may impact the elderly's ability to mount immune responses against cancers and compromise the effectiveness of immune checkpoint inhibition (ICI). In this context, data on tonsillar cancer (TC), a subset of head and neck squamous cell cancer (HNSCC), are lacking.

Aims/objectives: To compare the presence/distribution and features of immune cells in TC, and of bulk RNA-seq in HNSCC, between the young and the elderly.

Material and methods: TC tissue microarrays (TMAs) characterised by GeoMx digital spatial profiling were revisited and analysed, focusing on quantification and location of CD8⁺ and CD11c⁺ immune cells. De novo analyses of the TMAs targeted CD68⁺/CD163⁺ macrophages. Bulk RNA-seq and clinical data from patients with HNSCC were sourced from the Cancer Genome Atlas (TCGA). For all data, patients were stratified into age groups.

Results: Immune-cell characteristics in TC were similar across young and elderly individuals, although the elderly exhibited higher PD-1 levels. TCGA data revealed increased immune checkpoint molecules PD-L1 and LAG-3 in the elderly, alongside immunosuppression.

Conclusion and significance: In the elderly, key immune cells are present in TC, and immune checkpoint molecules are overexpressed. This may be relevant to the stratification of patients for ICI.

Background: Primary squamous cell carcinoma (SCC) of the major salivary glands is a rare malignancy with poor prognosis. Histological variants may differ in clinical presentation and outcomes.

Objectives: To clarify the clinicopathological features and prognostic impact of SCC variants in the major salivary glands using a large population-based dataset.

Patients and methods: We analysed 3581 patients with primary salivary gland SCC. Variants included conventional SCC, lymphoepithelial carcinoma (LEC), basaloid SCC (BSCC), and spindle cell carcinoma (SpCC). Overall survival (OS) and disease-specific survival (DSS) were evaluated by the Kaplan-Meier method and Cox regression analyses.

Results: Conventional SCC accounted for 92.7% of cases, followed by LEC (3.7%), BSCC (1.7%), and SpCC (1.3%). The 5-year OS rates were 39.0% for conventional SCC, 76.4% for LEC, 51.5% for BSCC, and 41.8% for SpCC (p < 0.001). The corresponding DSS rates were 60.0%, 85.6%, 62.7%, and 64.9% (p < 0.001). In multivariate analysis, LEC was independently associated with superior survival, with hazard ratios of 0.50 (95% confidence interval (CI) 0.36-0.71) for OS and 0.46 (95% CI 0.28-0.74) for DSS, whereas BSCC and SpCC showed outcomes comparable to conventional SCC.

Conclusions: Histological variant is a significant prognostic factor in salivary gland SCC. LEC showed favourable survival.

Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder causing transient episodes of vertigo. While canalith repositioning maneuvers are effective, the influence of physical activity levels on treatment response remains unclear.

Aims/objectives: To examine the correlation between post-maneuver benefit and physical activity frequency in BPPV patients.

Material and methods: Sixty-six patients diagnosed with BPPV at Başkent University Audiology Clinic were included. The International Physical Activity Questionnaire (IPAQ) and Physical Activity Habit Assessment Questionnaire (PAHAQ) were used to assess physical activity over the past week and year, respectively. Canalith repositioning maneuvers were repeated until full recovery. Significance was set at p < 0.05.

Results: No significant association was found between maneuver count and IPAQ scores. However, PAHAQ scores were significantly lower in patients requiring multiple maneuvers, suggesting that long-term physical inactivity may impact treatment response.

Conclusions and significance: Short-term activity did not affect BPPV treatment outcomes, while low long-term activity levels were linked to increased maneuver requirements. Identifying such modifiable risk factors may enhance recovery and reduce healthcare burden.

Background: Cochlear implantation (CI) is a standard intervention for congenital severe to profound sensorineural hearing loss. However, postoperative auditory and speech outcomes vary considerably across patients, and the developmental status of the cochlear nerve is considered a major determinant of rehabilitation efficacy.

Objective: This study aimed to assess the correlation between cochlear nerve cross-sectional area (CNCSA) and outcomes after cochlear implantation (CI).

Methods: We retrospectively analyzed 136 bilateral CI recipients, comparing auditory and speech rehabilitation results over 2 years postoperatively with bilateral CNCSA. Patients were grouped based on average CNCSA.

Results: A significant positive correlation was observed between CNCSA and scores on the IT-MAIS, MUSS, CAP, and SIR at 2 years post-CI. Patients with bilateral CNCSA >0.87 mm² had significantly better speech rehabilitation outcomes than those with one or both nerves below this threshold.

Conclusions: CNCSA is correlated with post-CI rehabilitation outcomes in patients with severe-to-profound sensorineural hearing loss, and may serve as a predictor for auditory and speech rehabilitation success.

Background: The efficacy and safety of 42 °C hot saline irrigation in haemostasis remain unclear.

Aims/objectives: This study aimed to investigate the effects of hot saline irrigation at 42 °C during endoscopic sinus surgery (ESS) to assess its efficacy in reducing intraoperative bleeding.

Material and methods: In this randomized, double-blind, within-person trial, 13 patients with bilateral chronic rhinosinusitis with nasal polyps undergoing ESS were randomly assigned to receive 42 °C hot saline irrigation on one side and room-temperature saline irrigation as a control on the contralateral side. The primary outcome was the Boezaart surgical field score, while secondary outcomes included operative time, histopathological changes, and postoperative complications. The Wilcoxon signed-rank test was used for statistical analyses.

Results: The Boezaart surgical field score significantly improved with hot saline irrigation compared with the control during anterior ethmoid surgery (p = 0.046); however, no significant difference was observed during posterior ethmoid and sphenoid surgeries. Operative times were comparable between groups. No adverse tissue changes or postoperative complications were observed.

Conclusions and significance: Hot saline irrigation at 42 °C improved surgical field visibility during ESS without adverse effects, demonstrating its potential as a haemostatic adjunct. This cost-effective and safe technique warrants further investigation for broader clinical application.

Trial registration: UMIN Clinical Trials Registry: UMIN000052864.

Background: Large language models (LLMs) are increasingly used in clinical decision-making and patient education, including in complex specialties such as head and neck cancer (HNC).

Objective: To evaluate the performance of ChatGPT-4o and DeepSeek-V3 in answering HNC-related clinical questions.

Methods: A set of 154 questions across six clinical categories was submitted twice to both models. Responses were independently graded by head and neck surgeons using a four-point accuracy scale. Accuracy, reproducibility, and inter-model agreement were assessed.

Results: ChatGPT-4o and DeepSeek-V3 provided ''comprehensive/correct'' answers in 92.2% and 89.6% of cases, respectively (p = .42). The accuracy ratings of both models' responses overlapped in 85.1% of cases; however, the statistical agreement between them remained low (Cohen's κ = 0.12; ICC = 0.21, p = .006). DeepSeek-V3 outperformed ChatGPT in Treatment category (96.3% vs. 81.5%, p = .08), while ChatGPT excelled in Recovery, Complications, and Follow-up (95.0% vs. 82.5%, p = .08); however, these differences did not reach statistical significance. Reproducibility was high for both models (ChatGPT-4o: 96.1%; DeepSeek-V3: 96.8%).

Conclusions: Both models demonstrated strong accuracy and consistency in HNC-related queries.

Significance: LLMs hold promise as reliable tools in clinical decision-making and patient education within HNCs when used with careful consideration of their inherent limitations.

Background: Age-related hearing loss (ARHL) represents the most prevalent sensory disorder among the elderly, significantly impairing daily functioning and increasing the risk of psychiatric conditions. Although Schwann cells (SCs) are critical for maintaining auditory nerve function, the mechanisms underlying their dysfunction in ARHL remain incompletely elucidated.

Aims: To investigate BST2's role in SCs dysfunction in ARHL and assess its potential value as a serum biomarker for early ARHL diagnosis.

Materials and methods: Adeno-associated virus (AAV) carrying a SC specific promoter-MBP, was injected into the posterior semicircular canal of mice. Immunofluorescence was employed to assess cochlear SCs function, while ELISA was used to measured BST2 levels in the serum of both humans and mice.

Results: Overexpression of BST2 inhibited SCs proliferation and differentiation, promoted apoptosis, and accelerated ARHL. Serum BST2 levels were elevated in both ARHL patients and mice, showing a significant positive correlation with audiometric thresholds and wave I latency of ABR.

Conclusions and significance: BST2 accelerates the progression of ARHL by exacerbating SCs dysfunction and serves as a potential serum biomarker for ARHL.

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.