Acta Oto-Laryngologica最新文献

Background: The evaluation of olfaction is classically based on three psychophysical axes: threshold, discrimination, and identification. However, these do not fully reflect the multisensory nature of odour perception. It is well established that numerous odours can activate the trigeminal system, thereby generating somatosensory sensations such as texture, density, or temperature. This is a dimension that is currently absent from clinical evaluation models.

Aims/objectives: The present study introduces and conceptualises osmotexia as the ability to experience odours in terms of internal texture. It proposes osmotexia as a fourth axis in chemosensory evaluation, with diagnostic, rehabilitative and perceptual relevance.

Methods: An integrative theoretical framework was developed, based on neurophysiological, psychophysical and linguistic evidence on olfactory-trigeminal interaction. A structured model is predicated on clinical observations and analyses of olfactory perception maps. The model incorporates a Likert scale of tactile descriptors and the Osmothexic Wheel, which is organised into perceptual texture categories.

Results: Osmotexia facilitates the systematisation of tactile descriptors frequently reported by patients but not captured by standard tests, thus revealing diversified perceptual profiles in subjects with similar olfactory scores. This approach facilitates the characterisation of qualitative smell disorders, the monitoring of olfactory rehabilitation, and the expansion of the clinical language of smell.

Background: Previous epistaxis studies report conflicting weather correlations, potentially reflecting year-to-year variation rather than geographic differences. Traditional combined analysis approaches may mask temporal correlation patterns, contributing to inconsistent research findings.

Aims/objectives: To examine annual stability of weather-epistaxis correlations and establish methodology for multi-year studies accounting for temporal variation in environmental health relationships.

Material and methods: Pilot study examining weather correlation stability using 2,201 epistaxis presentations from two UK hospitals (January 2023-December 2024). Weather parameters were analyzed separately for each year. Year-specific and combined analytical approaches were compared.

Results: Weather-epistaxis correlations demonstrated notable year-to-year differences, though none achieved statistical significance. Humidity showed complete directional reversal from positive correlation in 2023 (r= +0.1259) to negative in 2024 (r=-0.1058). Temperature correlations increased in magnitude from weak (r=-0.036) to stronger negative correlation (r=-0.379) and pressure correlations similarly increased (r=-0.080 to r=-0.399). Combined analysis masked this variation, showing weak non-significant correlations. Spring presentations increased 26% year-over-year suggesting potential allergic confounding.

Conclusions: Weather-epistaxis correlations show year-to-year differences that combined analyses may mask, despite lack of statistical significance. Future studies should consider extended observation periods spanning 5-10 years to distinguish relationships from temporal variation.

Significance: This study provides evidence that temporal variation may contribute to conflicting findings in epistaxis literature and establishes methodology for environmental health research.

Background: Anosmia is a loss of olfactory function caused by infectious, traumatic, or chemical injury and negatively affects quality of life. 3-Methylindole (3-MI) induces olfactory epithelial damage through oxidative and inflammatory mechanisms. Melatonin is a neuroprotective hormone with antioxidant and regenerative properties.

Aims/objectives: This study aimed to evaluate the therapeutic effects of melatonin in a 3-MI-induced mouse model of anosmia.

Materials and methods: Sixteen adult male mice were divided into melatonin-treated and control groups (n = 8). Anosmia was induced by intraperitoneal 3-MI administration. One week later, melatonin or saline was administered. Olfactory function was assessed using the food-finding test on days 7, 14, and 21. Histopathological evaluation was performed on day 21.

Results: Melatonin significantly improved olfactory performance at all time points compared with controls (p < 0.001). Histopathological analysis showed preserved epithelial structure, reduced ciliary loss, and decreased inflammation in the melatonin group.

Conclusions: Melatonin provided both functional recovery and morphological protection in a chemically induced anosmia model.

Significance: These findings highlight melatonin's potential as a safe and effective therapeutic agent for the treatment of olfactory dysfunction following chemical injury.

Background: Triple Semicircular Canal Occlusion (TSCO) has been developed in recent years as a surgical method for treating Meniere's disease(MD).

Aims/objectives: To explore the effectiveness of TSCO surgery in the treatment of patients with Tumarkin crisis associated with MD.

Materials and methods: Clinical data of 7 patients with Tumarkin crisis secondary to unilateral MD were analyzed. All 7 patients with Tumarkin crisis were treated with TSCO surgery. Audiological and vestibular function assessment was performed.

Results: None of the 7 patients in the Tumarkin group experienced drop attacks after TSCO surgery. Regarding vertigo control, 6 out of 7 patients (85.7%) achieved grade A improvement while 1 patient (14.3%) achieved grade B. No statistically significant differences were found in disease duration, pure tone average, ACS-cVEMP, or ACS-oVEMP between the two groups (all p > 0.05). However, vHIT gain values in both the lateral and posterior semicircular canals were significantly higher in the Tumarkin group than in the control group (p = 0.03 and p = 0.01, respectively), but not in the superior semicircular canal (p = 0.29).

Conclusions and significance: TSCO surgery can probably serve as an alternative treatment for patients with Tumarkin crisis associated with MD before labyrinthectomy or vestibular neurectomy.

Background and aims: Diabetes mellitus (DM) is known to impair wound healing in various tissues. However, its impact on tympanic membrane (TM) healing following tympanoplasty remains controversial. While clinical studies generally suggest that DM does not affect the final TM closure rate, animal experiments indicate it may significantly prolong healing time. This study aims to systematically investigate the correlation between diabetic status and perioperative glycemic control levels with tympanic membrane healing time following tympanoplasty, thereby enhancing the understanding of the impact of diabetes on outcomes in otologic surgery.

Methods: This study included 88 patients who underwent fully endoscopic tympanoplasty, comprising 34 patients with diabetes and 54 non-diabetic patients. Among the diabetic patients, 20 had well-controlled blood glucose and 14 had poorly controlled blood glucose preoperatively. Patients were followed up regularly postoperatively. The correlation between TM healing time and both diabetic status and perioperative glycemic control was analyzed.

Conclusion: This study suggests that, provided perioperative glycemic targets are met, the surgical outcomes of fully endoscopic tympanoplasty in diabetic patients are comparable to those in non-diabetic patients. Diabetes is not an independent risk factor for prolonged tympanic membrane healing time following totally endoscopic tympanoplasty.

Background: N-acetylcysteine (NAC) can protect against this damage.

Aim: To evaluate the effect of intratympanic NAC on the vestibulotoxicity model formed with intratympanic gentamicine in guinea pigs.

Design: Experimental Animal Study.

Methods: Guinea pigs were randomly divided into three groups. Group1 (control), group2 was treated with intratympanic(IT) gentamicin and group3 was treated with IT gentamicin + NAC. A single dose of NAC was applied on the 1st,3rd, and5th days. Cervical-vestibular evoked myogenic potentials (c-VEMP) measurements and blood samples were taken from the guinea pigs on the day 0,10,30.

Results: In group2 on day 10 c-VEMP latency was prolonged and on day 30 c-VEMP responses were lost in half of animals. A partial loss of c-VEMP values was observed in the group3. Serum total antioxidant capacity (TAC) and superoxide dismutase (SOD) activity in group3 (on the 7th and 30th day) were significantly higher than those in the group2. Tissue SOD and glutathione (GSH) were lower, while the malondialdehyde (MDA) and lipid hydroperoxide (LOOH) were the higher in group2.

Conclusion: Gentamicin induced loss in c-VEMP responses and NAC played an effective role in reducing this loss which were confirmed by oxidative capacity at tissue and serum level.

Background: The symptoms of chronic rhinosinusitis (CRS) are common. Diagnosis with computed tomography (CT) and endoscopy is not possible in all patients. Nasal nitric oxide (nNO) detects the obstruction of paranasal sinus ostia, but its clinical relevance is unknown.

Aims/objectives: We assessed whether nNO, Sinonasal Outcome Test 22 (SNOT-22) and Zinreich modified Lund-Mackay (ZL-M) CT-scores are associated with subsequent surgery among CRS or recurrent acute rhinosinusitis (RARS) patients.

Material and methods: Sixty-six CRS (with/without nasal polyps) or RARS patients were included in this prospective study. Appropriate medical therapy was used for at least 2 months. Patients were assessed during three consecutive visits: on current prescriptions, after a medication pause, and after intranasal fluticasone propionate. The clinician was unaware of the nNO results during subsequent treatment decisions.

Results: The positive predictive value (PPV) of nNO for the decision to proceed with surgical intervention "after fluticasone" was 76%, and the negative predictive value (NPV) was 80%. These results were not statistically significantly different from those of the ZL-M (PPV 76%; NPV 82%).

Conclusions and significance: Low nNO in patients with CRS symptoms was associated with a later decision for surgery. The applicability of nNO to guide ENT referrals from primary care should be further evaluated.

Background: This study analysed the long-term outcomes of single, first-time radiofrequency ablation of the inferior turbinates (RFAIT) on nasal obstruction and patient satisfaction in chronic inferior turbinate hypertrophy (ITH).

Aims/objectives: The primary aim was to assess RFAIT effectiveness and patient satisfaction; secondary aims included recovery and harms.

Material and methods: The SNOT-22 and a specific questionnaire were sent to 165 patients who underwent their first RFAIT for nasal obstruction between June 2014 and June 2015 at the Department of Otorhinolaryngology-Head and Neck Surgery, Hyvinkää Hospital, Finland. Eligible patients had identifiable ITH and had used intranasal corticosteroids for at least three months without adequate relief. Patients with nasal polyposis, severe septal deviation, or uncorrected bleeding disorders were excluded. A total of 102 patients responded. The median follow-up was 15.2 months (range 8.0-24.2).

Results: Nasal obstruction improved in 58% of patients after one RFAIT, and 75% reported a positive impact on daily life. No major postoperative complications occurred. Temporary increased obstruction, crusting, and minor bleeding were the most common complaints. Smoking and allergies had no significant effect on outcomes.

Conclusions and significance: Single RFAIT appears to be a safe and effective outpatient treatment for chronic ITH with high patient satisfaction.

Background: Soft tissue subglottic stenosis (SGS) progressively reduces the airway dimension below the vocal folds. The cause is unknown. As no cure is available patients face a recurrent need for surgical treatment. Previous research has not established whether the need for repeated interventions diminishes or intensifies as the disease evolves. Our hypothesis is that the number of surgical interventions decrease with disease duration. If true, these findings may have an impact on the surgical setting.

Aims/objectives: To investigate if the number of surgical interventions decreases with disease duration.

Material and methods: Participants were retrospectively included between 1999-2024 using medical records. The primary outcome measure was number of surgical interventions. A piecewise exponential additive mixed model (PAMM) was applied to assess changes in reoperation risk over time.

Results: 217 cases were identified, 60 (93% females) met the criteria for SGS. These 60 cases underwent 147 surgical procedures. There was a significant decrease in the hazard of re-operation along the timeline from the index surgery, corresponding to 7.7% annual reduction in the risk of requiring a new surgical intervention.

Conclusions and significance: The risk of reoperation decreased by 7.7%/yr. (p = 0.008), reflected in increased treatment-free intervals and interpreted as decreasing disease activity.

Background: As anatomical variations influence surgical difficulty, trainees must be exposed to a range of cases to gain mastery. While most surgeons believe they can predict the difficulty of a temporal bone, it is unclear whether these predictions align with trainee performance.

Objective: We hypothesized that expert judgement of temporal bone difficulty would correlate with trainee surgeons' performance in a VR environment.

Material and methods: Ten expert surgeons were recruited to assess the difficulty level of the VR bones using the developed difficulty scale. Thirty participants (10 medical students, 10 ENT trainees, and 10 consultants) performed mastoidectomy on these VR specimens. These dissections were scored by a blinded expert surgeon. We compared the correlation of expert-rated difficulty and surgical performance across experience levels.

Results: Expert ratings of bone difficulty showed high inter-rater reliability. Temporal bone dissection performance reflected experience: consultants performed best, followed by trainees, then medical students. Interestingly, trainees performed well on some expert-perceived difficult anatomical characteristics.

Conclusion: Anatomical variation-based difficulty ratings appear not to predict trainee performance on temporal bone dissection. This suggests difficulty may be better judged by actual surgical performance, which is feasible in VR environments and 3D printed models where standardised anatomy can be replicated.