Acta Oto-Laryngologica最新文献

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: 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: Partial parotidectomy is the most common surgical approach to treat benign parotid tumours. Studies on recovery from parotidectomy are lacking.

Objectives: To prospectively evaluate recovery and work ability after partial parotidectomy.

Methods: The study group comprised 80 patients who underwent surgery for benign parotid neoplasms. Patient-reported data were collected via the electronic Case Report Form database.

Results: Pain and swelling were the most frequently reported symptoms preventing work ability. A week after surgery, pain and the need for pain medication decreased steadily and at that time point, 56% of patients were already able to work. The predisposing factors for a longer recovery comprised physically demanding work, low education level, and no possibility of remote work. A postoperative complication also prolonged recovery, although no major complications occurred.

Conclusions and significance: Pain was mild thorough the recovery but tightening of the wound, numbness, and tingling last a relatively long time and may be regarded as pain. Over half of the patients were fully or partially able to work after one week. Thus, recovery and work ability are patient- and work-dependant. Remote work, patient counselling about common postoperative symptoms, and signing shorter sick leaves will encourage faster return to everyday life.

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 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 Supraclavicular artery islanded flap (SCAIF) is commonly used for the reconstruction of oral cavity defects.

Aim: This study evaluated the incidence of donor site phantom sensation following SCAIF reconstruction.

Methods: This was a prospective cohort study conducted on all consecutive cases of SCAIF reconstruction undertaken for oral cavity reconstruction over 3 years. The primary outcome was to document the incidence of phantom sensation at the donor site arising from sensory stimulation of the skin paddle in the oral cavity. The study was undertaken using questions to assess the type and duration of phantom symptoms.

Results: Of the 105 SCAIF reconstructions undertaken during this period, 30 (28.57%) of the patients were found to have phantom sensations. The spectrum of phantom sensations referred over the deltoid region were tactile (23), temperature (23) and pain (10). The mean duration of phantom sensation was 16.4 months (range: 6 months to 36 months). Intraoperative sectioning of supraclavicular nerves during flap harvest was shown to minimise the incidence of the development of phantom sensation (Odds ratio: 4.42, 95% CI: 0.95-20.40).

Conclusion: This study documented donor site phantom sensation in 28.57% of the patients undergoing SCAIF reconstruction. This carries immense implications in terms of preoperative patient counselling.

Background: Trismus, difficulty opening the jaw, and dysphagia, difficulty swallowing, are complications in head and neck cancer (HNC). Metabolic imbalances, including alterations in amino acids, lipids, and inflammatory markers, potentially influence these conditions.

Aim/objective: The aim of this study was to investigate associations of metabolic and inflammatory metabolites in HNC patients, focusing on trismus and dysphagia.

Material and methods: Nuclear Magnetic Resonance (NMR) spectroscopy, and Bruker IVDr Lipoprotein Subclass analysis was used to analyse metabolites in plasma from 302 patients before, during and after treatment for HNC.

Results: Sixteen lipoprotein subclasses (LDL 1-6, HDL 1-4 VLDL 1-6) as well as creatinine, creatine, glutamine, alanine, glycine, GlycA, GlycB, and a combined lipoprotein-derived NMR signal named Supramolecular Phospholipid Composite (SPC), were analysed. An increase in several lipoprotein sub fractions and elevated inflammatory biomarkers (GlycA and GlycB) were associated with Maximal Interincisal Opening (MIO) before treatment. The M.D. Anderson Dysphagia Inventory (MDADI) before treatment was associated with elevated GlycA and GlycB. The results also showed significant correlations between metabolites and BMI, sex, age, radiation therapy as well as tumour stage and location.

Conclusion and significance: Metabolic and inflammatory markers highlight the metabolic heterogeneity in HNC and provide potential targets for future therapeutic strategies.

Background: The studies on malnutrition/obesity and hearing argued that there may be a relationship between malnutrition/obesity and hearing loss, although many used behavioral measurements.

Aims/objectives: To investigate Auditory Brainstem Responses (ABR) in women by considering Body Mass Index (BMI).

Material and methods: A total of 60 females (n = 120 ears) between the ages of 18-40 years participated. All subjects had normal hearing, and they were grouped under three BMI categories (weak, ideal weight and overweight). ABR recorded with Click and CE-Chirp stimuli at 80-60 dB nHL intensity levels. Absolute latencies and inter- peak latencies of waves I, III and V were evaluated. Right-left ears results and the stimulus type (Click or CE-Chirp) were considered.

Results: Mainly, wave V absolute latency and I-V inter-peak latency were longest in subjects who were overweight. No interpretable differences were noted between the ears (p > 0.05). Regarding the stimulus type (Click or CE-Chirp), significant differences were observed in all BMI groups (p < 0.05).

Conclusions and significance: The ABR, which are affected by many other factors, are also directly related to BMI. The importance of taking BMI into consideration when creating normative data in ABR measurements and/or using ABR in clinics is emphasized. The stimulus type caused significant differences.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts the health-related quality of life (HrQoL) and sense of smell. The association between recurrent NPs after surgery and patient-reported outcomes has not been extensively studied.

Objective: To investigate whether patients with recurrent NPs can be distinguished from non-recurrent cases based on pre- and postsurgical evaluations of HrQoL, sense of smell, blood eosinophils and fractional exhaled nitric oxide (FeNO).

Methods: Thirty-five patients with CRSwNP were recruited pre-surgery and followed up to 12 months post-surgery. HrQoL was assessed with RAND-36 and SNOT-22, olfactory dysfunction with smell test and self-reported.

Results: SNOT-22 scores improved 6 months post-surgery but deteriorated 12 months post-surgery with no significant difference related to recurrent NPs. Patients with recurrent NPs had lower smell test scores and more frequent self-reported anosmia or hyposmia as well as higher blood eosinophil counts at pre-surgery. FeNO did not change post-surgery and was not related to NP recurrence.

Conclusion: A low smell test result before surgery may serve as an early indicator of recalcitrant NPs, whereas preoperative scores from HrQoL questionnaires may not be a good predictor. We confirm a significant role for blood eosinophils in refractory CRSwNP, while FeNO may not predict rapid NP recurrence.