Acta Oto-Laryngologica最新文献

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.

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: Hearing loss (HL) is genetically and phenotypically heterogeneous. Variants in GRHL2, which encodes the Grainyhead-like 2 transcription factor, cause autosomal dominant nonsyndromic HL (DFNA28). Only six pathogenic GRHL2 variants have been reported, predominantly associated with high-frequency HL.

Objectives: To elucidate the molecular etiology of ADNSHL presenting with low-to-mid frequency HL in a four-generation Chinese Han family.

Material and methods: Whole exome sequencing was performed to identify the candidate variant, followed by Sanger sequencing for co-segregation analysis. Functional assessments included protein subcellular localization, luciferase assays and co-immunoprecipitation.

Results: A novel nonsense variant, c.648C>G (p.Tyr216Ter), in GRHL2 was identified and co-segregated with the HL phenotype. Contrary to the characteristic high-frequency HL in DFNA28, the 11-year-old proband (IV:4) displayed low-to-mid frequency HL. The variant introduces a premature termination codon, producing a truncated protein missing 409 C-terminal amino acids. Initially classified as likely pathogenic according to the ACMG/AMP guidelines, functional analysis demonstrated cytoplasmic mislocalization and abnormal transcriptional upregulation, potentially via interaction with wild-type GRHL2, prompting reclassification to pathogenic.

Conclusion and significance: Our findings broaden the GRHL2 mutational spectrum, support a gain-of-function mechanism in DFNA28, and establish GRHL2 as a gene associated with low-to-mid frequency HL, expanding known genotype-phenotype correlations.

Background: Deep neck space abscesses (DNSA) are rare but can be life-threatening due to their rapid progression and variable presentation. Effective management requires prompt diagnosis, appropriate antimicrobial therapy, and timely surgical intervention.

Objective: To explore the clinical and microbiological characteristics of DNSA and their impact on treatment decisions.

Methods: This retrospective study analyzed 108 patients with DNSA treated at Eye & ENT Hospital, Fudan University from April 2013 to May 2021. Patient demographics, medical history, clinical symptoms, white blood cell count, imaging results, antibiotic use, and microbiological findings were collected. All patients underwent contrast-enhanced CT, and bacterial cultures guided antibiotic therapy.

Results: Recurrence of DNSA was strongly associated with undiagnosed branchial cleft fistulas, highlighting the need for thorough etiological evaluation. Larger abscesses were more likely to have detectable pathogens. Streptococcus was the most common pathogen; however, there was no significant correlation between abscess size and Streptococcus infection, suggesting that its pathogenic potential is similar to that of other bacteria.

Conclusion and significance: This study emphasizes the importance of timely surgical drainage, individualized antimicrobial therapy, and etiological investigation, particularly for branchial cleft fistulas, in managing DNSA.

Background: Cleft palate (CP) with otitis media with effusion (OME) often cause persistent conductive hearing loss, increasing the risk of long-term speech-language delay and social difficulties if untreated. While ventilation tube (VT) insertion is recommended for recurrent or persistent OME with significant hearing loss, its long-term benefits in CP remain unclear.

Objectives: To address the long-term effects of VT insertion on audiologic and speech-language development in children with CP and OME.

Materials and methods: In this non-randomized controlled study, 154 children aged 1-4 years with CP and OME were enrolled. The VT group (n = 74) received VT insertion during or after palatoplasty, while the conservative group (n = 80) underwent palatoplasty alone. Assessments at 3, 6, 12, 18, 24, and 36 months included air-bone gap, tympanogram, speech recognition in quiet/noise (SRS, SRN), speech clarity, and developmental scale scores (MUSS, SIR, MCDI).

Results: Over 36 months, the VT group showed greater improvement in air-bone gap and tympanogram normalization (q < 0.001) and higher speech clarity from 18 months (q < 0.05). MUSS, SIR, and MCDI scores were superior from 12 months onward.

Conclusions and significance: Early VT insertion with palatoplasty provides sustained hearing and speech-language benefits, supporting its integration into management for CP with OME.

Background: Benign paroxysmal positional vertigo (BPPV) has a characteristic, called BPPV fatigue, in which positional nystagmus (PN) and dizziness symptoms disappear when the patient repeatedly assumes a head position that causes dizziness.

Aims/objectives: We previously developed a new maneuver to restore PN that had disappeared because of BPPV fatigue in posterior-canal-type BPPV (pc-BPPV). This study aimed to demonstrate that the maneuver restores PN from BPPV fatigue to a level sufficient for diagnosing BPPV by macroscopic observation of PN.

Material and methods: Thirty patients with pc-BPPV underwent the Dix-Hallpike test (DHT) three times, and video recordings of PN were made during the DHTs. Twenty patients underwent the maneuver before the third DHT. The videos were shown to six examiners, who judged whether PN had been restored from BPPV fatigue to a level that allowed diagnosis, including on the affected side.

Results: PN was restored from BPPV fatigue in 18 of the 20 patients who underwent the maneuver, although PN was not restored in all 10 patients who did not undergo the maneuver.

Conclusions and significance: When BPPV fatigue occurs, the maneuver can induce sufficiently strong PN to diagnose pc-BPPV by macroscopic observation, including on the affected side, with 90% probability.

Background: A total of 890,000 new cases of head and neck squamous cell carcinoma are diagnosed worldwide annually.

Objectives: To assess whether lymph node density has an impact on the survival of patients undergoing neck dissection for squamous cell carcinoma of the oral cavity (OSCC).

Method: This was a longitudinal and retrospective study conducted with adult patients with OSCC. Clinical and demographic data, variables related to OSCC and surgery were reviewed. For statistical analysis, the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis tests, univariate Cox regression and Kaplan-Meier curve were used.

Results: A total of 96.8% of the patients were male. The mean age was 57.87 ± 8.20 years, and the majority was white as well as smoker and alcoholic. There was a statistical difference between the total number of lymph nodes resected and the types of neck dissection (p = 0.0189) and between the skin color and worse prognosis (p = 0.0227). The mortality rate was 35.5% and the mean overall survival time was 1.25 years.

Conclusions and significance: There was an association between T staging and a worse survival prognosis, and between the number of lymph nodes resected and the type of neck dissection. There was no association between lymph node density and patients' overall survival.

Background: Hypopharyngeal carcinoma often requires extensive surgical resection, making reconstruction challenging.

Objectives: This study aimed to compare the clinical outcomes of hypopharyngeal defect reconstruction using thoracoacromial artery perforator (TAAP) flaps and supraclavicular artery island flap (SCAIF), to provide guidance for clinical practice.

Material and methods: This prospective study included 40 patients with hypopharyngeal carcinoma who underwent surgery at the Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Chongqing Medical University, between October 2021 and April 2023. The patients were randomly assigned to the TAAP and SCAIF groups (n = 20 each). Preoperative Doppler ultrasonography was performed to localize vascular perforators. Postoperative flap survival, complication rates, shoulder function, and scar appearance were compared between the two groups.

Results: The groups did not differ significantly in terms of intraoperative defect size, flap harvesting area, or intraoperative blood loss (p > 0.05). Pedicle length (p = 0.015) and operation time (p < 0.01) were significantly longer in the TAAP group than in the SCAIF group. No necrosis was observed in the TAAP group, whereas two patients in the SCAIF group experienced partial flap necrosis leading to pharyngocutaneous fistula, which healed after dressing changes. The donor-site complication rate was 0% in the TAAP group and 20% in the SCAIF group (p < 0.05). The TAAP group had significantly lower Shoulder Pain and Disability Index scores one, three, and six months postoperatively than those in the SCAIF group (p < 0.05), indicating better shoulder function and less pain. Additionally, the TAAP group showed superior cosmetic outcomes, with significant differences in Vancouver Scar Scale scores three and six months postoperatively (p < 0.05).

Conclusions and significance: The TAAP flap demonstrated significant advantages over the SCAIF in hypopharyngeal reconstruction, including a longer pedicle and better preservation of shoulder function and aesthetic outcomes, despite a longer operative time. The choice of flap should be selected based on patient needs and surgeon experience.

Background: Vestibular dysfunction is prevalent in severe/profound unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) and may influence hearing recovery. This study investigates associations between vestibular function (cVEMP/oVEMP, vHIT, caloric tests) and short-term auditory outcomes.

Aims: To evaluate whether vestibular test abnormalities predict treatment response in severe/profound ISSNHL and identify independent prognostic factors.

Material and methods: Retrospective analysis of 133 patients (mean age 53.58 ± 18.56 years) treated with steroids/hyperbaric oxygen. Vestibular tests (cVEMP, oVEMP, vHIT, caloric) were performed pre-treatment. Outcomes were categorized as effective (complete/marked recovery) or ineffective (mild/no recovery).

Results: The ineffective group had higher vertigo prevalence (65/93 vs 14/40, p < 0.001) and older age (55.98 ± 17.85 vs 48.00 ± 19.22 years, p = 0.022). Univariate analysis showed abnormal vestibular tests (oVEMP/cVEMP/vHIT/caloric) correlated with outcomes (p < 0.05). Multivariate analysis identified three independent predictors of poor outcome: vertigo (OR 0.367), abnormal caloric test (OR 0.339), and abnormal vHIT (OR 0.316). cVEMP/oVEMP abnormalities were not independently associated (p > 0.05).

Conclusions: Vertigo, abnormal caloric/vHIT results predict poorer short-term hearing recovery in severe/profound ISSNHL. Vestibular assessment aids prognosis but should not be used alone. Larger studies are needed for validation.

Background: The long-term balance and motor development of infants and children with bilateral aplasia of the labyrinth, known as Michel aplasia is currently unknown.

Objective: To follow up, over a period of twenty years from two months after birth to age twenty, the balance and motor development of a patient with bilateral aplasia of the labyrinth and the VIIIth nerve, Michel aplasia, and offer insight to his remarkable compensation.

Materials and methods: Our patient is a twenty-year-old male who was followed up from the age of two months. CT and MRI scans were performed for imaging of the temporal bones and brain. The balance function and motor development were evaluated.

Results: His CT of temporal bone demonstrated bilateral aplasia of the labyrinth and the VIIIth nerve. His primitive and postural reflexes appeared later than usual. In early childhood, the milestones of his gross motor function were delayed. In adulthood, he has become a professional athlete with no problems observed in balance or motor functions.

Conclusions and significance: Even with bilateral aplasia of the labyrinth and the VIIIth nerve, as long as no other problems are present, the balance and gross motor functions can be acquired with delay through central compensation.