Acta Oto-Laryngologica最新文献

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.

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.