Acta Oto-Laryngologica最新文献

Background: Understanding the anatomy and orientation of the semicircular canals is essential for effective diagnosis and treatment.

Aims: We aimed to examine the angular relationship between the auricular helix and the PSC to explore a potential visual reference for benign paroxysmal positional vertigo (BPPV) management.

Material and methods: Adult patients scheduled for temporal bone or paranasal sinüs computed tomography (CT) scans participated in this study. Using the Protractor application, we measured the cephaloauricular angles (CAA) and sagittal auricular angles (SAA). The PSC angles (PSCA) measurments were obtained from the CT images. Statistical analyses, including descriptive statistics and correlation tests, assessed the relationships between these measurements.

Results: Fifty ears from 25 participants (14 males, 11 females) were analyzed. The mean CAA was 33.6° (±11.0), the SAA was 27.6° (±11.1), and the PSCA was 43.1° (±6.5). The average differences between the PSCA and the CAA and SAA were 9.6° and 15.6°, respectively.

Conclusions: This study indicates an anatomical alignment between the auricular helix and the PSC. Utilizing the external auricle as a reference during repositioning maneuvers could enhance both educational and clinical practices related to BPPV.

Background: Fungal ball has been known as a noninvasive subtype of chronic rhinosinusitis (CRS). Recently, other endotypes of sinonasal bioballs, which we reported as bacterial balls and mixed balls.

Objectives: This study aimed to investigate the pseudoball as a distinct endotype of sinonassal bioballs.

Methods: This study included 41 CRS patients with suspected fungal balls who underwent functional endoscopic sinus surgery (FESS) from January 2020 to November 2022. All fungus-like biomaterials were stained with Hematoxylin-Eosin, Gomori-Methenamine-Silver (GMS), and Gram stains. Diagnosis of pseudoballs was made when both GMS and Gram staining were negative. Clinical and computed tomography (CT) findings were compared between fungal balls and pseudoballs.

Results: Four endotypes of sinonasal bioballs were identified: fungal balls (56.1%), mixed balls (26.8%), pseudoballs (12.2%), and bacterial balls (4.9%). During FESS, the pseudoballs had heterogeneous gross features with a gel-like or semi-solid consistency and yellow-to-gray colors. Histopathology of the pseudoballs showed a matrix with thick acellular mucous material without any fungi or bacteria. When compared with fungal balls, all pseudoballs cases were immunocompetent (100%) and prone to involvement of the posterior ethmoid sinus (60%, p = 0.01) in CT scans.

Conclusions: The pseudoballs were dual-negative in GMS and Gram staining and showed distinct clinical and radiological characteristics as a different endotype.

Backgrounds: Hearing loss (HL) is associated with various functional deficits.

Aims/objectives: This study aimed to evaluate the quality of life (QOL) of patients with HL according to their gender.

Materials and methods: Participants aged 40 or older from the 8th Korea National Health and Nutrition Examination Survey (2019-2021) with data on otologic evaluations and the Health-Related Quality of Life Instrument with 8 Items (HINT-8) were included. They were classified into the bilateral hearing, unilateral hearing, or disabling HL groups based on moderate HL (> 40 dB) in each ear.

Results: Among males, the disabling HL group scored significantly worse in climbing stairs, vitality, working, and depression compared to both the bilateral and unilateral hearing groups (p < 0.05 for all), and reported significantly lower happiness than the bilateral hearing group (p = 0.041). Furthermore, hearing aid users had significantly higher vitality than non-users (p = 0.009). In females, only vitality was significantly worse in the disabling HL group (p = 0.019).

Conclusions and significance: Republic of Korea Male patients with disabling HL experienced a greater decline in QOL and hearing aids might be associated with preserving vitality in males. Further research is required to elucidate greater vulnerability to HL in males.

Introduction: Frontal sinus surgery is among the most technically demanding areas in rhinology due to the complex anatomy of the frontal recess and proximity to critical structures such as the orbit and anterior cranial fossa. Although endoscopic sinus surgery (ESS) is the standard for most sinonasal pathologies, the frontal osteoplastic flap (OPF) remains important in select clinical scenarios.

Objectives: To evaluate the role of OPF in current rhinologic practice by presenting a retrospective case series and reviewing contemporary literature.

Methods: A retrospective analysis was conducted on 11 patients who underwent OPF between 2007 and 2019 at a Portuguese center. Surgical data, indications, approaches, and outcomes were reviewed. A literature review was also performed to contextualize findings.

Results: The most common indications were frontal sinus osteomas, mucoceles with orbital involvement, and refractory chronic frontal sinusitis. Supraciliary and bicoronal incisions were used, and in some cases, combined with ESS. No major complications occurred, and outcomes were highly satisfactory both functionally and esthetically.

Conclusion: Despite advancements in endoscopic techniques, OPF remains a valuable option for anatomically challenging, recurrent, or bone-involving frontal sinus disease. This case series and literature review support its continued role in the comprehensive surgical armamentarium in rhinology.

Background: Nasal septal perforations (NSPs) are a challenging clinical problem due to impaired healing under constant airflow, dryness, and microbial exposure. Adjuncts that enhance mucosal regeneration and extracellular matrix activity are needed.

Objectives: This study evaluated whether topical caffeic acid (CA) delivered in a thermoresponsive Pluronic F127 gel improves histopathological and macroscopic healing in a rat NSP model.

Material and methods: Nineteen male Sprague Dawley rats were randomly assigned to control (n = 8) or CA (n = 11) groups. A standardized full-thickness septal perforation (∼2 mm) was surgically created. Controls received intranasal saline, while the CA group received 0.2 mL CA-loaded Pluronic F127 gel once daily for 14 days. Histopathological parameters (epithelial regeneration, degeneration, fibroblast density, collagen density, angiogenesis, inflammation) were scored on a 0-3 scale. Macroscopic closure was also evaluated. Fisher's exact test was applied (p < 0.05).

Results: CA significantly increased epithelial regeneration (p = 0.005), fibroblast density (p = 0.014), and collagen density (p = 0.018), while reducing epithelial degeneration (p < 0.001). Angiogenesis and inflammation showed favorable trends. Macroscopic closure improved but was not statistically significant (p = 0.101).

Conclusions and significance: Topical CA in a thermoresponsive gel enhanced mucosal repair and extracellular matrix activity in a rat NSP model, supporting its potential as a therapeutic adjunct in septal perforation management.

Background: Although relatively rare, major salivary gland tumors pose notable diagnostic and therapeutic challenges. Accurate preoperative differentiation between benign and malignant lesions is crucial for preoperative surgical planning and better outcomes. Computed tomography (CT-scan) is widely used due to its accessibility and detailed anatomical imaging.

Objective: To evaluate the diagnostic accuracy of preoperative CT-scan in distinguishing malignant from benign major salivary gland tumors, using histopathology diagnosis as the reference standard.

Methods: This retrospective study included 90 patients who underwent surgery for major salivary gland tumors between 2005 and 2019. Preoperative CT-scans were reviewed for radiologic signs of malignancy and compared with histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were calculated.

Results: Of the 90 tumors, 20 (22.2%) were malignant and 70 (77.8%) benign. CT-scan identified 12 true positives and 61 true negatives, with 10 false positives and 7 false negatives. Sensitivity was 63.2%, specificity 85.9%, PPV 54.5%, NPV 89.7%, and AUC 0.75.

Conclusion: Preoperative CT-scan demonstrates high specificity and NPV for benign tumors but limited sensitivity for malignancies. Histological confirmation remains essential in cases with indeterminate or challenging preoperative imaging features, supporting the use of multimodal diagnostic approaches.

Background: Swallowing function may undergo subtle changes with age, even in asymptomatic adults. However, objective and reproducible metrics for characterising normal swallowing motion remain limited.

Aims/objectives: This pilot study aimed to quantify the spatiotemporal trajectory of the bolus centre of mass (CoM) during swallowing in healthy adults and explore its potential as a kinematic marker for identifying individualised and age-associated patterns.

Materials and methods: Thirteen healthy adults (aged 26-62 years) underwent videofluoroscopic swallowing studies using contrast-enhanced liquid boluses. Bolus CoMs were tracked throughout the oropharyngeal phase. Multiple swallows per participant were analysed to assess intra-individual consistency. K-means clustering and silhouette analysis were applied to the CoM trajectory data to evaluate pattern reproducibility and explore potential age-related differences.

Results: CoM trajectories were highly consistent within individuals (silhouette score = 0.718). Clustering revealed age-related patterns: older participants exhibited more centralised trajectories, whereas younger participants demonstrated more lateralised movement. Additional differences in bolus descent and pharyngeal coordination existed between age groups.

Conclusions and significance: Bolus CoM trajectory analysis is a feasible and reproducible approach for assessing swallowing kinematics. These trajectories may represent individualised motor signatures and could help identify subtle, age-related changes. The findings underscore the need for personalised dysphagia assessment and rehabilitation strategies.

Background: Tracheostomy is widely used in critically ill patients, yet limited clinical data exist from Danish ENT departments.

Aims/objectives: To describe clinical outcomes and perioperative care in patients undergoing tracheostomy at a secondary ENT department in Denmark.

Material and methods: This retrospective cohort study included all adult patients who underwent tracheostomy at Gødstrup Hospital between 2019 and 2024. Data were extracted from electronic records. Postoperative pneumonia was the primary outcome; secondary outcomes included perioperative care assessment and in-hospital mortality.

Results: Seventy-seven patients were included, of whom 71 were evaluable for pneumonia outcome. Postoperative pneumonia occurred in 63% of patients. Neurological comorbidity was more frequent among patients with pneumonia (31% versus 8%, p = 0.037). Prophylactic antibiotics alone did not reduce pneumonia rates (61% versus 67%, p = 0.81). Postoperative dysphagia screening, pulmonary physiotherapy, and dietetic referral were more common in patients with pneumonia. In-hospital mortality was 14%, primarily in patients with prolonged intubation due to non-ENT causes. No deaths were directly related to the procedure.

Conclusions and significance: Postoperative pneumonia rates were high and associated with neurological comorbidity. Prophylactic antibiotics alone did not reduce pneumonia rates. These findings highlight the need for structured perioperative care in patients undergoing tracheostomy.

Background: The vestibular system is essential for spatial orientation and is increasingly implicated in higher-order cognitive processes.

Objective: To investigate specific cognitive domains affected by unilateral vestibular neuritis (VN).

Methods: In a cross-sectional comparative study, 30 patients with uncompensated unilateral VN and 30 age- and sex-matched healthy controls were assessed. Participants completed a cognitive test battery including reaction time tasks, visuospatial memory (Corsi Block-Tapping Test), processing speed and response inhibition (Visual Stroop Task), verbal fluency, working memory (Reverse Digit Span), and attention (Serial 7 Subtraction). Between-group comparisons were conducted using independent t-tests or Mann-Whitney U-tests, with effect sizes calculated using Cohen's d.

Results: No significant demographic differences were observed between groups. Patients with VN performed significantly worse on the Corsi Block-Tapping Test (p = 0.004, d = 1.02) and exhibited prolonged reaction times in the choice reaction task and incongruent Stroop condition (p = 0.01, d = 0.8). No significant differences were found in other cognitive domains.

Conclusion: Unilateral VN is associated with deficits in visuospatial memory and slowed processing speed. These findings emphasize the vestibular system's role in cognition and support the inclusion of cognitive assessment and rehabilitation in the management of vestibular disorders.