Acta Oto-Laryngologica最新文献

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.

Background: Traditional imaging and pathological examinations lack sufficient sensitivity for detecting minimal residual disease (MRD), limiting early identification of subclinical recurrence in head and neck squamous cell carcinoma (HNSCC).

Aims/objectives: To explore the clinical utility of dynamic circulating tumor DNA (ctDNA) monitoring in detecting MRD after surgery for locally advanced HNSCC.

Material and methods: Sixteen patients with locally advanced HNSCC who underwent radical treatment were enrolled. Peripheral blood samples were collected preoperatively and one week to five years postoperatively for ctDNA analysis. Tumor tissue targeted sequencing and clinicopathological parameters were integrated to evaluate the sensitivity, specificity, and prognostic value of MRD detection.

Results: The preoperative ctDNA positivity rate was 81.3% (13/16), with a median content of 22.6 hGE/ml (range: 0.45-131.92). High-frequency genetic alterations included TP53 mutations (81.3%, 13/16), with hotspot mutations such as p.R273C, p.H193L, and p.R342. Copy number reduction in CDKN2A (43.8%, 7/16) and PIK3CA mutations (18.8%, 3/16) were the main driver alterations. One patient with hypopharyngeal carcinoma (T3N2bM0) tested ctDNA-positive 1.5 months postoperatively, which was 6.5 months earlier than radiological recurrence (tongue metastasis detected 8 months postoperatively).

Conclusions and significance: Dynamic ctDNA monitoring effectively identifies postoperative MRD in HNSCC.

Background: Nasal polyps (NP) contribute to treatment resistance in chronic rhinosinusitis with nasal polyps (CRSwNP); however, the cellular and molecular mechanisms underlying nasal polypogenesis are not completely understood.

Objectives: To investigate whether the characteristics of fibroblasts differ under the surrounding tissue environment.

Material and methods: Patients with CRSwNP were divided into two groups based on the eosinophil infiltration in the NP; the gene expression levels were evaluated. Fibroblasts established from NP were assessed for functional changes following cytokine stimulation, and RNA sequencing (RNA-seq) was performed.

Results: IL5 and IL13 expression was higher, and IFNG and TNF lower, in NP from eosinophilic CRS (ECRS) patients compared to non-ECRS. FOXP3 expression was significantly upregulated in ECRS patients. Cytokine-stimulated fibroblasts from both ECRS and non-ECRS showed similar expression of fibroblast-to-myofibroblast transition-related genes and significantly reduced migratory capacity following IL-13 and TNF-α treatment. RNA sequencing revealed six and thirty-five significant activated and inactivated signaling pathways, respectively, in the Diseases Bio Functions analysis.

Conclusions and significance: Fibroblasts contribute to nasal polypogenesis irrespective of inflammation type in CRSwNP. Although their behavior is regulated by the immune microenvironment, our findings also highlight fibroblasts as potential therapeutic targets, supporting both endotypic classification and novel treatment strategies.