Acta Oto-Laryngologica最新文献

Background: Fine-needle aspiration cytology (FNAC) is extensively employed in the assessment of neoplastic pathology involving the parotid and submandibular glands.

Aims/objectives: This study assessed the diagnostic value of FNAC in salivary gland tumors using the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).

Materials and methods: 152 patients who underwent surgery for parotid or submandibular gland tumors were included. FNAC results were compared with final histopathology. The risk of malignancy (ROM) and risk of neoplasia (RON) were investigated in all categories.

Results: FNAC showed a sensitivity of 93.3%, specificity of 95.2%, positive predictive value of 70%, negative predictive value of 99.2%, and overall accuracy of 95% for detecting malignancy. Pleomorphic adenoma was the most common benign tumor, while salivary duct carcinoma was the most common malignancy. The risk of malignancy in the Milan categories V and VI was 100%. When the diagnostic value of FNAC in the detection of neoplasia was examined, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92.7%, 62.5%, 95.0%, 52.6%, and 89.3%, respectively.

Conclusions and significance: MSRSGC offers a standardized and effective approach for distinguishing benign from malignant salivary gland tumors.

Background: Aging is characterized by a gradual loss of normal physiological function, culminating in frailty and increased susceptibility to diseases. One plausible candidate for this is the decrease in oxygen supply that occurs with aging.

Aims/objectives: The purpose is to compile a literature review to provide well-founded guidelines for healthy aging.

Material and methods: Based on published literature, the significance of changes in oxygen supply and autonomic regulation in aging is analyzed.

Results: Both oxygen uptake and its delivery to organs decline with age. This induces low-level hypoxia and further oxidative stress (OS) that is thought to cause aging-related disease conditions. Therefore, aging and hypoxia are connected. Hypoxia-induced OS also leads to imbalance of the autonomous nervous system (ANS) that is involved in more than 85% of chronic illnesses. Therefore, targeting hypoxia, OS and ANS imbalance is likely an effective treatment strategy for most age-related neurodegenerative and other diseases. This is best done with a hybrid strategy consisting of hyperbaric air or oxygen and non-invasive vagal nerve stimulation for reversing sympathoexcitation and stress.

Conclusions and significance: In all, two strategies to slow down age-related dysfunctions and diseases are to correct hypoxia and to reduce stress.

Background: Chronic rhinosinusitis (CRS) affects all ages, but inflammatory differences between pediatric and adult patients are unclear.

Methods: Nasal secretions from 14 pediatric and 28 adult CRS without nasal polyps (CRSsNP) patients, plus 14 pediatric and 14 adult controls, were analyzed for 27 inflammatory mediators via bio-plex.

Results: Compared to controls, pediatric CRSsNP showed only decreased bFGF. Adult CRSsNP exhibited increased IL-6 and IL-7. Fourteen mediators (including IFN-γ, IL-4, IL-5, IL-9, IL-13, IL-6, TNF-α, IL-8, bFGF, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES) were significantly higher in adult CRSsNP patients than pediatric CRSsNP patients. Comparing control groups, adults had higher IL-5, bFGF, MIP-1α and lower IL-1Ra than children. Age positively correlated with levels of several cytokines, especially IL-5, IL-6, bFGF, and MCP-1.

Conclusion: Pediatric CRSsNP demonstrates a low-inflammatory profile relative to both pediatric controls and adult CRSsNP. Adult CRSsNP presents a significantly heightened inflammatory state. The data indicate that CRSsNP inflammation becomes more pronounced with age in the nasal mucous. This age-dependent increase in inflammatory mediators may explain why a better prognosis is typically observed in pediatric CRSsNP compared to adults.

Background: The use of topical haemostatic agents in head and neck surgery has increased. Although generally considered safe, concerns have arisen about potential associations with postoperative complications.

Aims/objectives: This study aims to evaluate whether haemostatic agent use in parotidectomy and thyroidectomy is associated with increased risk of seroma or postoperative infection.

Material and methods: A retrospective cohort study was conducted on patients who underwent parotidectomy between 2017-2024 and thyroidectomy between 2022-2024.

Results: 82, 31, 35 and 15 patients underwent drainless parotidectomy (DLP), drained parotidectomy (DP), drainless thyroidectomy (DLT) and drained thyroidectomy (DT) respectively. Haemostatic agent use was the only significant factor associated with increased risk of seroma/sialoma in parotidectomy (OR3.58, p = 0.02). No seroma occurred in patients who underwent thyroidectomy. Haemostatic agent use was associated with higher risk of post-parotidectomy infection (OR 6.74, p = 0.01), but this may be confounded since all infections occurred in DLP where these agents were more commonly used. Further analysis found a weak, non-significant association (Cramer's V = 0.20, p = 0.07). Concurrent neck dissection was the only significant predictor of post-thyroidectomy infection (OR6.33, p = 0.04).

Conclusions and significance: Haemostatic agent use in parotidectomy is associated with increased seroma/sialoma risk and potentially infection risk, particularly when drains are omitted.

Background: Choanal atresia (CA) is rare. Unilateral CA (UCA) can be detected late in life. Recurrences following CA repair are challenging.

Objectives: To examine the long-term surgical and subjective outcomes in patients with CA and the reason for recurrences.

Methods: Outcome of transnasal endoscopic repair of congenital CA was examined between 2010 and 2022 in 25 patients with UCA and 31 patients with bilateral CA (BCA). Demographics, surgical data, and postoperative course were investigated. Subjective outcomes with regard to function and quality of life were examined via a visual analogue scale (VAS).

Results: Twelve surgeries were performed in ten patients with BCA due to recurrence. Insufficiently resected posterior vomer, and granulation tissue growth caused recurrences. VAS demonstrated a significant improvement in function (p < 0.0001) and quality of life (p < 0.0001) following surgery in patients with UCA and BCA with the highest levels of postoperative satisfaction (median satisfaction score of 10).

Conclusion: Insufficient vomer resections and granulation tissue cause recurrences. Patients with UCA exhibited substantial impairment in both function and quality of life.

Significance: BCA requires immediate treatment at birth. But also, the treatment of patients with UCA should be timely, contingent on present symptoms, as CA repair significantly increase their quality of life.

Background and aims: Human papillomavirus (HPV) is the main cause of the rapidly increasing incidence of oropharyngeal squamous cell carcinoma (OPC) in high-income countries, particularly in men. Studies have shown a lower awareness of HPV-associated cancers, particularly OPC, in men. This study assessed the information provided by health authorities on HPV-induced OPC in multiple high-income countries.

Materials and methods: A standardized search for HPV information was conducted on health authority websites. Webpages were categorized as high, moderate-to-low or no awareness according to the extent of patient information that was provided on the link between HPV and OPC.

Results: Seven health authorities demonstrated high awareness of the link between HPV and the development of OPC, 24 showed moderate-to-low awareness, and three exhibited no awareness. In European Medicines Agency Member countries, only 17.4% of the population had access to the high awareness content through their public health bodies.

Conclusion and significance: Only seven out of the 39 health authorities analyzed provided high awareness content on the link between HPV and OPC. This demonstrates the general lack of public awareness of this important link, suggesting public health bodies currently fail to prioritize this matter and do not provide relevant information to the public.

Background: Transoral robotic surgery (TORS) is performed for both benign as malignant diseases. It has been suggested that patients treated for benign indications may report higher postoperative pain, though supporting evidence is limited.

Aims/objectives: To evaluate which factors are associated with acute postoperative pain severity following TORS.

Material and methods: A retrospective observational cohort study was conducted in patients undergoing TORS. Maximum postoperative pain scores (numerical rating scale, NRS 0-10) were recorded for postoperative day (POD) 1,2,3. Clinically well-controlled pain was defined as NRS < 3. Variables including surgical indication (benign or malignant), gender, age, BMI, analgesic use, chronic pain and antidepressant use were analysed. Univariable and multivariable regression analysis were performed for NRS ≥ 3.

Results: Of the 119 cases, the mean maximum POD1 pain score was 2.7 (SD 1.89). Univariable analysis showed higher POD1 were associated with benign disease, chronic pain, pain relief, female gender and age. On multivariable regression analysis, only female gender was significantly associated with NRS ≥3.

Conclusions and significance: Female gender was found to be the only independent predictor of higher postoperative pain, other factors, including surgical indication were not.

Background: The use of ChatGPT in the field of otolaryngology is increasing; however, there are not enough studies related to cochlear implants.

Aim/objectives: To assess the accuracy and reproducibility of ChatGPT (GPT-4o) responses to questions about cochlear implantation, evaluating its potential role in patient education.

Material and methods: A total of 104 questions across five categories (basic, preoperative, surgical, postoperative care, postoperative expectations) were selected from reliable online sources. Each was posed twice to ChatGPT-4o in separate sessions. Responses were graded by two reviewers for accuracy (comprehensive/correct, partially correct, misleading, or incorrect/irrelevant). Reproducibility was assessed based on consistency across sessions. Discrepancies were resolved by a third expert reviewer.

Results: Of 104 responses, 84.6% were correct, 5.8% partially correct, 6.7% misleading, and 2.9% incorrect. Reproducibility was 88.4% overall and 100% in the surgery category. No significant differences were found between question categories for accuracy (p = 0.829) or reproducibility (p = 0.348).

Conclusion and significance: ChatGPT provided highly accurate and reproducible responses to cochlear implant-related questions, supporting its use as an educational tool. Nonetheless, expert review remains essential for complex or critical topics.

Background: MicroRNAs play a critical role in laryngeal carcinogenesis, yet their stage-dependent dysregulation in tumor and peritumoral mucosa remains unclear.

Objectives: To evaluate expression of miR-144 and miR-145 in tumor and peritumoral mucosa of early- and advanced-stage laryngeal carcinoma, and assess their association with stage progression and field cancerization.

Methods: Expression levels of miR-144 and miR-145 were analyzed by qPCR in tumor and matched peritumoral mucosa from 91 patients (26 early-stage glottic and 60 advanced-stage laryngeal carcinomas).

Results: In early-stage tumors, miR-144 was downregulated in 32% and miR-145 in 36% of cases, with a subset showing upregulation. Peritumoral mucosa displayed similar dysregulation. Distinct stage-associated patterns emerged: peritumoral miR-144 was significantly reduced in advanced versus early disease (p = 0.013), whereas tumor miR-145 was significantly lower in advanced tumors (p = 0.004). No stage-related differences were detected for tumor miR-144 or peritumoral miR-145. miR-144 and miR-145 expression correlated moderately in both compartments (ρ = 0.40 tumor; ρ = 0.37 peritumor). ROC analysis revealed modest discriminatory potential (AUC 0.62-0.64).

Conclusions: miR-144 and miR-145 exhibit distinct, stage-dependent dysregulation in laryngeal carcinoma. Tumor miR-145 and peritumoral miR-144 alterations support a dynamic model of field cancerization, suggesting potential biomarker roles in disease progression and risk assessment.

Background: Age-related immunosenescence, also known as 'inflammageing', may impact the elderly's ability to mount immune responses against cancers and compromise the effectiveness of immune checkpoint inhibition (ICI). In this context, data on tonsillar cancer (TC), a subset of head and neck squamous cell cancer (HNSCC), are lacking.

Aims/objectives: To compare the presence/distribution and features of immune cells in TC, and of bulk RNA-seq in HNSCC, between the young and the elderly.

Material and methods: TC tissue microarrays (TMAs) characterised by GeoMx digital spatial profiling were revisited and analysed, focusing on quantification and location of CD8⁺ and CD11c⁺ immune cells. De novo analyses of the TMAs targeted CD68⁺/CD163⁺ macrophages. Bulk RNA-seq and clinical data from patients with HNSCC were sourced from the Cancer Genome Atlas (TCGA). For all data, patients were stratified into age groups.

Results: Immune-cell characteristics in TC were similar across young and elderly individuals, although the elderly exhibited higher PD-1 levels. TCGA data revealed increased immune checkpoint molecules PD-L1 and LAG-3 in the elderly, alongside immunosuppression.

Conclusion and significance: In the elderly, key immune cells are present in TC, and immune checkpoint molecules are overexpressed. This may be relevant to the stratification of patients for ICI.