Acta Oto-Laryngologica最新文献

Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder causing transient episodes of vertigo. While canalith repositioning maneuvers are effective, the influence of physical activity levels on treatment response remains unclear.

Aims/objectives: To examine the correlation between post-maneuver benefit and physical activity frequency in BPPV patients.

Material and methods: Sixty-six patients diagnosed with BPPV at Başkent University Audiology Clinic were included. The International Physical Activity Questionnaire (IPAQ) and Physical Activity Habit Assessment Questionnaire (PAHAQ) were used to assess physical activity over the past week and year, respectively. Canalith repositioning maneuvers were repeated until full recovery. Significance was set at p < 0.05.

Results: No significant association was found between maneuver count and IPAQ scores. However, PAHAQ scores were significantly lower in patients requiring multiple maneuvers, suggesting that long-term physical inactivity may impact treatment response.

Conclusions and significance: Short-term activity did not affect BPPV treatment outcomes, while low long-term activity levels were linked to increased maneuver requirements. Identifying such modifiable risk factors may enhance recovery and reduce healthcare burden.

Background: Cochlear implantation (CI) is a standard intervention for congenital severe to profound sensorineural hearing loss. However, postoperative auditory and speech outcomes vary considerably across patients, and the developmental status of the cochlear nerve is considered a major determinant of rehabilitation efficacy.

Objective: This study aimed to assess the correlation between cochlear nerve cross-sectional area (CNCSA) and outcomes after cochlear implantation (CI).

Methods: We retrospectively analyzed 136 bilateral CI recipients, comparing auditory and speech rehabilitation results over 2 years postoperatively with bilateral CNCSA. Patients were grouped based on average CNCSA.

Results: A significant positive correlation was observed between CNCSA and scores on the IT-MAIS, MUSS, CAP, and SIR at 2 years post-CI. Patients with bilateral CNCSA >0.87 mm² had significantly better speech rehabilitation outcomes than those with one or both nerves below this threshold.

Conclusions: CNCSA is correlated with post-CI rehabilitation outcomes in patients with severe-to-profound sensorineural hearing loss, and may serve as a predictor for auditory and speech rehabilitation success.

Background: The efficacy and safety of 42 °C hot saline irrigation in haemostasis remain unclear.

Aims/objectives: This study aimed to investigate the effects of hot saline irrigation at 42 °C during endoscopic sinus surgery (ESS) to assess its efficacy in reducing intraoperative bleeding.

Material and methods: In this randomized, double-blind, within-person trial, 13 patients with bilateral chronic rhinosinusitis with nasal polyps undergoing ESS were randomly assigned to receive 42 °C hot saline irrigation on one side and room-temperature saline irrigation as a control on the contralateral side. The primary outcome was the Boezaart surgical field score, while secondary outcomes included operative time, histopathological changes, and postoperative complications. The Wilcoxon signed-rank test was used for statistical analyses.

Results: The Boezaart surgical field score significantly improved with hot saline irrigation compared with the control during anterior ethmoid surgery (p = 0.046); however, no significant difference was observed during posterior ethmoid and sphenoid surgeries. Operative times were comparable between groups. No adverse tissue changes or postoperative complications were observed.

Conclusions and significance: Hot saline irrigation at 42 °C improved surgical field visibility during ESS without adverse effects, demonstrating its potential as a haemostatic adjunct. This cost-effective and safe technique warrants further investigation for broader clinical application.

Trial registration: UMIN Clinical Trials Registry: UMIN000052864.

Background: Large language models (LLMs) are increasingly used in clinical decision-making and patient education, including in complex specialties such as head and neck cancer (HNC).

Objective: To evaluate the performance of ChatGPT-4o and DeepSeek-V3 in answering HNC-related clinical questions.

Methods: A set of 154 questions across six clinical categories was submitted twice to both models. Responses were independently graded by head and neck surgeons using a four-point accuracy scale. Accuracy, reproducibility, and inter-model agreement were assessed.

Results: ChatGPT-4o and DeepSeek-V3 provided ''comprehensive/correct'' answers in 92.2% and 89.6% of cases, respectively (p = .42). The accuracy ratings of both models' responses overlapped in 85.1% of cases; however, the statistical agreement between them remained low (Cohen's κ = 0.12; ICC = 0.21, p = .006). DeepSeek-V3 outperformed ChatGPT in Treatment category (96.3% vs. 81.5%, p = .08), while ChatGPT excelled in Recovery, Complications, and Follow-up (95.0% vs. 82.5%, p = .08); however, these differences did not reach statistical significance. Reproducibility was high for both models (ChatGPT-4o: 96.1%; DeepSeek-V3: 96.8%).

Conclusions: Both models demonstrated strong accuracy and consistency in HNC-related queries.

Significance: LLMs hold promise as reliable tools in clinical decision-making and patient education within HNCs when used with careful consideration of their inherent limitations.

Background: Age-related hearing loss (ARHL) represents the most prevalent sensory disorder among the elderly, significantly impairing daily functioning and increasing the risk of psychiatric conditions. Although Schwann cells (SCs) are critical for maintaining auditory nerve function, the mechanisms underlying their dysfunction in ARHL remain incompletely elucidated.

Aims: To investigate BST2's role in SCs dysfunction in ARHL and assess its potential value as a serum biomarker for early ARHL diagnosis.

Materials and methods: Adeno-associated virus (AAV) carrying a SC specific promoter-MBP, was injected into the posterior semicircular canal of mice. Immunofluorescence was employed to assess cochlear SCs function, while ELISA was used to measured BST2 levels in the serum of both humans and mice.

Results: Overexpression of BST2 inhibited SCs proliferation and differentiation, promoted apoptosis, and accelerated ARHL. Serum BST2 levels were elevated in both ARHL patients and mice, showing a significant positive correlation with audiometric thresholds and wave I latency of ABR.

Conclusions and significance: BST2 accelerates the progression of ARHL by exacerbating SCs dysfunction and serves as a potential serum biomarker for ARHL.

Background: The Supraclavicular artery islanded flap (SCAIF) is commonly used for the reconstruction of oral cavity defects.

Aim: This study evaluated the incidence of donor site phantom sensation following SCAIF reconstruction.

Methods: This was a prospective cohort study conducted on all consecutive cases of SCAIF reconstruction undertaken for oral cavity reconstruction over 3 years. The primary outcome was to document the incidence of phantom sensation at the donor site arising from sensory stimulation of the skin paddle in the oral cavity. The study was undertaken using questions to assess the type and duration of phantom symptoms.

Results: Of the 105 SCAIF reconstructions undertaken during this period, 30 (28.57%) of the patients were found to have phantom sensations. The spectrum of phantom sensations referred over the deltoid region were tactile (23), temperature (23) and pain (10). The mean duration of phantom sensation was 16.4 months (range: 6 months to 36 months). Intraoperative sectioning of supraclavicular nerves during flap harvest was shown to minimise the incidence of the development of phantom sensation (Odds ratio: 4.42, 95% CI: 0.95-20.40).

Conclusion: This study documented donor site phantom sensation in 28.57% of the patients undergoing SCAIF reconstruction. This carries immense implications in terms of preoperative patient counselling.

Background: Trismus, difficulty opening the jaw, and dysphagia, difficulty swallowing, are complications in head and neck cancer (HNC). Metabolic imbalances, including alterations in amino acids, lipids, and inflammatory markers, potentially influence these conditions.

Aim/objective: The aim of this study was to investigate associations of metabolic and inflammatory metabolites in HNC patients, focusing on trismus and dysphagia.

Material and methods: Nuclear Magnetic Resonance (NMR) spectroscopy, and Bruker IVDr Lipoprotein Subclass analysis was used to analyse metabolites in plasma from 302 patients before, during and after treatment for HNC.

Results: Sixteen lipoprotein subclasses (LDL 1-6, HDL 1-4 VLDL 1-6) as well as creatinine, creatine, glutamine, alanine, glycine, GlycA, GlycB, and a combined lipoprotein-derived NMR signal named Supramolecular Phospholipid Composite (SPC), were analysed. An increase in several lipoprotein sub fractions and elevated inflammatory biomarkers (GlycA and GlycB) were associated with Maximal Interincisal Opening (MIO) before treatment. The M.D. Anderson Dysphagia Inventory (MDADI) before treatment was associated with elevated GlycA and GlycB. The results also showed significant correlations between metabolites and BMI, sex, age, radiation therapy as well as tumour stage and location.

Conclusion and significance: Metabolic and inflammatory markers highlight the metabolic heterogeneity in HNC and provide potential targets for future therapeutic strategies.

Background: The studies on malnutrition/obesity and hearing argued that there may be a relationship between malnutrition/obesity and hearing loss, although many used behavioral measurements.

Aims/objectives: To investigate Auditory Brainstem Responses (ABR) in women by considering Body Mass Index (BMI).

Material and methods: A total of 60 females (n = 120 ears) between the ages of 18-40 years participated. All subjects had normal hearing, and they were grouped under three BMI categories (weak, ideal weight and overweight). ABR recorded with Click and CE-Chirp stimuli at 80-60 dB nHL intensity levels. Absolute latencies and inter- peak latencies of waves I, III and V were evaluated. Right-left ears results and the stimulus type (Click or CE-Chirp) were considered.

Results: Mainly, wave V absolute latency and I-V inter-peak latency were longest in subjects who were overweight. No interpretable differences were noted between the ears (p > 0.05). Regarding the stimulus type (Click or CE-Chirp), significant differences were observed in all BMI groups (p < 0.05).

Conclusions and significance: The ABR, which are affected by many other factors, are also directly related to BMI. The importance of taking BMI into consideration when creating normative data in ABR measurements and/or using ABR in clinics is emphasized. The stimulus type caused significant differences.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts the health-related quality of life (HrQoL) and sense of smell. The association between recurrent NPs after surgery and patient-reported outcomes has not been extensively studied.

Objective: To investigate whether patients with recurrent NPs can be distinguished from non-recurrent cases based on pre- and postsurgical evaluations of HrQoL, sense of smell, blood eosinophils and fractional exhaled nitric oxide (FeNO).

Methods: Thirty-five patients with CRSwNP were recruited pre-surgery and followed up to 12 months post-surgery. HrQoL was assessed with RAND-36 and SNOT-22, olfactory dysfunction with smell test and self-reported.

Results: SNOT-22 scores improved 6 months post-surgery but deteriorated 12 months post-surgery with no significant difference related to recurrent NPs. Patients with recurrent NPs had lower smell test scores and more frequent self-reported anosmia or hyposmia as well as higher blood eosinophil counts at pre-surgery. FeNO did not change post-surgery and was not related to NP recurrence.

Conclusion: A low smell test result before surgery may serve as an early indicator of recalcitrant NPs, whereas preoperative scores from HrQoL questionnaires may not be a good predictor. We confirm a significant role for blood eosinophils in refractory CRSwNP, while FeNO may not predict rapid NP recurrence.

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.