Acta Oto-Laryngologica最新文献

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.

Background: No randomized trials confirm the efficacy of concurrent chemoradiotherapy (CCRT) in platinum-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) post-induction chemotherapy (IC).

Objectives: This study evaluates the efficacy of platinum-based versus taxane-based CCRT after IC in LAHNSCC patients, excluding nasopharyngeal carcinoma, to assess the viability of taxanes as a platinum alternative.

Materials and methods: A retrospective analysis was conducted on 215 LAHNSCC patients treated with IC using nab-paclitaxel/docetaxel, cisplatin, and fluorouracil (AP/APF or TP/TPF). During CCRT, patients were divided into platinum and taxane groups. Survival rates, and safety profiles of nab-paclitaxel versus docetaxel were compared. All patients received Helical tomotherapy and Intensity-modulated radiotherapy at 60-70 Gy.

Results: No significant differences were observed in CR rates, 3-year progression-free survival (PFS) (75.2 vs. 84.8%), or overall survival (OS) (72.1 vs. 84.1%) between taxane and platinum groups. Within the taxane group, CR rates and 3-year PFS showed no significant difference. However, the nab-paclitaxel group demonstrated significantly improved 3-year OS (80.9 vs. 67.6%) and disease-specific survival (DSS) (94.09 vs. 70.72%) compared to the docetaxel group.

Conclusions: Taxane-based CCRT after IC is as effective as platinum-based treatment with manageable toxicity. Nab-paclitaxel surpassed docetaxel in 3-year OS and DSS.

Background: The three-dimensional (3D) exoscope is an emerging alternative to the operating microscope (OM) in otologic surgery.

Aims: To assess its clinical utility in cholesteatoma surgery.

Methods: Retrospective review of 36 primary cases (21 OM, 15 exoscope) comparing setup time, surgical duration, audiological outcomes, and recurrence.

Results: Groups were comparable in background and stage. Setup time was shorter with exoscope (microscope: 20 min, range 18-22, exoscope: 17 min, range 14-20) (p = .002), while other outcomes showed no significant difference.

Conclusions: The 3D exoscope reduced setup time with equivalent surgical and functional outcomes to OM.

Background: The vestibular system is crucial for balance and gaze stability. Proprioceptive inputs from the musculoskeletal system significantly contribute to vestibular processing, especially under postural challenge.

Objectives: To examine how proprioceptive inputs in various body positions affect the vestibulo-ocular reflex (VOR) and otolith organ function.

Materials and methods: Thirty healthy adults (18-40 years, no vertiginous symptoms) underwent cervical and ocular vestibular evoked myogenic potentials (c-VEMP, o-VEMP) and video head impulse testing (v-HIT) in four positions: sitting, standing, one-leg standing, and on a balance disk. Primary outcomes included latency, amplitude, and asymmetry for VEMPs; gain and asymmetry for semicircular canals (SCCs) via v-HIT.

Results: c-VEMP latencies and amplitudes did not differ significantly across positions; however, amplitude asymmetry was significantly different between sitting and other conditions (p = .041). o-VEMP results remained consistent (p > .05). v-HIT revealed progressively reduced SCC gain from sitting to disk stance, with significant decreases in lateral SCCs (p < .05) and vertical SCCs (p < .001); asymmetry remained stable.

Conclusions and significance: Increased proprioceptive demand reduced VOR gain and modified c-VEMP asymmetry, reflecting enhanced vestibulospinal engagement. These outcomes likely arise from multisensory interactions rather than proprioceptive input alone, underscoring integrated sensory contributions to postural control.

Background: Daily and regular use of cochlear implant (CI) processors is crucial for adapting to them and achieving optimal benefits. However, some obstacles to using CI processors exist, and it is important to identify these barriers and find solutions.

Purpose: This research evaluated the validity and reliability of the Turkish version of the Cochlear Implant Use Questionnaire (CIUQ) related to the barriers to cochlear implant use.

Methods: This is a cross-cultural adaptation of the CIUQ questionnaire. One hundred thirty-four adult CI users aged 18-60 participated in the study. This study evaluated the construct validity of the CIUQ using confirmatory factor analysis and the internal consistency reliability using Cronbach's alpha coefficient.

Results: In the current study, the Kaiser-Meyer-Olkin coefficient was 0.75. The fit values obtained from the CFA applied to the CIUQ were satisfactory and within acceptable limits. Cronbach's α internal consistency coefficient for subscales ranged from 0.70 to 0.78, and the value was 0.8 for the overall scale.

Conclusion: The Turkish adaptation of the CIUQ, which was developed to measure CI usage habits and barriers to daily CI usage, was determined to be a reliable and valid measurement tool for adults using CI.

Background: The sensation of food 'sticking' in the throat is a frequent but diagnostically challenging symptom that often persists despite normal ENT findings. Videofluoroscopic swallowing study (VFSS) enables dynamic evaluation of swallowing physiology and may reveal hidden abnormalities.

Aims/objectives: To assess the diagnostic yield of VFSS in patients with throat-related dysphagia, focusing on abnormality type, localisation, and bolus consistency.

Materials and methods: This retrospective study included 42 patients with persistent symptoms but normal endoscopic examinations between January 2020 and January 2025. Reflux-related findings were excluded. VFSS was performed with nectar-thick liquids, pudding, and solids. Abnormalities were classified by site and etiology. Concordance between symptom site and VFSS findings was analysed.

Results: VFSS detected abnormalities in 74% of patients, predominantly physiological (65%) and within the oesophageal body (55%). Symptom-pathology concordance was low (26%). Solids provided the highest diagnostic yield (50%).

Conclusions and significance: VFSS is valuable in unexplained dysphagia with normal ENT findings, particularly when symptoms occur with solids. Including oesophageal evaluation and varied consistencies improves diagnostic precision and guides management.

Background: Preoperative differentiation between benign and malignant parotid gland tumors is challenging. Apparent Diffusion Coefficient (ADC) from Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) and systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as non-invasive diagnostic tools.

Aims/objectives: To evaluate the diagnostic utility of ADC, NLR, and PLR individually and in combination for distingushing benign from malignant parotid tumors and for differentiating major histopathological subtypes.

Material and methods: This retrospective study included 138 patients with histopathologically confirmed parotid tumors. ADC values were obtained from DW-MRI, and NLR and PLR were calculated from preoperative CBC. A decision tree model incorporating age, gender, ADC, PLR, and NLR was developed, and diagnostic performance was assessed using ROC analysis.

Results: Complete data was available for for 108 patients. The decision tree achieved an AUC of 0.837 for malignancy prediction, with age and PLR as key predictors. Excluding ADC did not impact model performance (AUC=0.837; p=1.0). While ADC alone did not differentiate malignancy, it was effective for subtype classification: AUC=0.891 for Warthin tumor vs pleomorphic adenoma, and 0.771 for pleomorphic adenoma vs mucoepidermoid carcinoma.

Conclusions and significance: Systemic inflammation markers enhance malignancy prediction, whereas ADC contributes meaningfully to histological subtype differentiation.

Background: The Visual Vertical, an iOS mobile application, enables a more practical implementation of the subjective visual vertical (SVV) test compared to the bucket method.

Objectives: To determine the effectiveness of the iOS mobile application on SVV in children.

Materials and methods: A bucket test specifically designed for SVV assessment was administered to 44 children aged 11 to 14 years. The bucket was rotated 45° from the neutral (0°) head position in both clockwise and counter-clockwise rotations. Participants were instructed to indicate the moment they perceived the line inside the bucket as vertically aligned after 10 s. Angular deviations were recorded using both a protractor and an iOS application. Each participant underwent five trials in each rotational direction, and the mean was calculated to determine the SVV deviation angle.

Results: SVV deviation angle was determined as 0.92° in clockwise rotation and 0.96° in counter-clockwise rotation in the bucket test; and as 0.97° and 1.03° in the iOS application, respectively. No statistically significant difference was observed between SVV deviation angles in both applications (p > 0.05).

Conclusions and significance: Visual Vertical, an iOS mobile application, offers a practical and accessible alternative to the bucket method for assessing utricular function in children.