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: 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.

Backgrounds: Appropriate diagnosis and treatment of problems leading to balance dysfunction requires accurate information on the balance of the population at all ages, but little data are available.

Objective: To test the dynamic balance function in normal individuals and gather baseline data and performance characteristics across various age groups.

Methods: A total of 100 healthy subjects underwent Sensory Organization Tests (SOT), Motor Control Tests (MCT), Adaptation Tests (ADT), and Limits of Stability (LOS) using computerized dynamic posturography (CDP).

Results: Results showed that the scores for balance function and strategy in the SOT test decreased as the difficulty level increased. During the MCT test, the postural latencies of the young group's limbs were lower than those of the elderly and middle-aged groups (p < 0.05). In the ADT test, the swinging energy during ankle stretching varied significantly among the young, middle-aged, and elderly groups (p < 0.05). In the LOS test, the young group had significantly faster reaction times but higher average movement rates and maximum movement distance than older groups (p < 0.05).

Conclusion: Compared to other age groups, the elderly exhibit poor dynamic balance, slow recovery from balance disturbances, and limited exercise adaptability, and require more time to react to maintain balance.

Background: Sentinel lymph node biopsy (SLNB) is increasingly used in oral cavity squamous cell carcinoma (OCSCC) as a minimally invasive approach that may reduce overtreatment and morbidity compared to elective neck dissection (END).

Aim: This study evaluated the diagnostic performance of SLNB in clinically node-negative (cN0) OCSCC and its utility in mapping lymphatic drainage, particularly in advanced tumors.

Methods: A retrospective cohort of 57 cN0 OCSCC patients undergoing SLNB followed by completion neck dissection was analysed.

Results: In early-stage tumors (T1/T2), SLNB demonstrated 100% sensitivity and negative predictive value, with an occult metastasis rate of 23.8%. No false negatives were observed, and only one patient was upstaged. In T3/T4 tumors, sensitivity and NPV decreased to 55.6% and 60%. The false-negative rate (FNR), calculated as the proportion of false negatives among patients with histopathologically confirmed nodal metastases, was 44.4%. Contralateral or bilateral drainage occurred in 40% of well-lateralized advanced tumors, reflecting altered drainage with progression.

Conclusion: SLNB is a reliable staging tool in early OCSCC. In advanced disease, although diagnostic accuracy is reduced, it provides valuable information on atypical drainage pathways.

Significance: These findings support SLNB as an effective staging and lymphatic mapping tool, reinforcing its selective integration into OCSCC management.