Acta Oto-Laryngologica最新文献

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.

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.