Acta Oto-Laryngologica最新文献

Background: The trabecular mesh of the inner ear plays a critical role in maintaining the structure of the vestibular organs, particularly within the pars superior. Cases have been reported in which the saccule cannot be visualized in the pars inferior lacking this structure.

Objectives: To investigate the clinical features and endolymphatic hydrops (EH) and perilymphatic enhancement (PE) on MRI in ears with an invisible saccule (IS) and to clarify the mechanism of IS.

Materials and methods: Retrospective study of 89 IS ears and 71 contralateral visible saccule (VS) ears from 406 patients with hearing impairment and vertigo between 2021 and 2024. Middle ear disease, schwannoma, perilymphatic fistula, and ears after intratympanic injection were excluded.

Results: Compared with VS ears, IS ears had worse hearing, especially in the low-frequency range, and higher PE. Cases diagnosed with Meniere's disease accounted for 13% of IS, all of which showed EH limited to the cochlea, and PE showed higher in IS ears with vertigo than in those without.

Conclusions and significance: The development of IS is associated with loss of anatomical support and subsequent collapse and fistula of the membranous labyrinth, which may cause the breakdown of the blood-labyrinth barrier and changes in lymphatic flow.

Background: Currently, Intratympanic steroid injection (ITSI) has been identified as a common method for delivering dexamethasone to the inner ear in idiopathic sudden sensorineural hearing loss (ISSNHL).

Objective: This study analyzed factors influencing dexamethasone effective dose in ITSI, aiming to optimize injection protocols and efficacy assessment.

Materials and methods: A total of 251 ISSNHL patients received ITSI with 5 mg dexamethasone, and drug leakage from the external auditory canal was quantified. The effects of Eustachian tube function (assessed via taste method), injection speed (5 vs. 10 s), and injection site (anteroinferior, posteroinferior, anterosuperior tympanic membrane) on the effective dose were evaluated. The pretreatment and posttreatment audiological examination results were collected, and the relationship between the effective dosage and the efficacy was analyzed.

Results: Significantly higher median leakage (1.90 mg vs. 0.75 mg, p < 0.01) was showed in patients with bitter taste, indicating passive eustachian tube opening. However, injection speed and site had no significant impact on leakage (p > 0.05). No significant differences in hearing outcomes were observed between high (>3.5 mg) and low (≤3.5 mg) effective dose groups (p > 0.05).

Conclusions and significance: ITSI effective dose primarily depends on eustachian tube function, and low-dose dexamethasone (sufficient to fill the tympanic cavity) is equally efficacious, suggesting simplified clinical protocols.

Background: Eustachian tube represents the anterior part of the middle ear. Its role is to maintain the pressure balance between the external and middle ear, especially in some jobs such as divers.

Objectives: This clinical study aimed to evaluate Eustachian tube (ET) dysfunction in a cohort of professional divers. The primary objectives were: 1) to compare the prevalence of ET dysfunction in experienced divers versus non-divers, and 2) to assess the potential impact of diving-related immersion factors on ET function.

Materials and methods: This case-control study enrolled 34 professional divers from the Italian Navy (Group A) and 35 individuals with no diving experience (Group B). Both groups underwent clinical and physical examinations, assessment of ET function via tympanometry, and completed the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7).

Results: Tympanometry revealed that 2.9% of participants in both groups had a pathological tympanogram, with no significant differences between groups. ETDQ-7 scores were similarly distributed. However, significant differences were found in tympanometric results after the Valsalva maneuver (p = 0.004 for right ear pressure peaks and p = 0.001 for left ear pressure peaks, comparing Groups A and B). Professional divers showed a low risk of developing ET dysfunction, comparable to non-divers, and this risk was not associated with the duration or frequency of diving activity.

Conclusions: Navy divers show a lower incidence of ET dysfunction.

Significance: This article could explain to the readers the functioning of the ET function between navy divers and normal divers.

Background: This study aimed to investigate the efficacy of three-dimensional (3D) printing-assisted treatment for naso-orbito-ethmoid (NOE) fractures and to compare it with conventional surgical methods.

Methods: This research conducted a retrospective analysis of 84 patients with NOE fractures who received surgical treatment at the 900th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from January 2018 to July 2023. The patients were divided into two groups based on whether 3D printing was applied as the experimental group (n = 44) and the traditional group (n = 40). Surgical duration, hospital stay duration, intraoperative blood loss, postoperative visual analog scale (VAS) score, simotic index, and complications were compared.

Results: The 3D printing group had a shorter average surgical time, average hospital stay duration, average indwelling time of drainage tube, intraoperative blood loss, postoperative pain and satisfaction VAS score, and complications compared to the traditional group. No statistically significant differences were found between the two groups in the simotic index after treatment.

Conclusions: Compared to conventional surgical treatment, preoperative 3D printing-assisted treatment for adult patients with NOE fractures can significantly reduce surgical duration, intraoperative bleeding loss and complications, reducing surgical difficulty and improving surgical safety.

Background: Laryngeal cancer poses a persistent global health burden. Although age-standardized rates have declined, absolute case numbers continue to rise due to population growth and aging.

Aims/objectives: To assess global, regional, and national trends in laryngeal cancer burden (1990-2021), evaluate disparities by Socio-demographic Index (SDI), and project future trends to 2045.

Material and methods: We used data from the Global Burden of Disease 2021 study. Trends in incidence, mortality, prevalence, and DALYs were analyzed using estimated annual percentage change (EAPC). Das Gupta decomposition assessed contributions of aging, population growth, and epidemiological shifts. Frontier analysis evaluated control efficiency across SDI levels. Forecasts were generated using a Bayesian age-period-cohort (BAPC) model selected by root mean square error.

Results: From 1990 to 2021, age-standardized rates declined, but absolute burden increased. Middle-SDI regions and males bore disproportionately high burden. Low-SDI areas saw increases mainly from demographic drivers, while high-SDI areas saw reductions from improved epidemiology. Frontier analysis showed widening control inefficiencies. An inverted U-shaped SDI-burden pattern was identified. Projections indicate continued increases in absolute burden by 2045.

Conclusion and significance: Despite falling rates, global laryngeal cancer burden is growing. Targeted, SDI- and sex-specific interventions are needed to reduce disparities and improve outcomes.

Background: Tuberculous otitis media (TOM) is a rare form of chronic otitis media, which presents diagnostic challenges due to nonspecific symptoms.

Aims/objectives: To characterize the clinical features and identify strategies for early diagnosis.

Materials and methods: A retrospective analysis was conducted on 32 patients (40 ears) diagnosed with TOM between 2002 and 2024. Clinical, audiologic, radiologic, and laboratory findings were reviewed.

Results: Mean diagnostic delay was 28.9 months. Persistent otorrhea (90%) and hearing loss (HL) (100%) were predominant. Tympanic membrane findings varied: single perforation (70%), multiple (12.5%), and intact (17.5%). Granulations were universal. Age stratification revealed conductive HL and pneumatized mastoids predominated in patients <40 years, while mixed HL and mixed-type mastoid were more common in patients >40 years (p = 0.016, p = 0.005). Bone destruction was evident in 25% of the cases. Mastoid type correlated with HL patterns in non-destructive cases (p = 0.040). Interferon-gamma release assay (IGRA) and polymerase chain reaction (PCR) showed relatively high detection rates.

Conclusions and significance: Early suspicion of TOM in refractory/recurrent otitis media, combined with IGRA/PCR screening, prompt imaging, and consideration of age-specific patterns, facilitates timely diagnosis. Surgical biopsy remains critical for confirmation. Integration of age-stratified clinical, laboratory, and radiological findings improves detection accuracy and patient outcomes.

Background: The ideal ossiculoplasty technique should effectively restore sound transmission, be surgically feasible, biocompatible, and stable. Currently, no single material fully meets these criteria in a cost-effective manner.

Objectives: To evaluate and compare the long-term audiological outcomes of various ossiculoplasty techniques.

Materials and methods: This retrospective study included 116 patients (aged 11-72) who underwent ossiculoplasty using cortical bone, bone cement, or titanium prostheses between 2013 and 2019. Preoperative and 2-year postoperative air and bone conduction thresholds (500-4000 Hz), air-bone gap (ABG), and hearing gains were analyzed.

Results: Significant postoperative ABG improvement was observed in the malleus-incus, incus-stapes bone cement, TORP, and PORP groups (p < 0.05). Although hearing gain was noted in the malleus-stapes bone cement and cortical bone groups, the improvement was not statistically significant (p = 0.18 and p = 0.95, respectively). Hearing gain >10 dB was achieved in 76.5% of incus-stapes bone cement and 53% of TORP procedures.

Conclusions and significance: Bone cement offers an effective and economical option for ossiculoplasty, particularly in incudostapedial repairs. Despite no statistically significant difference (p = 0.206), the favorable outcomes of TORP suggest it may be superior to cortical bone in patients with non-functional ossicular chains.

Background: While extensive research exists on the efficacy of the Epley maneuver, studies examining nystagmus findings during treatment are limited.

Aims/objectives: This study aimed to examine posterior canal benign paroxysmal positional vertigo (BPPV) to determine whether nystagmus findings during the Epley maneuver can predict efficacy. Additionally, we investigated the occurrence of nystagmus in the sitting position immediately following treatment.

Materials and methods: The participants comprised 50 consecutive cases of posterior canal BPPV. Eye movements during and after the Epley maneuver were observed. Patients were asked to revisit within a week for the Dix-Hallpike test.

Results: A high incidence of torsional nystagmus towards the affected side was observed in the healthy-ear-down 135° position, occurring in 62% of cases. This finding indicates that the treatment was successful. However, not all cases exhibiting this nystagmus achieved complete recovery. Ninety-four % of patients did not exhibit nystagmus in the final position, even though pathological debris was stimulating the utricle.

Conclusions and significance: Nystagmus findings during the Epley maneuver cannot always predict the efficacy. The occurrence of nystagmus in the final position is very low, suggesting that stimulating the utricle may not always induce nystagmus.

Background: Snoring often limits sleep quality and quality of life of the affected person. Effective therapies for snoring are scarce.

Aims/objectives: This prospective, randomized, controlled study aims to investigate the efficacy of an orolingual myofunctional therapy for the treatment of snoring.

Material and methods: In total 125 participants with history of snoring were included in this single center study. Participants were randomized to orolingual (treatment) or finger coordination exercises (control) for 6 weeks. The primary endpoint was a subjective snoring score derived from visual analogue scales for snoring qualities. The secondary endpoints included snoring index, -time and apnea-hypopnea index determined by home sleep apnea test and sleep questionnaires.

Results: 92 patients reached final analysis (51 experimental, 41 controls). In analysis of covariance, the snoring score at follow-up was 2.3 scale points lower in the treatment group, compared to the control group (95% CI 0.6 to 3.9, p = 0.007). Explorative analysis suggested that older participants benefit more than younger. Secondary parameters did not differ significantly.

Results: 92 patients reached final analysis (51 experimental, 41 controls). In analysis of covariance, the snoring score at follow-up was 2.3 scale points lower in the treatment group, compared to the control group (95% CI 0.6 to 3.9, p = 0.007). Explorative analysis suggested that older participants benefit more than younger. Secondary parameters did not differ significantly.

Conclusions and significance: Results of this study indicate that orolingual myofunctional therapy improves subjective snoring score with respect to the bed partner compared to control.

Background: Castleman disease, a rare lymphoproliferative disorder with diverse features, is often misdiagnosed due to rarity and similarity to malignancies.

Aims: The study analyzed the clinicopathological characteristics, diagnostic challenges, and outcomes of head and neck Castleman disease (HNCD) to improve diagnostic accuracy and optimize management strategies.

Material and methods: Retrospective study of 21 HNCD patients treated at Beijing Tongren Hospital (2007-2024). Demographics, presentation, imaging, histopathology, treatment, and outcomes were analyzed using t-tests, Mann-Whitney U, and Fisher's exact tests.

Results: Mean age 36.1; 52.4% female. Mainly painless cervical masses (95.2%). Histology: 85.7% hyaline vascular, 14.3% plasma cell. Imaging showing non-specific hypoechoic nodules (ultrasound) and homogeneous enhancement (CT/MRI). Surgical excision (85.7%) achieved 76.2% complete remission (mean follow-up: 85.2 months). Tumor size (34.6 ± 15.3 mm) didn't correlate with outcome (p = 0.756). One plasma cell patient (4.8%) died of unrelated causes. No recurrences or malignant transformations were observed.

Conclusions and significance: HNCDs are predominantly unicentric and can be cured with complete surgical resection. Due to the lack of specificity of imaging and laboratory findings, diagnosis relies on histopathology. Collaborations among multiple centers and molecular studies are essential to advancing the precision treatment of HNCD.