American Journal of Otolaryngology最新文献

{"title":"Fibrin glue enhances early hearing recovery in tympanoplasty: A randomised controlled trial","authors":"Benyamin Rahmaty ,&nbsp;Sanam Asgari ,&nbsp;Mohammad Sayyadi ,&nbsp;Ali Kouhi ,&nbsp;Saeed Golparavaran ,&nbsp;Ali Aalizade ,&nbsp;Mohammad Taghi Khorsandi Ashtiani ,&nbsp;Kayvan Aghazadeh","doi":"10.1016/j.amjoto.2026.104791","DOIUrl":"10.1016/j.amjoto.2026.104791","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the efficacy of fibrin glue versus Gelfoam in cartilage tympanoplasty, focusing on graft uptake rates and short-term hearing outcomes.</div></div><div><h3>Methods</h3><div>In this double-blind, randomised clinical trial, forty-six patients with dry tympanic membrane perforations were randomly allocated to two groups: fibrin glue with cartilage graft (Group A) and Gelfoam with cartilage graft (Group B). A single surgeon carried out all surgeries. Graft integrity and air–bone gap (ABG) closure (≤15 dB) were evaluated three months post-surgery.</div></div><div><h3>Results</h3><div>Graft uptake rates were 91.3% in the fibrin group and 82.6% in the Gelfoam group (<em>p</em> &gt; 0.05). However, ABG closure ≤15 dB was achieved in 87% of the fibrin group compared to 60.9% of the Gelfoam group (<em>p</em> = 0.044), indicating a significant improvement in early hearing outcomes.</div></div><div><h3>Conclusion</h3><div>Fibrin glue tympanoplasty achieved comparable graft uptake rates to conventional Gelfoam tympanoplasty, while providing superior short-term hearing improvement. Both techniques demonstrated comparable graft integration, while fibrin glue was associated with superior early hearing recovery.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104791"},"PeriodicalIF":1.7,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive big database analysis of outcomes and complications of combination endoscopic sinus surgery and septorhinoplasty","authors":"Robert E. Africa ,&nbsp;Scott A. Hardison ,&nbsp;Felix Maldonado-Chapa ,&nbsp;Brian J. McKinnon","doi":"10.1016/j.amjoto.2026.104795","DOIUrl":"10.1016/j.amjoto.2026.104795","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate postoperative outcomes and complications of combination functional endoscopic sinus surgery (FESS) and septorhinoplasty (SRP).</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective database study utilizing data from 106 healthcare organizations in the United States from January 1, 2010 to July 31, 2025. The TriNetX database was used to obtain summary statistics on adult patients aged 18 years or older who underwent combination FESS/SRP, FESS alone, or SRP alone. Postoperative outcomes and complications evaluated in comparing combined FESS/SRP with either procedure alone included epistaxis, mucocele formation, postoperative pain, orbital injury, abscess or infection, revision rhinoplasty, and septal perforation needing repair among others.</div></div><div><h3>Results</h3><div>Compared with FESS alone, combination FESS/SRP showed higher rates of acute postoperative pain and nasal mucocele (RR: 1.25 [1.02–1.52]; 1.33 [1.15–1.53]) but no increased risk of recurrent acute sinusitis or chronic sinusitis (RR: 0.97 [0.89–1.06]; 0.99 [0.97–1.03]). Combination FESS/SRP did not have a higher rate of cerebrospinal fluid (CSF) leak (RR: 0.24 [0.13–0.44), meningitis (0.44 [0.21–0.91]), and orbital injury (0.84 [0.74–0.95]) compared to FESS alone. Compared with SRP alone, combination surgery was associated with more persistent septal deviation (RR: 1.18 [1.10–1.26]) and higher rates of epistaxis and control of epistaxis procedures (RR: 1.85 [1.49–2.29]; 2.00 [1.28–3.12]). Septal perforation repair was not significantly increased with combination surgery (RR: 1.11 [0.60–2.05]), though nasal infection or abscess was more frequent (RR: 1.17 [1.13–1.21]).</div></div><div><h3>Conclusion</h3><div>Combination surgery did not show significant major complications, though rates of epistaxis, nasal congestion, and infection were higher. Differences in complications and outcomes may reflect patient selection, potentially explaining the lower risk of major complications in the combined surgery group. The data from this study does not support combined surgery for complicated sinus disease, as anatomic complexity could not be distinguished.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104795"},"PeriodicalIF":1.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can microbial profiles influence type II inflammation in chronic rhinosinusitis with nasal polyps?","authors":"Gaia Vertillo Aluisio, Maria Santagati, Giovanna Stilo, Mario Lentini, Leigh J Sowerby, Miguel Mayo-Yáñez, Ahmad R Sedaghat, Jerome R Lechien, Stefania Stefani, Igo La Mantia, Antonino Maniaci","doi":"10.1016/j.amjoto.2026.104786","DOIUrl":"https://doi.org/10.1016/j.amjoto.2026.104786","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess how different treatments - dupilumab vs surgery - influence the nasal microbiota, type 2 inflammation, and clinical outcomes in CRSwNP patients.</p><p><strong>Methods: </strong>This was a prospective observational study of 44 CRSwNP patients assigned to 6 months of biweekly dupilumab injections or functional endoscopic sinus surgery (FESS). Nasal microbiotas were analyzed at baseline and 6 months using culture techniques. Inflammatory biomarkers (IgE, eosinophils) and clinical endpoints (polyp score, SNOT-22, smell test) were measured. Patients were also stratified into groups based on which bacteria were cultured from their sinuses.</p><p><strong>Results: </strong>At baseline, the most prevalent bacteria were Staphylococcus aureus (43%), Stapylococcus epidermidis (36%), and Pseudomonas aeruginosa (16%). After 6 months, S. aureus and S. epidermidis significantly increased while P. aeruginosa decreased. Eosinophil counts were stable. IgE levels notably decreased in the S. aureus and S. epidermidis groups but increased with P. aeruginosa. All bacterial groups showed reduced polyp score and SNOT-22, and improved smell, but P. aeruginosa had smaller gains. Higher baseline S. aureus and S. epidermidis correlated with more significant IgE decrease.</p><p><strong>Conclusions: </strong>Dupilumab and surgery-induced favourable microbiota changes by reducing pathogenic bacteria. Nasal microbiota composition may be associated inflammatory and clinical treatment responses in CRSwNP. S. aureus and S. epidermidis correlated with a greater improvement of IgE levels, whereas P. aeruginosa correlated with worse IgE outcomes. Analyzing each patient's nasal microbiome could enable more personalized, microbiome-directed treatment approaches for optimal CRSwNP management.</p>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"104786"},"PeriodicalIF":1.7,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of migraine in recurrent benign paroxysmal positional vertigo","authors":"Pelin Koçdor ,&nbsp;Emel Işık ,&nbsp;Oğuzhan Çetin ,&nbsp;Rüya Somer ,&nbsp;Suat Avcı ,&nbsp;Merve Kaşıkcı ,&nbsp;Levent Naci Özlüoğlu","doi":"10.1016/j.amjoto.2026.104794","DOIUrl":"10.1016/j.amjoto.2026.104794","url":null,"abstract":"<div><h3>Objective</h3><div>Benign paroxysmal positional vertigo (BPPV) frequently recurs, affecting quality of life. Although migraine and environmental factors such as atmospheric pressure and temperature have been proposed as predictors, their precise influence remains unclear. We aimed to evaluate whether migraine, thyroid disease, and environmental factors (atmospheric pressure and temperature) predict recurrence of BPPV.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 374 patients diagnosed with BPPV between 2018 and 2024 at a university otolaryngology clinic. Clinical history, migraine and thyroid status, and meteorological data were evaluated. Multivariate logistic regression assessed independent predictors of recurrence.</div></div><div><h3>Results</h3><div>Recurrence occurred in 20.1% of patients. Migraine was significantly associated with increased recurrence risk (OR 2.07; 95% CI: 1.01–4.22; <em>p</em> = 0.046), independent of age and sex, independent of thyroid disease, and environmental conditions. No significant associations were found between recurrence and atmospheric pressure (<em>p</em> = 0.586), temperature (<em>p</em> = 0.224), or thyroid disease (<em>p</em> = 0.089).</div></div><div><h3>Conclusion</h3><div>Migraine significantly predicts BPPV recurrence, independent of environmental factors. These findings strongly support routine migraine screening in clinical practice for patients with BPPV, to facilitate early identification and tailored management strategies aimed at reducing recurrence.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104794"},"PeriodicalIF":1.7,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of vitamin D supplementation on sudden sensorineural hearing loss in vitamin D deficient patients: A double-blind, placebo-controlled trial: A pilot study","authors":"Bahareh Tavakoli,&nbsp;Sohrab Rabiei","doi":"10.1016/j.amjoto.2026.104793","DOIUrl":"10.1016/j.amjoto.2026.104793","url":null,"abstract":"<div><h3>Background</h3><div>Given the high prevalence of vitamin D deficiency among sudden sensorineural hearing loss (SSNHL) patients, this study endeavours to evaluate the impact of incorporating vitamin D supplementation into the standard treatment for individuals confirmed to be vitamin D deficient.</div></div><div><h3>Method</h3><div>In this randomized, placebo-controlled study, patients with SSNHL occurring within 45 days prior to the study and serum vitamin D levels less than 50 nmol/L or 20 ng/mL were divided into two groups. The control group received routine corticosteroid treatment plus placebo, whereas the intervention group received routine corticosteroid treatment plus Pearl, 50000 IU vitamin D3. Patients were assessed for pure-tone average (PTA) frequencies of 500, 1000, 2000, 4000, and 6000 Hz, speech reception threshold (SRT), and speech discrimination score (SDS) at baseline, 10th, and 30-day follow-up.</div></div><div><h3>Results</h3><div>Baseline demographic, biochemical, and audiological characteristics showed no significant differences between groups. PTA, SRT, and SDS were assessed at baseline, 10 days, and 30 days post-treatment. Both groups exhibited significant hearing improvement at one month; however, vitamin D supplementation led to significantly greater improvements at 2000 Hz and 4000 Hz frequencies (<em>P</em> = 0.004 and <em>P</em> = 0.001, respectively), which are critical for speech perception. No significant benefits were observed at lower frequencies (500 Hz and 1000 Hz) or at 6000 Hz, where the control group showed greater improvement. Vitamin D levels significantly increased in the intervention group without affecting serum phosphorus or calcium concentrations.</div></div><div><h3>Conclusion</h3><div>Vitamin D supplementation may enhance auditory recovery at key speech-related frequencies in SSNHL patients with vitamin D deficiency.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104793"},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical shift toward personalized cochlear implantation: Using preoperative planning to optimize insertion depth","authors":"Benjamin Bircher ,&nbsp;Philipp Aebischer ,&nbsp;Wilhelm Wimmer ,&nbsp;Georgios Mantokoudis ,&nbsp;Stephan Schraivogel ,&nbsp;Marco Caversaccio ,&nbsp;Stefan Weder","doi":"10.1016/j.amjoto.2025.104777","DOIUrl":"10.1016/j.amjoto.2025.104777","url":null,"abstract":"<div><h3>Objective:</h3><div>To evaluate the clinical implementation of preoperative, anatomy-tailored planning for electrode selection in cochlear implantation, quantify planning accuracy under routine conditions, and identify factors associated with deviations from the planned angular insertion depth (AID).</div></div><div><h3>Methods:</h3><div>We retrospectively analyzed 71 consecutive implantations; 17 cases were excluded due to unsuccessful segmentation/fusion, yielding 54 implanted ears. Before 2023 (Group A, <span><math><mrow><mi>n</mi><mo>=</mo><mn>32</mn></mrow></math></span>), electrode choice followed surgeon preference independent of cochlear duct length (CDL). From 2023 (Group B, <span><math><mrow><mi>n</mi><mo>=</mo><mn>22</mn></mrow></math></span>), automated OTOPLAN-based planning targeted an AID of 600° (cap 650°). Pre- and postoperative computed tomography scans provided cochlear metrics and postoperative AID. Planning accuracy was defined as the difference between planned and achieved AID. Linear models assessed demographic/clinical, anatomical, and surgical predictors. Speech outcomes at 6 months used Freiburger monosyllables at 65 dB HL.</div></div><div><h3>Results:</h3><div>Group B showed deeper and more consistent insertions (median AID 568° [IQR 62°]) than Group A (527° [IQR 99°]; <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>01</mn></mrow></math></span>). Median planning deviation was <span><math><mrow><mo>−</mo><msup><mrow><mn>9</mn></mrow><mrow><mo>∘</mo></mrow></msup></mrow></math></span> (IQR 78°) with no relationship to planned depth ( <span><math><mrow><msup><mrow><mi>R</mi></mrow><mrow><mn>2</mn></mrow></msup><mo>=</mo><mn>0</mn><mo>.</mo><mn>008</mn></mrow></math></span>, <span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>514</mn></mrow></math></span>). Greater inaccuracies were found in patients with shorter CDL (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>001</mn></mrow></math></span>) and in cases with observed intraoperative resistance (<span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>001</mn></mrow></math></span>).</div></div><div><h3>Conclusion:</h3><div>cochlear anatomy exhibited substantial inter-individual variability. Implementing preoperative, anatomy-tailored planning was associated with the selection of longer arrays, deeper and more consistent AID, and overall high planning accuracy. Deviations from the planned position were primarily linked to shorter CDL and intraoperative resistance, whereas deeper targets themselves did not reduce accuracy. Audiological performance at 6 months did not differ significantly between groups, although a modest trend favored the planned cohort. These findings support the feasibility of routine, examiner-independent planning and suggest that patient-specific anatomical markers should inform the selection of an appropriate electrode array.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104777"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment preferences and values in chronic tinnitus patients: A cross-sectional survey study","authors":"Jeon Mi Lee ,&nbsp;Hyun Jung Kim ,&nbsp;Yong-Hwi An ,&nbsp;Ah. Rang Cho ,&nbsp;Jae Ho Chung ,&nbsp;Jae Sang Han ,&nbsp;Woojae Han ,&nbsp;Da Jung Jung ,&nbsp;Jung-Yup Lee ,&nbsp;Euyhyun Park ,&nbsp;Kyu-Yup Lee ,&nbsp;Ho Yun Lee","doi":"10.1016/j.amjoto.2026.104790","DOIUrl":"10.1016/j.amjoto.2026.104790","url":null,"abstract":"<div><h3>Purpose</h3><div>Tinnitus is a common condition that can severely impact patients' quality of life. However, little is known about how individuals with chronic tinnitus evaluate and prioritize available treatment options. This study aimed to explore the preferences, values and expectations of patients with chronic tinnitus to inform more patient-centered strategies in clinical care.</div></div><div><h3>Material and methods</h3><div>A cross-sectional survey was conducted from May 8 to June 19, 2025, involving 45 patients with chronic tinnitus. A structured 36-item questionnaire assessed demographic information, tinnitus severity using the Tinnitus Handicap Inventory (THI) and the Visual Analog Scale (VAS), treatment preferences across 16 key questions, perceived information needs, and impact on daily functioning.</div></div><div><h3>Results</h3><div>Participants (mean age 50.7 ± 14.8 years, 62.2% male, median tinnitus duration 12 months) showed strong preferences for non-invasive treatments: sound therapy (73.4%), tinnitus retraining therapy (TRT; 55.6%), and cognitive behavioral therapy (CBT; 44.4%). Pharmaceutical interventions had lower acceptance, with hearing aids showing highest rejection (33.3%). Key concerns included drug dependency (48.9%) and psychiatric medication stigma (28.9%). 51.1% of respondents expected complete symptom resolution despite limited evidence. Information needs were high across all modalities (40–50%). Sleep disorders (THI difference: 12.9 points) and anxiety (6.5 points) significantly associated with increased tinnitus severity.</div></div><div><h3>Conclusions</h3><div>Tinnitus patients strongly prefer non-invasive treatments while harboring unrealistic expectations for cure. These findings underscore the importance of structured education and shared decision-making to align clinical care with patient values and promote more effective tinnitus management.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104790"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of acupuncture combined with various traditional Chinese medicine therapies for peripheral facial paralysis: A systematic review and network meta-analysis","authors":"Mengzhong Li ,&nbsp;Wenjie Liang ,&nbsp;Wei Liang ,&nbsp;Jianguo Zhang ,&nbsp;Xiaoping Lei","doi":"10.1016/j.amjoto.2026.104787","DOIUrl":"10.1016/j.amjoto.2026.104787","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This meta-analysis aimed to evaluate whether acupuncture combined with other traditional Chinese medicine (TCM) therapies is more effective in the treatment of peripheral facial palsy (PFP) than acupuncture alone.</div></div><div><h3>Methods</h3><div>Eight databases were searched until May 2025. Two independent reviewers extracted relevant data on study characteristics and used the Cochrane Risk of Bias Assessment Tool 2 (RoB2) to assess the risk of bias of the included studies.</div></div><div><h3>Results</h3><div>266 articles were included. Results showed that compared with acupuncture alone, acupuncture combined with tuina and cupping (surface under the cumulative ranking curve (SUCRA) = 99.33%) was the most effective intervention for improving the overall effective rate; acupuncture combined with topical application of TCM (SUCRA = 90.61%) was the optimal approach for enhancing facial nerve function (House-Brackmann (H<img>B) scale); acupuncture combined with herbal fumigation and steaming therapy (SUCRA = 80.40%) was the best intervention for improving social function (Facial Disability Index - Social Function (FDIS)) in patients with facial paralysis; acupuncture combined with pricking blood (SUCRA = 87.62%) was the most effective method for improving physical function (Facial Disability Index - Physical Function (FDIP)) in patients with facial paralysis; and acupuncture combined with cupping and pricking blood (SUCRA = 86.90%) was associated with the lowest incidence of adverse reactions.</div></div><div><h3>Conclusion</h3><div>This study showed that interventions such as acupuncture+tuina+cupping, acupuncture+topical application of TCM, acupuncture+herbal fumigation and steaming therapy, and acupuncture+pricking blood are all associated with facial nerve recovery and demonstrate superior efficacy compared with acupuncture alone.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104787"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-scale fusion vision transformer model for vocal cord leukoplakia risk stratification: A multicenter study","authors":"Jie-Lin Huang ,&nbsp;Li-Juan Li ,&nbsp;Ji-Qing Zhu ,&nbsp;Li-Zhou Dou ,&nbsp;Yu-Meng Liu ,&nbsp;Yan Ke ,&nbsp;Yu-Da Zhao ,&nbsp;Mei-Ling Wang ,&nbsp;Jian-Hui Wang ,&nbsp;Quan-Mao Zhang ,&nbsp;Xiao-Guang Ni","doi":"10.1016/j.amjoto.2026.104789","DOIUrl":"10.1016/j.amjoto.2026.104789","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop an artificial intelligence (AI) system for accurate three-tier risk stratification of vocal cord leukoplakia (VCL), with particular focus on distinguishing high-risk lesions (severe dysplasia and carcinoma in situ) from low-risk and malignant lesions, while enhancing diagnostic performance among clinicians with limited experience.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study analyzed 8510 laryngoscopic images from 743 patients across three tertiary hospitals in China. A dual-scale Vision Transformer (ViT) architecture was constructed, integrating multi-scale feature analysis with cross-attention fusion mechanisms. The model was rigorously evaluated through internal-external validation and a prospective reader study involving 12 endoscopists of varying expertise.</div></div><div><h3>Results</h3><div>The AI system demonstrated superior performance in three-tier classification, achieving F1-scores of 0.883 (95% CI: 0.869–0.896) and 0.861 (95% CI: 0.844–0.878) for high-risk lesion identification in internal and external validation, respectively. AI assistance significantly improved junior endoscopists' sensitivity from 67.1% to 81.4% (<em>P</em> &lt; 0.001), effectively narrowing diagnostic performance disparities with senior experts. The system maintained robust generalizability across institutions, with 90.5% accuracy under heterogeneous imaging protocols.</div></div><div><h3>Conclusion</h3><div>The proposed AI framework provides a clinically effective solution for reliable VCL risk stratification and reduces diagnostic variability between clinicians. Validated across multiple centers, this dual-scale ViT approach establishes a novel paradigm for laryngoscopic diagnosis and holds significant potential to standardize diagnostic workflows in resource-limited settings.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104789"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single-center, randomized, double-blinded, placebo-controlled clinical study on the efficacy and safety of voriconazole ear drops in the treatment of otomycosis","authors":"Shen'er Qian ,&nbsp;Guolin Tan ,&nbsp;Hongyi Tan ,&nbsp;Lihua Chen ,&nbsp;Yonghong Yu ,&nbsp;Ru Gao ,&nbsp;Wei Li","doi":"10.1016/j.amjoto.2026.104792","DOIUrl":"10.1016/j.amjoto.2026.104792","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the efficacy and safety of voriconazole ear drops.</div></div><div><h3>Methods</h3><div>A single-center, randomized, double-blind, placebo-controlled clinical design was adopted. A total of 108 patients with otomycosis were enrolled and randomly assigned in a 2:1 ratio to the experimental group (<em>n</em> = 72) and the control group (<em>n</em> = 36). The experimental group received voriconazole ear drops for 7 days followed by placebo for 7 days; the control group received the treatments in reverse order. The primary efficacy endpoint was the clinical response rate. Secondary endpoints included improvement in ear symptoms and signs, and the recurrence rate after discontinuation of treatment.</div></div><div><h3>Results</h3><div>The experimental group showed significant superiority over the control group in the clinical response rate (62.50% vs 38.89%, <em>P</em> &lt; 0.05). Among the secondary endpoints, the improvement rates for ear fullness and ear swelling were significantly higher in the experimental group (P &lt; 0.05), while no significant statistical differences were observed for the other symptoms. The recurrence rate after treatment discontinuation was 7.89%. Regarding safety, no drug-related clinical abnormalities, adverse events, or serious adverse events were observed in any patient.</div></div><div><h3>Conclusion</h3><div>Voriconazole ear drops demonstrated good efficacy and safety in the treatment of otomycosis, showing significant therapeutic effects particularly against filamentous fungal infections. Topical application showed no significant toxicity, indicating promising clinical application prospects.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104792"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}