Pub Date : 2026-03-01Epub Date: 2026-03-11DOI: 10.1016/j.amjoto.2026.104806
Ying Li , Gang Luo
Objective
To report a rare case of a marked improvement in bone conduction (BC) thresholds following the reinforcement of the oval window (OW) prior to the implantation of a total ossicular replacement prosthesis (TORP).
Methods
A clinical case involving OW reinforcement followed by TORP implantation was retrospectively analyzed, with pre- and postoperative pure tone averages (PTA) at four frequencies for BC and air conduction (AC) measured and compared.
Results
The bone conduction PTA across four frequencies improved significantly from 62 dB preoperatively to 16 dB postoperatively in the patient's only hearing ear, which had previously experienced acute hearing loss and was affected by cholesteatoma. Concurrently, the AC PTA also improved, decreasing from 76 dB to 33 dB.
Conclusion
In patients presenting with benign middle ear lesions that result in destruction of the stapes footplate and concomitant reduction in BC, it is essential to first exclude sensorineural etiologies, including labyrinthitis and auditory neuropathy. Subsequently, consideration should be given to reinforcing the OW utilizing autologous cartilage.
{"title":"Marked enhancement of bone conduction subsequent to TORP implantation following oval window reinforcement: A case report and comprehensive narrative review","authors":"Ying Li , Gang Luo","doi":"10.1016/j.amjoto.2026.104806","DOIUrl":"10.1016/j.amjoto.2026.104806","url":null,"abstract":"<div><h3>Objective</h3><div>To report a rare case of a marked improvement in bone conduction (BC) thresholds following the reinforcement of the oval window (OW) prior to the implantation of a total ossicular replacement prosthesis (TORP).</div></div><div><h3>Methods</h3><div>A clinical case involving OW reinforcement followed by TORP implantation was retrospectively analyzed, with pre- and postoperative pure tone averages (PTA) at four frequencies for BC and air conduction (AC) measured and compared.</div></div><div><h3>Results</h3><div>The bone conduction PTA across four frequencies improved significantly from 62 dB preoperatively to 16 dB postoperatively in the patient's only hearing ear, which had previously experienced acute hearing loss and was affected by cholesteatoma. Concurrently, the AC PTA also improved, decreasing from 76 dB to 33 dB.</div></div><div><h3>Conclusion</h3><div>In patients presenting with benign middle ear lesions that result in destruction of the stapes footplate and concomitant reduction in BC, it is essential to first exclude sensorineural etiologies, including labyrinthitis and auditory neuropathy. Subsequently, consideration should be given to reinforcing the OW utilizing autologous cartilage.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104806"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448563","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}
Pub Date : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.amjoto.2026.104786
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
Objective
This study aimed to assess how different treatments – dupilumab vs surgery - influence the nasal microbiota, type 2 inflammation, and clinical outcomes in CRSwNP patients.
Methods
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.
Results
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.
Conclusions
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.
{"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":"10.1016/j.amjoto.2026.104786","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess how different treatments – dupilumab vs surgery - influence the nasal microbiota, type 2 inflammation, and clinical outcomes in CRSwNP patients.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>At baseline, the most prevalent bacteria were <em>Staphylococcus aureus</em> (43%), <em>Stapylococcus epidermidis</em> (36%), and <em>Pseudomonas aeruginosa</em> (16%). After 6 months, <em>S. aureus</em> and <em>S. epidermidis</em> significantly increased while <em>P. aeruginosa</em> decreased. Eosinophil counts were stable. IgE levels notably decreased in the <em>S. aureus</em> and <em>S. epidermidis</em> groups but increased with <em>P. aeruginosa</em>. All bacterial groups showed reduced polyp score and SNOT-22, and improved smell, but <em>P. aeruginosa</em> had smaller gains. Higher baseline <em>S. aureus</em> and <em>S. epidermidis</em> correlated with more significant IgE decrease.</div></div><div><h3>Conclusions</h3><div>Dupilumab and surgery-induced favourable microbiota changes by reducing pathogenic bacteria. Nasal microbiota composition may be associated inflammatory and clinical treatment responses in CRSwNP. <em>S. aureus</em> and <em>S. epidermidis</em> correlated with a greater improvement of IgE levels, whereas <em>P. aeruginosa</em> correlated with worse IgE outcomes. Analyzing each patient's nasal microbiome could enable more personalized, microbiome-directed treatment approaches for optimal CRSwNP management.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104786"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.amjoto.2026.104788
Udi Shapira , Riana Kipiani Abdul Halim , Jeong Geum Lee , In Seok Moon
Objective
To investigate characteristics of pediatric sporadic (non-NF2) vestibular schwannoma (VS), we compare outcomes of sporadic adult-type vestibular schwannoma which were size- and location-matched cohort.
Pediatric patients (≤21 years) with sporadic unilateral VS and ≥ 15 months of follow-up were identified and each matched 1:2 to adult patients (>21 years) by tumor size and location. The primary outcome was tumor control (stable vs recurrence/regrowth requiring treatment). Outcomes within the pediatric cohort were further analyzed for age-related differences.
Results
Nine pediatric patients were matched to 18 adult controls. Baseline characteristics and presenting symptoms were similar. Gross total resection was achieved in 44% of children and 22% of adults (P = 0.071). Tumor control differed significantly: recurrence/regrowth occurred in 44% of children versus 6% of adults (P = 0.005). Within the pediatric group, patients with recurrence were younger (13.8 ± 2.8 vs 17.6 ± 2.6 years; P = 0.043). Using a 14-year cutoff, three of four recurrences (75%) occurred in children <14 years versus none in older children (P = 0.048).
Conclusions
Children, particularly those under 14 years, experienced significantly poorer tumor control after surgery for sporadic VS compared with adults, despite similar tumor size and location. The higher recurrence and regrowth rates observed in the pediatric cohort suggest that a more aggressive treatment and surveillance approach may be warranted.
{"title":"Unique characteristics of pediatric sporadic vestibular schwannoma","authors":"Udi Shapira , Riana Kipiani Abdul Halim , Jeong Geum Lee , In Seok Moon","doi":"10.1016/j.amjoto.2026.104788","DOIUrl":"10.1016/j.amjoto.2026.104788","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate characteristics of pediatric sporadic (non-NF2) vestibular schwannoma (VS), we compare outcomes of sporadic adult-type vestibular schwannoma which were size- and location-matched cohort.</div></div><div><h3>Study design</h3><div>Single-institution retrospective matched case–control study.</div></div><div><h3>Methods</h3><div>Pediatric patients (≤21 years) with sporadic unilateral VS and ≥ 15 months of follow-up were identified and each matched 1:2 to adult patients (>21 years) by tumor size and location. The primary outcome was tumor control (stable vs recurrence/regrowth requiring treatment). Outcomes within the pediatric cohort were further analyzed for age-related differences.</div></div><div><h3>Results</h3><div>Nine pediatric patients were matched to 18 adult controls. Baseline characteristics and presenting symptoms were similar. Gross total resection was achieved in 44% of children and 22% of adults (<em>P</em> = 0.071). Tumor control differed significantly: recurrence/regrowth occurred in 44% of children versus 6% of adults (<em>P</em> = 0.005). Within the pediatric group, patients with recurrence were younger (13.8 ± 2.8 vs 17.6 ± 2.6 years; <em>P</em> = 0.043). Using a 14-year cutoff, three of four recurrences (75%) occurred in children <14 years versus none in older children (<em>P</em> = 0.048).</div></div><div><h3>Conclusions</h3><div>Children, particularly those under 14 years, experienced significantly poorer tumor control after surgery for sporadic VS compared with adults, despite similar tumor size and location. The higher recurrence and regrowth rates observed in the pediatric cohort suggest that a more aggressive treatment and surveillance approach may be warranted.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104788"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211834","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}
Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.amjoto.2026.104793
Bahareh Tavakoli, Sohrab Rabiei
Background
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.
Method
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.
Results
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 (P = 0.004 and P = 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.
Conclusion
Vitamin D supplementation may enhance auditory recovery at key speech-related frequencies in SSNHL patients with vitamin D deficiency.
{"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, 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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-01-30DOI: 10.1016/j.amjoto.2026.104796
Richa S. Nathan , Michael Setzen
Anterior epistaxis is one of the most common emergencies encountered by otolaryngologists and is usually managed with anterior nasal pressure, topical vasoconstrictors, anesthetics, cautery, and nasal packing. While traditional methods are often effective, they can cause discomfort and can result in recurrent bleeding and repeat emergency department visits. Tranexamic acid (TXA) is a synthetic lysine analog developed in the 1960s as an antifibrinolytic agent and has become an emerging adjunct in the acute management of epistaxis. By inhibiting fibrinolysis locally at the bleeding site, topical TXA offers rapid hemostasis without the discomfort and complications of traditional packing.
Evidence from randomized controlled trials and meta-analyses shows that topical TXA improves acute bleeding control, reduces rebleeding, and shortens emergency department stays compared to packing, especially in patients on antiplatelet or anticoagulant therapy. TXA preparations typically include 500 mg in 5 mL applied to a pledget or sponge and put in place for 10–15 min before reassessment of bleeding. Advantages include improved patient comfort, reduced need for follow-up removal, and minimal systemic absorption. Precautions include avoidance in patients with active thromboembolic disease, though safety data are favorable overall.
The implementation of topical TXA in clinical protocols demonstrates a movement toward less invasive evidence-based treatments which provide better patient outcomes without compromising effectiveness. The emergency care team along with otolaryngologists can use TXA as a safe and effective treatment for epistaxis management. Incorporating TXA into treatment protocols has the potential to reduce the need for packing and follow-up visits.
{"title":"Stopping the flow: Tranexamic acid as an adjunct to anterior epistaxis management – An invited commentary","authors":"Richa S. Nathan , Michael Setzen","doi":"10.1016/j.amjoto.2026.104796","DOIUrl":"10.1016/j.amjoto.2026.104796","url":null,"abstract":"<div><div>Anterior epistaxis is one of the most common emergencies encountered by otolaryngologists and is usually managed with anterior nasal pressure, topical vasoconstrictors, anesthetics, cautery, and nasal packing. While traditional methods are often effective, they can cause discomfort and can result in recurrent bleeding and repeat emergency department visits. Tranexamic acid (TXA) is a synthetic lysine analog developed in the 1960s as an antifibrinolytic agent and has become an emerging adjunct in the acute management of epistaxis. By inhibiting fibrinolysis locally at the bleeding site, topical TXA offers rapid hemostasis without the discomfort and complications of traditional packing.</div><div>Evidence from randomized controlled trials and meta-analyses shows that topical TXA improves acute bleeding control, reduces rebleeding, and shortens emergency department stays compared to packing, especially in patients on antiplatelet or anticoagulant therapy. TXA preparations typically include 500 mg in 5 mL applied to a pledget or sponge and put in place for 10–15 min before reassessment of bleeding. Advantages include improved patient comfort, reduced need for follow-up removal, and minimal systemic absorption. Precautions include avoidance in patients with active thromboembolic disease, though safety data are favorable overall.</div><div>The implementation of topical TXA in clinical protocols demonstrates a movement toward less invasive evidence-based treatments which provide better patient outcomes without compromising effectiveness. The emergency care team along with otolaryngologists can use TXA as a safe and effective treatment for epistaxis management. Incorporating TXA into treatment protocols has the potential to reduce the need for packing and follow-up visits.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104796"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123474","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}
Pub Date : 2026-03-01Epub Date: 2026-03-04DOI: 10.1016/j.amjoto.2026.104799
Roberto Peribáñez García , Francisco Álvaro Rodriguez Rodriguez , Blanca Ascaso Adiego , María Isabel Adiego Leza
Introduction-objectives
There is a probable relationship between hearing loss and cognitive decline and dementia: patients with hearing loss appear to develop cognitive difficulties earlier and more frequently. However, the relationship is not completely clear. A meta-analysis of high-quality studies is needed to clarify the nature of this relationship.
Materials and methods
Meta-analysis of cohort studies in which the exposure factor is hearing loss, necessarily measured with pure-tone audiometry, and the outcome is the progression of cognitive decline measured with validated scales or the onset of dementia. The inclusion period for the studies was 2019–2023.
Results
Of the 5349 articles identified, 11 cohort studies were included in the systematic review; and 8 in the meta-analysis. In those where the outcome was dementia (expressed as Hazard Ratio [HR]), a statistically significant relationship was found, with an HR of 1.32 (1.30–1.34), with low heterogeneity and a low risk of publication bias. In those where the outcome was expressed as linear regression (beta), no statistically significant results were found.
Conclusions
There appears to be a relationship between hearing loss and cognitive impairment/dementia. Other forms of hearing loss (such as central hearing loss) need to be evaluated to fully assess the effect and implications of this relationship.
{"title":"Relationship between hearing loss, cognitive impairment, and dementia; meta-analysis of cohort studies in which the exposure factor is hearing loss measured by audiometry","authors":"Roberto Peribáñez García , Francisco Álvaro Rodriguez Rodriguez , Blanca Ascaso Adiego , María Isabel Adiego Leza","doi":"10.1016/j.amjoto.2026.104799","DOIUrl":"10.1016/j.amjoto.2026.104799","url":null,"abstract":"<div><h3>Introduction-objectives</h3><div>There is a probable relationship between hearing loss and cognitive decline and dementia: patients with hearing loss appear to develop cognitive difficulties earlier and more frequently. However, the relationship is not completely clear. A meta-analysis of high-quality studies is needed to clarify the nature of this relationship.</div></div><div><h3>Materials and methods</h3><div>Meta-analysis of cohort studies in which the exposure factor is hearing loss, necessarily measured with pure-tone audiometry, and the outcome is the progression of cognitive decline measured with validated scales or the onset of dementia. The inclusion period for the studies was 2019–2023.</div></div><div><h3>Results</h3><div>Of the 5349 articles identified, 11 cohort studies were included in the systematic review; and 8 in the meta-analysis. In those where the outcome was dementia (expressed as Hazard Ratio [HR]), a statistically significant relationship was found, with an HR of 1.32 (1.30–1.34), with low heterogeneity and a low risk of publication bias. In those where the outcome was expressed as linear regression (beta), no statistically significant results were found.</div></div><div><h3>Conclusions</h3><div>There appears to be a relationship between hearing loss and cognitive impairment/dementia. Other forms of hearing loss (such as central hearing loss) need to be evaluated to fully assess the effect and implications of this relationship.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104799"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421676","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}
Despite the increasing use of artificial intelligence (AI) platforms in healthcare communication, their efficacy in producing patient-facing materials for pediatric surgeries is still unexplored. The readability, understandability, and actionability of postoperative instructions generated by three AI platforms (ChatGPT, Gemini, and DeepSeek) for common pediatric otorhinolaryngology (ORL) surgeries were compared in this study.
Methods
Postoperative instructions were generated from each AI platform using a standardized prompt. Readability was assessed using the Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL). Understandability and actionability were evaluated using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). Comparative statistical analyses and Pearson correlation coefficients were calculated.
Results
ChatGPT showed the highest readability with FKRE 64.57 (±7.20) and the lowest FKGL 7.40 (±1.54), significantly outperforming others in FKRE (p = 0.030). The Gemini had the highest understandability (83.20% ± 1.56; p = 0.027), while the DeepSeek led in actionability (71.10% ± 3.81; p = 0.140). No AI platform met all the adequacy thresholds (FKGL <6, FKRE >60, PEMAT-P > 80%) at one time. Across the procedures, the differences in the readability, understandability, and the actionability were not statistically significant (all p > 0.5). The correlation analysis showed that there is significant inverse relationships of FKRE with FKGL (r = −0.711, p = 0.032) and FKRE with understandability (r = −0.669, p = 0.049). The actionability was not significantly correlated with any metric.
Conclusion
Although each AI platform shown strengths in some domains, none consistently fulfilled the criteria for optimal patient education. These findings underscore the necessity for enhanced AI training utilizing pediatric and caregiver-specific data to improve the quality of postoperative guidance in pediatric ORL care.
{"title":"Artificial intelligence in pediatric otorhinolaryngology: Assessing readability, understandability, and actionability of postoperative instructions","authors":"Alya AlZabin , Hisham AlMutawa , Lulwah AlTurki , Yasser AlBalawi , Mazyad M. AlEnezi , Danah AlJomah","doi":"10.1016/j.amjoto.2026.104798","DOIUrl":"10.1016/j.amjoto.2026.104798","url":null,"abstract":"<div><h3>Background</h3><div>Despite the increasing use of artificial intelligence (AI) platforms in healthcare communication, their efficacy in producing patient-facing materials for pediatric surgeries is still unexplored. The readability, understandability, and actionability of postoperative instructions generated by three AI platforms (ChatGPT, Gemini, and DeepSeek) for common pediatric otorhinolaryngology (ORL) surgeries were compared in this study.</div></div><div><h3>Methods</h3><div>Postoperative instructions were generated from each AI platform using a standardized prompt. Readability was assessed using the Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL). Understandability and actionability were evaluated using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). Comparative statistical analyses and Pearson correlation coefficients were calculated.</div></div><div><h3>Results</h3><div>ChatGPT showed the highest readability with FKRE 64.57 (±7.20) and the lowest FKGL 7.40 (±1.54), significantly outperforming others in FKRE (<em>p</em> = 0.030). The Gemini had the highest understandability (83.20% ± 1.56; <em>p</em> = 0.027), while the DeepSeek led in actionability (71.10% ± 3.81; <em>p</em> = 0.140). No AI platform met all the adequacy thresholds (FKGL <6, FKRE >60, PEMAT-<em>P</em> > 80%) at one time. Across the procedures, the differences in the readability, understandability, and the actionability were not statistically significant (all <em>p</em> > 0.5). The correlation analysis showed that there is significant inverse relationships of FKRE with FKGL (<em>r</em> = −0.711, <em>p</em> = 0.032) and FKRE with understandability (<em>r</em> = −0.669, <em>p</em> = 0.049). The actionability was not significantly correlated with any metric.</div></div><div><h3>Conclusion</h3><div>Although each AI platform shown strengths in some domains, none consistently fulfilled the criteria for optimal patient education. These findings underscore the necessity for enhanced AI training utilizing pediatric and caregiver-specific data to improve the quality of postoperative guidance in pediatric ORL care.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104798"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185176","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}
Pub Date : 2026-03-01Epub Date: 2026-02-09DOI: 10.1016/j.amjoto.2026.104797
Xu Shuihua, Chen Ying, Wu Lanjing, Hu Zhengming
Objectives
To evaluate the efficacy and safety of a modified ultrasound-guided polidocanol sclerotherapy protocol in treating benign cystic-solid thyroid nodules, and to provide a reference for clinical treatment.
Methods
This retrospective study involved 125 patients with 126 pathologically confirmed benign cystic-solid thyroid nodules who underwent ultrasound-guided polidocanol sclerotherapy at our institution between January 2021 and December 2023. Before administering the sclerosant injection, cystic components were aspirated and irrigated with saline, and the nodules were classified on the basis of the proportion of cystic components and baseline volume, as well as patient sex and age and the color and consistency of the cystic fluid. Nodule volume was measured using ultrasonography before treatment and at 1, 3, 6, and 12 months after treatment. The volume reduction rate (VRR) at 12 months was calculated, and treatment efficacy and adverse events were compared among different nodule subgroups.
Results
Among the 126 nodules in 125 patients, 115 nodules showed an effective outcome, corresponding to an overall effectiveness rate of 91.3% (115/126). The effective rates for nodules with cystic components ≤70%, 70%–90%, and > 90% were 80.0% (28/35), 94.2% (49/52), and 97.4% (38/39), respectively, and the differences among the three groups were statistically significant (P < 0.05). Overall efficacy did not differ significantly in relation to cyst fluid color, cyst fluid consistency, baseline nodule volume, patient age, or sex. Fourteen patients (11.2%) experienced minor adverse reactions, including mild local pain (n = 9), transient low-grade fever with nausea and vomiting (n = 2), intermittent swallowing discomfort (n = 2), and postoperative hemorrhage that was controllable by local compression (n = 1). All adverse reactions resolved spontaneously or with conservative management. The patients showed no significant complications, such as infection, severe pain, voice alterations, esophageal or tracheal injury, or sclerosant extravasation.
Conclusions
Modified ultrasound-guided polidocanol sclerotherapy for benign cystic-solid thyroid nodules is safe and effective, and the treatment efficacy is positively associated with the proportion of cystic components. This technique may represent a promising alternative to ethanol injection for the management of cystic-solid thyroid nodules.
{"title":"Modified ultrasound-guided polidocanol sclerotherapy is an effective treatment for thyroid cystic-solid nodules: A single-center retrospective study","authors":"Xu Shuihua, Chen Ying, Wu Lanjing, Hu Zhengming","doi":"10.1016/j.amjoto.2026.104797","DOIUrl":"10.1016/j.amjoto.2026.104797","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the efficacy and safety of a modified ultrasound-guided polidocanol sclerotherapy protocol in treating benign cystic-solid thyroid nodules, and to provide a reference for clinical treatment.</div></div><div><h3>Methods</h3><div>This retrospective study involved 125 patients with 126 pathologically confirmed benign cystic-solid thyroid nodules who underwent ultrasound-guided polidocanol sclerotherapy at our institution between January 2021 and December 2023. Before administering the sclerosant injection, cystic components were aspirated and irrigated with saline, and the nodules were classified on the basis of the proportion of cystic components and baseline volume, as well as patient sex and age and the color and consistency of the cystic fluid. Nodule volume was measured using ultrasonography before treatment and at 1, 3, 6, and 12 months after treatment. The volume reduction rate (VRR) at 12 months was calculated, and treatment efficacy and adverse events were compared among different nodule subgroups.</div></div><div><h3>Results</h3><div>Among the 126 nodules in 125 patients, 115 nodules showed an effective outcome, corresponding to an overall effectiveness rate of 91.3% (115/126). The effective rates for nodules with cystic components ≤70%, 70%–90%, and > 90% were 80.0% (28/35), 94.2% (49/52), and 97.4% (38/39), respectively, and the differences among the three groups were statistically significant (<em>P</em> < 0.05). Overall efficacy did not differ significantly in relation to cyst fluid color, cyst fluid consistency, baseline nodule volume, patient age, or sex. Fourteen patients (11.2%) experienced minor adverse reactions, including mild local pain (<em>n</em> = 9), transient low-grade fever with nausea and vomiting (<em>n</em> = 2), intermittent swallowing discomfort (n = 2), and postoperative hemorrhage that was controllable by local compression (<em>n</em> = 1). All adverse reactions resolved spontaneously or with conservative management. The patients showed no significant complications, such as infection, severe pain, voice alterations, esophageal or tracheal injury, or sclerosant extravasation.</div></div><div><h3>Conclusions</h3><div>Modified ultrasound-guided polidocanol sclerotherapy for benign cystic-solid thyroid nodules is safe and effective, and the treatment efficacy is positively associated with the proportion of cystic components. This technique may represent a promising alternative to ethanol injection for the management of cystic-solid thyroid nodules.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104797"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300867","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}
Pub Date : 2026-03-01Epub Date: 2026-01-25DOI: 10.1016/j.amjoto.2026.104791
Benyamin Rahmaty , Sanam Asgari , Mohammad Sayyadi , Ali Kouhi , Saeed Golparavaran , Ali Aalizade , Mohammad Taghi Khorsandi Ashtiani , Kayvan Aghazadeh
Objective
To compare the efficacy of fibrin glue versus Gelfoam in cartilage tympanoplasty, focusing on graft uptake rates and short-term hearing outcomes.
Methods
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.
Results
Graft uptake rates were 91.3% in the fibrin group and 82.6% in the Gelfoam group (p > 0.05). However, ABG closure ≤15 dB was achieved in 87% of the fibrin group compared to 60.9% of the Gelfoam group (p = 0.044), indicating a significant improvement in early hearing outcomes.
Conclusion
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.
{"title":"Fibrin glue enhances early hearing recovery in tympanoplasty: A randomised controlled trial","authors":"Benyamin Rahmaty , Sanam Asgari , Mohammad Sayyadi , Ali Kouhi , Saeed Golparavaran , Ali Aalizade , Mohammad Taghi Khorsandi Ashtiani , 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> > 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":"2026-03-01","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}
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.
Methods
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.
Results
Recurrence occurred in 20.1% of patients. Migraine was significantly associated with increased recurrence risk (OR 2.07; 95% CI: 1.01–4.22; p = 0.046), independent of age and sex, independent of thyroid disease, and environmental conditions. No significant associations were found between recurrence and atmospheric pressure (p = 0.586), temperature (p = 0.224), or thyroid disease (p = 0.089).
Conclusion
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.
{"title":"Role of migraine in recurrent benign paroxysmal positional vertigo","authors":"Pelin Koçdor , Emel Işık , Oğuzhan Çetin , Rüya Somer , Suat Avcı , Merve Kaşıkcı , 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":"2026-03-01","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}
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