American Journal of Otolaryngology最新文献

英文中文

A single-center, randomized, double-blinded, placebo-controlled clinical study on the efficacy and safety of voriconazole ear drops in the treatment of otomycosis 一项单中心、随机、双盲、安慰剂对照的伏立康唑滴耳液治疗耳真菌病的疗效和安全性临床研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2026-01-01 DOI: 10.1016/j.amjoto.2026.104792

Shen'er Qian , Guolin Tan , Hongyi Tan , Lihua Chen , Yonghong Yu , Ru Gao , Wei Li

Objective

This study aimed to investigate the efficacy and safety of voriconazole ear drops.

Methods

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 (n = 72) and the control group (n = 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.

Results

The experimental group showed significant superiority over the control group in the clinical response rate (62.50% vs 38.89%, P < 0.05). Among the secondary endpoints, the improvement rates for ear fullness and ear swelling were significantly higher in the experimental group (P < 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.

Conclusion

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.

目的探讨伏立康唑滴耳液的有效性和安全性。方法采用单中心、随机、双盲、安慰剂对照的临床设计。共纳入108例耳真菌病患者，按2:1的比例随机分为实验组（72例）和对照组（36例）。试验组患者先服用伏立康唑滴耳液7 d，再服用安慰剂7 d；对照组按相反的顺序进行治疗。主要疗效终点为临床有效率。次要终点包括耳部症状和体征的改善以及停止治疗后的复发率。结果实验组在临床有效率上明显优于对照组（62.50% vs 38.89%, P < 0.05）。在次要终点中，实验组在耳丰满、耳肿胀方面的改善率显著高于对照组（P < 0.05），其他症状的改善率差异无统计学意义。停药后复发率为7.89%。在安全性方面，未观察到任何患者出现与药物相关的临床异常、不良事件或严重不良事件。结论伏立康唑滴耳液治疗耳真菌病疗效好，安全性高，对丝状真菌感染疗效显著。局部应用无明显毒性，具有良好的临床应用前景。

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引用次数: 0

The role of metformin in dysplastic mucosa of the larynx: A follow up study 二甲双胍在喉粘膜发育不良中的作用：一项随访研究。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-11 DOI: 10.1016/j.amjoto.2025.104769

Diana N. Kirke , Diana S. Shaari , Corina Din-Lovinescu , Andrew Blitzer , Marshall Strome

Objective

This longitudinal case series reports our ongoing experience with metformin, an oral antihyperglycemic drug, as a possible agent to halt the progression of dysplastic lesions to carcinoma, in those with previously treated head and neck squamous cell carcinoma (HNSCC).

Design

Case series.

Results

Three patients were included who had laryngeal dysplasia (age 66.67 ± 7.09; range 59–73 years; 3 male) with a follow up time of 17 to 88 months. The average dose of metformin was 500 mg twice daily. Two patients showed complete or partial regression of the dysplastic mucosa, while the third demonstrated a worsening of dysplasia after he halted treatment for six weeks.

Conclusion

Metformin is a safe agent that has the potential to prevent progression of laryngeal dysplasia in patients with a history of HNSCC. Further studies are needed to verify and expand on this limited case series.

目的：这个纵向病例系列报告了我们正在进行的二甲双胍治疗的经验，二甲双胍是一种口服降糖药物，可以阻止先前治疗过的头颈部鳞状细胞癌（HNSCC）患者的发育不良病变进展为癌。设计：案例系列。结果：3例喉发育不良患者（年龄66.67±7.09岁，年龄59 ~ 73岁，男性3例），随访时间17 ~ 88个月。二甲双胍的平均剂量为500毫克，每日两次。两名患者表现出完全或部分增生不良粘膜消退，而第三名患者在停止治疗六周后表现出增生不良恶化。结论：二甲双胍是一种安全的药物，有可能预防有HNSCC病史的患者喉部发育不良的进展。需要进一步的研究来验证和扩展这一有限的病例系列。

引用次数: 0

Preliminary study on classification and treatment of type I variant preauricular fistula 变异型耳前瘘分型及治疗的初步探讨。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-08 DOI: 10.1016/j.amjoto.2025.104782

Haigang Zhang

引用次数: 0

Preliminary study on classification and treatment of type I variant preauricular fistula 变异型耳前瘘分型及治疗的初步探讨

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-08 DOI: 10.1016/j.amjoto.2025.104781

Kanu Lal Saha

引用次数: 0

Sarcopenia and postoperative morbidity in head & neck cancer: A systematic review and meta-analysis 头颈癌骨骼肌减少症与术后发病率：一项系统综述和荟萃分析。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-06 DOI: 10.1016/j.amjoto.2025.104758

Michael Xie , Han Zhang , Phillip Staibano , Zahra Abdallah , Michael K. Gupta , Nhu Tram Nguyen

Objective

To identify the prognostic value of sarcopenia in surgically treated HNC patients on postoperative morbidity.

Design

Systematic review and meta-analysis.

Information sources, study selection, and methods

EMBASE, MEDLINE, SCOPUS, and CINAHL databases were searched from January 1, 1946 to November 4, 2024. Published trials and observational studies reporting the association of sarcopenia and postoperative complications in surgically treated HNC patients were included. Two reviewers independently screened, extracted, and appraised studies using Covidence. Disagreements were resolved through consensus, and/or by consulting a third reviewer. Data were pooled using a random-effects model in RevMan 5.4.1.

Results

Of 6345 screened studies, 17 out of the 23 included studies had outcomes which were incorporated in the meta-analysis (2884 patients from studies between 1996 and 2024). The meta-analysis revealed a statistically significant association between sarcopenia and all postoperative complications (odds ratio (OR) 2.26, 95 % CI [1.54, 3.33], p < 0.0001), postoperative complications grade 3 (OR 2.34, 95 % CI [1.80, 3.03], p < 0.00001), fistula (OR 2.64, 95 % CI [1.68, 4.16], p < 0.0001), and flap complications (OR 2.77, 95 % CI [1.58, 4.85], p = 0.0004). Subgroup analysis revealed the high risk of bias studies did not significantly bias the results (p = 0.76), but the different measurements of sarcopenia contributed significant heterogeneity (p < 0.00001). The level of evidence is moderate, primarily due to publication bias, for all outcomes, as per GRADE.

Conclusions

In patients undergoing curative surgery for HNC, preoperative sarcopenia is associated with higher odds of postoperative complications.

目的：探讨手术治疗的HNC患者肌肉减少症对术后发病率的预后价值。设计：系统回顾和荟萃分析。信息来源、研究选择和方法：检索1946年1月1日至2024年11月4日的EMBASE、MEDLINE、SCOPUS和CINAHL数据库。已发表的试验和观察性研究报告了手术治疗的HNC患者肌肉减少症与术后并发症的关系。两名审稿人独立筛选、提取和评价了使用covid - ence的研究。分歧通过协商一致和/或咨询第三方审稿人来解决。数据采用RevMan 5.4.1中的随机效应模型进行汇总。结果：在6345项筛选的研究中，23项纳入的研究中有17项的结果纳入了荟萃分析（来自1996年至2024年研究的2884名患者）。荟萃分析显示，肌肉减少症与所有术后并发症之间存在统计学意义上的相关性（优势比（OR） 2.26, 95% CI [1.54, 3.33], p）。结论：在接受根治性手术的HNC患者中，术前肌肉减少症与术后并发症的发生率较高相关。

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引用次数: 0

Reply to the comment on “Clinicopathological features and prognostic value of CD276 expression in head and neck cancer: A meta-analysis” 回复“CD276在头颈癌中的临床病理特征及预后价值：荟萃分析”评论。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-05 DOI: 10.1016/j.amjoto.2025.104783

Ziyu Chen , Hang Su , Juanjuan Hao , Fenghua Zhang

引用次数: 0

Continuous positive airway pressure vs palatal surgery: Outcomes in obstructive sleep apnea treatment 持续气道正压与腭部手术：阻塞性睡眠呼吸暂停治疗的结果

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-05 DOI: 10.1016/j.amjoto.2025.104776

Alec Kadrie , Jonathan Laredo , Evan Thomson , M. Boyd Gillespie

Objective

To compare short- and long-term clinical outcomes of continuous positive airway pressure versus palatal surgical interventions such as uvulopalatopharyngoplasty, including their impacts on sleep apnea-related cardiac, respiratory, and metabolic comorbidities.

Study design

Retrospective cohort study.

Setting

Database study using the TriNetX Network of Tennessee (2014–2024).

Methods

Adult patients diagnosed with obstructive sleep apnea and treated with either continuous positive airway pressure or palatal surgery were identified. Propensity score matching was performed to balance demographics and preexisting comorbidities between groups. Primary outcomes were cardiopulmonary events, and secondary outcomes were new-onset type 2 diabetes and weight change. Odds ratio with 95 % confidence intervals were computed across outcome measures.

Results

A total of 5030 continuous positive airway pressure and 220 palatal surgery patients met inclusion criteria. Following matching, 220 patients remained in each group. Patients treated with continuous positive airway pressure had significantly higher odds of post-treatment electronic medical record coding of acute respiratory failure (OR 4.67, [2.27, 9.60]), pulmonary hypertension (OR 20.0, [2.71, 147.7]), and new-onset atrial fibrillation/flutter (OR 3.32, [1.60, 6.96]) compared to the surgical cohort. No significant differences were observed in myocardial infarction, stroke, or new-onset type 2 diabetes.

Conclusion

Patients treated with continuous positive airway pressure had higher odds of post-treatment electronic medical recording coding of cardiorespiratory complications than those undergoing palatal surgery. These findings highlight potentially important differences between treatment modalities in long-term obstructive sleep apnea related comorbidities.

目的比较持续气道正压通气与腭外科手术（如悬雍垂腭咽成形术）的短期和长期临床结果，包括它们对睡眠呼吸暂停相关的心脏、呼吸和代谢合并症的影响。研究设计回顾性队列研究。基于田纳西州TriNetX网络的数据库研究（2014-2024）。方法对诊断为阻塞性睡眠呼吸暂停的成人患者进行持续气道正压通气或腭部手术治疗。进行倾向评分匹配，以平衡组间人口统计学特征和先前存在的合并症。主要结局是心肺事件，次要结局是新发2型糖尿病和体重变化。在结果测量中计算95%置信区间的优势比。结果5030例持续气道正压通气患者和220例腭部手术患者符合纳入标准。配对后，每组保留220名患者。与手术组相比，持续气道正压治疗的患者在治疗后电子病历编码中出现急性呼吸衰竭（OR 4.67,[2.27, 9.60]）、肺动脉高压（OR 20.0,[2.71, 147.7]）和新发心房颤动/扑动（OR 3.32,[1.60, 6.96]）的几率明显更高。在心肌梗死、卒中或新发2型糖尿病方面没有观察到显著差异。结论持续气道正压治疗患者出现心肺并发症电子病历编码的几率高于腭部手术患者。这些发现强调了长期阻塞性睡眠呼吸暂停相关合并症的治疗方式之间潜在的重要差异。

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引用次数: 0

Surgical strategy in submandibular sialolithiasis: Impact of stone location and size on approach selection and outcomes 下颌下涎石症的手术策略：结石位置和大小对入路选择和结果的影响。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 10.1016/j.amjoto.2025.104768

Joo Hyun Kim

Purpose

To evaluate how stone location and size influence surgical approach selection in submandibular sialolithiasis, and to identify computed tomography (CT)-based imaging predictors to aid preoperative planning.

Methods

We retrospectively reviewed 428 consecutive surgeries (March 2020–December 2024). Preoperative non-contrast CT classified stones as distal duct, mid-duct, hilum, or intraglandular. Surgical approaches were transoral ductal incision, sialendoscopy-assisted removal, and external submandibular gland excision. Group comparisons used standard parametric/non-parametric tests. Receiver operating characteristic (ROC) analysis assessed size thresholds associated with selection of an invasive approach.

Results

Distal duct stones were most often treated by transoral incision (83.7 %), mid-duct stones by sialendoscopy-assisted removal (58.1 %), and intraglandular stones by external excision (71.0 %). Stones in the hilum/intraglandular regions were significantly larger than those in distal or mid-duct locations (p < 0.001). ROC analysis identified 5.5 mm as the optimal cutoff for predicting selection of an invasive approach (AUC = 0.83; sensitivity 74.2 %; specificity 78.9 %). Overall surgical success was 97.8 %. Complication rates varied by approach, lowest after sialendoscopy-assisted removal (4.4 %) and highest after external excision (15.2 %).

Conclusions

A simple CT-based framework incorporating stone location and size was associated with approach selection and outcomes in submandibular sialolithiasis. Using a 5.5 mm size threshold alongside anatomic zoning may help guide minimally invasive, gland-preserving strategies and reduce morbidity. Prospective validation is warranted.

目的：评估结石的位置和大小如何影响下颌下涎石症的手术入路选择，并确定基于计算机断层扫描（CT）的成像预测指标，以帮助术前计划。方法：我们回顾性分析了428例连续手术（2020年3月- 2024年12月）。术前非对比CT将结石分类为导管远端、导管中端、门部或腺体内。手术入路为经口导管切开、鼻内镜辅助切除及外颌下腺切除。组间比较采用标准参数/非参数检验。受试者工作特征（ROC）分析评估了与选择有创入路相关的大小阈值。结果：远端胆管结石多采用经口切开（83.7%），中端胆管结石多采用鼻内镜辅助切除（58.1%），腺内胆管结石多采用外切（71.0%）。门部/腺体内区域的结石明显大于远端或导管中位置的结石(p结论：一个简单的基于ct的框架，结合结石的位置和大小，与下颌骨涎石症的入路选择和结果有关。使用5.5 mm的阈值与解剖分区可能有助于指导微创，腺体保留策略和降低发病率。前瞻性验证是必要的。

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引用次数: 0

Dexamethasone palmitate: A promising intratympanic treatment option for severe sudden hearing loss 地塞米松棕榈酸酯：严重突发性听力损失的一个有前途的鼓室内治疗选择。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 10.1016/j.amjoto.2025.104766

Joong Ho Ahn

Dexamethasone palmitate (DXP) is a lipophilic, esterified corticosteroid with sustained-release properties that may provide advantages over conventional water-soluble dexamethasone in intratympanic therapy for sudden sensorineural hearing loss (SSNHL). We report the safety and clinical outcomes of intratympanic DXP injection in three patients with profound SSNHL. All patients also received systemic steroids and hyperbaric oxygen therapy, along with six sessions of intratympanic DXP. Two patients demonstrated substantial improvement in hearing thresholds and speech discrimination within 3 months, whereas one patient who presented late showed no recovery. No adverse effects, such as pain, inflammation, or tympanic membrane complications, were observed. The increased viscosity and lipophilicity of DXP likely enhance cochlear drug delivery and prolong therapeutic retention. These findings suggest that DXP is a safe and potentially effective intratympanic option for SSNHL, particularly when administered early.

棕榈酸地塞米松（Dexamethasone palmitate， DXP）是一种亲脂、酯化的皮质类固醇，具有缓释特性，在突发性感音神经性听力损失（SSNHL）的鼓内治疗中可能比传统的水溶性地塞米松具有优势。我们报告了3例深部SSNHL患者鼓腔内注射DXP的安全性和临床结果。所有患者还接受了全身类固醇和高压氧治疗，以及6次鼓室内DXP治疗。2例患者在3个月内听力阈值和言语辨别有明显改善，而1例患者迟来无恢复。没有观察到不良反应，如疼痛、炎症或鼓膜并发症。DXP黏度和亲脂性的增加可能会增强耳蜗给药能力，延长治疗效果。这些发现表明，DXP是治疗SSNHL的一种安全且潜在有效的鼓室内选择，尤其是在早期使用时。

引用次数: 0

Preservation of adaptive immunity is associated with survival in invasive fungal sinusitis 保存适应性免疫与侵袭性真菌鼻窦炎的生存有关。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 10.1016/j.amjoto.2025.104779

Iris Lee , Sonam Verma , John S. Schneider , Nyssa F. Farrell , Peggy L. Kendall , Lauren T. Roland

Background

Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.

Objective

The goal of this study was to immunophenotype cells associated with IFS survival.

Methods

Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).

Results

Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.

Conclusion

Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.

背景：侵袭性真菌性鼻窦炎（Invasive fungi Sinusitis， IFS）是一种致命且病态的副鼻窦疾病。免疫功能低下的患者有发生IFS的风险，6个月生存率约为50%。先前研究的治疗方法如粒细胞刺激因子并没有提高生存率。因此，在这一脆弱人群中负责生存的免疫细胞并没有得到很好的定义。目的：本研究的目的是与IFS存活相关的免疫表型细胞。方法：在2022年4月至2023年12月期间，在IFS手术时收集同意患者的血液样本。外周血单个核细胞（PBMCs）主要淋巴细胞和髓细胞亚群的评估采用细胞计数法，IFS幸存者和非幸存者之间的飞行时间（CyTOF），以诊断后6个月的生命状态来定义。采用降维算法优化t分布随机邻居嵌入（opt-SNE）对数据进行分析。结果：7例患者有可用于分析的PBMCs（3例幸存者和4例非幸存者）。非幸存者的总白细胞计数较低。与幸存者相比，非幸存者的总T细胞和B细胞计数减少，但其他免疫细胞群（如NK细胞或单核细胞）没有差异。百分比差异被确定为IFS非幸存者CD4 T细胞，特别是记忆细胞的缺陷。结论：未来的工作包括研究CD4 T细胞作为IFS存活的生物标志物，以及研究T细胞在IFS患者中的操作或刺激。

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