American Journal of Otolaryngology最新文献_第5页

A randomized clinical trial of peritonsillar abscess treatment comparing drainage and tonsillectomy 扁桃体周围脓肿的随机临床试验比较引流和扁桃体切除术。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-11-01 DOI: 10.1016/j.amjoto.2025.104745

François Voruz , Rebecca Revol , Maxime Mermod , Pascal Senn , Yan Monnier , Nicolas Dulguerov

Purpose

To assess the efficacy, safety, and tolerance of drainage under local anesthesia compared to immediate tonsillectomy to treat uncomplicated unilateral peritonsillar abscess (PTA) in adults.

Methods

A randomized clinical trial was conducted in a tertiary care university hospital. Adults with PTA radiologically confirmed as ≥1 cm and uncomplicated were randomly assigned to two groups using block randomization. They immediately underwent either tonsillectomy under general anesthesia or drainage under local anesthesia. The primary outcome was treatment success at 48 h, defined as a reduction in swelling and restoration of swallowing function, allowing hospital discharge. Secondary outcomes included pain and anxiety levels, along with postoperative bleeding.

Results

A total of 41 patients were included (66 % male; age range 18—77 years). Twenty-one patients underwent tonsillectomy, while 20 underwent drainage. The success rate was higher in the tonsillectomy group (100 %) than in the drainage group (75 %, p = 0.02). Pain and anxiety levels were significantly higher in the drainage group (p < 0.01). Postoperative bleeding occurred in 33 % of the tonsillectomy group, while no bleeding was reported in the drainage group (p < 0.01).

Conclusion

Immediate tonsillectomy for treating PTA offers definitive management with high efficacy, albeit with an increased risk of postoperative bleeding. Drainage under local anesthesia is associated with a higher failure rate and increased patient discomfort but demonstrates a better safety profile. Treatment decisions should be tailored based on patient preferences, clinical presentation, and available resources.

Trial registration

ClinicalTrial.gov protocol record NCT04543708.

目的：评价局麻引流与即刻扁桃体切除术治疗成人单侧无并发症的扁桃体周围脓肿（PTA）的疗效、安全性和耐受性。方法：在某大学三级医院进行随机临床试验。影像学证实PTA≥1 cm且无并发症的成人采用分组随机法随机分为两组。他们立即接受了全麻扁桃体切除术或局部麻醉引流术。主要结局是48小时治疗成功，定义为肿胀减轻和吞咽功能恢复，允许出院。次要结果包括疼痛和焦虑水平，以及术后出血。结果：共纳入41例患者，其中66%为男性，年龄18-77岁。21例行扁桃体切除术，20例行引流。扁桃体切除术组的成功率（100%）高于引流组（75%,p = 0.02）。结论：尽管术后出血风险增加，但即刻扁桃体切除术治疗PTA是一种明确有效的治疗方法。局部麻醉下引流失败率较高，患者不适感增加，但安全性较好。治疗决定应根据患者偏好、临床表现和现有资源进行调整。试验注册：ClinicalTrial.gov协议记录NCT04543708。

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引用次数: 0

The relationship between subjective and objective nasal obstruction and polysomnographic parameters in obstructive sleep apnea 阻塞性睡眠呼吸暂停患者主客观鼻塞与多导睡眠图参数的关系

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-22 DOI: 10.1016/j.amjoto.2025.104733

Reza Erfanian , Shirin Irani , Reihaneh Heidari , Maryam Keyfari Alamdari

Background

Nasal obstruction has been identified as a significant factor in the development and exacerbation of obstructive sleep apnea (OSA). This study aimed to explore the correlation between objective and subjective measures of nasal obstruction with polysomnographic features.

Methods

A cross-sectional study was conducted on 100 patients suspected of OSA. Participants completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire to assess subjective nasal obstruction. Objective nasal airflow was measured using peak nasal expiratory flow (PNEF). All participants underwent type I polysomnography to assess sleep-related breathing disturbances. Correlations between NOSE scores, PNEF, and various polysomnographic parameters, including the apnea-hypopnea index (AHI), mean oxygen saturation, time spent below 90 % oxygen saturation, lowest oxygen saturation, and arousal index, were calculated.

Results

The mean total NOSE scale score was 9.5 (SD = 5.6), indicating a moderate level of nasal obstruction. The mean PNEF was 0.56 L/s (SD = 0.44 L/s). A significant negative correlation was found between PNEF and the total NOSE scale score (Spearman's rho = ‐0.319, p = 0.003). Additionally, PNEF was significantly negatively correlated with the arousal index (Spearman's rho = ‐0.329, p = 0.002). However, no significant correlations were found between PNEF and other polysomnographic parameters. Furthermore, individual NOSE questions and the total NOSE score were not significantly correlated with any polysomnographic parameter.

Conclusion

This study demonstrates a link between subjective nasal obstruction and reduced nasal airflow, as indicated by PNEF, in patients with OSA. The association between lower PNEF and a higher arousal index suggests that reduced nasal airflow may contribute to a low arousal threshold phenotype in OSA. Future research should further investigate the complex interplay between nasal obstruction, nasal airflow, and other factors that influence OSA severity and treatment response.

背景：鼻阻塞已被确定为阻塞性睡眠呼吸暂停（OSA）发生和恶化的重要因素。本研究旨在探讨客观和主观测量鼻塞与多导睡眠图特征的相关性。方法对100例疑似OSA患者进行横断面研究。参与者完成鼻塞症状评估（NOSE）问卷来评估主观鼻塞。目的用鼻呼气流量峰（PNEF）法测定鼻腔气流。所有参与者都接受了I型多导睡眠描记术来评估与睡眠相关的呼吸障碍。计算NOSE评分、PNEF和各种多导睡眠图参数之间的相关性，包括呼吸暂停低通气指数（AHI）、平均血氧饱和度、血氧饱和度低于90%的时间、最低血氧饱和度和唤醒指数。结果鼻腔评分总分平均为9.5分（SD = 5.6），提示中度鼻塞。平均PNEF为0.56 L/s （SD = 0.44 L/s）。PNEF与NOSE总分呈显著负相关（Spearman’s rho =‐0.319,p = 0.003）。此外，PNEF与觉醒指数呈显著负相关（Spearman’s rho =‐0.329,p = 0.002）。然而，PNEF与其他多导睡眠图参数之间没有明显的相关性。此外，单个NOSE问题和总NOSE得分与任何多导睡眠图参数均无显著相关。结论本研究表明OSA患者主观鼻塞与PNEF显示的鼻气流减少之间存在联系。较低的PNEF和较高的唤醒指数之间的关联表明，鼻腔气流减少可能有助于OSA的低唤醒阈值表型。未来的研究应进一步探讨鼻塞、鼻腔气流及其他影响OSA严重程度和治疗反应的因素之间的复杂相互作用。

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引用次数: 0

Examination of opioid prescribing guidelines on sinus surgery opioid prescription trends 检查阿片类药物处方指南对鼻窦手术阿片类药物处方趋势的影响

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-21 DOI: 10.1016/j.amjoto.2025.104747

Robert E. Africa, Amber M. Dunmire, Shahrukh R. Ali, Brian J. McKinnon, Charles A. Hughes, Tyler A. Janz, Farrah Siddiqui, Scott A. Hardison

Background

To evaluate the trends in opioid and non-opioid prescribing for functional endoscopic sinus surgery (FESS) in relation to the publication of guidelines by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in April 2021.

Methods

This is a retrospective study utilizing de-identified patient data obtained from the TriNetX database including patients who were prescribed either opioid or non-opioid analgesics within 1–5 days following FESS from January 1, 2023 to December 31, 2023. To evaluate the trends of prescription before and after the new opioid prescription guidelines, interrupted time series analysis in Statistical Analysis System (SAS) 9.4 was performed with significance at p < 0.05.

Results

Opioid prescription had an immediate increase by 0.87 % after guideline publication, but it was not statistically significant (p = 0.92). Throughout the rest of the study period, the trend decreased by 0.20 %, but it was not statistically significant (p = 0.35). For non-opioid prescriptions, there was a significant sustained increase in non-opioid prescriptions after the guideline change by 0.07 % (p = 0.03).

Conclusions

No associated decrease in opioid prescription for FESS after the guideline publication was observed. Non-opioid prescription did not have an immediate increase, but the trend increased in the post-publication period.

根据美国耳鼻喉头颈外科学会（AAO-HNS）于2021年4月发布的指南，评估功能性内窥镜鼻窦手术（FESS）中阿片类药物和非阿片类药物处方的趋势。方法：本研究是一项回顾性研究，利用从TriNetX数据库中获得的去识别患者数据，包括2023年1月1日至2023年12月31日FESS后1 - 5天内处方阿片类或非阿片类镇痛药的患者。为评价新阿片类药物处方指南前后的处方变化趋势，采用SAS 9.4进行中断时间序列分析，p <； 0.05为显著性水平。结果阿片类药物处方在指南发布后立即增加0.87%，但差异无统计学意义（p = 0.92）。在其余研究期间，该趋势下降了0.20%，但无统计学意义（p = 0.35）。对于非阿片类药物处方，指南改变后非阿片类药物处方持续显著增加0.07% （p = 0.03）。结论指南发布后，FESS患者阿片类药物处方未见相关减少。非阿片类药物处方没有立即增加，但在出版后的时期有增加的趋势。

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引用次数: 0

Comparative efficacy and safety of monoclonal antibodies biologic therapies for chronic rhinosinusitis with nasal polyps: A systematic review and network meta-analysis 单克隆抗体生物治疗慢性鼻窦炎伴鼻息肉的比较疗效和安全性：系统综述和网络荟萃分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-21 DOI: 10.1016/j.amjoto.2025.104734

Abdulhakeem Almutairi , Lina Yousef Aloraini , Bader Muzhier Alshahrani , Maan Omar Alzuhairi , Rabab Hussain Alzanadi , Khalid Fahad Alanazi , Yahya Ali Khubrani , Ahmed Y. Azzam

Introduction

Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a significant therapeutic challenge with high recurrence rates despite the current standard treatments. Several biologic therapies targeting type-2 inflammation have emerged, but detailed comparisons between these agents are lacking.

Methods

We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating biologics for CRSwNP. Literature databases were searched up to the date of 28th of April 2025. Primary outcomes included changes in nasal polyp score (NPS), nasal congestion, SNOT-22, and surgery/systemic corticosteroid reduction.

Results

Sixteen studies (with total of 3040 patients included) investigating six biologics (dupilumab, omalizumab, mepolizumab, benralizumab, tezepelumab, reslizumab) were included. For NPS reduction, dupilumab showed greatest improvement (−2.44; 95 %CI: −2.85,-2.03), followed by tezepelumab (−2.07; 95 %CI:-2.39,-1.74). Mepolizumab demonstrated superior nasal congestion improvement (−2.64; 95 %CI:-3.24,-2.04). For quality of life, preliminary findings from a single study showed tezepelumab with the greatest SNOT-22 improvement (−27.26; 95 %CI:-32.32,-22.21), however validation in additional trials is needed. Surgery/systemic corticosteroid need was most reduced with tezepelumab in this single study (HR:0.02; 95 %CI:0.00–0.09). Omalizumab had the lowest adverse event rate (49.6 %). Network meta-analysis identified omalizumab and tezepelumab as highest-ranked overall (efficacy/safety combination).

Conclusion

Our study demonstrated significant efficacy and safety profiles among biologics for CRSwNP. Treatment selection should consider specific symptom focus and comorbidity patterns, with network meta-analysis suggesting favorable overall profiles for omalizumab, with tezepelumab showing promise but requiring additional validation.

慢性鼻窦炎伴鼻息肉（CRSwNP）是一个显著的治疗挑战，尽管目前的标准治疗具有高复发率。几种针对2型炎症的生物疗法已经出现，但缺乏这些药物之间的详细比较。方法对评价生物制剂治疗CRSwNP的随机对照试验进行系统综述和网络荟萃分析。检索文献数据库至2025年4月28日。主要结局包括鼻息肉评分（NPS）、鼻塞、SNOT-22和手术/全身皮质类固醇减少的变化。结果纳入16项研究（共3040例患者），研究了6种生物制剂（dupilumab、omalizumab、mepolizumab、benralizumab、tezepelumab、reslizumab）。对于NPS的降低，dupilumab表现出最大的改善（- 2.44;95% CI:- 2.85,-2.03），其次是tezepelumab （- 2.07; 95% CI:-2.39,-1.74）。Mepolizumab表现出较好的鼻塞改善（- 2.64;95% CI:-3.24,-2.04）。对于生活质量，一项研究的初步结果显示tezepelumab具有最大的SNOT-22改善（- 27.26;95% CI:-32.32,-22.21），但需要在其他试验中验证。在这项单一研究中，tezepelumab最能减少手术/全身皮质类固醇的需求（HR:0.02; 95% CI: 0.00-0.09）。Omalizumab的不良事件发生率最低（49.6%）。网络荟萃分析确定omalizumab和tezepelumab是总体排名最高的（疗效/安全性组合）。结论我们的研究显示了CRSwNP在生物制剂中的显著有效性和安全性。治疗选择应考虑特定的症状焦点和合并症模式，网络荟萃分析显示omalizumab总体概况良好，tezepelumab显示出希望，但需要额外的验证。

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引用次数: 0

Guidewire-Assisted dilation in sialendoscopy: How I use the modified Marchal's dilator 导丝辅助扩张涎镜检查：我如何使用改良的Marchal扩张器

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-21 DOI: 10.1016/j.amjoto.2025.104739

Necdet Özçelik, Elvin Alaskarov, Atila Gungor

Objective

This study aims to describe a novel and practical modification of the standard Marchal's dilator to facilitate atraumatic ductal cannulation and sialendoscope insertion in sialendoscopy. The proposed technique integrates a detachable handpiece and a guidewire, streamlining the most technically challenging steps of the procedure.

Methods

A modified version of the “000” Marchal's dilator was developed by incorporating an internal guidewire and a detachable handle. Following initial ductal cannulation, the handle is removed, leaving the guidewire in place to preserve intraductal access. A conical dilator with a central lumen is then advanced over the guidewire to achieve stepwise, controlled dilation. Subsequently, the sialendoscope is inserted using the Seldinger technique, allowing atraumatic entry into the salivary duct. This approach was applied and evaluated in a series of routine sialendoscopy procedures. No patient-identifiable data were collected, and ethics committee exemption was granted.

Results

The modified dilator enabled consistent ductal access, significantly reduced cannulation and dilation times, and minimized the need for repeated instrument exchanges. Surgeons, including those with limited experience, were able to perform the procedure efficiently and with fewer complications. The guidewire-assisted technique reduced trauma to the ductal orifice and surrounding tissues, contributing to improved visualization and procedural success.

Conclusion

The guidewire-assisted modification of the Marchal's dilator offers a safe, reproducible, and user-friendly enhancement to standard sialendoscopy techniques. By simplifying access and minimizing tissue trauma, this method may reduce operative times and improve patient outcomes. Its ease of use and compatibility with existing sialendoscopic systems make it particularly advantageous in training settings and low-resource environments.

目的本研究旨在描述一种新颖实用的改良标准马尔查尔扩张器，以方便在鼻内镜检查中进行无伤性导管插管和鼻内镜插入。该技术集成了可拆卸的机头和导丝，简化了最具技术挑战性的步骤。方法采用内导丝和可拆卸把手，研制了一种改进型“000”马尔查尔扩张器。在初始导管插管后，取下手柄，留下导丝以保留导管内通路。然后将带中心腔的锥形扩张器置于导丝上方，以实现逐步可控的扩张。随后，使用Seldinger技术插入唾液内窥镜，允许自动进入唾液管。该方法在一系列常规鼻内镜检查中得到应用和评估。未收集患者身份数据，伦理委员会给予豁免。结果改进后的扩张器使导管通路一致，显着减少了插管和扩张时间，并最大限度地减少了重复更换器械的需要。外科医生，包括那些经验有限的医生，都能有效地完成手术，并发症也更少。导丝辅助技术减少了对导管口和周围组织的创伤，有助于提高视觉效果和手术成功率。结论导丝辅助下改良Marchal扩张器是一种安全、可重复性好、用户友好的标准鼻内镜技术。通过简化通道和减少组织创伤，该方法可以减少手术时间并改善患者预后。它的易用性和与现有的鼻内窥镜系统的兼容性使其在培训环境和低资源环境中特别有利。

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引用次数: 0

Evaluating the use of advanced large language models to improve readability of head and neck cancer patient education materials 评估使用先进的大型语言模型来提高头颈癌患者教育材料的可读性。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104744

Soumil Prasad , Danielle Abdennour , Coral Levkovitz , Taylor Kring , Janice Huang , Garrett Forman , Supriya Dadi , Emeil Stewart , Elizabeth Franzmann

To evaluate whether advanced large language models (LLMs) ChatGPT-4o, ChatGPT o3, Microsoft Copilot, Claude Sonnet 4, Gemini 1.5 Flash, and DeepSeek V3-R1 can improve the readability of head and neck cancer patient education materials while maintaining accuracy.

Eleven publicly available articles were assessed for baseline readability using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Each article was rewritten by six LLMs using a standardized prompt to simplify text to a sixth-grade level. Readability was reassessed post-intervention, and paired t-tests with repeated-measures ANOVA and Bonferroni correction compared performance across models. Baseline readability was poor, with a mean FKGL of 10.1 and FRES of 51.5, exceeding national recommendations. Gemini, Copilot, ChatGPT o3, and DeepSeek significantly reduced FKGL compared to originals, while ChatGPT-4o showed minimal change and Claude increased difficulty. Gemini performed best, achieving FKGL ≤7 in 81.8 % of cases, followed by Copilot and DeepSeek at 72.7 %. ChatGPT-4o met this threshold in 18.2 % of articles, and Claude met it in none. LLMs can improve the readability of head and neck cancer patient education materials, but effectiveness varies substantially among models. Gemini, Copilot, and DeepSeek were most successful in meeting clinical readability thresholds, whereas ChatGPT-4o and Claude underperformed. Careful model selection and clinical oversight are essential when applying AI to patient education, as rewritten materials must still be reviewed for accuracy before public use.

评估先进的大型语言模型（llm） ChatGPT- 40、ChatGPT o3、Microsoft Copilot、Claude Sonnet 4、Gemini 1.5 Flash和DeepSeek V3-R1是否可以在保持准确性的同时提高头颈癌患者教育材料的可读性。使用Flesch- kincaid Grade Level （FKGL）和Flesch Reading Ease Score （FRES）评估11篇公开文章的基线可读性。每篇文章都由六位法学硕士使用标准化的提示重写，以简化文本到六年级的水平。干预后重新评估可读性，并使用重复测量方差分析和Bonferroni校正配对t检验比较各模型的性能。基线可读性较差，平均FKGL为10.1，FRES为51.5，超过了国家推荐值。与原版相比，Gemini、Copilot、ChatGPT o3和DeepSeek显著降低了FKGL，而ChatGPT- 40变化很小，Claude增加了难度。Gemini表现最好，在81.8%的情况下达到FKGL≤7，其次是Copilot和DeepSeek，为72.7%。chatgpt - 40在18.2%的文章中达到了这个阈值，Claude没有达到。llm可以提高头颈癌患者教育材料的可读性，但不同模型的有效性差异很大。Gemini、Copilot和DeepSeek最成功地满足了临床可读性阈值，而chatgpt - 40和Claude表现不佳。在将人工智能应用于患者教育时，仔细的模型选择和临床监督是必不可少的，因为在公开使用之前，必须对重写的材料进行准确性审查。

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引用次数: 0

Nasal septal hematoma is a rare and self-recognizable complication of nasal bone fracture: A retrospective study 鼻中隔血肿是鼻骨骨折的一种罕见且可自我识别的并发症：一项回顾性研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104748

Leon Guchlerner , Benjamin Philipp Ernst , Christian Issing , Iris Burck , Timo Stöver , Maximilian Gröger

Purpose

Nasal septal hematoma (NSH) is a rare but potentially severe complication which can occur after nasal bone fracture (NBF). A subperichondrial accumulation of blood in the nasal septum can lead to breathing difficulties, infections and nasal deformities. To prevent such complications our department's standard operating procedure requires clinical exclusion of NSH both on the day after NBF and the day after nasal bone repositioning. These repeated appointments create a high organizational effort in the outpatient department. The aim of this study was to assess the incidence of NSH after NBF and nasal bone repositioning in our patient population and thus to evaluate the necessity of repeated follow-up examinations.

Methods

In this retrospective study patients diagnosed with NBF over a nine-year period (January 2015 – June 2024) were included (n = 675). We assessed the presence of NSH, nature of trauma, pre-existing conditions (especially coagulopathies) and the clinical course.

Results

NSH was diagnosed in 0.6 % of cases (n = 4). The NSH-incidence after nasal bone repositioning was n = 0. There was no significant correlation between coagulopathy or anticoagulant therapy and the incidence of NSH (p = 1). Painful septal swelling combined with nasal obstruction was exclusively observed in NSH-patients (n = 4, 100 %).

Conclusion

The incidence of post-traumatic and post-interventional NSH in our population is negligible. Affected patients showed specific clinical features. Therefore, routine follow-ups appear not be justified given the organizational effort. Instead, emphasis should be placed on counseling patients to recognize signs of NSH that require immediate reevaluation.

目的鼻中隔血肿（NSH）是鼻骨骨折（NBF）后发生的一种罕见但潜在的严重并发症。鼻中隔的骨膜下积血可导致呼吸困难、感染和鼻畸形。为了防止此类并发症的发生，我科的标准操作程序要求在鼻骨复位后和鼻骨复位后的第二天均排除NSH。这些重复的预约在门诊部门创造了高度的组织性努力。本研究的目的是评估NBF和鼻骨复位后NSH的发生率，从而评估反复随访检查的必要性。方法本回顾性研究纳入了9年（2015年1月- 2024年6月）诊断为NBF的患者（n = 675）。我们评估了NSH的存在、创伤的性质、先前存在的疾病（尤其是凝血功能障碍）和临床病程。结果诊断为snsh的病例为0.6% （n = 4）。鼻骨复位后nsh发生率n = 0。凝血功能障碍或抗凝治疗与NSH发生率无显著相关性（p = 1）。疼痛性鼻中隔肿胀合并鼻塞仅在nsh患者中观察到（n = 4,100%）。结论创伤后和介入后NSH在我国人群中的发生率可以忽略不计。患者表现出特殊的临床特征。因此，考虑到组织的努力，例行的随访似乎是不合理的。相反，重点应放在咨询患者认识到NSH的迹象，需要立即重新评估。

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引用次数: 0

Prevalence of alcohol use over time in survivors of head and neck cancer 头颈癌幸存者长期饮酒的流行程度

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104743

M. Bryant Howren , Alan J. Christensen , Nitin A. Pagedar

Objectives

Alcohol use is a risk factor for the development of head and neck cancer (HNC) and continued use after diagnosis is associated with recurrence, comorbidities, and poor psychosocial outcomes. This retrospective observational descriptive study sought to report the prevalence of alcohol use in survivors of HNC from diagnosis through 10 years postdiagnosis.

Methods

Adult patients with upper aerodigestive tract carcinomas from the head and neck oncology clinic at a large Midwestern healthcare system were eligible to participate. Between 1998 and 2014, 2095 patients reported alcohol use status at diagnosis. By 10 years postdiagnosis, this number was 187. Self-reported alcohol use was classified as current/previous/never.

Results

At diagnosis, 48.8 % reported currently using alcohol, 36.6 % reported previous use, and 14.7 % reported never using; 24.5 % of those with a history of alcohol use were likely problem users. At 1 year postdiagnosis, 44.7 % reported currently using alcohol, 40.2 % reported previous use, and 15.1 % reported never using. At 5 years postdiagnosis, 48.9 % reported currently using alcohol, 38.3 % reported previous use, and 12.8 % reported never using. At 10 years postdiagnosis, 42.2 % reported currently using alcohol, 44.9 % reported previous use, and 12.8 % reported never using alcohol.

Conclusions

Continued alcohol use remains an issue over time in HNC survivors. Screening protocols should be incorporated into clinical workflow and more research is needed to understand correlates and degree of use in long-term HNC survivors to facilitate optimal recovery and adjustment during the survivorship period.

目的：饮酒是头颈癌（HNC）发生的一个危险因素，诊断后继续饮酒与复发、合并症和不良的社会心理结局相关。本回顾性观察性描述性研究旨在报告HNC幸存者从诊断到诊断后10年的酒精使用情况。方法选取美国中西部某大型医疗保健系统头颈部肿瘤门诊的成年上气消化道癌患者为研究对象。1998年至2014年间，2095名患者在诊断时报告了酒精使用状况。到确诊后10年，这一数字为187。自我报告的酒精使用情况分为目前/以前/从未。结果在诊断中，48.8%的患者报告目前有酒精使用，36.6%的患者报告曾经有过酒精使用，14.7%的患者报告从未有过酒精使用；24.5%有酒精使用史的人可能是问题使用者。在诊断后1年，44.7%报告目前使用酒精，40.2%报告以前使用过，15.1%报告从未使用过。在诊断后5年，48.9%报告目前使用酒精，38.3%报告以前使用过酒精，12.8%报告从未使用过酒精。在诊断后10年，42.2%报告目前使用酒精，44.9%报告以前使用过酒精，12.8%报告从未使用过酒精。结论：在HNC幸存者中，长期持续饮酒仍然是一个问题。筛查方案应纳入临床工作流程，需要更多的研究来了解长期HNC幸存者的相关性和使用程度，以促进生存期间的最佳恢复和调整。

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引用次数: 0

Sinus and palatal Rosai-Dorfman Disease: Case report and review of the literature 窦及腭罗塞-多尔夫曼病：病例报告及文献复习。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104736

Clare Moffatt , Hanna K. Mandl , Jessa E. Miller , Jonathan W. Said , Elliot Abemayor , Daniel M. Beswick

Rosai-Dorfman Disease (RDD) is a rare non-Langerhans cell histiocytosis. We present a unique case of RDD with sinus and palatal involvement managed with surgical biopsy, debulking and radiation, and review the literature on this topic. A 69-year-old female presented with a two-year history of nasal obstruction and left-sided epiphora. CT imaging demonstrated a large soft tissue mass with extension into and bony destruction of the left maxillary sinus and hard palate. An initial biopsy obtained at an outside center reported an inflammatory myofibroblastic tumor. MRI and PET-CT were obtained and identified no additional lesions or lymphadenopathy. A repeat biopsy was performed in clinic but was non-diagnostic. The patient was taken to the operating room for biopsy and debulking of the sinonasal mass, and final pathology demonstrated proliferation of large histiocytic cells with clear cytoplasm and emperipolesis on a background of fibrosis. The tumor stained positive for S100, BCL1 and OCT2, consistent with RDD. The patient then underwent targeted radiation therapy. At 15-month follow-up, MRI showed no evidence of disease recurrence.

While RDD is classically described as “sinus histiocytosis with massive lymphadenopathy”, this case features extranodal sinus and palatal involvement with no lymphadenopathy. RDD is notoriously challenging to diagnose, and we highlight that our pathology is positive for OCT2, which has recently been found to be a novel and specific marker associated with the monocyte-macrophage phenotype of RDD. We demonstrate that symptomatic extranodal sinus and palatal RDD can be diagnosed and treated with a combination of surgical biopsy, debulking and radiation.

Rosai-Dorfman病（RDD）是一种罕见的非朗格汉斯细胞组织细胞增多症。我们提出一个独特的RDD与窦和腭累及手术活检，减积和放射治疗的病例，并回顾了有关该主题的文献。一名69岁女性，有鼻塞和左侧泪显两年的病史。CT影像显示一大块软组织肿块，并延伸至左侧上颌窦及硬腭骨破坏。在外部中心获得的初步活检报告为炎症性肌纤维母细胞瘤。MRI和PET-CT均未发现其他病变或淋巴结病变。临床复查活检，但无诊断意义。患者被带到手术室进行活检和鼻窦肿块减积，最终病理显示大的组织细胞增生，细胞质清晰，纤维化背景下的细胞增多。肿瘤S100、BCL1、OCT2染色阳性，与RDD一致。患者随后接受了靶向放射治疗。随访15个月，MRI未见疾病复发。虽然RDD通常被描述为“窦性组织细胞增生伴大量淋巴结病”，但本病例以结外窦和腭受累为特征，无淋巴结病。众所周知，RDD的诊断具有挑战性，我们强调我们的病理是OCT2阳性，最近发现OCT2是与RDD的单核巨噬细胞表型相关的一种新的特异性标记物。我们证明，有症状的结外窦和腭RDD可以通过手术活检、减积和放疗的结合来诊断和治疗。

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引用次数: 0

Objective diagnosis of Patulous Eustachian Tube following bariatric surgery using dynamic tympanometry 目的应用动态鼓室测量法诊断减肥手术后咽鼓管扩张。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104742

Servet Erdemes , Hasan Elkan , Mehmet Çiftçi

Objective

The aim of this study is to evaluate Patulous Eustachian Tube (PET) dysfunction developing after bariatric surgery using objective audiological tests, and to investigate the effect of rapid weight loss on the development of PET.

Methods

This prospective study was conducted between January and December 2024. A total of 64 patients with a body mass index (BMI) ≥ 40 who underwent bariatric surgery were included. Patients underwent otorhinolaryngological examination and audiological tests preoperatively and postoperatively (six-month postoperative). The diagnosis of PET was made objectively using the Patulous Eustachian Tube program of the Interacoustics AT235 device.

Results

68.8 % of the patients included in the study were female (n = 44) and 31.3 % were male (n = 20), with a mean age of 32.47 ± 5.11 years. While PET was not detected in any of the patients in the preoperative period (0 %), it developed in 25 % (n = 16) of the patients in the postoperative period. Greater weight loss was observed in patients who developed PET; however, this difference was not statistically significant (p > 0.05). Symptoms such as autophony, ear fullness, and hearing their own breath sounds were observed in patients diagnosed with PET.

Conclusion

Rapid weight loss after bariatric surgery may trigger the development of PET. In this study, PET was reliably diagnosed through objective tympanometric tests. It is important that the diagnosis of PET be supported not only by subjective symptoms but also by objective tests. Patients with otological complaints after surgery should be carefully evaluated for PET.

目的：通过客观听力学试验评价减肥手术后扩张性咽鼓管（PET）功能障碍的发生，并探讨快速减肥对PET发育的影响。方法：本前瞻性研究于2024年1月至12月进行。共纳入64例接受减肥手术的体重指数(BMI)≥40的患者。患者术前和术后（术后6个月）均行耳鼻喉科检查和听力学检查。应用Interacoustics AT235装置的扩张性咽鼓管程序对PET进行客观诊断。结果：纳入研究的患者中女性占68.8% (n = 44)，男性占31.3% (n = 20)，平均年龄32.47±5.11岁。术前未发现PET(0%)，术后出现PET的患者占25% （n = 16）。发生PET的患者体重减轻幅度更大；但差异无统计学意义（p < 0.05）。在诊断为PET的患者中观察到自音、耳充盈和听到自己的呼吸音等症状。结论：减肥手术后体重迅速下降可能诱发PET的发生。在本研究中，PET通过客观的鼓室测量试验得到了可靠的诊断。PET的诊断不仅要有主观症状的支持，还要有客观检查的支持，这一点很重要。术后有耳科疾患的患者应仔细评估PET。

{"title":"Objective diagnosis of Patulous Eustachian Tube following bariatric surgery using dynamic tympanometry","authors":"Servet Erdemes , Hasan Elkan , Mehmet Çiftçi","doi":"10.1016/j.amjoto.2025.104742","DOIUrl":"10.1016/j.amjoto.2025.104742","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to evaluate Patulous Eustachian Tube (PET) dysfunction developing after bariatric surgery using objective audiological tests, and to investigate the effect of rapid weight loss on the development of PET.</div></div><div><h3>Methods</h3><div>This prospective study was conducted between January and December 2024. A total of 64 patients with a body mass index (BMI) ≥ 40 who underwent bariatric surgery were included. Patients underwent otorhinolaryngological examination and audiological tests preoperatively and postoperatively (six-month postoperative). The diagnosis of PET was made objectively using the Patulous Eustachian Tube program of the Interacoustics AT235 device.</div></div><div><h3>Results</h3><div>68.8 % of the patients included in the study were female (<em>n</em> = 44) and 31.3 % were male (<em>n</em> = 20), with a mean age of 32.47 ± 5.11 years. While PET was not detected in any of the patients in the preoperative period (0 %), it developed in 25 % (<em>n</em> = 16) of the patients in the postoperative period. Greater weight loss was observed in patients who developed PET; however, this difference was not statistically significant (<em>p</em> > 0.05). Symptoms such as autophony, ear fullness, and hearing their own breath sounds were observed in patients diagnosed with PET.</div></div><div><h3>Conclusion</h3><div>Rapid weight loss after bariatric surgery may trigger the development of PET. In this study, PET was reliably diagnosed through objective tympanometric tests. It is important that the diagnosis of PET be supported not only by subjective symptoms but also by objective tests. Patients with otological complaints after surgery should be carefully evaluated for PET.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104742"},"PeriodicalIF":1.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353361","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}

引用次数: 0