Ear, nose, & throat journal最新文献

Hemangiomas are rare and benign tumors originating from the pterygopalatine fossa (PPF). In this study, we report a rare case of PPF hemangioma in a 66-year-old male, for which he underwent surgical resection via the anterior nasolacrimal recess after preoperative arteria maxillaris embolization. To enhance our understanding on this rare condition, we conducted a comprehensive review of existing literature on this disease to discuss its clinical characteristics, differential diagnoses, and potential treatment approaches.

Objectives: The study aimed to determine the residual disease rate due to the affected canal in patients diagnosed with benign paroxysmal positional vertigo (BPPV) and reveal the factors affecting the residual disease. Materials and Methods: A comprehensive investigation was conducted to determine the effect of the affected canal, sociodemographic data, body mass index, hospital admission time, systemic disease history, betahistine use, and previous otologic vertigo history on the residual BPPV rate. This investigation was carried out on 201 patients who underwent repositioning maneuvers with BPPV diagnosis and came for a follow-up 1 week later, ensuring a robust and reliable dataset. Results: Two hundred one patients were included in the study: 91 (45.3%) male and 110 (54.7%) female. The mean age of the patients was 60.44 + 13.83 (min = 23-max = 90) years. Residual disease was significantly higher in bilateral canal involvement (P = .001), anterior canal involvement, and those presenting 72 hours after the onset of the vertigo attack (P = .001). There was no significant difference between residual disease and those with successful initial maneuver results regarding age, gender, obesity, canalolithiasis, or cupulolithiasis. Conclusion: The most effective treatment for BPPV is canalith reposition maneuvers. We recommend that patients be called for follow-up after 1 week, especially in cases of anterior canal involvement and bilateral involvement. These findings provide valuable insights for the management of BPPV.

Purpose: Lymphadenopathies in the neck are associated with several etiological factors, such as inflammation, infection, and tumors. We diagnose some of these lymphadenopathies using serologic tests, while others are diagnosed using biopsies. The C-reactive protein/albumin ratio (CAR) has recently emerged as a crucial inflammatory marker in cardiovascular diseases and various types of cancer. Our aim in this study was to investigate the role of the CAR in the preliminary diagnosis of patients with unexplained neck lymphadenopathy. Methods: Between 2013 and 2020, 223 patients presented to our clinic with neck lymphadenopathy. Among these patients, whose cause of lymphadenopathy was not identified, 74 patients (8 children, 66 adults) who underwent neck lymphadenopathy excision were included in the study. Patients were divided into 4 groups according to pathology results: (1) patients with reactive lymphoid hyperplasia; (2) patients with granulomatous disease; (3) patients with lymphoma; and (4) patients with metastatic disease. C-reactive protein (CRP), albumin, and CAR values were compared. Results: When the CAR of the patients were compared, a significant difference was found between reactive lymphoid hyperplasia and lymphomas (P = .006). CRP values were significantly higher in lymphomas than in lymphoid hyperplasia (P = .007). When the albumin values of the patients were compared, it was found that the albumin value was significantly lower in patients with metastatic disease than in those with reactive lymphoid hyperplasia (P = .032). Patients with carcinoma metastases were more common in male patients than in other groups. Conclusion: The CAR is a parameter that can be used in the preliminary diagnosis of unexplained neck lymphadenopathy. The elevation should be evaluated in favor of malignancy. It can be used as an auxiliary parameter, particularly in the diagnosis between the preliminary diagnosis of reactive lymphoid hyperplasia and lymphoma.

Background: Chronic lymphocytic leukemia (CLL) is a slowly progressive disease most often affecting older patients. Although CLL is typically identified on routine blood work, unique manifestations of the disease have been described both at the time of diagnosis and in the setting of indolent disease. Methods: We present on 3 CLL patients with previously stable oncologic disease who presented with orbital pathologies including dacryocystitis, epiphora, proptosis, and diplopia. Results: All 3 cases were found to have recurrences of CLL confirmed on pathology and were managed both surgically and medically with collaboration from ophthalmology and medical oncology. All patients experienced significant improvement in their symptoms. Conclusions: Otolaryngologists should be suspicious of local active disease in CLL patients with orbital complaints. Awareness of rare orbital and sinonasal manifestations of the disease can improve early detection of CLL.

Objective: In-office tympanostomy tube insertion (TTI) is becoming more available in the practice of pediatric otolaryngology. This study evaluated the tolerability of this procedure in young children. Method: Four methods were used to assess tolerability. (1) Standardized video recordings were collected from 30 patients under 24 months who underwent in-office TTI with a single-pass insertion device with topical anesthesia alone. The videos were then reviewed by 3 independent experts in pediatric care and rated at 5 procedural time points using a defined response scale developed with the U.S. Food and Drug Administration. (2) Separately, overall tolerability was subjectively assessed by the same experts. (3) Patient recovery was assessed by the participating otolaryngologist and support staff. (4) Patient caregivers were surveyed for their impressions of the procedure, including whether they would recommend it to other caregivers. Results: In a total of 90 reviews, 100% of children were successfully treated and were rated as having acceptably tolerated the in-office tympanostomy tube procedure. All patients returned to an acceptable baseline without inappropriate crying and were assessed as fully recovered immediately following the procedure or by the time the child was leaving clinic. For caregivers, 93% agreed or strongly agreed that they would recommend the use of in-office TTI to other caregivers. Conclusions: In-office TTI in young children was determined to be universally well tolerated in young children and is a procedure that patient caregivers would recommend to other caregivers for their children. These results should help reassure otolaryngology specialists and caregivers alike that in-office ear tube placement is a viable option for young children with middle ear disease.

Background and Objectives: Laryngopharyngeal reflux disease (LPRD) has been implicated in the etiology of many laryngeal disorders and is also closely related to the occurrence and progression of a variety of throat diseases, including chronic cough, leukoplakia of the larynx, dysphonia, and even laryngeal tumors. LPRD can significantly reduce the quality of life of patients and cause substantial medical and economic burdens to the society. Reflux Symptom Index (RSI), a self-administered 9-item outcomes instrument for laryngopharyngeal reflux (LPR), has been widely used to screen for LPRD, but there is a lack of feasibility studies on the use of RSI for LPRD screening and alternative diagnostic tools in otolaryngology-head and neck surgery (OHNS) clinics. To study the incidence, clinical characteristics, diagnostic status, and influencing factors of LPRD at OHNS clinics, RSI as an alternative diagnostic tool has also been studied. LPRD was defined as RSI > 13. Methods: Systematic collection of data by the RSI questionnaire was used to identify patients in the outpatient clinic suffering from LPRD; in addition, the personal history of participants was collected. Follow-up observation was carried out for 6 months for patients with suspected LPRD (RSI > 13), including whether they were treated with standardized anti-reflux therapy, and the questionnaire based on RSI was completed again after treatment. Results: The LPRD rate was 7.92% (94/1187) in this survey. The proportions of LPRD patients with smoking history (vs no smoking) and alcohol consumption history (vs. no alcohol consumption) were significantly higher (χ² values: 7.025 and 4.562, and P values: .008 and .033; respectively). Smoking significantly increased the risk of LPRD (OR: 2.140, 95% CI: 1.058-4.331, P = .034). Among patients with LPRD positive, the incidence of "foreign body sensation in the throat" (symptom 8) score equal to 5 was the highest (19.15%). The severity of "excess mucus in the throat or postnasal drip" (symptom 3) contributed mostly to the total RSI score in patients with LPRD (r = .409, P < .001). ROC curve analysis showed that RSI ≥ 14 had a sensitivity of 72.9% and a specificity of 71.4% for the diagnosis of LPRD, with AUC = 0.797 (95% CI: 0.577-0.884, P < .001). Conclusions: The incidence of LPRD was high in patients we examined in OHNS clinics. We recommend that RSI can be used by otolaryngologists as a reliable tool for screening and diagnosing LPRD in OHNS clinics, which is beneficial for clinical practice.

Objective: To analyze the clinical effect of tympanoplasty performed for chronic suppurative otitis media (CSOM) patients with otomycosis under the oto-endoscope. Methods: A retrospective analysis was conducted on the healing of the tympanic membrane and hearing improvement of 431 CSOM patients who underwent endoscopic type 1 tympanoplasty. The patients with CSOM were divided into the control group (n = 203, without otomycosis) and the trial group (n = 184, with otomycosis). The patients were followed up for at least 3 months. The graft uptake rate and hearing improvement were compared. Results: The graft uptake rate was 94.57% (174/184) in the trial group and 96.06% (195/203) in the control group, indicating no significant difference between the 2 groups. The preoperative and postoperative average air-conduction hearing thresholds of CSOM with otomycosis were 42.68 ± 11.46 dBHL and 33.01 ± 11.51 dBHL, respectively (P = .000). Mean air-bone gap (ABG) reduction values were 3.96 ± 7.20 dBHL and 3.34 ± 7.96 dBHL, respectively. There was no significant difference in the average ABG (P = .420) and average air-conduction hearing threshold (P = .649) between the trial group and the control group after operation. The culture results of the CSOM group with otomycosis showed that the most common fungal genus was Aspergillus (87/173), with 32 cases of mixed infection of fungi and bacteria, and the most common mixed infection of bacteria was Staphylococcus epidermidis (9/32). The failure graft uptake was noticed in 8.8% (5/57) cases in the trial group with postoperative fungal infection and 3.9% (5/127) without otomycosis (P = .289). No significant difference was found in the successful healing rate among age, duration, perforation size, fungal type, postoperative fungal infection. Conclusion: CSOM with otomycosis is not a contraindication for endoscopic type 1 tympanoplasty, and external auditory canal fungal infection does not affect postoperative healing and hearing improvement. Intraoperative repeated rinsing with povidone-iodine may reduce the occurrence of postoperative infection.

Objective: To present our experience in the diagnosis and treatment of the migrating pharyngeal foreign bodies. Methods: Seven patients with migrating pharyngeal foreign bodies were retrospectively reviewed. The following data were collected: symptoms, time of onset, examination methods, buried sites of foreign bodies, methods of removal, and clinical outcomes. Results: All the 7 patients were diagnosed by computed tomography (CT) scan or ultrasound and then underwent foreign body removal through the transoral approach surgery under laryngoscope. The transoral removal of foreign bodies failed in 2 cases, in which the foreign bodies were removed via the transcervical approach subsequently. No complications were observed during the follow-up of 1 month. Conclusions: Migrating pharyngeal foreign bodies can be found and located by CT scan or ultrasound preoperatively. It is feasible and minimally invasive to remove migrating pharyngeal foreign bodies with radiofrequency coblation or CO₂ laser through transoral approach surgery under laryngoscope.

Objectives: This study aimed to investigate the treatment methods used for alar rim problems during the last 5 years and the efficacy of pull-out sutures on the outcomes. Methods: A retrospective study was conducted on patients with alar contour grafting and pull-out suture procedures between 2018 and 2023. Patient records and images, such as retraction or collapse, were evaluated before surgery. The average duration of follow-up after surgery was 26 months, but it may be as long as 5 years. Results: The study enrolled 148 patients, 120 females and 28 males, between the ages of 20 and 44. The distance measured between the alar rim and the long axis of the nostril varied between 3 and 5 mm, with an average value of 3.5 mm. Postoperatively, the exact measurement was performed. However, subjective and objective observational evaluation was preferred for comparison instead of calculating the difference in millimeter due to the minimal change in dimension but significant effects on the outcome. According to patient survey responses, 83.8% of patients (124/148) were satisfied, and 9.5% (14/148) had a moderate response, but 10 cases (6.7%) were not happy with the result. The observational evaluation of the surgeon was very close to the patient's subjective evaluation. We did not have any complications or infections. Conclusion: Postoperative alar retraction may occur due to over-resection of the inner mucosa of the nose or the lower lateral cartilages. Cartilage and mucosal grafts are helpful tools to correct this deformity. Pulling the alar rim's caudal end with a suture prevents the alar mucosa's shrinkage and the alar rim from retracting. The same suture can also help correct retracted alas.