Ear, nose, & throat journal最新文献

Background: Congenital pyriform fossa malformations (CPFM) are rare types of branchial anomalies. The management approach was previously anatomical, based on outlining the complete surgical excision of the vestige tract. Endoscopic obliteration of the pharyngeal opening of the tract evolved as an alternative to less invasive treatment. Although different techniques have been reported, long-term follow-up data are relatively deficient.

Methods: This is a retrospective analysis of patients with CPFM treated in a tertiary referral hospital. Direct laryngoscopy was the only diagnostic method used. Endoscopic radiofrequency ablation was done as described. Patients with at least 24 months of follow-up were included.

Results: Fourteen patients met inclusion criteria, 10 males and 4 females, with a mean age of 8 years. Only one patient had an external cervical component. All patients had the pharyngeal opening in the left pyriform fossa except for one. Average follow-up period was 41.5 months. No complications or recurrences were reported during the follow-up period.

Conclusion: Endoscopic radiofrequency cauterization can be described as a safe, effective sole treatment of CPFM. The approach we adopted is simple, less demanding with long-term reliability.

Background: Vitamin B12 is an essential nutrient crucial for overall health, and deficiencies can lead to hearing loss. Objective: The aim of the systematic review was to explore the intricate connection between vitamin B12 deficiency and hearing loss using a systematic literature review. Methods: A systematic literature search was carried out to identify the articles exploring the connection between vitamin B12 deficiency and hearing loss. Electronic databases such as PubMed, Scopus, and Cochrane databases were used to identify the relevant studies. Results: A total of 612 studies were identified from 3 databases, and after stepwise screening, 9 articles were found eligible for the data extraction and inclusion in the review. Most of the studies had observed statistically-significant differences in the hearing thresholds with low vitamin B12 levels. However, few studies found hearing loss in the low frequencies (250 and 500 Hz), and others have found elevated thresholds above 4 KHz. Factors such as age, gender, and treatment for vitamin B12 did not show any significant changes in the hearing thresholds. Conclusion: The systematic review revealed that individuals with lower vitamin B12 levels tended to have a higher prevalence of hearing impairment than those with normal or elevated levels. Vitamin B12 deficiency, coupled with high homocysteine levels and low folate concentrations, may contribute to different degrees of hearing loss, particularly in the elderly. Lower serum levels of vitamin B12 have been associated with slight to mild hearing loss, while cochlear dysfunction and poorer hearing thresholds have also been observed in individuals with vitamin B12 deficiency. These findings highlight the importance of maintaining optimal levels of vitamin B12 for preserving hearing health and warrant further investigation into potential interventions.

Objective: The purpose of this study was to evaluate and clarify the effects of menopause on voice by comparing postmenopausal female participants who did not receive hormone therapy (HT) to premenopausal female participants.

Methods: The study included 50 postmenopausal women who had not undergone HT, as well as 50 premenopausal women. The acoustic voice analysis considered fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio (HNR), and noise-to-harmonic ratio (NHR). Jitter is variations of F0, and shimmer is of peak amplitude. Experts completed the Grade, Roughness, Breathiness, Asthenia, Strain scale for perceptual assessment, while participants self-evaluated their voice using the Voice Handicap Index-10 (VHI-10).

Results: Postmenopausal women had lower acoustic parameters (F0 [P = .01], G [P = .037], R [P = .011], and S [P = .031]) scores. Age had a link with G (r = 0.303, P = .002), R (r = 0.417, P < .001), A (r = 0.297, P = .003), and S (r = 0.370, P = .001) and the F0 (r = -0.455, P = .001). There was no significant difference in the VHI-10 (P = .526), jitter (P = .216), shimmer (P = .920), HNR (P = .261), and NHR (P = .301) values.

Conclusion: Postmenopausal women's voice have lower frequency, and perceptually-lower grade, roughness, and strain than premenopausal women; however, these changes do not affect their quality of life.

Objectives: Laimer's diverticulum (LD) is a very rare clinical entity originating between the cricopharyngeus muscle (CPM) and circular muscular fibers of the esophagus. Its diagnosis and management remain to be elucidated. This article summarizes our experience in its diagnosis and open surgical management.Methods: A retrospective review of LD cases treated at our tertiary medical institution was conducted between July 2018 and May 2023. The clinical and demographic data were retrieved from case notes.Results: Three cases were included in this review. There were 2 male patients and 1 female patient. The average and median ages were 47.3 and 54 years, respectively. Presenting symptoms included hoarseness, pharyngeal foreign body sensation, and neck mass. All 3 diverticula were on the left side, with the first 2 cases discovered accidentally on gastric endoscopic or cervical MRI examinations. After evaluating esophageal swallowing with barium sulfate or urografin contrast media, all the patients consented to undergo an open surgical procedure. During surgical exploration, the diverticula were found to be on the posterior part of the cervical esophagus, below CPM, and away from the recurrent laryngeal nerve, and only then, could the diagnosis of LD be established. Then, diverticulectomy and manual suturing of the esophagus was performed. Recovery of all 3 patients was uneventful. Nasogastric tube feeding lasted 7 to 12 days until esophageal examinations demonstrated no leak, and then, oral liquid feeding resumed. The median duration of follow-up was 50 months. No recurrence of symptoms or diverticulum was observed, and the swallowing function of all 3 patients was excellent.Conclusions: An open surgical approach is not only important for the diagnosis of LD, but can also be utilized as a safe and effective treatment.

Objective: Brachial plexus schwannoma (BPS) is a rare clinical entity that poses a significant challenge for head and neck surgeons due to its neuroanatomical complexity and potential severe complications, such as major motor or sensory neurological deficits or pain of the corresponding upper extremity. This article summarizes our experience in its diagnosis and intracapsular enucleation with intraoperative neuromonitoring (INM).

Methods: A retrospective review of BPS cases treated at our tertiary medical institution was conducted between April 2020 and May 2023. The clinical and demographic data were retrieved from case notes.

Results: Totally, 3 cases were included. All 3 patients were male, aged 43 to 54 years (median age = 52). The presenting symptom was a palpable supraclavicular mass in all these cases (2 on the left side and 1 on the right side). Neuromonitoring was performed with a 4-channel nerve integrity monitor, with the electrodes placed in the upper arm and forearm muscles, as demonstrated in the literature. After exposing the mass and identifying its origin from the brachial plexus, a unipolar stimulating probe was used to stimulate the tumor surface or the nerves with a 1.0-mA current, and a longitudinal incision into the tumor capsule was made along a carefully mapped line with no INM response. Then the mass was carefully exposed and meticulously dissected from its capsule to achieve an intact enucleation. Immediate postoperative neurological deficit was documented in Case 1 as a mild grasping weakness. The recovery of the other 2 patients was uneventful. The follow-up duration was 7 to 38 months (median = 8 months). The minor motor deficit of Case 1 recovered completely 1 month after surgery. No recurrence of BPS was observed.

Conclusions: Intracapsular enucleation with INM could result in complete removal of BPS and minimal postoperative neurological deficit, whose recovery was quick and satisfactory.

Background: Congenital cholesteatoma is defined as a white mass behind an intact eardrum without a history of otitis media or previous otologic procedures. Congenital cholesteatoma is a relatively rare disease that accounts for about 2% to 5% of all cholesteatomas. However, the actual incidence rate of congenital cholesteatoma may be underestimated. Conductive hearing loss is the most common presenting symptom. The current study aims to describe the clinical characteristics and management of patients with congenital cholesteatoma and promote awareness of the disease in unilateral or asymmetric conductive hearing loss patients. Methods: In this study, we report a case series of 3 patients including 1 child, 1 adolescent, and 1 young adult, managed in our department between June and August 2023, and present a summary of the literature. Results: Congenital cholesteatoma is primarily a pediatric disease, but it has also been reported in adults. Two cases presented with unilateral secretory otitis media, and 1 case presented with asymmetric unilateral conductive hearing loss. Two patients of Potsic stage III congenital middle ear cholesteatomas underwent transcanal endoscopic ear surgery, and 1 patient of Potsic stage IV underwent conventional microscopic approach canal wall-up mastoidectomy combined with endoscopy. Conclusions: In children or young adults with persistent unilateral or asymmetric conductive hearing loss, congenital middle ear cholesteatoma should be considered. Congenital cholesteatoma cannot be ruled out in children with unilateral secretory otitis media.

Objective: This meta-analysis aimed to assess and compare the results of microwave ablation (MWA) and surgical intervention for the management of solitary T1N0M0 papillary thyroid carcinoma (PTC), including T1A- and T1B-staged tumors.

Methods: A search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The variables included in the study were oncological outcomes, complications, surgery-related indicators, and tumor volume.

Results: The findings from the meta-analysis indicated that, in comparison to surgical intervention, MWA treatment for isolated T1N0M0 PTC did not show significant differences in local tumor progression (P = .91), new-onset tumors (P = .88), lymph node metastasis (P = .19), technical success rate (P = 1.00), local recurrence (P = .50), transient hyperthyroidism (P = .60), permanent hyperthyroidism (P = .18), permanent hypoparathyroidism (P = .07), transient hoarseness (P = .29), hematoma (P = .12), infection (P = .27), and airway obstruction (P = .14). In contrast, MWA significantly reduced the overall complication rate, hypothyroidism, transient hypoparathyroidism, permanent hoarseness, dysphagia, and laryngeal edema. MWA also shortened the operation time, bleeding volume, and hospital stay, lowered the treatment cost, reduced the size of the incision, reduced the tumor volume, and improved quality of life (all P < .05). Subgroup analysis based on tumor stages showed similar trends in the outcome indicators within the T1A/T1B subgroup. However, in the new-onset tumors, the risk of new tumors increased in the T1B subgroup (P = .03).

Conclusion: Ultrasound-guided MWA may be a potential treatment option for highly selected patients with isolated T1N0M0 PTC. It shows advantages in short-term outcomes, but its long-term oncological safety still needs to be confirmed by longer and higher-quality studies. However, in the T1B subgroup, preoperative ultrasound or computed tomography (CT) examinations are required to screen for suspicious lymph nodes. If any suspicious metastasis is found, surgical treatment should be given priority.

Objective: This study aimed to identify key clinical predictors for obstructive sleep apnea (OSA) in pilots from routine aeromedical examination data and to assess the predictive value of the Psychomotor Vigilance Task (PVT).

Methods: A retrospective 1:1 matched case-control study was conducted, including 37 pilots with polysomnography (PSG)-confirmed OSA and 37 matched non-OSA controls. Data from routine examinations, including anthropometric, biochemical, cardiovascular, and PVT parameters, were analyzed. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select significant predictors from a wide range of variables. These selected factors were then entered into a multivariable logistic regression model to determine their independent predictive value, calculated as odds ratios (ORs).

Results: The OSA group had a significantly higher body mass index (BMI; 28.11 ± 2.72 vs 23.93 ± 1.89 kg/m²) and fasting plasma glucose (FPG; 5.29 ± 0.81 vs 4.82 ± 0.41 mmol/L) compared to controls (both P < .05). Conversely, no PVT metrics differed significantly between groups (P > .05). LASSO regression identified six key predictors: BMI, FPG, hyperuricemia, hyperlipidemia, systolic blood pressure (SBP), and high-density lipoprotein (HDL); no PVT parameters were selected by the model. Multivariable logistic regression confirmed BMI (OR = 3.43; 95% CI, 1.97-8.77; P < .001) and FPG (OR = 60.24; 95% CI, 3.45-5052.71; P < .05) as significant independent predictors of OSA.

Conclusion: The core predictors for OSA in pilots are primarily indicators of metabolic syndrome, notably BMI and FPG. A framework based on the six physiological factors identified by LASSO regression provides a solid evidence-based foundation for developing an efficient and accurate OSA screening tool. In this study cohort, the PVT, as a measure of cognitive performance, demonstrated limited predictive value and is not recommended as a primary screening tool for OSA in pilots.