Ear, nose, & throat journal最新文献

Objective: This study aimed to investigate the optimal head position (OHP) following intratympanic injection, a critical intervention in treating inner ear disorders. Identifying OHP is essential to maximize drug retention in the middle ear, thereby significantly enhancing the therapeutic efficacy by mitigating the significant issue of injectate leakage through the eustachian tube (ET). Exploratory various positions of ET orifice and round window (RW) were investigated and associated with head movements. Methods: Twenty-two (10 males and 12 females) anonymized high-resolution computed tomography (HRCT) datasets of patients without structural ear disease were selected from January 2022 to December 2022 in the study. The subjects were categorized into two groups: children (≤18 years) and adult group (>18 years). The reconstruction of the ET orifice and RW from HRCT were analyzed using Mimics software and the distances from the center point of ET orifice or the center point of RW to the reference plane were defined as distance of ET orifice (D_ET) and distance of RW (D_RW). Results: In the supine position, the OHP for intratympanic injection was 23°of pronation and 24° of posterior extension, and the maximum distance between the ET orifice and RW (D_ET-RW) was 9.29 ± 2.13 mm. As the head position extended posteriorly beyond 43°, D_ET was relatively high compared with D_RW, resulting in the OHP a fully posteriorly extended 90° of the head being the optimal position with D_ET-RW of 2.13 ± 1.60 mm in the supine position, however, it is not realized in human beings. Moreover, the OHP had no obvious relevance corresponding to age following intratympanic injections. Conclusion: Our study suggested that OHP after intratympanic injections treatment consists of supine position, along with a slight pronation and posterior extension.

Solitary fibrous tumor (SFT) is an uncommon spindle cell neoplasm, which generally arises from the pleura. There have been documented a number of extrapleural origins including the head and neck in the literature. It is emphasized to make a diagnosis in a rare location such as the retropharyngeal space. We present a case of a 54-year-old man diagnosed with giant solitary retropharyngeal SFT. Clinical symptoms were pharyngeal foreign body sensation and dysphagia associated with dyspnea. Physical examination showed a sizable submucosal mass under the posterior pharyngeal wall, which partially obstructed the upper aerodigestive tract. With radiologic images to evaluate the dimension and relationship with surrounding structures, the tumor was surgically removed en bloc via a transcervical approach. The histology and immunohistochemistry play a crucial role in differential diagnosis. Complete surgical excision is an alternative and curative strategy.

NUT carcinoma is a rare, aggressive malignancy characterized by chromosomal rearrangements involving the NUTM1 gene. We present the case of a 47-year-old male with a history of hypertension, diagnosed with NUT carcinoma originating in the ethmoid sinus and accompanied by extensive neck metastases. The patient underwent a left modified radical neck dissection and endoscopic nasal tumor excision, followed by concurrent chemoradiotherapy. Pathological examination confirmed NUT carcinoma with metastatic cancer cells in 41 out of 72 lymph nodes of left neck, along with extranodal extension. The patient remained alive at the 4-month follow-up. This case highlights the importance of early identification and including NUT carcinoma in the differential diagnosis to optimize treatment outcomes.

This case involved a 21-year-old male patient who was admitted due to having a lump behind the left ear that had been present for 2 years and had gradually increased in size for over a year. This was accompanied by palpable hard masses on the same side of the neck. Laboratory tests indicated an elevated eosinophil count, and magnetic resonance imaging confirmed the "string-of-beads" sign in the left cervical lymph nodes. Fine-needle aspiration cytology prior to surgery revealed reactive lymphoid hyperplasia with eosinophils. Ultimately, surgical excision confirmed the diagnosis of Kimura's disease. Following glucocorticoid treatment, the patient was monitored, and no new masses were detected during 7-months follow-up period.

Cutaneous involvement of chronic lymphocytic leukemia (CLL) is rare but has been previously documented to involve the head and neck region. Generally, involvement to the ears is limited to the ear lobule; however, this study presents a unique case of recurrent CLL with cutaneous involvement overlying the auricular ear. The presentation was initially concerning for possible perichondritis but remained unresponsive to antibiotics and steroids. Eventual punch biopsy confirmed the recurrent CLL, although the lesion also presented with unique pathology, notably associated granulomata. This case demonstrates auricular involvement of CLL with unique pathology and highlights the importance of a widened differential and early, definitive tissue biopsy when evaluating refractory inflammation of the external ear.

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, with considerable variability in its clinical presentation and prognosis. Recent studies have focused on the relationship between its clinicopathological characteristics and inflammatory biomarkers, particularly the preoperative neutrophil-to-lymphocyte ratio (NLR). Our aim was to investigate the correlation between NLR and the clinicopathological features of PTC. Methods: This was a retrospective study. We involved patients who underwent surgery for PTC over a 5-year period from January 2016 to December 2021. Based on the mean NLR value, the study population was divided into 2 groups, with Group 1 corresponding to patients with an elevated NLR. Results: Our study included 102 patients aged between 20 and 83 years. All patients were euthyroid. The mean preoperative NLR was 2.01 ± 0.62, with 53% of patients classified into Group 1. On ultrasound, most nodules were classified as EU-TIRADS 5, and 38% had a Bethesda category 6 cytology. Final histopathological analysis revealed microcarcinoma in the majority of cases. PTC was multifocal in 35 cases and bilateral in 38, with an aggressive histological variant observed in 45 cases. Multivariate analysis demonstrated a statistically significant correlation between NLR and extrathyroidal invasion, lymph node metastasis, aggressive histological subtypes, and multifocality. Conclusion: NLR is a readily accessible and cost-effective preoperative biomarker. Its use could improve risk stratification and support personalized therapeutic strategies. However, prospective studies with larger, multicenter cohorts are required to validate NLR as a reliable predictive biomarker.

Objectives: We aimed to analyze the influencing factors for residual symptoms following canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 193 patients with BPPV who attended our hospital from July 2019 to December 2023 and were followed up in the outpatient clinic for 4 weeks after treatment were selected. The presence or absence of residual symptoms 4 weeks after repositioning was recorded, based on which the patients were assigned into a presence group (n = 72) and an absence group (n = 121). Their general data, incidence features, mental health, and sleep quality were compared. Results: After canalith repositioning maneuver and 4-week follow-up, the Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, and Pittsburgh Sleep Quality Index (PSQI) scores of the BPPV patients significantly decreased (P < .05). The presence of residual symptoms after repositioning in patients with BPPV had significant positive correlations with the time from onset to consultation, DHI score, HADS anxiety score, and PSQI score (P < .05). The area under the curve of the DHI score for predicting residual symptoms after repositioning in patients with BPPV was the largest (0.727), and the time from onset to consultation and the HADS anxiety score had the highest sensitivity (0.764) and specificity (0.801), respectively. Conclusions: Time from onset to consultation, DHI score, HADS anxiety score, and PSQI score are independent risk factors for and display significantly positive correlations with residual symptoms after canalith repositioning maneuver in patients with BPPV.