Ear, nose, & throat journal最新文献

Objective: To evaluate the prevalence and predictors of no residual disease on wide local excision (WLE) specimens in patients with shave biopsy-confirmed head and neck basal cell carcinoma (BCC).

Study design: Retrospective cohort study of patients in an integrated healthcare system referred from dermatology to otolaryngology-head and neck surgery.

Setting: Otolaryngology-head and neck surgery clinic.

Methods: We reviewed medical records of adults with shave biopsy-confirmed BCC referred for WLE between January 2022 and December 2023. Data included patient demographics, comorbidities, histologic subtype, and timing of excision. Bivariate and multivariate analyses assessed associations with residual disease status on final pathology.

Results: Among 243 cases, 66 (27.2%) WLE specimens had no residual tumor found on pathologic analysis. Patients with no residual disease were younger on average compared to those with residual cancer (65.4 ± 14.2 years vs 72.6 ± 13.0 years, P < .001). Of the 97 female patients, 39 (40.2%) had no residual disease and female sex was independently associated with no residual disease (odds ratio 3.398, 95% confidence interval 1.80-6.42, P < .001). Histologic subtype, diabetes, transplant history, and prior radiation showed no significant associations.

Conclusion: Over one-quarter of patients had no residual tumor at excision, particularly younger individuals and women. These findings underscore the value of individualized risk assessment during preoperative counseling, especially for elderly or frail patients and those with lesions in cosmetically sensitive regions. Predictive models incorporating patient-level factors may help reduce overtreatment and improve decision-making in BCC management.

Mature cystic teratomas most commonly arise from the ovaries and testes, but may also occur at extragonadal sites, with a relatively higher incidence in children. However, mature cystic teratomas located on the ventral surface of the tongue are exceedingly rare. We report a case of a 6-month-old female infant with a gradually enlarging oral mass since birth, causing feeding and breathing difficulties. The tumor was situated beneath the mucosal layer on the ventral tongue. Preoperative magnetic resonance imaging suggested a sublingual gland cyst or dermoid cyst, but histopathological examination following surgical excision confirmed the diagnosis of mature cystic teratoma.

Background: Radiofrequency ablation (RFA) is a mucosal-sparing, in-office technique for inferior turbinate hypertrophy (ITH) with favorable short-term outcomes. Data regarding the efficacy of revision RFA in patients with treatment failure are limited.

Objectives: To identify predictors of RFA failure requiring revision and to evaluate the safety and efficacy of revision RFA.

Methods: A retrospective cohort study was conducted, including patients with ITH who underwent RFA between 2016 and 2023 at a tertiary referral center. Patients requiring revision treatment were identified and compared with those who did not require revision.

Results: The cohort included 260 patients (66.9% male; age range, 18-88 years). Thirty-three patients (12.7%) required revision treatment, of whom 24 (9.2%) underwent revision RFA. No post-revision RFA complications were observed. The overall revision rates were higher among older patients (P = .015), patients with medical comorbidities (P < .001), and those with middle turbinate hypertrophy (P = .047). Short-term revision (<6 months) was more common among patients with diabetes (P < .001) and obstructive sleep apnea (OSA; P = .012), while revision in the long term (<24 months) was associated with diabetes (P < .001), hypertension (P = .019), and rhinitis medicamentosa (P = .045). On multivariate Cox proportional hazards analysis, diabetes mellitus, OSA, and rhinitis medicamentosa were independently associated with an increased risk of revision for both short and long term.

Conclusions: Revision RFA is a safe and effective treatment option for selected patients with recurrent nasal obstruction due to ITH. Higher revision rates were observed in older patients and those with medical comorbidities and rhinitis medicamentosa. Revision RFA should be considered as a conservative second-line treatment in appropriately selected patients.

Objective: Allergic rhinitis (AR) and chronic sinusitis (CRS) are prevalent upper airway inflammatory diseases with growing public health burdens. Sedentary behavior (SB) has emerged as an independent risk factor for multiple chronic conditions, yet its association with AR and CRS remains unclear.

Methods: A cross-sectional analysis was conducted using data from the Korea National Health and Nutrition Examination Survey (2017-2018). AR and CRS were defined based on self-reported physician diagnoses. SB was assessed via self-reported daily sedentary time (ST) and categorized as <6, 6 to 8, and ≥ 8 hours/day. Multivariable logistic regression was performed to examine associations, adjusting for demographic, lifestyle, and clinical covariates. Subgroup analyses were conducted to assess potential heterogeneity across population subgroups.

Results: Among 14 748 participants, the weighted prevalence of AR and CRS was 15.8% and 6.5%, respectively. Individuals with prolonged ST exhibited prominently higher prevalence rates of AR and CRS compared to those with low ST. Multivariable analysis indicated high ST (≥ 8 hours/day) was associated with increased odds of AR (OR = 1.161, 95% CI: 1.013, 1.329) and CRS (OR = 1.282, 95% CI: 1.038, 1.584). The association between SB and AR was more pronounced in individuals aged <40 years, alcohol users, those with a high school education, and white-collar workers.

Conclusion: Prolonged ST was associated with a higher prevalence of AR and CRS in Korean adults. These findings highlight the potential public health relevance of SB in relation to upper airway inflammatory diseases; however, longitudinal studies are required to clarify causality and inform preventive strategies.

Background: Voice disorders caused by vocal fold lesions or mobility disorders are common, but current diagnosis depends on mildly invasive laryngoscopy.

Objective: To develop and validate a deep learning model for automatic classification of multiple voice disorder categories using non-invasive voice recordings.

Methods: We retrospectively analyzed 897 patients and healthy controls from a tertiary ENT center. Sustained Mandarin vowels (/a/, /e/, /o/, /i/, /u/, /v/) were recorded and converted to Mel spectrograms. A ResNet and feature pyramid network-based model was trained with weighted cross-entropy loss and evaluated on 3-class (normal, laryngeal lesions, vocal fold mobility disorders) and binary (high-risk vs benign laryngeal lesions) tasks.

Results: For the 3-class task, the model achieved accuracy 0.795, sensitivity 0.818, specificity 0.900, precision 0.786, and F1 score 0.794. For the binary task, performance improved to accuracy 0.826, sensitivity 0.933, specificity 0.625, precision 0.824, and F1 score 0.876, indicating high sensitivity for detecting high-risk laryngeal lesions.

Conclusion: A deep learning model using multi-vowel Mel spectrograms can non-invasively classify common voice disorders with clinically meaningful accuracy and shows particular promise as a screening tool for high-risk laryngeal lesions.

Distant metastasis occurs in 1% to 4% of patients with papillary thyroid carcinoma (PTC) and most commonly involves the lungs and bones, with skull base involvement being exceedingly rare. We present a case of a 58-year-old male patient who experienced skull-base metastasis of tall-cell variant PTC 4 years after multimodal treatment of aggressive disease. The patient presented to the otolaryngology clinic with left-sided postnasal drip, anosmia, ptosis, and proptosis. Magnetic resonance imaging of head showed a 1.9 × 2.7 × 4.4 cm mass with extensive invasion of the sinonasal cavities, cribriform plate, and left orbit, complicated by a postobstructive mucocele. In-office biopsy was consistent with metastatic PTC. He underwent endoscopic surgical debulking followed by postoperative radiation therapy. This case demonstrates how PTC with aggressive features can develop anterior skull base metastases years after initial treatment. Management required recognition of this diagnostic challenge and combined endoscopic resection and stereotactic radiotherapy, achieving local control while preserving neurologic function. The patient has remained stable at 7-month follow-up.

Objective: This study aimed to examine the epidemiological characteristics of patients with sudden sensorineural hearing loss (SSNHL) to provide an evidence-based foundation for its prevention and treatment.

Methods: A retrospective analysis was conducted on the clinical data of 2030 SSNHL patients admitted to our department between February 2001 and February 2025. Variables analyzed included sex, age, treatment duration, and prognosis.

Results: The cohort comprised 957 males (47.14%) and 1073 females (52.86%), with a median age of 54 years. Incidence peaked in the 51 to 60 age group (22.41%). Seasonal peaks occurred in March, July, and November. The overall cure rate was 32.12%, with a total effective rate of 78.72%. Cure rates were significantly higher in younger patients (19-40 years) and lower in patients over 60. Univariate analysis showed a higher cure rate in females (35.32%) than in males (28.56%). However, multivariate logistic regression identified female gender (adjusted odds ratio [OR] = 0.712, 95% confidence interval: 0.586-0.865, P = .001), increased age (adjusted OR = 0.978 per year, P < .001), and longer treatment duration (adjusted OR = 0.942 per day, P < .001) as independent negative predictors of cure.

Conclusion: This study delineates key epidemiological patterns of SSNHL, including a female predominance, peak incidence in middle age, and distinct seasonal variation. While younger age at presentation predicts better outcomes, female gender, advanced age, and prolonged hospitalization are independent risk factors for poorer prognosis. The findings underscore the need for prompt, targeted management and highlight the complex interplay of demographic and clinical variables in determining SSNHL recovery. As a single-center retrospective study, the generalizability of these findings may be limited to similar clinical settings.