Ear, nose, & throat journal最新文献

Riedel's thyroiditis is a rare inflammatory disease characterized by extensive fibrosis, often mimicking malignancy. The concurrent presence of Riedel's thyroiditis with noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) is exceptionally rare and has not been previously reported. A 63-year-old male presented with an acute onset anterior cervical mass, fever, and dysphagia. Imaging revealed a large cystic mass in the right thyroid lobe extending into the mediastinum. Initial treatment with antibiotics led to partial improvement, but persistent swelling necessitated a deferred total thyroidectomy. Intraoperatively, the thyroid gland was fibrotic and adherent to surrounding structures. Histopathological examination confirmed Riedel's thyroiditis with extrathyroidal extension and an underlying NIFTP. Postoperatively, the patient developed left vocal cord paresis and primary hypoparathyroidism. Systemic fibrotic involvement was ruled out through a thoracoabdominal-pelvic computed tomography (CT) scan. This case highlights the diagnostic challenges, atypical presentation, and management strategies of this unique coexistence, initially masquerading as a thyroid abscess.

Acute suppurative thyroiditis (AST) is a rare endocrine emergency, typically of bacterial origin, that can lead to significant morbidity and life-threatening complications. It is far less common than other inflammatory thyroid conditions, such as subacute thyroiditis, and may mimic noninfectious inflammatory disorders. Case 1 describes a 40-year-old man with a 5-day history of anterior neck swelling and odynophagia. Physical examination and imaging confirmed AST with retropharyngeal space involvement. He was treated with broad-spectrum intravenous antibiotics and thyroid abscess aspiration. Case 2 involved a patient with an 11-day history of fever and odynophagia. Imaging, including computed tomography and neck ultrasound, revealed a left thyroid lobe abscess extending into the retropharyngeal space. Further evaluation led to the diagnosis of a fourth branchial cleft cyst and a left pyriform fossa sinus tract. A multidisciplinary approach successfully managed both the acute infection and the underlying anatomical anomaly. Retropharyngeal extension of suppurative thyroiditis is exceedingly rare but signifies a severe disease progression with complex clinical implications. This report highlights the need to consider suppurative thyroiditis in the differential diagnosis of midline cervical infections.

Anaplastic thyroid cancer (ATC), a rare thyroid malignancy, accounts for only 5% of all thyroid cancers. However, it is the most aggressive form and has a very poor prognosis. Increasing evidence suggests that ATC arises from papillary thyroid carcinoma (PTC). However, the exact mechanism underlying this transformation remains unclear. In almost all cases, ATC originates within, but rarely outside, the thyroid gland. Transformation of metastatic PTC into ATC within the cervical lymph nodes is extremely rare. In this report, we present a rare case in a 63-year-old male patient who was initially diagnosed with PTC at his first hospital visit, which underwent anaplastic transformation in lymph node metastasis, and was subsequently diagnosed during the follow-up visit.

Objective: To explore the prognostic factors of patients with sudden sensorineural hearing loss (SSNHL), analyze the possible influencing factors, and construct a nomogram for personalized evaluation of their prognosis. Methods: A retrospective study was conducted on 269 patients with SSNHL. The prognostic factors were analyzed by univariate analysis and multivariate logistic regression analysis. The nomogram was constructed based on the results of multivariate logistic regression analysis, and the model was verified by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: Among the 269 patients hospitalized, 136 cases were improved (44 cases were cured, 28 cases were markedly effective, 64 cases were effective) and 133 cases were ineffective. After univariate analysis, it was found that age, duration from onset to treatment, audiometric configuration, serum albumin (ALB), and neutrophil-to-lymphocyte ratio (NLR) were associated with hearing outcomes. Duration from onset to treatment and audiometric configuration were independent risk factors when the treatment outcome was divided into ineffective, effective, significant improvement, and complete recovery groups or divided into improvement and ineffective groups after multivariate logistic regression analysis. The factors according to univariate analysis and multivariate logistic regression analysis results were included in the nomogram to construct the prediction models. The area under the ROC curve of model discrimination was 0.752 [95% confidence interval (CI): 0.695-0.808] when the treatment outcome was divided into 2 groups. The calibration curve showed the consistency of the results, and the DCA prediction curve showed good clinical efficacy. The C-index was 0.756 (95% CI: 0.710-0.802) when the treatment outcome was divided into 4 groups. Conclusion: Age, duration from onset to treatment, audiometric configuration, ALB, and NLR are influencing factors for SSNHL. Duration from onset to treatment and audiometric configuration are independent risk factors for SSNHL. The nomogram presents the prognosis of patients with SSNHL in an intuitive, visual, and readable graph, providing clinicians with a personalized assessment.

Objectives: To assess the impact of hypoglossal nerve stimulation (HNS) on neurocognitive, psychological, and sleep outcomes in older adults with obstructive sleep apnea (OSA).

Methods: A retrospective analysis of 42 patients aged 50 years and older who underwent HNS for OSA was conducted. Patient-reported outcomes were collected using validated tools, including the Insomnia Severity Index (ISI), PROMIS measures (Sleep-Related Impairment, Cognitive Function, Depression, Anxiety, Anger, Physical Function), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-10), and NIH Toolbox Loneliness survey. Pre- and post-HNS scores were compared using paired t-tests and Wilcoxon tests.

Results: Significant improvements were observed in apnea-hypopnea index (AHI) (-17.6, P < .0001), ISI (-7.02, P < .0001), ESS (-3.4, P < .0001), and FOSQ (4.05, P < .0001). PROMIS measures showed significant posttreatment improvements in sleep impairment, cognitive function, depression, anxiety, anger, and loneliness (all P < .01). Physical function and pain did not change.

Conclusion: HNS significantly improves sleep characteristics, cognitive function, and psychosocial outcomes in older adults with OSA. Future studies should include larger and more diverse samples with longer follow-up, as well as a control condition.

Objective: This study aimed to investigate the influence of cancer type on radiotherapy-induced otitis media with effusion (RTOME) occurrence and to assess the impact of anatomical region-specific radiation exposure on both RTOME incidence rates and associated pathogenic processes.

Methods: A retrospective analysis was conducted on 1046 head and neck cancer (HNC) patients who underwent radiotherapy at Peking Union Medical College Hospital between 2016 and 2023. The incidence of RTOME was assessed across various cancer types, and the radiation exposure probabilities of different head and neck regions were compared between patients with and without RTOME using the chi-squared test (χ²) test and the Mann-Whitney U test.

Results: The overall incidence of RTOME in patients with HNC was 5.83%. The incidence varied significantly by cancer type, with nasopharyngeal carcinoma showing the highest rate (17.40%), followed by ocular and orbital cancers (6.25%), nasal cavity and paranasal sinus cancer (4.35%), oral cavity and oropharyngeal cancers (4.32%), laryngeal and hypopharyngeal cancers (0.32%), and thyroid cancers (0%). Furthermore, patients with RTOME exhibited significantly-higher radiation exposure frequencies in five specific anatomical regions: the skull base and intracranial, parotid and periauricular, nasal cavity and paranasal sinuses, nasopharynx, and parapharyngeal space, than those without RTOME.

Conclusions: The incidence of RTOME is strongly associated with both cancer type and radiation exposure to specific anatomical regions. Radiation targeting certain areas may increase the risk of developing RTOME.

Introduction: Tracheotomy is a common procedure in otorhinolaryngology, aimed at bypassing upper airway. Various surgical techniques exist, including the Bjork flap method and the window technique, each with distinct advantages. The study aimed to compare early complications between these techniques.

Materials and methods: This retrospective study analyzed 164 patients over 18 years old who underwent tracheotomy. Patients were divided based on the technique used: Bjork flap (28.7%) or window (71.3%). Data collected included demographics, comorbidities, and early complications within 7 days postsurgery.

Results: The median age was 68 years, with no significant age difference between the techniques. The Bjork technique involved ligation of the thyroid isthmus in 66.0% of cases versus 20.5% in the window technique (P < .001). Early complications occurred in 69.1% of patients: 12.8% for Bjork and 7.7% for the window technique, with no significant difference (P = .370). Types of complications varied, with cannula displacement, surgical site infection noted in Bjork cases and bleeding, subcutaneous emphysema, false pouch formation, and pneumothorax in window cases.

Conclusion: Although complication rates are similar, subcutaneous emphysema, false pouch formation and pneumothorax have been seen in the window technique. This may indicate that the flap sutured to the skin in the Bjork technique may be useful in preventing the formation of false passage.