Ear, nose, & throat journal最新文献

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.

Chronic rhinosinusitis with nasal polyps (CRSwNP), particularly the type 2 endotype driven by IL-4/IL-13, remains challenging in a subset of patients refractory to surgery, allergen immunotherapy (AIT), and existing biologics. This case report describes a 29-year-old male with severe, multirefractory CRSwNP who achieved rapid and sustained remission with stapokibart (CM310), a novel anti-IL-4Rα monoclonal antibody, after failing 2 endoscopic sinus surgeries, omalizumab, and AIT. Following a regimen of 300 mg every 2 weeks, the patient exhibited significant olfactory improvement within 1 week and near-complete anosmia resolution by week 4. At 32 weeks, marked reductions in polyp burden, symptom scores (22-item Sinonasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS), nasal congestion score (NCS), total symptom score (TSS)), and serum total IgE were documented. This case highlights stapokibart as a potent therapeutic option capable of inducing significant clinical response where conventional interventions have failed, supporting further investigation into IL-4Rα blockade for treatment-refractory CRSwNP.

Objective: This study aimed to identify the risk factors associated with olfactory dysfunction (OD) in patients with chronic rhinosinusitis without nasal polyps (CRSsNP), a prevalent condition where impaired smell significantly reduces quality of life. The goal was to provide insights for improving clinical management strategies.

Methods: A prospective study was conducted on patients undergoing endoscopic surgery. CRSsNP patients were categorized into an OD group (n = 36) and a normosmic group (n = 36) based on olfactory tests, with 21 septoplasty patients as healthy controls. Demographic and clinical data were analyzed. Logistic regression and receiver operating characteristic (ROC) curves were used to identify independent risk factors and assess their predictive value.

Results: A total of 93 subjects were included. Comparative analysis revealed no significant differences in age, body mass index, sex, disease duration, smoking history, drinking history, diabetes, or hypertension among the 3 groups. However, the OD group exhibited significantly lower nasal cavity volume and counts of mucosal olfactory marker protein-positive cells (STOMP). Conversely, they had significantly higher sinusitis severity scores (Lund-Mackay CT), nasal endoscopic scores (Lund-Kennedy), interleukin-5 (IL-5) levels, total serum immunoglobulin E (IgE), olfactory detection/recognition thresholds, and olfactory visual analog scale scores. Multivariate analysis confirmed that nasal cavity volume, Lund-Mackay score, Lund-Kennedy score, IL-5, IgE, and STOMP were independent influencing factors for OD. Correlation analysis further supported these findings. The ROC curve analysis validated that all these parameters had significant predictive value for identifying OD, with area under the curve values all >0.6.

Conclusion: Nasal cavity volume, Lund-Mackay CT score, Lund-Kennedy endoscopy score, IL-5, IgE, and STOMP are significantly and independently associated with OD in CRSsNP patients. These parameters demonstrate efficacy in screening for olfactory abnormalities, enabling early identification and providing a valuable reference for optimizing clinical therapeutic strategies to improve patient outcomes.

Airway involvement in epidermolysis bullosa (EB) is rare and most commonly associated with junctional EB. Laryngotracheal disease in epidermolysis bullosa simplex (EBS), particularly PLEC (Plectin gene)-related variants, is uncommon but may cause significant morbidity. We report a 7-year-old girl with autosomal recessive PLEC-related EBS who developed progressive supraglottic and glottic stenosis. She presented at 8 months old with severe respiratory distress requiring emergent tracheostomy. Serial endoscopies revealed persistent supraglottic granulation, an anterior glottic web, posterior glottic stenosis, and occasional bullae near the carina, with a patent subglottis and distal trachea. She underwent multiple direct laryngobronchoscopies for cold web release, dilation, mitomycin-C application, Kenacort injection, and excision of suprastomal granulation. Despite clinical stabilization, she remains tracheostomy-dependent with ongoing evaluation for potential decannulation. This case highlights the potential for significant airway disease in PLEC-related EBS, and underscores the importance of early recognition, gentle airway handling, and multidisciplinary management.

Objective: To investigate a minimally invasive treatment method for piriform sinus fistula during infection.

Methods: A retrospective analysis was performed on children diagnosed with pyriform sinus fistula infection at the Women's and Children's Hospital of Qingdao University from January 2022 to December 2024. All patients underwent ultrasound-guided puncture combined with endoscopic low-temperature plasma closure of the internal fistula. Successful treatment was defined as complete fistula closure following a single hospitalization and surgical procedure.

Results: A total of 14 children (7 males and 7 females) were included, of whom 12 had left-sided lesions and 2 had right-sided lesions. In all 14 cases, the internal fistula scar in the piriform sinus healed well, exhibiting only slight mucosal edema. MRI findings showed significant reductions in cystic cavity size and relief of airway compression. Fiberoptic laryngoscopy confirmed closure of the internal fistula without evident tissue swelling. Postoperative dysphagia occurred in 4 patients but resolved gradually within 1 week. No complications related to recurrent or superior laryngeal nerve injuries, such as hoarseness or cough, were observed. During a follow-up period of 6 to 24 months, 1 patient experienced relapse, while the remaining patients exhibited no swelling or symptoms of respiratory compression.

Conclusion: Ultrasound-guided puncture combined with endoscopic low-temperature plasma closure is an effective, minimally invasive, and safe approach for the treatment of infected piriform sinus fistula. This method can serve as a minimally invasive therapeutic option during active infection.

Objective: To ascertain brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) and their usefulness as an additional indicator of idiopathic sudden sensorineural hearing loss (ISSNHL) etiology and prognosis.

Methods: We retrospectively analyzed 89 adult patients with unilateral ISSNHL and 89 age-matched controls. Patients were classified into good- or poor-prognosis groups based on hearing recovery. All participants accepted the examinations of baPWV, ABI, and pure-tone audiometry testing. Other clinical variables were also collected. Multiple linear regression analysis was used to assess the associations between arterial stiffness factors and pure-tone average; univariate logistic regression was used to evaluate predictors of prognosis.

Results: ISSNHL patients showed significantly higher baPWV than controls (P < .001). Elevated baPWV was associated with increased air-conduction (β = .244, P = .040) and bone-conduction threshold (β = .286, P = .014), and was also associated with poor prognosis (P = .015).

Conclusions: BaPWV was related to the incidence of ISSNHL and may serve as a useful indicator of disease severity. Its potential relevance to hearing outcomes requires further validation in larger prospective studies.

Objective: This study aimed to investigate the clinical features and risk factors of otomycosis.

Methods: A case-control study included 160 patients with otomycosis as the case group and 320 healthy individuals as the control group. Clinical data were collected through a standardized questionnaire, including habitual ear picking, ear cleaning at salons, swimming habits, use of earphones/hearing aids, external auditory canal stenosis, and presence of diabetes. Binary logistic regression analysis was used to determine the risk factors.

Results: The most common symptom was ear fullness/blockage (28.3%). Otoscopic examination before debridement most frequently revealed external auditory canal secretions (45.2%). Aspergillus species were the predominant pathogens, accounting for 80.0% of cases. Binary multivariable logistic regression analysis identified the following as significant risk factors for otomycosis: habitual ear picking (OR = 2.748, 95% CI: 1.669-4.525, P < .001), ear cleaning at salons (OR = 7.434, 95% CI: 3.023-18.281, P < .001), and external auditory canal stenosis (OR = 3.737, 95% CI: 2.384-5.857, P < .001). Swimming habits, frequent use of earphones/hearing aids, and diabetes were not significantly associated with otomycosis.

Conclusion: Frequent ear picking, ear cleaning at salons, and external auditory canal stenosis are major risk factors for otomycosis.