Ear, nose, & throat journal最新文献

Objective: To explore the key factors influencing hearing recovery in patients with sudden sensorineural hearing loss (SSNHL) and provide a basis for clinical prognosis evaluation and individualized treatment.

Methods: Clinical data of 164 inpatients with SSNHL at a tertiary hospital in Fujian Province from January 2022 to December 2024 were retrospectively analyzed, including basic characteristics, hearing features, examination findings, and treatment measures. Univariate analyses (Chi-square test, Kruskal-Wallis H test) and a multivariate logistic regression model were used to identify prognostic factors, and a neural network model was constructed to evaluate its predictive performance.

Results: Among the 164 patients, 27 (16.46%) showed no response, 61 (37.20%) responded, 32 (19.51%) showed marked response, and 44 (26.83%) were cured. Univariate analysis revealed that age, length of hospital stay, degree of hearing loss, type of hearing loss, brain MRI findings, triglyceride (TG) levels, low-density lipoprotein (LDL-C) levels, and the use of glucocorticoids and batroxobin were associated with treatment outcomes (all P < .05). Multivariate logistic regression indicated that TG (OR = 0.559, P = .002) and LDL-C (OR = 0.352, P = .001) were independent risk factors, while glucocorticoid use was a protective factor (OR = 8.564, P = .004). The neural network model exhibited good predictive performance (AUC = 0.889, accuracy rate 86.5%).

Conclusion: Advanced age, severe hearing loss (especially total deafness), abnormal brain MRI findings, and elevated TG and LDL-C levels may lead to poor prognosis in SSNHL, while early use of glucocorticoids can improve outcomes. The neural network model can effectively evaluate patients' potential for hearing recovery.

Objective: Evaluation of the feasibility and surgical applicability of the ENDOFIXexo robotic endoscope holder (AKTORmed) in various ear, nose, and throat (ENT) procedures.

Methods: This study was conducted as a prospective single-center feasibility study involving 26 patients who underwent endoscopic ENT surgery between September 2022 and May 2025. The ENDOFIXexo system was used as a passive robotic assistant. The study assessed surgical performance, intraoperative handling, system limitations, and safety outcomes.

Results: The device provides stable endoscopic visualization and allows truly bimanual operation in multiple procedures. It is particularly beneficial for orbital decompression, dacryocystorhinostomy, eustachian tube balloon dilation, and endoscopic ear and laryngeal surgeries. Nonetheless, its application is limited to narrow nasal cavities and highly hemorrhagic procedures. No adverse events were observed, and the setup time remained below 10 minutes.

Conclusions: The ENDOFIXexo is a safe and practical tool with the potential to enhance the quality of endoscopic ENT surgery by strongly facilitating bimanual techniques. Its utility is highly valuable in complex or assistant-limited procedures. However, further studies are necessary to strengthen these findings.

We report a case of cervical upper digestive tract reconstruction using a laryngotracheal flap following resection of hypopharyngeal carcinoma. A 53-year-old man presented with a 1-year history of dysphagia accompanied by a persistent sensation of obstruction. Gastroscopy revealed a cauliflower-like mass involving the right pyriform sinus and postcricoid region, extending to the esophageal inlet. Histopathological examination of biopsy specimens confirmed squamous cell carcinoma. Reconstruction of the surgical defect was achieved by anastomosing the hypopharynx to the cervical esophagus using the preserved larynx and the first 3 tracheal rings. This approach allowed circumferential reconstruction of the defect with the laryngeal cavity and a segment of the cervical trachea. At 46 months of follow-up, the patient was able to maintain oral intake without restriction, and no evidence of tumor recurrence was observed.

Background: Lingual thyroglossal duct cysts (LTGDCs) are rare, and there is no clinical consensus on the use of transoral endoscopic resection assisted by radiofrequency plasma ablation for their treatment.

Objective: To evaluate the feasibility, safety, and perioperative outcomes of transoral endoscopic assisted by radiofrequency plasma ablation resection for LTGDCs.

Materials and methods: We reviewed 17 patients aged 34 ± 12 years (range 12-61) who underwent transoral endoscopic resection assisted by radiofrequency plasma ablation for LTGDCs over 5 years. The procedure involved endoscopic exposure, circumferential dissection, cyst dome resection, fluid evacuation, multi-angle ablation, and cervical compression-aided ablation. Operative time, blood loss, complications, feeding recovery, and recurrence rates were analyzed.

Results: All procedures were completed endoscopically, without conversions to open surgery or tracheostomy. The mean operative time was 75.0 ± 31.2 minutes, and the average intraoperative blood loss was 28.0 ± 9.2 mL. All patients resumed liquid diets on postoperative day 3 and semiliquid diets by day 5. No severe complications occurred. Over a 2 to 40 months follow-up, the recurrence rate was 29.4% (5/17).

Conclusions and significance: Transoral endoscopic resection assisted by radiofrequency plasma ablation is a feasible and safe option for LTGDCs, with favorable cosmetic outcomes. However, the higher recurrence rate may limit its broader clinical applicability.

Objective: This study's primary objective was to determine the predictive value and clinical significance of chest X-ray in diagnosing foreign body aspiration (FBA) in children. In addition, demographic, clinical, radiological, and bronchoscopic findings were evaluated.

Methods: This retrospective study included 203 children (0-18 years of age) admitted to the hospital with suspected FBA during 2013 to 2023. Patients' data were evaluated in terms of age, gender, symptoms, radiological findings, bronchoscopic findings, length of hospital stay, period of presence of foreign bodies (FBs), and post-procedural complications.

Results: FBA was confirmed in 52.2% (n = 106) of the children, the majority (76.4%) of cases occurring in children aged 0 to 3 years. Symptoms most frequently reported presenting were cough (63.0%), wheezing (25.1%), vomiting (24.6%), choking (23.2%), fever (11.0%), stridor (9.4%), and cyanosis (6.4%). Chest radiographs revealed pathological findings in 62.1%, most commonly being prominent bronchovascular markings (50.4%), hyperinflation (15.2%), reduced transparency (15.2%), and visible radiopaque FBs (3.2%). Auscultation was abnormal in 65.0% of cases, with wheezing, diminished breath sounds, and crackles found most frequently. Although both auscultation and X-ray findings are independently associated with FB detection, auscultation demonstrates stronger predictive value. Bronchoscopy identified the right bronchial tree as the most frequent location of FBs (47.2%), with nuts being the item most commonly retrieved (51.9%).

Conclusions: This study highlights the value of chest X-ray in combination with clinical signs. While auscultation alone is more predictive, using both improves diagnostic accuracy. A structured approach with clinical exam, imaging, and timely bronchoscopy is essential for optimal outcomes.

Background: Chronic rhinosinusitis (CRS) is a prevalent condition frequently evaluated using computed tomography (CT). The application of artificial intelligence (AI) in CRS imaging analysis is expanding; however, comprehensive assessments of its diagnostic performance remain scarce.

Objective: To systematically review and compare the diagnostic accuracy of AI models for interpreting CT images of CRS, focusing on sensitivity, specificity, accuracy, and area under the curve (AUC).

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for original studies that assessed AI, machine learning, or deep learning models for CRS diagnosis using CT. Eligible studies reported diagnostic performance metrics for human subjects. The extracted data included the AI model type, validation method, imaging modality, reference standard, and diagnostic outcomes.

Results: Of the 1502 screened articles, 6 studies involving 2178 patients met the inclusion criteria. Most utilized convolutional neural networks, residual networks (ResNets), or hybrid deep learning models. The sensitivity, specificity, and accuracy ranged from 11.1% to 98.1%, 86.4% to 98.7%, and 63.6% to 98.4%, respectively. AUC values could reach 0.99.

Conclusion: AI, particularly ResNets-based models, demonstrates promising diagnostic accuracy for CRS CT interpretation. However, methodological heterogeneity limits comparability, underscoring the need for standardized, multicenter validation and integration of clinical data to enhance generalizability.

Objective: To investigate 6 month changes in hearing thresholds among neonates with hearing impairment and to explore potential factors associated with these changes.

Methods: This retrospective study was conducted from June 2016 to June 2024 at a regional hospital. It included neonates with auditory brainstem response (ABR) thresholds exceeding 25 dBnHL in diagnostic audiology tests. Exclusions were made for those with auditory neuropathy spectrum disorder, craniofacial anomalies, non-type A tympanograms, and those with only one recorded hearing evaluation at corrected ages of 1, 3, and 6 months. ABR thresholds and birth medical records were analyzed, categorizing cases into "hearing changed" and "hearing unchanged" groups based on changes in ABR thresholds.

Results: The study included 96 neonates (154 ears), during the 6 month follow-up, hearing thresholds improved in 45 ears and worsened in 2 ears. Significant associations were found between sex (P = .002), birth weight (P = .020), gestational age (P = .002), care unit (P = .006). Multivariate analysis indicated that sex was the only significant predictor of ABR threshold changes. Decision-tree analysis revealed that male neonates transferred to the neonatal intensive care unit (NICU) as well as male neonates cared for in the baby room or with an unknown care unit and a birth weight <2.6 kg, were more likely to demonstrate improvement in hearing thresholds in 6 months.

Conclusion: Hearing thresholds in neonates with hearing impairment may improve over a 6 month follow-up period. These changes were associated with male sex, younger gestational age, lower birth weight, and postnatal transfer to NICU in univariate analyses; however, multivariate analysis identified sex as the only independent predictor. Given these findings, structured and ongoing audiological follow-up is crucial to facilitate early detection and timely intervention.

SMARCA4-deficient sinonasal carcinoma is a recently proposed tumor entity that is rare and associated with a poor prognosis. No standardized treatment strategy has been established. We report a case of SMARCA4-deficient sinonasal carcinoma treated at our department. A 47-year-old woman was referred for treatment of a tumor of the left nasal cavity. The biopsy at a previous institution suggested a neuroendocrine tumor, but it was finally diagnosed as olfactory neuroblastoma. Imaging revealed no lymph node or distant metastases. Endoscopic endonasal resection of the malignant sinonasal tumor was performed with resection and reconstruction of the anterior skull base, achieving complete removal of the tumor. Postoperative intensity modulated radiation therapy (IMRT, 60 Gy) was administered. During IMRT, the histopathological examination confirmed the diagnosis of SMARCA4-deficient carcinoma. Adjuvant chemotherapy following the protocol for undifferentiated carcinoma was administered using the FP regimen (5-fluorouracil 800 mg/m² and cisplatin 80 mg/m²) for 3 cycles. At 2 years and 1 month after surgery, the patient remains alive with no evidence of disease. SMARCA4-deficient carcinoma is an aggressive and poorly differentiated tumor with a poor prognosis, and our experience suggests that a multimodal approach combining surgery, radiation therapy, and chemotherapy following the treatment strategy for undifferentiated carcinoma is effective.

Objective: Otomatch.com is a public forum where otolaryngology residency applicants share anonymous impressions from subinternship rotations and interviews. We conducted a qualitative analysis of posted comments to describe the program attributes and experiences most frequently discussed on Otomatch.

Methods: We extracted interview and subinternship comments from spreadsheets covering the 2023 to 2024 and 2024 to 2025 application cycles. Each comment was coded to a theme and sub-theme and labeled as positive, negative, or neutral.

Results: In total, 1791 comments were coded, of which 56.8% were positive, 21.6% negative, and 21.6% neutral. Most feedback related to interpersonal relationships (30.4%). Within this theme, the most frequent positive sub-themes were interactions with residents, fellows, and attending physicians (64.0%) and overall culture (16.0%). The second most frequent theme was the subinternship rotation (17.6%), followed by surgical training (15.6%). The most negative feedback concerned interactions with resident and attending physicians, followed by criticism of call schedules.

Conclusion: Individuals posting on Otomatch frequently described inclusive culture, robust surgical training, thoughtful interview experiences, and positive interactions with residents and attending physicians during subinternship rotations and the interview process. Conversely, negative posts most often described unfavorable experiences in these same domains. Our analysis may support program leadership reflection and targeted refinements to modifiable aspects of the residency applicant experience.