Ear, nose, & throat journal最新文献

Subglottic stenosis (SGS) may arise from both mechanical and inflammatory airway injury. Patients with mast cell activation syndrome (MCAS) are uniquely vulnerable, due to both direct effects of systemic inflammation and indirect effects of repeated intubation for anaphylaxis that can converge to cause life-threatening airway compromise. We describe a sentinel case of a 34-year-old female with MCAS and multiple prior intubations who presented with progressive dyspnea. Flexible laryngoscopy revealed grade III SGS. She underwent urgent endoscopic intervention, including balloon dilation, carbon dioxide (CO₂) laser radial incisions, and steroid injection. Airway patency was restored, and postoperative care focused on optimizing systemic mast cell control with cromolyn, fexofenadine, montelukast, and omalizumab. Literature review supports a mechanistic role for mast cell mediators in airway fibrosis and impaired wound healing, compounding the effects of mechanical trauma in MCAS. This sentinel case highlights clinically significant risk of SGS in patients with MCAS. By integrating case findings with mechanistic insights, this report underscores the urgent need for interdisciplinary awareness, proactive airway evaluation, and research into surveillance and prevention strategies in MCAS and related disorders.Level of Evidence: Level V/Case Report and Narrative Review.

Objectives: Allergic rhinitis (AR) is increasingly recognized as a systemic inflammatory condition. While symptom scores are commonly used for disease monitoring, objective biomarkers to predict treatment outcomes remain limited. This study evaluated systemic inflammatory indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune-inflammation index [SII], eosinophil count, and total immunoglobulin E [IgE]) as biomarkers in AR over 6 month follow-up.

Methods: This prospective cohort study enrolled 105 patients with moderate-to-severe persistent AR and 92 matched healthy controls. Baseline and 6 month measurements included complete blood count-derived indices and total serum IgE. Symptom severity was assessed using Total Nasal Symptom Score and visual analog scales. ROC analyses determined optimal cutoff values for predicting treatment response.

Results: At baseline, AR patients had significantly-higher NLR, PLR, SII, and eosinophil counts than controls (all P < .001). These indices declined significantly in parallel with symptom improvement. Baseline NLR >2.7 showed the strongest predictive value for nonresponse (sensitivity 84%, specificity 76%, OR 4.2). PLR >240, SII >1100, eosinophils >600/µL, and IgE >450 IU/mL were also associated with increased nonresponse risk. Total IgE remained stable and was not useful for short-term monitoring. A mixed-effects longitudinal model confirmed that reductions in NLR, PLR, and eosinophil count were significantly greater in AR patients than in controls, supporting that these biomarker changes were treatment related.

Conclusion: NLR, PLR, SII, and eosinophil count are promising biomarkers for monitoring disease activity and predicting treatment response in AR. NLR may serve as a simple, cost-effective tool for early risk stratification. These findings support integrating routine hematologic markers into clinical management of AR.

Objective: This study aims to evaluate the surgical technique, indications, and clinical outcomes of facial nerve decompression performed via the transcanal endoscopic approach (TEA) for traumatic facial paralysis caused by temporal bone fracture. Given the anatomical constraints of TEA, this study targets patients with lesions limited to the tympanic segment and/or geniculate ganglion to provide preliminary evidence of its feasibility.

Methods: A retrospective analysis was conducted on 6 patients with traumatic facial paralysis refractory to conservative treatment who were admitted between January 2021 and February 2024. All patients underwent facial nerve decompression via TEA, during which the surgical procedure steps were recorded. In addition, facial nerve function was assessed using the House-Brackmann (HB) grading system preoperatively and postoperatively, and pure-tone audiometry was used to compare audiological results.

Results: All 6 patients underwent preoperative evaluation with temporal bone high-resolution computed tomography. Of these patients, 5 had injuries located at the geniculate ganglion and 1 at the tympanic segment. Preoperatively, the facial nerve function of the patients was graded as grade V in 5 patients and grade IV in 1 patient. All patients had an electroneurography value of ≥90%. At 6 months postoperatively, facial nerve function improved to HB grade I in 4 patients and grade II in 2 patients, and the overall improvement was statistically significant (P = .024). For audiological outcomes, both the postoperative air-bone gap and air-conduction thresholds improved significantly compared with preoperative values (both P = .028), whereas bone-conduction thresholds showed no significant change (P = .197).

Conclusion: For patients with traumatic facial paralysis whose lesions are confined to the tympanic segment and/or geniculate ganglion and who fail conservative therapy, TEA may represent a feasible and minimally invasive salvage option.

Objective: To investigate the association between clinical sleep parameters and olfactory function (OF) in patients with obstructive sleep apnea (OSA) and to evaluate the therapeutic effect of 12-month continuous positive airway pressure (CPAP) on olfactory dysfunction (OD).

Methods: A total of 146 participants were included: 55 healthy controls, 68 untreated OSA patients, and 23 CPAP-treated patients. OSA severity was classified according to the apnea-hypopnea index (AHI). OF was assessed using the Sniffin' Sticks test. Clinical variables, sleep parameters, and olfactory scores were compared among groups. Subgroup analysis between CPAP-treated and untreated OSA patients used the Mann-Whitney U test. Multivariate logistic regression identified predictors of olfactory improvement.

Results: Our findings demonstrated that OD was correlated with the severity of OSA. Olfactory scores were significantly negatively correlated with AHI (r = -.544, P < .001), but positively correlated with average SpO₂% (r = .333, P = .006) and minimum SpO₂% (r = .449, P < .001). After 12 months of CPAP treatment, the mean olfactory score reached 13.87 ± 1.96, significantly higher than 9.78 ± 4.217 in the untreated group, demonstrating substantial functional recovery.

Conclusion: The results indicated a close relationship between OD and disease severity in patients with OSA and confirmed that long-term CPAP therapy can effectively improve OF. These findings provide new insights into the multisystem impact of OSA and suggest that olfactory assessment may serve as a complementary clinical tool for OSA evaluation.

Background: Intraoperative bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases operative risks. Hot saline irrigation (HSI) has been proposed as a simple, safe hemostatic adjunct compared with room temperature saline.

Objective: To evaluate the effects of HSI versus room temperature saline on surgical field visibility, blood loss, operative duration, and hemodynamic stability in ESS.

Methods: Systematic review and meta-analysis of randomized and nonrandomized controlled trials identified through PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to 30 October 2025. Outcomes were pooled using random-effects inverse-variance models in RevMan 5.4.1 by Cochrane.

Results: Seven studies (n = 453 patients) were included. HSI significantly improved Boezaart bleeding scores (mean difference [MD] -0.68, 95% confidence interval [CI] -1.01 to -0.34; P = .0002; I² = 79.7%), reduced intraoperative blood loss (MD -56.33 mL, 95% CI -57.22 to -55.44; I² = 37.1%), and shortened operative time (MD -9.78 minutes, 95% CI -14.62 to -4.94; P < .0001; I² = 85.0%). No significant difference was observed in mean arterial pressure (MD -0.68 mmHg, 95% CI -2.22 to 0.86; P = .39).

Conclusion: HSI significantly enhances surgical field visibility, reduces blood loss, and shortens operative duration during ESS without affecting hemodynamic stability. It represents a safe, low-cost alternative or complement to pharmacological hemostatic agents.

Objective: To compare the operative closure time and early postoperative outcomes between nasal septal retainer and trans-septal suturing techniques in patients undergoing septoplasty.

Methods: This single-center, prospective, open-label, randomized controlled trial included patients aged 18 to 65 years with nasal obstruction. Participants were randomized to trans-septal suturing or nasal septal retainer after septoplasty. The primary outcome was operative closure time. Secondary outcomes included symptom burden assessed by visual analog scale (VAS) at 48 hours postoperatively, Sino-Nasal Outcome Test-22 (SNOT-22) scores at baseline, 1 week, and 3 months, and postoperative complications.

Results: A total of 23 patients were randomized (11 to trans-septal suturing and 12 to nasal septal retainer). Baseline characteristics were comparable between groups. The mean closure time was significantly shorter in the septal retainer group than in the trans-septal suturing group (18.1 ± 1.5 seconds vs 763.3 ± 59.9 seconds; P < .001). The nasal septal retainer group reported significantly higher VAS scores for nasal obstruction (3.83 ± 1.34 vs 1.91 ± 1.04), facial pressure (2.33 ± 1.30 vs 0.27 ± 0.65), and dysphagia (2.14 ± 1.98 vs 0.00 ± 0.00) compared to the trans-septal suturing group (all P < .05). No significant differences were observed in SNOT-22 scores or complication rates during follow-up.

Conclusions: The nasal septal retainer significantly reduced operative closure time compared with trans-septal suturing, with comparable safety profiles and similar patient-reported outcomes at 1 week and 3 months postoperatively, suggesting that it may serve as a reasonable and efficient alternative to trans-septal suturing in septoplasty.Clinical Trial Registry identifier:ChiCTR2300073690.

Respiratory epithelial adenomatoid hamartoma (REAH) represents a category of tumor-like lesion arising from congenital developmental anomalies, characterized by aberrant differentiation or maturational arrest of multiple tissue lineages during embryogenesis. The predominant anatomical site involves the nasal cavity, specifically the nasal septum, with additional potential locations including the middle meatus and ethmoidal sinuses. Definitive diagnosis generally requires histopathological examination. These uncommon nasal neoplasms are amenable to complete excision through endoscopic surgical approaches performed under general anesthesia. A 55-year-old patient with nasal vestibular REAH presented with nasal obstruction, intermittent nasal pruritus, and diminished olfactory function. Clinical examination detected an ovoid mass in the right nasal vestibule, while radiological imaging demonstrated soft tissue density in the corresponding area. The diagnosis of REAH was confirmed through histopathological assessment after complete surgical excision. The patient fortunately experienced no procedure-related complications throughout the perioperative course and follow-up period. Postoperative surveillance through scheduled follow-up examinations is essential to prevent local recurrence.

Objectives: To compare postoperative auditory outcomes after cochlear implantation (CI) between patients with chronic otitis media (COM) and those with noninflammatory sensorineural hearing loss (SNHL) and to evaluate the impact of labyrinthitis and duration of deafness.

Methods: We retrospectively analyzed 33 postlingual COM cases and 70 age- and sex-matched SNHL controls. Pre- and postoperative audiologic tests were obtained, and preoperative computed tomography and magnetic resonance imaging were reviewed for labyrinthitis. The surgical status and stage (single- or 2-stage procedure) of cases with COM cases were documented.

Results: Postoperative aided thresholds and word recognition scores (WRS) did not differ significantly between the groups. Complete bone conduction scale-out was more frequent in the SNHL group (P = .003). Labyrinthitis, found in 3 patients with COM (9.1%), was associated with a significantly lower WRS (P = .007 vs SNHL; P = .024 vs COM without labyrinthitis). In contrast to the SNHL group, patients with COM maintained stable WRS even with long-term deafness (>20 years).

Conclusion: CI in COM yields auditory outcomes comparable to non-COM cases. In the absence of labyrinthitis, patients with COM showed preserved speech performance despite long-standing deafness, suggesting preserved cochlear/neural integrity. Preoperative imaging is valuable for detecting labyrinthitis, which predicts poorer postoperative results.