Ear, nose, & throat journal最新文献

Level of evidence: 5 - expert opinion.

A man in his late 60s, with a history of psoriatic arthritis, presented with a 10-year history of hoarseness and exertional dyspnea. Flexible laryngostroboscopy demonstrated bilateral true vocal cord immobility resting in paramedian positions with glottic airway space reduction at ~5 to 10 mm on respiration. A contrast-enhanced computed tomography scan of the neck was performed to assess for a lesion along the course of the recurrent laryngeal nerves (RLNs), and it confirmed the findings of vocal cord immobility, evidenced by enlarged pyriform sinus and laryngeal ventricle, medialization and thickening of the aryepiglottic folds, and anteromedial deviation of the arytenoid cartilage, but no lesions along the RLNs. In the absence of structural, neurologic, or malignant causes, the findings were suggestive of cricoarytenoid joint fixation secondary to psoriatic arthritis. While cricoarytenoid arthritis is associated with other rheumatologic conditions, its association with psoriatic arthritis is exceedingly rare, with only 1 previously documented case. Our case highlights the importance of considering psoriatic arthritis in the workup of bilateral vocal cord immobility, particularly in patients with no other identifiable cause.

Objectives: To examine the success and limitations of office removal of nasal foreign bodies (FBs) in a pediatric population.

Methods: Children presenting to an academic pediatric outpatient department were identified from a computerized collection of office notes. FB removal was performed via: (1) preprocedure discussion with shared decision-making, (2) topical anesthesia and vasoconstriction of the nose, (3) restraint in supine position with a trained second person holding the head, and (4) FB removal using an operative microscope with instrumentation. Removal was considered a failure if subsequent removal under general anesthesia was required.

Results: Among 547 consecutive children presenting with head and neck FBs during a 22 year period, exactly 100 had nasal FBs. Forty-four percent had previous attempts at FB removal in an emergency department or pediatricians' office. Ninety-six percent of FBs were successfully extracted in the office. Four percent required removal in the operating room. No complications were reported. Children with neurodevelopmental disorders were no more likely to experience failed removal ([0/4] vs [6/96], P = .61). The most common FBs were beads (19%), plastic (12%), and foam rubber (10%).Concluearsion:This protocol resulted in a high rate of successful nasal FB removal, even in children with prior failed attempts with no significant nasal injuries. This approach should be considered by otolaryngologists who care for children.

Level of evidence: 3 - retrospective review.

Objectives: To investigate and identify the most reliable method for assessing Eustachian tube function (ETF) in pediatric patients with otitis media with effusion (OME).

Methods: A total of 49 ears from pediatric patients diagnosed with OME and 32 healthy control ears were included. The assessment methods for ETF included acoustic immittance measurement (AIM), tubomanometry (TMM), Eustachian tube score (ETS), sonotubometry (STM), and tubo-tympano-aerodynamic-graphy (TTAG).

Results: AIM was used as the standard, and the consistency of TMM, ETS, STM, and TTAG was tested with sensitivities of 75.6%, 60.0%, 82.05%, and 53.85%, specificities of 94.4%, 97.2%, 66.67%, and 83.33%, and Youden indices of 0.700, 0.572, 0.487, and 0.372, respectively. ROC analysis revealed an optimal diagnostic threshold for TMM values of 4.5. Significant differences in AIM results were observed between groups stratified by this TMM-based diagnostic threshold (χ² = 36.690, P = .000). When the TMM values were <4.5, the rate of normal Eustachian tube opening was 5.55%, which increased to 75.56% for values ≥4.5.

Conclusion: TMM demonstrates superior diagnostic performance compared to ETS, STM, and TTAG. The combination of AIM and TMM is recommended for the evaluation of ETF in pediatric patients with OME.

Introduction: Motion sickness (MS) has traditionally been attributed to visual-sensory mismatch. Research on the cause-and-effect relationship between postural instability and MS has emerged, although evidence remains scarce.

Methods: A literature review from inception to December 31, 2024, was conducted to understand the relationship between MS and postural instability by searching several databases over a 1-month period in January 2025. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies investigated various forms of MS, including car sickness, virtual reality (VR), simulator sickness, cybersickness, travel-related sickness, and space MS.

Results: A total of 16 articles were identified, encompassing 1518 participants with ages ranging from 9 to 63 years. Most studies used force platforms and balance boards to assess postural instability, and 13 studies reported a relationship between postural instability and MS. These findings were consistent across VR, simulator, and transport-based motion paradigms. In contrast, 3 studies reported no consistent relationship between sway magnitude and symptom development.

Conclusions: Although postural instability precedes MS, the quality of evidence is inadequate to determine the cause-and-effect relationship between MS and postural instability until extensive, multicentre, randomised controlled studies are conducted.

Objective: To present our experience in the diagnosis and treatment of the migrating pharyngeal foreign bodies. Methods: Seven patients with migrating pharyngeal foreign bodies were retrospectively reviewed. The following data were collected: symptoms, time of onset, examination methods, buried sites of foreign bodies, methods of removal, and clinical outcomes. Results: All the 7 patients were diagnosed by computed tomography (CT) scan or ultrasound and then underwent foreign body removal through the transoral approach surgery under laryngoscope. The transoral removal of foreign bodies failed in 2 cases, in which the foreign bodies were removed via the transcervical approach subsequently. No complications were observed during the follow-up of 1 month. Conclusions: Migrating pharyngeal foreign bodies can be found and located by CT scan or ultrasound preoperatively. It is feasible and minimally invasive to remove migrating pharyngeal foreign bodies with radiofrequency coblation or CO₂ laser through transoral approach surgery under laryngoscope.

Oculomotor nerve palsy (ONP) is an extremely-uncommon complication of endoscopic endonasal surgery (EES). To date, there have been only 6 reports of immediate ONP post-EES in the PubMed/MEDLINE-indexed literature. This report illustrates the clinical presentation of complete, pupil-involving ONP that recovered fully over 6 months after surgery in a 28 year-old man who underwent medial maxillectomy through endoscopic modified Denker's approach for sinonasal inverted papilloma. An attempt has been made to evaluate the possible etiology for such a complication through a thorough literature review, and following an in-depth introspection of the surgical team. The relevant surgical anatomy and the management aspects are also discussed in detail. This report provides a caveat to the endoscopic endonasal surgeons and the residents regarding ONP as an unexpected and unusual complication of sinus and skull-base surgery. It further underlines the importance of being knowledgeable of the somatic and parasympathetic neural anatomy of the oculomotor nerve in the skull base, and of the finesse and meticulous dissection that are needed for a safe surgery around the confines of the orbit.

Objectives: Head and neck squamous cell carcinoma (HNSCC) management is complex due to its unique anatomical location and multimodal treatment strategies. Multidisciplinary teams (MDT) including surgeons, radiation and medical oncologists, speech pathologists, nutritionists, physical and occupational therapy specialists, and nursing personnel are critical for optimal care. Despite the benefits of MDTs, effective collaboration among teams can be challenging, leading to fragmented or skewed care. We developed an online curriculum with the goal of increasing knowledge, competence, and confidence of MDTs caring for HNSCC patients.

Methods: An online continuing medical education (CME) curriculum was available to all healthcare professional. Physician participants were categorized as surgeons, oncologists, radiologists, or pathologists. Participants completed pre- and posteducation questions. The effectiveness of the curriculum was evaluated based on question performance, self-reported confidence levels, and a qualitative questionnaire assessing program impact and participant satisfaction.

Results: All modules were available through an online platform (www.medscape.com) for 8 years (2015-2022). A total of 24 631 physicians participated. All physician specialties demonstrated improved knowledge, competence, and confidence levels, with the highest gains observed in understanding treatment mechanisms and the ability to create customized care plans. Physicians intended to modify their treatment plans (83%), committed to making these changes in actual practice (92%), and expect improved impact in their practice (86%).

Conclusions: The online HNSCC-focused curriculum significantly improved knowledge and confidence levels among MDT members. These findings underscore the value of CME to support well-coordinated MDTs and optimize HNSCC management.