Ear, nose, & throat journal最新文献

Background: Rhinoplasty is one of the most common aesthetic surgical procedures. Columellar strut and septal extension grafts are commonly used for tip support, but their long-term effectiveness and stability remain debated. This study aims to compare the long-term postoperative stability of these two techniques. Methods: A retrospective cohort study of patients underwent primary rhinoplasty using either columellar strut or septal extension grafts between March 2021 and March 2022 was conducted. Nasal tip projection and rotation stability were analyzed through photographic evaluations conducted preoperatively, as well as at 6 and 18 months postoperatively. Additionally, participant's satisfaction and the incidence of postoperative complications were assessed. Results: Both grafting techniques exhibited an initial increase in tip projection, followed by a slight regression at later stages. However, this change was not statistically significant for either group. A distinct difference emerged in tip rotation, as measured by the nasolabial angle. The columellar strut group experienced a notable increase in tip rotation initially, followed by a significant decrease, while the septal extension graft group exhibited minimal and statistically insignificant changes in tip rotation over the same period. Conclusion: Nasal tip rotation was more stable in cases with septal extension grafts compared to those with columellar strut grafts.

Objective: This study evaluated the effects of radiofrequency ablation (RFA) eustachian tuboplasty on the treatment of chronic otitis media with effusion (COME), and associated complications, in patients with premature extrusion of the tympanostomy tube (TT). Materials and Methods: Tuboplasty and T-tube reinsertion were performed in 23 ears with COME, a history of premature TT extrusion, and thickened mucus. Tube retention, perforation closure, hearing improvement, and complications were evaluated. Results: All 23 patients with COME and previous premature TT extrusion had remarkable mucosal hypertrophic disease or mucosal polypoid changes in the posterior cushion or posterior wall in the nasopharyngeal eustachian tube (ET) orifice. All surgeries were completed within 20 minutes after general anesthesia and were performed in the operating room. Pre-and post-air-bone gap gain was 18.3 ± 2.5 dB. The TT was retained for at least 12 months in 19 patients, whereas intentional premature removal at postoperative 8 to 9 months was required in 2 patients and premature extrusion occurred in 2 patients. Thus, the tube retention success rate was 91.3% (21/23). Of the 21 ears with intentional removal, the perforation closure rate was 81.0% (17/21). None of the patients reported RFA-related serious adverse events or a patulous ET. However, a scar synechia of the anterior-posterior wall was seen in 1 ET orifice, and stenosis of the ET orifice in 4 patients. Conclusions: RFA eustachian tuboplasty combined with TT insertion is a simple and minimally invasive technique for the treatment of intractable COME in patients with a thickened mucosa of the nasopharyngeal ET orifice. This technique may prevent premature TT extrusion.

Objectives: To identify the reading levels of existing patient education materials in pediatric otolaryngology and to utilize natural language processing artificial intelligence (AI) to reduce the reading level of patient education materials. Methods: Patient education materials for pediatric conditions were identified from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. Patient education materials about the same conditions, if available, were identified and selected from the websites of 7 children's hospitals. The readability of the patient materials was scored before and after using AI with the Flesch-Kincaid calculator. ChatGPT version 3.5 was used to convert the materials to a fifth-grade reading level. Results: On average, AAO-HNS pediatric education material was written at a 10.71 ± 0.71 grade level. After requesting the reduction of those materials to a fifth-grade reading level, ChatGPT converted the same materials to an average grade level of 7.9 ± 1.18 (P < .01). When comparing the published materials from AAO-HNS and the 7 institutions, the average grade level was 9.32 ± 1.82, and ChatGPT was able to reduce the average level to 7.68 ± 1.12 (P = .0598). Of the 7 children's hospitals, only 1 institution had an average grade level below the recommended sixth-grade level. Conclusions: Patient education materials in pediatric otolaryngology were consistently above recommended reading levels. In its current state, AI can reduce the reading levels of education materials. However, it did not possess the capability to reduce all materials to be below the recommended reading level.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition which may have a significant impact on quality of life. Endoscopic sinus surgery (ESS) is usually indicated for patients' refractory to maximal medical treatment and presents high recurrence and revision surgery rates. Objective: The aims of this study are to evaluate ESS outcome in CRSwNP management and to assess independent predictive factors for recurrence. Methods: Retrospective medical chart review of patients who underwent ESS for recalcitrant CRSwNP, from January 2002 to December 2021, with a minimum follow-up time of 12 months. Results: This study enrolled 280 patients; 52.5% of whom were males, with a mean age of 41.44 ± 14.25 years. Asthma was the most common comorbidity (36.4%, n = 102) and aspirin exacerbated respiratory disease was present in 16.8% (n = 47) of the study population. We found a recurrence rate of 20.7% (n = 58) and 8.9% (n = 25) of patients required revision surgery. Multivariate analysis identified as independent variables of recurrence (95% CI): no compliance with medication after surgery using topical steroids (OR = 16.056; CI 7.887-32.684; P < .001). Conclusions: ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of postoperative topical steroids compliance with disease recurrence.

Myeloid sarcoma (MS) is a proliferation of immature myeloid cells that occurs extramedullary, often accompanying acute myeloid leukemia (AML). It typically presents in areas such as lymph nodes, skin, and the head and neck regions. The emergence of MS within the temporal bone is rare, and it can manifest through nonspecific symptoms. In this paper, we reported a case of A 47-year-old female presented with right-sided otalgia, otorrhea, tinnitus, reduced hearing, and ear fullness, and developed facial asymmetry. She was initially diagnosed with necrotizing otitis externa and was treated accordingly. Further investigations were conducted, leading to the diagnosis of MS. She began treatment with induction chemotherapy followed by consolidation therapy. And we reviewed the literature and included 14 MS cases with the same anatomical localization, discussing the primary presentation, immunohistochemistry, and treatment approaches of these patients. In conclusion, temporal bone MS should be considered in patients with a history of AML presenting with nonspecific symptoms. Diagnostic modalities for MS include computed tomography and magnetic resonance imaging scans. Systemic chemotherapy remains the preferred treatment approach. The complexity and diversity of temporal bone MS presentations necessitate further comprehensive research to enhance understanding and improve management strategies for this rare condition.

Background: World Health Organization defines palliative care as a multidisciplinary approach to enhancing patients physical, psychological, and emotional well-being. Our study investigated palliative care unit decannulation rates and factors affecting success. Methods: The data of patients hospitalized in the palliative care clinic between 2017 and 2019 were analyzed retrospectively. Demographic data, diagnoses, comorbidities, nutritional status, Norton and Braden Scale scores, day of hospitalization, and discharge direction of the patients were recorded. All patients were evaluated and treated by a multidisciplinary team. Results: One hundred two tracheostomy patients were monitored. Patients in the palliative care clinic had an average stay of 22.19 ± 13.67 days (median: 21, min: 4, max: 66). Forty-one patients were decannulated. Statistically significant age difference was observed between decannulated and non-cannulated groups, with the decannulated group having a significantly lower mean age (52.10 ± 20.54, median: 53) compared to the non-decannulated group (61.48 ± 18.07) (z = -2.516, P = .012). The mean Braden scale score of the decannulated group (14.29 ± 2.50) was significantly higher than that of the non-decannulated group (12.20 ± 2.82) (z = 3.823, P < .001), and the mean Norton scale score of the decannulated group (11.34 ± 2.50) was significantly higher than that of the non-decannulated group (9.46 ± 2.46) (z = 3.472, P = .001). Conclusion: Patients with tracheostomy can be easily followed and decannulated in palliative care clinics. It is important that a multidisciplinary team is involved in palliative care units. Age, immobility, Norton and Braden scales, and level of consciousness are factors affecting the success of decannulation.

To determine the genetic causes of sensorineural hearing loss (SNHL) associated with inner ear anomalies, 11 unrelated Turkish individuals diagnosed with SNHL and an inner ear anomaly using temporal bone computed tomography and inner ear magnetic resonance imaging underwent exome or whole genome sequencing to identify underlying genetic defects. None of the individuals was diagnosed with a recognized syndrome. Four of the 11 probands were homozygous for SLC26A4 variants, c.283G>A, c.845G>A, c.1061T>C, and c.1198delT. Another proband was homozygous for a TECTA variant, c.4163G>A. Patients with variants of the SLC26A4 gene had bilateral enlarged vestibular aqueduct, bilateral incomplete partition type 2 anomaly, bilateral hypoplastic cochlea and bilateral enlarged vestibular aqueduct plus hypoplastic cochlea anomaly. Patients with the variant TECTA gene had bilateral hypoplastic cochlea. This study identified variants of SLC26A4 in 36% of probands with inner ear anomalies. While we identified a variant of the TECTA gene in a proband with cochlear hypoplasia, further studies are needed to see if TECTA variants can cause cochlear malformations.

Objective: The aim of this study was to evaluate the educational quality of endonasal endoscopic dacryocystorhinostomy (EE-DCR) videos on YouTube with Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY) and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) guidelines and to evaluate the correlation of the 2 guidelines. Methods: EE-DCR videos were queried using search terms on YouTube. Views, likes, likes/dislikes ratio, age, and length of videos were noted. Videos were evaluated using the IVORY and LAP-VEGaS guidelines. Two IVORY scores were created: total (IVORY-1) and organ-specific (IVORY-2). The correlation analysis between video features and guideline scores was performed. Results: A total of 61 EE-DCR videos were evaluated. The mean score of LAP-VEGaS was 10.3 (±SD 2.7), the mean IVORY-1 score was 22.5 (±SD 5.5), and the mean IVORY-2 score was 10.6 (±SD 1.94). Correlation analysis revealed a statistically significant correlation between the IVORY-1 total score and the number of likes, the duration of the video, the age of the video, and the LAP-VEGaS score. Linear regression analysis showed that higher IVORY-1 scores predicted longer video duration, newer video age, and higher LAP-VEGaS scores. There was a significant association between LAP-VEGaS categories and the IVORY-1 total score (P < .001). Conclusion: The quality of EE-DCR videos is generally low to moderate. The IVORY and LAP-VEGaS guidelines were found to be correlated with each other. Both guidelines can be used to evaluate EE-DCR videos and otolaryngology surgical education videos in general. We believe that scales such as IVORY and LAP-VEGaS may be improved according to specific surgical procedures.

Objective: Posterior edentulism reduces occlusal support, thus increasing the risk and symptoms of temporomandibular disorder. No previous study has explored its effect on the treatment of temporomandibular disorders. This study aimed to examine the relationship between neck posture, balance, and posterior edentulism in patients with temporomandibular disorder and compare the effectiveness of physical therapy. Methods: In a quasi-experimental controlled trial, 26 patients with temporomandibular disorder were divided into 13 in the partly edentulous group and 13 in the dentate group. Both groups received manual therapy, postural exercises, deep neck flexor stabilization, and Kinesio tapping for 6 weeks. Each participant completed 12 physiotherapy sessions, administered twice weekly, with a minimum interval of 48 hours between sessions. Outcomes were assessed at baseline and after the 6-week program, including pain, mandibular movement, posture, and balance. Results: The physical therapy program significantly improved all measured outcomes (P < .05). Furthermore, the partially edentulous group showed more remarkable improvement in pain and balance compared to the dentate group (P < .05). Conclusions: Postural exercises effectively alleviate symptoms in patients with temporomandibular disorder, with more significant improvements observed in the partially edentulous group than in the dentate group.