Ear, nose, & throat journal最新文献

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.

Background: Rhinoplasty is a widely performed cosmetic and functional procedure. Despite its popularity, postoperative dissatisfaction remains a common concern. This study aims to assess patient satisfaction and quality of life using the rhinoplasty outcome evaluation (ROE) survey, to help improve preoperative planning and postoperative care.

Patients and methods: A systematic literature review was conducted in PubMed, Cochrane, Google Scholar, EBSCO, and Web of Science using the terms "Rhinoplasty OR Septorhinoplasty," "Satisfaction OR Prognosis OR Outcome," "Quality of Life OR QoL," and "ROE OR Rhinoplasty Outcome Evaluation." All studies published between 2018 and 2024 were selected, and nonrelevant studies were excluded after full text review.

Results: Twenty-four studies were included in a meta-analysis comparing ROE scores pre- and postoperative. The results demonstrated a significant improvement in satisfaction and quality of life postoperatively. The subgroup analysis revealed a notable variation in the outcome according to the country of origin. Although the study heterogeneity was high (I² = 99.8%), a random-effects model was used for the analysis.

Conclusions: Gender was not a major determinant of satisfaction. However, the country of origin significantly influenced ROE scores. These findings emphasize the need for culturally sensitive counseling, individualized surgical planning, and management of patient expectations to enhance satisfaction.

Myeloid sarcoma (MS) is a rare extramedullary myeloid malignancy that may occur with or without bone marrow involvement. Nasopharyngeal cases are exceedingly rare, making diagnosis challenging, and most reported cases present with local symptoms caused by a bulky mass. We report a 64-year-old man with a history of myelodysplastic syndrome who presented with cervical lymphadenopathy without any nasal or otologic symptoms. Endoscopic examination revealed a small, smooth bulging lesion on the left nasopharyngeal wall. Contrast-enhanced computed tomography demonstrated a polypoid mass with bilateral cervical lymphadenopathy. Histopathological and immunohistochemical analyses confirmed MS. Bone marrow evaluation revealed leukemic transformation to acute myeloid leukemia. The patient received combination chemotherapy with venetoclax and azacitidine but died 2 months after treatment initiation. This asymptomatic presentation emphasizes the diagnostic difficulty of MS arising in atypical anatomical locations. Early tissue biopsy and prompt hematologic assessment are essential for accurate diagnosis and timely management. Nasopharyngeal MS should be considered in the differential diagnosis of nasopharyngeal masses, particularly in patients with a history of myelodysplastic or myeloproliferative disorders.

Level of evidence: 5 - expert opinion.

Background: Among the various materials used for harvesting in tympanoplasty, the temporal fascia is a commonly-used material due to its accessibility and size. Surgeons can choose to use either the superficial or deep temporal fascia, or both. This study aimed to investigate the influence of the method used to harvest the temporal fascia on postoperative pain experienced by patients.

Methods: The medical records of 89 patients who underwent canal wall up mastoidectomy with tympanoplasty and ossiculoplasty, performed by a single surgeon between 2021 and 2024, were retrospectively reviewed. In group A, the superficial temporal fascia is harvested. In group B, both the superficial and deep temporal fasciae are harvested together, resulting exposed temporal muscle. In group C, only the deep temporal fascia is harvested and the exposed temporal muscle is sealed by suturing the superficial temporal fascia. Postoperative pain was measured using the visual analog scale (VAS) in 3 groups on postoperative days 1, 3, and 14.

Results: The baseline characteristics are not significantly different in the 3 groups. VAS scores on postoperative days 1 and 3 showed a significant difference in 3 groups. Group B, which was supposed to have undergone most resection, exhibited the highest VAS scores, followed by group C and group A. The VAS scores on postoperative day 14 showed no difference among the 3 groups.

Conclusion: Resection of the superficial temporal fascia is thought to be important for postoperative pain due to its rich innervation. Postoperative pain and the properties of the superficial and deep temporal fasciae can be taken into account when otologic surgeons select a harvesting method.