Ear, nose, & throat journal最新文献

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.

Objective: Carotid body tumors (CBTs) are rare neurogenic tumors that may indirectly affect cardiac autonomic regulation. This study aims to investigate the relationship between tumor size and electrocardiographic (ECG) findings, particularly the corrected QT (QTc) interval.

Methods: This retrospective study included 21 patients with histologically or radiologically confirmed CBTs treated at a tertiary center between 2021 and 2025. Patients with comorbidities or medications affecting cardiac conduction were excluded. Tumor sizes were measured via contrast-enhanced computed tomography or magnetic resonance imaging. Preoperative ECGs were analyzed for heart rate, P wave, PR, QRS, T wave, and QTc intervals. The correlation between tumor size and ECG parameters was assessed using Spearman's rank correlation.

Results: A statistically significant and strong positive correlation was observed between tumor size and QTc interval (r = 0.940, P < .001). No other ECG parameter showed a significant association with tumor size. Tumor size explained 88.36% of the variance in QTc duration (r ² = 0.8836).

Conclusion: This study demonstrates a strong correlation between CBT size and QTc prolongation, suggesting vagal overactivity as a possible mechanism. QTc may serve as a noninvasive marker of subclinical autonomic dysregulation in CBT patients. Larger prospective studies are warranted to validate this association and explore its clinical significance.

Orbital floor implants are commonly used to repair fractures, but complications such as infection, diplopia, or implant misplacement may develop. We describe a 68 year-old male presenting with chronic orbital pain and purulent discharge many years after undergoing repair of an orbital floor fracture with a titanium and porous polyethylene implant. Imaging and surgical findings demonstrated a malpositioned orbital floor implant in the maxillary sinus with resultant chronic infection and complete bony encapsulation of the implant - a previously-unreported phenomenon. The implant was retrieved using a combined transconjunctival, endoscopic, and Caldwell-Luc trans-antral approach. We propose that chronic low-grade inflammation and mechanical stress induced by the implant misplacement are likely causes of the observed unusual osteogenesis. Other factors including titanium surface characteristics, immune signaling, and systemic determinants have been associated with pathologic osteogenesis and can provide a broader context for this unusual finding. This case emphasizes the potential for undesirable osteogenesis in the orbit and the importance of keeping such rare complications in the differential. It also emphasizes the need for multi-approach surgical technique and multidisciplinary planning in treating complex implant-related infections and revisions.

Purpose: This study aimed to explore the predictive factors of early-tracheostomy decannulation in patients with laryngeal cancer undergoing partial laryngectomy and to develop a nomogram for predicting the probability of early decannulation (within 1 month).

Materials and methods: This study conducted a retrospective analysis of patients with laryngeal cancer who underwent laryngeal function preservation surgery at the First Affiliated Hospital of Wenzhou Medical University from January 2012 to December 2021. Univariate analysis and multivariate logistic regression analysis were used to identify independent predictors factors, and the nomogram is constructed based on the results of multivariate logistic regression analysis. Receiver operating characteristic (ROC) curves, calibration curves, and decision curves were employed to validate the clinical utility of the model.

Results: A total of 141 patients were analyzed. Among them, 82 patients successfully achieved early decannulation, while 59 patients failed to undergo early decannulation, the multivariate logistic regression analysis showed age (odds ratio [OR] 0.954, 95% CI 0.912-0.999), history of smoking (OR 0.975, 95% CI 0.951-0.998), surgical modality (OR 0.590, 95% CI 0.404-0.861), drainage tube (OR 0.216, 95% CI 0.08-0.580) is the independent risk factor for early-tracheostomy decannulation. The area under the curve of the ROC curve is 0.756 (95% CI 0.673-0.840) indicating good discriminative capacity. The calibration curve and the Hosmer-Lemeshow test (P = .138) demonstrate good model fitted and high calibration. The incidence of early decannulation was 58.2%, and at the threshold of 58.2%, the decision curve was above the none and all lines, so the model has clinical utility.

Conclusion: A nomogram model based on age, history of smoking, surgical modality, and drainage tube was successfully developed to predict the probability of early-tracheostomy decannulation.