Ear, nose, & throat journal最新文献

Purpose: Facial nerve stimulation (FNS) represents a significant complication of cochlear implantation (CI), yet its risk factors and optimal management strategies remain incompletely understood.

Method: This study investigated 3750 CI recipients, identifying 265 cases (7.07%) of FNS, to evaluate its incidence and therapeutic outcomes using a novel stepped management protocol.

Results: Analysis revealed a significant association between FNS and specific underlying etiologies (χ² = 27.10, P < .001), with large cavity malformation emerging as the predominant anatomical risk factor (Adjusted Residual = +3.12). Temporal distribution analysis demonstrated that 34.7% of FNS cases occurred within 1 week of device activation, while 26.0% manifested more than 1 year postimplantation, suggesting progressive etiologies such as electrode fibrosis. A four-tiered stepped management strategy was employed based on FNS severity: Grade 2 (mild, n = 62) achieved 100% resolution through programming adjustments, including pulse width reduction and bipolar stimulation; Grade 3 (moderate, n = 97) exhibited a 46.4% complete remission rate (45/97) with adjunctive steroid therapy; Grade 4 (severe, n = 87) showed improvement following selective electrode deactivation, with 55.2% downgraded to Grade 3 and 44.8% to Grade 2; and Grade 5 (refractory, n = 19) necessitated surgical revision.

Conclusion: These findings underscore the importance of preoperative imaging in identifying high-risk patients, such as those with cochlear malformations, and demonstrate the efficacy of a stratified management approach in achieving symptom control. This study also establishes a robust, patient-centered framework for managing FNS in CI recipients, emphasizing adaptability to individual clinical profiles and optimizing therapeutic outcomes.Level of Evidence for the Manuscript:Level 3.

Introduction: Neurogenic cough is a classification of chronic cough characterized by laryngeal hypersensitivity. Despite standard treatments, complete symptom resolution remains rare. Tetracaine lollipops, commonly used for oropharyngeal anesthesia, have not been studied for acute cough suppression. This study evaluates their efficacy in providing acute symptom relief in patients with neurogenic cough.

Material and methods: A retrospective, survey-based study was conducted with 23 patients diagnosed with neurogenic cough treated over a 1 year period with 0.5% tetracaine lollipops. Patients applied the lollipop to the posterior oropharynx for 20 to 30 seconds until numbing occurred. Cough relief was categorized as significant (≥70% reduction), moderate (40%-60%), mild (10%-30%), or no relief (0%).

Results: Tetracaine lollipops reduced cough intensity by an average of 42%. Sixteen patients (69.6%) reported them effective, with 6 patients (26.1%) reporting significant relief, 6 patients (26.1%) reporting moderate relief, 9 patients (39.1%) reporting mild relief, and 2 patients (8.7%) reporting no relief. Cough suppression lasted 30 minutes to 2 hours in most cases (56.5%). A majority of the cohort (56.5%) expressed willingness to continue lollipop use, and 60.9% reported using them daily.

Conclusion: Tetracaine lollipops are an effective short-term treatment option for acute neurogenic cough, providing improvement in most patients, with an average response reflecting moderate relief. They were well-adopted and frequently utilized daily. Further research is needed to refine their role in treatment.

Objective: Theophylline has been theorized to promote neural olfactory signaling and sensory axonal regeneration. In this study, our objective was to investigate the effect of oral theophylline on the treatment of traumatic anosmia.

Methods: We enrolled patients who had complained of traumatic complete anosmia. Eligible patients were randomly assigned to 2 groups. In the theophylline group, oral theophylline (400 mg bid) was prescribed for 6 months and patients also underwent olfactory training (OT). In the OT group, patients performed OT only for 6 months. The bilateral and unilateral olfactory function was evaluated using the phenyl ethyl alcohol (PEA) odor detection threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC), before and after treatment.

Results: A total of 41 patients in the theophylline group and 41 in the OT group completed the study. Before treatment, the PEA threshold for all patients was -1. After 6 months of treatment, the unilateral right PEA threshold improved significantly in patients taking theophylline for 6 months (P = .018), but did not change significantly in patients who only performed OT (P = .317), and was significantly better in patients taking theophylline for 6 months than in those who only performed OT (P = .027). However, UPSIT-TC scores did not improve significantly in either the theophylline or OT group.

Conclusions: The combination therapy of oral theophylline with OT could have a better effect on traumatic anosmia than OT alone.

Purpose: Residual cholesteatoma poses a great challenge in middle ear surgery. Considering that microscopes only offer line-of-sight vision, it was suggested earlier that endoscopes might prove useful to control difficult-to-visualize areas during surgery to ensure total evacuation of squamous epithelium. In this retrospective chart study, we evaluated intraoperative endoscopic findings of difficult-to-access sites in the tympanic cavity and postoperative cholesteatoma recidivism rate in these areas in a patient cohort who underwent primarily microscopic surgery.

Main findings: Residual cholesteatoma mass was intraoperatively detected in difficult-to-visualize areas using an endoscope during 50% of the procedures (10 cases), mostly in the sinus tympani (6 cases), but also in the supratubal recess (3 cases). During a mean follow-up of 36.1 months (range: 20-59 months, targeted magnetic resonance imaging [MRI] mean follow-up: 31.3 [range: 12-59]), recurrent attic cholesteatoma was found in 2 patients (10%), and residual disease was detected with dedicated MRI sequences in another 2 cases (10%). None of the residual cholesteatomas developed in the endoscopically controlled areas. The mean air-bone gap closure at 1 year was 1.9 ± 10.2 dB (range: -18.3-21.7).

Conclusions: Intraoperative endoscopic surveillance helps uncovering hidden cholesteatoma mass during routine microscopic surgery and thus offers an effective control of residual disease in these areas during a medium-term follow-up.

Objective: This study compares complications between drainless parotidectomies versus parotidectomies where drains were inserted post-operatively.

Data sources: PubMed, MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Web of Science databases.

Review methods: This systematic review and meta-analysis compared outcomes of parotidectomy with and without intraoperative drain insertion. A comprehensive database search was conducted in accordance with PRISMA reporting guidelines, yielding 186 articles, of which 21 met the inclusion criteria. Studies were assessed for risk of bias using the Newcastle-Ottawa Scale for non-randomized studies and the Cochrane Risk of Bias 2.0 tool for randomized controlled trials. Post-operative complication rates - including hematoma, seroma, and sialocele formation - were extracted and analyzed.

Results: The database search yielded 284 citations, of which 98 citations were omitted due to duplication. Of the remaining 186 citations, 142 were omitted during title/abstract screening, and the remaining 43 underwent full-text screening, of which 22 were excluded, resulting in 21 studies included in the systematic review and 5 being included in quantitative analysis. Across included studies, 3138 individuals underwent parotidectomy (2263 with drains and 875 without). No significant differences were found between drain and drainless groups in hematoma (OR = 0.9, CI: 0.14 to 5.7, P = .91) or sialocele/seroma formation (OR = 0.45, CI: 0.17 to 1.18, P = .10). In single-arm studies, hematoma rates were similar (1.03% with drains vs 0.5% without), while sialocele/seroma rates were higher in drainless cases (11.5% vs 6.4%).

Conclusion: There was no significant difference in complication rates post-operatively between the drain and no drain groups, with an increased length of hospital stay in the drain group, and a trend toward higher seroma rates in the drainless group. Nevertheless, it is feasible to perform outpatient parotidectomy with drains.

Objective: To investigate changes in the serum allergen-specific IgE (sIgE) profile in allergic rhinitis (AR) before and after widespread mask usage, home isolation, and reduced outdoor activities.

Methods: This retrospective study enrolled 3715 patients with AR in Wuhan (September 2020-October 2024), with a cutoff date of January 8, 2023, when the coronavirus disease-19 control policy transitioned from "category B with class A management" to "category B with class B management." Changes in the allergen profile before and after the implementation of mask wearing, home isolation, and reduced outdoor activities were compared in analyses stratified by age, sex, and season.

Results: Post-policy adjustment, most allergen sIgE positivity rates declined, and significantly for inhalant allergens (Dermatophagoides farinae, 12.9% vs 9.9%, P = .005; mulberry tree, 12.1% vs 9.5%, P = .012; and cockroach, 9.4% vs 6.3%, P < .001) and food allergens (56.3% vs 39.9%, P < .001), especially for milk, egg white, and crab. Trends remained consistent after adjusting for age and sex through propensity score matching. Individuals aged 18 to 59 showed marked declines, except for D. farinae, cat/dog dander, and short ragweed. In males, most allergens decreased, except cat/dog dander, short ragweed, mixed trees, and mango (P < .05). In the autumn subgroup, allergen positivity rates decreased for most allergens, excluding short ragweed, Dermatophagoides pteronyssinus, cat dander, dog dander, and beef (P < .05).

Conclusion: Policy relaxation was associated with reduced positivity rates for most inhalant and food allergens, particularly among adults, males, and during the autumn. Changes in environmental exposure significantly influenced allergen profiles.

Background: Adenotonsillectomy is a common pediatric procedure, but pharyngeal stenosis remains one of its most severe complications. This condition, characterized by cicatricial narrowing of the airway, leads to significant morbidity. Given its rarity and the absence of a standard management protocol, a comprehensive synthesis of the evidence is crucial.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, Web of Science, and Scopus from inception through December 2025 identified studies reporting pharyngeal stenosis following adenotonsillectomy, tonsillectomy, or adenoidectomy. Data on epidemiology, etiology, clinical features, management, and outcomes were extracted and analyzed.

Results: The review analyzed 39 studies encompassing 166 cases. The mean age was 14.87 years, with a near-equal sex distribution. The nasopharyngeal was the most common site of stenosis (122 cases). The most frequent symptoms were nasal obstruction and snoring. Thermal techniques, particularly electrocautery, were the most commonly associated surgical method. Over 40 distinct surgical techniques were identified for management. While significant symptomatic improvement was achieved in 85.2% of cases, the overall recurrence rate was high at 25.4%. Analysis of recurrent cases revealed no single superior technique, underscoring the condition's refractory nature. The adjunctive use of anti-fibrotic agents like mitomycin C and steroids was a common feature in modern management strategies.

Conclusion: Pharyngeal stenosis, though rare, is a devastating complication strongly associated with thermal surgical techniques and characterized by a high recurrence rate. Prevention through meticulous surgical technique is paramount. Successful management requires a personalized, multimodal approach combining surgical release, resurfacing with vascularized flaps, anti-fibrotic agents, and, in select cases, prolonged stenting. Long-term follow-up is essential to monitor for recurrence and manage sequelae effectively.

Objectives: The inconspicuous location and nonspecific symptoms of pharyngeal foreign bodies (FBs) can lead to diagnostic challenges and suboptimal outcomes. This retrospective cohort study aimed to investigate the endoscopic characteristics of pharyngeal FBs to provide guidance for clinical diagnosis and management.

Methods: Patients with a chief complaint of FB sensation in the pharynx who underwent flexible fiberoptic endoscopy were included. The χ² test was used to compare FB incidence between anatomical regions; association analysis was used to identify factors associated with an FB sensation.

Results: Of the 460 patients included in the study, FB were confirmed in 190 patients (41%). The root of the tongue (46.84%) and lower poles of the tonsils (18.95%) were the most frequent hypopharyngeal and oropharyngeal sites, respectively. Juvenile patients exhibited a higher incidence of oropharyngeal FB. Additionally, 29 patients (10.7% of patients with an FB sensation) had pharyngeal injury without FB; injuries occurred significantly more frequently in the hypopharynx (21/29, 72.41%) than in the oropharynx (8/29, 27.59%).

Conclusions: Pharyngeal FBs occur more frequently in younger patients and at the root of the tongue. Hypopharyngeal injury is a likely cause of FB sensation in patients with no FB detected on endoscopy.

Background: To optimize the oto-endoscopic treatment of patients with adhesive otitis media (AdOM).

Methods: In this observational retrospective cohort study, a total of 73 patients (81 ears) diagnosed with AdOM were included. Surgical interventions included insertion of the tympanotomy tube, tympanoplasty, or a combination of both. Follow-up evaluations were carried out at 2 weeks and at 1, 3, 6, and 12 months. Pure tone audiometry was administered between 1 and 3 months post-surgery, and imaging examinations were carried out at 6 months.

Results: Tympanotomy tube insertion was performed in 11.1% (9 out of 81) of the cases, while tympanoplasty was performed in 79% (64 out of 81) of the cases, and both procedures were performed in 9.9% (8 out of 81). The rate of tympanoplasty increased with the Sade grade. Postoperatively, air conduction hearing and air-bone gap (ABG) in patients classified as Sade grades III to V showed a significant improvement.

Conclusions: The individualized oto-endoscopic surgery significantly improves hearing outcomes in advanced AdOM (Sade grades III-V), as evidenced by reduced ABG. Patients with varying degrees of AdOM require customized treatment approaches.

Level of evidence: 4.