Ear, nose, & throat journal最新文献

Objectives: Endoscopic dacryocystorhinostomy (Endo DCR) is a standard treatment for nasolacrimal duct obstruction, though outcomes may be compromised by intraoperative bleeding and postoperative inflammation. This study evaluated the clinical efficacy of Novacol Fibrillar^®, a collagen-based absorbable hemostatic agent, in Endo DCR.

Methods: A retrospective review was conducted on 357 patients who underwent Endo DCR from January 2018 to September 2024. The Novacol group (n = 168) received Novacol packing, while the Nasopore group (n = 189) received Nasopore. Primary outcomes included anatomical and functional success, operative time, and intraoperative bleeding. Secondary outcomes included granulation, infection, epistaxis, postnasal drip, and revision surgery within 3 months.

Results: The Novacol group showed higher anatomical (94.6% vs 85.2%, P = .039) and functional (93.5% vs 84.1%, P = .023) success. Intraoperative bleeding was lower (9.5 vs 12.4 gauzes, P = .022), as were rates of granulation (9.5% vs 24.3%, P = .009), epistaxis (5.4% vs 21.7%, P = .028), postnasal drip (6.5% vs 23.3%, P = .032), and revision surgery (2.4% vs 16.4%, P = .041). Infection rates were not significantly different (P = .083).

Conclusions: Novacol Fibrillar improved surgical outcomes and reduced complications in Endo DCR, supporting its use as an effective hemostatic packing material.

This case report details a rare and severe presentation of refractory otomastoiditis caused by Mycobacterium abscessus in an immunocompetent pediatric patient who presented with a 1-month history of left ear pain, swelling, and fever unresponsive to antibiotics. Computed tomography imaging was suggestive of coalescent otomastoiditis, and she underwent urgent left mastoidectomy, subperiosteal abscess drainage, and myringotomy with tube insertion, followed by conventional antibiotic management. Despite these interventions, she remained symptomatic and cultures revealed M. abscessus 1 week later. Multidisciplinary management involved serial microdebridement and prolonged multidrug antimicrobial therapy with shared decision-making between otolaryngology, infectious diseases, and international experts. Pharmacological management was complicated by adverse effects including aminoglycoside-induced hearing loss, myelosuppression, and gastrointestinal intolerance requiring drug substitutions. Eighteen months after initial presentation, revision mastoidectomy, canaloplasty, mastoid obliteration, tympanoplasty, and ossiculoplasty were performed for the eradication of residual disease and reconstruction. At follow-up, there was no disease recurrence although left-sided moderate-to-severe mixed hearing loss persisted. This case highlights the importance of early recognition and coordinated medical-surgical interventions in atypical presentations of mastoiditis.

We present the case of a 7-week-old female with a segmental, beard-distributed infantile hemangioma, and acute upper airway obstruction. The patient presented with progressive stridor and respiratory distress, prompting urgent evaluation. Bedside flexible laryngoscopy was inconclusive due to patient distress, but operative direct laryngoscopy and bronchoscopy revealed near-circumferential subglottic hemangioma, necessitating endotracheal intubation for airway protection. She was transferred to a tertiary care center for multidisciplinary evaluation and management. Given the distribution of the hemangioma and airway involvement, PHACE syndrome was strongly considered. MRI and MRA of the brain and neck demonstrated no cerebral or large vessel anomalies, though extensive hemangiomatous involvement of the facial and deep neck soft tissues was noted. Echocardiogram and ophthalmologic evaluations were unremarkable. The patient underwent direct laryngoscopy, bronchoscopy, and intralesional Kenalog injection into the supraglottic and subglottic hemangioma. Propranolol was initiated with favorable clinical and radiographic responses. This case emphasizes the importance of early airway evaluation in infants with beard-distributed hemangiomas and highlights the role of comprehensive PHACE syndrome workup. It demonstrates the utility of early propranolol therapy and steroid injection in the management of airway-compromising hemangiomas.

Objective: To identify factors influencing time-to-operating room and time-to-airway intervention in urgent tracheotomy and synthesize strategies to reduce delays in airway emergencies.

Methods: A scoping review was conducted following the Joanna Briggs Institute framework and reported according to PRISMA-ScR guidelines. MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to June 2024. Eligible studies involved adults (≥18 years) undergoing urgent tracheotomy for airway obstruction due to malignancy or infection. Trauma, angioedema, laryngotracheal stenosis, post-radiation edema, and vocal fold paralysis were excluded to reduce heterogeneity and focus on institutional/system-level factors.

Results: Of 1339 records identified, 3 studies (n = 531 patients) met the inclusion criteria. Dyspnea and stridor were the most common presenting symptoms. Malignancy and deep neck infection accounted for most indications. Reported delays were related to operating room access, staffing shortages, and coordination challenges. Complication rates ranged from 8% to 28%, with hemorrhage and infection most frequent; no deaths were directly attributed to tracheotomy. Decannulation rates were higher in non-malignant than in malignant cases.

Conclusions: Urgent tracheotomy for airway obstruction due to malignancy or infection is time-sensitive, with delays shaped by institutional barriers. Standardized protocols, improved staffing, simulation-based training, and rapid-response teams represent actionable strategies to enhance airway emergency readiness and outcomes.

Introduction: Primary tracheal tumors are rare, with an estimated incidence of 1/million individuals. Tracheal schwannomas are exceptionally uncommon, and no consensus exists regarding optimal management. Reported treatment options include open surgical resection (OSR) and endoscopic (ES) approaches.

Objective: To provide a narrative synthesis of reported cases of tracheal schwannoma, summarizing patient demographics, tumor characteristics, management strategies, outcomes, and recurrence.

Materials and methods: A narrative review was conducted through a comprehensive literature search across PubMed, Google Scholar, EMBASE, Scopus, Web of Knowledge, and Ovid. Data on baseline characteristics and outcomes were extracted from eligible studies. Findings were summarized descriptively using counts, percentages, means, and ranges. No inferential statistical analyses or meta-analytic synthesis were performed.

Results: Forty-two studies reporting 48 patients were included. Twenty-seven patients underwent ES management, and 21 underwent OSR. Patients reported in the ES group were generally older, while sex distribution appeared broadly similar across the 2 treatment approaches. ES cases often involved smaller, intraluminal tumors, whereas open resection was more frequently applied to larger or extratracheal lesions. Across both approaches, over 90% of patients experienced symptom resolution, and recurrence was rarely reported. Follow-up durations varied widely, with many studies lacking long-term data.

Conclusions: Both ES and OSR have been reported as effective treatment options for primary tracheal schwannoma. The choice of approach should be individualized based on tumor size, morphology, extension, and patient comorbidity. Given the narrative design and reliance on case reports and small series, these findings should be interpreted with caution, and further studies are needed to establish standardized management strategies.

This case report describes a male patient with chronic invasive fungal sinusitis, mainly characterised by swelling of the eye. After a definitive diagnosis was made based on clinical symptoms and imaging studies, the patient received timely antimicrobial and symptomatic treatment, followed by functional endoscopic sinus surgery and orbital abscess drainage. The foci of infection in the sinuses were completely removed and adequate drainage of the sinuses was achieved, resulting in significant relief of the patient's symptoms. The follow-up examination 1 month after discharge showed a good recovery.

Objective: The differences in the outcomes between the totally endoscopic approach and the traditional microscopic approach remain unclear for limited attic cholesteatomas. This systematic review and meta-analysis aim to compare the outcomes of the endoscopic approach and the microscopic approach for the management of cholesteatoma limited to the attic.

Data sources: Searches were performed using PubMed, Cochrane Library, Web of Science, Clinical Trials, and Google Scholar.

Review methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol 2020 guidelines. Studies were included based on predefined eligibility criteria and assessed for quality using the revised Cochrane risk-of-bias 2 tool and the Methodological Index for Non-Randomized Studies criteria. The primary outcomes for this review were audiological outcomes, healing time, operating time, middle ear structures visibility index (MESVI), postoperative complications, and long-term outcomes.

Results: Seven studies with a total of 539 patients (541 operated ears) were included. The endoscopic group had a statistically significantly higher MESVI (Z = 23.205, P < .0001). The overall effect showed less postoperative pain among patients undergoing the endoscopic technique (Z = -6.942, P = .000). No statistically significant difference between both groups was found in terms of healing time, operating time, postoperative complications and audiological outcome.

Conclusion: The endoscopic approach for the management of cholesteatoma limited to the attic region has some advantages compared to the microscopic approach, namely in terms of better middle ear structures visibility and less postoperative pain. Future research conducted with high-quality comparative prospective studies is needed to further compare both surgical approaches and confirm the advantages of the endoscopic approach.

Burkitt Lymphoma (BL) is a highly aggressive B-type non-Hodgkin lymphoma. It rarely develops at the level of the sinonasal cavities, especially in young children. We present the case of a 2-year-old boy who presented with a 2-month history of nasal obstruction, snoring, and epistaxis followed by a recent dyspnea. Examination revealed a protruding tissue mass in the left nasal cavity. Computed tomography scan showed a homogenous soft-tissue mass in the left nasal cavity extending toward the ipsilateral orbit, infratemporal fossa, nasopharynx, as well as the ethmoid and maxillary sinuses. Magnetic resonance imaging revealed a homogenous infiltrating mass with a hypo-intense signal on T2-weighted images reaching the infratemporal fossa and oropharynx. Biopsy confirmed the diagnosis of BL. The patient was referred to the clinical hematology department and received complex chemotherapy. Following chemotherapy, imaging revealed significant regression of the mass. We performed a nasopharyngeal biopsy which confirmed the absence of any persistent disease. This case report highlights a rare case of an extensive sinonasal BL emphasizing the importance of a high level of suspicion to ensure an early diagnosis and treatment.

The tracheoesophageal fistula (TEF) is an abnormal flow between the esophagus and the trachea. Most patients with TEF experience severe symptoms. Asymptomatic TEF is rare. In this case report, a 47-year-old woman planned to undergo orthopedic surgery under general anesthesia. She had no symptoms related to TEF, and the preoperative chest computed tomography was also normal. However, there was significant airway resistance after induction. Using a fiber bronchoscope, a TEF was discovered. The TEF found after anesthesia due to high airway pressure is unusual, and the outcome and treatment of these patients need to be further discussed.

Venous malformations often manifest in early childhood and do not spontaneously resolve. Most vein malformations of the lips are typically treated at a young age, with giant arteriovenous malformations being particularly rare. Herein, we introduce the case of a 47-year-old man who presented to our department complaining of a progressive mass on his lower lip. Clinical examination revealed a mass measuring 10 cm × 8 cm × 4 cm in size, characterized by a soft texture and smooth edges. Despite a series of sclerotherapy interventions, the lesion remained unresponsive. Consequently, we performed a preoperative embolization of the malformed vessel using digital angiography, followed by extensive resection of the lesion and repair of the defect using an adjacent flap. The postoperative period was uneventful, and no local recurrence was observed during a 4-year follow-up period. Therefore, we recommend preoperative angioembolization as a valuable approach for addressing large lower lip deformities to enable extensive surgical resection and robust therapeutic outcomes.