\nMax Lee, \nAndrew Wood, \nOmid Ahmadi, \nBert van der Werf, \nKumanan Selvarajah\n
Publicatie 28-12-2024
\nSeyed Javad Hosseini, \nSeyed Reza Hosseini, \nAmirreza Jamshidbeigi, \nGholam Reza Mahmoodi‐Shan, \nFatemeh Hajiabadi, \nMasoud Abdollahi, \nMahbobeh Firooz\n
Publicatie 27-12-2024
ABSTRACTBackgroundThis study investigates the effect of locally applied honey on pain intensity, analgesia consumption, pain relief and nighttime awakenings in children following tonsillectomy, addressing conflicting evidence and the lack of differentiation between adult and paediatric populations in previous reviews.MethodsA systematic search was conducted across multiple databases, including Cochrane Library, ClinicalTrials.gov, MEDLINE, Web of Science and Google Scholar. Randomised controlled trials (RCTs) comparing pain outcomes in children receiving honey in addition to standard treatments versus those receiving standard treatments alone were included. Pain intensity was measured with the VAS tool. Meta-analysis was performed using STATA version 14 software. Also, risk of bias and certainty of evidence were evaluated.ResultsOut of 537 articles, seven studies (n = 710) with RCT design met the inclusion criteria. The average duration for measuring pain intensity was 7.37 days. Pooled effect size showed a statistically significant reduction in pain intensity in the honey intervention group compared to the control group (WMD: −0.90, 95% CI −1.32, −0.48, p < 0.001, I2: 92.5%; certainty of evidence: low). Also, the results demonstrated that honey significantly decreased the average time required for pain relief and analgesic consumption in the intervention group compared to the control group. One study was deemed low risk of bias, four studies were of intermediate quality and two studies were evaluated as high.ConclusionWhile honey shows promise in reducing post-tonsillectomy pain, cautious use is advised due to the limited quality of evidence. More robust RCTs are needed to address biases and reinforce confidence in the findings.
Pubmed PDF Web\nMark E. Lutman, \nJohn de Carpentier, \nKevin Green\n
Publicatie 27-12-2024
ABSTRACTObjectivesA recent paper by Moore, Lowe and Cox has proposed guidelines for diagnosing noise-induced hearing loss (NIHL). It is referred to here as the MLC guidelines. Our aim was to assess the specificity of those guidelines (i.e., freedom from false-positive outcomes) and compare with pre-existing guidelines.DesignWe applied the MLC guidelines and pre-existing guidelines to three data sets composed of adults who do not have a history of material noise exposure and therefore cannot have NIHL.SettingNational Health Service (NHS) ENT clinic.ParticipantsFive hundred thirty-six patients with hearing difficulty and/or tinnitus who denied material noise exposure. Two large archival population studies of hearing were also assessed, which included 3250 participants without material noise exposure.Main Outcome MeasureFalse-positive outcome from guidelines.ResultsThe MLC guidelines demonstrated moderate or high false-positive rates overall, the magnitude depending on the noise exposure scenario and whether clinical or population samples were considered. For the procedure applicable to steady broadband noise exposure, the false-positive rate averaged 56% in the population samples, compared to 31% for previous guidelines. For exposure to intense impulse sounds, the MLC guidelines take a different approach and the false-positive rate was about 70% in the population samples and even higher in the clinic sample. For exposure to intense tones, the MLC guidelines take yet another approach and the false-positive rate reached 80%.ConclusionsThe MLC guidelines demonstrate poorer specificity than previous guidelines. Medical experts should be aware of their poor specificity and consequential likelihood of false-positive diagnoses of NIHL.
Pubmed PDF Web\nKeshav Kumar Gupta, \nJustin Yeo, \nCecily Young, \nMegan Nash, \nMatthew Weller\n
Publicatie 26-12-2024
\nShayan Shahidi, \nMusharrat Tasnuva Zaman Mim, \nLima Gharbawi, \nHarish Viswanathan, \nStephen M. Hayes, \nTim C. Biggs\n
Publicatie 26-12-2024
\nThomas Hampton, \nAndrew Lau\n
Publicatie 25-12-2024
\nTanika Curry, \nAndrea Lasso, \nShaun Kilty\n
Publicatie 24-12-2024
ABSTRACTObjectiveTo assess the effectiveness of auditory and visual distraction interventions on patient discomfort, pain and anxiety during office-based otolaryngologic upper airway procedures.Data SourcesLiterature searches were done through Cochrane Central Register of Controlled Trials, Lilacs, MEDLINE, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature.Review MethodsThe protocol was registered in PROSPERO on August 17th 2022, under Registration number CRD42020204354.ResultsWe identified 138 records; two randomised controlled trials using virtual reality as a distraction technique in adults and one in children were included. All studies had some concerns regarding risk of bias. In adults, anxiety was lower in the virtual reality group than in the standard of care, (mean difference −16.72, 95% CI −27.19 to −6.24, p = 0.002, I2 = 0%). There was no difference in procedure related pain between groups, (mean difference −0.28, 95% CI −1.24 to 0.68, p = 0.57, I2 = 10%). There was no difference in satisfaction between groups (standardised mean difference 0.18, 95% CI −0.22 to 0.58, p = 0.37, I2 = 0%). Only one Paediatric study was included hence no meta-analysis was done. Anxiety and pain were lower and satisfaction was higher in the group using virtual reality.ConclusionsThe use of virtual reality distraction in addition to standard analgesia during office-based otolaryngology upper airway procedures reduced anxiety in adults. It did not decrease pain or increase the level of patient satisfaction. In the paediatric population, there is a reported benefit for procedural anxiety, pain and satisfaction.
Pubmed PDF Web\nS. A. R. Nouraei\n
Publicatie 23-12-2024
\nSelim Kul, \nSema Zer Toros, \nÇağrı Becerik, \nLütfü Şeneldir, \nSebahat Aksaray\n
Publicatie 12-12-2024
ABSTRACTObjectivesThis study aims to examine the effects of autologous platelet-rich plasma (PRP), which increases new connective tissue synthesis and revascularisation, on healing in parotid surgery wounds, prevention of salivary fistula formation, drain removal time and hospitalisation in the postoperative period.Materials and MethodsFifty-four patients who had an operation on partial parotidectomy were randomised, and then two groups were created. PRP was obtained by centrifuging the blood taken from the patients in the study group at the end of the surgery. This obtained PRP was injected into the surgical site, and then the wound flap was closed by suturing. Patients were evaluated for parameters such as the development of salivary fistula, duration of drain removal, discharge time and all other complications during the postoperative 4 weeks.ResultsDrain removal and discharge times of the PRP group cases were statistically shorter than those in the control group. The rate of development of a salivary fistula was remarkably high in the control group, but it was not statistically significant. A statistically significant correlation was found between the location of the compared tumour, the volume of material removed and the incidence of all complications.ConclusionsPRP reduced the duration of drain removal and discharge times for those who had an operation on partial parotidectomy. Thus, the decreased discharge time provides both reduced health costs and reduced risk of developing nosocomial infections. Although it was not statistically significant, a significant difference was observed in the rates of salivary fistula development.
Pubmed PDF Web\nAnnabel Hill, \nTimothy Davies, \nKate Howson, \nJeffrey Lancaster, \nKatharine Davies\n
Publicatie 12-12-2024
"\nAmarkumar Rajgor, \nRhona Hurley, \nCatriona M. Douglas, \nClaire Paterson, \nJames Moor, \nShane Lester, \nSara Sionis, \nKatharine Davies, \nJames OHara, \nGareth Inman, \nTerry Jones, \nDavid Winston Hamilton, \nNorthern Head & Neck Alliance, \nSarah Hill, \nSeamus O’Neill, \nAlison McLoughlin, \nJemy Jose, \nWinson Wong, \nMichael Ho, \nDebbie Horne, \nJarrod Homer, \nMatthew Kennedy, \nEmma Kinloch, \nRobert Metcalf, \nIain Varley, \nThomas Carroll, \nSarah Healy, \nHelen Cocks, \nMichael Nugent, \nLeo Vassilou, \nPanos Kyzas, \nJohn Greenman, \nAndrew Schache, \nJason Fleming, \nJoanne Patterson, \nKeith Hunter, \nPaula Parvulescu, \nRachel Brooker, \nRichard Shaw, \nStephanie Meysner, \nOla Rominiyi, \nOlena Mandrik\n"
Publicatie 11-12-2024
ABSTRACTIntroductionHistorically, 15% of laryngeal cancer patients undergo non-curative management, but pragmatic data on this group are limited. This information is crucial to help patients make informed decisions about their care. Supported by the Northern Head & Neck Alliance, this retrospective study is the first to present survival outcomes for non-curative laryngeal cancer patients in Northern UK.MethodsRetrospective data were compiled for patients with laryngeal squamous cell cancer from five large tertiary head and neck centres in Northern UK (Newcastle, Glasgow, Sheffield, Leeds, and Middlesbrough). The collected data encompassed demographic details, treatment and clinical outcomes.ResultsAmong 373 patients, the mean age was 72, and 73% were male. The median follow-up was 6 months. 17% had early-stage (T1-2), and 83% had late-stage (T3-4) disease. By data collection, 99% had died.The mean survival time (MST) was 9.1 months. Patients with metastases had an MST of 6.9 months, while those without had 9.4 months. Early-stage patients had an MST of 13.3 months, compared to 8.2 months for advanced disease. By subsite, MSTs were 8.2 months for supraglottic, 12.5 for glottic, 5.5 for subglottic, and 7.9 for transglottic cancers.ConclusionThis study stands as the first to explore survival outcomes in laryngeal cancer patients undergoing non-curative management. The findings can provide valuable insights for informing patients about survival in the absence of radical treatment, facilitating important decision-making conversations.
Pubmed PDF Web\nManon Louvrier, \nNoémie Nemry, \nJennifer Aoun, \nMejdeddine Al Barajraji, \nJerome R. Lechien\n
Publicatie 05-12-2024
Publicatie 05-12-2024
\nTimothy Davies, \nXicheng Peng, \nJoseph Salem, \nZeynep C. Elcioglu, \nAnna Kremneva, \nMei‐yin Gruber, \nKristijonas Milinis, \nMichael W. Mather, \nJason Powell, \nSunil Sharma\n
Publicatie 05-12-2024
ABSTRACTObjectivesAcute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance.Design and SettingA comprehensive literature search was undertaken using Medline (1946–October 2023) and Embase (1974–October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic.Main Outcome MeasuresThe effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. Secondary outcomes: assessment of antimicrobial agents and outcomes in children with risk factors.ResultsAssessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45–0.77).ConclusionFamilies and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.
Pubmed PDF Web\nRonan W. Hsieh, \nWilliam E. Gooding, \nMarci Nilsen, \nMark Kubik, \nZahra Kelly, \nShaum Sridharan, \nHeath Skinner, \nUzoma Iheagwara, \nJose P. Zevallos, \nUmamaheswar Duvvuri, \nSeungwon Kim, \nRobert L. Ferris, \nDan P. Zandberg\n
Publicatie 05-12-2024
ABSTRACTIntroductionWe retrospectively studied young patients with head and neck squamous cell carcinoma (HNSCC) to identify factors associated with disease-specific survival (DSS).MethodsPatient and tumor characteristics of patients aged ≤45 who received treatments for non-metastatic HNSCC were collected to identify factors associated with DSS. Proportional hazards regression was applied separately for surgical and non-surgical patients.Results230 patients were included. Surgical and non-surgical patients had similar DSS. Higher pathologic stages, positive margins, perineural invasion (PNI), extranodal extension and negative HPV status were associated with worse DSS for surgical patients and negative HPV status for non-surgical patients. In the multivariate analysis, pathologic stages, positive margins, and PNI were associated with worse DSS in surgical patients.ConclusionPathologic stages, positive margins, and PNI are independently associated with worse DSS in young surgical HNSCC patients. PNI is a uniquely strong prognostic factor for young patients.
Pubmed PDF Web\nHollie Black, \nDavid Young, \nAlexander Rogers, \nJenny Montgomery\n
Publicatie 05-12-2024
ABSTRACTObjectiveMachine learning has been effective in other areas of medicine, this study aims to investigate this with regards to HNC and identify which algorithm works best to classify malignant patients.DesignAn observational cohort study.SettingQueen Elizabeth University Hospital.ParticipantsPatients who were referred via the USOC pathway between January 2019 and May 2021.Main Outcome MeasuresPredicting the diagnosis of patients from three categories, benign, potential malignant and malignant, using demographics and symptoms data.ResultsThe classic statistical method of ordinal logistic regression worked best on the data, achieving an AUC of 0.6697 and balanced accuracy of 0.641. The demographic features describing recreational drug use history and living situation were the most important variables alongside the red flag symptom of a neck lump.ConclusionFurther studies should aim to collect larger samples of malignant and pre-malignant patients to improve the class imbalance and increase the performance of the machine learning models.
Pubmed PDF Web"\nPavithran Maniam, \nAlison Bray, \nMichael Drinnan, \nTony Fouweather, \nM. Dawn Teare, \nSean Carrie, \nJames OHara\n"
Publicatie 05-12-2024
ABSTRACTBackgroundThe role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined.ObjectiveTo explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction.MethodsThis is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB–arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, NPR and PNIF) were measured using PNIF and rhinospirometry.ResultsThe mean NPR for left-sided, both-sided and right-sided septal deviation was −0.35, −0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and −0.29, respectively (p < 0.001).ConclusionThis study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.
Pubmed PDF Web\nSamuel J. M. Hale, \nOlivia Lengyel, \nDeanna Louis, \nRaymond Kim, \nRichard G. Douglas\n
Publicatie 05-12-2024
ABSTRACTObjectivesNasal anaesthetic-decongestant sprays are commonly used prior to nasal instrumentation, such as flexible and rigid nasal endoscopy. Co-phenylcaine (lignocaine 5%, phenylephrine 0.5%, ENT Technologies Pty Ltd., Melbourne, VIC, Australia) is a combination spray commonly used for this purpose. However, lignocaine is less potent than other local anaesthetics, and both active constituents of Co-phenylcaine have a bitter taste. It was hypothesised that a combination spray containing tetracaine and oxymetazoline would both offer more potent topical anaesthesia and have a better taste.MethodsFour anaesthetic-decongestant nasal sprays were tested in 10 healthy participants (Co-phenylcaine, and tetracaine 0.5%, 1% and 2% with oxymetazoline 0.05%). Sensory thresholds were sequentially measured at the head of the inferior turbinate using Semmes-Weinstein monofilaments over the following hour. Participants also rated taste on a Likert-style scale, and reported whether they experienced subjective numbness of the maxillary teeth.ResultsA median peak sensory threshold of 60 g (the maximum tested) was observed with Co-phenylcaine, but this threshold was exceeded by all the tetracaine-based sprays. Tetracaine 2% with oxymetazoline 0.05% had a significantly more rapid onset than Co-phenylcaine (4 min vs. 6 min, p < 0.05) and a longer duration of action. Eight participants reported dental numbness after administration of tetracaine 2% with oxymetazoline 0.05%, but only one participant after Co-phenylcaine. Tetracaine-based sprays were generally perceived to taste less unpleasant than Co-phenylcaine.ConclusionTetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic-decongestant spray than Co-phenylcaine, with a longer duration of action.
Pubmed PDF Web\nHuajie Yuan, \nYuping Yang, \nBo Zhang, \nAng Li, \nJiang Su, \nXiaoyan Ding, \nHaisu Yan, \nHua Zhang\n
Publicatie 05-12-2024
ABSTRACTObjectiveTo provide guidance for clinical endotypes by constructing a risk-predictive model of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP).DesignA cross-sectional study.SettingSingle-centre trial at tertiary medical institutions.ParticipantsA cross-sectional study included 343 CRSwNP patients divided into ECRSwNP (n = 237) and non-ECRSwNP (n = 106) groups using surgical pathology.Main Outcome MeasuresSingle-factor and multivariate analysis were used to identify statistically significant variables for constructing a nomogram, including the history of AR, hyposmia score, ethmoid sinus score, BEP and BEC. The models performance was evaluated based on the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).ResultsAllergic rhinitis, hyposmia score, ethmoid sinus score, peripheral blood eosinophil percentage (BEP) and eosinophil count (BEC) were retained for the construction nomogram of ECRSwNP. The nomogram exhibited a certain accuracy, with an AUC of 0.897 (95% CI: 0.864–0.930), good agreement in the calibration curve and a 0.891 C-index of internal validation. Moreover, the DCA with a threshold probability between 0.0167 and 1.00 indicated a higher net benefit and greater clinical utility.ConclusionThe construction of a predictive risk model of ECRSwNP based on easily accessible factors could assist clinicians in more conveniently defining endotypes to make optimal diagnoses and treatment choices.
Pubmed PDF Web\nMadelyn Frank, \nKaren Tawk, \nElla J. Lee, \nJoshua K. Kim, \nAbdula Al‐Seraji, \nMehdi Abouzari, \nHamid R. Djalilian\n
Publicatie 05-12-2024
ABSTRACTObjectiveTo evaluate the effectiveness of nortriptyline regimen and migraine dietary/lifestyle modifications on dizziness and stress levels in patients diagnosed with vestibular migraine (VM).MethodsA total of 35 patients diagnosed with definite VM based on the International Classification of Headache Disorders were included in this intervention study. Patients self-selected to receive either nortriptyline regimen alone (10–40 mg daily with biweekly escalation) (group A, n = 17) or migraine dietary/lifestyle modifications alone (group B, n = 18). Main outcome measures were dizziness severity and stress level measured by the visual analog scale (VAS).ResultsAt 4-week post-treatment, dizziness decreased from 6.0 ± 2.5 to 4.2 ± 3.4 (p = 0.069) in group A and from 8.7 ± 1.5 to 3.6 ± 3.0 (p < 0.001) in group B. VAS for stress changed from 5.5 ± 1.3 to 5.4 ± 2.9 (p = 0.93) and from 6.9 ± 3.2 to 5.0 ± 2.7 (p = 0.025) in groups A and B, respectively. The δ values of the VAS score for dizziness were 1.8 ± 3.7 and 5.1 ± 3.1 and the δ values of the VAS score for stress were 0.06 ± 2.9 and 1.9 ± 3.3 in groups A and B, respectively. Quality of life (QOL) improved in 88% patients in group A and 94% patients in group B.ConclusionsNortriptyline, at a maximum dose of 40 mg, effectively alleviates patient symptoms, while a migraine diet and lifestyle modifications notably reduce vertiginous symptoms and stress levels in VM patients in 4 weeks. Both interventions are equally effective in ameliorating the QOL of patients. The ideal treatment for patients would likely need to include both medication and diet/lifestyle changes.
Pubmed PDF Web\nBernhard Prem, \nDavid T. Liu, \nKatharina Boehme, \nMia T. Maurer, \nBertold Renner, \nChristian A. Mueller\n
Publicatie 05-12-2024
ABSTRACTBackgroundFortunately, the majority of COVID-19 patients recover from olfactory dysfunction (OD) within the first couple of weeks. However, from approximately 5% up to 20% continue to suffer from OD even more than 1 year after the onset. Nonetheless, factors associated with long-lasting OD are hardly known. The aim of this study was to identify favourable and disadvantageous markers of persisting OD in COVID-19 patients.MethodologySixty-six patients (46 female; mean age: 39.9 years) that suffer from OD longer than 6 months due to laboratory-confirmed SARS-CoV-2 infection have participated in this longitudinal study. Participants completed comprehensive psychophysical chemosensory tests (i.e., Sniffin Sticks = TDI) and questionnaires twice at our department—on average 219 ± 80 (T-1) and 489 ± 89 (T-2) days after the onset of symptoms, respectively. Olfactory recovery rates were associated with demographic factors and questionnaires using linear regression analysis.ResultsPatients below 40 years of age improved better (TDI: 4.1 ± 4.3 vs. 0.7 ± 5.8; p = 0.008) and achieved statistically significant higher scores (TDI: 31.5 ± 4.0 vs. 27.3 ± 6.7; p = 0.033) regarding psychophysical chemosensory tests. Furthermore, linear regression analysis revealed that parosmia was associated with worse orthonasal smell function (T-1: β = −0.346, p = 0.004; T-2: β = −0.384, p = 0.001), especially concerning identification subtest (T-1: β = −0.395, p = 0.001; T-2: β = −0.398, p < 0.001). Moreover, increasing parosmia between T-1and T-2 led to worse orthonasal olfactory function (β = −0.294, p = 0.016).ConclusionsOlder age and parosmia seem to be unfavourable factors of persisting OD in COVID-19 patients.
Pubmed PDF Web\nMurat Yaşar, \nFatih Öner, \nFatma Atalay, \nSezai Sacid Anbar\n
Publicatie 05-12-2024
ABSTRACTObjectiveThis study examined patients with normal hearing thresholds who had trouble understanding speech in noise. We used electrocochleography (ECochG) to detect and compare SP/AP amplitude area ratios, a potential indicator of cochlear synaptopathy, and investigate speech perception disorder in noise.MethodsThe study included 68 people aged between 18 and 65 years, 35 patients and 33 healthy volunteers, who applied to the otorhinolaryngology clinic between November 2023 and March 2024 with a 2-month history of difficulty understanding speech in noisy environments. Everyone was given a tiptrode electrode ECochG test, and the results were compared between groups. An ECochG test was recorded with tiptrode electrodes and was performed on all participants, and the results were compared between groups.ResultsIn the ECochG test, the summation potential/action potential (SP/AP) amplitude and area ratios of patients who had difficulty understanding speech in a noisy environment were statistically higher than those of the control group.ConclusionECochG testing may provide additional evidence to evaluate auditory nerve pathways.
Pubmed PDF Web\nMengya Shen, \nShujin Xue, \nXingmei Wei, \nBiao Chen, \nYing Kong, \nYongxin Li\n
Publicatie 05-12-2024
ABSTRACTObjectivesThe increase of bilateral cochlear implantation (CI) in recent years has made it essential to comprehend the effects of CI on otolith function. This study aimed to investigate the development of gross motor and otolith function in patients with inner ear malformations (IEMs) using vestibular-evoked myogenic potentials (VEMPs).Materials and MethodsOverall, 78 patients with sensorineural hearing loss (SNHL) (age 5.7 ± 4.1 years) were divided into two groups based on the presence (IEM group, n = 39) or absence (control group, n = 39) of IEMs. VEMP testing was performed both before and 1–3 months after CI, and the evaluation of gross motor development was carried out.ResultsThe mean ages for achieving head control and independent walking were delayed in the IEM group compared with the control group (p = 0.02). The preoperative cervical VEMP (cVEMP) and ocular VEMP (oVEMP) response rates were higher in the control group (60% and 86.95%) than in the IEM group (57.69% and 74.35%) (p < 0.05). Additionally, abnormal cVEMP was associated with delayed acquisition of independent walking (p = 0.017). Saccular and utricular functions after CI were lost by 40% and 31.75%, respectively, in patients who elicited preoperative VEMPs waveform (n = 25).ConclusionsAmong SNHL patients, balance development is more delayed in patients of IEMs than in patients without IEMs. The cVEMP and oVEMP waveforms differed greatly between the two groups. The otolith-vestibular nerve conduction pathway can be affected by CI, potentially leading to otolith function impairment. Therefore, it is essential to assess otolith and balance functions before CI, and this evaluation should be considered an integral part of clinical practice.
Pubmed PDF Web\nSilvia Giovanna Marinone Lares, \nGeorgia Mackay, \nSita Tarini Clark, \nJeyasakthy Saniasiaya, \nCraig McCaffer\n
Publicatie 05-12-2024
ABSTRACTObjectiveVocal fold immobility (VFI) is a cause of significant morbidity and mortality in the paediatric population. Laryngoscopy is the current first-line investigation for patients with suspected VFI. Laryngeal ultrasound (LUS) has recently emerged as an alternative method of identifying VFI. Compared to laryngoscopy, LUS is less invasive, does not require anaesthesia, and can be performed by non-otolaryngologists. The objectives of this study are to evaluate LUS as a diagnostic method for the identification of VFI in a cohort of paediatric patients in Aotearoa New Zealand (NZ) and to estimate the frequency of use of LUS in the paediatric population by clinicians around the world.MethodsA retrospective, single-centre cohort study was performed on all paediatric patients who had undergone laryngoscopy and LUS at Starship Childrens Health in Auckland, NZ, between 2020 and 2023. An eight-question survey was also developed and distributed to better understand clinicians use of LUS in their clinical practice to diagnose paediatric VFI globally.ResultsTwenty-nine paediatric patients met the inclusion criteria. LUS demonstrated good sensitivity (80.95%) for detecting VFI and increased to 93.33% for the detection of unilateral VFI. Of the 87 respondents to the survey, 41.38% utilise LUS in their clinical practice in the paediatric population. The main barriers to implementation of LUS as identified by non-users were lack of equipment, expertise, and training.ConclusionsThese findings support the use of LUS as an accurate diagnostic tool for the detection of unilateral VFI. Further studies in non-surgical populations and in patients with bilateral VFI, as well as standardised guidelines for LUS technique and reporting, are required.
Pubmed PDF Web\nPeipei Yang, \nYongcong Shen, \nWenqing Wang, \nYuhong Wang, \nYuhui Fan, \nJisheng Liu, \nDan Zhang\n
Publicatie 05-12-2024
ABSTRACTPurposeChronic rhinosinusitis with nasal polyps (CRSwNP) is a highly heterogeneous disease with varied clinical features and treatment effects. This study aimed to investigate the additive effect of blood and tissue eosinophilia on patients with CRSwNP.MethodsBased on the blood eosinophil (Beos) count and tissue eosinophil (Teos) count, we divided 144 CRSwNP patients into four groups, analysed their clinical features and histopathologic changes, and investigated their postoperative control.ResultsPatients in the Beos+Teos+ (blood eosinophil count > 0.3 × 109/L, tissue eosinophil count > 10/HPF) group had a higher incidence of allergic rhinitis (AR) and asthma. Lund-Mackay (LM) scores, hyposmia visual analogue scale (VAS) scores and Global Osteitis Scoring Scale (GOSS) scores were higher in the Beos+Teos+ group than those in the other groups. Tissue remodelling, such as connective tissue oedema and basement membrane thickening was more severe in the Beos+Teos+ group compared with other groups. There were more uncontrolled patients after surgery in Beos+Teos+, Beos+Teos− (blood eosinophil count > 0.3 × 109/L, tissue eosinophil count ≤ 10/HPF)and Beos−Teos+ (blood eosinophil count ≤ 0.3 × 109/L, tissue eosinophil count > 10/HPF)groups compared with the Beos−Teos− group.ConclusionsEosinophilic inflammation both in blood and tissue was accompanied by more severe clinical features and tissue remodelling. Eosinophilia in blood or tissue indicated poorer disease control after surgery.
Pubmed PDF Web\nZehra Betül Paksoy, \nFatma Cemre Sazak Kundi\n
Publicatie 05-12-2024
ABSTRACTPurposeSialocele or salivary fistula formation is common after parotidectomy. This study aims to evaluate the predictive value of the prognostic nutritional index in the development of salivary fistulas and sialoceles after parotidectomy.MethodsPatients who underwent parotidectomy at our clinic and were diagnosed with benign salivary gland masses were included in the study. Patients who developed postoperative sialoceles or salivary fistulas were identified. Various factors were assessed, including surgical technique, tumour size, gender, age, prognostic nutritional index, and the volume of the excised mass. Variables associated with sialocele or salivary fistula were later included in a multiple logistic regression model. Possible factors related to the formation of sialocele or salivary fistulas were analysed.ResultsThe study comprised 158 patients (95 male and 63 female). The frequency of sialocele or salivary fistula development was 13.9% (n = 22). The multiple logistic regression model found that the prognostic nutritional index(PNI) was linked to the occurrence of sialocele or salivary fistula (ORs = 0.9, 95% CI = 0.9, p = 0.003). Warthin tumour was associated with an elevated risk of sialocele or salivary fistula (ORs = 0.38, 95% CI = 0.184, 0.79, p = 0.009). ROC analysis demonstrated that the PNI had a specificity of 90% and a sensitivity of 68%. No significant associations were observed between the excised tumour size, surgical technique with the development of sialocele or salivary fistula.ConclusionPrognostic nutritional index can be utilised as an independent risk factor for the development of sialocele, or salivary fistula.
Pubmed PDF Web\nAyça Başkadem Yilmazer, \nElif Aksungur, \nCem Çelik, \nAvni Akin Bayram, \nHüseyin Turgut, \nMehmet Emre Dinç, \nAyşe Enise Göker, \nYavuz Uyar\n
Publicatie 05-12-2024
ABSTRACTIntroductionPharyngocutaneous fistula (PCF) is one of the most challenging complications observed after a total laryngectomy. Since the biochemical components of platelet-rich fibrin (PRF) have well-known synergistic effects on the healing processes, this study aimed to demonstrate the contribution of PRF application to pharyngeal healing in patients undergoing a total laryngectomy for laryngeal cancer.MethodsThe study compared patients who underwent a total laryngectomy due to laryngeal squamous cell carcinoma and had a PRF membrane placed during the pharyngoesophageal closure with those who did not. There were two groups: PRF-positive and PRF-negative. In the PRF-positive group, after the completion of the total laryngectomy and moving on to the pharyngoesophageal closure stage, along the suture line, PRF material is laid in two pieces in a T-shape and secured with several sutures. No PRF application was done in the PRF-negative group. Pharyngeal healing steps (nasogastric feeding, oral feeding, development of a fistula), haemoglobin and albumin values, tumour involvement areas, time to oral intake and length of hospital stay were recorded for all patients.ResultsThis study reviewed the records of 33 patients who underwent pharyngoesophageal closure with PRF application after a total laryngectomy (PRF-positive group) and 35 patients without PRF application (PRF-negative group). When comparing patients in terms of developing a PCF, 6% (n = 2) of patients in the PRF-positive group and 25.7% (n = 9) in the PRF-negative group developed a fistula. This ratio was significantly higher in the PRF-negative group (p = 0.027).ConclusionThe application of PRF in pharyngoesophageal reconstruction after a total laryngectomy may strengthen wound healing and reduce the risk of PCF development.Trial RegistrationThis study is a retrospective designed study; therefore, there is no clinical trial registration
Pubmed PDF Web\nSabrina Tengku, \nAislinn FitzGerald, \nAlison E. Lim, \nJenny Montgomery\n
Publicatie 05-12-2024
ABSTRACTIntroductionSocioeconomic deprivation is a known risk factor for head and neck cancer (HNC). Despite this, there is no current way to acknowledge this in two-week wait (2WW) referrals. 2WW HNC referrals have continually risen, and a self-reporting questionnaire was trialled with referrals to the ear, nose and throat (ENT) department with suspected HNC, allowing additional triage information not included in referrals to be obtained.MethodsPatients referred through the 2WW pathway for HNC between February 2021 and March 2022 were asked to complete an electronic self-reporting symptom questionnaire. The vetting process resulted in the referral being accepted or regraded to less urgent referral streams. Scottish Index of Multiple Deprivation (SIMD) quintiles were derived using the online postcode checker tool.ResultsA total of 984 2WW referrals were retrospectively reviewed. The questionnaire was completed by 717 (72.9%) patients. Regrading of urgency resulted in 292 (29.7%) 2WW appointments not required. Of those regraded, 264 (90.4%) patients completed the questionnaire. A significantly greater number of patients (p = 0.03) from SIMD 4 and SIMD 5 were regraded (33.3%) compared to SIMD 1 and SIMD 2 (26.4%). Patients who did not complete the questionnaire had a higher median age (61.0 years, range: 17–96, IQR: 25.0) compared to those who completed the questionnaire (56.0 years, range: 17–88, IQR: 23.5, p < 0.001).ConclusionA self-reported symptom questionnaire can help rebalance urgent appointments to those with genuine red flag symptoms. This in turn reduces social inequality in 2WW referrals and reduces the number of inappropriate 2WW appointments.
Pubmed PDF Web\nLiang Peng, \nHui‐Fang Wang, \nDong‐Fang Wang, \nYi‐Hui Wen, \nHua Zhong, \nWei‐Ping Wen, \nJian Li\n
Publicatie 05-12-2024
ABSTRACTObjectiveTo assess the prevalence of depression, anxiety, insomnia and somatic symptom disorder (SSD) in chronic rhinosinusitis (CRS) patients who were waiting for surgery and to predict these psychiatric disorders using the 22-item Sinonasal Outcome Test (SNOT-22).DesignA prospective cross-sectional study.SettingThe rhinology ward at our institution, a tertiary hospital.ParticipantsAdult patients (> 18 years) diagnosed with CRS who were admitted to the rhinology ward for endoscopic sinus surgery and were able to understand and complete the study questionnaires.Main Outcome MeasuresPatient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI), Patient Health Questionnaire-15 (PHQ-15) and SNOT-22.ResultsOf the 159 participants recruited, 58 were at risk of depression (defined by PHQ-9 > 4, while 25 with PHQ-9 > 9), 49 were at risk of anxiety (defined by GAD-7 > 4, while 25 with GAD-7 > 9), 81 were at risk of insomnia (defined by ISI > 7, while 51 with ISI > 14) and 69 were at risk of SSD (defined by PHQ-15 > 4, while 24 with PHQ-15 > 9). The SNOT-22 score was closely correlated with the scores of psychometric tests and was an independent predictor of these psychiatric disorders. Patients with a high SNOT-22 score (> 30) are likely to be affected by comorbid psychiatric disorders and should be further evaluated by otolaryngologists.ConclusionDepression, anxiety, insomnia and SSD are prevalent in CRS patients. Otolaryngologists should have a low threshold to ask the patient about psychiatric symptoms, especially for patients with an SNOT-22 score > 30.
Pubmed PDF Web\nMila Roode, \nAdam J. Donne\n
Publicatie 05-12-2024
\nDiane Picard, \nRemi Hervochon, \nElodie Lannadere, \nCloe Cabos, \nLoeiza Gourves, \nFrederic Tankere, \nPeggy Gatignol\n
Publicatie 05-12-2024
\nE. Tian Tan, \nLaura Simpson, \nRory Braggins, \nOvie Edafe\n
Publicatie 05-12-2024
\nGani Nuredini, \nPriscilla Parmar, \nAndrew Hall, \nAnnakan Navaratnam\n
Publicatie 05-12-2024
\nChang Woo Lee, \nVirginia Fancello, \nAlex Dando, \nFenella Bennett, \nVirginia Ludwig, \nKate J. Heathcote\n
Publicatie 05-12-2024
\nKatrina Mason, \nKaren Young, \nKanishka Rao, \nMairead Kelly, \nErnest Lim, \nAisling Higham, \nNick de Pennington, \nSarah Little, \nEnyi Ofo\n
Publicatie 05-12-2024
\nAshwini Reddy, \nNidhi Singh, \nNarender Kaloria, \nShiv Lal Soni, \nAjay Singh, \nNaveen Banavathu Naik, \nPriya Thappa, \nNaresh Panda\n
Publicatie 05-12-2024
\nAlberto Caranti, \nRuggero Campisi, \nAngelo Cannavicci, \nGiuseppe Meccariello, \nLuigi Marco Stringa, \nAndrea Catalano, \nAndrea Migliorelli, \nChiara Bianchini, \nAndrea Ciorba, \nFrancesco Stomeo, \nGiannicola Iannella, \nAntonino Maniaci, \nStefano Pelucchi, \nClaudio Vicni\n
Publicatie 05-12-2024
\nMohamed Abdelmohsen Alnemr, \nJohannes A. Rijken, \nWeibel W. Braunius, \nDominique N. V. Donders, \nRemco de Bree\n
Publicatie 05-12-2024
\nLifeng Li, \nShangfeng Zhao, \nJun Kang, \nXiaohong Chen\n
Publicatie 05-12-2024
\nYongjia Chen, \nXinzhang Cai, \nYulu Zhang, \nChufeng He, \nXuewen Wu, \nLu Jiang, \nHongsheng Chen, \nJing Liu, \nBo Pang, \nShuai Zhang, \nAnhai Chen, \nMengzhu Jiang, \nHuping Huang, \nYijiang Bai, \nZequn Nie, \nLingyun Mei\n
Publicatie 04-12-2024
ABSTRACTObjectivesThe first purpose of this study was to ascertain the distribution of unilateral Ménières disease (MD) clinical subgroups in China and compare with the population reported in Europe and the United States. The second purpose was to investigate the effectiveness in different clinical phenotypes.MethodsParticipants were categorised into one of five subtypes using a previously reported classification scheme based on cluster analysis. The distribution and clinical characteristics were analysed and compared with the two cohorts reported in Europe and the United States. Participants were followed up to observe the therapeutic effectiveness over a 2-year period.ResultsA total of 245 patients diagnosed with UMD were enrolled in the study, with 84 of these participants providing complete and detailed follow-up data. All of the unilateral MD patients were accurately classified: 58.0% were classic MD, 25.7% were delayed MD, 1.2% was familial MD, 12.7% were sporadic MD with migraine and 2.4% were autoimmune MD. Our findings revealed a significant difference in the distribution between this cohort and the European cohort. Follow-up assessments revealed worse vertigo control rate in the patients with migraine compared to the classical MD (50.0% vs. 82.6%, p = 0.034).ConclusionThe distribution of unilateral MD subtypes in this Chinese population differs from that in the European population, and the therapeutic effectiveness varies across subtypes in this cohort. Our study highlights the importance of the clinical heterogeneity in unilateral MD, and further studies are needed to identify the optimal interventions for specific subgroups.
Pubmed PDF Web\nEmma Wilson, \nBarbara Anne Jennings, \nMizanur Khondoker, \nCarl M. Philpott, \nPeter Prinsley, \nDaniel S. Brewer\n
Publicatie 04-12-2024
ABSTRACTObjectivesTo identify factors associated with cholesteatoma in a large UK cohort. Although some risk factors are frequently reported (male sex, history of chronic otitis media), other associations require further evidence (deprivation, smoking).Design and SettingBriefly, 1140 cholesteatoma cases from UK BioBank were compared to 4551 non-cholesteatoma middle ear disease and 493 832 ear disease-free controls. Adjusted odds ratios were calculated for demographic factors including age, sex, ethnicity, deprivation and smoking status with logistic regressions. Odds ratios for overlapping ICD-10 codes are also calculated.ResultsCholesteatoma was significantly associated with sex (Adjusted odds ratio (AOR) for males = 1.33, 95%CI = 1.179–1.491), age (AOR = 1.02, 95%CI = 1.011–1.026) and deprivation (AOR = 1.08, 95%CI = 1.059–1.097) compared to ear disease-free controls (p < 0.001). Age and deprivation distributions for cholesteatoma and non-cholesteatoma ear disease were similar. Although there was no significant association with smoking status, cholesteatoma was significantly associated with the ICD-10 code mental and behavioural disorders due to tobacco use (OR = 2.34, p < 0.001, 95%CI = 1.942, 2.813). Cholesteatoma was also strongly associated with a wide range of inflammatory middle ear conditions and chronic sinus inflammation, suggesting an increased susceptibility to inflammation of the upper airways.ConclusionThis study shows a large overlap between cholesteatoma and non-cholesteatoma ear disease in terms of numbers and demographics, with sex being a key factor distinguishing between the two, suggesting that there are both common and distinct associated factors.
Pubmed PDF Web\nAkash Srinivasan, \nViktorija Kaminskaite, \nStuart C. Winter\n
Publicatie 04-12-2024
ABSTRACTObjectivesThe aim of surgery for head and neck squamous cell carcinoma (HNSCC) is to achieve clear resection margins, whilst preserving function and cosmesis. Fluorescent markers have demonstrated potential in the intraoperative visualisation and delineation of tumours, such as glioma, with consequent improvements in resection. The purpose of this scoping review was to identify and compare the fluorescent markers that have been used to detect and delineate HNSCC to date.MethodsA literature search was performed using the Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, ClinicalTrials.gov and ICTRP databases. Primary human studies published through September 2023 demonstrating the use of fluorescent markers to visualise HNSCC were selected and reviewed independently by two authors.ResultsThe search strategy identified 5776 records. Two hundred and forty-four full texts were reviewed, and sixty-five eligible reports were included. The most used fluorescent markers in the included studies were indocyanine green (ICG) (n = 14), toluidine blue (n = 11), antibodies labelled with IRDye800CW (n = 10) and 5-aminolevulinic acid (5-ALA) (n = 8). Toluidine blue and ICG both have limited specificity, although novel targeted options derived from ICG may be more effective. 5-ALA has been demonstrated as a topical marker and, recently, via enteral administration but it is associated with photosensitivity reactions. The fluorescently labelled antibodies cetuximab-IRDye800CW and panitumumab-IRDye800CW are promising options being investigated by ongoing trials.ConclusionMultiple safe fluorescent markers have emerged which may aid the surgical resection of HNSCC. Further research in larger cohorts is required to identify which marker should be considered gold standard.
Pubmed PDF Web\nPaolo Boscolo‐Rizzo, \nAlberto Vito Marcuzzo, \nChiara Lazzarin, \nFabiola Giudici, \nJerry Polesel, \nMarco Stellin, \nAndrea Pettorelli, \nGiacomo Spinato, \nGiancarlo Ottaviano, \nMarco Ferrari, \nDaniele Borsetto, \nSimone Zucchini, \nFranco Trabalzini, \nEgidio Sia, \nNicoletta Gardenal, \nRoberto Baruca, \nAlfonso Fortunati, \nLuigi Angelo Vaira, \nGiancarlo Tirelli\n
Publicatie 04-12-2024
ABSTRACTIntroductionArtificial Intelligences (AIs) are changing the way information is accessed and consumed globally. This study aims to evaluate the information quality provided by AIs ChatGPT4 and Claude2 concerning reconstructive surgery for head and neck cancer.MethodsThirty questions on reconstructive surgery for head and neck cancer were directed to both AIs and 16 head and neck surgeons assessed the responses using the QAMAI questionnaire. A 5-point Likert scale was used to assess accuracy, clarity, relevance, completeness, sources, and usefulness. Questions were categorised into those suitable for patients (group 1) and those for surgeons (group 2). AI responses were compared using t-Student and McNemar tests. Surgeon score agreement was measured with intraclass correlation coefficient, and readability was assessed with Flesch–Kincaid Grade Level (FKGL).ResultsChatGPT4 and Claude2 had similar overall mean scores of accuracy, clarity, relevance, completeness and usefulness, while Claude2 outperformed ChatGPT4 in sources (110.0 vs. 92.1, p < 0.001). Considering the group 2, Claude2 showed significantly lower accuracy and completeness scores compared to ChatGPT4 (p = 0.003 and p = 0.002, respectively). Regarding readability, ChatGPT4 presented lower complexity than Claude2 (FKGL mean score 4.57 vs. 6.05, p < 0.001) requiring an easy-fairly easy English in 93% of cases.ConclusionOur findings indicate that neither chatbot exhibits a decisive superiority in all aspects. Nonetheless, ChatGPT4 demonstrates greater accuracy and comprehensiveness for specific types of questions and the simpler language used may aid patient inquiries. However, many evaluators disagree with chatbot information, highlighting that AI systems cannot serve as a substitute for advice from medical professionals.
Pubmed PDF Web\nDaniel Soibelman, \nOhad Ronen\n
Publicatie 26-11-2024
ABSTRACTBackgroundIn January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well-differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low-risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines.MethodsA systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta-analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines.ResultsWe found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology.ConclusionsApparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre-ATA 2015 era.
Pubmed PDF Web\nDong Keon Yon, \nDokyoung Kim, \nMyung Chul Yoo, \nSung Soo Kim, \nHwa Sung Rim, \nSang Hoon Kim, \nJae Yong Byun, \nSeung Geun Yeo\n
Publicatie 21-11-2024
ABSTRACTObjectivesAlthough many studies have assessed the clinical features and the factors affecting treatment outcomes of Bells palsy, few have analysed differences between men and women. This study therefore evaluated whether the clinical features and treatment results, and the factors affecting them, differ between men and women with Bells palsy.MethodsThis retrospective study included 1708 patients (791 men and 917 women) who presented with facial palsy to the otolaryngology department between January 1986 and December 2022. Clinical features and treatment outcomes were compared in men and women diagnosed with Bells palsy.ResultsAge distribution, side affected by facial palsy, House-Brackmann (HB) Grade, underlying disease such as diabetes and hypertension, electroneuronography (ENoG) results, electromyography (EMG) results, and treatment methods did not differ significantly between men and women with Bells palsy (p > 0.05 each). Factors significantly associated with better prognosis in men included milder initial facial palsy and better electromyography (EMG) results (p < 0.05). Factors significantly associated with better prognosis in women included younger age, milder initial facial palsy, and better EMG results (p < 0.05). Women had significantly better prognosis than men when treated with steroids within 3 days of the onset of paralysis (p < 0.05).ConclusionMilder initial facial palsy and better EMG results were associated with better prognosis in both men and women with Bells palsy. Younger age at onset and early stage treatment with steroids were associated with a higher recovery rate in women, but not in men.
Pubmed PDF Web\nAyesha Chowdhury, \nRong Tian, \nPaul McIlhiney, \nDona M. P. Jayakody\n
Publicatie 14-11-2024
ABSTRACTIntroductionIn Australia, older Aboriginal and Torres Strait Islander people have the highest prevalence of hearing loss, for which dedicated audiological services are available.However, there is limited research on the experiences older Aboriginal and Torres Strait Islander people have with hearing loss and audiological services. Therefore, this study aimed to consolidate existing literature with a scoping review, specifically on the above to identify gaps and guide future research.MethodTen databases, including electronic journal databases and government databases, were systematically searched. Additional studies were sought from article reference lists, review articles, conference abstracts and Google Scholar. We identified 540 records and 22 of them met our inclusion criteria. Our inclusion criteria constituted research of any design on the experiences of older Aboriginal and Torres Strait Islander people (aged 45+ years) with hearing loss and audiological services.ResultsSeventeen studies reported on experiences with hearing loss, four studies reported on experiences with audiological services and one study reported on both experiences. Prevalence of hearing loss was estimated to be 20%–34% in older Aboriginal and Torres Strait Islander people; a discrepancy between self-reported and objective hearing difficulties was also identified. Audiological services currently available to older Aboriginal and Torres Strait Islander people were also underutilised.ConclusionsFuture research on older Aboriginal and Torres Strait Islander people is required to uncover: (1) the reasons for underreported hearing loss; (2) types of hearing loss experienced; (3) barriers to accessing audiological services; and (4) best hearing-loss management and rehabilitation practices.
Pubmed PDF Web\nArun G. Karthat, \nSoumya Regi, \nHabie Thomas, \nKatti B. Sara, \nP. Beula Subashini, \nRajan Sundaresan, \nRegi Thomas\n
Publicatie 12-11-2024
ABSTRACTObjectiveApparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients.DesignRetrospective observational study.SettingQuaternary care referral centre.ParticipantsA retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done.Main Outcome MeasureChi-square or Fishers exact test was used to compare ADC values of bacterial and fungal SBO.ResultsThe most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10−3 mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10−3 mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142).ConclusionThis study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.
Pubmed PDF Web\nIvy Drake, \nHazel Fountain, \nHaytham Kubba\n
Publicatie 11-11-2024
ABSTRACTObjectiveIt is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low.MethodsRetrospective case note review of children attending the nurse-led epistaxis clinic between 2019 and 2022.ResultsNine hundred and twenty children were seen in the nurse-led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery.ConclusionTo the authors knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service.
Pubmed PDF Web\nRoee Noy, \nNadeem Habashi, \nJacob T. Cohen, \nYotam Shkedy\n
Publicatie 10-11-2024
\nMahmoud F. Mandour, \nMohamed Tomoum, \nMohamed N. Elsheikh, \nAmani El‐Gharib, \nSaad Elzayat, \nMaurizio Barbara, \nValerio Margani, \nHaitham H. Elfarargy, \nMohamed Amer\n
Publicatie 10-11-2024
ABSTRACTObjectivesWe aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM).Study DesignIt was a prospective randomised comparative study.SettingsIt was held in tertiary referral institutions between May 2020 and April 2022.ParticipantsWe included 100 patients with a large-sized eardrum perforation (50%–75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients.Main Outcome MeasuresWe evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation.ResultsFat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference.ConclusionsFat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.
Pubmed PDF Web\nMaxime Tabey, \nXavier Dubernard, \nEmilien Chebib, \nNathaniel Assouly, \nLe‐Uyen France Truong, \nMarc Labrousse, \nEsteban Brenet\n
Publicatie 10-11-2024
The use of the 3D exoscope in cervicofacial reconstruction has demonstrated its effectiveness, yet few studies have compared its utility to that of the microscope. To compare the reliability of microanastomoses performed with both tools, along with postoperative outcomes and user experience. This was a retrospective single-center study that included all cases of microanastomosed forearm or fibula free flap reconstructions performed between June 2019 and June 2022. For each procedure, microsurgical characteristics were collected and compared. The primary outcome measure was the reliability of anastomoses (lack of intraoperative events and absence of early surgical revisions). Secondary outcome measures pertained to postoperative evolution. Forty patients underwent microanastomosed flap reconstruction (20 forearm flaps, 20 fibula flaps) using either a microscope (n = 10 in each group) or a 3D exoscope (n = 10 in each group). Patient characteristics were comparable between the two groups. No significant difference was observed between the use of the microscope and the 3D exoscope in terms of anastomosis reliability; OR = 2.07 [0.09-130.88], p = 1. No differences were noted between the two groups in postoperative outcomes except for a shorter hospitalization period for patients undergoing forearm flap reconstruction with the exoscope compared to the microscope (p = 0.03). The use of the 3D exoscope appears to be an interesting alternative to the microscope in cervicofacial reconstruction due to similar microsurgical results, good ergonomics and significant pedagogical appeal.
Pubmed PDF Web\nXiang Xin, \nYang Yang, \nLi Xuelei, \nYao Hongbing, \nTang Xinye, \nLiang Jia\n
Publicatie 03-11-2024
ABSTRACTIntroductionObservational studies have shown a bidirectional association between gastroesophageal reflux (GER) and chronic rhinosinusitis (CRS) or chronic rhinitis (CR), but it is not clear whether this association is causal.ObjectivesThis study was to investigate the causality between GER and CRS or CR using bidirectional two-sample Mendelian randomization (MR) analysis.MethodsUsing pooled data from large genome-wide association studies (GWAS), genetic loci independently associated with GER, CRS and CR in populations of European and American ancestry were selected as instrumental variables (IVs). The inverse variance weighted (IVW) method was used to analyse the random effects model of MR, and the odds ratio (OR) was used as the evaluation index to explore the bidirectional causality between GER and CRS or CR. Single nucleotide polymorphism (SNP) outliers were detected using MR-pleiotropy Residual Sum and Outliers (MR-PRESSO). The MR–Egger intercept test examined the horizontal pleiotropy of SNPs. The “leave-one-out” sensitivity analysis examined whether MR results were affected by a single SNP.ResultsThe main results of IVW showed that GER increased the risk of CRS (OR = 1.3795, 95% CI = 1.188–1.603, p < 0.0500) and CR (OR = 1.3941, 95% CI = 1.1671–1.6652, p < 0.0500). The obtained SNPs as IVs for GER, CRS and CR had no significant horizontal pleiotropy, heterogeneity or bias. Regarding the reverse directions, no notable associations could be found.ConclusionThis MR analysis revealed that genetically predicted GER had a causal effect on an increased risk of CRS or CR, but not vice versa. These results have great implications for the management of CRS (especially for refractory CRS) or CR in clinical practice.
Pubmed PDF Web\nHye‐Bin Jang, \nDong\xa0Hoon Lee, \nShin Jung, \nSang\xa0Chul Lim\n
Publicatie 01-11-2024
\nAdam J. Donne, \nKim Keltie, \nJulie Burn, \nEmma Belilios, \nSteven Powell, \nPaola Cognigni, \nIain J. Nixon, \nNeil Bateman, \nHaytham Kubba, \nOwen Judd, \nAndrew Sims\n
Publicatie 24-10-2024
ABSTRACTObjectivesTo determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS.DesignProspective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022).SettingUK NHS hospitals treating RRP patients.ParticipantsChildren and adults diagnosed with RRP and managed in an NHS hospital.Main Outcome MeasuresDisease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death).ResultsThree hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period.ConclusionsThis is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time.Trial Registration: NCT03465280, ISRCTN36100560
Pubmed PDF Web\nMairi Weir, \nHaytham Kubba\n
Publicatie 24-10-2024
\nAntonino Maniaci, \nGaia Vertillo\xa0Aluisio, \nStefania Stefani, \nSalvatore Cocuzza, \nJerome\xa0Rene Lechien, \nThomas Radulesco, \nJustin Michel, \nMaria Santagati, \nIgnazio La\xa0Mantia\n
Publicatie 23-10-2024
ABSTRACTIntroductionThe role of microbial profiles in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) pathogenesis is increasingly recognised, with microbial imbalances perpetuating inflammation. We performed this study to associate the different nasal microbiological profile changes with the response to surgical or monoclonal treatment.MethodsThis prospective observational study evaluated changes in the nasal microbial profiles of 44 patients (22 dupilumab, 22 surgery) over 6 months. Clinical assessments were performed at baseline and follow-ups, including Sino-Nasal Outcome Test-22 (SNOT-22) scores and Sniffin Sticks-Identification (SS-I) olfactory testing. Microbial profiling of nasal swabs was carried out by microbial culture and subsequent molecular identification by Polymerase chain reaction (PCR) and sequencing.ResultsBaseline characteristics of 44 patients (22 dupilumab, 22 surgery) enrolled in this study were similar between groups. In the dupilumab group, Staphylococcus epidermidis prevalence rose from 37.03% to 59.25%, while Pseudomonas aeruginosa was eradicated. Moreover, dupilumab stabilised Staphylococcus aureus at 63.64%, while its prevalence increased in the surgery group (from 22.72% to 50%). When bacterial groups were associated with clinical scores, P. aeruginosa carriers had worse SNOT-22 (21.00 ± 1.41) and SS-I (5.50 ± 0.71) scores. Instead, S. epidermidis-colonised patients exhibited significantly lower mean SNOT-22 (15.39 ± 8.54) and greater SS-I scores (8.39 ± 3.77). The best outcomes were found in the subgroup of S. epidermidis carriers undergoing the dupilumab treatment.ConclusionThe two treatments modulated the microbial profiles differently, and, most importantly, clinical responses might depend on the association between treatment and the dominant bacterial species colonising the nasal cavity. Further investigation into microbial-restorative strategies could enhance outcomes for better treatment of CRS.
Pubmed PDF Web\nJingman Deng, \nYan Huang, \nWuhui He, \nJintao Lou, \nWei Liu, \nZhigang Zhang, \nYu Si\n
Publicatie 22-10-2024
\nRui Zhao, \nTianhua Yi, \nQinqin Wu, \nXuemei Liu, \nJianqiao He, \nYufang Tan\n
Publicatie 22-10-2024
ABSTRACTObjectiveThis study aims to explore the role of serum aquaporin 8 (AQP8) expression in evaluating the degree of hydrolabyrinth and predicting prognosis in patients with Menieres disease.MethodsOne hundred and five patients diagnosed with Menieres disease in our hospital were enrolled in the Menieres disease group. Another 102 healthy subjects were enrolled as the control group. The expression of serum AQP8 mRNA was determined by the quantitative real-time PCR (qRT-PCR) method. Receiver operating characteristic (ROC) curve analysis was carried out to analyse the predictive value of serum AQP8 mRNA expression for poor prognosis in Menieres disease patients. Multivariate logistic regression was used to analyse the influencing factors of poor prognosis in patients with Menieres disease.ResultsThe expression level of serum AQP8 mRNA in the Menieres disease group was significantly higher than that in the control group (p < 0.05). In the severe hydrops group, serum AQP8 mRNA expression levels were higher than in the mild hydrops group and the no endolymphatic hydrops group. Additionally, the mild hydrops group had higher serum AQP8 mRNA levels than the no endolymphatic hydrops group (p < 0.05). The disease course, proportion of severe hydrops and serum AQP8 mRNA expression were all higher in the poor prognosis group compared to the good prognosis group (p < 0.05). The area under the curve (AUC) for serum AQP8 mRNA in predicting poor prognosis in Menieres disease patients was 0.812 (95%CI: 0.702–0.922).ConclusionAQP8 mRNA is associated with the degree of hydrolabyrinth in patients with Menieres disease and plays an important role in predicting prognosis.
Pubmed PDF Web\nYohanna\xa0M. Takwoingi, \nShiraz Syed, \nOghogho Braimah\n
Publicatie 22-10-2024
\nWeidong Zhang, \nJiapei Xie, \nSongbai Li, \nBo Zhang\n
Publicatie 20-10-2024
ABSTRACTObjectiveThe aim of this investigation was to explore the potential correlation between the signal intensity ratio (SIR) at the internal auditory canal (IAC) fundus and hearing impairment in Menieres disease (MD), thereby providing a foundation to further understand the mechanisms underlying hearing loss.DesignFifty patients diagnosed with unilateral definite MD were enrolled in the study. 3D-FLAIR MRI was conducted 4 h after intravenous administration of gadobutrol to determine the SIR of the bilateral IAC fundus. The difference in the SIR of the IAC fundus between the affected and unaffected sides was assessed, followed by an analysis of its correlation with low-, middle-, and high-tone hearing thresholds. Correlation analysis was also conducted between the degree of endolymphatic hydrops (EH) in the vestibule and cochlea and the SIR on the affected side.ResultsThe degree of EH in MD can be clearly visualised using 3D-FLAIR MRI. The SIR on the affected side was significantly higher than that on the unaffected side (p = 0.000). Furthermore, a positive correlation was observed between the SIR at the affected and low (r = 0.692, p = 0.000), middle (r = 0.615, p = 0.000) and high-tone (r = 0.440, p = 0.001) hearing thresholds, while the SIR showed no significant correlation with cochlear (r = 0.315, p = 0.088) or vestibular hydrops (r = 0.215, p = 0.244).ConclusionThe IAC fundus barrier may be damaged in patients with MD, representing one of the factors affecting the level of hearing.
Pubmed PDF Web