Samuel\xa0J.\xa0M. Hale, Olivia Lengyel, Deanna Louis, Raymond Kim, Richard\xa0G. Douglas
Publication date 17-09-2024
ABSTRACTObjectives Nasal 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.
Methods Four 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.
Conclusion Tetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic-decongestant spray than Co-phenylcaine, with a longer duration of action.
Huajie Yuan, Yuping Yang, Bo Zhang, Ang Li, Jiang Su, Xiaoyan Ding, Haisu Yan, Hua Zhang
Publication date 14-09-2024
ABSTRACTObjective To provide guidance for clinical endotypes by constructing a risk-predictive model of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP).
DesignA cross-sectional study.
Setting Single-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 Measures Single-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).
Results Allergic 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.
Conclusion The 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.
Hollie Black, David Young, Alexander Rogers, Jenny Montgomery
Publication date 14-09-2024
ABSTRACTObjective Machine 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.
Design An observational cohort study.
Setting Queen Elizabeth University Hospital.
Participants Patients who were referred via the USOC pathway between January 2019 and May 2021.
Main Outcome Measures Predicting the diagnosis of patients from three categories, benign, potential malignant and malignant, using demographics and symptoms data.
Results The 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.
Conclusion Further 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.
Gani Nuredini, Priscilla Parmar, Andrew Hall, Annakan Navaratnam
Publication date 08-09-2024
ABSTRACTIntroduction Measurements in endoscopic sinus surgery (ESS) are usually obtained with variable accuracy. We aimed to validate endoscopic multipoint integrated laser systems (EIMLS) for use in ESS, which can acquire measurements within one-hundredth of a millimetre.
MethodsA 4.4 mm flexible endoscopic EIMLS projecting 49 laser points into the view was used to assess simulated anterior skullbase defects. Antero-posterior and lateral measurements were obtained and repeated 20 times by two surgeons. These were compared to measurements with surgical callipers. Intra and inter-observer reliability was assessed.
Results Eighty measurements were obtained of simulated skullbase defects by each otolaryngology surgeon and compared to manual measurements. The mean difference shown was 0.56 cm. Bland–Altman plot shows low bias (0.044) but wide 95% limits of agreement (−1.8–1.9).
ConclusionEIMLS allows reliable and easy to obtain measurements within a simulated ESS environment. Translation of this technology offers promise in a future clinical setting but will require further refinement to improve accuracy.
"Pavithran Maniam, Alison Bray, Michael Drinnan, Tony Fouweather, M.\xa0Dawn Teare, Sean Carrie, James OHara"
Publication date 08-09-2024
ABSTRACTBackground The 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.
Objective To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction.
Methods This 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.
Results The 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).
Conclusion This 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.
Chang\xa0Woo Lee, Virginia Fancello, Alex Dando, Fenella Bennett, Virginia Ludwig, Kate\xa0J. Heathcote
Publication date 05-09-2024
ABSTRACTBackground The primary objective of this study was to assess the efficacy and safety of in-office transnasal oesophagoscopy (TNO) and balloon dilatation for patients presenting with symptoms of high dysphagia. The secondary objective was to conduct a subgroup analysis to better understand patient selection.
Methods Retrospective observational study from a single university hospital.
Results Two-hundred four TNO and balloon dilatations were performed for 146 patients (median age 73 years; range 12–94 years). Indications included cricopharyngeal hypertrophy ± pouch (n = 70), hypopharyngeal/upper oesophageal web/stenosis (n = 18), head and neck cancer treatment-related (n = 41), multi-level obstruction (n = 13) and symptom-based (n = 4). The mean EAT-10 score improved from 21.2 (SD ± 8.92) pre-dilatation to 12.6 (SD ± 10.7) post-dilatation overall (median follow-up 4.4 months; range 1.5 months–6.21 years). Cricopharyngeal hypertrophy and/or web without dysmotility cohort responded the best with the mean EAT-10 score improvement from 20.4 (SD ± 8.21) to 4.4 (SD ± 6.71).
Head and neck cancer patient group showed three types of responses: good response although effect transient requiring repeat dilatations; initial good response however stops responding over time and no response. The overall complication rate was 0.98% (n = 2/204; both failed in-clinic attempts) with 0% perforation rate.
ConclusionTNO and balloon dilatation is a safe and effective treatment modality for managing high dysphagia in patients with identifiable non-malignant obstructive pathologies at and around the level of the upper oesophageal sphincter, including head and neck cancer treatment-related patients, both short-term and long-term. Barium swallow is an excellent screening tool for assessing the swallow as a whole.
E.\xa0Tian Tan, Laura Simpson, Rory Braggins, Ovie Edafe
Publication date 03-09-2024
ABSTRACTUnilateral tonsillar enlargement (UTE) generally prompts suspicion of malignancy and tonsillectomy is often performed for histological diagnosis. This may be unnecessary in asymptomatic patients. We performed a retrospective study of all patients who had asymptomatic UTE and underwent tonsillectomy over a 5-year period. We found no malignancies in our cohort of 78 patients. 22 out of 74 (29.7%) patients had a difference of 50% or more in the size of their tonsils. Around 1 in 4 patients had an inaccurate clinical diagnosis of UTE compared to the final size of their tonsil specimens. In a comprehensive literature review, only 2 out of 1152 patients (0.17%) were found to have lymphoma with UTE as the only presenting symptom and no other suspicious features. There can be huge variability between the size of normal tonsils. UTE alone without any other concerning features should prompt clinicians to consider other management options such as a period of observation rather than diagnostic tonsillectomy.
Pubmed PDF WebDiane Picard, Remi Hervochon, Elodie Lannadere, Cloe Cabos, Loeiza Gourves, Frederic Tankere, Peggy Gatignol
Publication date 31-08-2024
ABSTRACTObjectives The primary objective of this study was to describe the distribution of the Sunnybrook Facial Grading System scores in the general population. Secondary objectives included analyzing the effects of age, gender and facial side on these scores.
Design Two speech therapists specializing in facial motor skill assessment evaluated the healthy participants using the Sunnybrook Facial Grading System, first with the right hemiface as a reference and then with the left hemiface as a reference.
Setting The study was conducted in our ENT department from September 2022 to June 2023.
Participants One hundred eleven healthy participants were included (57 women and 54 men), aged 18 to 79 years.
Main Outcome MeasuresSFGS composite scores (SFGS-Total) and sub-scores at rest (SFGS-Rest) and in movement (SFGS-Movement) were studied according to three age categories (18–39 years) (40–59 years) and (60–79 years) and gender. Inter-rater reliability was collected between the two evaluators with Cronbachs alpha.
Results Taking the right hemiface as a reference, SFGS-Total scores ranged from 65% to 100% (median = 96, IQR 91–100). When the left hemiface was considered as the reference, scores ranged from 78% to 100% (median = 95; IQR 90–100). Right and left SFGS-Total scores showed high inter-rater reliability (respectively α = 0.953 and α = 0.926). There was a slight negative correlation between age and SFGS-Total scores.
Conclusions By embracing a more realistic approach that acknowledges natural variations and asymmetry in facial movements, we can enhance patient care and promote a more holistic understanding of facial rehabilitation outcomes.
"Wannitta\xa0E. Ting Wong, Jeyasakthy Saniasiaya, Nur\xa0Syazwani\xa0Mohd Salehuddin, Shih\xa0Ying Hng, Anna\xa0Marie Nathan"
Publication date 22-08-2024
ABSTRACTObjectives This study aimed to devise a modified oximetry scoring system and calculate its diagnostic accuracy in detecting paediatric obstructive sleep apnoea syndrome (OSAS).
Study Design This prospective diagnostic accuracy study was divided into two phases.
Setting The study was conducted at a quaternary teaching hospital.
Methods Polysomnograms performed from 1 April 2014 to 31 December 2021 were included. In Phase 1, the parameters of 95 oximetry trend graphs were evaluated, and a modified scoring system was constructed. In Phase 2, the modified scoring system was employed in 272 oximetry trend graphs, and its diagnostic accuracy was determined. A logistic regression model was used to assess the ability of each scoring system to predict paediatric OSAS.
ResultsA total of 367 patients were recruited. In Phase 1, a four-tier severity classification system was constructed. In Phase 2, its diagnostic accuracy was found to be 53.3% sensitive, 97% specific, with positive predictive value of 98.5% and negative predictive value of 34.6%. The lowest detectable apnoea–hypopnoea index (AHI) was 4.5. The inter-rater reliability calculated was 80%. Logistic regression was applied to assess associations of the modified Mc Gill score (MMS) or Mc Gill oximetry score (MOS) with OSAS. The area under the receiver operating characteristic curve was higher for the MMS than for MOS (0.78 95% CI 0.73–0.84 vs. 0.59 95% CI 0.51–0.66).
Conclusion This study demonstrated that our modified scoring system had increased sensitivity at detecting OSAS at a much lower AHI and showed a much greater ability to predict paediatric OSAS.
Mila Roode, Adam\xa0J. Donne
Publication date 22-08-2024
"Tom Bradish, David Hamilton, James OHara"
Publication date 22-08-2024
Ronan\xa0W. Hsieh, William\xa0E. Gooding, Marci Nilsen, Mark Kubik, Zahra Kelly, Shaum Sridharan, Heath Skinner, Uzoma Iheagwara, Jose\xa0P. Zevallos, Umamaheswar Duvvuri, Seungwon Kim, Robert\xa0L. Ferris, Dan\xa0P. Zandberg
Publication date 22-08-2024
ABSTRACTIntroduction We retrospectively studied young patients with head and neck squamous cell carcinoma (HNSCC) to identify factors associated with disease-specific survival (DSS).
Methods Patient 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.
Conclusion Pathologic 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.
Nadia Sadok, Tobias Bastian, Noemi Voss, Kerstin Stähr, Diana Arweiler‐Harbeck, Stephan Lang, Moritz Meyer
Publication date 15-08-2024
ABSTRACTPurpose The primary objective of this study was to explore the potential disparity in postoperative fistula occurrence rates between patients who undergo (partial) lateral parotidectomy and those who undergo the extracapsular dissection technique for the management of benign parotid gland tumours.
MethodsA consecutive series of 363 patients treated with (partial) lateral parotidectomy and extracapsular dissection technique for benign parotid gland tumours at one tertiary centre between 2018 and 2022 were included. To evaluate the impact of the surgical technique and possible other risk factors (tumour location, tumour size, Body Mass Index, age, smoking, diabetes mellitus, arterial hypertension) for the development of fistulas, multivariate logistic regression analyses using backward lection were applied to estimate odds ratios (ORs) and 95%-confidence intervals (CIs).
Results In 363 patients, 21 patients (5.8%) developed a fistula. Patients who underwent (partial) lateral parotidectomy had three times higher chance of developing a fistula compared to patients who were operated using the extracapsular dissection technique (ORadjusted = 2.6, 4.1% vs. 12.5%, p = 0.044). In the multivariate analyses, no other risk factors for the development of fistulas were statistically significant in this cohort. The incidence of facial nerve paralysis was not significantly different between the extracapsular dissection and lateral parotidectomy group (5/73 = 6.8% vs. 11/290 = 3.8%, p = 0.333).
Conclusion Fistulas occur more often in patients treated by means of a (partial) lateral parotidectomy approach compared to patients treated using the extracapsular dissection technique. Therefore, surgeons should be vigilant about postoperative fistula risks in lateral parotidectomy and consider preventive measures.
Muhammed Ayas, Yu\xa0Chuen Tam, Dakota Bysouth‐Young, Susan\xa0T. Eitutis, Marina Salorio‐Corbetto, Patrick\xa0R. Axon, Neil\xa0P. Donnelly, James\xa0R. Tysome, Daniele Borsetto, Mathew\xa0E. Smith, Manohar\xa0L. Bance
Publication date 12-08-2024
Po‐Jun Yu, Wei‐Chen Hung, Chi‐Te Wang
Publication date 12-08-2024
ABSTRACTObjectives Vocal process granuloma (VPG) is a chronic condition resulting from a mucoperichondrial injury of vocal process. Initial conservative treatment typically involves vocal hygiene education and antireflux medication. Treatment challenges arise with refractory cases. Outcomes of second-line treatments such as surgical excision and botulinum toxin injections remain inconsistent. Thus, we propose this study to investigate the effectiveness of intralesional steroid injections for refractory VPG.
Methods We conducted a retrospective review of 23 patients with VPG who showed no improvement after 3 months of proton pump inhibitors. These patients underwent one to three courses of monthly in-office intralesional steroid injections as a second-line therapy. Treatment outcomes were evaluated by measuring the size of the VPG relative to the length of the vocal folds before and after the final injection procedure.
Results Results showed a significant reduction in VPG size from baseline of 27.74 ± 15.06 to 5.48 ± 8.95 (p < .001). 15 out of 23 patients were responsive (size reduction ≥ 75%) to intralesional steroid injection. Alcohol consumption and longer symptom duration were associated with a poor response (size reduction <75%), whereas prior intubation was associated with better response.
Conclusions For refractory VPG not responding to conservative treatment, intralesional steroid injection appears to be a promising alternative option without significant adverse effects.
Annelise\xa0C. Cron, Michael David, Jane Orbell‐Smith, Anne\xa0B. Chang, Kelly\xa0A. Weir, Thuy\xa0T. Frakking
Publication date 08-08-2024
ABSTRACTBackground Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta-analyses.
Objectives To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments.
Search Methods Databases searched included MEDLINE, Pub Med, Embase, CINAHL, Aust Health, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022.
Selection Criteria Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included.
Data Collection and Analysis Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS-2.
Main Results Ten studies met the inclusion criteria for this review and meta-analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS-2, likely attributed to a lack of high-quality prospectively designed studies.
Conclusions There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA.
Yi‐Chan Lee, Yao‐Te Tsai, Ming‐Shao Tsai, Ti‐Yung Tseng, Chih‐Chen Chang, Kai‐Ping Chang
Publication date 08-08-2024
ABSTRACTBackground This study was designed to evaluate the diagnostic efficacy of the minimum fascia-tumour distance (MFTD) in distinguishing deep-lobe benign parotid tumours from superficial-lobe tumours through both an original study and a meta-analysis.
Methods In this study, we performed a retrospective analysis of data from 91 patients who had been diagnosed with benign parotid tumours. The MFTD values were sourced from preoperative ultrasound examinations. The locations of these tumours were confirmed through surgical findings. We assessed the diagnostic accuracy of MFTD by utilising receiver operating characteristic (ROC) curves. Additionally, we conducted a systematic review of the pertinent literature and performed a diagnostic meta-analysis to ascertain the overall diagnostic efficacy of MFTD in identifying benign parotid tumours.
Results Patients with tumours in the deep lobe had a significantly greater MFTD than patients with tumours in the superficial lobe. Using a cutoff value of 3.50 mm for MFTD, we found an AUC of 0.93, a sensitivity of 81.8%, and a specificity of 98.8%. Our meta-analysis included seven studies covering a total of 1689 tumours. The pooled values for sensitivity, specificity, and diagnostic odds ratio (OR) of MFTD were 81.0%, 89.0%, and 32.2, respectively. The AUC of the summarised ROC curve of MFTD was 0.90.
Conclusion The MFTD demonstrated reliable diagnostic accuracy in identifying deep-lobe benign parotid tumours and may be incorporated into standard evaluations before parotidectomy.
Anda Gata, Lajos Raduly, Liviuța Budișan, Adél Bajcsi, Teodora‐Maria Ursu, Camelia Chira, Laura Dioșan, Ioana Berindan‐Neagoe, Silviu Albu
Publication date 07-08-2024
ABSTRACTObjective Evaluating the possibility of predicting chronic rhinosinusitis with nasal polyps (CRSwNP) disease course using Artificial Intelligence.
Methods We prospectively included patients undergoing first endoscopic sinus surgery (ESS) for nasal polyposis. Preoperative (demographic data, blood eosinophiles, endoscopy, Lund-Mackay, SNOT-22 and depression PHQ scores) and follow-up data was standardly collected. Outcome measures included SNOT-22, PHQ-9 and endoscopy perioperative sinus endoscopy (POSE) scores and two different microRNAs (miR-125b, miR-203a-3p) from polyp tissue. Based on POSE score, three labels were created (controlled: 0–7; partial control: 8–15; or relapse: 16–32). Patients were divided into train and test groups and using Random Forest, we developed algorithms for predicting ESS related outcomes.
Results Based on data collected from 85 patients, the proposed Machine Learning-approach predicted whether the patient would present control, partial control or relapse of nasal polyposis at 18 months following ESS. The algorithm predicted ESS outcomes with an accuracy between 69.23% (for non-invasive input parameters) and 84.62% (when microRNAs were also included). Additionally, miR-125b significantly improved the algorithms accuracy and ranked as one of the most important algorithm variables.
Conclusion We propose a Machine Learning algorithm which could change the prediction of disease course in CRSwNP.
Nir Tsur, Elchanan Zloczower, Michal Tunik, Ido Amir, Eyal Yosefof, Hagit\xa0Shoffel Havakuk, Yaniv Hamzany, Noga Kurman
Publication date 07-08-2024
ABSTRACTObjectives Laryngeal squamous cell carcinoma (SCC) is a predominantly male illness. Although the rate of female patients increased, a knowledge gap exists in the medical literature regarding gender-based differences.
Design Retrospective cohort study.
Setting Adult patients treated for laryngeal SCC in a tertiary medical centre between 2006 and 2020. Data were collected on demographics, clinical presentation, treatment modalities, disease recurrence and survival status.
Participants Two hundred ninety-one patients with laryngeal SCC, 50 (17.2%) females and 241 (82.8%) males.
Main Outcome Measures Disease-specific survival (DSS), overall survival (OS) and disease-free survival (DFS), as well as differences in disease characteristics and treatment modalities.
Results Tumour subsites differed significantly between females and males (36% vs. 19.5% supraglottic, 62% vs. 80.5% glottic and 2% vs. 0% subglottic, respectively; p = 0.006). Females were diagnosed at younger ages (61.7 ± 10.58 vs. 65.87 ± 11.11 years, p = 0.016) and advanced-stage disease (58% vs. 39.4%, p = 0.018). Females were treated with combined modalities at higher rates (36% vs. 54.8% for single modality, p = 0.031). DSS rates did not differ between genders (log-rank p = 0.12). Despite being diagnosed at more advanced disease stages, females demonstrated prolonged median OS compared to males (130.17 vs. 106.17 months, log-rank p = 0.017). No significant differences in DFS were observed (log-rank p = 0.32). In a multivariate Cox proportional hazards model, male gender remained an independent negative OS predictor (HR = 2.08; CI, 1.10–3.96; p = 0.025), along with increasing age (HR = 1.06; CI, 1.04–1.09; p < 0.001) and advanced disease stage (HR = 1.7; CI, 1.08–2.67; p = 0.023).
Conclusions Our findings suggest the importance of considering gender-specific factors in the management of laryngeal SCC.
Publication date 06-08-2024
Yuxin Ban, Brendan Mcneely, Neil K. Chadha, Mark Felton
Publication date 06-08-2024
Abstract Objective Three-dimensional (3D) endoscopy has been developed to provide depth perception to allow for improved visualisation during otolaryngology surgery. We conducted a systematic review to determine the surgical safety and efficacy of 3D endoscopy in comparison to two-dimensional (2D) endoscopy in performing otolaryngology procedures, and the role of 3D endoscopy as a training tool for novice otolaryngology surgeons.
Methods Primary studies were identified through MEDLINE, Embase and Web of Science databases, which were searched for articles published through June 2022 that compared the outcomes of 2D and 3D endoscopy in otolaryngology surgical procedures or otolaryngology-relevant simulations. Candidate articles were independently reviewed by two authors.
ResultsA total of 18 full-text articles met inclusion criteria for this study. In clinical trials (n = 8 studies, 362 subjects), there were no significant differences in performance time, intraoperative or postoperative complications with 3D endoscopes when compared to 2D. In simulation studies (n = 10 studies, 336 participants), 3D endoscopes demonstrated a decreased error rate (n = 5 studies) and shorter performance time (n = 3 studies). Studies also reported improved depth perception (n = 14 studies) and visualisation preference (n = 5 studies) with 3D over 2D systems. The 3D systems were found to have a shorter learning curve and better manoeuvrability among novice surgeons.
Conclusion3D endoscopy showed equivalent safety and efficacy compared to 2D endoscopy in otolaryngology surgery. The improved depth perception and performance for novices using 3D endoscopes suggests the technology may be superior to 2D endoscopes as a training tool for otolaryngology surgeons.
C. M. Bowe, M. Garg
Publication date 06-08-2024
Abstract Introduction This systematic review aims to evaluate the role of biopsies in non-oropharyngeal subsites in patients with cervical metastasis from head and neck squamous cell carcinoma of unknown primary (HNSCCUP).
Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles that encompassed non-oropharyngeal biopsies in HNSCCUP as part of the diagnostic work-up were selected and analysed.
ResultsA comprehensive search strategy was used to search relevant literature in Pub Med from inception to October 2021. Eleven articles out of 860 were included, comprising 990 patients. There are no randomised control trials comparing the outcomes of survival and or locoregional control between patients who have or have not undergone non-targeted biopsies of non-oropharyngeal sub-sites for HNSCCUP.
Several retrospective studies which showed an extremely low yield from random biopsies (range of yield, 0%–9%) of non-oropharyngeal subsites. Even targeted biopsies showed a low yield (range of yield, 0.6%–16.6%) from non-oropharyngeal subsites. The primary site identified for Epstein–Barr virus (EBV) positive cervical lymph nodes with an unknown primary is mainly the nasopharynx (51.7%). Narrow band imaging (NBI) (sensitivity range, 64%–91%) helps in the detection of primaries to target biopsies in non-oropharyngeal subsites.
Conclusions On the basis of this systematic review, it is not appropriate to offer biopsies of clinically and radiologically normal upper aerodigestive tract mucosa at non-oropharyngeal sites. Offer nasopharyngeal biopsies when the cervical node sampling reveals EBV-positive metastasis. Where available, NBI should be used to help detect and target biopsies in non-oropharyngeal subsites.
Rachael Thomas, Noemi Kelemen, Emma Molena, Shane Lester
Publication date 06-08-2024
Abstract Introduction Patients presenting with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remain challenging clinical scenarios as large variation exists in practices used to locate the primary.
Objective The objective of this systematic review is to review of the literature and offer recommendations for oropharyngeal biopsies in HNSCCUP.
Method Pubmed, Medline and Embase were searched to identify studies from inception to October 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.
ResultsA total of 483 articles were included and screened, 41 studies met the inclusion criteria, including over 3400 patients from the original articles (122 of these patients were reported on in two sequential articles by a single author – table 1) and 4 large metaanalyses including 1852 patients. The primary site identification rate following random biopsies or deep tissue biopsies is less than 5% in most studies. The mean detection rate following ipsilateral tonsillectomy is 34%; two pooled analyses indicate that the mean detection rate following tongue base mucosectomy is 64%, with this figure rising when the tonsils are negative.
Conclusions High level evidence is lacking, with heterogeneity in the reported studies. Published meta-analyses are based on retrospective data. There is little evidence supporting the practice of random/non-directed oropharyngeal biopsies. Available evidence supports palatine tonsillectomy and tongue base mucosectomy compared to deep tissue biopsies.
Umm E Salma Shabbar Banatwala, Abdul Rehman Shah Syed, Noor Ul Ain, Aimen Zulfikar, Ilqa Ikram Akhund, Rija Lodhi, Rameesha Baig, Laiba Ghufran, Ayesha Rizwan, Meena Bai, Mahima Khatri, Satesh Kumar
Publication date 06-08-2024
Abstract Objectives Tonsillectomy and adenoidectomy are common surgical procedures that cause persistent pain, bleeding, and functional limitations. We aimed to investigate the efficacy of celecoxib compared with a placebo for managing post-tonsillectomy or adenoidectomy pain and other adverse events.
Design Systematic review and meta-analysis.
Methods We conducted a systematic literature search in the Pub Med, Cochrane, and Google Scholar databases from inception until July 2023. Dichotomous outcomes have been reported as risk ratios (RR) while continuous outcomes were reported using mean differences (MD). A funnel plot was drawn to investigate publication bias.
Results From 1394 records identified, 6 randomised double-blind trials comprising 591 participants undergoing tonsillectomy and/or adenoidectomy were eligible for inclusion. A high dose (400 mg) of celecoxib was effective in decreasing the pain score for ‘worst pain’ after the procedure (MD: −10.98, 95% CI: −11.53, −10.42, p < .01, I2 = 0%) while a low dose (200 mg) was not significantly effective (p = 0.31). For managing other outcomes such as vomiting (RR: 1.37 95% CI: 0.69, 2.68, p = 0.37, I2 = 67%), diarrhoea (RR: 1.41, 95% CI: 0.75, 2.64, p = .29, I2 = 42%), dizziness/drowsiness (RR: 0.90, 95% CI: 0.71, 1.15, p = .48, I2 = 0%), functional recovery time (p = .74), and headache (p = .91), there was no significant difference between the group on celecoxib and the placebo group regardless of dosage. Finally, there was no significant difference (RR: 1.02, 95% CI: 0.91, 1.15, p = .69, I2 = 0%) in the effect of the intervention on minimum bleeding, moderate bleeding, and profuse bleeding.
Conclusion This meta-analysis provides robust evidence pooled from high-quality trials and raises questions about the efficacy of celecoxib for tonsillectomy and/or adenoidectomy, challenging existing perceptions.
Ebraheem Albazee, Hemail M. Alsubaie, Roaa Alkanderi, Mubarak Althaidy, Husain Alsafar, Saad Alsaleh, Shawkat Abdulrahman
Publication date 06-08-2024
Abstract Introduction To comprehensively evaluate the reported clinical effectiveness of platelet-rich plasma (PRP) in patients with chronic sinusitis undergoing endoscopic sinus surgery (ESS).
Methods We performed a systematic review and meta-analysis of randomised controlled trials (RCTs). Five digital online databases (Pub Med, Scopus, Web of Science, Google Scholar and Cochrane CENTRAL) were searched from inception up to 1st May 2023. Our specific outcomes involved postoperative nasal endoscopy scores measured via Lund-Kennedy score or Meltzer score, olfactory sensation scores and pre-operative anosmia duration. All data were pooled as standardised mean difference (SMD) with a 95% confidence interval (CI), using the Rev Man software.
Results Six RCTs were included in this systematic review and meta-analysis, with a total of 169 patients. The risk of bias in the included RCTs was low in three RCTs, some concerns in one RCT and high risk in two RCTs. The overall analysis of the postoperative nasal endoscopy scores showed that the PRP group had lower scores compared to the control group (n = 3 RCTs, SMD = −1.19; 95% CI −1.94, −0.44, p = .002). There was no significant difference between the PRP and control groups regarding anosmia duration (n = 2 RCTs, SMD = 0.21; 95% CI −0.17, 0.59, p = 0.28) or olfactory sensation scores, despite the PRP group having higher scores (n = 2 RCTs, SMD = 0.53; 95% CI −0.32, 1.39, p = 0.22).
Conclusion This study highlights the potential advantages of using PRP as an additional treatment for individuals with chronic sinusitis undergoing ESS. The improvements associated with PRP include facilitating wound healing, reducing inflammation and enhancing surgical outcomes. To optimise the use of PRP in clinical settings, future research should focus on conducting larger trials with standardised protocols.
Emma M. Teunissen, Herman J. W. Kok, Arno M. Janssen, Myrthe K. S. Hol, Arjan J. Bosman
Publication date 06-08-2024
Abstract Introduction Although the Baha 5SP has been commercially available for six years, very few studies have been performed on the devices efficacy. The current study aims to evaluate the characteristics and audiological results in patients with severe-to-profound mixed hearing loss fitted with this superpower sound processor.
Methods This retrospective evaluation was conducted at a tertiary referral centre where a series of 82 adult patients with severe-to-profound mixed hearing loss were implanted with a percutaneous bone-anchored hearing system and fitted with a superpower sound processor between 2016 and 2019. Patients with incomplete or unreliable audiological data (n = 24) were excluded, resulting in 58 data sets for analysis. The main outcome measures were unaided and aided pure-tone thresholds and aided free-field speech perception in quiet.
Results The median unaided air conduction (AC) threshold averaged across 0.5, 1 and 2 k Hz (PTA0.5–2k Hz) of all patients was 75 dB hearing loss (HL); the median unaided AC averaged across 1, 2 and 4 k Hz (PTA1–4k Hz) was 84 dB HL. For bone conduction and direct bone conduction, the median PTA0.5–2k Hz was 52 and 47 dB HL, respectively. With the superpower device, the median free-field speech reception threshold was 54 dB sound pressure level (SPL), and the median speech perception score at 65 dB SPL was 80%.
Conclusions At least 75% of the patients reached a maximum phoneme score of 70%. For patients with lower scores, the superpower device still provides a substantial hearing benefit. This makes the superpower device particularly suitable for patients with severe-to-profound mixed hearing loss with a contraindication for conventional hearing aids and/or cochlear implants.
Bini Faizal, Lakshmi Nair, Jayanthy Pavithran, Merlin Moni, V. S. Sheejamol
Publication date 06-08-2024
Abstract Introduction Study aimed to ole of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO).
MethodsA prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment.
Results According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%).
Conclusions The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
Xin‐Da Xu, Hui‐Ping Luo, Jing Yu, Na Gao
Publication date 06-08-2024
Abstract Introduction This study aimed to evaluate the prevalence and psychometric properties of vertigo and dizziness in an obstructive sleep apnoea (OSA) population.
Methods Five hundred and twelve OSA patients and 53 controls were enroled. All eligible subjects were asked to complete the basic information questionnaire, the Chinese version of Vestibular Disorders Activities of Daily Living (VADL-C), the Dizziness Handicap Inventory (DHI) and the Activities-Specific Balance Confidence (ABC) scale.
Results Among 512 enroled OSA patients, a 22.46% (115) prevalence of vertigo and dizziness was found. The scores of the VADL-C, DHI and ABC of the study group were significantly worse (p < .001) than those of the control group, while the abnormal rates of the three scales in the study group were higher than those of the control group. In the study group, the results of the VADL-C were correlated with those of the DHI (r = .55, p < .001) and inversely correlated with those of the ABC (r = −.50, p < .001), and the results of the DHI were inversely correlated with those of the ABC (r = −.60, p < .001).
ConclusionsA high prevalence of vertigo and dizziness in the OSA population was detected. Psychometric results showed that vertigo and dizziness in OSA patients led to changes in activities of daily living, increased frequency of somatic symptoms, and reduced balance confidence. In the diagnosis and treatment of OSA patients, the occurrence of vertigo and dizziness is worth clinicians attention.
Ankit Patel, Cillian Forde, Suneal Doal, Jay Patel, Dawn Clare, Michael Burslem, Joseph\xa0G. Manjaly, Nishchay Mehta
Publication date 06-08-2024
ABSTRACTIntroduction Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT-integrated-community-ear service (ENTICES—combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES.
MethodENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety.
Results No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively.
ConclusionENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.
Jonathan C. Pang, Leo L. T. Meller, Cecilia H. Nguyen, Arash Abiri, Dean D. Chung, Theodore V. Nguyen, Benjamin F. Bitner, Frank P. K. Hsu, Edward C. Kuan
Publication date 06-08-2024
Abstract Background Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks.
Methods Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression.
Results Seventy-nine patients (57.7%) had high-flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV 95% CI = 7.6% 4.8%, 11.9%), followed by severe headache (n = 47, 34.3%; 6.3% 3.1%, 12.5%), dizziness (n = 43, 31.4%; 2.3% 0.4%, 12.1%), salty or metallic taste (n = 20, 14.6%; 9.9% 3.3%, 25.8%), and throat drainage (n = 10, 7.3%; 9.9% 1.7%, 41.4%). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV 95% CI = 4.1% 2.0%, 8.1%). On univariate regression, no sign or symptom, including rhinorrhea (OR 95% CI = 7.00 0.76–64.44), throat drainage (3.42 0.35–33.86), salty/metallic taste (4.22 0.66–27.04), severe headache (3.00 0.48–18.62), dizziness (0.54 0.06–4.94), fever (3.16 0.50–19.99), and nausea/vomiting (1.33 0.22–8.21), associated with postoperative CSF leak.
ConclusionsA range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response.
Zhiyong Dou, Yingqiang Li, Dongzhou Deng, Yunxue Zhang, Anran Pang, Cong Fang, Xiang Bai, Dan Bing
Publication date 06-08-2024
Abstract Objective Pure tone audiometry has played a critical role in audiology as the initial diagnostic tool, offering vital insights for subsequent analyses. This study aims to develop a robust deep learning framework capable of accurately classifying audiograms across various commonly encountered tasks.
Design, Setting, and Participants This single-centre retrospective study was conducted in accordance with the STROBE guidelines. A total of 12 518 audiograms were collected from 6259 patients aged between 4 and 96 years, who underwent pure tone audiometry testing between February 2018 and April 2022 at Tongji Hospital, Tongji Medical College, Wuhan, China. Three experienced audiologists independently annotated the audiograms, labelling the hearing loss in degrees, types and configurations of each audiogram.
Main Outcome MeasuresA deep learning framework was developed and utilised to classify audiograms across three tasks: determining the degrees of hearing loss, identifying the types of hearing loss, and categorising the configurations of audiograms.
The classification performance was evaluated using four commonly used metrics: accuracy, precision, recall and F1-score.
Results The deep learning method consistently outperformed alternative methods, including K-Nearest Neighbors, Extra Trees, Random Forest, XGBoost, LightGBM, Cat Boost and FastAI Net, across all three tasks. It achieved the highest accuracy rates, ranging from 96.75% to 99.85%. Precision values fell within the range of 88.93% to 98.41%, while recall values spanned from 89.25% to 98.38%. The F1-score also exhibited strong performance, ranging from 88.99% to 98.39%.
Conclusions This study demonstrated that a deep learning approach could accurately classify audiograms into their respective categories and could contribute to assisting doctors, particularly those lacking audiology expertise or experience, in better interpreting pure tone audiograms, enhancing diagnostic accuracy in primary care settings, and reducing the misdiagnosis rate of hearing conditions. In scenarios involving large-scale audiological data, the automated classification system could be used as a research tool to efficiently provide a comprehensive overview and statistical analysis. In the era of mobile audiometry, our deep learning framework can also help patients quickly and reliably understand their self-tested audiograms, potentially encouraging timely consultations with audiologists for further evaluation and intervention.
Jun Yup Kim, Dachan Kim, In Seok Moon, Ji Hyuk Han, Seong Hoon Bae
Publication date 06-08-2024
Abstract Introduction The modified nine-step test is a classical method for evaluating Eustachian tube function. However, clinical interpretation of the increased maximal difference in middle ear pressure (mdMEP) in the modified nine-step test is unknown. We hypothesised that the different reservoir effects of the mastoid cavity can bias the results of the modified nine-step test.
MethodsA total of 108 consecutive participants (216 ears) were retrospectively screened. Of these, 55 participants (82 ears) who met the inclusion/exclusion criteria were enrolled. The volumetric results of the mastoid cavity, parameters of the modified nine-step test (mdMEP, middle ear pressure, tympanic membrane compliance), and demographic data were analysed.
ResultsA significant negative correlation was found between mdMEP and mastoid cavity volume (R = .467, p < .001). Ears with mdMEP >70 da Pa showed poor pneumatization in the mastoid cavity, with volumes less than 3000 mm3 (10th percentile of all ears analysed). Ears with mastoid cavity volumes lower than the 25th percentile showed a significantly higher mdMEP (p < .001). Patients with mastoid cavity volumes higher than the 75th percentile were significantly younger (p < .001). Multivariate regression analysis for mdMEP showed a good fit (R = .854) using factors including middle ear pressure, admittance and, most importantly, the reciprocal of mastoid volume (Beta = 0.752, p < .001).
Conclusions The mdMEP, the main parameter of the modified nine-step test, was negatively correlated with the mastoid cavity volume. Therefore, the results of the modified nine-step test should be interpreted with consideration of mastoid cavity volume.
Sara Olaison, Malin Berglund, Tahir Taj, Johan Knutsson, Eva Westman, Per\xa0Olof Eriksson, Åsa Bonnard
Publication date 06-08-2024
ABSTRACTObjectives This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty.
Design This retrospective nationwide registry-based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (Swed Ear).
Setting The data were obtained from clinics in Sweden that perform ossiculoplasty.
Participants Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in Swed Ear between 2013 and 2019.
Main Outcome Measures Hearing outcome expressed as air–bone gap (ABG) gain.
Results The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI confidence interval, 0.1–4.4) in ABG and 2.2 dB (95% CI, 1.7–4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high-frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group.
Conclusion Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques.
"John C. Hardman, James Constable, Sian Dobbs, Christopher Hogan, Kate Hulse, Shivun Khosla, Kristijonas Milinis, Ben Tudor‐Green, Andrew Williamson, Vinidh Paleri, INTEGRATE (The UK ENT Trainee Research Network), Panagiotis Asimakopoulos, Fergus Cooper, Prerana Rao, Katharine Davies, Timothy Davies, Stephen Derbyshire, Chuanyu Gao, Chiugo Ike, Maged Abdelkader, Christopher Hogan, Paul Spraggs, Anthony Bashyam, Jamie Patel, Oliver Dale, Laura Brennan, Mark Puvanendran, Billy LK Wong, Tanzime Ahmed, Jemy Jose, Emma Molena, Stuart C. Winter, James Rudd, Caroline Anderson, Waqqas Patel, Arcot Maheshwar, Haran Devakumar, Bhavesh Tailor, Ramesh Gurunathan, Gavin Donaldson, Paul Counter, Ayla Tabaksert, Trung Ton, Chang Woo Lee, Rajeev Srinivasan, Muhammad Hamza Qureshi, Richard Williams, Natasha Keates, Molly Jones, Ethne Grey‐Still, Karan Kapoor, Anusha Balasubramanian, Nathan Anorson, Alex Bowen, Sian Dobbs, James OHara, Lepa Lazarova, Tom Bradish, Aoife Waters, Lisa Pitkin, Shivun Khosla, Stephanie Germain, Vinod Prabhu, Priyanka Shastri, Malcolm Buchanan, Theofano Tikka, Anna Loroch, Jean‐Pierre Jeannon, Jack Faulkner, Mriganka De, Rodney Rodrigues, George Garas, Andreas Hilger, Tharsika Myuran, Dana Low, Basil Al Omari, Rachael Collins, James Moor, Mark Williams, Amy Round, Alexander Chadha, Oladejo Olaleye, Rishi Vasanthan, Quentin Bonduelle, Sultan Hatab, John Shotton, Nadine Caton, Syed Shah, Jaiganesh Manickavasagam, Ross Bannon, Estelle How Hong, Mrinal Supriya, Jacob Thoppil, Emma King, Andrew McGaughey, Neil Sharma, Hannah Nieto, Daniel Snelson, Paul C Nankivell, Jenny Montgomery, Kate Hulse, Christy Moen, Kishan Ubayasiri, Alex Charlton, Nada Dwiddar, Zach Shellman, Athena Togo, Sam Arman, Antonio Belloso, Fatima Seedat, Elliot Heward, Sarah Knowles, Venkat Reddy, Clare Perkins, Mouli Doddi, James Heyman, Alison Zander, Hannah Collins, Andrew Harris, Christian Johnatty, Nigel Beasley, Adam Gaunt, Natasha Quraishi, Ajith George, Ahmad K. Abou‐Foul, Saumil Shah, David Walker, Kenneth Lai, Chi Ike, Chuanyu Gao, Rony Raju, Stuart Gillett, Victoria Harries, Andrew Carswell, Georgina Wellstead, Ramzan Ullah, Jonathan Smith, Andrea Zuccarelli, Konstantinos Marinakis, Shraddha Jain, Jonathan Philpott, Javier Ash, Oliver Sanders, Iain J. Nixon, Justin Yeo, Mamoona Khalid‐Raja, Anastasha Herman, Shane Lester, Tobias James, Vinidh Paleri, John C. Hardman, Paul Stimpson, Peter Lion, Ankit Patel, Richard Townsley, Andrew Williamson, Ian Smillie, Christy Moen, Mehaab Jaffer, Sandeep Berry, Laura Burton, Charlie Holden, Marcos Martinez Del Pero, Jeremy Wong, Andrew Mizen, Ram Moorthy, Haleema Siddique, Haroen Sahak, Robert Hone, Sheikh Momin, Rohit Kumar, Emma Gosnell"
Publication date 06-08-2024
Abstract Introduction To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP).
MethodsA retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status.
Results Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, n = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4–92.3) and 43.5% (95% CI 32.9–57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all p < .0001 on log-rank test) but not local control (LC) (p = .16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (p < .0001) and LC (p < .0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (p = .16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (p = .017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis.
ConclusionsHPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.
Beverley Yu, Natasha Quraishi, Zain Sheikh, Shahed Quraishi
Publication date 06-08-2024
H. Nieto, J. Lee, C. Hall, A.\xa0L. McDermott
Publication date 06-08-2024
ABSTRACTIntroduction Effective medical staffing is pivotal for a successful healthcare system, demanding strategic planning to ensure a high-quality service. Although the UK’s doctor to population ratio has improved over time, it remains below global averages. The COVID-19 pandemic has exacerbated existing challenges, resulting in an unprecedented NHS waiting list with Ear, Nose, and Throat (ENT) surgeries ranking third highest in waiting times amongst all specialties.
Methods This study utilized a national jotform survey to gather data from ENTUK members, primarily focusing on consultant staffing within ENT departments across the UK. Additional information collected encompassed registration status, part-time roles, gender, vacancies, locum roles, associate specialists, registrars and other junior doctors, and advanced nurse practitioners. When survey responses were inadequate, direct communication was established with departmental consultants or secretaries, followed by Freedom of Information requests as necessary. All data were compiled using Microsoft Excel.
Results Among the 65 responses to the ENTUK survey, 53 individual trusts were identified. These included 41 English acute trusts, with supplementary participation from Scotland, Wales, and Northern Ireland. Data from 749 consultants across 115 English acute trusts were collected in combination with a Freedom of Information request.
Conclusion Despite an increased number of ENT consultants, the persistence of unfilled posts coincides with mounting waiting lists. The pandemic’s effects, including early retirements and part-time roles, emphasise the urgency of expanding training positions to counterbalance these shifts. Local and national interventions are essential to fortify and diversify the ENT workforce through a variety of strategies.
Hanifi Korkmaz, Emine Aydin, Fatma\xa0Ceyda\xa0Akin Ocal, Bulent Satar
Publication date 06-08-2024
ABSTRACTObjectives This study investigated the effects of optokinetic stimuli and dual-task performance on vestibulo-ocular reflex (VOR) function. The study primarily focused on understanding the effects of attention deficit and hyperactivity disorder (ADHD) and its subtypes.
Study DesignA case–control study.
Setting Tertiary medical centre.
Methods Thirty-eight children diagnosed with ADHD and 40 typically developing (TD) children aged 8–18 were included in the study. According to their diagnostic reports, children diagnosed with ADHD were also examined in three subtypes: predominantly inattentive (ADHD-PI), predominantly hyperactive–impulsive (ADHD-HI) and the combined type. Functional head impulse test (fHIT) was applied to all participants in three conditions—with no additional stimulus, optokinetic stimulation and dual-task. Correct responses (CR) were determined for each group, and the conditions were compared. For the dual-task test performance, children were given a counting task.
Results The findings of the study are significant. The CR values obtained from the fHIT tests applied under three different conditions were lower in the ADHD group compared to the control group. CR values for all fHIT conditions and all semicircular canals were lower in the ADHD-PI subtype and higher in the ADHD-HI subtype compared to other subgroups.
Conclusion This study has significant practical implications underscoring its relevance. fHIT, when applied with different protocols, can provide valuable information about the vestibular and cognitive states of children with ADHD. These results are particularly significant as the diagnosis of ADHD often relies on subjective interpretations, and fHIT offers a more objective and reliable method of evaluation.
"Vinidh Paleri, John Hardman, Tom Roques, Ben OLeary"
Publication date 30-07-2024
Hanae\xa0Fumiyo Namba, Mariëlle\xa0Bernadette Plug, Adriana\xa0Leni Smit
Publication date 30-07-2024
ABSTRACTObjectives The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation.
Databases Reviewed Pub Med, Embase and the Cochrane Library.
Methods The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated.
Results The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high.
Conclusions We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high-quality prospective or randomized studies are needed.
Sang‐Yoon Han, Young\xa0Ho Kim
Publication date 24-07-2024
ABSTRACTObjectives Tinnitus is one of the irritating symptoms that should be addressed in adolescents. Since tinnitus affects mental health, it is important to treat it. However, identifying the cause of tinnitus is very challenging and the treatment strategies of tinnitus are controversial. The objective of this study was to identify the prevalence of tinnitus in adolescents and systemic diseases as risk factors of adolescent tinnitus to find evidence for new treatment strategies.
Materials and Methods We extracted the subjects and data using the 5th Korea National Health and Nutrition Examination Survey from 2010 to 2012. One thousand five hundred ninety-three adolescents with bilateral normal tympanic membranes and availability of the results of physical, laboratory and audiological examinations, were selected. We evaluated their systemic diseases based on these results and assessed the association of tinnitus with demographic factors, systemic diseases and hearing levels.
Results The prevalence of tinnitus in Korean adolescents was 21.7%. The hearing level was not associated with tinnitus. Tinnitus was significantly associated with age (p = 0.005), 25(OH)-D level (p = 0.007) and anaemia (p = 0.003). After controlling the other factors, age (p = 0.045), 25(OH)-D level (p = 0.041) and anaemia (p = 0.019) were independently related to tinnitus.
Conclusion Tinnitus in adolescents was significantly associated with age, vitamin D and anaemia. Physicians should consider the higher likelihood of these deficiencies or diseases in adolescent tinnitus patients. Additionally, recognizing these associations may be helpful in developing treatment strategies for adolescent tinnitus.
Chang\xa0Woo Lee, Ashleigh Ivy, Brittany Brownlee, Mohammed Bahgat, Aoife Waters, Lakhbinder Pabla, Claire McLarnon, Gerard Siou, Steven Powell
Publication date 19-07-2024
Alexander\xa0E. Graf, Rahul\xa0D. Gulati, Simon Bellido, Krishnamurthi Sundaram, Richard\xa0M. Rosenfeld
Publication date 18-07-2024
Asad\xa0Gul Rao, Neha Pervez
Publication date 12-07-2024
Remzi Dogan, Ramazan\xa0Bahadir Kucuk, Selahattin Tugrul, Alper Yenigun, Omer\xa0Faruk Calim, Elif\xa0Ece Dogan, Emre Polat, Orhan Ozturan
Publication date 09-07-2024
ABSTRACTObjectives Insulin resistance is associated with increased levels of IGF-1. IGF-1 has been shown to increase the risk of laryngeal squamous cell carcinoma. The Triglyceride-glucose index (TyG index) is a marker of insulin resistance. Our study aimed to investigate the relationship between the TyG index and laryngeal squamous cell carcinoma.
Design Retrospective cohort study.
Setting Two tertiary care academic hospitals.
Methods The study included 53 patients with laryngeal squamous cell carcinoma (Group 1) and 48 healthy volunteers (Group 2). Laryngeal cancer patients were divided into two groups according to their stage. Stages I and II were named Group 1A, and Stages III and IV were called Group 1B. The TyG index was calculated as ln fasting Triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2. The effect of the TyG index on laryngeal cancer was investigated on the parameters of sex, age, body mass index, and stage of the disease.
Results There were no significant differences in age, sex, and BMI between the groups. The TyG index of group 1 (4.75 ± 0.33) was significantly higher than that of group 2 (4.59 ± 0.15). The TyG index value of group 1B (4.84 ± 0.31) was significantly higher than both group 1A (4.61 ± 0.32) and group 2 (4.59 ± 0.15). There was no significant difference between the TyG index values of group 1A (4.61 ± 0.32) and group 2 (4.59 ± 0.15).
Conclusion The TyG index may be a promising laryngeal squamous cell carcinoma biomarker. People with a higher TyG index may have a higher incidence of laryngeal squamous cell carcinoma and a higher risk of progression.
Risa Wakisaka, Takumi Kumai, Hiroki Komatsuda, Hidekiyo Yamaki, Michihisa Kono, Ryosuke Sato, Kenzo Ohara, Kan Kishibe, Tatsuya Hayashi, Atsutaka Okizaki, Miki Takahara
Publication date 01-07-2024
ABSTRACTIntroduction Fluorine 18-fluoro-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the staging of head and neck cancer. This study aimed to evaluate the correlation between 18F-FDG PET/CT, haematological parameters and prognosis in patients with advanced head and neck cancer.
Methods This was a single-institutional retrospective study of 83 patients with advanced head and neck squamous cell carcinoma (HNSCC) who underwent 18F-FDG PET/CT imaging before initial treatment between 2014 and 2018. 18F-FDG PET/CT after treatment was performed in 57 patients. The prognostic parameters of the pre- and post-treatment maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG) of primary tumours and haematological parameters were analysed to evaluate the association between overall survival (OS) and progression-free survival (PFS).
Results Pre-MTV, pre-TLG and post-SUVmax were significantly associated with poor OS and PFS (p < 0.05). Haematological parameters, including pretreatment neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio, were associated with 18F-FDG PET/CT parameters. In multivariate analysis, post-SUVmax was an independent prognostic factor for OS and PFS.
ConclusionA correlation between PET/CT metabolic and haematological parameters was observed. The volume and intensity of 18F-FDG uptake region, in addition to haematological parameters, are feasible markers for predicting the progression of HNSCC in daily practice. Further, post-SUVmax could be an independent parameter for predicting poor survival.
Yu‐Chun Chang, Meng‐Shan Wu, Shu‐Fen Siao, Ming‐Jhuan Wang, Yu‐Juan Xu, Cheryl\xa0Chia‐Hui Chen
Publication date 28-06-2024
ABSTRACTIntroduction As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high-quality, non-instrumental dysphagia screening tools used for the detection of adult dysphagia cases in all disease categories in acute-care settings.
MethodA literature search was conducted in five databases from each databases earliest inception to 31 July 2021 and guided by five keywords: ‘dysphagia’, ‘deglutition’, ‘screening’, ‘test’ and ‘measure’. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass–fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self-report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
Result Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS-2 review. We found six high-quality, non-instrumental screening tools for detecting adult dysphagia cases in acute-care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two-Step Thickened Water Test. These high-quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head-and-neck cancer.
Conclusions The results highlight the gap in the unavailability of high-quality dysphagia screening tool in several emerged high-risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high-risk populations in acute-care settings to screen for cases finding.
Süleyman Korkut, Mustafa Altıntaş
Publication date 28-06-2024
Abstract Objectives This study aimed to examine the frequency of anxiety disorder, coronavirus anxiety and health anxiety in tinnitus patients during the pandemic and also, determined the psychophysiological impact of COVID-19 on tinnitus.
Methods This cross-sectional study was conducted in a tertiary central pandemic hospital from 15 July 2021 to 15 December 2022. In total, 124 patients with tinnitus and 77 healthy controls participated in the study. The sociodemographic data, a set of valid and reliable assessment instruments were used to measure outcomes of anxiety disorder, coronavirus anxiety, health anxiety and severity of tinnitus.
Results Patients with tinnitus were found to experience higher levels of coronavirus anxiety, health anxiety and anxiety disorder than controls (p < 0.05). In tinnitus patients, the frequency of coronavirus anxiety was 22.6% and anxiety disorder was 18.5%. Notably, the levels of tinnitus severity were moderate to severe in more than half of the patients (51.6%) and also most of them (81.3%) reported that the severity of tinnitus during the pandemic was higher compared with the pre-pandemic.
Conclusion Tinnitus patients had high levels of anxiety disorder, coronavirus anxiety and health anxiety. In line with these findings, it was evaluated that there was a relationship between the COVID-19 pandemic with psychological problems and tinnitus. Therefore, the predominance of tinnitus symptoms at presentation should not lead the clinician to neglect the underlying psychopathological problems in these patients.