Myiasis, an infestation of living vertebrates by dipteran larvae, is relatively uncommon in otorhinolaryngology. Chronic otitis media and other ear pathologies are significant predisposing factors. This article presents the case of an 89-year-old bedridden female patient who presented with right ear discharge and visible maggots. Following mastoid exploration and systemic antibiotic therapy, her clinical symptoms improved. This case highlights the increased susceptibility of elderly, bedridden patients to aural myiasis.
Yung Jee Kang, Yun Gon Lee, Myung Jin Chung
et al.
Abstract Traditional survival predictions for oral squamous cell carcinoma (OSCC) rely on TNM staging, which lacks individualized prognostic value. Clinical factors such as performance status, age, sex, and lifestyle affect outcomes but are underrepresented in conventional models. This study applied artificial intelligence (AI) to integrate diverse factors for OSCC survival prediction. We retrospectively analyzed 1,018 OSCC patients surgically treated between 1996 and 2020. Variables included demographics, lifestyle, ASA classification, TNM stage, PET SUVmax, peri-neural and lympho-vascular invasion, extranodal extension, depth of invasion, resection margin, and treatment modalities. A deep neural network (DNN) for multi-group classification was developed and compared with regression-based DNN, Cox proportional hazards, and random survival forest models. To address class imbalance, least squares and multi-task learning were applied. Performance was assessed with concordance index and linearity testing. Death occurred in 18.1% of patients, with mean survival of 36.8 months. Recurrence occurred at 33 months. The DNN achieved an AUC of 0.922, sensitivity 0.514, specificity 0.992, and concordance index 0.888. Linearity testing confirmed strong correlation between predicted and observed outcomes. AI models integrating clinical variables provide more accurate OSCC survival predictions than conventional staging. The multi-group DNN is a promising tool for individualized prognosis and treatment planning.
Mami Matsunaga, Masahiro Kikuchi, Yuji Kitada
et al.
Objective: The apparent diffusion coefficient (ADC), obtained from diffusion-weighted imaging (DWI) on MRI, quantifies water diffusion within tissues and is commonly used to distinguish benign from malignant tumors. In the sinonasal region, preoperative diagnosis is often challenging due to diverse histologies and limited biopsy samples. This study aimed to assess the utility of ADCmean values in categorizing sinonasal tumors into benign tumors (excluding papillomas), papillomas, and malignant tumors, and to evaluate their potential as a supplementary diagnostic tool. Methods: We retrospectively analyzed 74 patients with sinonasal tumors who underwent surgery between January 2011 and April 2022 and had preoperative DWI-MRI for ADC measurement. Tumors were classified into three groups based on final pathology: benign tumors excluding papillomas (12 cases), papillomas (28 cases), and malignant tumors (34 cases). Receiver operating characteristic (ROC) analysis was used to determine ADCmean cutoff values for each category. Diagnostic accuracy of ADC-based classification was compared with that of preoperative biopsy. Additionally, 8 cases without biopsy due to technical or safety concerns were assessed using ADCmean values alone. Results: Mean ADC values significantly differed across groups: 1.89 ± 0.37 × 10−3 mm2/s for benign tumors excluding papillomas, 1.38 ± 0.33 × 10−3 mm2/s for papillomas, and 1.06 ± 0.27 × 10−3 mm2/s for malignant tumors. ROC analysis yielded optimal cutoff values: >1.57 for benign tumors excluding papillomas, 1.23–1.57 for papillomas, and < 1.23 for malignant tumors. Based on these thresholds, tumors were categorized into high (>1.57), intermediate (1.23–1.57), and low (<1.23) ADC groups. ADC-based classification achieved 68.9 % accuracy (51/74), lower than biopsy (95.4 %, 63/66), but correctly predicted tumor categories in all three cases where biopsy results were discordant with final pathology. In 8 cases without biopsy, ADC-based categorization achieved 87.5 % accuracy (7/8). Conclusion: ADCmean values from DWI-MRI can effectively differentiate between benign tumors excluding papillomas, papillomas, and malignant tumors. Although not as accurate as biopsy, ADC-based categorization adds diagnostic value, especially in cases where biopsy is inconclusive or infeasible. Combining ADC analysis with biopsy findings may improve preoperative diagnostic accuracy and assist clinical decision-making in managing sinonasal tumors.
Andreas H. Mueller, Kathleen Klinge, Gerhard Foerster
et al.
ABSTRACT Objectives To achieve glottal gap closure in unilateral vocal fold paralysis (UVFP) through complementary ansa cervicalis nerve muscle pedicle laryngeal reinnervation (ANMP‐LR). Introduction ANMP‐LR is easy to learn and does not require recurrent laryngeal nerve (RLN) transection. Materials and Methods Twelve patients with unilateral vocal fold paralysis (UVFP) were included, who received ANMP‐LR and could be followed up for at least 6–24 months. At baseline, after 3–6 (T1), 12 (T2) and 24 months (T3), Voice Handicap Index (VHI), perceived roughness (R) and breathiness (B), sound pressure level (SPLmax), maximum phonation time (MPT), Dysphonia Severity Index (DSI) and glottal gap (GG) were recorded. Results R and B were significantly reduced at T1, MPT and SPLmax increased significantly up to T1 (MPT to 15.8 s; SPLmax to 91.5 dB). Similarly, VHI dropped significantly and the residual glottal gap (GG) was significantly reduced between T0 and T1. All outcomes remained stable until T3. There was a non‐significant tendency to further improvement until T3 in SPLmax and GG. Discussion The T1–T3 outcomes of the complementary ANMP‐LR are comparable with the standard LR and also with thyroplasty. As with all LR techniques, younger patients and those with shorter paralysis benefit more. Patients with evidence of unfavorable laryngeal synkinesis are more likely to benefit from a standard LR with RLN transection. Conclusions Younger patients with insufficient synkinetic reinnervation and persisting or progressive glottis closure insufficiency in UVFP benefit from early reinnervation. When the easy‐to‐learn ANMP technique is used, any partial rehabilitation that has already been achieved or any remaining chance of spontaneous reinnervation via the RLN is not compromised. Level of Evidence: 3
Abstract The tumor necrosis factor receptor superfamily (TNFRSF) plays a vital role in eliciting immune responses against infections. The tree shrew, closely related to primates, is often utilized in human disease models. Here, we analyzed TNFRSF members from 11 different animal species, including the Chinese tree shrew, and identified 24 tree shrew TNFRSF (tTNFRSF) genes, which were grouped into seven subcategories with similar motifs, sequences, and gene structures. As expected, the multi-species collinearity analysis revealed that tTNFRSF genome bears a greater resemblance to humans than to mice. Transcriptome data from 28 samples across ten organ types showed high TNFRSF expression predominantly in immune organs. It was seen that TNFRSF13C co-expresses consistently with the B cell surface marker CD79A, which is consistent with its characteristics in humans. The tissue distribution and co-expression were confirmed via RT-qPCR and immunofluorescence. Evaluation of transcriptome data from 70 samples infected with six types of viruses showed that most TNFRSF genes were upregulated in tree shrew post-viral infection. TNFRSF exerts antiviral function most probably through the activation of the NF-κB pathway, subsequently causing apoptosis of infected cells. Our findings provide evolutionary and functional insights into tTNFRSF, indicating its potential utility in human viral infection models.
Yao-Te Tsai, Ming-Hsien Tsai, Geng-He Chang
et al.
Abstract We probed the associations of preoperative modified geriatric nutritional risk index (mGNRI) values with prognosis in patients receiving surgery for oral cavity squamous cell carcinoma (OCSCC). This retrospective study analyzed the clinical data of 333 patients with OCSCC and undergoing surgery between 2008 and 2017. The preoperative mGNRI was calculated using the following formula: (14.89/C-reactive protein level) + 41.7 × (actual body weight/ideal body weight). We executed receiver operating characteristic curve analyses to derive the optimal mGNRI cutoff and employed Kaplan–Meier survival curves and Cox proportional hazard model to probe the associations of the mGNRI with overall survival (OS) and disease-free survival (DFS). The optimal mGNRI cutoff was derived to be 73.3. We noted the 5-year OS and DFS rates to be significantly higher in the high-mGNRI group than in the low-mGNRI group (both p < 0.001). A preoperative mGNRI below 73.3 was independently associated with unfavorable DFS and OS. A mGNRI-based nomogram was constructed to provide accurate OS predictions (concordance index, 0.781). Hence, preoperative mGNRI is a valuable and cost-effective prognostic biomarker in patients with OCSCC. Our nomogram facilitates the practical use of mGNRI and offers individualized predictions of OS.
Vicky Galstyan-Minasova, Agustín Alamar-Velazquez, Isabel Ibañez-Alcañiz
et al.
We report a case of a 12-year-old adolescent diagnosed with Pott’s puffy tumor and epidural empyema as a complication of acute sinusitis. Pott’s puffy tumor is described as an inflammation in the frontal region due to the formation of a subperiotic abscess and osteomyelitis of the frontal bone. Although uncommon nowadays, this entity usually appears in adolescents, and it is frequently associated with intracranial complications. Early diagnosis, antibiotic therapy and endoscopic treatment when required are essential to avoid the risk of intracranial progression.
Nestorović Dragoslav, Nikolić Igor, Pavlović Bojan
et al.
Introduction. Juvenile nasopharyngeal angiofibroma are benign tumors, with locally aggressive behavior. Preoperative tumor embolization with polyvinyl alcohol particles can reduce intraoperative blood loss and facilitate surgical resection. Case outline. A 16-year-old male was admitted to hospital due to profuse epistaxis and sense of nose fullness. Multidetector computed tomographic angiography examination showed a tumor mass in the right nasal cavity with extension to the right maxillary sinus and ethmoidal cells on the right, and in the left nasal cavity. It rested on the nasal septum, but without bone destruction. After application of contrast agent, described mass became intensely opacified. Preprocedural digital subtraction angiography of external and internal carotid arteries of both sides showed extensive pathological vascularization, which received main contribution from branches of maxillary artery on right and, to a lesser extent, on left side. Due to danger of penetration of a particle embolization agent of smaller diameter into orbital branches and possible retrograde migration into carotid artery, we decided to apply particle embolization agent of larger diameter (500–700 μm) than prescribed by modern standards. Tumor was completely surgically removed third day after embolization, and patient was discharged without any neurological deficit. Control contrast enhanced multidetector computed tomographic angiographies were performed at third and seventh month after surgery and showed no tumor residue or recurrence. Conclusion. The use of particles of larger diameter gave satisfactory results during operation – surgical excision of tumor, when dangerous anastomoses do not allow use of particles of smaller diameter and can be safely performed without significant neurological nor systemic complications.
Ashraf Khaled, Ahmed Saeed, Mohamed Abdeltawab
et al.
The goal of th study is to evaluate the role of high‑resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media (COM). 30 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra‑operative findings were compared and correlated with the radiological findings, to calculate the predictive value of HRCT temporal bone. According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters.The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.
To investigate the effect of choline alfoscerate (CA) on hearing amplification in patients with age related hearing loss, we performed a prospective case-control observational study from March 2016 to September 2020. We assessed patients with bilateral word recognition score (WRS) <50% using monosyllabic words. The patients were 65–85 years old, without any history of dementia, Alzheimer’s disease, parkinsonism, or depression. After enrollment, all patients started using hearing aids (HA). The CA group received a daily dose of 800 mg CA for 11 months. We performed between-group comparisons of audiological data, including pure tone audiometry, WRS, HA fitting data obtained using real-ear measurement (REM), and the Abbreviated Profile of Hearing Aid benefit scores after treatment. After CA administration, the WRS improved significantly in the CA group (4.2 ± 8.3%), but deteriorated in the control group (−0.6 ± 8.1%, p = 0.035). However, there was no significant between-group difference in the change in pure tone thresholds and aided speech intelligibility index calculated from REM. These findings suggest that the difference in WRS was relevant to central speech understanding rather than peripheral audibility. Therefore, administering oral CA could effectively enrich listening comprehension in older HA users.
Rocco Pio Ortore, Maria Pia Leone, Orazio Palumbo
et al.
Hearing loss (HL) affects 1–3 newborns per 1000 and, in industrialized countries, recognizes a genetic etiology in more than 80% of the congenital cases. Excluding <i>GJB2</i> and <i>GJB6</i>, <i>OTOA</i> is one of the leading genes associated with autosomal recessive non-syndromic HL. Allelic heterogeneity linked to <i>OTOA</i> also includes genomic rearrangements facilitated by non-allelic homologous recombination with the neighboring <i>OTOAP1</i> pseudogene. We present a couple of Italian siblings affected by moderate to severe sensorineural hearing loss (SNHL) due to compound heterozygosity at the <i>OTOA</i> locus. Multigene panel next-generation sequencing identified the c.2223G>A, p.(Trp741*) variant transmitted from the unaffected mother. Assuming the existence of a second paternal deleterious variant which evaded detection at sequencing, genomic array analysis found a ~150 Kb microdeletion of paternal origin and spanning part of <i>OTOA</i>. Both deleterious alleles were identified for the first time. This study demonstrates the utility of an integrated approach to solve complex cases and allow appropriate management to affected individuals and at-risk relatives.
Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.
Diseases of the endocrine glands. Clinical endocrinology
Background: Acute Otitis media (AOM) and its recurrence is a prevalent health problem among pre-school children. Different strategies to prevent recurrent have been established with questionable efficacy. Vitamin D is suspected as a possible preventable risk factor. Aim of the work:To evaluate the effect of vitamin-D supplementation on recurrence rate of acute otitis media among Pre-school children.Patients and Methods:60 pre-school children with a recurrent episode of acute otitis media [by history and otoscopic examination] were included. After diagnosis, all children received standard treatment and after recovery, serum levels of vitamin-D were estimated; those with reduced vitamin D had been included, then divided into: Study group (30 children, received oral vitamin-D supplementation for 4 months; and Control group (30 children; received placebo). New attacks of AOM had been document during the regular visits for the six months. Vitamin D had been re-estimated after 6 months.Results: Both groups were comparable regarding studied variables at the start. Upper respiratory tract infection and ear discharge significantly decreased; vitamin D significantly increased among study group at 6 months. Recurrent AOM after 6 months, had been significantly reduced among study vs control group (1.43±0.62 vs 3.46±0.62 respectively). Also, vitamin-D significantly increased at the end in study vs control group (21.76±5.95 vs 14.53±4.73 ng/ml respectively). The mean percentage of increase of vitamin-D in study group was 135.98% compared to 33.91%. In control group.Conclusion: Vitamin D supplementation to children with a history of rAOM plays a significant role in reduction of attack frequency.
Cyclic AMP (cAMP) is involved in many biological processes but little is known regarding its role in shaping immunity. Here we show that cAMP-PKA-CREB signaling (a pattern recognition receptor [PRR]-independent mechanism) regulates conventional type-2 Dendritic Cells (cDC2s) in mice and reprograms their Th17-inducing properties via repression of IRF4 and KLF4, transcription factors essential for cDC2-mediated Th2 induction. In mice, genetic loss of IRF4 phenocopies the effects of cAMP on Th17 induction and restoration of IRF4 prevents the cAMP effect. Moreover, curdlan, a PRR-dependent microbial product, activates CREB and represses IRF4 and KLF4, resulting in a pro-Th17 phenotype of cDC2s. These in vitro and in vivo results define a novel signaling pathway by which cDC2s display plasticity and provide a new molecular basis for the classification of novel cDC2 and cDC17 subsets. The findings also reveal that repressing IRF4 and KLF4 pathway can be harnessed for immuno-regulation.
Josef Heusinger, Heika Hildebrandt, Robert‐Benjamin Illing
Abstract Introduction Cochlear ablation causing sensory deafferentation (SD) of the cochlear nucleus triggers complex re‐arrangements in the cellular and molecular communication networks of the adult mammalian central auditory system. Participation of the extracellular matrix (ECM) in these processes is not well understood. Methods We investigated consequences of unilateral SD for the expression and distribution of the chondroitin sulfate proteoglycans, neurocan (Ncan) and aggrecan (Agg), alongside various plasticity markers in the auditory brainstem of the adult rat using immunohistochemical techniques. Results In the deafferented ventral cochlear nucleus (VCN), Ncan expression increased massively within 3 postoperative days (POD), but rapidly decreased thereafter. Agg showed a similar but less pronounced progression. Decrease in Ncan was spatially and temporally related to the re‐innervation of VCN documented by the emergence of growth‐associated protein Gap43 contained in nerve fibers and presynaptic boutons. Concurrently, astrocytes grew and expressed matrix metalloproteinase‐2 (MMP2), an enzyme known to emerge only under re‐innervation of VCN. MMP2 is capable of cleaving both Ncan and Agg when released. A transient modulation of the ECM in the central inferior colliculus on the side opposite to SD occurred by POD1. Modulations of glutamatergic synapses and Gap43 expression were detected, reflecting state changes of the surrounding tissue induced by transsynaptic effects of SD. Conclusions The ECM variously participates in adaptive responses to sudden deafness by SD on several levels along the central auditory pathway, with a striking spatial and temporal relationship of Ncan modulation to astrocytic activation and to synaptogenesis.
Paul W. Gidley MD, Jennifer Maw MD, Bruce Gantz MD
et al.
Objective To examine the current trend in intraoperative facial nerve monitoring (IOFNM) training, performance, and reimbursement by subspecialists. Study Design Cross-sectional survey of the American Neurotology Society, American Otological Society, American Society of Pediatric Otolaryngology, and program directors of otolaryngology–head and neck surgery programs accredited by the Accreditation Council on Graduate Medical Education. Setting American Academy of Otolaryngology–Head and Neck Surgery Intraoperative Nerve Monitoring Task Force. Subjects and Methods The task force developed 2 surveys, which were implemented through Surveymonkey.com: (1) a 10-question survey sent to 1506 members of the societies listed to determine IOFNM practice and reimbursement patterns and (2) a 10-question survey sent to the 107 accredited US otolaryngology residency program directors to examine the state of resident training on facial nerve monitoring. Results Response rates were 18% for practicing physicians and 15% for residency program directors. The majority agreed that IOFNM was indicated for most otologic and neurotologic procedures. In addition to facial nerve monitoring, facial nerve stimulation was used in complex skull base and temporal bone procedures. When queried about reimbursement by Medicare, only 4.4% of surgeons responded that they received reimbursement. Program directors indicated universal exposure of residents to IOFNM, with 61% of programs giving residents formal training. Conclusions IOFNM is widely used among otologists and neurotologists in the United States. The majority of residents receive formal training, and all residents are exposed to the setup, use, monitoring, and troubleshooting of the device. Reimbursement for IOFNM is reported by a paucity of those surveyed.