Hasil untuk "Otorhinolaryngology"

Mengzhong Li, Wenjie Liang, Wei Liang et al.

Background and purpose: This meta-analysis aimed to evaluate whether acupuncture combined with other traditional Chinese medicine (TCM) therapies is more effective in the treatment of peripheral facial palsy (PFP) than acupuncture alone. Methods: Eight databases were searched until May 2025. Two independent reviewers extracted relevant data on study characteristics and used the Cochrane Risk of Bias Assessment Tool 2 (RoB2) to assess the risk of bias of the included studies. Results: 266 articles were included. Results showed that compared with acupuncture alone, acupuncture combined with tuina and cupping (surface under the cumulative ranking curve (SUCRA) = 99.33%) was the most effective intervention for improving the overall effective rate; acupuncture combined with topical application of TCM (SUCRA = 90.61%) was the optimal approach for enhancing facial nerve function (House-Brackmann (HB) scale); acupuncture combined with herbal fumigation and steaming therapy (SUCRA = 80.40%) was the best intervention for improving social function (Facial Disability Index - Social Function (FDIS)) in patients with facial paralysis; acupuncture combined with pricking blood (SUCRA = 87.62%) was the most effective method for improving physical function (Facial Disability Index - Physical Function (FDIP)) in patients with facial paralysis; and acupuncture combined with cupping and pricking blood (SUCRA = 86.90%) was associated with the lowest incidence of adverse reactions. Conclusion: This study showed that interventions such as acupuncture+tuina+cupping, acupuncture+topical application of TCM, acupuncture+herbal fumigation and steaming therapy, and acupuncture+pricking blood are all associated with facial nerve recovery and demonstrate superior efficacy compared with acupuncture alone.

Andres Gonzalez Fernandez, Manuela Del Carmen Zapata, Iñigo Ruiz de Erenchun Lasa et al.

Abstract Objective To determine the efficacy of salvage intratympanic corticosteroid therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) who exhibited an insufficient response to initial systemic corticosteroids. Material and methods In this retrospective quasi-experimental study, ISSNHL patients treated from 2019 to 2024 were included. Pure tone audiometry (PTA) thresholds were measured at baseline (pre-treatment), after systemic corticosteroids, and three months post-final intervention. Outcomes were defined as. • Complete recovery: final mean PTA ≤ 10 dB poorer than the unaffected ear or pre-loss baseline. • Partial recovery: ≥ 10 dB PTA improvement, yet final PTA still > 10 dB poorer. • No recovery: < 10 dB PTA improvement. A secondary binary classification categorized patients as “recovered” (≥ 10 dB PTA gain) or “non-recovered” (< 10 dB gain). Results Systemic corticosteroids achieved a significant mean PTA improvement of 5.6 dB (p = 0.001) in this group (patients with no complete recovery after oral treatment). Subsequent intratympanic therapy added a further 1.76 dB gain, though this was not statistically significant (p = 0.115). After systemic therapy, 27.9% of patients attained partial recovery; 72.1% showed no improvement. At final follow-up, 9.3% achieved complete recovery, 29.1% partial recovery, and 61.6% no recovery. According to the binary criterion, 38.4% were classified as recovered post-intratympanic treatment, a non-significant increase (p = 0.078). Conclusions These findings indicate that systemic corticosteroid therapy provides a notable audiometric benefit in ISSNHL. However, in this cohort, salvage intratympanic steroid therapy did not yield a statistically significant additional effect. Further prospective, controlled trials are warranted to clarify the role of intratympanic steroids for patients with incomplete systemic response.

Asghar Akhavan, Mahdieh Hasanalifard, Reyhaneh Abolghasemi et al.

Introduction: Sufficient sleep is one of the most important factors in maintaining focus and attention in pilots. In this matched cross-sectional comparative study, the sleep status and related factors in commercial airline flight pilots were evaluated. Methods: All pilots and the healthy sex- and age-matched controls who met the inclusion criteria and signed informed consent were included in the study. Information about sleep quality was collected using the Pittsburgh sleep quality index. The Epworth sleepiness scale assessed the subjective daytime sleepiness. The Stop-Bang sleep apnea questionnaire was a tool for the risk of obstructive sleep apnea screening. Results: One hundred and seven airline pilots and 100 healthy control people were included in this study. The results showed that the risk of obstructive sleep apnea was significantly equal in pilot and control groups. The sleep quality and daytime sleepiness were significantly worse in the pilot group. In the pilot group, the marital status, sleep duration of 24 hours, education level, physical activity, and exercise correlated to sleep quality. The sleep apnea state was correlated to age, Body Mass Index, marital status, and morning headache. The flight hours and distances were correlated with at least one of the sleep questionnaires results. The regression model analysis showed that none of the independent variables had a significant effect on the probability of the Stop-Bang questionnaire and PSQI scores. But nine independent variables had a significant effect on the Epworth sleepiness scale. Discussion: Among the Iranian commercial airline pilots, the risk of sleep apnea is not higher than those in the control group. Even though they are at higher risk of reducing sleep quality and increasing daytime sleepiness. Appropriate intervention on demographic factors and blood parameters improves pilots' sleep status.

Sarah AlMansour, Manal Bukhari, Mohammed AlMohizea et al.

Abstract Background The Subglottic Stenosis-6 (SGS-6) is a concise, disease-specific questionnaire designed to assess the severity and progression of subglottic stenosis (SGS), thereby aiding decision-making about the need for intervention. Although it has been validated in English, it has not yet been translated into Arabic. Objectives To translate the SGS-6 into Arabic and validate its psychometric properties in an Arabic-speaking population with SGS. Methods Following forward and backward translation and a comprehension assessment, the Arabic SGS-6 was administered to 28 SGS patients. Internal consistency, test-retest reliability (n = 20), and external validity by correlation with the EuroQoL five-dimension questionnaire (EQ-5D) were analyzed. Results Participants (mean age 44.6 years, 75% female) found the Arabic SGS-6 clear (93%) and easy to complete (96%). Internal consistency was high (Cronbach’s alpha = 0.786 test; 0.812 retest), and test-retest reliability was excellent (ICC = 0.872 single measures; 0.932 average measures). SGS-6 scores correlated significantly with EQ-5D dimensions, notably mobility, usual activities, and pain/discomfort items, confirming external validity. Multiple interventions, the use of inhaled corticosteroids, and dietary modifications were associated with higher SGS-6 scores. The number of previous interventions was the sole independent predictor of SGS-6, suggesting the tool’s sensitivity to disease complexity. Conclusion The Arabic SGS-6 is a reliable, valid, and user-friendly tool for assessing disease severity and QOL in Arabic-speaking SGS patients. Its implementation may improve patient-centered care and guide clinical decision-making, particularly in identifying patients who may require a timely intervention.

Rongrong Liu, Wenjing Shang, Yingying Liu et al.

Abstract The Fscn2 (Fascin2) gene encodes an actin cross-linking protein that is involved in the formation of hair cell stereocilia and retina structure. Mutations in Fscn2 gene have been linked to hearing impairment and retinal degeneration in humans and mice. To understand the function of the Fscn2 gene, we generated the Fscn2 knockout mice, which showed progressive loss of hearing and hair cells. Our goal of the present study was to investigate the mechanism underlying cochlear cell death in the Fscn2 knockout mice. Microarray analysis revealed upregulation of expression of PARVB, a local adhesion protein, in the inner ears of Fscn2 knockout mice at 8 weeks of age. Further studies showed increased levels of PARVB together with cleaved-Caspase9 and decreased levels of ILK, p-ILK, p-AKT, and Bcl-2 in the inner ears of Fscn2 knockout mice of the same age. Knockdown of Fscn2 in HEI-OCI cells led to decreased cell proliferation ability and migration rate, along with increased levels of PARVB and decreased levels of ILK, p-ILK, p-AKT, Bcl-2 and activated Rac1 and Cdc42. Overexpression of Fscn2 or inhibition of Parvb expression in HEI-OC1 cells promoted cell proliferation and migration, with increased levels of ILK, p-ILK, p-AKT, and Bcl-2. Finally, FSCN2 binds with PPAR-γ to reduce its nuclear translocation in HEI-OC1 cells, and inhibition of PPAR-γ by GW9662 decreased the level of PARVB and increased the levels of p-AKT, p-ILK, and Bcl-2. Our results suggest that FSCN2 negatively regulates PARVB expression by inhibiting the entry of PPAR-γ into the cell nucleus, resulting in inhibition of ILK-AKT related pathways and of cochlear cell survival in Fscn2 knockout mice. Our findings provide new insights and ideas for the prevention and treatment of genetic hearing loss.

Mahzad Erami, Mahzad Erami, Hossein Mirhendi et al.

Along with the pandemic COVID-19 spreads, new clinical challenges have emerged in the health care settings, among which there is a high risk of secondary invasive fungal infections with significant mortality. Here, we report a case of invasive fungal rhino orbital sinusitis due to the simultaneous co-infection by Rhizopus oryzae and Lomentospora prolificans, both identified by sequencing, in a 70-year-old Afghanistanian female with COVID-19. The patient was subjected to surgical debridement as well as taking liposomal amphotericin B, voriconazole, and on discharge, her condition was good. As far as we know, this is the first case of co-infection of COVID-19-associated mucormycosis (CAM) and Lomentospora prolificans infection. Multiple fungal co-infections in COVID-19 patients are reviewed.

Tatsuya Yamakura, Akira Shimizu, Isaku Okamoto et al.

Transoral robotic surgery (TORS) and transoral videolaryngoscopic surgery (TOVS) are minimally invasive procedures for early-stage head and neck cancers. However, due to its unique nature, transoral resection often leads to skeletal and anatomical disorders. We describe a case in which TORS was used in a 71-year-old man with a skeletal disorder, spastic stridor, and a T2N1M0 stage I p16-positive oropharyngeal carcinoma. Prior to the procedure, he underwent right cervical dissection (levels II–IV). Although he had an oblique neck, the right side of his neck was naturally hyperextended because the dissection was performed on the right side. The right facial, lingual, and external carotid arteries were ligated in preparation for TORS. Postoperative pathological examination revealed no extranodal involvement of the metastatic lymph nodes. A two-stage TOVS procedure was performed for the oropharyngeal tumor, in which the surgeon was required to be positioned at the patient’s head to allow direct manipulation. This makes the neck and oral cavity more susceptible to the skeletal effects. In contrast, in TORS, the da Vinci insertion angle can be set to match the angle of the neck, allowing surgeons to operate with less skeletal influence. TORS is more useful in this setting.

Yi-An Lu, Yun-Chen Tsai, Wan-Ni Lin et al.

Objectives. Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. Methods. In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. Results. Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. Conclusion. CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.

Inês Falcão, Maria Luís Marques, Filipa Rodrigues dos Santos et al.

A dermatite do ouvido é uma doença inflamatória cutânea crónica de difícil tratamento, uma vez que a etiologia, na maioria das vezes, permanece desconhecida e o ouvido é um local de difícil acesso para aplicação de medicação tópica. O prurido auricular é a principal queixa, com grandes repercussões na qualidade de vida do doente e desempenho pessoal e profissional. Este trabalho tem como objetivo uma revisão sobre as dermatites do ouvido e atualização sobre o seu tratamento, uma vez que até ao momento não existe publicada uma revisão em português sobre as linhas orientadoras de diagnóstico e tratamento da doença.

Akina Tamaki MD, Shruthi Sethuraman BS, Lucy Shi MD et al.

Objectives Osseous microvascular free tissue transfer (MFTT) is the gold standard for reconstruction for most segmental mandibulectomy defects. The most common osseous MFTT utilized in reconstruction is the fibular, scapular, and osteocutaneous radial forearm (OCRF) free flap. We evaluated postoperative bone union as well as clinical complications following MFTT and the impact of various patient and reconstructive characteristics, including type of osseous MFTT. Study Design Retrospective cohort study. Setting Tertiary care academic hospital. Methods This study examined patients who underwent osseous MFTT for mandibular defects from January 2017 to January 2019. Results An overall 144 osteotomies in 58 patients were evaluated. Of the 144 junctions, 28 (19.4%) showed radiographic nonunion. Patients who underwent preoperative (odds ratio [OR] = 0.30, P = .027) and postoperative (OR = 0.28, P = .003) radiation had a significantly lower bone union score. Time from surgery to postoperative imaging was associated with higher bone union scores (OR = 1.07, P = .024). When bone union scores were compared among types of MFTT, fibular (OR = 5.62, P = .008) and scapular (OR = 4.69, P = .043) MFTT had significantly higher scores than OCRF MFTT. Twelve (20.7%) patients had postoperative complications. There was no statistically significant correlation between clinical complications and various variables, including type of osseous MFTT. Conclusion Pre- and postoperative radiation and time from surgery have an impact on bone union. Regarding the type of MFTT, fibular and scapular MFTT appeared to have higher bone union when compared with OCRF. There was no impact of bone union or type of osseous MFTT on clinical complications.

Alexander G. Foote, Julianna Tibbetts, Stephanie M. Bartley et al.

Abstract Objective The primary aim of this study was to identify expression of TRPV3 and TRPV4 chemoreceptors across perinatal and adult stages using a murine model with direct comparisons to human laryngeal mucosa. Our secondary aim was to establish novel cell expression patterns of mechanoreceptors PIEZO1 and PIEZO2 in human tissue samples. Study design In vivo. Methods We harvested murine laryngeal tissue to localize and describe TRPV3/4 endogenous protein expression patterns via immunofluorescence analyses across two developmental (E16.5, P0) and adult (6 weeks) timepoints. Additionally, we obtained a 60‐year‐old female larynx including the proximal trachea and esophagus to investigate TRPV3/4 and PIEZO1/2 protein expression patterns via immunofluorescence analyses for comparison to murine adult tissue. Results Murine TRPV3/4 expression was noted at E16.5 with epithelial cell colocalization to supraglottic regions of the arytenoids, aryepiglottic folds and epiglottis through to birth (P0), extending to the adult timepoint. Human TRPV3/4 protein expression was most evident to epithelium of the arytenoid region, with additional expression of TRPV3 and TRPV4 to proximal esophageal and tracheal epithelium, respectively. Human PIEZO1 expression was selective to differentiated, stratified squamous epithelia of the true vocal fold and esophagus, while PIEZO2 expression exhibited selectivity for intermediate and respiratory epithelia of the false vocal fold, ventricles, subglottis, arytenoid, and trachea. Conclusion Results exhibited expression of TRPV3/4 chemoreceptors in utero, suggesting their importance during fetal/neonatal stages. TRPV3/4 and PIEZO1/2 were noted to adult murine and human laryngeal epithelium. Data indicates conservation of chemosensory receptors across species given similar regional expression in both the murine and human larynx.

Steven A. Gordon MD, MPH, Alana Aylward MD, Neil S. Patel MD et al.

Objective To evaluate whether frailty or age increases the risk of postoperative complications following cochlear implant (CI) surgery. Study Design Retrospective cohort study. Setting Tertiary academic center. Methods An evaluation of all adult patients undergoing cochlear implantation between 2006 and 2020 was performed. The 5-item Modified Frailty Index (mFI-5, comprising preoperative history of pulmonary disease, heart failure, hypertension, diabetes, and partially/totally dependent functional status) was calculated for all patients included in analysis in addition to demographic characteristics. The primary outcome was postoperative complications following CI within a 3-month period. Major complications included myocardial infarction, bleeding, and cerebrospinal fluid leak, among others. Predictors of postoperative complications were examined using multivariable logistic regression reporting odds ratios (ORs) and 95% CIs. Results There were 520 patients included for review with a median age of 68 (range, 18-94) years and a slight male predominance (n = 283, 54.4%). There were 340 patients (65.4%) who were robust (nonfrail) with an mFI of 0, while 180 (34.6%) had an mFI of ≥1. There were 20 patients who experienced a postoperative complication (3.85%). There was no statistically significant association between postoperative complications as a result of preoperative frailty (OR, 1.56; 95% CI, 0.98-2.48, P = .06) or age as a continuous variable (OR, 0.99; 95% CI, 0.97-1.02, P = .51). Conclusions CI is safe for elderly and frail patients and carries no additional risk of complications when compared to younger, healthier patients. While medical comorbidities should always be considered perioperatively, this study supports the notion that implantation is low risk in older, frail patients.

Jacob I. Tower MD, Lynn Acton MS, CCC-SLP, Jessica Wolf et al.

Objective The purpose of this study was to investigate the effect of vocal training on acoustic and aerodynamic characteristics of student actors’ voices. Study Design Prospective cohort study. Setting Tertiary medical facility speech and swallow center. Subjects and Methods Acoustic, aerodynamic, and Voice Handicap Index–10 measures were collected from 14 first-year graduate-level drama students before and after a standard vocal training program and analyzed for changes over time. Results Among the aerodynamic measures that were collected, mean expiratory airflow was significantly reduced after vocal training. Among the acoustic measures that were collected, mean fundamental frequency was significantly increased after vocal training. On average, Voice Handicap Index–10 scores were unchanged after vocal training. Conclusion The cohort of drama students undergoing vocal training demonstrated improvements in voice aerodynamics, which indicate enhanced glottal efficiency after training. The present study also found an increased average fundamental frequency among the actors during sustained voicing and no changes in jitter and shimmer despite frequent performance.

Mark Anthony Gomez, Romeo Villarta, Ruzanne Caro et al.

Objective:  This study aimed to determine the prevalence of nasopharyngeal tuberculosis among patients who were initially assessed to have a nasopharyngeal mass and subsequently underwent biopsy in a Philippine Tertiary General Hospital from 2013 to 2015.   Methods:       Design:           Case Series      Setting:           Tertiary National University Hospital      Participants: All patients with nasopharyngeal mass identified from January 2013 to December 2015 from a hospital wide census who underwent biopsy were investigated using chart and histopathology review. The prevalence of tuberculosis, malignancies and other findings were determined.   Results:  Among 285 nasopharyngeal biopsies done between 2013 and 2015, 33 (11.6%) were histologically compatible with nasopharyngeal tuberculosis, 177 (62.1%) were different types of nasopharyngeal carcinoma, 59 (20.7%) were chronic inflammation, 4 (1.4%) were lymphoma, 5 (1.8%) were normal, and 7 (2.5 %) had diagnoses other than those above.   Conclusion: This study suggests a relatively high prevalence rate (11.6%) of nasopharyngeal tuberculosis in patients who have a nasopharyngeal mass. This indicates that nasopharyngeal tuberculosis should always be a differential when confronted with a mass in the nasopharynx especially in tuberculosis endemic areas.   Keywords: nasopharyngeal tuberculosis; prevalence; censuses; tertiary care centers; Philippines; carcinoma; nasopharynx; biopsy; tuberculosis; lymphoma

F.T. AIRES, R.A. DEDIVITIS, M.A.V. KULCSAR et al.

Katharina Stölzel, Judith Droste, Linda Josephine Voß et al.

Acute low-tone sensorineural hearing loss (ALHL) is a type of idiopathic sudden sensorineural hearing loss. ALHL is rarely a solitary condition but rather co-occurs with vertigo and tinnitus, being an element of contemporary diagnostic criteria for Menière's disease (MD). The goal of our present study was to determine the value of ALHL for the early diagnosis of MD in patients presenting in the emergency room with ALHL as a main complaint. The files of 106 patients with ALHL who were admitted to the emergency room over the period of 7 years and 104 patients with acute high- tone sensorineural hearing loss (AHHL) from the same period were included in this retrospective study. Forty ALHL patients presented with recurrent episode of hearing loss and 66 remaining patients presented with ALHL for the first time. Of the latter group, 25 patients gave consent for the follow-up. First, we analyzed the difference in the occurrence of tinnitus and vertigo between the ALHL and AHHL groups. In patients with ALHL, the incidence of vertigo with tinnitus and the number of recurrent episodes were statistically higher than in patients with AHHL. Next, we focused on the ALHL follow-up group (25 patients). In that group, two patients had all MD symptoms at presentation, 18 had ALHL and tinnitus and five ALHL only. Of 18 patients with ALHL and tinnitus at admission, five developed vertigo and thus the triad of Menière's disease. None of the five patients with AHLH as a sole symptom developed MD during the follow-up time but four of them have developed tinnitus. Patients with recurrent ALHL had significantly higher incidence of MD than the patients with first episode. We conclude that some patients who present with ALHL and concomitant tinnitus or have recurrent episodes of ALHL are more likely to develop Menière's disease than these patients, who present with ALHL as a sole symptom. Nonetheless, we recommend otological follow-up for all patients presenting with ALHL.