Acta Oto-Laryngologica最新文献

Background: Cervical ultrasonography (US) may complement cross-sectional imaging for nodal assessment in pharyngeal and laryngeal squamous cell carcinoma.

Aims/objectives: To compare US with contrast-enhanced CT and MRI for patient-level detection of cervical nodal metastasis using pathology as the reference standard; T-staging performance was secondary.

Material and methods: This retrospective study included 107 surgically treated patients. CT and MRI were reassessed by two pathology-blinded radiologists, whereas US classifications were extracted from clinical reports. Nodal performance was evaluated in 72 patients with neck dissection.

Results: For N-positive disease, US sensitivity, specificity, and accuracy were 81.2%, 79.2%, and 80.6%. In the matched N cohort (n = 41), correct classification rates were 82.9%, 80.5%, and 90.2% for US, CT, and MRI (p = 0.395). US primary-tumour assessment was evaluable in 54 of 107 patients (50.5%); sensitivity, specificity, and accuracy for T3-4 disease were 45.5%, 90.5%, and 63.0%. In the matched T cohort (n = 30), correct classification rates were 56.7%, 80.0%, and 76.7% (p = 0.028); no pairwise comparison remained significant after Holm adjustment.

Conclusions and significance: US may complement assessment of accessible cervical nodes, but primary-tumour applicability is limited. CT and MRI remain essential for assessment of primary-tumour extent and deep nodal disease.

Background: Parotid gland squamous cell carcinoma (PSCC) is a rare malignancy with limited evidence regarding optimal management strategies.

Aims/objectives: To compare survival outcomes between surgery and definitive chemoradiation therapy (CRT) in patients with locally advanced PSCC.

Materials and methods: Data on 1,320 patients with T3/T4a M0 PSCC treated with surgery or CRT were retrieved from a population-based database. Inverse probability of treatment weighting (IPTW) was applied to adjust for selection biases. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method and Cox proportional hazards models.

Results: After IPTW adjustment, the surgery group achieved significantly superior 5-year OS (38.9% vs. 27.7%, p = 0.027) and 5-year CSS (61.2% vs. 43.8%, p = 0.003) compared with the CRT group. In multivariate analyses, CRT was an independent adverse prognostic factor for OS (HR 1.50, 95% confidence interval (CI) 1.12-2.01) and CSS (HR 1.76, 95%CI 1.21-2.55). In surgical patients, postoperative radiotherapy or CRT significantly improved survival over surgery alone.

Conclusions and significance: Surgery followed by adjuvant therapy provides superior survival outcomes and remains the preferred strategy for resectable advanced PSCC. Definitive CRT yields inferior survival rates but may be considered for organ preservation.

Background: Optimal initial management of posterior epistaxis remains controversial. We compared primary endoscopic sphenopalatine artery (SPA) cauterization with double-balloon posterior nasal packing.

Aims/objectives: To compare treatment success, hospital stay, and costs between both strategies.

Materials and methods: This retrospective cohort included 75 consecutive patients with posterior epistaxis treated at a tertiary referral center (January 2020 and December 2025). Clinical outcomes, hospitalization, and hospital costs were compared by primary treatment strategy (intention-to-treat) and by definitive treatment received, using generalized linear models, and a hospital cost-per-success analysis.

Results: Primary treatment success was higher with SPA cauterization than packing (97.0% vs. 69.1%; p = 0.002); 30.9% of packing required rescue surgery. Hospital stay was shorter after SPA cauterization (2.64 ± 1.02 vs. 4.71 ± 1.96 days; p < 0.001). Mean hospital cost per patient did not differ significantly between primary strategies (€4,115.69 vs. €4,193.31), resulting in a lower cost per successfully treated patient with primary cauterization (€4,224 vs. €6,073). Rescue surgery-patients had the longest hospitalization and highest costs.

Conclusions: Primary endoscopy SPA cauterization achieved higher success and shorter hospitalization, without increasing hospital cost per patient at the strategy level. Despite higher adjusted costs, delayed surgery after packing failure was the least efficient strategy.

Background: Paranasal sinus malignancies are rare and frequently present at an advanced stage. The optimal management of the clinically or radiologically N0 neck remains controversial.

Aims/objective: To evaluate cervical lymph node management based on preoperative radiological findings and long-term oncological outcomes in patients with advanced paranasal sinus malignancies.

Material and methods: Thirty-four patients who underwent surgery for T3 or T4a paranasal sinus malignancies between 2014 and 2020 were retrospectively evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis, and survival curves were compared using the log-rank test.

Results: Twenty-seven patients (79.4%) had T3 and seven (20.6%) had T4a disease. Eight patients (23.5%) had radiologically suspicious cervical lymph nodes and underwent neck dissection; two (25.0%) had pathological nodal metastasis. Cervical recurrence occurred in three patients (8.8%), and 14 (41.2%) experienced local or cervical recurrence. Five-year OS and DFS were 48.6% and 49.4%, respectively. T4a disease was associated with poorer DFS (p < 0.001).

Conclusions and significance: Cervical nodal involvement was uncommon. Our findings do not provide evidence supporting routine elective neck treatment in radiologically N0 patients. T4a disease was associated with poorer DFS.

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that can initially present with diverse neurological symptoms. Vestibular dysfunction may be an early manifestation, and can mimic common peripheral vestibular disorders, creating a diagnostic challenge.

Objectives: To characterize vestibular symptoms and clinical signs in patients with MS presenting initially with vestibular dysfunction.

Materials and methods: This retrospective observational case series included ten patients evaluated between 2019 and 2024 whose first clinical manifestation of MS was vestibular dysfunction. Clinical and neuro-otologic assessment, vHIT, and VNG were performed, and brain MRI was obtained when central vestibular involvement was suspected.

Results: Four main presentations were identified: acute vestibular syndrome (n = 2), imbalance (n = 4), recurrent vertigo (n = 2), and positional vertigo (n = 2). Nine of ten patients had at least one finding suggestive of central vestibular involvement, whereas one patient had a normal vestibular examination. Brain MRI demonstrated lesions fulfilling the radiological criteria for MS in all ten patients.

Conclusions: Central vestibular signs in young adults presenting with vestibular symptoms should raise suspicion of an underlying central lesion and possible MS. Recognition of these signs, together with appropriate neuroimaging when clinically indicated, may facilitate earlier diagnosis during the clinically isolated syndrome stage.

Background: The optimal treatment strategy for T4b parotid gland squamous cell carcinoma (PSCC) remains unclear.

Aim/objectives: To evaluate the survival outcomes of T4b PSCC according to the treatment modality.

Subjects and methods: Patients with T4b PSCC without distant metastases were identified from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cancer-specific survival (CSS) were analysed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using Cox proportional hazards models.

Results: A total of 163 patients were enrolled in the study. The five-year OS and CSS rates were 27.6% and 36.9%, respectively. Surgical treatment and chemoradiotherapy (CRT) demonstrated comparable survival outcomes (five-year OS rates: 38.2% and 30.8%). Multivariate Cox analyses confirmed that CRT was associated with survival outcomes comparable to surgery (hazard ratios 1.19 for OS and 1.03 for CSS). Among surgically treated patients, adjuvant CRT showed a trend towards improved survival.

Conclusions and significance: CRT provides survival outcomes comparable to those of surgery in T4b PSCC. Surgery followed by adjuvant CRT may offer additional benefits to selected patients. These findings support individualised treatment selection and shared decision-making for this rare disease.

Background: Ankylosing spondylitis (AS) may impair postural control and balance through musculoskeletal and proprioceptive alterations.

Aims/objectives: To evaluate vestibulo-ocular reflex parameters, balance performance, and fear of falling in patients with AS compared with healthy controls.

Material and methods: This prospective controlled study included 30 patients with AS and 32 age- and sex-matched healthy controls. Participants underwent videonystagmography (VNG) and static posturography assessments, including Limits of Stability (LOS), Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), and Fall Risk (FR) tests. Fear of falling was assessed using the Fall Efficacy Scale.

Results: Patients with AS demonstrated significantly lower LOS endpoint excursion, maximum excursion, and direction control values than controls (p = 0.020, p = 0.001, and p < 0.001, respectively). In the mCTSIB assessment, sway velocity during the eyes-closed condition was significantly higher in the AS group (p = 0.020). Fear of falling scores were also significantly higher in patients with AS (p < 0.001). No significant differences were observed in composite FR parameters.

Conclusions and significance: Patients with AS exhibited impaired balance performance and increased fear of falling. Balance impairment became more evident under reduced visual input, suggesting altered sensory integration and postural control mechanisms in AS.

Background: The Mid-term efficacy of endoscopic posterior nasal nerve neurectomy (PNN) combined with functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is a question.

Aims/objectives: To evaluate the Mid-term efficacy and safety of PNN + FESS.

Material and methods: This was a multicenter, randomized, controlled, assessor-blinded trial. 60 patients were randomly assigned to PNN + FESS group (n = 30) or the FESS group (n = 30). The primary outcome measures were the VAS, Total Nasal Symptom Score (TNSS), and SNOT-22 scores assessed at baseline and at 3, 6, and 12 months postoperatively. Secondary outcomes included changes in serum levels of IL-4 and IL-5.

Results: At 12 months, symptom scores in both groups showed significant improvement from baseline (p < 0.001). Intergroup comparisons revealed that the experimental group demonstrated significantly greater TNSS improvement at all time points (p < 0.05). The improvement in SNOT-22 score in the experimental group was also significantly greater at 12 months (p < 0.05). Both groups exhibited a decrease in serum IL-4 and IL-5 levels.

Conclusions and significance: Combined PNN and FESS provides sustained medium-term improvements in nasal symptoms and quality of life for patients with CRSwNP, showing superior efficacy compared to FESS alone.

Background: In comparisons between retroauricular and transcanal approaches, recent studies suggest retroauricular approaches might result in higher postoperative pain.

Objectives: to evaluate correlation between surgical approach (retroauricular or transcanal) and subjective postoperative pain intensity.

Materials and methods: a prospective single-center cohort study was conducted on patients undergoing middle ear surgery from November 2022 to November 2023. Pain was measured using Visual Analog Scale (VAS) and self-reported analgesic consumption from postoperative day (POD) 1 to POD 30. Patients were grouped by surgical approach, with retroauricular cases stratified considering presence of mastoidectomy.

Results: eighty-five patients were included (37 retroauricular, 48 transcanal). Retroauricular access with mastoidectomy (canal-wall-up/down) showed higher VAS scores than retroauricular without mastoidectomy and transcanal access at discharge (4.67/4.00 vs 1.71/1.38) and POD 7 (3.13/3.00 vs 1.29/0.83). No significant differences were observed between retroauricular incision without mastoidectomy and transcanal access. Pain was effectively managed with Acetaminophen and NSAIDs; opioids were not required. No complications occurred during the 30-day follow-up.

Conclusion and significance: postoperative pain in middle ear surgery appears mainly related to mastoidectomy rather than retroauricular incision. Higher pain reported in retroauricular approaches in unstratified literature likely reflects confounding effect of mastoidectomy. Opioid drugs prescription after this surgery should be discouraged.

Background: The vestibular-organ site that is responsible for vertigo-associated idiopathic sudden sensorineural hearing loss (ISSNHL) has not been identified clearly.

Aims/objectives: To analyze the function of each semicircular canal (SCC) separately in patients with vertigo-associated ISSNHL.

Patients/methods: ISSNHL patients with or without vertigo (n = 19 each) underwent a video head impulse test. Their vestibulo-ocular reflex (VOR) and catch-up saccades (CUS) were recorded.

Results: As for the affected side, the VOR gains of the lateral and posterior SCCs were lower in the vertigo group versus the nonvertigo group. The percentage of patients with decreased VOR gains of the posterior SCC and those with CUS (+) for the lateral and posterior SCCs were higher in the vertigo group versus the nonvertigo group. In the vertigo group, the VOR gain was lower in the affected side in all SCCs. The percentage of patients with decreased VOR gains and that with CUS (+) were higher for the posterior SCC in the affected side versus the unaffected side.

Conclusion/significance: The posterior SCC was predominantly impaired in patients with vertigo-associated ISSNHL. Considering the vascular anatomy of the inner ear, these results indicate that a microcirculatory disturbance plays a crucial role in the pathophysiology of ISSNHL.