BACKGROUND:Early T-stage (cT1-T2) hypopharyngeal squamous cell carcinoma (HSCC) presents a therapeutic challenge in balancing oncological control with functional preservation. OBJECTIVES:To compare the oncological and functional outcomes between transoral laser microsurgery (TLM)-based treatment pathway and definitive radiation-based (radiotherapy with or without concurrent chemotherapy, RT/CCRT) treatment pathway for early T-stage HSCC. DESIGN, SETTING, AND PARTICIPANTS:This prospective randomized pilot study was conducted at a tertiary care hospital from 2016 to 2021. Seventeen treatment-naïve patients with cT1-T2 HSCC were included. INTERVENTIONS:Participants were randomized to undergo either TLM-based pathway (n = 9) or definitive RT/CCRT (n = 8). PRIMARY OUTCOMES:The primary endpoint was the functional laryngeal preservation rate at last follow-up (minimum follow-up: 1 year). KEY RESULTS:In the TLM group, 55.6% (5/9) of patients required adjuvant CCRT due to adverse pathological features. The 1-year functional laryngeal preservation rate was significantly higher in the RT/CCRT group than in the TLM group (100% vs. 44.4%; Cramer's V = 0.61; 95% CI, 0.39-0.88; P = 0.029). Regarding voice quality, RT/CCRT demonstrated favorable outcomes with lower jitter (0.76% vs. 1.68%; effect size, 0.49; 95% CI, -0.02 to 0.76; P = 0.046). A potential trend favoring the RT/CCRT group was observed for disease-free survival (Hazard Ratio, 0.26; 95% CI, 0.03-2.30; P = 0.189). HARMS:No grade 4 or higher treatment-related adverse events (CTCAE v5.0) were reported in either arm. However, a potential trend toward a higher incidence of hypopharyngeal fibrosis with narrowing was observed in the TLM group (Cramer's V = 0.52; P = 0.082). CONCLUSION:For early T-stage (cT1-T2) HSCC, definitive RT/CCRT suggested potential functional advantages in laryngeal preservation and acoustic quality over a TLM-based pathway, likely by avoiding the cumulative morbidity of trimodality therapy in pathologically node-positive or high-risk disease. While oncological control appeared comparable, these findings remain hypothesis-generating given the limited pilot cohort, warranting validation in larger multicenter trials. TRIAL REGISTRATION:Not prospectively registered (Pilot trial approved by IRB of Taichung Tzu Chi Hospital, REC105-07).
OBJECTIVE:Mastoid cavity obliteration is a surgical strategy rather than an intervention per se, that has been proposed as an effective approach to reduce post-operative complications and long-term morbidity associated with canal wall down (CWD) tympanomastoidectomies. The present study aims to evaluate, in a retrospective case series, audiological, functional, and quality-of-life (QoL) outcomes in adult patients undergoing revision tympanomastoidectomy and ossicular chain reconstruction with mastoid obliteration. MATERIALS AND METHODS:A retrospective analysis was performed on a cohort of patients affected by recurrent cholesteatomatous chronic otitis media (CCOM) who underwent revision tympanomastoidectomy, ossiculoplasty, and mastoid cavity obliteration in the same surgical session. Inclusion criteria were age >18 years and a minimum follow-up of 12 months with available pre- and postoperative audiometric data. Audiological outcomes were assessed using mean pure-tone average (PTA, 250-4000 Hz) and air-bone gap (ABG), calculated over the same frequency range and consistently applied to all cases. QoL was evaluated pre- and postoperatively using the validated Italian versions of the Chronic Otitis Media Outcome Test-15 (COMOT-15) and the Chronic Ear Survey-Italian version (CESI), scored according to their original validated format. Outcomes were also compared, as an exploratory analysis, in a subgroup analysis between patients receiving partial ossicular replacement prostheses (PORP) and total ossicular replacement prostheses (TORP). RESULTS:Fourteen of eighteen eligible patients (6 males, 8 females; mean age 45.4 years) met the established inclusion criteria, completing both audiological and QoL assessments. Mastoid obliteration was performed using different autologous or synthetic biocompatible materials, whose choice was based on intraoperative findings and surgeon preference. A significant improvement in mean PTA was observed postoperatively (66.7 ± 5.3 dB preoperatively vs. 53.8 ± 7.3 dB postoperatively; p < 0.05), as well as a significant reduction in ABG (34.5 ± 7.3 dB vs. 22.3 ± 10.8 dB; p < 0.05). Greater audiological improvement was noted, in this small and non-randomized subgroup comparison, in patients rehabilitated with PORP compared to TORP. QoL scores, based on patient-reported questionnaires, significantly improved at 12 months postoperatively, with CES-I scores increasing (30.5 ± 11 vs. 76 ± 14.2; p < 0.01) and COMOT-15 scores decreasing (78.7 ± 15.7 vs. 40.5 ± 20.8; p < 0.01), particularly in domains related to activity limitation. CONCLUSION:Mastoid cavity obliteration combined with ossiculoplasty in revision tympanomastoidectomy was associated - in our retrospective analysis - with postoperative improvement in hearing outcomes and QoL, with greater audiological improvement observed in patients reconstructed with PORP. Because of the small sample size, heterogeneous obliteration materials, and the absence of a non-obliterated control group, our findings are preliminary and explanatory, and warrant confirmation in larger, prospective, controlled studies to fully demonstrate the independent or causal benefit of mastoid obliteration.
Background Ménière's disease (MD) is a chronic, progressive disorder of the inner ear, which is currently incurable. Anxiety is a known exacerbating factor for vertigo episodes in these patients; however, its precise frequency and levels in this population remain undefined. Objective The purpose of this study is to synthesize the available evidence related to the frequency and levels of anxiety in patients with MD. Design A systematic review and meta-analysis reported according to PRISMA and MOOSE guidelines. Participants Observational studies, published until May 2023, reporting the frequency and/or severity of anxiety in patients with MD were included, with no restrictions by country or publication date. Main outcome measures PubMed, Embase, Scopus, LILACS, Web of Science, and PsycINFO were systematically searched to identify relevant articles. Two independent reviewers selected studies, extracted data, and assessed the methodological quality of the included studies. Because the included studies used different anxiety instruments, exploratory meta-analyses were restricted to studies using the Beck Anxiety Inventory (BAI), which provided comparable data on anxiety severity categories and mean scores. Results Eight studies involving 283 patients were selected. Three contributed to the BAI-based meta-analyses. The pooled prevalence of moderate-to-severe anxiety, as assessed by the BAI scale, was 68% (95% CI: 43–75%; I2 = 56.3%; 2 studies; n = 99). The pooled mean BAI score was 23.26 points (95% CI: 19.31–27.21; I2 = 53.8%, 2 studies; n = 88), which falls within the moderate anxiety range according to BAI cut-off points. Most studies had good methodological quality. Conclusions Based on the limited BAI-based evidence available, moderate-to-severe anxiety appears to be frequent among patients with MD, and the pooled mean BAI score suggests moderate anxiety severity. Relevance Major MD management guidelines have not addressed this issue. Psychological and/or pharmacological anxiety treatment should be considered an essential component of its management.Record: CRD42023431494 (PROSPERO).
Background Deviated nasal septum (DNS) is a common condition in children that may present with symptoms such as nasal obstruction and mouth breathing. This study aimed to describe the distribution of DNS types, clinical manifestations, and documented birth- and trauma-related characteristics among children with DNS. Methodology A retrospective cross-sectional chart review was conducted among children aged 6–10 years diagnosed with DNS. Demographic characteristics, birth-related parameters, trauma history, and clinical features were extracted from medical records. Associations between DNS type, documented clinical characteristics, and birth- and trauma-related factors were analyzed using the chi-square test or Fisher's exact test, as appropriate, with statistical significance set at p < 0.05 using IBM SPSS Statistics version 29.0.0. Results A total of 150 children were included, comprising 117 boys (78.0%) and 33 girls (22.0%), with a mean age of 8.47 ± 1.23 years (mean ± standard deviation [SD]). Mid-septal DNS was the most common type (116, 77.3%), followed by anterior/caudal deviation (34, 22.7%). The most frequently documented clinical manifestations were nasal obstruction (77, 51.3%) and mouth breathing (70, 46.7%). Among children with available birth-related data (n = 89), most were delivered by normal vaginal delivery (64, 71.9%) and had a cephalic fetal presentation (83, 93.3%), while low birth weight was documented in 10 cases (11.2%). Mode of delivery (p = 0.032) and fetal presentation (p < 0.001) were significantly associated with DNS type. Documented facial trauma was reported in 37 children (24.7%). Nasal obstruction (p < 0.001) and external nasal deformity (p = 0.009) were also significantly associated with DNS type. Documented facial trauma was significantly associated with age (p = 0.017) and nasal obstruction (p = 0.008), but not with sex or other evaluated variables. Conclusion Mid-septal deviation was the most frequently documented type of DNS in this pediatric cohort. Nasal obstruction and mouth breathing were the most common clinical manifestations. Several documented birth-related characteristics, facial trauma, and clinical features were significantly associated with DNS type within this cohort. These findings describe the characteristics of children with DNS in this retrospective cross-sectional chart review and may help guide future prospective studies.
Remote-access thyroidectomy comprises a group of endoscopic and robotic procedures, including the bilateral axillo-breast, gasless axillary, retroauricular, and transoral vestibular approaches, developed to relocate or conceal the cervical incision while maintaining operative efficacy. This review summarizes current evidence regarding safety, oncologic adequacy, cosmetic outcomes, learning curve, cost, and patient selection. Across multiple meta-analyses, rates of recurrent laryngeal nerve injury and hypoparathyroidism are comparable to conventional open thyroidectomy in appropriately selected patients. However, results vary with technique and surgeon experience. Each approach introduces specific risks, including mental nerve injury in transoral cases, brachial plexus symptoms and anterior chest dysesthesia in axillary or breast routes, and greater auricular neuropathy following retroauricular dissection. Rare complications such as CO2 embolism and pneumomediastinum have also been reported. Current oncologic data are primarily observational. Existing guidelines limit remote-access procedures to low-risk, well-differentiated carcinomas that do not require central or lateral neck dissection. Cosmetic satisfaction tends to be greater in the early postoperative period, while differences diminish over time. Operative duration remains longer and costs higher than open thyroidectomy, primarily due to equipment and operating room time. Remote-access thyroidectomy should be offered selectively to motivate patients who prioritize cosmetic outcomes and be performed by high-volume surgeons with dedicated training. Further prospective studies are needed to clarify long-term oncologic safety, cost-effectiveness, and quality-of-life outcomes.
PURPOSE:Present an intriguing case of a man suffering of OSA who has a homozygous monochorionic twin. Made a systematic review of the literature to summarize existing data and the reported incidence of OSA in twins. METHODS:Case presentation and systematic literature review, according to the PRISMA guidelines about twins and Obstructive sleep Apnea. RESULTS:Our patient had a severe OSA condition with an Apnea Hypopnea index (AHI) of 57.6. This patient had a twin who did not suffer from sleep apnea and presented different oropharyngeal and endoscopic anatomical characteristics. Six eligible studies were identified investigating OSA or OSA-related traits in twins. All studies demonstrated higher concordance among monozygotic than dizygotic twins and substantial heritability estimates (40%-83%), particularly for AHI and ODI. However, non-shared environmental and anatomical factors accounted for considerable phenotypic variability. CONCLUSION:Despite the genetic factors related to the sleep apnea, differences in anatomical features and lifestyle could contributed to the different expression of OSA.
Purpose The JK-05A platform performs up to four Eustachian tube (ET) subtests in a single session; however, the outputs often disagree. We evaluated discordant JK-05A outputs in a single-center cohort and developed a practical framework for their interpretation. Materials and methods We retrospectively analyzed 51 patients who underwent JK-05A testing between September 2025 and April 2026 using explicit reading rules. Inter-test concordance, sonotubometric threshold provenance, and the Japan Otological Society (JOS) criteria informed a history-anchored, functional-domain approach. Patulous ET (PET)-suspected cases were categorized according to the JOS criteria, whereas obstructive dysfunction was described functionally. Results Outputs were concordant in only a minority: sonotubometry agreed with tubo-tympano-aerodynamic graphy resting synchrony in 52.3%, and only 34.1% of the 44 patients with all four binary signals evaluable were unanimous. Directional sonotubometric patterns demonstrated an ordered distribution: PET was present in 60.0%, 24.0%, and 6.7% of the patulous-leaning, intermediate, and obstructive-leaning patterns, respectively, whereas obstructive ET dysfunction, with or without otitis media, increased from 20.0% to 36.0% to 60.0%, respectively. This ordering is partly circular because the patulous-leaning features are themselves JOS objective signs. Conclusions JK-05A is better interpreted as a history-anchored functional profile than as independent diagnostic verdicts. A negative sonotubometric response does not exclude PET, and obstructive dysfunction should be described functionally rather than diagnosed by JK-05A alone. Discordant outputs may reflect differences in functional domains, intermittent physiology, or measurement conditions rather than a single disease category. This internally derived framework requires prospective evaluation with independent readers and control ears.
BACKGROUND:Salivary gland carcinoma (SGC) lacks reliable preoperative prognostic markers. This exploratory study evaluated whether volume-based apparent diffusion coefficient (ADC) parameters derived from preoperative diffusion-weighted magnetic resonance imaging (MRI) were associated with clinical outcomes in patients with SGC. METHODS:Sixty-five patients who underwent radical surgery for SGC between 2014 and 2024 were retrospectively reviewed; 55 had evaluable preoperative diffusion-weighted imaging (DWI) data for ADC analysis. Whole-tumor ADC values were derived using dedicated software with a threshold-based semi-automated workflow, and the median ADC and entropy were extracted. Disease-free survival (DFS), local control, and overall survival were analyzed using the Kaplan-Meier method. Associations between clinicopathological or imaging variables and outcomes were assessed using log-rank tests, Cox proportional hazards regression, and Spearman's correlation analysis. RESULTS:Advanced pathological stage, high-grade histology, preoperative facial nerve palsy, and low median ADC were associated with worse DFS in univariate analyses. The median ADC was negatively correlated with pathological grade. In the multivariable Cox proportional hazards model, median ADC remained associated with DFS; however, this finding should be interpreted cautiously because of the limited number of events and the wide confidence interval. Entropy showed no significant association with clinical outcomes. CONCLUSIONS:Preoperative volume-based median ADC was associated with DFS in this exploratory cohort of patients with SGC. The median ADC may represent a candidate prognostic imaging marker for preoperative risk assessment. Further validation in larger cohorts with standardized MRI protocols is required before clinical application.
OBJECTIVE:Tongue squamous cell carcinoma is associated with a substantial risk of recurrence after primary surgical treatment. Accurate identification of pathological prognostic factors is therefore essential to optimize postoperative management and risk stratification. This study aimed to identify clinicopathological factors associated with recurrence and overall survival (OS), with particular emphasis on the prognostic significance of lymphatic invasion. METHODS:The data of 96 patients who underwent primary surgical treatment for tongue squamous cell carcinoma between 2013 and 2022 at Chiba University Hospital were retrospectively collected. Recurrence-free survival and OS, measured from the date of initial treatment, were estimated using the Kaplan-Meier method and compared using the log-rank test. A multivariate Cox proportional hazards regression model including lymphatic invasion, T classification, and N classification was performed to evaluate factors associated with recurrence. RESULTS:Lymphatic invasion and a positive horizontal margin were significantly associated with poorer recurrence-free survival in univariable analysis (p = 0.016 and p = 0.040, respectively). In multivariate Cox proportional hazards regression analysis, lymphatic invasion remained independently associated with recurrence after adjustment for T and N classification (hazard ratio [HR], 2.44; 95% confidence interval [CI], 1.11-5.38; p = 0.026). For overall survival, lymphatic invasion, venous invasion, perineural invasion, positive horizontal margin, and DOI were significantly associated with OS in univariable analysis (p = 0.011, 0.014, 0.020, 0.011, and 0.048, respectively). CONCLUSION:Lymphatic invasion was independently associated with recurrence after adjustment for T and N classification. Assessment of lymphatic invasion may provide additional prognostic information for postoperative risk stratification.
Tympano-ossicular damage, associated with tympanic membrane injury, may be a severe consequence of ear trauma. Several ossiculoplasty types have been employed as therapeutic options, usually with favourable hearing outcomes. However, in case of traumatic mixed hearing loss with a sensorineural component, ossiculoplasty might not be sufficient to restore serviceable hearing. In such cases, hearing rehabilitation with bone conduction implants might rationally be seen as a possible approach. However, to the best of our knowledge, there is no previous report of bone conduction implant placement during primary TM repair in this specific subset of patients. The aim of this report is to describe the first case of a simultaneous tympanoplasty and implantation of the bone conduction device Osia®3 (Cochlear Ltd., Lane Cove, NSW, Australia) for a traumatic tympano-ossicular damage, also providing details on surgical technique and outcomes. A 67-year-old man with traumatic tympano-ossicular damage was admitted to our unit, showing severe mixed hearing loss. A cone-beam CT scan showed a complex ossicular chain dislocation, involving the malleus head, incus, incudo-stapedial joint, and stapes footplate. Given such ossicular damage and the mixed hearing loss, an ossiculoplasty was unlikely to provide complete hearing restoration. Therefore, simultaneous tympanoplasty and Osia 3® implantation was performed. Two months after surgery, the neotympanum was stable and the unaided pure tone and speech recognition thresholds improved, due to TM reconstruction. The sound-field audiometry with the Osia® sound processor on demonstrated a mean functional gain of 20 dB, and the 100% speech discrimination score was achieved at 40 dB.
OBJECTIVE:Adenotonsillectomy (ADT) is a common indication for children with sickle cell disease (SCD) and comorbid obstructive sleep apnea (OSA) or recurrent infections (adenoidits and tonsillitis), despite the paucity of data in this population. This review aims to evaluate the surgical outcomes of ADT in pediatric patients with SCD. METHODS:We conducted a systematic review by searching the PubMed and Embase electronic databases. The PRISMA guidelines were followed, and the review protocol was registered in PROSPERO. A qualitative analysis was performed. RESULTS:Ten studies, comprising a total of 454 subjects, were included. The mean age ranged from 6 to 12 years, with a comparable sex distribution between groups. The combined cohort consisted of 303 cases of HbSS, 24 of HbSC, 16 of HbS/β-thalassemia, and 3 cases of HbSS-HPFH. Baseline hemoglobin (Hb) levels ranged from 6.7 to 9.3 g/dL, while mean Hb levels at the time of surgery varied between 8.9 and 11.4 g/dL. The proportion of patients receiving preoperative transfusions ranged from 72% to 100%. Follow-up duration spanned from 1 month to 1 year. The primary surgical indications were OSA and recurrent infections. Regarding surgical outcomes, the improvement in the AHI ranged from 50.56% to 82.90%, with mean hospital stays of 2 and 3.5 days. Postoperative acute chest syndrome and emergency department visits decreased significantly, whereas the reduction in vaso-occlusive crises was not significant. Finally, surgical complications were reported in 5.2% to 11.3% of cases. CONCLUSION:ADT may provide clinical benefits for children with SCD. However, given the limited evidence, outcomes must be interpreted with caution, and a multidisciplinary approach is required to manage potential complications.
Objective To evaluate the postoperative outcomes of cold dissection combined with systematic suture ligation hemostasis in pediatric adenotonsillectomy. Methods This retrospective study included 303 pediatric patients who underwent tonsillectomy performed by a single surgeon between 2016 and 2024 at two healthcare centers. Postoperative outcomes, including operative time, pain scores, return to a normal diet, and postoperative complications, were evaluated. Results A total of 303 patients were included (mean age, 6.38 ± 3.26 years). The mean operative time was 31.2 ± 6.9 min at the secondary healthcare center and 32.8 ± 6.4 min at the tertiary healthcare center, with no significant difference between centers (p = 0.110). The mean time to return to a normal diet was 5.96 ± 1.5 days (95% CI, 5.81–6.11 days). Postoperative bleeding requiring surgical intervention occurred in 2 patients (0.7%; 95% CI, 0.08–2.4%), and all cases were primary hemorrhage. No secondary hemorrhage was observed during the follow-up period. Transient velopharyngeal insufficiency occurred in 18 patients (5.9%; 95% CI, 3.6–9.2%) and resolved spontaneously in all cases. No significant differences were observed between the two centers regarding postoperative pain, return to a normal diet, or complication rates. Conclusion Cold dissection combined with systematic suture ligation hemostasis, particularly routine lower pole ligation, was associated with low primary hemorrhage rates and the absence of secondary hemorrhage in this cohort. The technique was also associated with favorable postoperative recovery and may represent a safe and feasible surgical approach in pediatric adenotonsillectomy.
AIM:To report olfactory dysfunction (OD) as measured by psychophysical testing in the post-acute COVID-19 patient over a 12-month period; to correlate this with patient-reported quality of life (QOL) outcomes. METHODS:In this multi-centre UK prospective cohort, adults with confirmed COVID-19 completed the University of Pennsylvania Smell Identification Test (UPSIT), the validated Sinonasal Outcome Test-22 (SNOT-22) and the English Questionnaire of Olfactory Disorders (eODQ) at baseline (median 3 months after infection), then at 1, 3 6, 9 and 12 months after baseline. RESULTS:Seventy-eight (78) patients completed baseline testing and 55 completed testing at 12 months. At baseline, OD was present in 70/78 participants (89.7%; 95% CI 81.0-94.7%). At 12 months, 50/55 participants had persisting OD (90.9%; 95% CI 80.4-96.1%). Mean UPSIT scores were 26.8 ± 6.3 at baseline and 27.4 ± 6.3 at 12 months, indicating minimal change. Symptom burden and disease-specific QOL improved over 12 months with mean SNOT-22 test scores going from 29.5 ± 21.8 to 22.2 ± 18.6, p < 0.01; Mean eODQ scores from 59.8 ± 31.0 to 48.3 ± 32.6, p = 0.53, though neither trends were statistically significant. CONCLUSIONS:Olfactory dysfunction frequently persisted one year beyond post-acute COVID-19 diagnosis, whereas a trend of improvement on quality of life measures were observed. Combined use of psychophysical testing and QOL questionnaires is supported for follow-up and patient counselling.
Riedel's thyroiditis (RT) is a rare IgG4-related disease typically presenting with fibrotic thyroid enlargement and compressive symptoms. However, we herein report an unusual case of probable RT that involved laryngeal invasion and the thyroid cartilage destruction. In this case, a 46-year-old man presented with hoarseness, dysphagia, and a laryngeal mass. Imaging further revealed the thyroid cartilage permeative destruction with communication into the laryngeal lumen, raising suspicion of malignancy. Subsequent surgical exploration showed inflammatory granulation tissue eroding the thyroid cartilage. Histopathological examination demonstrated fibrous hyperplasia with lymphoplasmacytic infiltration, in hotspots approximately 15 IgG4-positive plasma cells per high-power field, and an IgG4/IgG-positive plasma cell ratio of ∼43%. Storiform fibrosis and obliterative phlebitis were absent. These findings confirmed probable RT with inflammatory pseudotumor formation. To our knowledge, this appears to be among the first reported cases of RT causing thyroid cartilage destruction. The mechanism is speculative but may involve chronic vascular compromise or direct inflammatory erosion. Therefore, RT should be considered in the differential diagnosis of atypical laryngeal lesions with cartilage involvement.
OBJECTIVE:To compare postoperative hearing outcomes across different frequency ranges following endoscopic type I tympanoplasty using perichondrium or tragal cartilage grafts. METHODS:Consecutive patients undergoing endoscopic type I tympanoplasty for inactive chronic otitis media with tympanic membrane perforation between January 2021 and September 2025 were retrospectively identified from our institutional database. Patients with cholesteatoma, ossicular abnormalities, severe sensorineural hearing loss, revision surgery, eustachian tube dysfunction, follow-up shorter than 3 months were excluded. Air-bone gap (ABG) improvement was defined as postoperative reduction in ABG. Air-bone gaps (ABGs) were evaluated at low frequencies (average of 0.25 and 0.5 kHz) and full frequencies (average of 0.5,1,2,4 kHz). Analysis of covariance was performed to adjust for baseline hearing differences. RESULTS:Of 143 screened patients, 101 met the inclusion criteria, including 54 receiving perichondrium grafts and 47 receiving tragal cartilage grafts. Baseline low-frequency and full-frequency ABGs differed significantly between groups. After adjustment for baseline differences, postoperative ABGs did not differ significantly between groups at either low- frequency ranges (adjusted mean difference 2.1 dB, 95% CI -0.7 to 4.8, P = .136) or full-frequency ranges (adjusted mean difference -2.1 dB, 95% CI -4.6 to 0.5, P = .112). Both groups demonstrated significant postoperative hearing improvement with stable bone-conduction thresholds. CONCLUSION:Both perichondrium and tragal cartilage grafts achieved comparable short-term anatomical and audiological outcomes after endoscopic type I tympanoplasty. Frequency-range evaluation did not identify clinically meaningful differences between graft materials beyond those detected by conventional pure-tone average measures after adjustment for baseline hearing status. Further prospective studies with longer follow-up are warranted to confirm these findings.
BACKGROUND:Endoscopic ear surgery (EES) offers advantages over microscopic techniques but remains challenging for beginners, particularly due to one-handed operation and limited access to training. This study aimed to develop a low-cost, self-assembled model and preliminarily evaluate its feasibility and usability for early-stage EES training. METHODS:An external auditory canal-tympanic membrane (EAC-TM) model was constructed using readily available materials (e.g., paper straw and polyethylene film). Fifteen otolaryngology trainees (postgraduate years 1-7) participated in a 2-h training session involving three basic EES tasks (cerumen removal, tympanocentesis, and ventilation tube insertion). Self-reported confidence and participant perceptions of model usability and educational value were assessed before and after training using 5-point Likert scales. RESULTS:Most participants had prior experience with cerumen removal but limited experience with endoscopic tympanocentesis, ventilation tube insertion, and more advanced procedures. Self-reported confidence scores were significantly higher after training for tympanocentesis (median 3 to 4, p = 0.004) and ventilation tube insertion (median 2 to 4, p = 0.003), whereas confidence in cerumen removal remained high with no significant change (p = 0.374). Participants also reported high satisfaction and positive perceptions of the model, particularly regarding endoscopic instrument handling and hand-eye coordination. CONCLUSIONS:The EAC-TM model provides a low-cost, self-assembled platform for early-stage EES training. It provides an accessible environment for repetitive practice of fundamental endoscopic skills and may serve as an accessible training resource, particularly in resource-limited and self-directed learning settings. Further evaluation using objective performance assessment and clinical transfer outcomes will help clarify its educational value.
OBJECTIVE:To explore spatial hearing outcomes in patients undergoing auricular resection and reconstruction for non-melanoma skin cancer (NMSC) of the external ear. STUDY DESIGN:Consecutive case series. METHODS:Twenty-three patients treated surgically for NMSC of the auricle between December 2023 and January 2026 were evaluated. Postoperative functional assessment included pure-tone audiometry (PTA) and the 12-item Speech, Spatial and Qualities of Hearing Scale (SSQ-12). Associations between spatial hearing performance and demographic, clinical, and surgical variables were analyzed using Spearman correlation and nonparametric group comparisons. RESULTS:The mean age was 77.0 ± 9.2 years. Mean bilateral PTA was 40.2 ± 9.7 dB HL, consistent with mild-to-moderate hearing loss. The mean SSQ-12 total score was 3.9 ± 1.6, indicating mild-to-moderate self-reported spatial hearing difficulty. SSQ-12 total score demonstrated a strong correlation with PTA (ρ = -0.767, p < 0.001), whereas no significant association was observed with age, lesion size, or surgical duration. Comparison between patients undergoing reconstruction and those managed by primary/secondary intention revealed no significant difference in overall SSQ-12 scores. CONCLUSIONS:In this exploratory series, spatial hearing outcomes following auricular resection for NMSC were primarily associated with baseline auditory thresholds rather than lesion size or reconstructive strategy. While restoration of auricular morphology did not significantly affect global spatial hearing scores, task-dependent differences in challenging listening environments suggest a potential functional role of restoring auricular contour. These preliminary findings highlight the need to integrate functional hearing considerations into auricular oncologic surgery and support further prospective studies incorporating objective localization measures.
BACKGROUND:Obstructive Sleep Apnea Syndrome (OSAS) is increasingly recognized as a serious, worldwide public health concern characterized by significant systemic consequences, primarily metabolic dysfunction driven by intermittent hypoxia (IH). The specific metabolic phenotype of pediatric OSAS remains largely unexplored, as the pediatric form differs substantially from the adult phenotype. To address this gap, this pilot investigation sought to characterize plasma acylcarnitine signatures in a children cohort using tandem mass spectrometry. METHODS:We analyzed 27 plasma acylcarnitines in 11 children (4-10 years) with polysomnography-confirmed moderate-to-severe OSAS using FIA-MS/MS. The resulting data were compared to age-stratified reference limits for the pediatric population. RESULTS:Our data reveal a severe and statistically significant depletion exclusively in two species, Acetylcarnitine (C2) and Octenoylcarnitine (C8:1), compared to age-matched reference values, which remained significant even after stringent False Discovery Rate (FDR) correction. CONCLUSION:Our study has provided important insights into the pediatric OSAS metabolic landscape, albeit based on a small sample size. We observed a selective reduction of circulating C2 and C8:1 in children with OSAS, proposing them as intriguing biomarkers and/or possible targets of nutritional intervention, warranting further investigation.
Background: Neck configuration is a key determinant of thyroidectomy difficulty, yet it lacks a simple, reproducible definition for research, risk stratification, and operative planning. A short, thick neck is intuitively associated with limited exposure and longer operative times, but evidence has been largely anecdotal. Methods: In a prospective single-center observational cohort, 843 consecutive adults undergoing primary total thyroidectomy (2019–2024) had preoperative neck phenotype assessed by anesthetists using neck circumference (NC) and cervicomental height (CMH). A Difficult Neck Phenotype Index (DNPI = NC/CMH) was derived. Associations with operative time, exposure maneuvers, Thyroidectomy Difficulty Scale (TDS), and postoperative complications were examined using multivariable models adjusting for BMI, thyroid volume, Graves' disease, malignancy, and retrosternal extension. Results: Mean NC, CMH, and DNPI were 372 ± 41 mm, 200 ± 27 mm, and 3.88 ± 0.67, respectively. Higher DNPI correlated with longer operative time (Spearman ρ = 0.41, p < 0.001) and increased use of exposure maneuvers (partial strap division, long retractors, lateral incision extension), as well as greater blood loss and drain placement, independent of clinical confounders. An exploratory DNPI cut-off of 4.1 was associated with operative time > 75th percentile with an AUC of 0.78 (95% CI 0.71–0.84), sensitivity 76.3%, and specificity 68.5%. Postoperative morbidity was low, and DNPI was not an independent predictor of RLN injury, hypocalcemia, cervical hematoma, or wound complications. Conclusions: DNPI is an exploratory, internally derived morphometric marker that operationalizes neck phenotype and was independently associated with intraoperative complexity in total thyroidectomy. In a high-volume specialist setting, difficult neck phenotype was associated with greater technical demand and resource use without a detectable increase in short-term morbidity, although power for rare events was limited. External validation across populations, techniques, and institutional volumes is warranted.
