Pediatric voice disorders are common conditions that may significantly affect communication, psychosocial development, and quality of life in children. Despite their clinical importance, considerable variation exists in diagnostic approaches and treatment strategies, partly due to difficulties in performing invasive examinations and limited high-quality evidence. To address these challenges, the Korean Society of Laryngology, Phoniatrics and Logopedics developed evidence-based clinical practice guidelines for the diagnosis and management of pediatric voice disorders. These guidelines were developed de novo through a systematic literature review addressing predefined key clinical questions related to pediatric vocal fold mucosal lesions and vocal fold paralysis. Searches were conducted in Medline, Embase, the Cochrane Library, and KoreaMed for studies published up to May 31, 2025. Evidence was critically appraised using standardized tools according to study design, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations were formulated by considering the balance of benefits and harms, quality of evidence, patient values and preferences, clinical feasibility, and resource implications. A total of nine key clinical questions were addressed, covering diagnostic strategies, voice assessment, noninvasive imaging, voice therapy, surgical intervention, and postoperative management in children with voice disorders. Most recommendations were conditional due to low or very low certainty of evidence, reflecting current limitations in pediatric voice research. These guidelines aim to support consistent, patient-centered clinical decision-making, reduce unwarranted practice variation, and promote optimal outcomes in the care of children with voice disorders.
Objectives.:Several studies have demonstrated the benefits of tonotopic fitting on speech-in-noise perception in new cochlear implant (CI) users. However, these studies used different coding strategies (CIS, HDCIS, FSP, FS4, or mixed) with different frequency spectra. The aim of this study was to assess the impact of fine structure (FS) cues on speech perception in noise and in quiet and music perception, in new CI users with a tonotopic fitting map. Methods.:A prospective, randomized, double-blind, 2-period crossover study was performed from April 2023 to June 2024. All participants had tonotopic fitting determined by using flat-panel computed tomography (CT) and reconstruction software based on the Greenwood function. 24 new CI users aged 18 years or older with either bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were recruited at a single tertiary referral center. Participants were randomized to FS followed by conventional coding, or the reverse sequence, for 6-week periods with speech and music assessments after each period. Results.:FS cues significantly improved speech recognition in noise for high signal-to-noise ratio (SNR = +9 dB, Mean Effect (ME) = 6.0%, Standardized effect size (SES) = 0.62, p = 0.010). A period effect was observed beyond + 6 dB of SNR (SNR = +9 dB, p = 0.010; SNR = +6 dB, p = 0.018) without a statistically significant group effect. Speech recognition and tonal audiometry in quiet were not affected by FS coding. Melodic contour identification was enhanced by FS cues (ME = 7.2%, SES = 0.51, p = 0.030), and, in an exploratory subset analysis, low-frequency pitch discrimination was also improved (ME = 8.5 Hz, SES = 0.72, p = 0.04). Over 75% of the participants retained the tonotopic map with FS coding after study completion. Conclusion.:FS coding strategies on tonotopic maps may improve speech recognition in noise at favorable SNRs, without compromising speech understanding in quiet. It may also enhance selected complex sound perception aspects, particularly pitch- and contour-related processing, while benefits for subjective music perception appear less consistent.
Objectives.:To evaluate multidimensional outcomes of cochlear implantation (CI) in adults with single-sided deafness (SSD) or asymmetric hearing loss (AHL), and to examine how duration of deafness influences speech perception, tinnitus severity, and hearing-related quality of life. Methods.:This retrospective cohort study included 124 adults with SSD or AHL who underwent unilateral CI at a tertiary referral center (September 2019-October 2024) with at least 12 months of postoperative follow-up. The primary outcome, hearing-related quality of life, was assessed using the Speech, Spatial, and Qualities of Hearing Scale (SSQ); secondary outcomes included the Hearing Handicap Inventory for the Elderly (HHIE), Tinnitus Handicap Inventory (THI), Short Form-36 (SF-36), and open-set speech perception (n = 61). The association between duration of deafness and postoperative outcomes was evaluated using duration as a continuous predictor in linear regression. Results.:Significant postoperative improvements occurred in SSQ Speech (+0.97; d = 0.53; p < 0.001) and Spatial domains (+1.60; d = 0.88; p < 0.001), HHIE (- 13.0; d = 0.50; p < 0.001), THI (-15.8; d = 0.61; p < 0.001), and SF-36 (+4.2; d = 0.27; p = 0.031). Speech perception improved markedly under CI-only conditions (monosyllabic d = 1.98; bisyllabic d = 2.92; sentence recognition d = 3.59). Longer duration of deafness was significantly associated with smaller THI improvement (β = 1.13 points/year, 95% CI 0.43-1.84; p = 0.002; adjusted β = 0.98, 95% CI 0.18-1.78; p = 0.017), whereas quality-of-life and sentence recognition outcomes were not associated with deafness duration. Conclusion.:Unilateral CI produces clinically meaningful improvements in hearingrelated quality of life, tinnitus severity, hearing handicap, and speech perception in adults with SSD and AHL. Quality-of-life and speech outcomes were preserved regardless of deafness duration, whereas tinnitus suppression declined with increasing deaf duration. These findings support earlier CI for candidates with bothersome tinnitus.
Objectives.:Accurate preoperative differentiation of salivary gland malignancies is critical for surgical planning. This study aimed to perform an updated systematic review and meta-analysis comparing the diagnostic accuracy of ultrasound-guided core needle biopsy (CNB) and fine-needle aspiration cytology (FNAC) in detecting salivary gland malignancies. Methods.:A systematic search of electronic databases (MEDLINE, Embase, and the Cochrane Library) was conducted to update a foundational review. Studies comparing the diagnostic accuracy of CNB and FNAC for salivary gland tumors, with definitive surgical histopathology as the reference standard, were included. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were estimated using random-effects models. A bivariate random-effects model was used to construct summary receiver operating characteristic (SROC) curves. Results.:Ten studies comprising 3,902 procedures (2,064 FNAC and 1,838 CNB) were included. The pooled sensitivity of CNB (0.905 [95% CI, 0.874-0.936]; I2 = 0.0%) was higher than that of FNAC (0.601 [95% CI, 0.526-0.676]; I2 = 42.7%). Pooled specificity was comparably high for both modalities (CNB: 0.979 [95% CI, 0.958-1.000]; I2 = 82.9%; FNAC: 0.970 [95% CI, 0.954-0.985], I2 = 66.6%). The pooled DOR for CNB was higher than that for FNAC (492.468 vs. 42.624). The area under the SROC curve was also higher for CNB than for FNAC (0.903 vs. 0.865). The QUADAS-C assessment indicated predominantly low risk in the comparative index-test domain, with no high-risk judgements in any domain. Conclusion.:Ultrasound-guided CNB demonstrates higher pooled sensitivity than FNAC, while both modalities showed high pooled specificity. Given this higher sensitivity for detecting malignancies, CNB may be considered a preferred diagnostic option within a risk-adapted approach to salivary gland cancer management, especially when malignancy is clinically suspected.
Objectives.:A 2013 nationwide survey described tinnitus management in Korean university hospitals. Since then, conceptual frameworks have broadened, and new therapies have emerged. We aimed to investigate tinnitus practice patterns among Korean university hospital otologists in 2025 and compared them with the findings in 2013. Methods.:A cross-sectional electronic survey was distributed in October 2025 to otologists registered with the Tinnitus Study Group of the Korean Otologic Society. We assessed classification, diagnostic work-up, treatment strategies, hearing-aid fitting, and perceived barriers. Comparisons with 2013 used a predefined item-level mapping; formal hypothesis testing was not performed because individual-level 2013 data were unavailable and several items were not directly comparable. Results.:Thirty-four otologists from 28 of 45 university hospitals responded. Compared with 2013, 2025 practice more often involved broader classification, psychological assessment, and structured questionnaires. Pharmacotherapy, tinnitus retraining therapy, and hearing-aid-based rehabilitation remained the main treatments. Cognitive behavioral therapy-related approaches, digital therapeutics, and neuromodulation were more widely represented but showed limited routine use. Auditory rehabilitation expanded to include CROS/BiCROS and cochlear implantation. Barriers included a lack of effective treatments, online misinformation, unrealistic expectations, and reimbursement limitations. Conclusion.:: Korean university hospital tinnitus care appears more structured and diversified than in 2013, emphasizing psychological assessment and auditory rehabilitation. However, universal pharmacotherapy, frequent intratympanic steroid use, heterogeneous minimal clinically important difference criteria, low real-ear measurement adoption, and limited routine use of newer modalities indicate persistent evidence-practice and outcome-standardization gaps. These findings underscore the need for stronger evidence, standardized outcomes, and health-system support for patient-centered care.
Objectives.:To investigate whether prior endoscopic sinus surgery (ESS) influences long-term treatment response to Dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including patient-reported outcomes, nasal polyp score and olfactory function. Methods.:This retrospective, single-centre real-world study included adult CRSwNP patients treated with Dupilumab between 2019 and 2025. Patient-reported outcome measures (PROMs) to assess symptom burden (i.e., SNOT-22, TNSS, ACT, PHQ-2, EQ-5D-3L), nasal polyp score (NPS) and olfactory performance were recorded longitudinally. Linear and piecewise linear mixed-effects models were used to analyse trajectories over time and compare outcomes by surgical status. Results.:A total of 224 patients were followed for up to 4.5 years, including 146 patients who had previously undergone ESS. Surgery-naïve patients had higher baseline disease burden across all outcomes. Dupilumab led to significant improvements in 6 all groups. Except for PHQ-2, which improved significantly faster in surgery-naïve patients during the early treatment phase (=0.310.14, p-value=0.03), trajectories were comparable. No significant differences were observed according to the number of previous surgeries or N-ERD status. Conclusion.:Dupilumab provides rapid and sustained clinical benefit in CRSwNP, independent of prior sinus surgery status. However, it should be noted that the influence of surgical extent could not be assessed in this cohort.
Objective.:To evaluate whether initial visit motivation was associated with retention throughout the obstructive sleep apnea (OSA) diagnostic and treatment pathway, including polysomnography (PSG) completion and continued follow-up after positive airway pressure (PAP) initiation, among OSA patients in South Korea. Study design.:Retrospective observational study. Setting.:Tertiary hospital. Methods.:Adult patients presenting with suspected OSA between July 2021 and December 2023 were retrospectively reviewed. Demographic characteristics, PSG results, and questionnaire scores, including the Berlin Questionnaire, Beck Depression Inventory-II (BDI-II), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index 7 (ISI), were collected. Initial visit motivation was categorized as voluntary, encouraged, both, or other based on a self-reported questionnaire completed at the first visit. Retention was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. Results.:A total of 139 patients were included. Patients reporting both voluntary and encouraged motivations showed higher retention than those reporting either motivation alone (log-rank p = 0.029). Multivariable analysis identified obesity, high Berlin Questionnaire risk, combined motivation, and lower depressive symptom severity as independent predictors of retention. In a sensitivity analysis restricted to patients who completed PSG, the association between motivation and retention was attenuated but remained directionally consistent. Conclusion.:8 Initial motivation for seeking care was associated with clinic-based retention throughout the OSA care pathway. Assessment of patients' motivational profile at the initial visit may help identify those at risk of disengagement and facilitate individualized strategies to improve long-term retention.
Objectives.:Sensory impairments are common in older adults. However, their association with neurodegenerative diseases across multiple sensory domains remains unclear. This study aimed to investigate the associations between visual, hearing, and olfactory impairments and incident neurodegenerative diseases. Methods.:We analyzed data from the Korean National Health Insurance Service-Health Screening Cohort (2002-2015), excluding participants with pre-existing sensory impairment or neurodegenerative disease during a washout period (2002-2004). Sensory impairment was classified as visual, hearing, olfactory, or multisensory between 2005 and 2015. The outcomes were overall neurodegenerative diseases and their subtypes (Alzheimer's disease and related dementias, Parkinson's disease, and Huntington's and other neurodegenerative disorders). Kaplan-Meier curves and adjusted Cox models were used. Results.:Among the 410,749 participants, 389,659 were controls and 21,007 had sensory impairment (hearing, 16,651; olfactory, 642; visual, 3,426; multisensory, 288). The incidence differed by sensory status (log-rank p < 0.001) and was highest in multisensory impairment. Versus controls, multisensory impairment had the largest adjusted risk for overall neurodegenerative disease (Hazard ratio [HR] 5.23, 95% confidence interval [CI] 4.20-6.52) and across major disease subtypes (Alzheimer's disease, HR 4.43; Parkinson's disease, HR 5.07; and Huntington's and other neurodegenerative disorders, HR 9.90). In post hoc analyses using multisensory impairment as a reference, all single-sensory impairment groups showed significantly lower hazards. Conclusion.:: Sensory impairment across the visual, hearing, and olfactory domains was associated with an increased risk of neurodegenerative 73 diseases, showing a graded pattern with a greater sensory burden. The sensory status may serve as an accessible early risk marker for neurodegenerative diseases in older adults.
INTRO:Tracheoesophageal voice prosthesis (VP) is an effective method for restoring fluent speech after total laryngectomy, but its microbial colonisation can impair device performance. Aims of this study are to characterise VP microbiological colonisation in laryngectomised patients and assess whether regular probiotic supplementation, plus VP management, could reduce VP contamination, improving function and durability. METHODS:A total of 34 patients were enrolled; 15 received standard VP hygiene and management with nystatin four times/day for 5 days before and 5 days after each VP replacement (Group 1) and 19 received the same protocol as Group 1, plus a probiotic supplement (VSL#3, Actial Farmaceutica SRL, Rome, Italy) for 10 days each month throughout the observation period (Group 2). All removed VPs were cultured. Patients underwent a brief questionnaire regarding the VP functionality. RESULTS:Each patient of both groups had a single VP substitution. The most frequently isolated were Pseudomonas aeruginosa, Staphylococcus aureus and Candida species. When comparing VP microbial cultures at baseline and follow-up, no significant differences were observed in Group 1, while in Group 2, a significant reduction in the detection of multiple microbial species at follow-up was detected. Specifically, a significant decrease was observed in the prevalence of S. aureus methicillin-sensitive (p = 0.05), miscellaneous Gram-negative bacteria (p = 0.04) and Candida albicans (p = 0.02). Survey results showed a significant overall improvement in VP functionality in Group 2 versus Group 1 (p = 0.008). CONCLUSION:Microbiological findings and patient opinions suggest a positive impact of probiotics on reducing bacterial contamination and improving VP functionality.
INTRODUCTION:'Enhanced Recovery After Surgery' (ERAS) protocols have been developed for multiple surgical procedures with favourable outcome measures including Length of Stay (LoS). Trans-Oral Robotic Surgery (TORS) has similarly facilitated earlier patient discharges, particularly in comparison to open head and neck surgical techniques. There is a dearth of literature on the effect of ERAS protocols in TORS. We sought to comprehensively examine the effect of a TORS ERAS protocol across several key metrics, with a focus on LoS. METHODS:We conducted a retrospective cohort study following implementation of a TORS ERAS protocol. This protocol was developed at our institution and implemented in 2021; it included key features such as pharyngocutaneous risk stratification and thorough perioperative assessments. Patients managed prior to (p-ERAS) and post implementation (w-ERAS) were separated into two groups, with key outcomes, including LoS, estimated cost per patient, return to swallow, and complication rate, compared. RESULTS:A total of 40 TORS cases were included. Patients managed w-ERAS had a mean adherence rate to protocol of 90%. The w-ERAS group showed a statistically significant reduction in median length of stay by 3.5 days (p = 0.03) when compared to the p-ERAS group. There was also a trend towards decreased median cost per patient as well as decreased median time to oral intake. CONCLUSION:Our study demonstrates an easily implementable protocol for the perioperative management of TORS oncological surgery. The use of this ERAS protocol demonstrated a significant reduction in patient length of stay in a small sample size.
OBJECTIVES:To characterise adult tonsillectomy procedures conducted in the NHS from routine administrative data in England and investigate trends in their associated complications over time. DESIGN:Retrospective observational cohort study using routine data from Hospital Episode Statistics (HES). SETTING:Acute NHS trusts in England are conducting adult tonsillectomy. PARTICIPANTS:Adults (> 16 years old) undergoing tonsillectomy procedure with a primary diagnosis of any non-malignant indication, and with no current or historic cancer, or benign neoplasm. MAIN OUTCOME MEASURES:Number of procedures, in-hospital complications, readmissions within 28 days and trends over time. RESULTS:A total of 198 130 adult patients had a tonsillectomy between 1 April 2008 and 31st March 2023 in NHS trusts in England. The total number of procedures is falling over time. It is more commonly undertaken in women (68.3%), with 79.3% performed for tonsillitis. The majority (59.6%) are discharged on the same day, with 37.5% staying 1 night in hospital. 1.5% of patients had an in-hospital complication, with a total of 1967 patients having a haemorrhage or surgical arrest of post-operative bleeding from the tonsillar bed or adenoid; occurring more frequently in men (1.7% versus 0.7%, p < 0.001). A total of 33 934 patients were readmitted as an emergency within 28 days of surgery, almost doubling between 2008/09 and 2022/23. Readmission with bleeding within 28 days has also increased from 8.8% in 2008/09 to 15.6% in 2022/23. The return to theatre rate during readmissions has been relatively stable over the study time period with a higher proportion of admissions being managed without a further operative procedure. CONCLUSIONS:Tonsillectomy is a very common operation in the NHS in England. It currently has a readmission rate of 1 in 5 adults and this information is important for informed consent and local resource planning.
OBJECTIVE:To examine the association between serum cotinine and tympanometric abnormalities in US adults. DESIGN:Cross-sectional study. SETTING:National Health and Nutrition Examination Survey. PARTICIPANTS:Adults aged 20 years or older with available data on serum cotinine and tympanometry. MAIN OUTCOME MEASURES:The primary outcome was defined as a Type B or Type C tympanogram in either ear. Sensitivity analyses were performed for outcomes defined as a Type C tympanogram in either ear and a Type B tympanogram in either ear. RESULTS:A total of 13 169 adults were included. In the fully adjusted model, higher serum cotinine was associated with higher odds of the primary tympanometric abnormality outcome. For each log2 increase in serum cotinine, the odds ratio (OR) was 1.024 (95% confidence interval [CI], 1.011-1.037; p < 0.001). Compared with the lowest quartile, the highest quartile had an OR of 1.295 (95% CI, 1.060-1.582; p = 0.011), with a significant trend across quartiles (p for trend = 0.009). In sensitivity analyses, the association was more evident for Type C tympanometric patterns (OR 1.570, 95% CI 1.259-1.957 for the highest vs. lowest quartile) than for Type B patterns, for which no significant association was observed (OR 0.652, 95% CI 0.406-1.048; p = 0.077). CONCLUSIONS:Higher serum cotinine levels were associated with higher odds of tympanometric abnormalities in US adults. The association was more apparent for Type C than for Type B tympanometric patterns, suggesting that tobacco exposure may be more closely related to negative middle-ear pressure abnormalities than to nonspecific abnormal tympanograms.
Objective.:Microscopic positive surgical margin (mPSM) is found in around 10% of thyroid cancer cases, but it is controversial whether mPSM is associated with recurrence. This systematic review and meta-analysis integrated available evidence to clarify the association between mPSM and recurrence in differentiated thyroid carcinoma. Methods.:Cochrane Database of Systematic Reviews, MEDLINE/ PubMed, Web of Science Core Collection, and EMBASE were systematically searched from their inception through December 31, 2024. Three reviewers independently extracted study characteristics and hazard ratio (HR) of mPSM from included studies. The primary endpoint was cancer recurrence. Subgroup analysis of the primary outcome was conducted on the basis of margin location. Results.:Eleven studies comprising 20,446 patients were included in the analysis. Patients with mPSM had significantly higher recurrence rates than those with clear margins (pooled HR 1.78, 95% CI 1.43-2.20). This finding was replicated and validated when we examined 7 studies with 14,701 patients with only papillary thyroid carcinoma (pooled HR 1.87, 95% CI 1.34-2.60). Subgroup analysis revealed a markedly increased risk in cases with posterior mPSM (pooled HR 5.23, 95% CI 1.41-19.46), while anterior mPSM showed a nonsignificant association (pooled HR 1.22, 95% CI 0.82-1.82; P = 0.32). Conclusion.:This systematic review and meta-analysis suggests that mPSM may be associated with an increased risk of recurrence in differentiated thyroid carcinoma. Margin location may be an important factor to consider when evaluating the impact of mPSM on recurrence.
Empty nose syndrome (ENS) is a chronic sinonasal condition that typically results from overly aggressive turbinate reduction. It is characterized by nasal dryness, crusting, burning sensation, and a paradoxical perception of excessive airflow despite an anatomically wide nasal cavity, leading to significant impairment in quality of life. This narrative review summarized over 70 publications (PubMed, Embase, Google Scholar, and Cochrane Library; 2000-2026) to outline current diagnostic and therapeutic considerations for ENS. ENS most commonly develops following total or near-total inferior turbinectomy. Its pathophysiology involves transient receptor potential melastatin 8 cold receptor hypofunction, histopathological changes, autonomic nervous system dysfunction, and neuroinflammation. Diagnosis is based on the Empty Nose Syndrome 6-Item Questionnaire in combination with the cotton test, while the Standardized Empty Nose Syndrome Evaluation blinded protocol helps reduce placebo bias. The inferior meatus augmentation procedure is the most frequently reported surgical intervention, demonstrating clinically meaningful and sustained improvement in large meta-analyses; no single graft material has demonstrated consistent superiority. Non-surgical-including three-dimensional-printed nasal plugs, resorbable injectable fillers, intranasal trigeminal training, and cognitive behavioral therapy combined with selective serotonin reuptake inhibitors-serve as essential components of comprehensive management.
OBJECTIVE:To characterize paediatric hospitalizations for angioedema and identify the prevalence and outcomes of airway interventions using a large national database. METHODS:We performed a cross-sectional analysis of the Kids' Inpatient Database (2003-2019), including paediatric patients (0-20 years) hospitalized with angioedema identified by ICD-9/10 codes. Outcomes included hospital length of stay (LOS), total charges, and in-hospital mortality. Multivariable logistic regression evaluated predictors of airway intervention, and comparative analyses assessed outcome differences between patients with and without airway procedures. RESULTS:Among 4238 paediatric angioedema hospitalizations, 174 (4.1%) underwent airway procedures. Compared to non-intervention cases, these patients had significantly longer LOS (median 6 vs. 2 days, p < 0.001), higher charges ($59 571 vs. $7628, p < 0.001), and higher mortality (5.8% vs. 0.15%, p < 0.001). Black (adjusted odds ratio [AOR] 5.23, 95% CI 1.56-19.30) and Hispanic race (AOR 7.83, 95% CI 1.51-44.89) were associated with higher odds of intervention, while hospitalizations in the Northeast (AOR 0.10, 95% CI 0.015-0.55) and South (AOR 0.13, 95% CI 0.03-0.49) had lower odds compared to the Midwest. CONCLUSION:Airway interventions in paediatric angioedema are rare but linked to significantly higher morbidity, mortality, and healthcare costs. Geographic and racial disparities highlight the need to explore systemic factors shaping airway management decisions.
BACKGROUND:Tonsillectomy is one of the most common surgical procedures in otolaryngology, but the healing process remains unknown in individual patients. Several interventions, including platelet-rich plasma, have been investigated to improve healing and pain control due to their regenerative properties. OBJECTIVE:To assess the effect of platelet-rich plasma injection during tonsillectomy on postoperative results especially on epithelization stage and postoperative pain. METHOD:A prospective randomized controlled trial was conducted between January 2023 and December 2024, including 19 patients with platelet-rich plasma randomly injected in one of the fossae [treatment group] and normal saline in the other fossa [control group]. The endpoints were the epithelialization stage and pain score on days 1-7 after tonsillectomy. RESULTS:There were no statistically significant differences between groups in the postoperative epithelization stage. At the treatment sites, grade III wound epithelization was 21.1%, compared with the control site, where none had grade III wound epithelization. The p-values for wound epithelization (0.903) and pain score (0.222) indicate no difference between groups. Both groups' pain scores improved over time (p < 0.001). CONCLUSIONS:Intraoperative injection of platelet-rich plasma into the tonsillar beds was effective in stimulating tonsillar wound healing. Because of its properties, the treatment group appeared to have faster wound recovery than the control group. However, the differences were not statistically significant. Further studies with larger sample sizes are warranted to elucidate the potential benefits of platelet-rich plasma in post-tonsillectomy healing.
Objective.:Oropharyngeal squamous cell carcinoma (OPSCC) has undergone a major epidemiologic transition, with high-risk human papillomavirus (HPV) emerging as the dominant etiologic factor. Although HPV-16 accounts for most HPV-positive OPSCC worldwide, a substantial minority of tumors harbor non-HPV- 16 genotypes, the clinical and prognostic significance of which remains uncertain, particularly in Asian populations. This study aimed to investigate HPV genotype distribution and survival outcomes in a singleinstitution cohort of HPV DNA-positive OPSCC regardless of p16 and to assess the prognostic significance of HPV genotype. Methods.:We retrospectively reviewed patients treated with curative intent for HPV-positive OPSCC at Seoul National University Bundang Hospital between 2003 and 2023. HPV status was determined using p16 immunohistochemistry and HPV DNA genotyping. Patients were classified as having HPV-16 or non-HPV-16 genotype. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier method and compared using the log-rank test. Results.:Of 254 eligible patients, 174 with HPV DNA-positive tumors and available HPV genotyping results were included in the final analysis. HPV-16 accounted for 74.7% of tumors, while non-HPV-16 genotypes comprised 25.3%, most commonly HPV-33, HPV-35, HPV-58, and HPV-18. A marked male predominance was observed across all genotypes. The clinical stage distribution did not differ significantly between the HPV-16 and non-HPV-16 groups overall; however, HPV-33-positive tumors showed higher nodal stage compared with HPV-16. OS and DFS were similar between the HPV-16 and pooled non-HPV-16 groups. In genotype-specific analyses, DFS did not differ significantly across groups, whereas HPV-35 was associated with poorer OS compared with HPV-16. Conclusion.:In this cohort, non-HPV-16 genotypes accounted for approximately one-quarter of HPV-positive OPSCC cases and demonstrated clinicopathologic heterogeneity with selected genotype-specific prognostic differences. Given the substantial proportion of non-HPV-16 genotypes and the marked male predominance observed in our cohort, our findings may have implications for future HPV prevention strategies.
BACKGROUND:Prognosis in patients with N1 nasopharyngeal carcinoma (NPC) remains heterogeneous, partly due to variations in lymph node involvement. This study evaluated the prognostic significance of different lymph node characteristics in N1 NPC. METHODS:We retrospectively analysed 160 newly diagnosed non-metastatic N1 NPC patients treated at Liuzhou Worker's Hospital from January 2017 to May 2023. Kaplan-Meier curves were used to estimate survival outcomes, and Cox regression analysis was performed to identify independent prognostic factors. RESULTS:Among the 160 patients, 57 had retropharyngeal lymph nodes (RLNs) only, 24 had cervical lymph nodes (CLNs) only, and 79 had concurrent CLNs and RLNs involvement. The 5-year overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 94.7%, 80.1%, 89.6%, and 88.8%, respectively. Patients with concurrent CLNs and RLNs involvement had worse OS than those with single-region involvement (5-year OS: 90.2% vs. 98.4%, p = 0.0238). Subgroup analysis showed that in T1-2 patients, combined nodal involvement was associated with inferior OS, PFS, and LRRFS, whereas no significant survival differences were observed in T3-4 patients. Multivariate analysis identified lymph node necrosis (LNN) as an independent adverse prognostic factor for LRRFS (HR = 4.056; 95% CI: 1.262-13.035; p = 0.019). CONCLUSION:Lymph node characteristics further refine prognostic stratification in N1 NPC. Concurrent CLNs and RLNs involvement was associated with poorer survival, particularly in early T-stage disease, while LNN was associated with an increased risk of locoregional recurrence.
Objectives.:To compare survival outcomes between surgery-based salvage and non-surgical management in patients with locoregional recurrent salivary gland carcinoma (RSGC), and to explore whether surgery-based salvage is associated with more favorable outcomes in appropriately selected patients. Methods.:A search was performed in MEDLINE (Ovid), EMBASE, and the Cochrane Library. Observational studies were included that reported comparative outcomes for surgery-based salvage (resection ± adjuvant therapy) versus non-surgical management (re-irradiation, brachytherapy, systemic therapy, or palliative treatment) in locoregional recurrent disease. Patients with distant metastasis at recurrence were excluded from the pooled analysis. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) were calculated as non-surgical management versus surgery-based salvage and pooled using a random-effects model. Risk of bias was assessed using RoBANS 2.0. Results.:Five retrospective comparative studies (N = 163) met the inclusion criteria. Four studies contributed to a meta-analysis for OS (N = 153) and DFS (N = 145). In pooled observational analyses, non-surgical management showed higher hazard estimates for OS (pooled HR = 3.40; 95% confidence interval [CI], 1.17-9.84; p = 0.024) and DFS (pooled HR = 3.09; 95% CI, 1.21-7.91; p = 0.019) than surgery-based salvage. Heterogeneity was considerable for OS (I² = 80.1%) and moderate for DFS (I² = 56.4%). Most studies had moderate-to-high risk of bias, particularly for participant comparability and residual confounding. Conclusion.:Available comparative observational evidence suggests that surgery-based salvage may be associated with more favorable survival outcomes in appropriately selected patients with locoregional RSGC. However, the evidence base is small, retrospective, and clinically heterogeneous; therefore, these findings should be interpreted as exploratory rather than confirmatory, and treatment decisions should be individualized within a multidisciplinary approach.
