Objective:To investigate the safety and efficacy of endoscopic thyroidectomy by gasless unilateral axillary approach in the treatment of large thyroid nodules. Methods:A retrospective analysis was performed on 49 patients with large unilateral thyroid nodules who underwent endoscopic thyroidectomy by gasless unilateral axillary approach performed by the same surgeon in our hospital from August 2022 to October 2025（Large thyroid nodules were defined as maximum intrathyroidal lesion diameter ≥4 cm, or ≥3 cm with ipsilateral lobe volume ≥20 mL, malignancy, rapid progression（within 6 months） or clinical symptoms）. These patients were matched with 49 patients with thyroid cancer（microcarcinoma group） whose maximum diameter of single lesion was <1 cm and the volume of the affected lobe was<20 mL during the same period. The operation time, specimen retrieval time, intraoperative blood loss, postoperative drainage volume, and early complications were compared between the two groups. Results:All 98 operations were completed successfully, with rapid and intact specimen retrieval, and no conversion to open surgery. There were no statistically significant differences in operation time, specimen retrieval time, intraoperative blood loss, and total postoperative complication rate between the two groups. During the follow-up period of 3-39 months, no residual thyroid tissue, effusion, tumor recurrence or metastasis was observed in the surgical field, and vocal cord mobility was normal in all patients. Conclusion:Endoscopic thyroidectomy by gasless unilateral axillary approach provides a stable surgical space, a unique dorsolateral view of the thyroid lobe, and an excellent surgical field smoke evacuation system. This technique is safe and effective for large thyroid nodules without reducing surgical efficiency or increasing surgical risk and difficulty. Moreover, it allows complete and natural specimen retrieval, thus ensuring the accuracy of postoperative pathological diagnosis.
Objective:To explore the clinical efficacy of combined application of two pedicled myoperiosteal flaps for packing the mastoid cavity in canal wall down tympanomastoidectomy. Methods:A total of 85 patients who underwent canal wall down tympanomastoidectomy for middle ear cholesteatoma from January 2016 to January 2022 were included. All patients underwent preoperative temporal bone computed tomography（CT） examination, which confirmed they had pneumatized mastoids with extensive lesions or destruction of the posterior wall of the external auditory canal. Routine canal wall down mastoidectomy with tympanoplasty was performed, and two pedicled myoperiosteal flaps, with pedicles located at the temporal muscle and posteroinferior parts of the mastoid respectively, were used to pack the epitympanic antrum and mastoid tip regions. Patients were reexamined weekly after surgery until the surgical cavity was completely healed. Pure-tone audiometry and otoscopic examination were conducted 3 months postoperatively, and temporal bone CT was performed 1 year postoperatively. Subsequent follow-ups were scheduled every 3 months or 6 months. During the follow-up period, the shape and healing of the surgical cavity, recurrence of cholesteatoma, and the effect of hearing improvement were evaluated. Results:All patients successfully completed the surgery, with no complications such as facial paralysis, cerebrospinal fluid otorrhea, or vertigo, and no wound infection during the perioperative period. The average time for complete healing of the surgical cavity was 6 weeks, with a dry ear rate of 100%. Otoscopic examination at 3 months and temporal bone CT at 1 year postoperatively showed that the shape of the surgical cavity was close to that of a normal external auditory canal, with a slightly wider diameter. At 1 year postoperatively, 30.6% of patients had epitympanic retraction; at 2 years postoperatively, 43.5% of patients had epitympanic retraction, and 27.1% had mild retraction in the epitympanic antrum region. However, the overall surgical cavity was smooth and easy to clean. Hearing was significantly improved in 60.0% of patients, slightly improved in 25.9% of patients, and no significant change was observed in 14.1% of patients; no cases of hearing loss were reported. During the follow-up period of 2 to 7 years, no external auditory canal stenosis, surgical cavity infection, or cholesteatoma recurrence was found. Conclusion:The combined application of two pedicled myoperiosteal flaps in canal wall down tympanomastoidectomy can effectively reduce the size of the mastoid surgical cavity and optimize the cavity shape. Furthermore, these two pedicled myoperiosteal flaps are easy to manipulate and possess strong anti-infective ability, which can effectively solve the residual surgical cavity problem after canal wall down mastoidectomy.
Objective:To investigate the respiratory mechanics characteristics of female patients with obstructive sleep apnea-hypopnea syndrome（OSAHS） using calibrated respiratory inductance plethysmography（cRIP）, and to evaluate the clinical value of the Thoraco-Abdominal Asynchrony Index（TAAI） in identifying subclinical respiratory effort in women. Methods:A retrospective case-control study was conducted. Forty female OSAHS patients（female group） treated in the Department of Otorhinolaryngology at Liaoning Provincial People's Hospital from January 2022 to October 2025 were included. Through propensity score matching（PSM）, 40 male patients matched for age, body mass index（BMI）, and apnea-hypopnea index（AHI） during the same period were selected as the male group. All patients underwent simultaneous polysomnography（PSG） and cRIP monitoring. Differences in the percentage of thoraco-abdominal asynchrony time and TAAI were compared between the two groups. Pearson correlation analysis was used to explore the relationship between TAAI and Hamilton Anxiety Scale（HAMA） scores. Additionally, an independent validation cohort consisting of 30 female patients with upper airway resistance syndrome（UARS） and 30 age-matched healthy female controls was recruited. The diagnostic efficacy of TAAI for upper airway resistance syndrome（UARS） was evaluated using receiver operating characteristic（ROC） curve analysis. Results:With no significant difference in AHI between groups, the full-night microarousal index in the female group（25.6±8.9 events/h） was significantly higher than that in the male group（18.3±7.2 events/h, P<0.001）. cRIP analysis showed that the full-night percentage of thoraco-abdominal asynchrony time in the female group（24.6±8.9）% was significantly higher than that in the male group（17.6±7.1）%, P<0.001. The full-night TAAI in the female group（5.1±3.2） was also significantly higher than that in the male group（3.6±2.9, P<0.001）. Correlation analysis revealed a significant positive correlation between TAAI and HAMA scores in the female group（r=0.636, P<0.001）. ROC curve analysis indicated that the area under the curve（AUC） of TAAI for diagnosing UARS in women was 0.902（95%CI 0.823-0.981）. At a cut-off value of 3.2, the diagnostic sensitivity was 86.7% and specificity was 90.0%. Conclusion:Female OSAHS patients exhibited more significant respiratory effort（Thoraco-Abdominal Paradox） and higher microarousal frequency compared to male patients with similar disease severity. The cRIP-quantified TAAI can effectively identify covert respiratory disturbances characterized by increased upper airway resistance, and this index is closely associated with anxiety levels in female patients. TAAI can serve as a quantitative tool to assist in diagnosing UARS in women, demonstrating considerable clinical application value.
Objective:To explore the influencing factors of negative preoperative technetium-99m methoxyisobutyl isonitrile（99mTc-MIBI） imaging in patients with single parathyroid adenoma. Methods:A total of 378 patients with single parathyroid tumors who underwent primary open cervical surgery were retrospectively enrolled. According to the results of preoperative 99mTc-MIBI imaging results, the patients were divided into the 99mTc-MIBI negative group and positive group. The baseline data, laboratory indicators, imaging findings and pathological characteristics were compared between the two groups to analyze the correlative and independent influencing factors of preoperative negative 99mTc-MIBI results. ROC curve analysis was performed to evaluate the predictive value of preoperative serum calcium and tumor volume for 99mTc-MIBI negativity. Results:Of the 378 enrolled patients, postoperative pathology confirmed 372 cases（98.4%） of parathyroid adenoma and 6 cases（1.6%） of atypical parathyroid tumor. Among them, 70 patients（18.5%） presented with negative preoperative 99mTc-MIBI scintigraphy results. Compared with the 99mTc-MIBI positive group, the negative group had a milder elevation of preoperative serum calcium, lower alkaline phosphatase（ALP） levels, a lower proportion of tumor cystic degeneration and smaller tumor volume, with all differences being statistically significant（P<0.05）. Multivariate Logistic regression analysis demonstrated that mild preoperative hypercalcemia and small tumor volume were independent risk factors for 99mTc-MIBI negativity. ROC curve analysis showed that the area under the curve（AUC） of preoperative serum calcium for predicting99mTc-MIBI negativity was 0.612（95%CI 0.538-0.687, P<0.01）, with an optimal cut-off value of 2.59 mmol/L. The AUC of tumor volume was 0.750（95%CI 0.692-0.808, P<0.01）, and the optimal cut-off value was 563 mm³. The median follow-up duration was 39.5 months, and the biochemical cure rate was 99.7%. Conclusion:In patients with single parathyroid tumors, the correlated factors for negative preoperative 99mTc-MIBI imaging included mild elevation of preoperative serum calcium, low ALP level, absence of tumor cystic degeneration and small tumor volume. Among these factors, mild preoperative hypercalcemia and small tumor volume were independent risk factors for negative 99mTc-MIBI imaging.
Objective:To investigate the short-term efficacy and prognostic factors of severe to profound sudden sensorineural hearing loss（SSNHL） in pediatric patients. Methods:A retrospective analysis was conducted on the clinical data of 87 children with severe to profound SSNHL who were admitted to our department between January 2014 and December 2024. Hearing changes were evaluated 10 days after treatment initiation. Pearson's chi-square test was used to compare intergroup differences in categorical variables, including gender, affected side, vertigo, tinnitus, early combined use of batroxobin, degree of hearing loss, and upper respiratory tract infection. The Mann-Whitney U test was used to analyze intergroup differences in continuous variables, including age and duration of hearing loss. Univariate and multivariate logistic regression analyses assessed the short-term therapeutic efficacy and its influencing factors in severe and profound SSNHL. Grouped stacked bar charts and grouped box plots explored the relationship between significant influencing factors and therapeutic response rate. Results:Pearson's chi-square test and Mann-Whitney U test revealed that gender, age, duration of hearing loss, and early combined use of batroxobin were significantly associated with the therapeutic response rate of severe and profound SSNHL in children（P<0.05）. No statistically significant differences in therapeutic response rate were observed among groups with affected side, tinnitus, vertigo, degree of hearing loss, or upper respiratory tract infection（P>0.05）. Univariate logistic regression analysis indicated that age, gender, duration of hearing loss, and early combined use of batroxobin were influencing factors for the therapeutic efficacy of severe and profound SSNHL in children. Multivariate logistic regression analysis further demonstrated that duration of hearing loss was negatively correlated with the response rate, whereas female gender, older age, and early combined use of batroxobin were positively correlated with the response rate. Grouped stacked bar charts showed that the response rate was higher in females, and higher in patients with early batroxobin administration. Grouped box plots indicated that a shorter duration of hearing loss was associated with a more concentrated distribution of response rates, and older age was also correlated with a more concentrated distribution of response rates. Conclusion:Gender, age, early combined use of batroxobin, and duration of hearing loss are independent influencing factors for the short-term treatment of severe and profound SSNHL in children.
Objective:To compare the application value of two imaging evaluation methods, the Nakashima method and the Bernaerts method, in endolymphatic hydrops（ELH） in Meniere's disease, and to explore the correlation with clinical characteristics. Methods:Data from 54 patients with unilateral lesions were retrospectively analyzed. According to the Nakashima method and the Bernaerts method, the scores and positivity rates of cochlear endolymphatic hydrops（C-ELH）, vestibular endolymphatic hydrops（V-ELH）, and total endolymphatic hydrops（T-ELH） in the affected ears and contralateral ears were obtained. Inter-observer consistency was compared, and the correlations of ELH with disease duration, pure-tone audiometry（PTA）, and caloric test canal paresis（CP） values were analyzed. Results:①Inter-observer consistency: The weighted Kappa coefficients for C-ELH and V-ELH were 0.753 and 0.619 in the Nakashima method, and 0.837 and 0.774 in the Bernaerts method, respectively（all P<0.001）. ②Comparison of positivity rates between affected and contralateral ears: For C-ELH（Nakashima: 74.1% vs 11.1%; Bernaerts: 85.2% vs 13%）, V-ELH（Nakashima: 74.1% vs 7.4%; Bernaerts: 87.0% vs 22.2%）, and T-ELH（Nakashima: 90.7% vs 14.8%; Bernaerts: 92.6% vs 29.6%）, all differences were statistically significant（P<0.01）. No significant differences were found in the positivity rates of C-ELH, V-ELH, or T-ELH in either affected or contralateral ears between the two methods（P>0.05）. ③ Correlation with disease duration: For C-ELH, no correlation was found in the Nakashima method（P>0.05）, but a significant positive correlation was found in the Bernaerts method（P<0.05）. For V-ELH, a significant positive correlation was found in the Nakashima method（P<0.01）, but no correlation was found in the Bernaerts method（P>0.05）. For T-ELH, significant positive correlations were found in both methods（P<0.05）. ④ Correlation with PTA: For both methods, C-ELH showed a significant positive correlation（P<0.01）, V-ELH showed no correlation（P>0.05）, and T-ELH showed a significant positive correlation（P<0.01）. ⑤Correlation with clinical stage: In both methods, C-ELH showed a significant positive correlation（P<0.05）, V-ELH showed no correlation（P>0.05）, and T-ELH showed a significant positive correlation（P<0.05）. ⑥Correlation with CP values: No significant correlations were found between C-ELH, V-ELH, or T-ELH in affected ears and CP values in either method（P>0.05）. Conclusion:The Nakashima method and the Bernaerts method have comparable overall value in terms of the positive rate of endolymphatic hydrops and its correlation with clinical features, but they differ in assessing the relationship between cochlear hydrops, vestibular hydrops, and disease duration. The Bernaerts method is simpler and more efficient in its operational process. In clinical practice, the choice of evaluation method should take other factors into comprehensive consideration.
Objective:To evaluate the intervention effect and influencing factors of non-implantable bone conduction devices（BCD） in patients with single-sided deafness（SSD） under the S₀N₀condition. Methods:A total of 32 SSD patients were included. Pure tone audiometry, the Chinese translation of the Twelve-item version of the Speech, Spatial and Qualities of Hearing Scale（C-SSQ12）, the Digit Span Test（DST）, and multi-dimensional speech-in-noise recognition tests were used to evaluate the intervention effect of BCD under the S₀N₀condition. The influences of test materials, signal-to-noise ratio（SNR）, subjective auditory ability, and cognitive function on the intervention effect of BCDs were analyzed. Results:Among the C-SSQ12 dimensions, only the spatial hearing score was below 6.5 points, and it was also significantly lower than the average score as well as the scores for speech comprehension and listening quality（P<0.000 1）. There was no significant decrease in forward and backward digit span scores of SSD patients in the DST. BCD intervention could significantly improve the sentence recognition score in noise of SSD patients only under the condition of low SNR（speech recognition thresholdD-3 dB）（P<0.000 1）. The average score and spatial hearing score of C-SSQ12 in SSD patients were negatively correlated with the improvement of disyllabic word recognition threshold and SNR loss after BCD intervention（P<0.05）, and the backward digit span score was significantly positively correlated with the improvement of SNR loss after BCD intervention（P=0.03）. Conclusion:In the co-located condition, the intervention with BCD is more effective in SSD patients with superior cognitive function, particularly under low SNR environments. Clinical practice should combine multi-dimensional evaluations to achieve precise intervention.
Objective:To investigate the anatomical correlation between sigmoid sinus dominance type and high jugular bulb（HJB）, and their interactive effects on sigmoid sinus morphology, jugular bulb morphology, and bone wall integrity, thereby providing anatomical evidence for preoperative imaging evaluation in lateral skull base and middle ear surgeries to reduce intraoperative injury risk. Methods:A total of 288 patients with completely pneumatized mastoids who underwent temporal bone CT and CTA examinations at our hospital from August 2017 to March 2025 were consecutively enrolled. They were divided into nine groups based on sigmoid sinus dominance type（left/right/balanced） and jugular bulb position（low/middle/high）. Measurements included sigmoid sinus diameter, mastoid volume, bone wall thickness, jugular bulb bone wall thickness, area, and volume. Comparative analyses were performed on inter-group and intra-group differences in sigmoid sinus bone wall thickness and jugular bulb bone wall thickness; correlations between bone wall thickness of sigmoid sinus segments and jugular bulb; and distribution of bone wall integrity categories（normal, thinning, defect） across groups, using chi-square tests. Results:Sigmoid sinus diameter was significantly enlarged on the dominant side（P<0.01）, with the largest left diameter in the left-dominant high-position group and the largest right diameter in the right-dominant high-position group. The balanced-horizontal high-position group exhibited the largest jugular bulb cross-sectional area and volume（P<0.05）. Mastoid volume showed no significant differences among groups（P>0.05）. No statistically significant differences in bone wall thickness of sigmoid sinus segments or jugular bulb were found across groups（P>0.05）, but significant positive correlations between sigmoid sinus segment bone wall thickness and jugular bulb bone wall thickness were observed in specific subgroups（P<0.05）. Jugular bulb integrity and its communication with air cells varied significantly among groups（P<0.01）, whereas sigmoid sinus bone wall integrity showed no inter-group differences（P>0.05）. The jugular bulb was the primary site of bone wall defects and abnormal communications. Conclusion:Sigmoid sinus dominance type and jugular bulb position exhibit a coupled relationship, jointly influencing local vascular morphological features. High-positioned and enlarged jugular bulbs（particularly in the balanced-horizontal high-position group） are key risk factors for bone wall thinning, defects, and abnormal communications with air cells, while sigmoid sinus bone walls remain relatively stable. Preoperative CT imaging evaluation should integrate the anatomical relationship of both structures, with a focus on jugular bulb morphology and bone wall integrity, which is critical for preventing vascular injuries during lateral skull base and middle ear surgeries.
This consensus, developed by experts from the Yangtze River Delta region, systematically elucidates the properties and mechanisms of biodegradable packing materials-including poly（ether ester urethane）, gelatin-based, and hyaluronic acid-based materials-for use in nasal surgery, based on evidence-based medicine. Individualized and rational packing strategies are proposed for diverse clinical scenarios, such as septoplasty, sinus surgery, and naso-skull base surgery. Furthermore, the consensus explores the value of these materials in localized drug delivery and in special populations（e.g., patients with hematologic disorders, elderly patients, and pediatric patients）, with the aim of optimizing clinical pathways and balancing patient benefits with the utilization of healthcare resources.
Tertiary lymphoid structures（TLSs）are acpuired lymphoid aggregates in non-lymphoid tissues and play a significant role in the evolution, treatment, and prognosis of chronic inflammatory and tumor-related diseases.In recent years, research on TLSs has gradually expanded in the fields of chronic rhinosinusitis（CRS）and nasopharyngeal carcinoma（NPC）.Its existence is closely related to the progression of chronic inflammatory diseases and the improvement of tumor immunotherapy efficacy.This article comprehensively analyzes the research progress of TLSs in CRS and NPC, discusses the structural characteristics, formation regulatory mechanisms, and the role of TLSs in the treatment of CRS and NPC, further explores the potential of TLSs as prognostic markers and therapeutic targets, and points out their dual roles of exacerbating inflammation in CRS and promoting immune surveillance in NPC.It also looks forward to the future direction of jointly promoting the clinical translation of TLSs research through multi-omics technologies and artificial intelligence.
Objective:To investigate the effect of dust mite sublingual immunotherapy（SLIT） on serum specific immunoglobulin E（sIgE） levels of non-target allergens in patients with multiple-sensitized allergic rhinitis（AR）, and to analyze its clinical significance. Methods:A total of 86 patients with multiple-sensitized AR due to dust mites treated in the Department of Otorhinolaryngology, Affiliated Hospital of Zunyi Medical University from January 2021 to December 2023 were enrolled. All patients received standardized Dermatophagoides farinae drops SLIT for 24 months. The sIgE levels of target allergen（dust mite） and non-target allergens（pollen, mold, animal dander） were measured before treatment, and at 6, 12, and 24 months of treatment, respectively. Meanwhile, the Total Nasal Symptom Score（TNSS）, Total Medication Score（TMS）, and Visual Analogue Scale（VAS） were evaluated. The correlation between changes in non-target allergen sIgE levels and clinical efficacy was analyzed. Results:After 6, 12, and 24 months of treatment, the dust mite sIgE levels decreased significantly compared with baseline（P<0.05）, and continued to decline with prolonged treatment. The sIgE levels of non-target allergens（pollen, mold, animal dander） also showed a gradual downward trend, which were significantly lower at 12 and 24 months than at baseline（P<0.05）, and the decrease at 24 months was significantly greater than that at 12 months（P<0.05）. At each time point of treatment, TNSS, TMS, and VAS scores were significantly lower than those before treatment（P<0.05）, and were negatively correlated with the decrease in non-target allergen sIgE levels（r=-0.582, -0.537, -0.614, all P<0.05）. After 24 months of treatment, the total clinical effective rate was 87.21%. The decrease in non-target allergen sIgE levels in the effective group was significantly greater than that in the ineffective group（P<0.05）. Conclusion:Dust mite SLIT can significantly reduce non-target allergen sIgE levels in patients with multiple-sensitized AR, and this reduction is closely related to the improvement of clinical symptoms. It suggests that SLIT can improve the sensitization status to multiple allergens by regulating the overall immune tolerance of the body, providing theoretical basis and practical guidance for the clinical treatment of multiple-sensitized AR.
Vestibular schwannoma（VS） grows slowly, with a striking contrast in clinical manifestations at different stages. During the growth phase of VS, it often presents as an acute vestibular syndrome similar to vestibular neuritis, with prominent vestibular symptoms such as vertigo and balance disorders. However, with the slow growth of the tumor, central vestibular compensation develops promptly, resulting in the absence of typical vertigo indicative of unilateral vestibular injury, which may be inconsistent with vestibular test findings. This paper reports two cases of VS at different disease stages and their results of systematic vestibular function evaluation, and analyzes the severity, frequency bands, and compensatory status of vestibular injury from multiple perspectives. Considering the growth characteristics of VS, the clinical feature of inconsistency between patients' vestibular symptoms and objective examination results, the limitations of previous diagnoses, and the current neglect of vestibular function testing, which targets the primary lesion, this study explores the significance of systematic vestibular function evaluation in the clinical diagnosis of VS. Furthermore, integrated with the latest research advances in vestibular function associated with VS in recent years, it provides practical references for early clinical screening and the reduction of misdiagnosis and missed diagnosis.
Otitis media with effusion（OME） is a prevalent otologic condition in children that may lead to persistent hearing impairment and speech-language developmental delays. Recent studies have demonstrated that nasopharyngeal-middle ear microecological dysbiosis plays a central role in OME pathogenesis and chronicity. Advances in precision diagnostics-including AI-assisted otoscopy, wideband acoustic immittance, and electronic nasopharyngoscopy-have improved early detection, while individualized interventions such as microbiota-targeted probiotics and balloon Eustachian tuboplasty offer promising strategies for refractory cases. This review summarizes recent advances along the theme of "microecological imbalance-precision diagnosis-individualized intervention," aiming to provide a reference for clinical practice.
The repair of vocal fold injury is a complex process involving inflammatory response, cell proliferation, and extracellular matrix（ECM） remodeling. Aberrant repair can lead to scar formation and voice dysfunction. Recent research has revealed that this process is tightly regulated by a sophisticated network of cytokines, including TGF-β and HGF, and signaling pathways such as JAK/STAT and Wnt/β-catenin. Building on this deepened understanding of molecular mechanisms, vocal fold repair strategies are entering a new era of regenerative medicine. This article systematically elaborates on the pathophysiological and molecular events across various repair stages and reviews the latest therapeutic advances. These include targeting key cytokines, modulating signaling pathways, and utilizing stem cells and bioactive scaffolds（e.g., hyaluronic acid, decellularized matrices） to remodel the ECM. These interventions aim to suppress fibrosis at its root and promote functional tissue regeneration, offering promising new directions for overcoming the clinical challenge of vocal fold scarring.
Symptomatic benign nasopharyngeal lesions following adenoidectomy are uncommon in children. This study describes and investigates a previously unreported transient vascular granulation tissue in the nasopharynx post-adenoidectomy, focusing on its clinical features, imaging characteristics, and the effectiveness of conservative management. This study retrospectively analyzed the data of 4 children with nasopharyngeal neoorganisms treated in the outpatient department of Otolaryngology, Nanjing Children's Hospital from 2020 to 2022, and discussed the laryngoscopic manifestations, differential diagnosis and treatment of this disease.
Objective:To investigate the clinical features and diagnosis and treatment of extranodal Rosai-Dorfman disease（RDD） in nasal skull base. Methods:A retrospective analysis was conducted on 5 cases（2 males and 3 females; aged 13 to 61 years） of extranodal RDD in nasal skull base, diagnosed at Xiangya Hospital, Central South University, from February 2015 to May 2025. The lesions were found in various parts, including the nasal cavity, paranasal sinuses, pterygopalatine fossa, and nasopharynx, manifesting as nasal congestion, headache, visual impairment, and hearing loss, etc. Two patients were admitted to Xiangya Hospital due to postoperative residual lesions from other hospitals and unclear pathology. All patients had nasal endoscopic tumor resection surgery, where one patient underwent partial resection of the lesion due to the large lesion range. Five patients received oral methylprednisolone after surgery. Results:During a follow-up period of 49 to 126 months, none of 4 cases（4/5） who underwent gross total resection experienced a recurrence. The remaining patient （1/5） who underwent partial resection showed no significant symptomatic improvement after postoperative methylprednisolone treatment and requested a second surgery. Following further endoscopic tumor resection, this patient achieved a good postoperative recovery. Conclusion:Extranodal RDD in the nasal skull base is clinically rare and highly susceptible to misdiagnosis. Endoscopic surgical resection of localized nasal skull base RDD has shown favorable therapeutic outcomes, suggesting the importance of achieving maximal safe resection. The specific regimen of postoperative adjuvant steroid therapy still requires further investigation.
Objective:To investigate the associations between seven composite anthropometric indices-body mass index（BMI）, waist-to-height ratio（WHtR）, neck-to-height ratio（NHR）, body roundness index（BRI）, a body shape index（ABSI）, weight-adjusted-waist index（WWI）, and relative fat mass index（RFM） -and the severity of obstructive sleep apnea（OSA）, and to evaluate their predictive value and diagnostic efficacy for OSA severity. Methods:This retrospective study enrolled 4 364 patients with suspected OSA from the Department of Otolaryngology-Head and Neck Surgery at the Second Affiliated Hospital of Xi'an Jiaotong University between September 2021 and April 2025. All participants underwent overnight polysomnography（PSG） and were categorized into four groups based on the apnea-hypopnea index（AHI）: non-OSA, mild, moderate, and severe. Correlation analysis was used to examine the relationships between the indices and AHI. Logistic regression was employed to assess their associations with OSA severity. Principal component analysis（PCA） was applied for dimensionality reduction to extract comprehensive components. The predictive performance of individual indices and principal components was evaluated using receiver operating characteristic（ROC） curve analysis, with the area under the curve（AUC） calculated. The optimal cutoff point, sensitivity, and specificity of each index for detecting OSA and severe OSA were determined. Results:All composite anthropometric indices showed significant positive correlations with AHI（P<0.01）, with BMI demonstrating the strongest correlation（r=0.484）. PCA extracted three principal components（cumulative variance explained: 95.34%）: PC1（loading highly on BRI, WWI, NHR） was positively associated with OSA severity（OR=1.54, 95%CI 1.480-1.610）, whereas PC2（loading highly on ABSI, BMI, WWI） was negatively associated（OR=0.75, 95%CI 0.700-0.800）. ROC analysis revealed that BMI, BRI, WHtR, and NHR had the best overall predictive performance（AUC range: 0.706-0.708）. Diagnostic efficacy analysis indicated that NHR demonstrated superior balanced performance for OSA screening, whereas BRI and WHtR offered the highest sensitivity（>80.00%）. For identifying severe OSA, BRI and WHtR showed the best diagnostic efficacy. PC1 maintained robust performance across both screening and severe OSA identification tasks. Conclusion:In addition to BMI, composite anthropometric indices such as NHR, BRI, and WHtR are also effective tools for screening and assessing OSA severity, offering specific insights into regional fat distribution（NHR） and central obesity（BRI/WHtR）, respectively. Furthermore, the composite feature dominated by cervical and central obesity（PC1） was identified as an important risk factor for OSA.
Objective:To summarize the clinical outcomes of endoscopic mucosal flap technique combined with absorbable corticosteroid drug-eluting stent in children with congenital bony nasal stenosis. Methods:A retrospective review was performed on 9 children（age 7 days to 5 years） treated from January 2019 to July 2025. Among them, there were 6 cases of congenital choanal atresia and 3 cases of congenital nasal pyriform aperture stenosis （CNPAS）. Except for 1 case of stenosis of the nasal meatus treated conservatively, the rest were treated by endoscopic choanal atresia repair. During surgery, mucosa over the atretic plate was preserved and fashioned into mucosal flaps to cover raw surfaces; partial vomer removal was performed when necessary to enlarge the neochoana, followed by placement of an absorbable corticosteroid drug-eluting stent for support, flap stabilization, and local anti-inflammation. Follow-ups were scheduled at 2 weeks, 1, 2, 3 and 6 months, and thereafter, assessing nasal patency, feeding/sleeping, endoscopic findings, and restenosis/reatrestia. Results:Among 6 choanal atresia cases, 5 remained patent without reatrestia during follow-up, while 1 complete bony case developed reatrestia and was deemed a failure. Among 3 pyriform aperture stenosis cases, the conservatively managed child had prolonged symptoms（20 days） after upper respiratory infections requiring intranasal medications, whereas the two surgically treated children achieved resolution of nasal obstruction and normal feeding. Conclusion:Endoscopic mucosal flap technique combined with absorbable corticosteroid drug-eluting stent may provide favorable patency maintenance and mucosal healing in most children with congenital bony nasal stenosis, while complete bony choanal atresia remains at high risk of reatrestia.
The nasal microbiome serves as a pivotal regulator of immune homeostasis in the upper airway. Under physiological conditions, it maintains immune equilibrium through mechanisms such as reinforcing the epithelial barrier and modulating innate and adaptive immune responses. Microbial dysbiosis, however, is recognized as a key trigger in the pathogenesis of chronic rhinosinusitis （CRS） and allergic rhinitis （AR）. This review summarizes how the nasal microbiome regulates immune homeostasis by influencing epithelial barrier function and immune responses in both health and disease states, with a focus on CRS and AR. It focuses on the characteristics of microbial dysbiosis and immunopathological mechanisms in CRS and AR, and provides perspectives on microbiome-based diagnostic biomarkers and microecological interventional therapeutic strategies.
Objective:To analyze the clinical efficacy of tympanoplasty in patients with chronic suppurative otitis media（CSOM） complicated by fungal infection through a prospective randomized controlled study, and to explore the optimal surgical timing for chronic otitis media patients accompanied by fungal infection. Methods:A total of 92 patients diagnosed with chronic otitis media who were admitted to Yinchuan First People's Hospital from December 2024 to December 2025 were enrolled in this study. All subjects underwent preoperative microbiological examinations（including fungal smear counting and culture）, otoendoscopy, Zurich Chronic Middle Ear Inventory-21（ZCMEI-21） assessment, and pure-tone audiometry. According to the results of preoperative electronic otoendoscopy and microbiological tests, the patients were divided into the non-fungal infection group（n=58） and the fungal infection group（n=34）. The 34 patients in the fungal infection-complicated group were randomly assigned to the control group（n=17, receiving systemic antifungal treatment preoperatively） and the experimental group（n=17, without preoperative systemic antifungal treatment） using the double-blind design. All 92 patients underwent electronic otoendoscopy at 2, 4, 8, and 12 weeks postoperatively, and the time to dry ear was recorded during follow-up. ZCMEI-21 assessment and pure-tone audiometry were re-evalutaed at 12 weeks after surgery. Results:①There was no statistically significant difference in the preoperative and postoperative air-bone gap improvement （ΔABG=preoperative ABG-postoperative ABG） among the three groups（P>0.05）. ②No statistically significant difference was observed in the postoperative time to dry ear among the three groups（P>0.05）. ③The tympanic membrane healing rate showed no statistically significant difference among the three groups（P>0.05）. ④The ZCMEI-21 scale scores were not statistically different among the three groups（P>0.05）. However, in terms of medical resource utilization reflected by the scale, statistically significant differences were found between the blank group and the experimental group, as well as between the control group and the experimental group（P<0.05）. Conclusion:Patients with chronic otitis media complicated by external auditory canal fungal infection can undergo otoendoscopy-assisted tympanoplasty without preoperative systemic antifungal treatment, achieving clinical efficacy comparable to those without fungal infection.
