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.
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.: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.
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.
Objective:To develop evidence-based clinical practice guidelines for evaluating and managing peripheral facial nerve palsy within the Korean healthcare system. Methods:A multidisciplinary guideline committee-comprising otolaryngologists, a neurologist, a neurosurgeon, a rehabilitation medicine specialist, an ophthalmologist, a plastic surgeon, and a methodology expert-conducted de novo systematic reviews. Literature searches were performed in MEDLINE, Embase, the Cochrane Library, and KoreaMed through November 30, 2024. Evidence was appraised using the GRADE methodology, and nine key clinical questions (KQs) were formulated using the PICO framework. Recommendations were finalized through structured consensus requiring at least 70% agreement. A patient preference survey (n = 51) informed value considerations. The draft guideline underwent external review by seven independent experts. Results:Ten recommendations addressing nine KQs were developed. The House-Brackmann grading system is recommended as the standard assessment tool (Grade A). Routine testing is unnecessary for typical Bell's palsy; selective testing is advised for atypical features (Grade B). Electrodiagnostic studies may be used for prognostic evaluation in severe cases (Grade B). Oral corticosteroids are strongly recommended within 72 hours of symptom onset (Grade A). Antivirals may be added based on clinical judgment and patient preference (Grade B). Facial nerve decompression may be considered in selected patients with severe degeneration (Grade B). Rehabilitation therapy, surgery for chronic palsy, botulinum toxin injection for synkinesis, and multidisciplinary management are conditionally recommended (Grade B). Conclusion:This guideline provides an evidence-based framework for managing facial nerve palsy in Korea. It integrates systematic evidence, patient preferences, and healthcare system factors, including National Health Insurance coverage and regional accessibility.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by recurrent collapse of a structurally vulnerable upper airway during sleep. Airway caliber and stability are influenced by multiple anatomical structures, including the nasal cavity, soft palate, lateral pharyngeal walls, tongue base, hyoid complex, and craniofacial skeleton. Detailed knowledge of these structures is therefore essential for rational surgical planning. This narrative review summarizes key anatomical features relevant to upper pharyngeal surgery, including nasal obstruction and the internal nasal valve, palatal musculature and parapharyngeal fat, and the lateral palatal space as a target for reconstructive palatal and lateral wall procedures. It also outlines lower pharyngeal strategies, such as genioglossus advancement, hyoid myotomy–suspension, and tongue base reduction, which address retroglossal collapse and unfavorable skeletal–soft tissue relationships. Maxillomandibular advancement and hypoglossal nerve stimulation are discussed as anatomy-driven multilevel and neuromodulatory options, respectively. Across these modalities, an anatomically grounded, phenotype-based approach is central to optimizing patient selection, reducing complications, and improving long-term surgical outcomes in OSA.
Objectives.:To delineate the genetic landscapes and audiological trajectories of pediatric asymmetric hearing loss (AHL) and interaural asymmetry (IA) using a systematic multi-tiered genetic testing strategy extending to whole-genome sequencing (WGS), and to assess the clinical implications for individualized auditory rehabilitation. Methods.:The study was a retrospective cohort study of pediatric patients (≤18 years) with sensorineural hearing loss (SNHL) who underwent comprehensive genetic testing at a tertiary cochlear implantation (CI) center between March 2021 and February 2025. AHL was defined as better-ear pure-tone audiometry (PTA) of 30-60 dB HL, and worse-ear PTA >70 dB HL on two consecutive baseline audiograms. IA was defined as an interaural difference of >15 dB, and subclassified as mild (15-30 dB) or severe (>30 dB). Longitudinal changes in better-ear thresholds and progression to CI were evaluated. Results.:Of 551 pediatric patients with SNHL, 486 pediatric patients met the above inclusion criteria. AHL was present in 29/486 (6.0%), and mild and severe IA were observed in 45/486 (9.3%) and 40/486 (8.2%), respectively. Genetic diagnostic yield did not differ between AHL and symmetric SNHL (55.1% vs 62.1%, p=0.462), whereas it decreased with increasing IA (0-15 dB: 64.3%; 15-30 dB: 60.0%; >30 dB: 37.5%; p=0.004), The genetic landscape of AHL/IA was heterogeneous but converged on two recurrent deafness genes (SLC26A4 and GJB2), with SLC26A4 variants the most frequent. Genetically diagnosed patients exhibited progressive deterioration in better-ear thresholds across most frequencies, whereas genetically undiagnosed patients showed minimal change. Specifically, SLC26A4-related DFNB4 patients had the highest progression to CI in the better ear. Conclusion.:Genetically diagnosed cases show progressive better-ear deterioration. This is particularly evident in SLC26A4-related DFNB4, which has a higher rate of progression to CI than other AHL/IA-associated genes. These findings support etiology-based prognostication and individualized rehabilitation planning.
Objectives.:The current settings of cochlear implants (CIs) do not respect specific cochlear tonotopy, resulting in tonotopic mismatch and potentially decreased auditory performance. The development of new implant settings adapted to individual tonotopy, called anatomybased fitting (ABF), could improve the auditory information coding, particularly by making surrounding sounds more recognizable. This study aimed to evaluate whether ABF allows better environmental sound recognition in new CI users compared to the conventional setting (CS); and to investigate the effect of ABF on speech recognition in quiet and noise. Methods.:A prospective, randomized, double-blind, two-period cross-over study in 17 new CI users was performed between March 2022 and August 2024. Adult subjects were recruited from candidates selected for cochlear implantation within a single French university hospital. Newly implanted adult recipients of a MED-EL cochlear implant with an electrode array insertion angle greater than 540° were eligible. Subjects were randomized to receive either ABF or CS for 6 weeks, then switched to the other setting for the same duration. Audiometric testing, including Environmental Sound Identification Test (Test d'Identification des Sons de l'Environnement, TISE), speech audiometry in quiet using Fournier lists, and speech audiometry in noise (Vocale Rapide dans le Bruit, VRB) was performed at 6 and 12 weeks. Results.:Sixteen subjects (mean age 60 years [SD=15.1]) were analyzed. ABF showed a significant improvement in the TISE score (mean effect (ME)=1.2, 95% confidence interval (CI95%)=[0.3;2.0], standardized effect size (SES)=0.97, p=0.016). Speech recognition in quiet was statistically better with CS (ME=3.6, CI95%=[1.8;5.3], SES=1.4, p=0.001) while no statistically significant difference was found for speech recognition in noise (CI95%=[- 2.8;0.1], p=0.08). Conclusion.:In newly implanted cochlear implant users, ABF improved environmental sound recognition, suggesting improved perceived sound naturalness in the first weeks after implantation. This benefit did not extend to speech recognition in quiet and remains inconclusive in noise due to floor effect.
Objectives. This study investigated the effects of clinicopathological variables on rapid recurrence (defined as recurrence within 3 months) in oral tongue squamous cell carcinoma (OTSCC) and developed prediction models using multiple data combinations.Methods. A total of 944 patients with OTSCC were divided into two groups according to recurrence timing: the rapid recurrence group (RRG, n=89) and the non-rapid or no-recurrence group (n=855). Treatment-related variables were collected and analyzed to identify factors associated with overall survival (OS) and rapid recurrence. A logistic regression–based prediction model was developed to estimate the probability of rapid recurrence. Model performance was evaluated using 10-fold cross-validation, leave-group-out cross-validation, and calibration analysis.Results. Lower OS rates were observed with increasing age, advanced T (T3–4) and N (N1–3) stages, higher maximum preoperative positron emission tomography standardized uptake value (PET SUVmax), and rapid recurrence. In multivariable logistic regression analysis, advanced T (T2–T4) and N3 stages, positive resection margins, and higher PET SUVmax were associated with rapid recurrence, whereas postoperative chemoradiation demonstrated a protective effect. A nomogram was constructed to facilitate individualized risk estimation by integrating these clinical variables.Conclusion. Rapid recurrence was strongly associated with poor oncological outcomes in OTSCC. The validated prediction model, incorporating imaging and pathological variables, may help identify high-risk patients and support tailored treatment and surveillance strategies.
Objectives. Oropharyngeal squamous cell carcinoma (OPSCC) exhibits distinct clinical behaviors according to human papillomavirus (HPV) status. HPV-associated OPSCC is typically associated with a more favorable prognosis and improved response to therapy than non-HPV–associated OPSCC; however, the underlying differences in the tumor microenvironment (TME) remain incompletely understood.Methods. To investigate cellular and molecular factors associated with improved outcomes in HPV-associated OPSCC, we performed single-cell RNA sequencing and high-resolution spatial transcriptomics on samples from two non-HPV–associated OPSCCs, five HPV-associated OPSCCs, and three normal tonsils, with a particular focus on fibroreticular cells (FRCs).Results. Four distinct FRC subsets were identified, with FBLN1-positive FRCs significantly enriched in HPV-associated OPSCC. These cells expressed SLIT2, a molecule implicated in immune cell recruitment. Spatial mapping demonstrated that FBLN1-positive FRCs were closely associated with both tumor and immune cells, suggesting a role in promoting an immunogenic TME. In addition, HPV-associated OPSCC exhibited higher levels of proliferating epithelial cells and increased expression of antigen-presentation genes than non-HPV–associated tumors.Conclusion. These findings highlight the potential role of FBLN1-positive FRCs in promoting immune activation within the TME of HPV-associated OPSCC. Enhanced antigen presentation and epithelial proliferation may facilitate tumor-immune interactions, potentially contributing to improved clinical outcomes. This study advances understanding of TME dynamics in OPSCC and may inform future therapeutic strategies.
OBJECTIVES:Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is strongly influenced by obesity, the most important modifiable risk factor. Effective weight management is therefore essential for optimal OSA care. This guideline provides updated, evidence-based recommendations for the evaluation and management of obesity in adults with OSA, incorporating recent advances in lifestyle, pharmacologic, and surgical interventions. METHODS:The Korean Society of Sleep and Breathing convened a multidisciplinary panel. A systematic literature search was performed across major databases through 2025. Evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and recommendations were formulated by consensus using the Evidence-to-Decision framework. RESULTS:Eight statements were developed. Key recommendations include recognizing obesity as a major risk factor; routinely assessing overweight and obesity; and implementing structured weight reduction through diet, exercise, and behavioral therapy. Glucagon-like peptide-1 receptor agonists are recommended when lifestyle interventions are insufficient, and bariatric/metabolic surgery is advised for severe obesity unresponsive to nonsurgical treatment. Weight loss improves the apnea-hypopnea index, symptoms, and cardiometabolic markers and may reduce positive airway pressure needs. Continued follow-up is recommended even after clinical improvement. CONCLUSION:Weight management is a core component of OSA treatment. This guideline offers practical, evidence-based strategies to support clinicians in delivering effective, obesity-focused care for adults with OSA.
Objectives.:Rhinosinusitis disrupts the neuroepithelium, promotes inflammatory cell infiltration, and ultimately leads to olfactory dysfunction. Celecoxib, a selective cyclooxygenase 2 (COX-2) inhibitor, reduces neuroinflammation through its antiinflammatory effects. We hypothesize that celecoxib can mitigate sensorineural olfactory impairment by reducing inflammation, preserving neuroepithelial structure, and exerting neuroprotective effects. Methods.:Male C57BL/6 mice were intranasally administered lipopolysaccharide (LPS) for three weeks to induce rhinosinusitis. Celecoxib treatment was also administered via subcutaneous injection. The mice then underwent histological staining in sinonasal tissue, olfactory function test, and quantitative genomic expression patterns in the olfactory bulb. Results.:Following intranasal administration of LPS, mice exhibited impaired olfactory function, increased neutrophil infiltration, an elevated number of goblet cells in the sinonasal mucosa, and upregulated mRNA expression of inflammatory markers indicative of neuroinflammation in the olfactory bulb. Celecoxib treatment resulted in improved olfactory function, reduced neutrophil infiltration, decreased goblet cells number, and attenuated neuroinflammation in the olfactory bulb. Conclusion.:These findings suggest that celecoxib alleviates sensorineural olfactory dysfunction by reducing sinonasal neuroinflammation, highlighting its therapeutic potential in rhinosinusitis-associated olfactory loss.
