Background:Endoscopic endonasal approaches (EEA) to skull base tumors are a technically challenging procedure for both surgeons and trainees. Artificial intelligence and computer vision (CV) may offer an objective analysis that provides surgical assessment on technique and enhanced educational feedback for surgeons of all levels. Methods:Patients undergoing EEA from a tertiary care center between January 2022 and January 2023 were retrospectively analyzed. A large, publicly available CV model fine-tuned on endoscopic surgical video in collaboration with Surgical Data Science Collective (SDSC) was used for frame-by-frame detection of 14 different surgical instruments. Tool usage was depicted across different surgical phases of EEA. Dice-Sørensen Similarity Coefficients (DICE) were used to identify similarities between tool motion patterns across patients. Results:Ten patients (5 male, 5 female, ages 52.1 ± 13.8 years) were included, with over 35 h of video footage analyzed encompassing over 1.9 million individual frames. The sellar phase accounted for the majority of the analyzed frames. Within the sellar phase, the most frequently identified tools included suction (661,785), drill (138,031), Rhoton dissector (116,823), and cotton patties (105,038). Overall, DICE with higher frequency use exhibited substantially increased DICE scores: 0.52 for drill, 0.63 for Rhoton dissector, 0.67 for cotton patties, and 0.74 for suction. Conclusion:CV models reliably identified surgical instruments and can be used to capture both high-frequency patterns and deviations from common patterns in instrument usage across cases of endoscopic surgery.
Objectives:To develop a multi-sequence fusion model based on MRI images to differentiate between recurrent nasopharyngeal carcinoma (rNPC) and osteoradionecrosis (ORN) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy, and to evaluate its diagnostic performance. Methods:We retrospectively reviewed 370 patients with pathologically confirmed recurrent nasopharyngeal carcinoma (rNPC) or osteoradionecrosis (ORN). After screening, 346 patients (207 rNPC and 139 ORN) with both axial T1-weighted contrast-enhanced imaging (T1C) and T2-weighted imaging (T2WI) were included and randomly split into a training set (n = 212), validation set (n = 61), and test set (n = 73). A dual-branch 3D-ResNet-50-based fusion model was developed to integrate multi-sequence MRI features. Model performance was evaluated using AUC, accuracy, sensitivity, specificity, precision, and F1 score. Results:On the test set, the proposed 3D-ResNet-Fusion model achieved an AUC of 0.86 and an accuracy of 84%, with a sensitivity of 91%, specificity of 72%, precision of 83%, and an F1 score of 0.87. Based on AUC comparisons, the fusion model outperformed comparator models based on EfficientNet (0.77, p = 0.20) and DenseNet (0.70, p = 0.02), as well as single-sequence 3D-ResNet models trained on T1C alone (0.71, p = 0.02) or T2WI alone (0.73, p = 0.046). In the human-AI comparison experiment, the proposed AI model achieved a 3% higher ACC than the senior otolaryngologist (p = 0.83), and outperformed the two junior otolaryngologists by 15% (p = 0.05) and 22% (p < 0.01), respectively. Conclusion:The proposed AI model effectively integrates information from multiple MRI sequences, significantly improving classification performance in distinguishing rNPC from ORN.
Background:Chronic respiratory diseases impose a large global burden of morbidity, mortality, and cost. The concept of a global airway has become increasingly supported by epidemiologic, mechanistic, and clinical evidence. However, clinical care often remains fragmented between ear, nose, and throat (ENT), allergy, and pulmonology. Methods:A multidisciplinary expert panel composed of allergists, pulmonologists, and otolaryngologists from multiple tertiary care centres was convened. Experts were selected using predefined criteria encompassing clinical experience, academic output, geographic and institutional diversity, and gender balance. The panel performed a structured synthesis of current international guidelines and high-impact literature, using a modified Delphi consensus process over 3 rounds, with a predefined agreement threshold of ≥ 80% to define the scope of diseases, diagnostic approach, and interdisciplinary care model. Results:The Global Airways Unit (GAU) framework prioritizes multidisciplinary teamwork, early detection of comorbidities, phenotype‑directed investigations, streamlined imaging, and assignment of a lead specialty with scheduled follow‑up. Expected benefits include earlier diagnosis, improved disease control and quality of life (QoL), reduced duplication of testing, and potential cost‑savings for patients and health systems. Conclusions:The GAU operationalises the unified airway hypothesis into a reproducible clinical model. We propose the formation of a GAU to coordinate the management of patients with inflammatory airway diseases. Prospective real‑world evaluation of GAU implementation is the next critical step to validate clinical and economic outcomes.
Introduction:This paper aims to explore the current state of otorhinolaryngology-head and neck surgery (ORL-HNS) training and practice in Ethiopia, identify major barriers to development, and also highlight the optimistic prospects for the future, with strategies to build a self-sustaining ORL-HNS specialty capable of meeting the growing needs of the Ethiopian population. Methods:This study employed a mixed-methods approach, combining quantitative data from a cross-sectional survey, qualitative data from semi-structured interviews with otolaryngologists practicing in Ethiopia, and quantitative data from a review of relevant literature and publicly available datasets. Results:A total of 53 otolaryngologists practicing in Ethiopia participated in the survey. Head and neck surgery has progressed, with all major oncology surgeries now performed. Training opportunities for higher specialization are limited. Generally, there is a shortage of ORL-HNS clinical and surgical care equipment, outdated equipment, and poor maintenance availability. Discussion:Even with remarkable workforce growth, training for audiologists, speech therapists, and fellowship-trained otolaryngologists in the country is needed. Sustainable advancement and access to safe and affordable surgery will require strong collaborative efforts from multiple fronts, including improvements in the surgical supply chain, access to affordable surgical equipment, and institutional-level horizontal funding. Conclusion:Despite strides over the past two decades, significant deficits remain in Ethiopia's capacity to provide otolaryngologic care. Efforts aimed at bridging these disparities must focus not only on providing general and advanced training opportunities for local physicians but also on expanding access to basic resources and equipment needed for practice and making care more widely available outside of major population centers.
Objective:Otolith is a critical component of the peripheral vestibular system responsible for detecting linear acceleration. Dysfunction of the otolith organs can lead to vertigo, balance disturbances, and gaze instability. By elucidating the physiological foundations and evaluating both current and emerging methods for assessing otolith function, this review aims to provide a comprehensive resource for researchers and clinicians in the field of vestibular science, contributing to improved diagnostic accuracy and the development of more effective therapeutic strategies. Data Sources:The databases of PubMed, Embase, and Cochrane Library were systematically searched for the articles. Methods:The information of physiological mechanism and clinical significance were extracted from each article. Results:Vestibular-evoked myogenic potentials (VEMPs) are valuable for evaluating saccule and utricle function, with clinical applications in diagnosing several diseases. Subjective visual vertical (SVV) has clinical value in the diagnosis of peripheral and central vestibular diseases, with recent advancements in smartphone Apps and VR devices providing more accessibility. The ocular counter-roll (OCR) examination has a superior application prospect, but standardization including the normal range and duration of recovery, was incomplete. The off-vertical axis rotation (OVAR) can be used to explore motion sickness. The test of linear acceleration perception is limited by device, site and result instability, so it is difficult to apply clinically. Balance-related tests have been applied clinically, but the isolation of otolith components that determine balance is an unfinished task. Conclusion:The review emphasizes the need for more precise and standardized otolith function tests to enhance diagnostic accuracy and therapeutic strategies, ultimately improving patient outcomes in vestibular disorders.
Hypopharyngeal squamous cell carcinoma (HSCC) is an aggressive subtype of head and neck squamous cell carcinoma with insidious onset, early metastasis, and dismal prognosis. Conventional multimodal therapy achieves limited survival benefit, highlighting an urgent need for refined precision strategies. This review systematically summarizes the latest progress in HSCC, covering epidemiological characteristics, imaging diagnosis, prognostic prediction, surgical and non-surgical treatment advances, as well as coding and non-coding therapeutic targets, biomarkers, and candidate drugs. It further introduces the application of multi-omics and machine learning in HSCC research, analyzes current challenges and future directions, and provides a theoretical reference for precise diagnosis, individualized treatment, and prognostic evaluation of HSCC.
Background and Objective:The treatment available for chronic rhinosinusitis with nasal polyps (CRSwNP) has remained unsatisfactory. Patient-reported outcome measures (PROMs), capturing patient-perceived health status and well-being, are vehicles for measuring and improving the efficacy of care. This study aimed to establish machine learning (ML) models to predict PROMs in CRSwNP patients using minimally invasive and easily acquired clinical data. Methods:We collected commonly available clinical predictive data from 437 patients and established four separate ML models in the training set: a least absolute shrinkage and selection operator (LASSO)-based Logistic regression, a random forest (RF) regression, a gradient-boosted decision tree (GBDT), and a deep neural network (DNN). In the test and independent external validation sets, the predictive performance of these models was measured by calculating C statistics, expected prediction results, and decision curves. A feature-ranking analysis was performed using the ML algorithm. We then developed a predictive nomogram using LASSO-based Logistic regression. Results:The models performed well on an independent external validation set, with no statistically significant differences in generalization ability metrics between groups. LASSO regression identified key features of the predictive PROMs. A nomogram was created based on multivariate Logistic regression with LASSO regularization. Conclusions:All four ML models demonstrated similar performance in predicting PROMs in CRSwNP patients from which a clinical nomogram was developed. Early prediction of the subjective treatment response is crucial, as it influences clinician decisions and facilitates effective doctor-patient communication preoperatively; this could lead to more precise and personalized treatment for CRSwNP patients.
Thyroid carcinoma ranks as the seventh most common malignancy globally by incidence, though its mortality remains relatively low. We present a rare case of papillary thyroid carcinoma in a 32-year-old male, with supraglottic extension of the right thyroid lobe, managed successfully using a robotic-assisted bilateral axillo-breast approach (BABA). The total operative duration was 4 h, and the postoperative course was uneventful, with early recovery and excellent cosmetic outcome. Histopathology confirmed multifocal papillary thyroid carcinoma (mpT2N1b) with central and right selective neck node metastases. This case expands the boundaries of robotic thyroidectomy, demonstrating its feasibility and safety even in anatomically challenging scenarios. It emphasizes the potential need to revise current selection criteria as surgical expertise and robotic precision continue to evolve.
Objective:Obstructive sleep apnea (OSA) is associated with neurocognitive impairment, but its causal relationship with personality traits remains poorly understood. This study investigates the association and causality between OSA and personality using both cohort and genetic data. Method:This study included adults undergoing full-night polysomnography (PSG). Personality traits were assessed using the Eysenck Personality Questionnaire (EPQ), which assesses extraversion, neuroticism, psychoticism, and lie scales. Based on Eysenck's theory, participants were classified into melancholic, choleric, phlegmatic, and sanguine temperaments. Bidirectional Mendelian randomization (MR) analysis was conducted using GWAS data from the FinnGen database to infer causality. The inverse-variance weighted (IVW) method was used as the primary analysis. Sensitivity, pleiotropy, and heterogeneity analyses were conducted to validate the results. Results:A total of 233 participants were included. OSA was associated with significantly reduced neuroticism (p = 0.020) and psychoticism (p = 0.047). No significant differences were found in extraversion or lie scores. MR analysis indicated a modest causal effect of OSA on reduced neuroticism (p = 0.023-0.030), while cohort data showed temperament shifts from melancholic to choleric/sanguine types with OSA severity (p < 0.001). Conclusions:OSA may contribute to reduced neuroticism and altered temperament, highlighting the need for psychological screening in OSA management. Caution is warranted in interpreting causality due to modest MR effect sizes and potential heterogeneity.
Objective:To compare provider preferences for patient education materials generated by OpenEvidence, ChatGPT 5 Extended Thinking, and a laryngologist with fellowship training in response to common patient questions about vocal cord dysfunction (VCD). Study Design:Cross-sectional survey study. Methods:A laryngologist compiled four common patient questions about VCD and authored expert responses. Equivalent responses for patients were generated using OpenEvidence and ChatGPT 5 Extended Thinking with a standardized role prompt, each in a new chat session, and all outputs were limited to four sentences. Responses were de-identified and presented in a REDCap survey. Forty-five healthcare providers ranked responses based on perceived medical accuracy, clarity, and ability to address patient concerns. Preferences were analyzed using chi-square goodness-of-fit and Friedman testing with post hoc pairwise comparisons. Results:Among the 45 respondents, the most represented specialties were otolaryngology (n = 17) and allergy/immunology (n = 12), and most were attending physicians (n = 31). ChatGPT 5 Extended Thinking received the most first choice selections for three of the four questions, whereas OpenEvidence and ChatGPT performed similarly on the definition question. Analyses of full rankings confirmed significant differences among sources for all four questions (all Friedman p ≤ 0.001): responses generated by AI were preferred over the laryngologist response for the definition, diagnosis, and treatment process questions, while ChatGPT was preferred over both comparators for the etiology question. Otolaryngology respondents were more likely than non-otolaryngology respondents to rank the laryngologist response first for the definition question only. Conclusion:Responses generated by AI were frequently preferred over a single expert comparator for common VCD questions, with ChatGPT 5 Extended Thinking performing best overall and OpenEvidence showing similar performance on several items. These findings support further evaluation of LLMs as adjunctive tools in laryngology patient education, while highlighting the need for clinician oversight, assessment of individual model performance, and studies of patient outcomes.
Objective:To characterize speech recognition in presbyacusis and its associated neurophysiological and cortical structural features, and to explore structure-function-behavior relationships within the presbyacusis phenotype. Methods:Thirty elderly patients with presbyacusis(HI) and thirty-three healthy young controls(NH) completed a behavioral task involving Putonghua monosyllabic word recognition. Additionally, mismatch negativity (MMN) responses using the oddball paradigm to assess neurophysiological sensitivity, and acquired 3D T1-weighted MRI combined with Freesurfer to quantify cortical thickness (CTh) in six auditory-related regions of interest (ROIs) were recorded. Between-group differences were assessed, and exploratory associations were examined within the HI group; key associations were further evaluated using hierarchical regression adjusting for sex, age, and pure-tone average (PTA). Results:The HI group exhibited significantly poorer speech recognition performance, with prolonged MMN latency and increased amplitude compared to the NH group. CTh was generally thinner (except for the right supratemporal gyrus), with a left-hemisphere bias in the planum polare (PP). Within the HI group, exploratory unadjusted correlations suggested associations of speech recognition rate maximum (SRRmax) with MMN amplitude and right heschl's gyrus (HG) CTh; however, after adjustment for sex, age, and PTA, MMN amplitude and right HG CTh were not significant predictors, and adding these predictors did not improve model fit, whereas PTA remained independently associated with SRRmax. However, no significant associations were found between MMN features and the anatomical characteristics of the ROIs. Conclusions:Presbyacusis is associated with altered speech recognition, neurophysiological responses, and auditory-related cortical structure compared with young controls. Within the HI group, peripheral hearing thresholds accounted for a major proportion of variance in speech recognition, while MMN/MRI associations observed in exploratory analyses were attenuated after covariate adjustment, warranting replication in larger and better age-matched cohorts.
Objective:The aim of this study is to describe a clinical case of a SDHD germline mutation associated tympanic paraganglioma (TPGL). Patients:A female patient seen in the otology clinic at a tertiary care center with a diagnosis of tympanic paraganglioma and significant family history of head and neck paragangliomas. Intervention:Surgery and genetic management. Main Outcome Measurements:We describe the patient's clinical course and discuss the implications of genetic result on management. Results:The patient was diagnosed with a pathogenic variant of SDHD gene before the presentation of a tympanic paraganglioma. Her clinical course was complicated by locally aggressive and recurrent disease including ossicular erosion, tympanic membrane perforation, and cholesteatoma. Conclusion:This is a case of a SDHD associated tympanic paraganglioma, and the SDHD TPGL case to demonstrate recurrence. Such cases require multidisciplinary care for active surveillance of tumor development.
Background:Implantable hypoglossal nerve stimulation (HNS) is an established neuromodulatory therapy for obstructive sleep apnea (OSA) in patients intolerant to continuous positive airway pressure (CPAP). However, no domestically developed HNS system has been clinically implemented in China to date. Methods:We report the first clinical implantation of a novel, Chinese-developed HNS system in a patient with severe OSA. The patient was a 39-year-old man with a 20-year history of nocturnal snoring and apnea. Preoperative polysomnography (PSG) demonstrated an apnea-hypopnea index (AHI) of 46.3 events per hour and a lowest oxygen saturation of 83%. The device selectively activates the medial branch of the hypoglossal nerve, which induces genioglossus contraction and anterior tongue displacement, thereby stabilizing the upper airway during sleep. Results:The procedure was successfully performed. At short-term follow-up, the patient showed marked improvements: AHI decreased from 46.3 to 11.8 events/hour, LSaO2 increased from 83% to 86%, and the Epworth Sleepiness Scale Score improved from 1 to 0. No adverse events occurred. Conclusions:This first‑in‑human experience confirms that the domestic HNS system is feasible, safe, and clinically effective in patient with severe OSA who is intolerant to CPAP. These preliminary results support further clinical development and validation of this domestically manufactured HNS technology for broader application in China.
Background:Limited data exist on cardiocirculatory responses associated with extended periods of apnea during administration of high-flow nasal oxygen for laryngologic surgery (apneic oxygenation with HFNO, AO-HFNO). The possibility of hemodynamic compromise in the settings of acute hypercapnia, respiratory acidosis, hyperoxia, and IV anesthesia requires further investigation. This trial investigated the hemodynamic safety profile of prolonged AO-HFNO in adult patients undergoing laryngologic surgery. Methods:Using invasive hemodynamic monitoring, we conducted prospective, randomized, patient-blinded, two-arm parallel pilot trial in 20 adult patients (ASA physical status 1-3) undergoing elective laser laryngologic surgery expected to last over 40 min. The patients were randomly assigned to receive either AO-HFNO or conventional mechanical ventilation using a laser endotracheal tube (ETT). The primary outcome was the effect of prolonged permissive hypercapnia and IV anesthesia on intraoperative cardiocirculatory responses. Results:Extended AO-HFNO led to the development of moderate to severe hypercapnia with PaCO2 reaching as high as 113 mmHg and pH as low as 6.96. These changes were accompanied by induction of hyperdynamic state characterized by increase in heart rate (maximum median changes of ~38%), cardiac index (~36%) and decrease in systemic vascular resistance index (~46%). Maximum median decrease in mean arterial pressure was ~28% and was not associated with the need for extra vasopressor support compared to ETT group. There were no intraoperative or immediate postoperative complications. Conclusions:Prolonged AO-HFNO is associated with a safe intraoperative hemodynamic profile during extended periods of apnea for selected patients undergoing laryngologic surgery.
Objective:To investigate the possible association between adenotonsillar hypertrophy (ATH) and herpesviral infections in children, and to examine correlations between specific viral detection and clinical characteristics. Methods:We enrolled 43 children aged 3-14 years with ATH (mean age 76.56 ± 25.65 months; 31 boys). Paired tonsil and adenoid specimens were collected during non-acute infection periods, defined as the absence of fever (body temperature < 37.3°C), purulent tonsillar exudate, or new-onset respiratory symptoms within 2 weeks before surgery. Eight human herpesviruses (HHVs) were detected by qualitative real-time polymerase chain reaction (qPCR), and associations with demographic, clinical, and polysomnographic variables were explored. Results:The overall HHV detection rate was 97.7% (42/43). Epstein-Barr virus (EBV), HHV-6, and HHV-7 were the most prevalent in both tissues, with detection rates of 44.2%, 74.4%-79.0%, and 65.1%-67.5%, respectively. EBV DNA positivity in both tissue types was associated with older age, longer disease duration, and a lower arousal index (AI) (all p < 0.05). HHV-6 DNA positivity in tonsils was correlated with longer disease duration (p = 0.006), whereas HHV-7 DNA positivity in adenoids was associated with larger adenoid size (p = 0.012). No significant differences were identified between monoviral and multiviral groups. Conclusion:EBV, HHV-6, and HHV-7 are highly prevalent in pediatric ATH tissues and associate with select clinical parameters, yet viral positivity did not correlate with disease severity. These findings do not support routine viral screening or changes in clinical management for ATH. The role of herpesviruses in ATH pathogenesis warrants further investigation through controlled, longitudinal studies.
Objective:To quantitatively characterize the spatial relationships between intratemporal facial nerve segments and key cochlear implantation (CI) landmarks in cochlear hypoplasia (CH), and to compare these features with age-matched CI recipients with normal inner ear anatomy, thereby informing preoperative planning and facial nerve preservation strategies. Methods:CI recipients were reviewed retrospectively, and high-resolution temporal bone CT datasets were reconstructed. The measured parameters comprised cochlear-facial partition width (CFPW) of the labyrinthine segment, the distance between the tympanic facial nerve and oval window (FN‑OW), the distance between the mastoid facial nerve and round window (FN‑RW), the angle between the FN‑RW line and the anteroposterior axis (α), and the distance from the mastoid facial nerve to the posterior external auditory canal wall (FN‑EAC). Results:The CH cohort included 48 patients (91 ears: 40 CH‑Ⅱ, 43 CH‑Ⅲ, 8 CH‑Ⅳ); controls comprised 45 patients (90 ears). The median CFPW was larger in CH patients than in controls (0.7 vs. 0.57 mm; p < 0.01). Cochlear-facial dehiscence occurred at similar rates (CH 4.40% vs. controls 4.44%). FN-OW did not differ significantly between the two groups (2.33 vs. 2.37 mm; p = 0.198). A low‑lying tympanic segment was observed in 23.07% of CH ears but in none of the control ears. For the mastoid (vertical) segment, the CH group exhibited a shorter FN-RW (5.74 vs. 6.08 mm; p < 0.05) and a larger angle α (60.4° vs. 57.8°; p < 0.05). FN-EAC was slightly smaller in the CH group without reaching statistical significance (4.08 vs. 4.35 mm; p = 0.087). Conclusion:In CH, intratemporal facial nerve segments exhibit substantial positional variability. Anterior displacement of the vertical segment is common and may impede round window exposure via the facial recess. Preoperative HRCT should systematically assess nerve courses to reduce intra- and postoperative facial nerve complications.
Background:Large language models (LLMs) such as ChatGPT are being explored for various medical applications, but their performance across languages is not established. Despite the promising results in English from previous studies, it is unclear how ChatGPT performs in other languages. We assessed the ability of ChatGPT-4 to answer common otolaryngology-related frequently asked questions in Chinese, Korean, and Spanish in this study. Methods:Eighteen clinical questions were selected from the American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines and ENT Health across six subspecialties. Bilingual clinicians translated the questions to Chinese, Korean, or Spanish and input them into ChatGPT-4 (OpenAI, San Francisco, USA). The responses were rated on a five-point Likert scale for accuracy, completeness, and similarity to English reference answers. A linear mixed-effects model with language as a fixed effect and random intercepts for question and rater was used to compare performance across languages. Inter-rater reliability was assessed using intraclass correlation coefficients and Krippendorff's α. Subjective evaluations were also collected. Results:ChatGPT-4's performance differed significantly by language in all assessment domains. Responses in Spanish scored highest throughout and most frequently were characterized as clear and organized. Korean answers were generally accurate but tended to be more conservative and less detailed. Chinese answers showed greater variability, with reviewers noting a mix of clear and less accurate outputs. Conclusion:The clinical performance of ChatGPT-4 differed across Chinese, Korean, and Spanish. These findings underscore the importance of ongoing evaluation and refinement of LLMs to ensure they provide reliable multilingual support in clinical practice.
Introduction:Global health has become an increasing priority in medical training. In this cross-sectional study, we seek to evaluate the importance of a residency program's global health opportunities on otolaryngology-head and neck surgery (OHNS) applicants' residency selection. Methods:The questionnaire was distributed via snowball sampling and an electronic residency professional forum to 2023 and 2024 United States OHNS residency applicants. Results:Of 52 complete responses, the mean participant age was 28.67 years (SD 2.40). The average rating of global health importance in residency selection was 2.45 on a 1-4 scale (SD 0.86). Among the most influential factors in residency selection were faculty mentorship (88.5%), prior resident involvement in global health activities (73.1%), and funding opportunities (71.2%). Motivations for engagement in global health included opportunities to learn about new cultures (75%), career interest in working in a domestic resource-constrained setting (59.6%), and career interest in working internationally (53.8%). 63.5% of respondents reported prior engagement in global health activities. Conclusion:Global health opportunities can be an important factor in OHNS applicants' residency selection. Mentorship, funding, and institutional support for global health may attract applicants with an interest in working in resource-limited settings.
Obstructive sleep apnea is a clinical syndrome that triggers a series of pathophysiologic changes, including disturbed sleep architecture, chronic intermittent hypoxia and hypercapnia, and ultimately severe cognitive dysfunction. The hippocampus plays a key role in various cognitive processes such as learning and memory. Previous studies have focused on inflammatory factors, oxidative stress, and apoptotic changes in the hippocampus. However, studies on neurotransmitter changes are scarce. Dopamine is an important neurotransmitter that has a direct effect on learning and memory formation in the hippocampus. This article summarizes the relationship between hippocampus-dependent learning and memory deficits induced by obstructive sleep apnea and dopamine, and explores how dopamine mediates hippocampus-dependent learning and memory deficits associated with obstructive sleep apnea. Detailed searches were performed by utilizing open-ended keywords on PubMed and manually searching the reference lists of the identified articles; all references up to December 31, 2024, were used. Search terms included "obstructive sleep apnea," "OSA," "chronic intermittent hypoxia," "sleep fragmentation," "sleep deprivation," "sleep disorder," "apoptosis," "inflammation," "oxidative stress," "hippocampus," and "dopamine." The final article includes all articles that explicitly address dopamine maintenance of memory and how obstructive sleep apnea affects hippocampal dopamine. First, obstructive sleep apnea inhibits hippocampal dopamine synthesis. Second, downregulated dopamine induces hippocampus-associated inflammatory responses, oxidative stress, and apoptosis. Finally, intermittent hypoxia may also further exacerbate dopamine deficiency by inducing a positive cycle of dopamine downregulation. The net effect of these processes is a hippocampus-dependent decline in learning and memory capacity, which is characteristic of obstructive sleep apnea. Dopamine plays a crucial role in obstructive sleep apnea-associated hippocampus-dependent learning and memory deficits, not only due to the neural signaling role of dopamine itself, but also due to obstructive sleep apnea-associated inflammation, apoptosis, and oxidative stress, which are also closely related to dopamine.
