BACKGROUND:Allergic rhinitis (AR) represents a significant burden in Ear Nose Throat (ENT) practice and markedly affects quality-of-life and work productivity of AR patients. The fixed combination of intranasal azelastine and fluticasone propionate (AzeFlu) has emerged as a valuable therapeutic option for moderate-to-severe AR. Recent updates to international guidelines and real-world evidence warrant a comprehensive review of its role in ENT practice, with particular attention to both seasonal and perennial AR. METHODS:This narrative review synthesises evidence from the ARIA-EAACI 2024-2025 guidelines, systematic reviews and network meta-analyses of randomised controlled trials, pharmacovigilance data, and results from an Italian multidisciplinary inter-societal Delphi Consensus. We evaluated efficacy, safety, patient acceptability and implementation considerations specific to otorhinolaryngology practice. RESULTS:Network meta-analyses demonstrate that AzeFlu provides superior symptom control compared to monotherapy for both nasal and ocular symptoms in seasonal and perennial AR, with a rapid onset of action (15-30 min). The combination shows particular efficacy in patients with moderate-to-severe symptoms inadequately controlled by monotherapy. Safety profiles are comparable to those of monotherapy, with no significant effects on growth or the HPA axis in children. Real-world data indicate high treatment satisfaction and adherence. The Italian Delphi Consensus achieved > 80% agreement on key management principles, particularly emphasising control of Type 2 inflammation and the role of combination therapy in treatment algorithms. Evidence for perennial AR remains more limited, and future primary research specifically targeting perennial rhinitis populations is warranted. CONCLUSIONS:Azelastine-fluticasone combination therapy represents an evidence-based, guideline-recommended option for moderate-to-severe AR in ENT practice. Its dual mechanism, rapid onset, favourable safety profile and high patient acceptability support its integration into contemporary treatment algorithms, particularly for patients requiring enhanced symptom control beyond monotherapy. The combination represents a meaningful therapeutic advancement, and further research is needed to fully characterise its role in perennial AR management.
OBJECTIVES:To evaluate the treatment outcomes of various turbinate surgeries in patients with chronic rhinitis. DESIGN AND SETTING:A systematic review and meta-analysis. MAIN OUTCOME MEASURES:A systematic search was conducted using six databases. Treatment conditions included six surgical interventions-coblator-assisted turbinoplasty (CAT), laser ablation, microdebrider-assisted turbinoplasty (MAT), radiofrequency tissue volume reduction (RFVTR), submucosal diathermy (SMD) and partial inferior turbinectomy (PIT)-and a reference intervention (submucosal resection). Outcomes included symptom scores, turbinate size, operative time and surgery-related adverse effects such as atrophic changes, crusting, nasal dryness, mucosal tearing, revision rate and postoperative bleeding. Both pairwise and network meta-analyses were performed. RESULTS:MAT was associated with better outcomes across most parameters but showed a higher risk of mucosal tearing. SMD was associated with lower effectiveness in alleviating nasal obstruction at 6-12 months and laser ablation was associated with reduced effectiveness in decreasing turbinate size. RFVTR exhibited the shortest operative time and was associated with advantages in minimising nasal dryness and preserving the mucosa. Regarding adverse effects, laser ablation was associated with an increased risk of atrophic rhinitis, PIT with a higher incidence of crusting and dryness and SMD with a greater likelihood of requiring revision surgery. CONCLUSION:MAT was associated with relatively favourable outcomes across most parameters; however, it also showed a higher risk of mucosal tearing. RFVTR was associated with advantages in minimising nasal dryness and preserving mucosal integrity. Both SMD and laser ablation were associated with comparatively limited efficacy and relatively higher rates of adverse effects.
OBJECTIVE:The morphology of the frontal sinus (FS) has long been debated as a determinant of fracture type and severity. This study aimed to evaluate the association between sinus dimensions, fracture patterns, and clinical outcomes using real-world data. STUDY DESIGN:Retrospective cohort study. SETTING:Tertiary trauma referral center. METHODS:We retrospectively reviewed the records of 48 frontal sinus fractures treated at a tertiary trauma center. Volumetric and dimensional measurements (volume, height, width, and anteroposterior depth) were obtained from CT scans. Each sinus was segmented and analyzed separately using 3D Slicer software. Sinuses were categorised according to cohort-derived percentiles and established classifications. Associations between sinus anatomy, fracture type, and outcomes were analyzed using logistic regression. RESULTS:While most sinus dimensions showed odds ratios greater than 1 for anterior table fractures, only the categorical analysis of sinus height demonstrated statistical significance. Cohort-based high sinuses (≥ 22.22 mm) were associated with isolated anterior table fractures (p = 0.014, OR = 4.83, 95% CI: 1.38-16.9). When comparing sinuses with larger volumes, a similar trend towards anterior-only fractures was observed, though not statistically significant. Patients with anterior-only fractures had fewer displaced fractures, shorter hospitalisation, and lower rates of intracranial haemorrhage and ICU admission. CONCLUSION:Frontal sinus height appears to be the most clinically relevant parameter influencing fracture patterns. Vertically expanded sinuses may act as protective "crumple zones," mitigating posterior table involvement and severe intracranial injury.
BACKGROUND:Retronasal olfaction is essential for aroma perception. Its impairment in individuals with olfactory dysfunction (OD) negatively affects dietary behaviour and quality of life. Regular exposure to odours in a form of olfactory training (OT) is used to rehabilitate the sense of smell. However, retronasal recovery following OT remains insufficiently characterised. OBJECTIVE:To verify whether OT improves retronasal odour identification and whether such improvement is related to orthonasal odour identification recovery. STUDY DESIGN:Prospective, single-arm clinical study. METHODS:Fifty-three patients with OD (predominantly post-COVID-19) completed at least 3 months of OT (conducted bi-daily with four odours). Retronasal function was assessed with the ThreeT test and orthonasal function with the Sniffin' Sticks battery before and after training. RESULTS:OT significantly improved both retronasal (9.40 ± 0.42 vs. 10.85 ± 0.48; p < 0.001) and orthonasal odour identification (8.75 ± 0.50 vs. 10.53 ± 0.50; p < 0.001). Changes in retronasal performance positively, moderately correlated with changes in orthonasal identification (r = 0.38, p = 0.006). Clinically meaningful retronasal improvement was associated with a higher likelihood of orthonasal recovery, χ2(1) = 5.08, p = 0.024; OR = 4.00 (95% CIs: 1.16-13.83). CONCLUSIONS:OT improves retronasal odour identification. The mechanisms of orthonasal and retronasal recovery may be partially overlapping.
OBJECTIVES:Salivary pepsin has been proposed as a non-invasive biomarker for diagnosing laryngopharyngeal reflux (LPR); however, its diagnostic utility remains uncertain due to inconsistent findings across studies. This meta-analysis evaluated the diagnostic accuracy of a rapid lateral flow test (Peptest) compared to the reference standard of multichannel intraluminal impedance-pH (MII-pH) monitoring. DESIGN AND SETTING:Systematic review and meta-analysis of cohort studies. PARTICIPANTS:Patients with LPR. MAIN OUTCOME MEASURES:The primary outcomes were diagnostic odds ratio (DOR), summary receiver operating characteristic curve and area under the curve (AUC). RESULTS:In total, 11 studies comprising 928 samples were included. The diagnostic performance of salivary pepsin for LPR was analysed at cut-off values of 16, 45-50 and 100 ng/mL. The pooled DOR and AUC were 3.49 and 0.684 at 16 ng/mL, 6.08 and 0.772 at 45-50 ng/mL and 4.78 and 0.717 at 100 ng/mL, respectively. Multiple-time sampling significantly improved sensitivity compared to single-time sampling across all cut-off values (0.82 vs. 0.33-0.63 at 16 ng/mL; p < 0.0001), although specificity was slightly lower. CONCLUSIONS:The Peptest demonstrates potential as a simple, non-invasive diagnostic alternative to 24-h-MII-pH monitoring for LPR. Among the evaluated thresholds, a cut-off of 45-50 ng/mL provided the highest diagnostic accuracy. Collecting multiple saliva samples may further enhance detection sensitivity. However, in patients with a high clinical suspicion of LPR but negative Peptest results, 24-h-MII-pH monitoring remains necessary to confirm the diagnosis due to the test's limited negative predictive value.
PURPOSE:This systematic review tests the hypothesis that radiofrequency ablation (RFA) for benign non-functioning thyroid nodules is associated with favourable cost-effectiveness compared with surgery. MATERIALS AND METHODS:A systematic literature search of multiple databases (Embase, Medline, Web of Science, and Cochrane Central) was conducted through 16 May 2025, with no restrictions on publication date or language. Full economic evaluations comparing RFA with alternative management strategies were included in the primary synthesis. Secondary narrative synthesis included studies reporting cost data without formal cost-effectiveness modelling. All costs were converted to 2021 US dollars to enable cross-study comparability. Incremental cost-effectiveness ratios (ICERs), net monetary benefit (NMB), and net health benefit (NHB) were calculated where data allowed. RESULTS:Thirteen studies met the inclusion criteria: 3 full economic evaluations and 10 descriptive cost studies. All compared RFA to surgery. In the primary synthesis, two studies reported ICERs for RFA versus surgery, which ranged from -$14 994 (reflecting a lower cost and greater effectiveness for RFA) to $98 858 per QALY gained, with substantial variation in model design and assumptions. Post hoc estimates of NMB and NHB generally favoured RFA at $50 000 and $100 000 willingness-to-pay thresholds. In the narrative synthesis, 8 of 10 studies reported lower total costs for RFA (median: $2499) compared to surgery (median: $3579). Methodological heterogeneity limited comparability. Overall certainty of economic evidence was rated as low. CONCLUSION:RFA may be a cost-effective alternative to surgery for benign thyroid nodules, but current economic evidence is limited and of low certainty.
OBJECTIVE:To explore the associations between major modifiable risk factors and hearing loss. METHODS:This serial cross-sectional study was conducted within the National Health and Nutrition Examination Survey 1999-2020 in the United States. Associations were assessed using modified Poisson regression and within-sample population attributable fraction (PAF). RESULTS:Eight thousand seven hundred and seventy adults aged 40-85 years were included in the analyses, the mean (SD) age was 58.0 (11.7) years, with 4002 men (45.6%). Hearing loss was associated with low educational attainment with prevalence ratio 1.23, 95% confidence interval (1.15, 1.31); low income 1.11 (1.04, 1.19); diabetes 1.10 (1.03, 1.18); HDL-C dyslipidaemia 1.13 (1.06, 1.21); obesity 1.08 (1.01, 1.15) and tobacco use 1.11 (1.04, 1.19). Within our analysis, over 25% of hearing loss cases were attributed to modifiable risk factors, with low education or income, HDL-C dyslipidaemia, obesity and tobacco use being the leading contributors, though relative rankings varied slightly in survey-weighted analyses. CONCLUSION:Hearing promotion policies should prioritise related modifiable factors to reduce the burden of hearing loss.
OBJECTIVES:There remains an overall paucity of literature regarding malignant head and neck paragangliomas (MHNPs) and optimal treatment strategies. Our study aims to elucidate contemporary trends regarding the incidence, management modalities, and predictors of survival in a rare entity of a malignancy for which there is no well-established treatment guideline. DESIGN:The Surveillance, Epidemiology, and End Results (SEER) database was queried for all cases of MHNPs from 2000 to 2019. RESULTS:The age-adjusted incidence of MHNPs has increased 56% from 2000 to 2019 (0.096-0.150 per 1 000 000). One hundred forty-two patients were included for case-listed statistical analysis, with the mean age at diagnosis being 47 years ± 18.4, presence of regional disease in 47% of cases, and distant disease in 53%. Surgery was the most common form of treatment for MHNP (90, 63.4%) followed by radiation (57, 40.1%). Two-year and 5-year disease-specific survival were noted to be 92% and 79%, respectively. Patients treated with surgery had a decreased risk of mortality (0.227 [95% CI: 0.122-0.424], p < 0.001), whereas those with distant disease at diagnosis had an increased risk of mortality (3.47 [95% CI: 1.780-6.800], p < 0.001). CONCLUSION:This study represents the largest and most contemporary known cohort of patients with MHNP and provides details regarding the incidence, survival, and treatment strategies for this rare malignancy with little known treatment data. There was a statistically significant benefit for surgical management of MHNP. Distant metastasis at diagnosis was an independent predictor of increased mortality risk.
BACKGROUND:Unilateral vocal cord palsy (UVCP) significantly affects phonation and swallowing. While injection laryngoplasty and medialisation thyroplasty are effective, both may require revision. Vocal Implant System (VOIS; APrevent Biotech GmbH) is an adjustable titanium-silicone thyroplasty implant that allows postoperative modification, potentially reducing the need for further surgery. METHODS:Twelve patients, seven male and five female, underwent VOIS implantation. Voice outcomes were assessed pre- and postoperatively using the GRBAS scale and the Voice Handicap Index-10 (VHI-10). RESULTS:The composite GRBAS score improved significantly from 9.0 ± 1.87 to 3.75 ± 2.49 (p = 0.0024). The VHI-10 decreased from 25.75 ± 9.36 to 14.92 ± 9.55 (p = 0.0093). No intra- or postoperative complications occurred. Two patients required postoperative implant volume adjustments-one performed in clinic and one under local anaesthetic in theatre. CONCLUSION:The VOIS implant thyroplasty demonstrated significant improvement in both perceptual and patient-reported voice outcomes with a favourable safety profile. Larger, long-term studies are warranted to confirm its comparative efficacy and durability.
INTRODUCTION:Obstructive sleep apnea (OSA) is a potential contributor to vestibular dysfunction, though specific correlating parameters remain unclear. This study aimed to determine whether hypoxemia severity indices correlate quantitatively with caloric slow-phase eye velocity (SPV), a marker of vestibular function. METHODS:In a retrospective cohort of 82 adults undergoing both full-night PSG and bithermal caloric testing, the primary outcome was total caloric SPV (°/s; sum of four irrigations). Fifteen prespecified predictors were evaluated, including hypoxemia burden (apnea-hypopnea index [AHI], oxygen desaturation index [ODI], cumulative time with SpO2 < 90% [CT90], nadir SpO2), sleep fragmentation (total arousal index), sleep architecture (N1, N2, N3, rapid eye movement [REM] proportions and sleep efficiency) and ancillary measures (snoring index, pulse rate, age, sex and body mass index [BMI]). Unadjusted associations were calculated using Pearson's correlations. For adjusted inference, ordinary least squares with backward Akaike information criterion (AIC) reduction were employed. Feature importance was quantified without prespecifying functional form by training a random-forest regressor and computing TreeSHAP values. RESULTS:SPV was inversely correlated with AHI (r = -0.295, p = 0.007), ODI (r = -0.261, p = 0.018) and CT90 (r = -0.254, p = 0.021). Sleep efficiency, snoring index, pulse rate, nadir SpO2, and sleep stage proportions showed no significant associations. In the adjusted linear model, AHI and sex were retained; each 10-event/h AHI increase corresponded to a 3.16°/s lower SPV (95% CI: -6.05 to -0.28; p = 0.032). The random forest model achieved a pooled fivefold R2 of 0.065, indicating low explained variance. Regarding mean absolute SHAP values, hypoxemia-domain metrics ranked highest (ODI, AHI, CT90), followed by BMI, while other features had minimal impact. CONCLUSION:Nocturnal hypoxemia burden-reflecting the frequency and cumulative duration of oxygen desaturation-emerged as the principal predictor of reduced caloric SPV in patients with OSA. While the low explained variance of our models (R2 = 0.065) suggests these associations should be viewed as hypothesis-generating, the findings support prioritising desaturation assessment in clinical settings. Further longitudinal research is essential to verify whether reducing hypoxemia leads to improved vestibular outcomes.
BACKGROUND:Surgical site infection is one of the most common complications of septoplasty. The use of antibiotic prophylaxis has been debated for years. Since the practice at our centre has shifted towards a more frequent use of prophylactic antibiotics in septoplasties, our aim was to review its use and effect on the postoperative infection rate. METHODS:We retrospectively reviewed the medical records of all adult patients who had undergone septoplasty at the Helsinki University Hospital (Helsinki, Finland) during 2019-2023. Patient and surgery characteristics, use of surgical antibiotic prophylaxis, surgical site infections and their management were reviewed. RESULTS:The series consisted of 1169 septoplasties, and antibiotic prophylaxis was used in 90.1% of the cases. A postoperative infection was diagnosed in 1.9%. Longer operative time and the use of silicone splints were associated with a higher risk of postoperative infections (p = 0.007 and p = 0.03, respectively). There was no significant difference in the infection rate between those who received preoperative antibiotic prophylaxis and those who did not. Among those using a preoperative course of topical antibiotic cream, no infections were seen. Compared with previous studies on septoplasty infections at our centre, the infection rate has decreased whilst the use of antibiotic prophylaxis has increased. CONCLUSION:Based on the present results, antibiotic prophylaxis does not affect postoperative infection rate after septoplasty. A preoperative course of nasal mupirocin seems to be a promising and less harm-causing form of prophylaxis. To confirm our results, there is a need for analysis of larger patient cohorts and prospective, controlled studies.
OBJECTIVE:To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age. METHOD:A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records. RESULTS:1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as < 15 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p = 0.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p < 0.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p = 0.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p = 0.062), sudden onset asymmetrical hearing loss (OR 0.57, p = 0.46), mild asymmetrical hearing loss (OR 1.03, p = 0.98), or age (OR 0.74, p = 0.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis. CONCLUSIONS:The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines. LEVEL OF EVIDENCE: 4:
BACKGROUND:Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are commonly treated with intranasal corticosteroid sprays. Despite their efficacy, unpleasant sensations associated with their application, including post-nasal drip and nasal irritation, are often cited as reasons for poor compliance. Optimising the intranasal application experience is key to improving long-term adherence. We developed a nasal adaptor for metered-dose inhalers (MDIs) to reduce the unpleasantness of nasal administration, potentially improving patient compliance. METHODS:Two crossover trials were conducted in AR and postoperative CRS participants (n = 16 per group). Participants used a standard fluticasone nasal spray (50 μg) and a fluticasone MDI (125 μg) with the adaptor for 3 weeks each, separated by a 1-week washout period. Device order was alternated, and doses were adjusted to ensure an approximately equal fluticasone dose. Device preference was determined using an adjusted Clinical Trial Patient Preference Questionnaire, and symptom improvement was assessed using Total Nasal Symptom Score and Sino-nasal Outcome Test-22 questionnaires. RESULTS:Symptom improvement was comparable between the devices. However, in both groups, 11/16 (69%) participants preferred the MDI with the adaptor over the standard nasal spray, citing fewer unpleasant sensations. Satisfaction score improvement was significantly greater with the novel device in the CRS cohort. Participants reported a higher likelihood of compliance with the novel device, suggesting improved adherence. CONCLUSIONS:An MDI with the adaptor was preferred over a standard nasal spray among AR and postoperative CRS participants. The enhanced tolerability may promote improved compliance, and consequently, more effective long-term symptom control.
OBJECTIVES:This study aims to investigate the effects of oxymetazoline on the time required for the bronchoscope to reach the vocal cords, nasal manipulation difficulty during bronchoscopy, nasal mucosal injury, and patient-reported pain in individuals with turbinate hypertrophy undergoing bronchoscopic examination. MATERIALS AND METHODS:This prospective, double-blinded, randomised controlled trial enrolled 240 patients with turbinate hypertrophy (November 2023 to July 2024), randomised into oxymetazoline, saline, and blank control groups (n = 80 each). The primary outcome was bronchoscope-to-vocal-cords time. Secondary outcomes included operator-assessed nasal passage ease (negotiation visual analog scale [VAS]), assistant-evaluated facial pain (Facial Pain Scale), patient-reported nasal pain (Pain VAS), operator-rated mucosal trauma (Trauma VAS) and hemodynamic parameters. RESULTS:The oxymetazoline group demonstrated significantly shorter bronchoscope-to-vocal-cords time compared to the saline group (44.00 s [41.00-47.00] vs. 52.00 s [50.00-58.00], p < 0.001), improved nasal passage ease (negotiation VAS: 3.00 [2.00-4.00] vs. 5.00 [4.00-6.00], p < 0.001), and reduced mucosal trauma (Trauma VAS: 7.00 [6.00-8.00] vs. 9.00 [8.00-9.00], p < 0.001). Patients receiving oxymetazoline reported lower nasal pain scores (assistant-assessed: 4.00 [3.00-5.00] vs. 5.00 [5.00-6.00]; patient-reported: 4.00 [3.00-4.75] vs. 5.50 [5.00-6.00], both p < 0.001). CONCLUSION:Oxymetazoline optimises bronchoscopy in turbinate hypertrophy patients by shortening procedural time, easing nasal passage, mitigating mucosal injury, and alleviating pain. This trial is registered at chictr.org.cn (ChiCTR2300077642).
OBJECTIVES:The haemoglobin-albumin-lymphocyte-platelet (HALP) score is an inflammation- and nutrition-related biomarker derived from routine blood tests, but its prognostic value in head and neck cancer (HNC) has not been quantitatively synthesized. This systematic review and meta-analysis aimed to evaluate the association between pretreatment HALP and survival outcomes in HNC. METHODS:PubMed, Embase and Web of Science were searched to 24 January 2026 for cohort studies reporting hazard ratios (HRs) for survival outcomes by pretreatment HALP in HNC. Reviews, case reports, conference abstracts without full text, and studies lacking survival data were excluded. Random-effects meta-analysis was performed and risk of bias was assessed using QUIPS. The review was prospectively registered in the Open Science Framework. RESULTS:Six retrospective cohort studies (1759 patients) were included. Higher pretreatment HALP was associated with improved overall survival (pooled HR 0.52, 95% CI 0.41-0.67; I2 = 17.6%) and disease-free survival (pooled HR 0.60, 95% CI 0.47-0.76; I2 = 0.0%). After excluding the metastatic cohort, the pooled overall survival estimate remained similar (HR 0.56, 95% CI 0.45-0.70; I2 = 0.0%), and leave-one-out analyses showed stable estimates (HR range 0.48-0.56). CONCLUSIONS:Higher pretreatment HALP is associated with favourable survival in HNC. However, reported cutoff values for HALP have been inconsistent across studies. HALP might be helpful for clinicians in evaluating the prognosis of HNC patients.
OBJECTIVES:Smell and taste disorders (SATDs) are increasingly prevalent but remain underrecognised, significantly affecting patients' physical, social and psychological well-being. We recently published a large cohort study reporting Olfactory Disorder Questionnaire (ODQ), EQ-5D-5L (EuroQol Five-Dimension Five-Level) and EQ-5D-5L Visual Analogue Scale (VAS) scores for patients with SATDs. These results highlight the considerable impact of SATDs on quality of life and mental health. This review seeks to evaluate the disease burden of SATDs by comparing their impact on quality of life and mental health with other chronic conditions, using established metrics such as EQ-5D-5L and BDI from the existing literature. METHODS:A literature review was conducted from 1 January 2010 to 10 August 2024, to identify systematic reviews reporting EQ-5D-5L or BDI values in chronic conditions. RESULTS:Our findings show that EQ-5D-5L and BDI scores for patients with SATDs are comparable to those reported for other chronic conditions, including diabetes, stroke, cardiovascular, respiratory and ENT disorders. CONCLUSION:These results highlight the significant burden olfactory dysfunction imposes on individuals. However, unlike other chronic conditions with established treatment protocols, effective therapies for SATDs remain limited, emphasising a critical gap in both research and care. Increased awareness and further research are essential to develop effective treatments and improve outcomes for this often-overlooked population.
INTRO:Tracheoesophageal voice prosthesis (VP) is an effective method for restoring fluent speech after total laryngectomy, but its microbial colonisation can impair device performance. Aims of this study are to characterise VP microbiological colonisation in laryngectomised patients and assess whether regular probiotic supplementation, plus VP management, could reduce VP contamination, improving function and durability. METHODS:A total of 34 patients were enrolled; 15 received standard VP hygiene and management with nystatin four times/day for 5 days before and 5 days after each VP replacement (Group 1) and 19 received the same protocol as Group 1, plus a probiotic supplement (VSL#3, Actial Farmaceutica SRL, Rome, Italy) for 10 days each month throughout the observation period (Group 2). All removed VPs were cultured. Patients underwent a brief questionnaire regarding the VP functionality. RESULTS:Each patient of both groups had a single VP substitution. The most frequently isolated were Pseudomonas aeruginosa, Staphylococcus aureus and Candida species. When comparing VP microbial cultures at baseline and follow-up, no significant differences were observed in Group 1, while in Group 2, a significant reduction in the detection of multiple microbial species at follow-up was detected. Specifically, a significant decrease was observed in the prevalence of S. aureus methicillin-sensitive (p = 0.05), miscellaneous Gram-negative bacteria (p = 0.04) and Candida albicans (p = 0.02). Survey results showed a significant overall improvement in VP functionality in Group 2 versus Group 1 (p = 0.008). CONCLUSION:Microbiological findings and patient opinions suggest a positive impact of probiotics on reducing bacterial contamination and improving VP functionality.
INTRODUCTION:'Enhanced Recovery After Surgery' (ERAS) protocols have been developed for multiple surgical procedures with favourable outcome measures including Length of Stay (LoS). Trans-Oral Robotic Surgery (TORS) has similarly facilitated earlier patient discharges, particularly in comparison to open head and neck surgical techniques. There is a dearth of literature on the effect of ERAS protocols in TORS. We sought to comprehensively examine the effect of a TORS ERAS protocol across several key metrics, with a focus on LoS. METHODS:We conducted a retrospective cohort study following implementation of a TORS ERAS protocol. This protocol was developed at our institution and implemented in 2021; it included key features such as pharyngocutaneous risk stratification and thorough perioperative assessments. Patients managed prior to (p-ERAS) and post implementation (w-ERAS) were separated into two groups, with key outcomes, including LoS, estimated cost per patient, return to swallow, and complication rate, compared. RESULTS:A total of 40 TORS cases were included. Patients managed w-ERAS had a mean adherence rate to protocol of 90%. The w-ERAS group showed a statistically significant reduction in median length of stay by 3.5 days (p = 0.03) when compared to the p-ERAS group. There was also a trend towards decreased median cost per patient as well as decreased median time to oral intake. CONCLUSION:Our study demonstrates an easily implementable protocol for the perioperative management of TORS oncological surgery. The use of this ERAS protocol demonstrated a significant reduction in patient length of stay in a small sample size.
