Background Parathyroidectomy is associated with a spectrum of potential complications, including recurrent laryngeal nerve (RLN) injury, permanent hypocalcemia, postoperative hemorrhage, wound infection, and recurrence of hyperparathyroidism (HPT). The objective of this study was to evaluate the outcomes of 223 parathyroid procedures and to determine the incidence of procedure-related complications. Methods This retrospective observational study analyzed parathyroidectomy cases performed between 2013 and 2022. Demographic data and postoperative complications were collected and assessed. The success rates of surgical removal of parathyroid adenomas, hyperplasia, carcinomas, and cysts were evaluated in relation to preoperative and perioperative diagnostic methods. Results A total of 223 parathyroidectomy procedures were performed. Unilateral permanent RLN palsy was observed in 0.91% of cases (95% CI, 0.11–3.21%). Bilateral permanent vocal cord palsy was not observed. A positive response to the parathyroidectomy was observed in 98.43% (95% CI, 96.1–99.72%). Temporary hypercalcemia developed in 13.26% (95% CI, 9.41–18.35%). Revision surgery for persistent HPT or recurrence of HPT was necessary in 16 cases. Conclusion The combination of preoperative multimodal imaging and precise hyperparathyroidism diagnosis is essential for reducing the risk of unsuccessful localization in parathyroid surgery. Ultrasound and scintigraphy offers the most effective diagnostic method. Intraoperative neuromonitoring is recommended for revision surgeries.
Introduction This systematic review aimed to determine the prevalence of different subtypes of hearing disorders (hearing loss, noise-induced hearing loss, hearing impairment, and standard threshold shift) as well as to identify the risk factors associated with hearing disorders in working populations. Methods A systematic search was conducted in PubMed, Scopus and Web of Science for English-language studies published from 2016 to 2025. Eligible studies included studies that were conducted among worker populations and those reported prevalence and/or risk factors of hearing disorders. Extracted data include study countries, industrial sectors, subtypes of hearing disorders, assessment tools for hearing disorders, prevalence (or incidence) estimates, and risk factors. Commonly reported risk factors were identified through descriptive analysis and van Tulder's criteria. Results Among the 47 studies included, the prevalence of hearing loss, NIHL, and hearing impairment ranged from 3.8%–73.5%, 0.2%–63.6%, and 2.7%–71.2%, respectively. The prevalence of STS was 50.0%. There were 89 risk factors of hearing disorders, across eight domains, namely medical conditions (25 risk factors), work-related (18 risk factors), noise-related (13 risk factors), lifestyle (12 risk factors), sociodemographic characteristics (8 risk factors), HPD-related (5 risk factors), exposure to other occupational hazards (4 risk factors), and knowledge-related (4 risk factors). Among these 89 risk factors, only noise exposure and previous smoking showed consistent associations with hearing disorders. Conclusion The prevalence of hearing loss varied widely. Among the 89 reported risk factors (across eight domains) of hearing disorders, only noise exposure and previous smoking showed consistent associations with hearing disorders.
BACKGROUND:Early T-stage (cT1-T2) hypopharyngeal squamous cell carcinoma (HSCC) presents a therapeutic challenge in balancing oncological control with functional preservation. OBJECTIVES:To compare the oncological and functional outcomes between transoral laser microsurgery (TLM)-based treatment pathway and definitive radiation-based (radiotherapy with or without concurrent chemotherapy, RT/CCRT) treatment pathway for early T-stage HSCC. DESIGN, SETTING, AND PARTICIPANTS:This prospective randomized pilot study was conducted at a tertiary care hospital from 2016 to 2021. Seventeen treatment-naïve patients with cT1-T2 HSCC were included. INTERVENTIONS:Participants were randomized to undergo either TLM-based pathway (n = 9) or definitive RT/CCRT (n = 8). PRIMARY OUTCOMES:The primary endpoint was the functional laryngeal preservation rate at last follow-up (minimum follow-up: 1 year). KEY RESULTS:In the TLM group, 55.6% (5/9) of patients required adjuvant CCRT due to adverse pathological features. The 1-year functional laryngeal preservation rate was significantly higher in the RT/CCRT group than in the TLM group (100% vs. 44.4%; Cramer's V = 0.61; 95% CI, 0.39-0.88; P = 0.029). Regarding voice quality, RT/CCRT demonstrated favorable outcomes with lower jitter (0.76% vs. 1.68%; effect size, 0.49; 95% CI, -0.02 to 0.76; P = 0.046). A potential trend favoring the RT/CCRT group was observed for disease-free survival (Hazard Ratio, 0.26; 95% CI, 0.03-2.30; P = 0.189). HARMS:No grade 4 or higher treatment-related adverse events (CTCAE v5.0) were reported in either arm. However, a potential trend toward a higher incidence of hypopharyngeal fibrosis with narrowing was observed in the TLM group (Cramer's V = 0.52; P = 0.082). CONCLUSION:For early T-stage (cT1-T2) HSCC, definitive RT/CCRT suggested potential functional advantages in laryngeal preservation and acoustic quality over a TLM-based pathway, likely by avoiding the cumulative morbidity of trimodality therapy in pathologically node-positive or high-risk disease. While oncological control appeared comparable, these findings remain hypothesis-generating given the limited pilot cohort, warranting validation in larger multicenter trials. TRIAL REGISTRATION:Not prospectively registered (Pilot trial approved by IRB of Taichung Tzu Chi Hospital, REC105-07).
OBJECTIVE:Mastoid cavity obliteration is a surgical strategy rather than an intervention per se, that has been proposed as an effective approach to reduce post-operative complications and long-term morbidity associated with canal wall down (CWD) tympanomastoidectomies. The present study aims to evaluate, in a retrospective case series, audiological, functional, and quality-of-life (QoL) outcomes in adult patients undergoing revision tympanomastoidectomy and ossicular chain reconstruction with mastoid obliteration. MATERIALS AND METHODS:A retrospective analysis was performed on a cohort of patients affected by recurrent cholesteatomatous chronic otitis media (CCOM) who underwent revision tympanomastoidectomy, ossiculoplasty, and mastoid cavity obliteration in the same surgical session. Inclusion criteria were age >18 years and a minimum follow-up of 12 months with available pre- and postoperative audiometric data. Audiological outcomes were assessed using mean pure-tone average (PTA, 250-4000 Hz) and air-bone gap (ABG), calculated over the same frequency range and consistently applied to all cases. QoL was evaluated pre- and postoperatively using the validated Italian versions of the Chronic Otitis Media Outcome Test-15 (COMOT-15) and the Chronic Ear Survey-Italian version (CESI), scored according to their original validated format. Outcomes were also compared, as an exploratory analysis, in a subgroup analysis between patients receiving partial ossicular replacement prostheses (PORP) and total ossicular replacement prostheses (TORP). RESULTS:Fourteen of eighteen eligible patients (6 males, 8 females; mean age 45.4 years) met the established inclusion criteria, completing both audiological and QoL assessments. Mastoid obliteration was performed using different autologous or synthetic biocompatible materials, whose choice was based on intraoperative findings and surgeon preference. A significant improvement in mean PTA was observed postoperatively (66.7 ± 5.3 dB preoperatively vs. 53.8 ± 7.3 dB postoperatively; p < 0.05), as well as a significant reduction in ABG (34.5 ± 7.3 dB vs. 22.3 ± 10.8 dB; p < 0.05). Greater audiological improvement was noted, in this small and non-randomized subgroup comparison, in patients rehabilitated with PORP compared to TORP. QoL scores, based on patient-reported questionnaires, significantly improved at 12 months postoperatively, with CES-I scores increasing (30.5 ± 11 vs. 76 ± 14.2; p < 0.01) and COMOT-15 scores decreasing (78.7 ± 15.7 vs. 40.5 ± 20.8; p < 0.01), particularly in domains related to activity limitation. CONCLUSION:Mastoid cavity obliteration combined with ossiculoplasty in revision tympanomastoidectomy was associated - in our retrospective analysis - with postoperative improvement in hearing outcomes and QoL, with greater audiological improvement observed in patients reconstructed with PORP. Because of the small sample size, heterogeneous obliteration materials, and the absence of a non-obliterated control group, our findings are preliminary and explanatory, and warrant confirmation in larger, prospective, controlled studies to fully demonstrate the independent or causal benefit of mastoid obliteration.
