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11 pages, 2320 KiB

Open AccessArticle

Head and Neck Manifestations of Tularemia in Tyrol (Austria): A Case Series

by Roland Hartl, Matthias Santer, Wegene Borena, Charles Schmit, Hannes Thomas Fischer, Daniel Dejaco, Benedikt Gabriel Hofauer and Teresa Bernadette Steinbichler

Diagnostics 2025, 15(9), 1138; https://doi.org/10.3390/diagnostics15091138 - 29 Apr 2025

Abstract

Background: Tularemia is a rare zoonosis caused by the bacterium Francisella tularensis. In the head and neck region, it can manifest as cervical lymphadenopathy. Despite intensive therapy with various antibiotics, there is often a prolonged medical course. Methods: In this paper, all [...] Read more.

Background: Tularemia is a rare zoonosis caused by the bacterium Francisella tularensis. In the head and neck region, it can manifest as cervical lymphadenopathy. Despite intensive therapy with various antibiotics, there is often a prolonged medical course. Methods: In this paper, all documented cases of tularemia in the head and neck region at the Medical University of Innsbruck (Austria) are analyzed and the results compared with the literature. A retrospective analysis of all patients diagnosed with tularemia at the Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck (Austria), was performed. Tularemia was diagnosed using a serologic agglutination antibody test. Results: Thirteen patients with tularemia presented at the Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck (Austria), between 2010 and 2024. In 10 patients (10/13; 77%), animal contact or an insect bite was the suspected cause. The mean time from the onset of the first symptoms to diagnosis was 36 ± 15 days. The therapy took a mean of 5 ± 2 months until the last follow-up. On average, the patients were treated with 4 ± 1 different antibiotics. The median duration of hospital stay was 13 days (range: 0–36). In addition, a median of 9 (range: 2–20) further outpatient check-ups with several neck ultrasounds were carried out. Also, 10 patients (10/13; 77%) received a diagnostic and/or therapeutic surgical intervention. Conclusions: Tularemia is a rare infectious disease with a prolonged diagnostic and therapeutic course. Screening for tularemia should be performed in cases of cervical lymphadenopathy, especially if empirical antibiotic treatment has been ineffective or if there is a specific medical history. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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14 pages, 16518 KiB

Open AccessArticle

Long-Term Outcomes of Crooked Nose Correction: The Value of Instrumental Diagnosis Trough Nasal Grid Analysis

by Riccardo Nocini

Diagnostics 2025, 15(9), 1121; https://doi.org/10.3390/diagnostics15091121 - 28 Apr 2025

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Abstract

Background: Rhinoplasty is a leading cosmetic surgery, with the crooked nose being one of the most complex challenges due to its combination of functional and aesthetic issues. Involving multiple nasal components, a crooked nose remains difficult to correct, with a high recurrence [...] Read more.

Background: Rhinoplasty is a leading cosmetic surgery, with the crooked nose being one of the most complex challenges due to its combination of functional and aesthetic issues. Involving multiple nasal components, a crooked nose remains difficult to correct, with a high recurrence rate. The aim of this study was to analyze the long-term outcomes and stability of the nasal pyramid after surgery through a nasal grid analysis. Methods: A retrospective study was conducted on 360 patients (20 men and 16 women) treated for moderate to severe nasal deviation between January 2014 and January 2020. All patients underwent surgery by the same expert surgeon, with follow-ups extending to at least 24 months. Medical records, physical exams, and standardized photographic evaluations were used to assess outcomes. A nasal grid was adapted to analyze the long-term stability of nasal corrections, focusing on individual post-operative changes. Results: The study involved 360 patients, mostly men aged 22 to 65, with the majority having nasal deviations caused by extrinsic trauma (e.g., sports injuries). Nasal deviations affected various parts of the nose, and all patients underwent follow-up evaluations using a nasal grid to compare pre- and post-operative measurements. The results showed long-term stability in nasal corrections, with minimal changes observed between 1 month and 24 months post-surgery. Only one case had partial recurrence, requiring revision surgery, which was successful. Conclusions: The surgical correction of a crooked nose is complex and requires a personalized approach, particularly for severe septal deviations. Complete anatomical reconstruction, using advanced techniques like extracorporeal septal reconstruction and laser osteotomies, provides stable long-term results. The adapted nasal grid proved to be not only an effective post-operative assessment tool but also shows potential for the pre-operative classification of nasal deformity complexity. Although this study focused on a standardized surgical technique, future comparative analyses with alternative approaches are recommended to further validate the outcomes. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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9 pages, 1066 KiB

Open AccessArticle

MRI Detection of Unknown Primary Tumours in the Head and Neck: What Is the Expected Normal Asymmetry in the Size of the Palatine Tonsils?

by Kaijing Mao, Qi Yong H. Ai, Kuo Feng Hung, Irene O. L. Tse, Ho Sang Leung, Yannis Yan Liang, Yu Chen, Lun M. Wong, W. K. Jacky Lam and Ann D. King

Diagnostics 2025, 15(6), 788; https://doi.org/10.3390/diagnostics15060788 - 20 Mar 2025

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Abstract

Background/Objectives: The detection of unknown primary tumours in the palatine tonsils (PTs) on imaging relies heavily on asymmetry in size between the right and left sides, but the expected normal range in asymmetry is not well documented. This study aimed to document the [...] Read more.

Background/Objectives: The detection of unknown primary tumours in the palatine tonsils (PTs) on imaging relies heavily on asymmetry in size between the right and left sides, but the expected normal range in asymmetry is not well documented. This study aimed to document the expected range of asymmetry in the size of the PTs in adults without cancer. Methods: This retrospective study evaluated 250 pairs of normal PTs on MRIs of adults without head and neck cancer. The size (volume, V) of the PTs on the left and right sides were measured, and the percentage difference in volume (ΔV%) between the two sides was calculated. An additional analysis of PT volumes in 29 patients with ipsilateral early-stage palatine tonsillar cancer (PTCs) was performed. Results: In patients without PTC, the normal PTs had a mean volume of 3.0 ± 1.7 cm³, and there was a difference in size between the left and right PTs, showing a median ΔV% of 11.6% (range: 0.1–79.0%); most patients had a ΔV% of ≤40% (95%) for PTs. In patients with ipsilateral PTC, the normal PT had a smaller size compared with PTC (p < 0.01), showing a median ΔV% of 132.9% (range: 8.5–863.2%). Compared with patients without PTC, those with PTC showed a greater ΔV% (p < 0.01). An optimal ΔV% threshold of >39.6% achieved the best accuracy of 95% for identifying PTC. Conclusions: PTs are asymmetrical in size in adults without PTC. An additional analysis involving patients with PTC confirmed a threshold of ΔV% of 40% for PTs, which may be clinically valuable to help detect pathology using MRI. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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13 pages, 439 KiB

Open AccessArticle

Preventing Recurrent Otitis Media in Children Aged 2–7 Years: A Cross-Sectional Evaluation of Serum Vitamin D as a Modifiable Factor

by Alexia Manole, Lavinia Florica Mărcuț, Răzvan Cârciumaru and Felicia Manole

Diagnostics 2025, 15(5), 519; https://doi.org/10.3390/diagnostics15050519 - 20 Feb 2025

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Abstract

Background/Objectives: Otitis media (OM) is a common pediatric condition that significantly impacts hearing, language development, and quality of life. Emerging evidence suggests that vitamin D plays a crucial role in immune regulation and that deficiency may predispose children to recurrent OM. This [...] Read more.

Background/Objectives: Otitis media (OM) is a common pediatric condition that significantly impacts hearing, language development, and quality of life. Emerging evidence suggests that vitamin D plays a crucial role in immune regulation and that deficiency may predispose children to recurrent OM. This study aimed to evaluate whether low serum vitamin D levels are associated with increased incidence and severity of OM in children aged 2–7 years. Methods: A cross-sectional study was conducted at a pediatric otolaryngology clinic in northwest Romania between November 2023 and April 2024. A total of 118 children were enrolled, including 87 children with documented episodes of OM within the preceding six months and 31 quasi-controls without recent OM episodes. Participants were stratified into three age groups (2–3, 4–5, and 6–7 years) and classified into clinical subtypes of OM (Acute Suppurative Otitis Media, Serous Otitis Media, and Acute Congestive Otitis Media). Serum 25-hydroxyvitamin D levels were measured using a chemiluminescence immunoassay and categorized as deficient (≤20 ng/mL), insufficient (21–29 ng/mL), or sufficient (≥30 ng/mL). Statistical analyses included one-way ANOVA with post-hoc tests, chi-square tests, linear regression, logistic regression, and Poisson regression. Results: Children with OM exhibited significantly lower vitamin D levels compared to controls, with the most pronounced deficiency observed in the Acute Suppurative OM group. One-way ANOVA revealed significant differences among the groups (F(3,114) = 82.30, p < 0.001), and linear regression demonstrated a strong inverse correlation between vitamin D levels and the frequency of OM episodes (r = −0.793, adjusted R² = 0.63, p < 0.001). Logistic regression indicated that vitamin D insufficiency significantly increased the odds of OM (OR ≈ 120.74, p < 0.001), while Poisson regression showed incidence rate ratios of 13.62 for deficient and 10.47 for insufficient vitamin D status (p < 0.001). Conclusions: The findings indicate that low serum vitamin D levels are significantly associated with an increased risk and frequency of otitis media in preschool-aged children. These results support the role of vitamin D deficiency as an independent, modifiable risk factor for recurrent OM, suggesting that vitamin D screening and supplementation could be beneficial in reducing the clinical and economic burden of this condition. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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12 pages, 1258 KiB

Open AccessArticle

Establishment of the Normative Value of Classical Bluestone’s Nine-Step Inflation/Deflation Tympanometric Eustachian Tube Function Test

by Jing-Jie Wang, Rong-San Jiang and Chien-Hsiang Weng

Diagnostics 2024, 14(24), 2810; https://doi.org/10.3390/diagnostics14242810 - 13 Dec 2024

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Abstract

Background/Objectives: The nine-step inflation/deflation tympanometric Eustachian tube function test (commonly referred to as the nine-step test) is a widely utilized method for evaluating Eustachian tube function (ETF). This study aimed to establish normative values for the nine-step test to facilitate the diagnosis of [...] Read more.

Background/Objectives: The nine-step inflation/deflation tympanometric Eustachian tube function test (commonly referred to as the nine-step test) is a widely utilized method for evaluating Eustachian tube function (ETF). This study aimed to establish normative values for the nine-step test to facilitate the diagnosis of Eustachian tube dysfunction (ETD). Methods: A total of 160 adults, including 70 healthy volunteers and 90 patients with chronic rhinosinusitis (CRS), were recruited for this study. Participants were further categorized into “fair ETF” and “poor ETF” groups based on their scores on the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Eustachian tube function was assessed using both the nine-step test and the ETDQ-7. The diagnostic accuracy of the maximal peak pressure difference (MPD) from the nine-step test was evaluated, using an ETDQ-7 score of ≥14 as the reference standard. Discriminative ability was analyzed using receiver operating characteristic (ROC) curves. Results: An MPD value of ≤4 yielded an area under the ROC curve (AUC) of 0.619, indicating moderate discriminative ability in the Taiwanese population. The median MPD value on the nine-step test was 9.5 (interquartile range [IQR]: 4.5–14.0) in participants with an ETDQ-7 score of <14, compared to a median MPD value of 7.5 (IQR: 2.5–12.0) in those with an ETDQ-7 score of ≥14 (p = 0.033). This finding suggests a potential association between MPD values and ETDQ-7 scores. Conclusions: This study identified an MPD value of 4 as a normative cutoff for screening ETD in a Taiwanese population. However, the diagnostic discriminative power of this parameter was moderate. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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12 pages, 4363 KiB

Open AccessArticle

A Multimodal Protocol Combining ^99mTc-Tilmanocept with Indocyanine Green Fluorescence Lympho-Angiography for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer: A Case Series

by Andrea Galli, Carla Canevari, Emilio Salerno, Ayhan Irem, Marco Familiari, Carlo Pettirossi, Rosa Alessia Battista, Arturo Chiti, Mario Bussi and Leone Giordano

Diagnostics 2024, 14(16), 1805; https://doi.org/10.3390/diagnostics14161805 - 19 Aug 2024

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Abstract

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth [...] Read more.

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called “shine-through radioactivity” of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining ^99mTc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with ^99mTc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical “roadmap”. In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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11 pages, 1009 KiB

Open AccessArticle

Sinus Irrigation with N-Acetylcysteine after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Preliminary Report of a Single-Blind Randomized Controlled Trial

by Jee Hye Wee, Joo Hyun Park, Min Woo Park, Young Seok Choi and Hahn Jin Jung

Diagnostics 2024, 14(15), 1678; https://doi.org/10.3390/diagnostics14151678 - 2 Aug 2024

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Abstract

Nasal irrigation is crucial following endoscopic sinus surgery (ESS), especially for managing chronic rhinosinusitis (CRS). This study assessed the effectiveness of N-acetylcysteine (NAC) irrigation during the post-ESS period of patients with CRS without nasal polyposis. In this prospective, single-blind randomized controlled trial, 49 [...] Read more.

Nasal irrigation is crucial following endoscopic sinus surgery (ESS), especially for managing chronic rhinosinusitis (CRS). This study assessed the effectiveness of N-acetylcysteine (NAC) irrigation during the post-ESS period of patients with CRS without nasal polyposis. In this prospective, single-blind randomized controlled trial, 49 patients (NAC, n = 24; saline, n = 25) undergoing ESS were assigned to receive either NAC or saline irrigations twice daily for a month. The preoperative and postoperative assessments conducted included Lund–Macka (LM) and Lund–Kennedy (LK) endoscopic scores, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Sino-Nasal Outcome Test-20 (SNOT-20). At 2 weeks, 1 month, and 3 months after the operation, endoscopic findings and symptoms were evaluated. Both groups showed no differences in age, sex, LM and LK scores, NOSE scale, and SNOT-20 preoperatively. In terms of the endoscopic findings regarding the sinonasal mucosa after ESS, the NAC group had slightly lower scores 2 weeks, 1 month, and 3 months after the operation, but this difference was not statistically significant. The NAC group showed significant improvement in VAS scores, namely, postnasal drip (1.0, p = 0.041), smell dysfunction (0.8, p = 0.003), and crust (1.5, p = 0.034), compared to the control group’s scores of 2.6, 4.7, and 3.6, respectively, 2 weeks after the operation, although no significant differences were observed in VAS scores for any symptoms 1 and 3 months after the operation. NAC was well tolerated, and no adverse events were reported. NAC irrigation showed benefits over saline irrigation in terms of improving postnasal drip, smell dysfunction, and crust after ESS for CRS without nasal polyposis in the immediate postoperative period. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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16 pages, 2770 KiB

Open AccessArticle

Nasal Microbiome in Granulomatosis with Polyangiitis Compared to Chronic Rhinosinusitis

by Eliza Brożek-Mądry, Zofia Burska, Katarzyna Życińska and Janusz Sierdziński

Diagnostics 2024, 14(15), 1673; https://doi.org/10.3390/diagnostics14151673 - 2 Aug 2024

Cited by 1 | Viewed by 1341

Abstract

Rhinosinusitis in granulomatosis with polyangiitis (GPA) is categorised as a secondary, diffuse and inflammatory chronic rhinosinusitis (CRS). It is one of the conditions that impacts the nasal microbiota. This study aimed to compare the nasal microbiomes of patients with GPA, CRS and NSP. [...] Read more.

Rhinosinusitis in granulomatosis with polyangiitis (GPA) is categorised as a secondary, diffuse and inflammatory chronic rhinosinusitis (CRS). It is one of the conditions that impacts the nasal microbiota. This study aimed to compare the nasal microbiomes of patients with GPA, CRS and NSP. A total of 31 patients were included in the study (18 GPA, 6 CRS and 7 nasal septum perforation (NSP)). In all patients, SNOT 22, a nasal endoscopy (Lund–Kennedy scale) and a brush swab were performed. The metagenomic analysis was carried out based on the hypervariable V3-V4 region of the 16S rRNA gene. At the genus level, statistically significant differences were observed in two comparisons: the GPA/NSP and the GPA/CRS groups. In the GPA/NSP group, the differences were related to four genera (Actinomyces, Streptococcus, Methylobacterium-Methylorubrum, Paracoccus), while in the GPA/CRS group, they were related to six (Kocuria, Rothia, Cutibacterium, Streptococcus, Methylobacterium-Methylorubrum, Tepidimonas). Patients with GPA had lower diversity compared to CRS and NSP patients. There were no statistically significant differences found for the Staphylococcus family and Staphylococcus aureus between the three groups. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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10 pages, 3923 KiB

Open AccessArticle

The Auditory Steady-State Response and the Relationship between Electrophysiological and Behavioural Thresholds

by Cyntia Barbosa Laureano Luiz, Daniela Gil, Piotr Henryk Skarzynski, Magdalena Beata Skarżyńska, Milaine Dominici Sanfins and Marisa Frasson de Azevedo

Diagnostics 2024, 14(15), 1617; https://doi.org/10.3390/diagnostics14151617 - 26 Jul 2024

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Abstract

Background: This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. Materials and Methods: After being assessed, 45 children of [...] Read more.

Background: This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. Materials and Methods: After being assessed, 45 children of both sexes, ranging in age from 5 to 15, were split into four groups: 10 with moderate to moderately severe sensorineural hearing loss (G2M); 10 with steeply sloping sensorineural hearing loss (G2D); 10 with profound and severe sensorineural hearing loss (G2S); and 15 with normal hearing (G1). ASSR, tympanometry, acoustic reflex testing, pure tone audiometry, and speech audiometry (SRT and SDT) were performed. Results: The electrophysiological maximum in the group with normal hearing thresholds varied from 19 to 27 dB NA. The correlation in the group with moderate to moderately severe hearing loss was 0.42–0.74. The correlation in the steeply sloping hearing loss group was 0.68–0.94. The correlation in the group of people with profound and severe hearing loss was 0.59–0.86. The normal hearing group’s mean differences in ASSR threshold and audiometric threshold ranged from −0.3 to 12 dB, in the moderate and moderately severe hearing loss group from −9 to 2 dB, in the steeply sloping hearing loss group from 1.4 to 7.5 dB, and in the severe and profound hearing loss group from −0.40 to 8.5 dB. Conclusion: As expected, there was no strong relationship between behavioural and electrophysiological thresholds in the group with normal hearing. But in children with hearing loss, there was a strong correlation between electrophysiological and behavioural thresholds; this relationship was especially evident in children with severe and profound hearing loss and those with steeply sloping hearing loss. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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8 pages, 1586 KiB

Open AccessArticle

Automated Laryngeal Invasion Detector of Boluses in Videofluoroscopic Swallowing Study Videos Using Action Recognition-Based Networks

by Kihwan Nam, Changyeol Lee, Taeheon Lee, Munseop Shin, Bo Hae Kim and Jin-Woo Park

Diagnostics 2024, 14(13), 1444; https://doi.org/10.3390/diagnostics14131444 - 6 Jul 2024

Cited by 3 | Viewed by 1371

Abstract

We aimed to develop an automated detector that determines laryngeal invasion during swallowing. Laryngeal invasion, which causes significant clinical problems, is defined as two or more points on the penetration–aspiration scale (PAS). We applied two three-dimensional (3D) stream networks for action recognition in [...] Read more.

We aimed to develop an automated detector that determines laryngeal invasion during swallowing. Laryngeal invasion, which causes significant clinical problems, is defined as two or more points on the penetration–aspiration scale (PAS). We applied two three-dimensional (3D) stream networks for action recognition in videofluoroscopic swallowing study (VFSS) videos. To detect laryngeal invasion (PAS 2 or higher scores) in VFSS videos, we employed two 3D stream networks for action recognition. To establish the robustness of our model, we compared its performance with those of various current image classification-based architectures. The proposed model achieved an accuracy of 92.10%. Precision, recall, and F1 scores for detecting laryngeal invasion (≥PAS 2) in VFSS videos were 0.9470 each. The accuracy of our model in identifying laryngeal invasion surpassed that of other updated image classification models (60.58% for ResNet101, 60.19% for Swin-Transformer, 63.33% for EfficientNet-B2, and 31.17% for HRNet-W32). Our model is the first automated detector of laryngeal invasion in VFSS videos based on video action recognition networks. Considering its high and balanced performance, it may serve as an effective screening tool before clinicians review VFSS videos, ultimately reducing the burden on clinicians. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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13 pages, 585 KiB

Open AccessArticle

Side- and Sinus-Specific Relationships between Chronic Rhinosinusitis and Ischemic Stroke Using Imaging Analyses

by Eun Hyun Cho, Kyung Hoon Park, Ji Hee Kim, Heejin Kim, Hyo-Jeong Lee and Jee Hye Wee

Diagnostics 2024, 14(12), 1266; https://doi.org/10.3390/diagnostics14121266 - 15 Jun 2024

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Abstract

Recent studies have reported chronic rhinosinusitis (CRS) as an independent risk factor for stroke. However, the association with stroke depending on the affected sinuses has not been explored. This study aimed to elucidate the side- and sinus-specific relationship between CRS and ischemic stroke [...] Read more.

Recent studies have reported chronic rhinosinusitis (CRS) as an independent risk factor for stroke. However, the association with stroke depending on the affected sinuses has not been explored. This study aimed to elucidate the side- and sinus-specific relationship between CRS and ischemic stroke through imaging analyses. We retrospectively reviewed the medical records of patients who were diagnosed with ischemic stroke at a tertiary center. CRS was defined as having a total score of greater than or equal to 4, according to the Lund–Mackay scoring system, through brain magnetic resonance imaging or computed tomography. We investigated the side- and sinus-specific correlation between CRS and ischemic stroke. Subgroup analyses were performed for different age groups. CRS prevalence in patients with ischemic stroke was 18.4%, which was higher than the previously reported prevalence in the general population. Overall, there was no correlation between the directions of the CRS and ischemic stroke (p > 0.05). When each sinus was analyzed, the frontal (Cramer’s V = 0.479, p < 0.001), anterior (Cramer’s V = 0.396, p < 0.001)/posterior (Cramer’s V = 0.300, p = 0.008) ethmoid, and sphenoid (Cramer’s V = 0.383, p = 0.005) sinuses showed a statistically significant correlation with the side of stroke, but the maxillary sinus (Cramer’s V = 0.138, p = 0.208) did not. In subgroup analyses, a significant right-side correlation between the two diseases was observed in the older-age subgroup (≥65 years old, Cramer’s V = 0.142, p = 0.040). Diabetes mellitus (odds ratio = 1.596, 95% confidence interval = 1.204–2.116) was identified as an independent risk factor for having CRS in patients with ischemic stroke. CRS of the frontal, anterior/posterior ethmoid, and sphenoid sinuses has a directional relationship with ischemic stroke. Our results on which sinuses correlate with stroke advocate for the active surveillance of CRS in patients at high risk of ischemic stroke. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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11 pages, 4232 KiB

Open AccessArticle

High-Frequency Vestibular Function Is Vulnerable to Presbyvestibulopathy

by Seonghoon Bae, Jimin Yun, Seungmin Kwak, Hyuntaek Jung, Hancheol Lee, Juyoung Kim, Chanhee Kim, Yujin Lee and Sunghuhn Kim

Diagnostics 2024, 14(12), 1224; https://doi.org/10.3390/diagnostics14121224 - 11 Jun 2024

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Abstract

Introduction: In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and [...] Read more.

Introduction: In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and head impulse testing, respectively. However, there is still a lack of large-scale reports supporting the relationship between vestibular function tests (VFTs) and aging. In this study, we evaluated whether each test is correlated with aging in the elderly population aged over 50. Methods: This study retrospectively enrolled 1043 subjects from a single university hospital database after excluding those with unilateral and bilateral vestibulopathy, central dizziness, and acute dizziness. Enrolled subjects had caloric canal paresis <20%, vHIT lateral canal gain >0.6, vHIT interaural difference <0.3, and age >50 years old. Results: Significant negative correlations with age were identified in the vHIT (p < 0.001) and rotary chair test (RCT) 1.0 Hz gain (p = 0.030). However, the caloric test (p = 0.739 and 0.745 on the left and right sides, respectively) and RCT 0.12 Hz gain (p = 0.298) did not show a significant correlation with age. A total of 4.83% of subjects aged 70 years or older showed sub-normal vHIT gain that met the criteria of PVP, whereas only 0.50% of subjects aged 60 to 69 did. The prevalence of sub-normal caloric test results, however, was not significantly different between the two age groups (21.55% in the 60–69 age group and 26.59% in the >70 age group). Conclusions: The high-frequency range vestibular function seems vulnerable to aging, and this is more discernible at age >70 years. The weak correlation between age and low-frequency vestibular function tests, such as the caloric test and low-frequency rotary chair testing, suggests the need to revisit the diagnostic criteria for PVP. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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12 pages, 325 KiB

Open AccessSystematic Review

The Role of TORS in the Management of Benign Pathology of the Base of Tongue: A Systematic Review

by Riccardo Nocini, Valerio Arietti, Athena Arsie, Erica Zampieri and Luca Sacchetto

Diagnostics 2025, 15(1), 5; https://doi.org/10.3390/diagnostics15010005 - 24 Dec 2024

Cited by 2 | Viewed by 632

Abstract

Objective: Transoral robotic surgery (TORS) is becoming increasingly popular in head and neck surgery. Its applications have expanded beyond oncologic indications to obstructive sleep apnea syndrome (OSAS) and, more recently, to benign pathologies. Data Sources: A systematic search for articles published in the [...] Read more.

Objective: Transoral robotic surgery (TORS) is becoming increasingly popular in head and neck surgery. Its applications have expanded beyond oncologic indications to obstructive sleep apnea syndrome (OSAS) and, more recently, to benign pathologies. Data Sources: A systematic search for articles published in the PubMed and Google Scholar databases between January 2003 and December 2023 was performed using the following combined search query (robot OR sleep OR apnea OR syndrome) AND (robot OR tongue OR base). Review methods: Given the limited literature, we conducted a systematic review focusing on the outcomes of TORS for benign pathologies of the base of the tongue. Our search methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: We found 16 articles that met our inclusion criteria. These were mainly case reports and a few case series. Conclusions: Compared to other transoral techniques, TORS offers better exposure, visualization, and access to the oropharynx, especially the base of the tongue, even in benign pathology. TORS should be considered a feasible, safe, and effective technique. Several more studies are needed to effectively evaluate the role of TORS in benign pathology that does not correlate with OSAS. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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15 pages, 7110 KiB

Open AccessCase Report

Absorbable Haemostatic Artefacts as a Diagnostic Challenge in Postoperative Follow-Up After Oncological Resection in Head and Neck Tumours: Systematic Review of Current Literature and Two Case Reports

by Giorgio Barbera, Guido Lobbia, Federica Ghiozzi, Alessandra Rovescala, Carlotta Franzina, Sokol Sina and Riccardo Nocini

Diagnostics 2024, 14(23), 2667; https://doi.org/10.3390/diagnostics14232667 - 27 Nov 2024

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Abstract

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic [...] Read more.

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment in Otolaryngology)

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