Search Results (122)

Background and Objectives: This study investigated the association between periodontal procedure intensity, serving as an indirect proxy for periodontal disease burden, and incident tinnitus in Korean adults. Materials and Methods: Using the Korean National Health Insurance Service–National Health Screening Cohort (2002–2019), we included adults aged ≥40 years who had a diagnosis of periodontal disease (International Classification of Diseases, 10th Revision [ICD-10] code K05), had undergone relevant periodontal treatment, and had available health-screening data. Because direct clinical periodontal measures were unavailable, participants were classified according to treatment intensity into: a mild procedure group (scaling or root planing only) and a moderate-to-severe procedure group (subgingival curettage, extraction, periodontal flap surgery, bone grafting, or guided tissue regeneration). Incident tinnitus was defined as an ICD-10 H93.1 diagnosis recorded during two or more outpatient visits to a neurology or otolaryngology department to improve diagnostic specificity. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models adjusted for demographic, socioeconomic, cardiometabolic, and behavioral factors. Results: Among 132,808 participants (76,844 mild; 55,964 moderate-to-severe), the incidence rate of tinnitus was higher in the moderate-to-severe group than in the mild group (4.38 vs. 3.87 per 1000 person-years). After adjustment, the moderate-to-severe group showed a significantly higher risk of tinnitus (HR 1.24, 95% CI 1.17–1.30). These associations were consistent across sex- and age-stratified analyses and in sensitivity analyses using stricter tinnitus definitions. Conclusions: Greater periodontal procedure intensity was associated with a modestly higher incidence of tinnitus in this nationwide cohort. Because procedure intensity serves only as an indirect surrogate for periodontal disease burden, and because auditory confounders and short-term procedure-related factors were unavailable, causality and a specific inflammatory mechanism cannot be established. Further studies incorporating direct periodontal measurements, audiological data, and prespecified lag-time analyses are warranted to confirm these findings. Full article

Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms. Full article

Middle ear neuroendocrine tumours (MeNETs) are rare epithelial neoplasms with neuroendocrine differentiation that pose significant diagnostic and therapeutic challenges. The clinical presentation of MeNETs is often nonspecific and can mimic other middle ear pathologies, such as chronic otitis media, cholesteatoma, or paraganglioma Common symptoms include conductive hearing loss, otalgia, intermittent or persistent tinnitus, ear fullness, and dizziness. We present five patients who underwent surgery in our University Otolaryngology Centre between 2019 and 2025, in whom histopathological examination confirmed the diagnosis of MeNET. Although MeNET is typically considered an indolent tumour, rare cases of locally aggressive behaviour and distant metastases have been reported in the literature. Metastatic potential appears to correlate with histopathological features such as increased mitotic activity, Ki-67 proliferation index > 5%. The treatment of choice for MeNET is surgical resection of the tumour, with the choice of surgical technique depending on the stage of the tumour, its relationship to surrounding anatomical structures, and the possibility of hearing preservation. In our study, we highlighted the importance of radical tumour excision to minimize the risk of recurrence. Given the risk of recurrence and the risk of potential metastases, long-term follow-up is necessary, particularly in patients with advanced-stage tumours. Full article

Background/Objectives: Hybrid operating rooms combine advanced intraoperative imaging, endovascular capabilities, and multidisciplinary resources within a single procedural environment. However, their use in otolaryngology remains insufficiently characterized. This study evaluated institutional patterns of hybrid operating room use, principal clinical indications, multidisciplinary involvement, and perioperative resource utilization in otolaryngology. Methods: We conducted a retrospective single-center study of eligible otolaryngologic procedures performed between 1 October 2018 and 31 December 2025. Patient characteristics, operative sites, hybrid operating room applications, multidisciplinary involvement, intraoperative blood loss, postoperative intensive care unit admission, and length of hospital stay were analyzed. Results: A total of 55 unique procedures were included. The median age was 46.0 years (interquartile range, 33.0–58.5 years; range, 5–76 years), and 33 patients (60.0%) were male. Computed tomography-based localization and navigation represented the predominant application, accounting for nearly three-quarters of procedures. The sinonasal cavity, nasopharynx, and skull base were the most frequently treated anatomical regions, comprising approximately 60% of operative sites. Angiography and endovascular intervention constituted the second most common application. Multidisciplinary collaboration, most frequently involving cardiovascular surgery and interventional radiology, was required in nearly one-quarter of procedures. Procedures relying primarily on intraoperative imaging were associated with a median estimated blood loss of 20 mL and a median hospital stay of 3 days. Cases requiring vascular, cardiopulmonary, or other advanced hybrid capabilities showed greater postoperative resource utilization, including more frequent intensive care admission and longer hospitalization. Conclusions: The hybrid operating room served as a versatile platform for image-guided, vascular, and multidisciplinary procedures in otolaryngology. Its capabilities were used during the management of anatomically complex and high-acuity cases, while differences in postoperative resource utilization appeared to reflect procedural complexity and baseline clinical risk. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) is a frequent complication following general anesthesia. Ramosetron is a standard prophylactic agent for PONV; the efficacy of adjunctive dexamethasone in this specific population is not well established. We aimed to evaluate whether adding dexamethasone to ramosetron enhances antiemetic efficacy across diverse surgical procedures. Methods: This prospective, randomized, double-blind, multicenter trial enrolled adults undergoing gynecological, orthopedic, otolaryngologic, general, or plastic surgery managed without postoperative patient-controlled analgesia. We randomized 385 patients into two groups. Group D received 5 mg of dexamethasone immediately after anesthesia induction and ramosetron (0.3 mg) at the end of surgery, whereas Group C received only ramosetron. We assessed the incidence and severity of nausea and vomiting, pain scores, rescue antiemetic and analgesic requirements, and adverse events immediately after surgery and at 6 and 24 h postoperatively. Results: At 6 h, the incidence of nausea was significantly lower in Group D than in Group C (41.7% vs. 58.3%; p = 0.047). Group D also exhibited lower pain scores (VAS: 3.0 ± 1.8 vs. 3.5 ± 1.7; p = 0.012) and reduced consumption of additional analgesics (44.1% vs. 55.9%; p = 0.028). At 24 h, there were no significant differences between the two groups in the incidence of nausea, pain scores, or consumption of additional analgesics. Multivariable logistic regression analysis identified dexamethasone administration as an independent predictor of reduced postoperative nausea at 6 h (odds ratio 0.575; 95% confidence interval 0.344–0.962; p = 0.035). Conclusions: Low-dose dexamethasone to ramosetron substantially reduced postoperative nausea and improved analgesic profiles at 6 h in patients managed without PCA. However, no significant between-group differences were observed at 24 h. Full article

This study conducts a comparative analysis of surgical outcomes in patients who underwent FSF repair by a plastic surgeon versus an ENT using a national database. A retrospective analysis was conducted on patients who underwent surgical treatment of FSFs by a plastic or ENT surgeon using the de-identified American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients were identified based on surgical CPT codes. Data extracted included primary surgeon specialty and patient demographics, comorbidities, and surgical outcomes. Statistical analysis was performed using Fisher’s Exact test and the Wilcoxon Rank-Sum test, with a p-value < 0.05 representing statistical significance. A total of 111 patients were analyzed, of which 85.6% were male. The mean age was 30.0 years [22.0, 48.0]. There were 70 patients (63.1%) treated by an ENT and 41 (36.9%) by a plastic surgeon. The median operative time was 131.0 min for ENT and 115.0 min for plastic surgery (p = 0.19). The median length of postoperative stay was 1.0 day for both groups. Postoperative complications included surgical site infection (SSI), wound disruption, and sepsis in five patients (4.5%). There was no statistically significant difference in the rate of complications between patients who underwent surgery with an ENT surgeon versus a plastic surgeon (p = 0.16). There were no statistically significant differences in operative time, length of stay, or complications between patients who underwent FSF repair by an ENT or by a plastic surgeon. Surgeon specialty training does not appear to influence intraoperative or postoperative outcomes. Studies with larger sample sizes may demonstrate statistically significant differences in outcomes. Full article

Background. Recurrent respiratory papillomatosis (RRP) in children remains a pressing issue in pediatric otolaryngology, characterized by a chronic course, frequent relapses, and the need for repeat surgical interventions. The aim of this study was to evaluate whether the surgical technique used for primary removal of pediatric RRP—CO₂ laser, microdebrider, or a combined approach—was associated with clinically documented recurrence and early recurrence within 12 months. Materials and Methods. A retrospective study of 53 medical records of children who underwent their first surgery for RRP between 2019 and 2023 was conducted. Three surgical approaches were used: CO₂ laser, microdebrider, and a combined method. Statistical analysis was performed using Pearson’s χ² test, and the strength of association was evaluated with Cramér’s V. Results. The most frequently used method was the CO₂ laser (n = 25), followed by a microdebrider (n = 16), and a combined method (n = 12). During the observation period, disease recurrence was recorded in 35 of 53 patients (66.0%): in 20 children, within the first 12 months after surgery, and in 15, after more than 12 months. No recurrence was documented in the available medical records for 18 patients during the observation period. No statistically significant effect of the surgical treatment method on the recurrence rate (p = 0.813) or the risk of early recurrence (p = 0.926) was found. Also, no significant association was found between the child’s age and either the overall recurrence rate (p = 0.510) or the likelihood of early recurrence (p = 0.217). Conclusions. Within the limitations of this retrospective single-center study, neither the surgical treatment method nor the patient’s age was associated with clinically documented recurrence or early recurrence recorded in the available medical records. Full article

Background/Objectives: Vestibular migraine is a common but often underrecognized cause of dizziness in otolaryngology practice. Although awareness has increased, variation in clinician training and management may contribute to inconsistent care. This study evaluated current diagnostic and treatment practices of Canadian otolaryngologists for vestibular migraine, including familiarity with diagnostic criteria, therapeutic approaches, perceived barriers, and educational needs. Methods: A national cross-sectional electronic survey was distributed to practicing and emeritus members of the Canadian Society of Otolaryngology–Head and Neck Surgery from February to April 2025. The 14-item survey assessed demographics, clinical exposure to dizzy patients, residency training, diagnostic familiarity, treatment patterns, referral practices, barriers to care, and preferred educational resources. Responses were anonymized and analyzed using descriptive statistics. Results: Forty-four otolaryngologists completed the survey (response rate: 7.4%). Most respondents reported being very familiar (59.1%) or moderately familiar (38.6%) with vestibular migraine diagnostic criteria, and 97.7% reported currently diagnosing and/or treating these patients. However, only 15.9% had received extensive residency training specific to migraine or vestibular migraine. Common treatments included lifestyle and dietary modification (90.9%), nutraceutical supplements (59.1%), tricyclic antidepressants (54.5%), and analgesics (52.3%). Vestibular rehabilitation therapy (29.5%) and calcitonin gene-related peptide-targeted therapies (<10%) were used less frequently. Major barriers were clinical time constraints (65.9%), lack of training or knowledge (54.5%), and diagnostic complexity (47.7%). Clinical guidelines (70.5%) and continuing medical education courses (65.9%) were identified as the most valuable supports. Conclusions: Among surveyed Canadian otolaryngologists engaged in dizziness and vestibular migraine care, substantial heterogeneity existed in training and management practices. Standardized guidance, enhanced education, and interdisciplinary collaboration may improve consistency of care and patient outcomes. Full article

Background. Post-intubation cicatricial laryngeal stenosis (PICLS) represents one of the most severe long-term complications of pediatric airway management. By systematically analyzing clinical and procedural variables across different grades of PICLS, this study addresses a critical gap in pediatric airway research and provides clinically relevant descriptive data on stenosis severity. Materials and methods. A retrospective single-center case-series study was conducted and included pediatric patients (0–18 years) treated for PICLS at a tertiary referral pediatric otolaryngology center between 2016 and 2024. Spearman correlation and multiple regression analyses were used to evaluate possible associations between clinical factors and stenosis grade. Results. Among 172 children with PICLS, severe forms of stenosis (Grades 3–4) were observed in 37.2%, with predominant subglottic localization (85.3%). Age at primary intubation (p = 0.02) and the type of intubation (emergency/elective; p = 0.04) were the only variables significantly associated with stenosis severity in this cohort, whereas sex, reintubation, comorbidities, and delivery-related factors showed no significant associations. Mild stenosis (Grades 1–2) more frequently followed intubation for elective surgery and infections, whereas severe stenosis was more commonly associated with intubation due to central nervous system pathology and infections. Conclusions. Age at primary intubation and the type of intubation (emergency/elective) were associated with stenosis severity in this cohort. These findings should be interpreted in light of the retrospective case-series design and the absence of a control group, but they may contribute to improved clinical characterization of PICLS severity in children. Full article

Background: Endoscopic sinus surgery (ESS) is a core operative technique in otolaryngology and is associated with a steep learning curve due to complex sinonasal anatomy, limited depth perception with two-dimensional endoscopy, and the requirement for precise bimanual coordination. Given the potential for serious complications, including cerebrospinal fluid leak and visual loss, simulation provides an important opportunity for trainees to develop technical skills in a controlled environment without risk to patients. Recent advances in three-dimensional (3D) printing have enabled the development of high-fidelity models for ESS training. Methods: We describe an evidence-based, graded approach to ESS simulation using two commercially available 3D printed sinus surgery models tailored to the trainee’s stage of training. Early-stage simulation focuses on development of anatomical orientation, endoscopic hand–eye coordination, tissue handling, and basic procedures such as middle meatal antrostomy and anterior ethmoidectomy. Advanced simulation targets more complex procedures, including frontal and sphenoid sinus surgery, transsphenoidal approaches, and management of intraoperative complications. Results: Validation studies demonstrate high face and content validity for both models. Early-stage simulators support acquisition of fundamental technical skills, while advanced models allow simulation of complex anatomy, pathology, and operative complications. Conclusions: A structured, stage-appropriate simulation strategy using high-fidelity 3D printed models may enhance technical skill acquisition and support safe and effective training in endoscopic sinus surgery. Full article

Background/Objectives: Radiomics-based machine learning models have demonstrated high accuracy in differentiating benign from malignant orbital masses, with early studies suggesting performance comparable to expert radiologists. However, translation into clinical practice remains limited due to dataset constraints, including retrospective study designs, single-center cohorts, and underrepresentation of diverse patient populations. This review aims to evaluate the current evidence supporting radiomics in orbital disease while critically examining barriers to generalizability and equity across ophthalmology, otolaryngology, and plastic surgery. Methods: A narrative literature review was conducted to assess radiomics applications in orbital oncology and reconstruction. Studies evaluating diagnostic accuracy, margin assessment, postoperative surveillance, and surgical planning across ophthalmology, head and neck surgery, and reconstructive surgery were analyzed, with particular attention paid to dataset composition, validation strategies, and imaging standardization. Results: Radiomics models demonstrated high diagnostic performance in differentiating orbital tumors, optimizing surgical planning, and aiding postoperative monitoring. However, most studies relied on small, homogeneous datasets lacking racial, ethnic, and pediatric representation. External validation was uncommon, and imaging heterogeneity limited reproducibility. These deficiencies restrict the clinical translation of radiomics and risk exacerbating healthcare disparities, particularly among underrepresented populations. Conclusions: Radiomics holds promise as a precision medicine tool for orbital diagnosis, surgical navigation, and postoperative care. Nevertheless, its clinical adoption is constrained by dataset bias, lack of standardization, and limited prospective validation. Future progress requires multi-institutional, demographically diverse datasets and standardized imaging protocols to ensure equitable and generalizable implementation across specialties. Full article

Background/Objectives: Myocardial injury after non-cardiac surgery (MINS) is a common and serious postoperative complication. Its largely asymptomatic course hampers early recognition, highlighting the importance of systematic biomarker monitoring. The aim of this review is to summarize current evidence on the diagnosis, risk factors, and management of MINS, with a focus on otolaryngology, where intraoperative hypotensive techniques may increase risk. Methods: A basic science review was conducted using PubMed, Embase, and the Cochrane Library (2005–2025). From 2712 records, 30 studies met the inclusion criteria after removing duplicates, screening titles/abstracts, and full-text assessment. These studies formed the basis for the final analysis. Results: Observational studies and reviews identify perioperative troponin monitoring as the diagnostic gold standard. However, no evidence-based management guidelines exist, and otorhinolaryngology-specific data remain rare but not entirely absent. Troponin elevation in the early postoperative period reliably predicts adverse outcomes. While MINS is well documented in vascular and orthopedic surgery, evidence in otolaryngology is limited. Controlled hypotension in procedures such as functional endoscopic sinus surgery or head and neck tumor resection may further elevate risk. Conclusions: MINS is an underrecognized complication with major prognostic significance. The lack of standardized management and the absence of large otolaryngology cohorts underscore an urgent need for targeted research and specialty-specific guidelines and support the justification for integrating existing evidence into otolaryngologic practice. Full article

Background: Postoperative bleeding is a frequent complication in otolaryngology and head and neck surgery, often leading to readmissions and increased healthcare costs. Objectives: This systematic review evaluates the clinical efficacy, safety, and impact of RADA16, a synthetic self-assembling peptide hydrogel, as a topical haemostatic adjunct in this surgical field. Methods: In adherence with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted through December 2025. Eligible studies included adult patients undergoing otolaryngological or head and neck surgical procedures where RADA16 (CAS 289042-25-7, PuraBond^®/PuraStat^®/PuraGel^®, ^®, 3-D Matrix SAS; Caluire et Cuire, Lyon, France) was applied intraoperatively. Exclusion criteria included non-English publications, reviews, and studies without clinical outcome data. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies. A narrative synthesis was performed due to heterogeneity in outcome reporting. Results: Eight studies involving 1761 patients were included. In oropharyngeal surgery, RADA16 significantly reduced postoperative haemorrhage (6.3% vs. 16.7%, p = 0.016) and was associated with faster resumption of normal diet and lower pain scores (p = 0.016). In nasal surgery, it significantly lowered epistaxis rates (0.4% vs. 2.2%, adjusted OR 0.027, p = 0.026) and reduced the need for nasal packing. In cervical endocrine surgery, the rate of hematoma requiring revision was low (0.84%), with no delayed bleeding beyond 24 h. Surgeons consistently reported high satisfaction and ease of application. No serious device-related adverse events were reported. Discussion: Current evidence suggests RADA16 is a safe and effective haemostatic adjunct that can improve postoperative recovery and reduce readmission rates in specific surgical contexts. Limitations include heterogeneity in study designs, small sample sizes in some domains, and a lack of long-term follow-up. Further large-scale randomized controlled trials are needed to quantify its economic impact and formalize its role in surgical pathways. Funding: This study was funded by 3-D Matrix Medical Technology for article processing charges. The funder had no role in study design, data collection, analysis, interpretation, or writing. Registration: This review was not registered in a systematic review registry. Full article

Objective: The aim was to evaluate cochlear implantation (CI) outcomes in children with Down syndrome (DS) with severe-to-profound sensorineural hearing loss (SNHL), addressing a literature gap and discussing challenges including anatomical abnormalities, cognitive deficits, and Eustachian tube dysfunction. Data Sources: Systematic searches were conducted in PubMed, Web of Science, Scopus, and Embase from inception through to June 2025. Review Methods: A systematic review adhering to PRISMA guidelines was performed. Included studies reported CI outcomes in DS patients receiving otolaryngologic care for SNHL. Extracted data included findings on ear anatomy, auditory performance, speech/language development, intelligibility, and duration of CI use. Results: A total of 149 abstracts were screened, yielding six studies with 26 patients that met the inclusion criteria. The review included pediatric DS patients with documented ages at implantation spanning from 11 months to 17.9 years. CI provided significant benefits for DS patients, including improved audiometric results, enhanced environmental awareness, and psychosocial gains. Optimal outcomes were associated with early implantation, thorough preoperative imaging (CT/MRI), and management of middle ear disease. Variability in outcomes often reflected cognitive limitations and anatomical challenges such as cochlear nerve hypoplasia and Eustachian tube dysfunction. Conclusions: CI can significantly improve quality of life and communication in children with DS when tailored to their unique needs. Preoperative imaging is essential to assess candidacy, and middle ear disease should be addressed prior to surgery. Clinicians should counsel families with individualized goals that emphasize functional hearing gains over normative speech benchmarks. Broader adoption of CI in this population may be supported by standardized, population-sensitive outcome measures and future prospective studies. Full article

Surgical wound complications, particularly surgical site infection (SSI), remain common despite advances in perioperative care, and modern dressings—including emerging smart systems—are intended to optimize moisture balance, reduce bioburden, and support monitoring of healing. This narrative review, informed by PRISMA 2020, synthesized comparative clinical evidence on postoperative dressings across surgical specialties. PubMed and Embase were searched for peer-reviewed comparative human studies published in 2015–2025 involving adults undergoing surgery with primary closure or secondary intention healing. Outcomes included SSI, time to epithelialization/closure, scar outcomes, pain, peri-wound skin integrity, and dressing change frequency. Nine studies met the inclusion criteria across orthopedics, general and endocrine surgery, otolaryngology, maxillofacial surgery, and surgical oncology. In hip/knee arthroplasty, hydrofiber dressings were associated with lower SSI rates versus standard/absorbent dressings. A meta-analysis suggested that moist and silver-based dressings generally outperformed gauze, with ionic silver ranking highest for healing and metallic silver for SSI prevention, and hydrocolloids reduced dressing change frequency. Oxygen diffusion therapy improved scar outcomes after cervicotomy, and chitosan gel reduced synechiae after endoscopic sinus surgery. Evidence in oncologic surgery was inconclusive, and heterogeneity in interventions, endpoints, and follow-up limited pooling. Overall, advanced postoperative dressings may improve selected outcomes compared with traditional gauze, but effects appear procedure- and context-dependent; future studies should standardize outcomes, extend follow-up, and incorporate cost-effectiveness and patient-reported measures, alongside evaluation of sensor-enabled smart dressings. Full article