Medicinal plants are widely used worldwide for ear, nose, and throat (ENT) disorders and have a long history of traditional application. This review aims to summarize current experimental and clinical evidence on medicinal plants used for ENT conditions such as otitis externa/media, tinnitus, vertigo, allergic rhinitis, pharyngitis, and laryngitis, and to support the identification of new plant species with antimicrobial potential against ENT pathogens. This review thoroughly summarizes recent developments from 2020 to 2025 and was conducted using electronic databases, including PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar, with predefined ENT and medicinal plants-related keywords. Frequently used species include Lavandula angustifolia, Thymus vulgaris, Curcuma longa, Zingiber officinale, Origanum vulgare, Glycyrrhiza glabra, Mentha piperita, Matricaria chamomilla, and Syzygium aromaticum, many of which show In vitro antibacterial, antifungal, or antiviral activity relevant to upper airway and oral/ENT infections. Evidence indicates that selected medicinal plants and their extracts or essential oils inhibit key ENT-related pathogens, including multidrug-resistant respiratory and pharyngeal bacteria. The compiled data, structured in comparative tables, highlight promising taxa and preparation types, and underscore gaps in clinical validation, standardization, and safety assessment. Overall, this review provides an evidence-based overview of ENT-related phytotherapy and a framework for future pharmacological and phytochemical studies aimed at developing novel plant-derived antimicrobials for ear, nose, and throat diseases.
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a rapidly proliferating class of drugs used for diabetes and obesity management. Their use poses several implications for ear, nose and throat (ENT) surgeons, including high-risk airway surgery considerations. This review highlights pharmacological mechanisms, ENT-specific side effects and perioperative challenges. A narrative review was performed with comprehensive literature search across PubMed and Google Scholar (2000-2025). International anaesthetic, surgical and endoscopic guidelines were reviewed and synthesised to compare management strategies. GLP-1 RAs function to regulate glucose, reduce appetite and slow gastric emptying, increasing aspiration risk during airway surgery. ENT clinical implications include patulous eustachian tube dysfunction, nasopharyngitis and improvement in sleep apnoea and emerging sinus surgery outcomes. Pre-clinical data suggest a theoretical medullary thyroid cancer risk. Despite endoscopy data showing increased residual gastric content, no studies specifically address risks in airway surgery. Peri-operative guidelines vary, and this review reports the range of recommendations from major international anaesthetic organisations. ENT surgeons must recognise GLP-1 RA associated risks, especially during tubeless airway surgery. An individualised, team-based approach may be necessary for patients, as current guidelines do not reach consensus. ENT side effects of eustachian tube dysfunction, and theoretical risk of medullary thyroid cancer still needs further investigation.
Background and Objectives: This study aimed to evaluate associations between dental caries, periodontal pockets, and radiologically detected periapical lesions in relation to serum levels of Dickkopf-1 (Dkk-1) and tartrate-resistant acid phosphatase 5B (TRAP-5B) in oncologic patients with ear, nose, and throat (ENT) cancer compared with healthy controls. Materials and Methods: The study included 63 subjects divided into a study group of 33 patients diagnosed with ENT cancer and a control group of 30 healthy individuals. Blood samples were collected to assess serum Dkk-1 levels using a sandwich enzyme immunoassay and TRAP-5B levels. Radiological dental evaluation included orthopantomography (OPT) and cone beam computed tomography (CBCT) to assess the number and depth of dental caries and the presence of periapical lesions. Periodontal pockets were recorded through clinical examination. Results: Serum biomarker analysis demonstrated significant differences between groups: TRAP-5B levels were significantly higher in patients with ENT cancer, whereas Dkk-1 concentrations were significantly lower compared with healthy controls (p < 0.001). OPT revealed up to eight carious lesions in both groups. The mean number of carious lesions was higher in healthy subjects (2.97 ± 2.48) than in patients with ENT cancer (2.06 ± 2.29). CBCT evaluation revealed 0-8 carious lesions in healthy individuals and 0-6 lesions in patients with ENT cancer, with a significantly higher mean number of lesions in the control group (2.97 ± 2.48 vs. 1.85 ± 1.89). Periodontal pockets were more frequent in patients with ENT cancer (0.67 ± 1.32) than in controls (0.37 ± 0.81). OPT evaluation also showed a higher mean number of periapical lesions in patients with ENT cancer (0.82 ± 1.29) compared with controls (0.37 ± 0.67). CBCT examination demonstrated that the mean number of periapical lesions in patients with ENT cancer was more than twice that of the control group, although this difference did not reach statistical significance. Conclusions: Patients with ENT cancer exhibited significantly altered systemic bone turnover biomarker profiles, characterized by increased TRAP-5B and decreased Dkk-1 levels. Clinically, these patients also presented a higher prevalence of periodontal pockets and periapical lesions, whereas carious lesions were more frequently detected in healthy individuals. The combined radiological and biochemical findings contribute to a better understanding of oral-systemic interactions in oncologic patients and highlight the importance of comprehensive dental evaluation prior to oncologic therapy.
Developing region-specific clinical practice guidelines (CPGs) for ear, nose, and throat (ENT) diseases is crucial in Pakistan's primary care, given their significant contribution to clinical cases, aiming to enhance healthcare standards through evidence-based practices with local adaptations. To ensure the standardization of primary healthcare and reduce unnecessary specialist referrals by creating CPGs that are appropriate to our region. We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Ménière's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology-Head and Neck Surgery Foundation as the source guidelines, and employed the Grading of Recommendations, Assessment, Development, and Evaluation-Adoption, Adaptation, and De Novo Development (GRADE-ADOLOPMENT) approach to contextualize guidelines by adopting, adapting, or excluding recommendations from them. Clinical-referral algorithms were created using recommendations from the CPGs created, with additional recommendations sought through a best-evidence review process. We developed local CPGs for eight ENT conditions using the GRADE-ADOLOPMENT approach. While most recommendations were adopted in the local CPGs, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes. Six recommendations were excluded due to service limitations in Pakistan. Additionally, we created 8 clinical-referral algorithms, incorporating 17 additional recommendations to address gaps in practice, distributed across various conditions. The newly-established CPGs are instrumental in delivering standardized, high-quality care at the primary care level. Simultaneously, the development of clinical referral pathways empowers general physicians to manage patients effectively and make timely, appropriate referrals to ENT specialists.
This study compares the Acoustic Voice Quality Index (AVQI-3) with machine learning (ML) models to evaluate their clinical utility for estimating voice quality. Audio from 187 American English speakers (49 healthy, 138 with voice disorders) was rated for overall voice quality by six voice specialists. AVQI-3 and its six acoustic parameters were extracted, and these parameters were used to train 14 ML models (linear, curvilinear, nonlinear). Correlations and classification accuracy (normal-mild vs. moderate-severe) were compared against perceptual ratings as ground truth. AVQI-3 correlated strongly with perceptual ratings (Spearman rs=0.75), comparable to linear and curvilinear models, yet outperformed most nonlinear models. At a cutoff score of 2.52, AVQI-3 achieved the highest classification accuracy (0.92) with balanced sensitivity (0.90) and specificity (0.93). Among ML models, linear regression performed best (rs=0.77, accuracy=0.92, sensitivity=1.0, specificity=0.89), whereas nonlinear models showed reduced performance (average rs=0.74, accuracy=0.87, sensitivity=0.95, specificity=0.85). AVQI-3 is a simple, accessible index that quantifies voice quality as effectively as complex ML models. This is supported by the best-performing ML models being linear, indicating that linear combinations of acoustic measures are effective, accurate, and clinically interpretable, whereas added nonlinear complexity offered little benefit.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a high incidence of postoperative recurrence despite medical and surgical treatments. However, a universal definition of recurrence and its determinants is lacking. Our objective was to establish a clear definition of recurrence and reach consensus on the contributing factors. A consensus study was conducted using the Delphi method. The literature on recurrence of CRSwNP was reviewed and assessed by a multidisciplinary scientific committee. The committee designed a 2-round online Delphi questionnaire addressing recurrence in CRSwNP. As for consensus, ≥70% of panelists scored 1-3 (disagreement) or 7-9 (agreement). The survey involved 70 physicians (69 completed both rounds) with expertise in the management of CRSwNP (47 ear, nose, and throat [ENT] specialists and 22 allergists). Consensus was reached on the characteristics defining recurrence (87% overall agreement, 95% agreement among allergists, and 83% agreement among ENT specialists). Finally, a list of 10 key prognostic factors was agreed upon. The top 5 were presence of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, eosinophilic CRSwNP, asthma, extent of surgery, and eosinophils in nasal polyposis (>50/high-power field). This study identified 10 key prognostic factors for recurrence and clarified the definition of recurrence in CRSwNP as the reappearance or worsening of sinonasal symptoms (>3 points on a visual analog scale and/or ≥12 points in the 22-item Sino-Nasal Outcome Test) and/or objective evidence of inflammation (nasal polyposis grade ≥1 or other endoscopic or radiological signs of persistent mucosal inflammation) after initial postoperative improvement (baseline postoperative assessment 1 month after surgery, recurrence evaluated 6 months thereafter), excluding persistence and suboptimal surgical outcome.
This study aims to examine the impact of ear, nose, and throat (ENT) surgeons' involvement on intraoperative costs and operating room (OR) times for retrosigmoid craniotomies using time-driven activity-based costing (TDABC). A retrospective, single-center analysis was conducted. TDABC methodology was utilized to calculate total intraoperative costs. Multiple linear regression analysis was performed to assess the independent effect of ENT surgeons' involvement on surgical costs and OR time. All procedures were performed at the Thomas Jefferson University Hospital and affiliated sites between 2017 and 2022. About 255 patients underwent retrosigmoid craniotomy (166 neurosurgery only, 89 with ENT surgeons' involvement). Main outcome measures include total intraoperative costs calculated using TDABC methodology, OR time, supply costs, and personnel costs. Inclusion of ENT surgeons was significantly associated with increased total costs (B = $4,082 ± $1,015, p  < 0.001) and OR time (B = 135 ± 38 minutes, p  < 0.001). The mean total cost of neurosurgery-only cases was $7,538 ± $3,977, compared with $14,217 ± $3,485 for multidisciplinary cases. Personnel costs were the primary driver of this increase, with no significant difference in supply costs between groups. While ENT collaboration can enhance outcomes in select cases, such as those involving vestibular schwannomas, its routine inclusion may not be cost-effective. Our study demonstrates the marginal cost of ENT collaboration for retrosigmoid craniotomies. Future studies may build on our costing framework by integrating outcomes with costs to determine the true cost-effectiveness of cross-specialty collaboration.
ObjectiveThis cohort study examined whether documented coronavirus disease 2019 in young children affects the need for neurodevelopmental treatment and its association with developmental diagnoses and other medical conditions.MethodsChildren with and without coronavirus disease 2019 were compared before and after an index date, defined as the first confirmed severe acute respiratory syndrome coronavirus 2 infection for participants with an infection and a matched reference date for controls. Data were obtained from a large health maintenance organization.ResultsThe study included 227,728 children born between 1 January 2017 and 31 January 2022 who were followed up from birth until 1 January 2024. Before the index date, there was no significant difference in the neurodevelopmental treatment between the two groups. After diagnosis, the affected children received significantly more treatments than those without an infection. Diagnosed children also exhibited higher rates of ear, nose, and throat; respiratory; and gastrointestinal conditions both before and after diagnosis. Emotional difficulties, including anxiety and acute stress reactions, were more common post-infection, whereas no increase in developmental diagnoses, such as developmental delay and autism spectrum disorder, was observed.ConclusionObservations on the same cohort before and after severe acute respiratory syndrome coronavirus 2 exposure suggest that the infection rather than adverse neurodevelopmental outcomes prompted greater parental concern and increased therapeutic support.
Depending on the cause of the orofacial pain, different specialists can be involved in the healthcare process. In case the pain is not, or only partly, caused by dental structures, an interprofessional approach is warranted due to the complex nature of most of these complaints. Collaboration between (specialized) dentists, (specialized) physiotherapists, and other healthcare providers like the general medical physician, Ear Nose Throat (ENT) specialist, maxillofacial surgeon, neurologist, psychologist, and/or speech therapist can be necessary. For successful a collaboration, the specific roles of each member of the multidisciplinary team should be clear, both for the care providers and for the patient. The aim of this study was therefore to explore the role of different healthcare providers and their collaboration in the care of patients with orofacial pain. The secondary aim was to describe the when, how, and why regarding interprofessional collaboration for the management of orofacial pain. A three-round e-Delphi study was conducted from May 2023 to November 2023. There were three rounds, and all surveys were collected using the online program Qualtrics. Consensus was reached when ≥ 75% of the expert panel members agreed. There were 14 expert panel members actively participating in this study: 4 orofacial pain dentists, 5 orofacial physiotherapists, and 5 patients. In the Netherlands, non-complex orofacial pain complaints can be managed by the general dentist or general medical physician. In the case of complex orofacial pain complaints, the orofacial pain dentist and orofacial physiotherapist are essential members of the interprofessional team. Then, based on the specific needs of the patient, collaboration with other healthcare providers can be initiated. By incorporating interprofessional collaboration, experts believed that the patient would receive the right care sooner, which would benefit treatment outcomes. Interprofessional collaboration in the form of communication and, for complex cases, interprofessional consults, is recommended for patients with complex orofacial pain. All healthcare providers have their own role during the diagnostic and management process, depending on the complaints and needs of the patient.
Antineutrophil cytoplasmic antibody (ANCA)-associated pachymeningitis is a rare inflammatory disorder of the dura mater that may occur in isolation or as part of systemic vasculitis. The clinical features and outcomes of proteinase 3 (PR3)- and myeloperoxidase (MPO)-ANCA-associated pachymeningitis remain poorly defined. We aimed to synthesize clinical presentation, investigations, and treatment outcomes to improve diagnosis and guide management. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Scopus were searched to June 15, 2023. Eligible studies were case reports or series of patients with imaging-confirmed pachymeningitis and positive ANCA serology. Individual patient data were extracted, including demographics, clinical features, pathology, and outcomes. We identified 230 patients from 177 reports, including 108 MPO-ANCA-positive, 71 PR3-ANCA-positive, and 3 dual MPO/PR3-positive cases; 46 ANCA-positive cases had unspecified antigen specificity, and 2 were ELISA-negative but ANCA IIF-positive. Median age was 60 years; 53% were male. Headache and cranial neuropathies-particularly hearing loss, visual impairment, and diplopia-were predominant. Systemic involvement was present in 89% of cases, primarily affecting the ear, nose, throat, lungs, orbits and kidneys. Imaging often showed tentorium/falx, middle cranial fossa, and frontal convexities involvement. Inflammatory markers were raised in > 90%, and cerebrospinal fluid pleocytosis in 50%. Typical pathological features such as granulomas, vasculitis, or necrosis were documented in 66% of biopsied patients. At a median 9-month follow-up, mortality rate was 3.9% and relapse rate 23.5%. Rituximab (25%) was associated with lower rates of refractory disease. PR3- and MPO-ANCA-associated pachymeningitis typically presents with headache and cranial neuropathies, usually with systemic involvement. Relapse and incomplete recovery remain common despite treatment, underscoring the need for early recognition, targeted immunotherapy, and long-term follow-up.
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is increasingly recognized as a contributor to cognitive decline and a potential risk factor for neurodegeneration. Previous studies have also identified various associated comorbidities such as vascular dysfunction, metabolic alterations, and neuroinflammatory changes. Positive airway pressure (PAP) therapy has been associated with cognitive improvement in some studies, but its long-term effects on cognitive function remain uncertain. This study employs a prospective, observational, longitudinal cohort design to examine longitudinal associations between disease severity, PAP therapy and cognition. Additionally, we aim to examine the relationships between cognitive dysfunction, brain structure and associated OSA-related risk factors. A total of 100 eligible participants with mild to severe OSA will be recruited. All participants will undergo comprehensive assessments at baseline and after 12 months, including neurological, pulmonary, and ear, nose and throat clinical examinations, polysomnography, neuropsychological testing, brain magnetic resonance imaging with volumetry, anthropometric measurements, blood and saliva sampling for the assessment of the selected laboratory parameters, gut microbiome analysis, and evaluation of endothelial function and baroreflex sensitivity. This study may improve understanding of how PAP therapy and OSA-related pathophysiological processes influence cognitive outcomes.
Diagonal ear lobule fold (DELF)(Frank sign); It is a diagonal fold in the earlobe at an angle of about 45°, running diagonally from the tragus to the edge of the auricle at varying depths. In our study, the relationship between obstructive sleep apnea syndrome (OSAS) and DELF was examined. A total of 132 patients, including 99 patients with sleep apnea complaints and 33 volunteers without complaints, were included in the study. Ear, nose and throat examination of the participants was performed and their ear lobules were examined. All participants underwent polysomnography. The patients were examined in four groups. Group 1 (AHI < 5)(Normal, n = 33), Group 2 (AHI = 5-15)(Mild, n = 33), Group 3 (AHI = 15-30)(Moderate OSAS, n = 33), Group 4 (AHI > 30)(Severe OSAS, n = 33). Demographic information of all participants was recorded. There was no significant difference between the ages of the groups (43.48, 44.42, 48.69, 47.27, respectively) (p > 0.05). When evaluated in terms of BMI, group 1 was significantly lower than group 4 (p=0.002). There was no significant difference between the other groups (p > 0.05). There was no significant difference between the groups in terms of chronic diseases (CVO, CAD, HT, DM, COPD) (p > 0.05). DELF presence of groups; group 1: 0.59 ± 0.80, group 2: 0.57 ± 0.78. group 3: 0.80 ± 0.86, group 4: 1.10 ± 0.97. There was a significant increase in group 4 compared to group 1 and group 2 (p=0.004, p=0.006, respectively). There was no significant difference between the other groups (p > 0.05). The presence of DELF (Frank sign) in patients with severe OSASwas demonstrated for the first time in this study. According to the results we have reached, DELF can be used as a new examination finding in the diagnosis of OSAS. We also think that it can be used as a marker in the clinical course of the disease.
For skull base chordomas, two key aspects remain controversial: (1) the necessity of adjuvant RT following gross total resection (GTR) and (2) the comparative long-term efficacy of different RT modalities. This study aimed to evaluate the effects of endonasal endoscopic surgery, RT, and other variables on progression-free survival (PFS) and overall survival (OS) in patients with skull base chordomas. A retrospective analysis was conducted on 83 patients (2006-2025) treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University, to assess the prognosis of skull base chordoma between 2006 and 2025. Between 2006 and 2014, GTR was achieved in 25.8% of patients. Between 2015 and 2022, GTR was achieved in 50.0% of patients. Multivariate Cox regression analysis revealed several independent prognostic factors. For PFS, GTR, the presence of complications, and a tumor volume <25 cm3 were significantly associated with outcome. For OS, the independent predictors included STR, GTR and complications. Surgery remains the primary treatment for skull base chordoma. We therefore recommend pursuing maximal safe resection to achieve GTR whenever feasible. The efficacy of resection is also influenced by the endoscopic endonasal surgery learning curve. Our analysis also revealed tumor volume, and a complicated surgical course as independent prognostic factors. Furthermore, our data may not support the routine use of adjuvant RT following GTR.
To assess the long-term economic and welfare burden of Ménière's disease, focusing on healthcare costs, income, and reliance on social benefits before and after the first hospital-recorded diagnosis. We conducted a nationwide matched cohort study in Denmark, involving 5,434 patients with a hospital-recorded Ménière's disease diagnosis later confirmed by an otorhinolaryngologist and 16,302 matched controls based on age, sex, civil status, municipality, and index year defined by the first hospital registration of Ménière's disease. The mean age was 59 years, and 56% were females. The study assessed outcomes such as annual healthcare costs, income disparities, and social benefit receipt from ten years prior to ten years after diagnosis. Annual healthcare costs were higher in patients with Ménière's disease after diagnosis, peaking at index year (EUR 3,818 vs. EUR 1,862 in controls). Patients with Ménière's disease also showed a sustained decline in annual income, with the largest decline at year 8 after diagnosis (EUR - 1.908 compared to controls). At index year, 11% of patients transitioned to sickness benefits (vs. 3% of controls). From index year to 120 months post-diagnosis, disability pension rates increased from 10% to 18% in patients with Ménière's disease, whereas they remained almost stable going from 10% to 9% among controls. Similarly, participation in the flexible job scheme rose from 4% to 10% in Ménière's disease compared with 2% to 4% in controls. Ménière's disease was associated with persistently higher healthcare costs, reduced income, and greater reliance on social benefits compared with matched controls, particularly evident around and after the time of diagnosis. These findings highlight the substantial long-term economic and welfare burden of the disease.
Objective: To evaluate the efficacy of a surgery based multimodal therapy for locally advanced resectable cervical esophageal squamous cell carcinoma, focusing on surgical indications, selection of resection and reconstruction methods, and factors influencing prognosis. Methods: A retrospective analysis was conducted on the clinical data of 117 patients with primary cervical esophageal squamous cell carcinoma treated at Department of Head and Neck Surgery, Shandong Ear-Nose-Throat Hospital from September 2014 to October 2023. The cohort consisted of 93 males and 24 females, aged from 45 to 77 years. There were 35 cases with T1-T2 stage and 82 cases with T3-T4 stage. Gastroscopy screening upon admission identified synchronous middle-inferior esophageal carcinoma in 11 cases and synchronous hypopharyngeal cancer in 4 cases. Treatment regimens were as follows: surgery with postoperative adjuvant radiotherapy in 72 cases; surgery with adjuvant concurrent chemoradiotherapy/radiotherapy plus targeted therapy in 7 cases; neoadjuvant chemotherapy (or with immunotherapy) followed by surgery and postoperative radiotherapy in 7 cases; neoadjuvant concurrent chemoradiotherapy or planned preoperative radiotherapy followed by surgery in 6 cases; and surgery alone or incomplete postoperative radiotherapy in 25 cases. Total laryngectomy was performed in 112 patients, while, 5 patients retained laryngeal function. The main reconstruction methods included free jejunal graft in 26 cases and gastric pull-up with pharyngogastric anastomosis in 91 cases. Among these, one patients underwent free jejunal graft combined with middle and lower esophageal resection, while two patients with gastric pull-up combined with free skin grafts, one patient combined with pectoralis major myocutaneous flaps, and one patient combined with free jejunal grafts reconstruction. Clinical data were analyzed using SPSS 25.0 software. Results: Follow-up was completed until Feb 2025. Eighty seven patients competed 3-year follow-up. Sixty one patients completed 5-year follow-up. The 3-year and 5-year overall survival rates were 65.0% and 50.5% calculated by the Kaplan-Meier method. Fifty patients died during follow-up, among whom 28 (56.0%) patients died from distant metastases. One patient died perioperatively. Major complications included partial gastric necrosis (n=1), vascular thrombosis of the jejunum graft requiring a second jejunal graft reconstruction (n=1) or salvageable gastric pull-up (n=1), pharyngeal fistula (n=10), severe pulmonary infection (n=3), cervical hemorrhage (n=2), pharyngeal fistula leading to pharyngogastric anastomotic stricture (n=2), and pleural effusion (n=5). Multivariate analysis revealed that T3-T4 stage,N2-N3 stage and stage Ⅲ-Ⅳ diseases were independent prognostic factors (all P<0.05). Conclusions: Surgery-based multimodal therapy for cervical esophageal squamous cell carcinoma provides favorable local control and overall survival. Free jejunal graft and gastric pull-up are the most common reliable reconstructive approaches. Multidisciplinary comprehensive treatment is crucial to ensure surgical safety and efficacy. 目的： 分析以手术为主的综合治疗模式在颈段食管癌治疗中的疗效，探讨局部晚期可切除食管癌的手术切除与修复重建方式选择及预后影响因素。 方法： 回顾性分析2014年9月至2023年10月山东省耳鼻喉医院头颈外科手术治疗的117例原发颈段食管鳞癌患者的临床资料，男93例，女24例，年龄45~77岁。T1~T2期35例，T3~T4期82例。入院后胃镜筛查发现同期合并中下段食管癌11例，同期合并下咽癌4例。治疗方式包括：手术+术后辅助放疗72例；手术+术后同步放化疗/放疗+靶向治疗7例；新辅助治疗（化疗/化疗联合免疫）+手术+术后辅助放疗7例；术前单纯放疗/术前同步放化疗+手术6例；单纯手术或术后放疗未完成25例。本组112例行全喉切除术，5例保留喉功能。主要修复方式包括游离空肠移植26例，胃上提代食管术91例。其中1例行颈段食管切除游离空肠移植同期行下段食管切除胃上提修复，胃上提联合游离皮片修复2例、胃上提联合胸大肌肌皮瓣修复及游离空肠移植修复各1例。采用SPSS 25.0软件对临床数据进行分析。 结果： 至2025年2月，随访满3年患者87例，满5年患者61例，Kaplan-Meier法计算3年生存率为65.0%，5年生存率为50.5%。死亡50例患者中远处转移致死者28例，占56.0%。术后围手术期死亡1例。主要并发症包括胃壁部分坏死1例，移植空肠血管栓塞行二次取肠及改为胃上提修复各1例，咽瘘10例，重症肺部感染3例，颈部出血2例，咽瘘后胃咽吻合口狭窄2例，胸腔积液5例。根据多因素分析，T3-T4期、N2-N3、Ⅲ-Ⅳ期晚期病变为影响颈段食管癌患者预后的独立因素（P值均<0.05）。 结论： 以手术为主的颈段食管癌综合治疗可获得较好的肿瘤局部控制率及总生存率，游离空肠移植及胃上提是常用且疗效稳定的修复方式，多学科综合治疗模式是保障手术安全及疗效的关键。.
The etiology of chronic cough (CC) is varied, making it difficult to manage, particularly when the cough persists despite appropriate treatment of underlying disease (refractory CC) or when no underlying disease or cause can be identified (unexplained CC). There are currently no recommendations in Switzerland outlining how general practitioners (GPs) should approach the management of CC. The aim of this study was to establish a consensus among physicians from various specialties in Switzerland regarding the assessment, treatment, and referral of CC patients. This Delphi-based consensus study included two survey rounds (May-December 2023) evaluating 71 statements on the assessment of CC and referral pathways among a panel of GPs, pulmonologists, allergologists, gastroenterologists, and ear nose and throat (ENT) specialists with experience managing CC in Switzerland (N = 50). A 9-point scale was used to rate agreement with statements; consensus in agreement or disagreement was achieved when the median of responses fell within 7-9 or 1-3, respectively, less than one third voted outside these ranges, and the interquartile range (IQR) was <4. An interdisciplinary Scientific Committee with representatives from medical disciplines involved in managing CC led the study and provided the context for the referral pathways proposed. Consensus was reached on 84.5% of statements. Agreement was reached on general considerations for CC, initial actions to be taken in primary care, including clinical evaluation, 'red flags' to identify, pathologies to investigate, treatments to consider, and referral route. Two schematics were produced outlining 1) how to perform a basic assessment of CC patients in primary care, and 2) how and when to refer patients to specialists if CC persists. This study provides valuable recommendations for management of CC, promoting standardized assessment and referral of patients, which is not currently achieved in Switzerland.
Recurrent Respiratory Papillomatosis (also known as Laryngeal Papillomatosis) is a benign, sporadic tumor primarily affecting children, caused by the papillomavirus. The estimated prevalence of this condition is approximately four cases per 100,000 children and two cases per 100,000 adults. Human papillomavirus types 6 and 11, commonly associated with genital warts, are the predominant strains implicated in the disease. The most common symptoms include airway obstruction, voice disturbances, and difficulty speaking. These lesions are typically integrated and rarely appear in isolation; in rare cases, they may progress toward malignancy. A total of thirty-one laryngeal samples from patients with a positive pathological diagnosis of recurrent respiratory papillomatosis (RRP) were collected from the hospital's Ear, Nose, and Throat department. Each sample was preserved in formaldehyde and embedded in paraffin blocks. A form containing detailed patient information accompanied the samples. After confirming the presence of the β-globulin gene in the DNA of the samples, specific primers (MY09/11 and GP5+/6+) were employed to detect human papillomavirus (HPV). Among the 31 samples, 29 contained the HPV genome, with HPV-6 identified in 13 samples and HPV-11 in 16 samples. The phylogenetic tree of the isolated HPV strains was subsequently plotted. Statistical analyses revealed no significant difference in the incidence of HPV between men and women, nor in the incidence of RRP. However, a significant correlation was identified between residing in suburban areas, low income, and welfare status, and the incidence of RRP. Additionally, the research indicated that RRP lesions predominantly affect pediatric patients, with only a small proportion of adults affected. Further extensive studies are necessary to elucidate the main risk factors associated with RRP patients.
Allergic rhinitis (AR) is an IgE-mediated inflammatory reaction of the nasal mucosa triggered by various allergens, leading to nasal congestion, rhinorrhoea, sneezing, nasal itching, ocular redness, lacrimation, and postnasal dripping. This condition can also cause sleep disturbances and fatigue, which can affect productivity at work and academic performance, therefore posing substantial economic burden. Positive outcomes rely on efficacy of medications, potential adverse effects of medication, treatment response, and overall prognosis. To investigate the utility of the Rhinitis Control Assessment Test (RCAT) as a clinical tool in Urdu for evaluating and monitoring allergic rhinitis. The RCAT is a self-administered questionnaire consisting of six questions addressing specific rhinitis symptoms. The study included 60 (35 male and 25 female) patients with ages ranging from 18 to 55 (mean: 35) years. The RCAT demonstrated acceptable internal consistency with a Cronbach's alpha of 0.759. Interitem correlations supported that the questionnaire items reflected related constructs. Paired sample t-tests showed statistically significant improvements in all RCAT items posttreatment ( p  < 0.001), except for the compliance-related item (q5; p  = 0.166). The overall score increased significantly (mean difference = 9.28; p  < 0.001), indicating improved rhinitis control. The RCAT has proven to be a valuable tool for assessing allergic rhinitis control. Its ease of use and adaptability across languages make it an excellent choice for routine monitoring and management of AR. The successful application of RCAT in Urdu further enhances its accessibility and effectiveness for native speakers.
A machine learning prediction model was developed and validated using Clinical Multi-omics (CMO) indicators to assess the risk of postoperative complications in patients with Chronic Otitis Media (COM). This model is intended to aid in perioperative management and individualized intervention. Patients were randomly allocated into a training set (n = 237) and a validation set (n = 101) in a 7:3 ratio. A total of 21 CMO indicators, including demographic, clinical, laboratory, and imaging data, were collected. In the training set, univariate analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and multivariate logistic regression were used to identify core predictive variables. Four machine learning models-Random Forest, Logistic Regression, K-Nearest Neighbors, and Gradient Boosting Machine-were constructed using these variables. Model performance was assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Interpretability was analyzed with SHapley Additive exPlanations (SHAP). Multivariate analysis identified a history of diabetes, previous ear surgery, otorrhea, middle ear mucosal status, cholesteatoma presence, Eustachian tube function score, and preoperative C-reactive protein level as independent risk factors. Among the constructed models, the Random Forest model demonstrated superior overall performance, and the model was 0.885 in the training set and 0.853 in the validation set. The model also showed good calibration. DCA indicated significant clinical net benefit across a wide threshold probability range. SHAP analysis confirmed that a history of previous ear surgery and cholesteatoma presence were the most influential predictors. A machine learning-based prediction model for complications after COM surgery was developed and validated. The Random Forest model performed optimally, effectively predicting complication risk with favorable performance and considerable potential for clinical translation. It can serve as a promising tool for preoperative risk assessment and targeted postoperative monitoring.
Background and ObjectivesHearing impairment (HI) is one of the most common disabilities in older adults. This cross-sectional study examined the descriptive epidemiology of HI in 15,179 older adults in the 2016-2018 wave of the Health and Retirement Study.Research Design and MethodsHearing was assessed at two pitches (1000, 3000 Hz) and 3 loudness levels (35, 55, 75 dB HL). HI was defined as hearing <50% of tones in one or both ears. Demographics (age, race, ethnicity, sex, education), noisy occupation, smoking status, and medical comorbidities (diabetes, CVD, hypertension, cancer, stroke, dementia) were assessed via survey. Associations between HI and these factors were evaluated using Poisson regression.ResultsHI was highly prevalent (74% overall), and varied by sex (76.2% men, 72.1% women), ethnicity (78.7% Hispanic, 72.8% non-Hispanic) and age (21-65 years-old 64.3%, 65-80 years-old 81.3%, 80+ years-old 93.5%). After multivariable adjustment, HI was less common in women compared to men (IRR: 0.92; CI: 0.87-0.98) and was more common in those with Hispanic/Latino ethnicity compared to White (IRR:1.13, CI: 1.03-1.23). HI was more common in those with less than a college degree (less than high school: IRR = 1.47, CI = 1.34-1.61; high school graduate: IRR = 1.24, CI = 1.13-1.35; some college: IRR = 1.15, CI = 1.06-1.24). Compared to non-smokers, current smokers had higher risk of HI (IRR = 1.19, CI = 1.11-1.28). Lastly, history of stroke was associated with a greater risk of HI (IRR = 1.06, CI = 1.02-1.11).Discussion and ImplicationsHI is highly prevalent in the HRS sample and is correlated with chronic diseases and demographic factors. This study underscores the need for regular hearing screening and intervention among older US adults.