Clinical Otolaryngology最新文献

{"title":"Depressive and Anxiety Symptoms in Vestibular Migraine and Probable Vestibular Migraine.","authors":"Chisato Fujimoto, Naoko Ogata, Kento Koda, Kentaro Ichijo, Mineko Oka, Makoto Kinoshita, Kenji Kondo","doi":"10.1111/coa.70158","DOIUrl":"https://doi.org/10.1111/coa.70158","url":null,"abstract":"<p><strong>Introduction: </strong>It has been previously reported that patients with vestibular migraine (VM) are more prone to anxiety and depressive symptoms. However, the association between the pathophysiology of VM and anxiety and depressive symptoms is still unclear. This study aimed to investigate this association by comparing patients with VM and probable VM (PVM), based on the hypothesis that patients fulfilling the complete diagnostic criteria for VM more closely represent the core clinical phenotype of the disorder than those fulfilling the criteria for PVM.</p><p><strong>Methods: </strong>We reviewed the medical records of 1736 consecutive patients seen at our clinic between March 2018, when routine measurement of Self-rating Depression Scale (SDS) and State-Trait Anxiety Inventory (STAI) began, and December 2024. Thirty-four VM patients and 13 PVM patients were included. Multiple regression analyses were performed to see whether the subjects' age, sex or the VM diagnostic category (VM vs. PVM) had an association with SDS, STAI-1 and STAI-2 scores.</p><p><strong>Results: </strong>The VM diagnostic category was significantly associated with SDS scores, with VM patients showing higher scores than PVM patients (p = 0.0095; post hoc power = 0.92). There was no significant association between the VM diagnostic category and STAI-1 or STAI-2 scores (p = 0.542 and 0.367; post hoc power = 0.10 and 0.23), suggesting that limited statistical power may have affected detection of anxiety associations.</p><p><strong>Conclusion: </strong>VM patients are more likely to report depressive symptoms than PVM patients, suggesting an association between VM pathophysiology and depressive symptoms.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Versus Late Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.","authors":"Ahmed S Abdelmeguid, Mohamed Y Elkotb, Hemmat Baz, Abdelrahman A Kamal","doi":"10.1111/coa.70179","DOIUrl":"https://doi.org/10.1111/coa.70179","url":null,"abstract":"<p><strong>Objectives: </strong>Unilateral vocal fold paralysis (UVFP) is a condition characterized by the loss of functional movement of one vocal fold resulting in incomplete glottic closure, which compromises essential functions such as phonation, swallowing and coughing. Injection medialization laryngoplasty can temporarily restore glottic closure, improving voice quality and potentially reducing the risk of aspiration.</p><p><strong>Patients and methods: </strong>A prospective cohort study was conducted from September 2024 to January 2026. Patients with UVFP were divided into early (< 6 months from the onset of paralysis) and late (≥ 6 months). All patients received injection medialization using hyaluronic acid (Perfectha Derm, 20 mg/mL). This was done either under local anaesthesia or under general anaesthesia. Voice assessment was done before injection and at 1 and 6 months post-injection, including maximum phonation time (MPT), GRBAS, acoustic analysis (jitter, shimmer, HNR) using PRAAT and patient-reported Arabic Voice Handicap Index (VHI).</p><p><strong>Results: </strong>Forty-eight patients with UVFP were enrolled and divided into early (< 6 months) and late (≥ 6 months) groups. The early injection group showed significantly higher MPT at 1 week and 6 months. Fewer patients required Type I thyroplasty in the early injection group compared to patients who underwent later injection (p = 0.001). Long-term acoustic measures were also superior in the early group, indicating better voice quality.</p><p><strong>Conclusion: </strong>Early injection laryngoplasty was associated with superior long-term voice outcomes and a significantly reduced need for permanent medialization surgery compared with late injection. These findings highlight the clinical importance of early intervention in the management of UVFP.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Preoperative Examinations for Early Prognosis After Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Nasal Polyps.","authors":"Xinyi Zheng, Min Zhou, Huijun Qiu, Guixian Liang, He Zhang, Ruizhi Wang, Yiwen Li, Ruijie Li, Shuo Wu, Yana Zhang, Zhaohui Shi, Qintai Yang","doi":"10.1111/coa.70181","DOIUrl":"https://doi.org/10.1111/coa.70181","url":null,"abstract":"<p><strong>Background: </strong>Functional endoscopic sinus surgery (FESS) remains a primary treatment modality for chronic rhinosinusitis with nasal polyps (CRSwNP) refractory to medical management. This study aimed to evaluate the predictive value of routine preoperative examinations for early surgical outcomes following FESS in patients with CRSwNP.</p><p><strong>Methods: </strong>This prospective cohort study evaluated whether routine preoperative assessments predict early outcomes after FESS in 181 patients with bilateral CRSwNP. Preoperative evaluations included Lund-Mackay CT scores, Lund-Kennedy endoscopy scores, symptom Visual Analogue Scale (VAS), SNOT-22 and peripheral blood eosinophil counts. Patients were followed postoperatively at 2 weeks, 1, 3 and 6 months.</p><p><strong>Results: </strong>Preoperative VAS showed the strongest correlation with 2-week symptom improvement (r = 0.633), remaining an independent predictor in multivariate analysis (β = 0.58). Preoperative SNOT-22 also independently predicted 2-week outcomes (β = 0.15). At 3 months, blood eosinophil counts predicted endoscopic improvement (r = 0.305), while preoperative Lund-Kennedy scores strongly predicted 6-month endoscopic outcomes (r = 0.508).</p><p><strong>Conclusions: </strong>Routine preoperative assessments provide valuable predictive information for early postoperative outcomes following FESS in CRSwNP. We expect these findings to support the integration of multimodal preoperative assessment to guide patient counselling and postoperative management expectations.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"da Vinci Single-Port Transoral Robotic Surgery in European Practice: Early Outcomes and Comparison With Transoral Laser Microsurgery.","authors":"Matthew E Ryan, Matthew Zammit, Kristijonas Milinis, Omar Ahmed, Rupali Sawant, Ava Gubbay, Somer Scott-Clarkson, Harishanker Jeyarajan, Terry M Jones, Mark Wilkie, Katharine Davies, Christopher Loh, Jason C Fleming","doi":"10.1111/coa.70177","DOIUrl":"https://doi.org/10.1111/coa.70177","url":null,"abstract":"<p><strong>Objectives: </strong>To report early outcomes following implementation of a da Vinci Single-Port transoral robotic surgery (SP-TORS) programme in the United Kingdom. To provide contextual benchmarking, outcomes were compared with a historical institutional cohort treated using transoral laser microsurgery (TLM).</p><p><strong>Design: </strong>Retrospective institutional series with comparison against a historical cohort using stabilised inverse-probability-of-treatment weighting.</p><p><strong>Setting: </strong>High-volume UK Tertiary Head and Neck Centre.</p><p><strong>Participants: </strong>All patients undergoing SP-TORS between April 2024 and September 2025. Comparative analyses were limited to oncological resections and included 33 SP-TORS and 61 TLM cases.</p><p><strong>Main outcome measures: </strong>Feasibility, peri-operative safety, postoperative haemorrhage, return to theatre, mortality, length of stay, time to oral diet, margin status and adjuvant therapy use.</p><p><strong>Results: </strong>Sixty-six patients underwent SP-TORS. All procedures were completed transorally without unplanned conversion or peri-operative mortality. Postoperative haemorrhage occurred in 4.5%, with one return to theatre. Length of stay did not differ between groups. Time to oral diet was longer following SP-TORS (adjusted ratio 1.51, p= 0.005). ASCO-defined involved margins were similar (OR 0.30, 95% CI 0.06-1.56; p = 0.15), whereas specimen ink-positive margins were less frequent following SP-TORS (OR 0.31, 95% CI 0.11-0.91; p = 0.03). A sensitivity analysis using propensity-matched T1/T2 pairs demonstrated a consistent directional effect, though this did not reach significance in the smaller matched cohort. Adjuvant therapy use was comparable.</p><p><strong>Conclusion: </strong>SP-TORS implementation in a high-volume UK centre was feasible and safe during early adoption, with low complication rates. Peri-operative and early functional outcomes were broadly comparable with TLM. Although specimen ink-positive margins were less frequent following SP-TORS, interpretation should be cautious given the historical comparator and associated differences in departmental workflow. These findings support safe integration of SP-TORS into transoral surgical practice and justify prospective evaluation.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Postoperative Irrigation and Dual-Drain Suction Versus Single-Drain Suction in Ludwig's Angina: A Comparative Cohort Study.","authors":"Sante De Santis, Jacopo Cambi, Elena Cantone, Giuseppe Chiarella, Emmanuel Pio Pastore, Stefania Galassi","doi":"10.1111/coa.70175","DOIUrl":"https://doi.org/10.1111/coa.70175","url":null,"abstract":"<p><strong>Objectives: </strong>To compare a combined irrigation-assisted dual-drain suction protocol with single-drain suction alone after surgical drainage of Ludwig's angina.</p><p><strong>Design: </strong>Retrospective comparative cohort study with predefined quasi-randomised alternating allocation.</p><p><strong>Setting: </strong>A tertiary referral otolaryngology department in Tuscany, Italy.</p><p><strong>Participants: </strong>Sixty adults with odontogenic Ludwig's angina and bilateral submandibular abscesses ≥ 4 cm on contrast-enhanced CT were selected from 118 patients screened between January 2015 and April 2025. Consecutive eligible patients were alternately allocated to the combined protocol (Group A, n = 30) or single-drain suction (Group B, n = 30).</p><p><strong>Main outcome measures: </strong>Length of hospital stay and a prespecified major-complication composite of surgical reintervention, imaging-confirmed mediastinitis, or new postoperative tracheostomy. Superficial wound infection was analysed separately.</p><p><strong>Results: </strong>Mean hospital stay was shorter in Group A than Group B (6.1 ± 3.6 vs. 8.2 ± 3.4 days; mean difference, -2.1 days; 95% CI: -3.91 to -0.29; p = 0.024). The major-complication composite occurred in 2 of 30 patients (6.7%) and 7 of 30 (23.3%), respectively (RR: 0.29; 95% CI: 0.06-1.26; Fisher's exact p = 0.145). Superficial wound infection occurred in 2 of 30 and 5 of 30 patients, respectively. Several inflammatory markers declined more rapidly in Group A.</p><p><strong>Conclusions: </strong>The combined protocol was associated with shorter hospitalisation and a numerical, non-significant reduction in prespecified major complications. Because it combined irrigation with a dual-drain configuration, the independent contribution of irrigation cannot be determined.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, Risk Factors, and Long-Term Outcomes of Dysphagia Following Modified Uvulopalatopharyngoplasty: A Mixed-Methods Study.","authors":"Yujie Yan, Ran Shi, Qi Wang, Renyu Guo, Hui Yao, Wen Wang, Rui Lin","doi":"10.1111/coa.70173","DOIUrl":"https://doi.org/10.1111/coa.70173","url":null,"abstract":"<p><strong>Objective and design: </strong>Modified Uvulopalatopharyngoplasty (mUPPP) is a standard surgical intervention for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), but postoperative dysphagia remains an underdiagnosed and poorly managed complication due to the lack of standardised assessment protocols. This prospective mixed-methods observational study aimed to investigate the clinical characteristics, independent risk factors, and long-term outcomes of dysphagia following mUPPP.</p><p><strong>Main outcome measures: </strong>A prospective observational study was conducted on 120 OSAHS patients undergoing mUPPP. A mixed-methods assessment (EAT-10, interviews, and FEES) was performed at 2 weeks, 1, 6, and 12 months postoperatively. Univariate and multivariate logistic regression analyses were used to identify independent risk factors.</p><p><strong>Results: </strong>The rate of patients screening positive for clinically significant dysphagia symptoms (EAT-10 ≥ 3, patient-reported screening threshold) was 63.3% at 2 weeks postoperatively. FEES confirmed pathological swallowing abnormalities, such as delayed pharyngeal response and aspiration risk, in over 94% of EAT-10-positive patients. Four independent risk factors were identified: female gender, gastroesophageal reflux disease (GERD), anxiety/depression, and excessive daytime sleepiness (ESS ≥ 10). Symptoms persisted in approximately 19.2% of patients at 6 months and 9.2% at 12 months, with patients having multiple risk factors showing a significantly higher risk of long-term persistence.</p><p><strong>Conclusion: </strong>Dysphagia is a common and persistent sequela following mUPPP. The combination of EAT-10 and FEES is recommended for comprehensive postoperative monitoring. Preoperative identification and management of risk factors (gender, GERD, psychological status, and sleepiness) are crucial for risk stratification and implementing personalised interventions to reduce the burden of persistent dysphagia.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Routine Umbo Resection Necessary During Over-Underlay Tympanoplasty? A Histopathological and Clinical Study.","authors":"Emrah Gündüz, Mehmet Turan Çiçek, Mehmet Tan, Mehmet Aslan, Çiğdem Fırat Koca, İsmail Demir, Ayşe Nur Akatlı, Gloria Schiavo","doi":"10.1111/coa.70165","DOIUrl":"https://doi.org/10.1111/coa.70165","url":null,"abstract":"<p><strong>Background: </strong>The necessity of routine umbo resection during over-underlay tympanoplasty remains controversial.</p><p><strong>Objective: </strong>To evaluate histopathological persistence of epithelial remnants according to perforation-umbo relationship and to estimate the risk of postoperative cholesteatoma.</p><p><strong>Methods: </strong>Prospective cohort of 148 consecutive Type I over-underlay tympanoplasties with minimum 24-month follow-up. Patients were grouped by perforation relation to the umbo. All resected specimens were examined with haematoxylin-eosin (H&E); pan-cytokeratin immunohistochemistry was not performed in this series. Categorical comparisons used Fisher's exact test; proportions are reported with 95% confidence intervals (CI). Post hoc upper 95% bound for cholesteatoma incidence was calculated using the Poisson approximation.</p><p><strong>Results: </strong>Histopathology revealed epithelial remnants in 33.3% (12/36; 95% CI 18.6-51.0) of Group 1 and 21.9% (7/32; 95% CI 9.3-40.0) of Group 2; none were detected in Group 3. No cholesteatoma developed during mean follow-up of 24 months; the upper 95% confidence bound for true cholesteatoma incidence was 2.02%.</p><p><strong>Conclusion: </strong>Umbo-involving perforations are associated with higher rates of microscopic epithelial remnants, but microscopic remnants did not translate into cholesteatoma within the observed follow-up. Routine umbo resection is not mandatory when meticulous de-epithelialisation is achievable; selective resection based on intraoperative assessment is recommended. Longer follow-up and larger multicentre cohorts are required to exclude rare adverse events.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy and Optimal Thresholds of Salivary Pepsin (Peptest) in Laryngopharyngeal Reflux: A Systematic Review and Meta-Analysis","authors":"Do Hyun Kim,&nbsp;David W. Jang,&nbsp;Se Hwan Hwang","doi":"10.1111/coa.70154","DOIUrl":"10.1111/coa.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Salivary pepsin has been proposed as a non-invasive biomarker for diagnosing laryngopharyngeal reflux (LPR); however, its diagnostic utility remains uncertain due to inconsistent findings across studies. This meta-analysis evaluated the diagnostic accuracy of a rapid lateral flow test (Peptest) compared to the reference standard of multichannel intraluminal impedance-pH (MII-pH) monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>Systematic review and meta-analysis of cohort studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients with LPR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The primary outcomes were diagnostic odds ratio (DOR), summary receiver operating characteristic curve and area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 11 studies comprising 928 samples were included. The diagnostic performance of salivary pepsin for LPR was analysed at cut-off values of 16, 45–50 and 100 ng/mL. The pooled DOR and AUC were 3.49 and 0.684 at 16 ng/mL, 6.08 and 0.772 at 45–50 ng/mL and 4.78 and 0.717 at 100 ng/mL, respectively. Multiple-time sampling significantly improved sensitivity compared to single-time sampling across all cut-off values (0.82 vs. 0.33–0.63 at 16 ng/mL; <i>p</i> &lt; 0.0001), although specificity was slightly lower.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Peptest demonstrates potential as a simple, non-invasive diagnostic alternative to 24-h-MII-pH monitoring for LPR. Among the evaluated thresholds, a cut-off of 45–50 ng/mL provided the highest diagnostic accuracy. Collecting multiple saliva samples may further enhance detection sensitivity. However, in patients with a high clinical suspicion of LPR but negative Peptest results, 24-h-MII-pH monitoring remains necessary to confirm the diagnosis due to the test's limited negative predictive value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"51 6","pages":"819-830"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Sinus, Lower Risk: A Paradigm Shift in Frontal Fracture Patterns","authors":"Shmuel Wechsler,&nbsp;Haim Gavriel,&nbsp;Limor Muallem Kalmovich,&nbsp;Itzhak Aronov,&nbsp;Uri Chavkin","doi":"10.1111/coa.70157","DOIUrl":"10.1111/coa.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The morphology of the frontal sinus (FS) has long been debated as a determinant of fracture type and severity. This study aimed to evaluate the association between sinus dimensions, fracture patterns, and clinical outcomes using real-world data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary trauma referral center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed the records of 48 frontal sinus fractures treated at a tertiary trauma center. Volumetric and dimensional measurements (volume, height, width, and anteroposterior depth) were obtained from CT scans. Each sinus was segmented and analyzed separately using 3D Slicer software. Sinuses were categorised according to cohort-derived percentiles and established classifications. Associations between sinus anatomy, fracture type, and outcomes were analyzed using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>While most sinus dimensions showed odds ratios greater than 1 for anterior table fractures, only the categorical analysis of sinus height demonstrated statistical significance. Cohort-based high sinuses (≥ 22.22 mm) were associated with isolated anterior table fractures (<i>p</i> = 0.014, OR = 4.83, 95% CI: 1.38–16.9). When comparing sinuses with larger volumes, a similar trend towards anterior-only fractures was observed, though not statistically significant. Patients with anterior-only fractures had fewer displaced fractures, shorter hospitalisation, and lower rates of intracranial haemorrhage and ICU admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frontal sinus height appears to be the most clinically relevant parameter influencing fracture patterns. Vertically expanded sinuses may act as protective “crumple zones,” mitigating posterior table involvement and severe intracranial injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"51 6","pages":"944-951"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/coa.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presenting Complaint and Diagnostic Yield of MRIs for Vestibular Schwannomas","authors":"Sebastian Powell,&nbsp;Wei Jia,&nbsp;Chang Woo Lee,&nbsp;Emma V. King","doi":"10.1111/coa.70136","DOIUrl":"10.1111/coa.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as &lt; 15 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (<i>p</i> = 0.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, <i>p</i> &lt; 0.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, <i>p</i> = 0.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, <i>p</i> = 0.062), sudden onset asymmetrical hearing loss (OR 0.57, <i>p</i> = 0.46), mild asymmetrical hearing loss (OR 1.03, <i>p</i> = 0.98), or age (OR 0.74, <i>p</i> = 0.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"51 6","pages":"849-854"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}