American Journal of Otolaryngology最新文献

{"title":"Vocal fatigue is a prevalent but significantly underestimated hidden burden among patients with laryngopharyngeal reflux","authors":"Jinkai Han,&nbsp;Keliang Li,&nbsp;Hongbin Xu,&nbsp;Ke Li,&nbsp;Xinghong Yin","doi":"10.1016/j.amjoto.2026.104917","DOIUrl":"10.1016/j.amjoto.2026.104917","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the characteristics of vocal fatigue in patients with laryngopharyngeal reflux (LPR) and evaluate the correlation between vocal fatigue and both subjective and objective reflux assessment indices.</div></div><div><h3>Methods</h3><div>A cross-sectional case-control study was conducted at the Department of Otolaryngology, Fuyang People's Hospital. Patients presenting with LPR symptoms (experimental group) and healthy volunteers (control group) were enrolled. All participants completed the Vocal Fatigue Index (VFI), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). A subset of participants underwent 24-h multichannel intraluminal impedance-pH (MII-pH). LPR was diagnosed based on the occurrence of at least one LPR episode. Objective acoustic analysis was also performed across all subjects.</div></div><div><h3>Results</h3><div>The study included 58 patients in the experimental group and 34 in the control group. Based on MII-pH monitoring, the LPR positivity rates were 72.5% in the experimental group and 16% in the control group. Total VFI scores and all three subscale factors were significantly higher in the experimental group (<em>p</em> &lt; 0.001). Notably, VFI Factor 2 demonstrated the most significant variance, with scores approximately sevenfold higher than those of the control group. Proximal esophageal MNBI values were significantly negatively correlated with VFI Factor 2. Furthermore, VFI Factor 2 showed a significant positive correlation with AET, while VFI Factor 1 correlated significantly with total reflux episodes. Spearman's rank correlation analysis showed a strong positive correlation between RSI and VFI total scores (ρ = 0.72, <em>P</em> &lt; 0.001). By contrast, the correlation between RFS and VFI total scores was significantly weaker (ρ = 0.35, <em>P</em> &lt; 0.05). Acoustic analysis revealed significantly elevated jitter, shimmer, and noise-to-harmonic ratio, alongside a significantly shortened maximum phonation time in the experimental group.</div></div><div><h3>Conclusions</h3><div>Vocal fatigue is a prevalent but frequently underestimated burden in LPR patients. The significant correlation between VFI scores and MNBI suggests that the VFI may serve as a sensitive, non-invasive indicator for auxiliary LPR assessment. Further longitudinal studies are needed to confirm its value in monitoring mucosal recovery.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104917"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872663","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":"Incidence and distribution of synchronous malignancies in head and neck cancer patients","authors":"N.J. McInerney,&nbsp;T. O'Neill,&nbsp;E. Esim-Enoh,&nbsp;D. Dev,&nbsp;A. Copperwaite,&nbsp;A. Thomas,&nbsp;S. Boyle,&nbsp;S. Hurley,&nbsp;T. Moran,&nbsp;F. O'Duffy","doi":"10.1016/j.amjoto.2026.104923","DOIUrl":"10.1016/j.amjoto.2026.104923","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104923"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886258","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":"Controversies in remote access thyroid surgery","authors":"Leonardo M. Volpi,&nbsp;David M. Goldenberg","doi":"10.1016/j.amjoto.2026.104920","DOIUrl":"10.1016/j.amjoto.2026.104920","url":null,"abstract":"<div><div>Remote-access thyroidectomy comprises a group of endoscopic and robotic procedures, including the bilateral axillo-breast, gasless axillary, retroauricular, and transoral vestibular approaches, developed to relocate or conceal the cervical incision while maintaining operative efficacy. This review summarizes current evidence regarding safety, oncologic adequacy, cosmetic outcomes, learning curve, cost, and patient selection. Across multiple meta-analyses, rates of recurrent laryngeal nerve injury and hypoparathyroidism are comparable to conventional open thyroidectomy in appropriately selected patients. However, results vary with technique and surgeon experience. Each approach introduces specific risks, including mental nerve injury in transoral cases, brachial plexus symptoms and anterior chest dysesthesia in axillary or breast routes, and greater auricular neuropathy following retroauricular dissection. Rare complications such as CO2 embolism and pneumomediastinum have also been reported. Current oncologic data are primarily observational. Existing guidelines limit remote-access procedures to low-risk, well-differentiated carcinomas that do not require central or lateral neck dissection. Cosmetic satisfaction tends to be greater in the early postoperative period, while differences diminish over time. Operative duration remains longer and costs higher than open thyroidectomy, primarily due to equipment and operating room time. Remote-access thyroidectomy should be offered selectively to motivate patients who prioritize cosmetic outcomes and be performed by high-volume surgeons with dedicated training. Further prospective studies are needed to clarify long-term oncologic safety, cost-effectiveness, and quality-of-life outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104920"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910588","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":"History-anchored interpretation of discordant JK-05A outputs in Eustachian tube function testing","authors":"Seung-Ho Shin,&nbsp;Jeeae Kim,&nbsp;Sung Wan Byun,&nbsp;Ho Yun Lee","doi":"10.1016/j.amjoto.2026.104924","DOIUrl":"10.1016/j.amjoto.2026.104924","url":null,"abstract":"<div><h3>Purpose</h3><div>The JK-05A platform performs up to four Eustachian tube (ET) subtests in a single session; however, the outputs often disagree. We evaluated discordant JK-05A outputs in a single-center cohort and developed a practical framework for their interpretation.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 51 patients who underwent JK-05A testing between September 2025 and April 2026 using explicit reading rules. Inter-test concordance, sonotubometric threshold provenance, and the Japan Otological Society (JOS) criteria informed a history-anchored, functional-domain approach. Patulous ET (PET)-suspected cases were categorized according to the JOS criteria, whereas obstructive dysfunction was described functionally.</div></div><div><h3>Results</h3><div>Outputs were concordant in only a minority: sonotubometry agreed with tubo-tympano-aerodynamic graphy resting synchrony in 52.3%, and only 34.1% of the 44 patients with all four binary signals evaluable were unanimous. Directional sonotubometric patterns demonstrated an ordered distribution: PET was present in 60.0%, 24.0%, and 6.7% of the patulous-leaning, intermediate, and obstructive-leaning patterns, respectively, whereas obstructive ET dysfunction, with or without otitis media, increased from 20.0% to 36.0% to 60.0%, respectively. This ordering is partly circular because the patulous-leaning features are themselves JOS objective signs.</div></div><div><h3>Conclusions</h3><div>JK-05A is better interpreted as a history-anchored functional profile than as independent diagnostic verdicts. A negative sonotubometric response does not exclude PET, and obstructive dysfunction should be described functionally rather than diagnosed by JK-05A alone. Discordant outputs may reflect differences in functional domains, intermittent physiology, or measurement conditions rather than a single disease category. This internally derived framework requires prospective evaluation with independent readers and control ears.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104924"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872712","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":"Association of age and serum ferritin with audiometric hearing loss in transfusion-dependent β thalassemia","authors":"Gholam abbas Sabz,&nbsp;Fariba Rad,&nbsp;Nader Cohan","doi":"10.1016/j.amjoto.2026.104908","DOIUrl":"10.1016/j.amjoto.2026.104908","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to examine the association of age and serum ferritin with audiometric hearing loss in patients with transfusion-dependent β-thalassemia major (TDT).</div></div><div><h3>Methods</h3><div>In this cross-sectional study, conducted from February to August 2025, 96 patients with TDT underwent pure-tone audiometry at frequencies from 250 to 8000 Hz. Hearing loss was defined as an auditory threshold greater than 25 dB. Serum ferritin was categorized as &lt;1000 ng/mL or ≥1000 ng/mL. Age was classified as &lt;20 years or ≥20 years. Statistical analyses were performed with SPSS-16, and significance was set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Hearing loss was detected in 10.42% of the patients (<em>n</em> = 10). Among these 10 patients, 9 had sensorineural hearing loss and 1 had mixed hearing loss. Regarding severity, 5/10 experienced mild impairment, 1 had moderate, and 4 suffered from severe impairment. A relatively strong correlation was observed between hearing loss and advancing age, although it was only borderline statistically significant (<em>r</em> = 0.65, <em>P</em> = 0.04). Conversely, serum ferritin levels showed no statistically significant correlation with hearing loss (<em>r</em> = 0.28, <em>P</em> = 0.44).</div></div><div><h3>Conclusions</h3><div>Advancing age showed a borderline significant correlation with hearing loss, while ferritin did not. This suggests iron overload alone is not the main cause of auditory dysfunction in these patients. Thus, routine hearing screening and further investigation of other risk factors are warranted.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104908"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148854277","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":"Glomus Tympanicum in an Asymptomatic 82-Year-Old Woman","authors":"Alexandra Matarazzo,&nbsp;Andrew Sabatino,&nbsp;Ghabrielle Almeida,&nbsp;Charles H. Hennekens,&nbsp;Nancy Liu","doi":"10.1016/j.amjoto.2026.104914","DOIUrl":"10.1016/j.amjoto.2026.104914","url":null,"abstract":"<div><h3>Importance</h3><div>Glomus tympanicum is a rare, highly vascular paraganglioma of the middle ear that may cause pulsatile tinnitus and hearing loss. Management decisions, particularly in older adults, must balance symptom control with the risks of intervention.</div></div><div><h3>Objective</h3><div>To describe the long-term clinical course of an incidentally discovered glomus tympanicum managed with watchful waiting and close surveillance.</div></div><div><h3>Design</h3><div>Case report with 5 years of longitudinal follow-up.</div></div><div><h3>Setting</h3><div>Outpatient otolaryngology and neuro-otology referral practice.</div></div><div><h3>Participants</h3><div>An 82-year-old woman evaluated for dizziness unrelated to the final diagnosis and without otologic symptoms at presentation.</div></div><div><h3>Exposure</h3><div>Observation with serial clinical assessments and imaging studies, without surgical or radiotherapeutic intervention.</div></div><div><h3>Main outcomes and measures</h3><div>Tumor stability on serial imaging, symptom development, and need for intervention.</div></div><div><h3>Results</h3><div>Otoscopic examination revealed a bright red mass occupying approximately one-third of the right tympanic membrane. MRI demonstrated a 3–4 mm lesion along the right cochlear prominence, consistent with a Glasscock-Jackson type I glomus tympanicum. Audiometry showed mild to moderate right-sided sensorineural hearing loss. Over 5 years of follow-up, the patient remained asymptomatic, with no significant tumor growth on serial imaging and no evidence of metastatic disease.</div></div><div><h3>Conclusions and relevance</h3><div>In this older asymptomatic patient, watchful waiting with careful surveillance was associated with long-term tumor stability and avoidance of invasive treatment. Conservative management may be an appropriate option for select patients with small, slow-growing glomus tympanicum tumors.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104914"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872666","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":"Admission neutrophil percentage-to-albumin ratio is associated with poor steroid response in idiopathic sudden sensorineural hearing loss","authors":"Pinar Atabey","doi":"10.1016/j.amjoto.2026.104909","DOIUrl":"10.1016/j.amjoto.2026.104909","url":null,"abstract":"<div><h3>Objective</h3><div>Sudden sensorineural hearing loss (SSNHL) is an otological emergency with an unpredictable prognosis. Reliable and accessible prognostic markers are needed. This study explored the prognostic value of the neutrophil percentage-to-albumin ratio (NPAR) in idiopathic SSNHL.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 62 patients with SSNHL presenting within 10 days of symptom onset and 64 age- and sex-matched healthy controls. Patients with major systemic inflammatory or metabolic diseases were excluded. NPAR was calculated from admission laboratory parameters. The primary analysis compared responders and non-responders within the SSNHL cohort; the comparison with healthy controls served as secondary context. Treatment response was assessed by pure-tone audiometry on day 10 according to Siegel's criteria. Given the limited number of outcome events, a reduced, pre-specified multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed and interpreted as exploratory.</div></div><div><h3>Results</h3><div>NPAR was significantly higher in non-responders (22.1 [19.6–29.7]) than responders (18.1 [16.6–22.7]), and higher in SSNHL patients than controls. In a pre-specified multivariable model, NPAR was independently associated with treatment non-improvement (OR 2.55, 95% CI 1.55–3.55; <em>p</em> = 0.01). In exploratory ROC analysis, NPAR showed moderate discriminative ability (AUC = 0.82, 95% CI 0.70–0.94), with an internally derived cutoff of 21.9 (sensitivity 70%, specificity 76%). The wide confidence interval reflects the limited sample size, and these findings should be interpreted as preliminary and hypothesis-generating.</div></div><div><h3>Conclusion</h3><div>In this exploratory single-centre study, NPAR an inexpensive, routinely available marker was associated with poor treatment response in idiopathic SSNHL. These preliminary findings require external validation before any clinical application. To our knowledge, this is the first study to evaluate NPAR in idiopathic SSNHL.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104909"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890541","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":"Obstructive sleep apnea and twins","authors":"Giannicola Iannella,&nbsp;Andrea Collettini,&nbsp;Antonella Polimeni,&nbsp;Armando De Virgilio,&nbsp;Patrizia Mancini,&nbsp;Annalisa Pace,&nbsp;Antonino Maniaci,&nbsp;Jerome R. Lechien,&nbsp;Carlos-Miguel Chiesa-Estomba,&nbsp;Luigi A. Vaira,&nbsp;Salvatore Cocuzza,&nbsp;Alberto Caranti,&nbsp;Claudio Vicini,&nbsp;Manuele Casale,&nbsp;Antonio Moffa,&nbsp;Mario Giuseppe Bellizzi,&nbsp;Enrica Croce,&nbsp;Saverio Nicoletti,&nbsp;Francesco Dispenza,&nbsp;Giuseppe Magliulo","doi":"10.1016/j.amjoto.2026.104919","DOIUrl":"10.1016/j.amjoto.2026.104919","url":null,"abstract":"<div><h3>Purpose</h3><div>Present an intriguing case of a man suffering of OSA who has a homozygous monochorionic twin. Made a systematic review of the literature to summarize existing data and the reported incidence of OSA in twins.</div></div><div><h3>Methods</h3><div>Case presentation and systematic literature review, according to the PRISMA guidelines about twins and Obstructive sleep Apnea.</div></div><div><h3>Results</h3><div>Our patient had a severe OSA condition with an Apnea Hypopnea index (AHI) of 57.6. This patient had a twin who did not suffer from sleep apnea and presented different oropharyngeal and endoscopic anatomical characteristics. Six eligible studies were identified investigating OSA or OSA-related traits in twins. All studies demonstrated higher concordance among monozygotic than dizygotic twins and substantial heritability estimates (40%–83%), particularly for AHI and ODI. However, non-shared environmental and anatomical factors accounted for considerable phenotypic variability.</div></div><div><h3>Conclusion</h3><div>Despite the genetic factors related to the sleep apnea, differences in anatomical features and lifestyle could contributed to the different expression of OSA.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104919"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886264","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":"Frequency and severity of anxiety in patients with Meniere's disease: a systematic review and meta-analysis","authors":"Andrea Desiree Ortega-Cueva,&nbsp;Shantall Coraima Vertiz-Pintado,&nbsp;Akram Hernández-Vásquez,&nbsp;Daniel Comandé,&nbsp;Diego Azañedo","doi":"10.1016/j.amjoto.2026.104921","DOIUrl":"10.1016/j.amjoto.2026.104921","url":null,"abstract":"<div><h3>Background</h3><div>Ménière's disease (MD) is a chronic, progressive disorder of the inner ear, which is currently incurable. Anxiety is a known exacerbating factor for vertigo episodes in these patients; however, its precise frequency and levels in this population remain undefined.</div></div><div><h3>Objective</h3><div>The purpose of this study is to synthesize the available evidence related to the frequency and levels of anxiety in patients with MD.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis reported according to PRISMA and MOOSE guidelines.</div></div><div><h3>Participants</h3><div>Observational studies, published until May 2023, reporting the frequency and/or severity of anxiety in patients with MD were included, with no restrictions by country or publication date.</div></div><div><h3>Main outcome measures</h3><div>PubMed, Embase, Scopus, LILACS, Web of Science, and PsycINFO were systematically searched to identify relevant articles. Two independent reviewers selected studies, extracted data, and assessed the methodological quality of the included studies. Because the included studies used different anxiety instruments, exploratory meta-analyses were restricted to studies using the Beck Anxiety Inventory (BAI), which provided comparable data on anxiety severity categories and mean scores.</div></div><div><h3>Results</h3><div>Eight studies involving 283 patients were selected. Three contributed to the BAI-based meta-analyses. The pooled prevalence of moderate-to-severe anxiety, as assessed by the BAI scale, was 68% (95% CI: 43–75%; <em>I</em>² = 56.3%; 2 studies; <em>n</em> = 99). The pooled mean BAI score was 23.26 points (95% CI: 19.31–27.21; <em>I</em>² = 53.8%, 2 studies; <em>n</em> = 88), which falls within the moderate anxiety range according to BAI cut-off points. Most studies had good methodological quality.</div></div><div><h3>Conclusions</h3><div>Based on the limited BAI-based evidence available, moderate-to-severe anxiety appears to be frequent among patients with MD, and the pooled mean BAI score suggests moderate anxiety severity.</div></div><div><h3>Relevance</h3><div>Major MD management guidelines have not addressed this issue. Psychological and/or pharmacological anxiety treatment should be considered an essential component of its management.</div><div><strong>Record:</strong> CRD42023431494 (PROSPERO).</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104921"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935200","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":"Exploratory evaluation of preoperative apparent diffusion coefficient as a candidate prognostic imaging marker in salivary gland carcinoma","authors":"Tomo Arai,&nbsp;Noriyuki Okonogi,&nbsp;Yasuo Kosugi,&nbsp;Jun Takatsu,&nbsp;Yoshifumi Matsumoto,&nbsp;Shinichi Ohba,&nbsp;Naoya Murakami,&nbsp;Naoto Shikama,&nbsp;Fumihiko Matsumoto","doi":"10.1016/j.amjoto.2026.104910","DOIUrl":"10.1016/j.amjoto.2026.104910","url":null,"abstract":"<div><h3>Background</h3><div>Salivary gland carcinoma (SGC) lacks reliable preoperative prognostic markers. This exploratory study evaluated whether volume-based apparent diffusion coefficient (ADC) parameters derived from preoperative diffusion-weighted magnetic resonance imaging (MRI) were associated with clinical outcomes in patients with SGC.</div></div><div><h3>Methods</h3><div>Sixty-five patients who underwent radical surgery for SGC between 2014 and 2024 were retrospectively reviewed; 55 had evaluable preoperative diffusion-weighted imaging (DWI) data for ADC analysis. Whole-tumor ADC values were derived using dedicated software with a threshold-based semi-automated workflow, and the median ADC and entropy were extracted. Disease-free survival (DFS), local control, and overall survival were analyzed using the Kaplan–Meier method. Associations between clinicopathological or imaging variables and outcomes were assessed using log-rank tests, Cox proportional hazards regression, and Spearman's correlation analysis.</div></div><div><h3>Results</h3><div>Advanced pathological stage, high-grade histology, preoperative facial nerve palsy, and low median ADC were associated with worse DFS in univariate analyses. The median ADC was negatively correlated with pathological grade. In the multivariable Cox proportional hazards model, median ADC remained associated with DFS; however, this finding should be interpreted cautiously because of the limited number of events and the wide confidence interval. Entropy showed no significant association with clinical outcomes.</div></div><div><h3>Conclusions</h3><div>Preoperative volume-based median ADC was associated with DFS in this exploratory cohort of patients with SGC. The median ADC may represent a candidate prognostic imaging marker for preoperative risk assessment. Further validation in larger cohorts with standardized MRI protocols is required before clinical application.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 5","pages":"Article 104910"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817298","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}