American Journal of Otolaryngology最新文献

{"title":"Dexamethasone palmitate: A promising intratympanic treatment option for severe sudden hearing loss","authors":"Joong Ho Ahn","doi":"10.1016/j.amjoto.2025.104766","DOIUrl":"10.1016/j.amjoto.2025.104766","url":null,"abstract":"<div><div>Dexamethasone palmitate (DXP) is a lipophilic, esterified corticosteroid with sustained-release properties that may provide advantages over conventional water-soluble dexamethasone in intratympanic therapy for sudden sensorineural hearing loss (SSNHL). We report the safety and clinical outcomes of intratympanic DXP injection in three patients with profound SSNHL. All patients also received systemic steroids and hyperbaric oxygen therapy, along with six sessions of intratympanic DXP. Two patients demonstrated substantial improvement in hearing thresholds and speech discrimination within 3 months, whereas one patient who presented late showed no recovery. No adverse effects, such as pain, inflammation, or tympanic membrane complications, were observed. The increased viscosity and lipophilicity of DXP likely enhance cochlear drug delivery and prolong therapeutic retention. These findings suggest that DXP is a safe and potentially effective intratympanic option for SSNHL, particularly when administered early.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104766"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773166","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":"Development and validation of a clinical prediction model to diagnose Warthin tumor based on non-contrast computed tomography features and clinical characteristics","authors":"Danyang Chang ,&nbsp;Fan Xu ,&nbsp;Xiangming Meng ,&nbsp;Changling Sun","doi":"10.1016/j.amjoto.2025.104767","DOIUrl":"10.1016/j.amjoto.2025.104767","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to develop and validate a clinical prediction model that integrates clinical features with non-contrast CT imaging characteristics to identify Warthin tumor (WT) in the parotid gland.</div></div><div><h3>Methods</h3><div>A total of 289 patients who underwent surgical resection of parotid tumors at the Affiliated hospital of Jiangnan University from June 2018 to December 2024 were consecutively and randomly divided into training (<em>n</em> = 202) and validation (<em>n</em> = 87) cohorts at a 7:3 ratio. Demographic and non-contrast CT imaging variables were collected. Logistic regression identified predictors, and a nomogram was constructed. To further validate the model, an independent dataset comprising 84 patients from a second hospital was used. The model's performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Age, smoking history, tumor distribution, earlobe position, and longitudinal-to-transverse ratio (LTR) were identified as independent predictors for differentiating WT from other parotid gland tumors. The nomogram showed high diagnostic accuracy, with the area under the curve (AUC) values of 0.942 (training), 0.937 (validation), and 0.953 (external validation). Calibration curves indicated good agreement with ideal predictions, supported by the Hosmer-Lemeshow test (<em>P</em> &gt; 0.05). DCA further demonstrated the superior clinical utility of the nomogram model.</div></div><div><h3>Conclusion</h3><div>The nomogram model incorporating clinical and non-contrast CT features demonstrates high accuracy for differentiating WT from other parotid gland tumors in clinical practice.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104767"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713023","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":"Preservation of adaptive immunity is associated with survival in invasive fungal sinusitis","authors":"Iris Lee ,&nbsp;Sonam Verma ,&nbsp;John S. Schneider ,&nbsp;Nyssa F. Farrell ,&nbsp;Peggy L. Kendall ,&nbsp;Lauren T. Roland","doi":"10.1016/j.amjoto.2025.104779","DOIUrl":"10.1016/j.amjoto.2025.104779","url":null,"abstract":"<div><h3>Background</h3><div>Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.</div></div><div><h3>Objective</h3><div>The goal of this study was to immunophenotype cells associated with IFS survival.</div></div><div><h3>Methods</h3><div>Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).</div></div><div><h3>Results</h3><div>Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.</div></div><div><h3>Conclusion</h3><div>Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104779"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712990","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":"Warthin's tumor of the parotid gland: A 14-year retrospective review of surgical outcomes, diagnostic accuracy and patient-reported aesthetic satisfaction","authors":"Ethem İlhan ,&nbsp;Melek Uyar ,&nbsp;Sibel Bektaş ,&nbsp;Çağla Arukan","doi":"10.1016/j.amjoto.2025.104775","DOIUrl":"10.1016/j.amjoto.2025.104775","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence, diagnostic accuracy, surgical outcomes, complications, and patient-reported aesthetic satisfaction among patients with surgically treated Warthin's tumor (WT) over a 14-year period in a single tertiary center.</div></div><div><h3>Methods</h3><div>A retrospective review of 150 patients undergoing parotidectomy (2009–2022) was performed. Fifty-four patients with histopathologically confirmed WT comprised the primary analysis group. Demographics, smoking history, preoperative diagnostics [fine-needle aspiration cytology (FNAC), ultrasonography (US), magnetic resonance imaging (MRI)], surgical technique, and outcomes were recorded. Aesthetic satisfaction was assessed in a prospective subgroup (<em>n</em> = 37) using a 5-point Likert scale. Statistical analyses were applied with significance at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>WT accounted for 41.2 % of benign parotid tumors, nearly equal to pleomorphic adenoma (42.0 %). Mean age was 59.5 ± 8.9 years; 75.9 % were male. Mean smoking exposure was 42 ± 12.5 pack-years, and all patients with metachronous contralateral tumors continued smoking. FNAC sensitivity was 77.8 % overall and 91.3 % for adequate samples (PPV 94.4 %). US suggested WT in 5/43 (11.6 %) of reported examinations; MRI suggested WT in 34/39 (87.2 %) of US/MRI reports available. Superficial parotidectomy was performed in 70.4 % and partial superficial parotidectomy in 29.6 %. The most common complication was great auricular nerve sensory deficit (35.2 %); permanent facial nerve paralysis occurred in 1.9 %. In the aesthetic subgroup, 8.1 % rated contour deformity as “Poor/Very Poor,” and 10.8 % reported similar dissatisfaction with scarring.</div></div><div><h3>Conclusion</h3><div>Our 14-year analysis confirms that WT now constitutes a substantial proportion of benign parotid tumors, approaching the incidence of pleomorphic adenoma, with a strong association with smoking. FNAC and MRI demonstrated high diagnostic accuracy, supporting their role in reliable preoperative evaluation. While surgical treatment remains safe, postoperative sensory deficits and aesthetic concerns are not uncommon and may meaningfully affect patient satisfaction, even after limited surgery. Individualized management—particularly active surveillance for small, asymptomatic tumors in elderly or comorbid patients—may help balance oncologic safety with quality-of-life considerations.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104775"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720103","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":"Adjunctive dual biologic therapy for persistent nasal symptoms in eosinophilic granulomatosis with polyangiitis (EGPA)","authors":"Giulia Gramellini ,&nbsp;Marco Borin ,&nbsp;Matteo Lazzeroni ,&nbsp;Alberto Giulio Dragonetti ,&nbsp;Pasquale Capaccio ,&nbsp;Niccolò Mevio ,&nbsp;Jan Walter Volk Schroeder","doi":"10.1016/j.amjoto.2025.104761","DOIUrl":"10.1016/j.amjoto.2025.104761","url":null,"abstract":"<div><div>Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic vasculitis frequently involving both upper and lower airways, commonly associated with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Although anti-IL-5/IL-5R biologics such as mepolizumab and benralizumab are established therapies for maintaining systemic remission, a subset of patients continues to experience refractory sinonasal symptoms. We report two EGPA cases with well-controlled systemic disease under anti-IL-5/IL-5R therapy but persistent uncontrolled CRSwNP, who were treated with add-on dupilumab. Both patients demonstrated substantial improvement in sinonasal outcomes, as reflected by reductions in SNOT-22 and nasal polyp scores, alongside maintenance of systemic remission (BVAS = 0). These findings highlight the potential role of dual biologic therapy targeting distinct inflammatory pathways in selected EGPA patients with refractory CRSwNP. Careful patient selection and close multidisciplinary monitoring are essential to ensure safety and optimize efficacy. Further studies are warranted to confirm long-term effectiveness and safety profiles.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104761"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676146","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":"Dual-scale fusion vision transformer model for vocal cord leukoplakia risk stratification: A multicenter study","authors":"Jie-Lin Huang ,&nbsp;Li-Juan Li ,&nbsp;Ji-Qing Zhu ,&nbsp;Li-Zhou Dou ,&nbsp;Yu-Meng Liu ,&nbsp;Yan Ke ,&nbsp;Yu-Da Zhao ,&nbsp;Mei-Ling Wang ,&nbsp;Jian-Hui Wang ,&nbsp;Quan-Mao Zhang ,&nbsp;Xiao-Guang Ni","doi":"10.1016/j.amjoto.2026.104789","DOIUrl":"10.1016/j.amjoto.2026.104789","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop an artificial intelligence (AI) system for accurate three-tier risk stratification of vocal cord leukoplakia (VCL), with particular focus on distinguishing high-risk lesions (severe dysplasia and carcinoma in situ) from low-risk and malignant lesions, while enhancing diagnostic performance among clinicians with limited experience.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study analyzed 8510 laryngoscopic images from 743 patients across three tertiary hospitals in China. A dual-scale Vision Transformer (ViT) architecture was constructed, integrating multi-scale feature analysis with cross-attention fusion mechanisms. The model was rigorously evaluated through internal-external validation and a prospective reader study involving 12 endoscopists of varying expertise.</div></div><div><h3>Results</h3><div>The AI system demonstrated superior performance in three-tier classification, achieving F1-scores of 0.883 (95% CI: 0.869–0.896) and 0.861 (95% CI: 0.844–0.878) for high-risk lesion identification in internal and external validation, respectively. AI assistance significantly improved junior endoscopists' sensitivity from 67.1% to 81.4% (<em>P</em> &lt; 0.001), effectively narrowing diagnostic performance disparities with senior experts. The system maintained robust generalizability across institutions, with 90.5% accuracy under heterogeneous imaging protocols.</div></div><div><h3>Conclusion</h3><div>The proposed AI framework provides a clinically effective solution for reliable VCL risk stratification and reduces diagnostic variability between clinicians. Validated across multiple centers, this dual-scale ViT approach establishes a novel paradigm for laryngoscopic diagnosis and holds significant potential to standardize diagnostic workflows in resource-limited settings.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104789"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973187","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":"A single-center, randomized, double-blinded, placebo-controlled clinical study on the efficacy and safety of voriconazole ear drops in the treatment of otomycosis","authors":"Shen'er Qian ,&nbsp;Guolin Tan ,&nbsp;Hongyi Tan ,&nbsp;Lihua Chen ,&nbsp;Yonghong Yu ,&nbsp;Ru Gao ,&nbsp;Wei Li","doi":"10.1016/j.amjoto.2026.104792","DOIUrl":"10.1016/j.amjoto.2026.104792","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the efficacy and safety of voriconazole ear drops.</div></div><div><h3>Methods</h3><div>A single-center, randomized, double-blind, placebo-controlled clinical design was adopted. A total of 108 patients with otomycosis were enrolled and randomly assigned in a 2:1 ratio to the experimental group (<em>n</em> = 72) and the control group (<em>n</em> = 36). The experimental group received voriconazole ear drops for 7 days followed by placebo for 7 days; the control group received the treatments in reverse order. The primary efficacy endpoint was the clinical response rate. Secondary endpoints included improvement in ear symptoms and signs, and the recurrence rate after discontinuation of treatment.</div></div><div><h3>Results</h3><div>The experimental group showed significant superiority over the control group in the clinical response rate (62.50% vs 38.89%, <em>P</em> &lt; 0.05). Among the secondary endpoints, the improvement rates for ear fullness and ear swelling were significantly higher in the experimental group (P &lt; 0.05), while no significant statistical differences were observed for the other symptoms. The recurrence rate after treatment discontinuation was 7.89%. Regarding safety, no drug-related clinical abnormalities, adverse events, or serious adverse events were observed in any patient.</div></div><div><h3>Conclusion</h3><div>Voriconazole ear drops demonstrated good efficacy and safety in the treatment of otomycosis, showing significant therapeutic effects particularly against filamentous fungal infections. Topical application showed no significant toxicity, indicating promising clinical application prospects.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104792"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973190","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":"Effectiveness of drug-induced sleep endoscopy in improving patients selection and outcomes of mandibular advancement device therapy for obstructive sleep apnea: A multicenter case-control study","authors":"Giannicola Iannella ,&nbsp;Sergio Terranova ,&nbsp;Marco Brunori ,&nbsp;Claudio Vicini ,&nbsp;Alberto Caranti ,&nbsp;Ruggero Campisi ,&nbsp;Vincenzo De Ceglie ,&nbsp;Manuele Casale ,&nbsp;Antonio Moffa ,&nbsp;Fabrizio Salamanca ,&nbsp;Federico Leone ,&nbsp;Andrea De Vito ,&nbsp;Giovanni Cammaroto ,&nbsp;Salvatore Cocuzza ,&nbsp;Antonino Maniaci ,&nbsp;Armando De Virgilio ,&nbsp;Jerome R. Lechien ,&nbsp;Carlos-Miguel Chiesa-Estomba ,&nbsp;Luigi A. Vaira ,&nbsp;Paolo Boscolo-Rizzo ,&nbsp;Annalisa Pace","doi":"10.1016/j.amjoto.2025.104740","DOIUrl":"10.1016/j.amjoto.2025.104740","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate, in Obstructive sleep apnea (OSA) patients, the use of pre-treatment drug-induced sleep endoscopy (DISE) as a patient selection tool, that could improve the outcomes of mandibular advancement device (MAD) therapy. A multicenter retrospective case-control study has been performed.</div></div><div><h3>Methods</h3><div>A multicenter case-control study with two parallel arms was conducted to compare functional outcomes in patients undergoing MAD therapy. Group A (n = 118) received MAD therapy based solely on static clinical assessments, including dentoskeletal features, oropharyngeal anatomy, and upper airway endoscopy. Group B (n = 87) underwent pre-treatment DISE to dynamically evaluate the site, type, and pattern of upper airway collapse, thereby guiding patient selection for MAD therapy.</div></div><div><h3>Results</h3><div>In Group A, the mean pre-treatment apnea-hypopnea index (AHI) was 28.1, decreasing significantly to 12.4 post-treatment (p = 0.0001). In Group B, the mean AHI decreased from 31.3 to 9.5 (p = 0.0001). The Delta apnea-hypopnea index (ΔAHI) was significantly greater in Group B (−21.7) than in Group A (−16.6; p = 0.04). Similarly, the Delta Oxigen desaturation index (ΔODI) was −18.6 in Group B versus −14.1 in Group A (p = 0.04). The therapeutic success rate was significantly higher in Group B (82.7 %) compared to Group A (60.1 %) (p = 0.001).</div></div><div><h3>Conclusion</h3><div>In OSA patients, a pre-treatment DISE evaluation, improves the selection of appropriate candidates for MAD therapy by enabling dynamic assessment of upper airway collapsibility during a pharmacologically induced sleep. This targeted selection results in significantly better therapeutic outcomes for MAD therapy for the OSA treatment.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104740"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537361","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":"Sarcopenia and postoperative morbidity in head & neck cancer: A systematic review and meta-analysis","authors":"Michael Xie ,&nbsp;Han Zhang ,&nbsp;Phillip Staibano ,&nbsp;Zahra Abdallah ,&nbsp;Michael K. Gupta ,&nbsp;Nhu Tram Nguyen","doi":"10.1016/j.amjoto.2025.104758","DOIUrl":"10.1016/j.amjoto.2025.104758","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the prognostic value of sarcopenia in surgically treated HNC patients on postoperative morbidity.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Information sources, study selection, and methods</h3><div>EMBASE, MEDLINE, SCOPUS, and CINAHL databases were searched from January 1, 1946 to November 4, 2024. Published trials and observational studies reporting the association of sarcopenia and postoperative complications in surgically treated HNC patients were included. Two reviewers independently screened, extracted, and appraised studies using Covidence. Disagreements were resolved through consensus, and/or by consulting a third reviewer. Data were pooled using a random-effects model in RevMan 5.4.1.</div></div><div><h3>Results</h3><div>Of 6345 screened studies, 17 out of the 23 included studies had outcomes which were incorporated in the meta-analysis (2884 patients from studies between 1996 and 2024). The meta-analysis revealed a statistically significant association between sarcopenia and all postoperative complications (odds ratio (OR) 2.26, 95 % CI [1.54, 3.33], <em>p</em> &lt; 0.0001), postoperative complications grade 3 (OR 2.34, 95 % CI [1.80, 3.03], <em>p</em> &lt; 0.00001), fistula (OR 2.64, 95 % CI [1.68, 4.16], <em>p</em> &lt; 0.0001), and flap complications (OR 2.77, 95 % CI [1.58, 4.85], <em>p</em> = 0.0004). Subgroup analysis revealed the high risk of bias studies did not significantly bias the results (<em>p</em> = 0.76), but the different measurements of sarcopenia contributed significant heterogeneity (<em>p</em> &lt; 0.00001). The level of evidence is moderate, primarily due to publication bias, for all outcomes, as per GRADE.</div></div><div><h3>Conclusions</h3><div>In patients undergoing curative surgery for HNC, preoperative sarcopenia is associated with higher odds of postoperative complications.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104758"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713039","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":"Rethinking congenital cytomegalovirus: A narrative review of the clinical, public health, and ethical challenges of a preventable cause of childhood hearing loss","authors":"M. Peyton Simons ,&nbsp;Gauri Mankekar","doi":"10.1016/j.amjoto.2025.104682","DOIUrl":"10.1016/j.amjoto.2025.104682","url":null,"abstract":"<div><div>Congenital cytomegalovirus (cCMV) is the most common non-genetic cause of pediatric sensorineural hearing loss, affecting approximately tens of thousands of infants annually in the United States. While cCMV may present symptomatically at birth, many infants are asymptomatic initially and later develop progressive or fluctuating hearing loss, which is often undiagnosed without early screening. Despite advances in diagnostic methods such as polymerase chain reaction (PCR) testing, the absence of a national screening policy in the U.S. results in significant variability in early detection and follow-up care. This narrative review provides an overview of the clinical manifestations, diagnostic strategies, and treatment options for cCMV, while highlighting critical gaps in public health infrastructure, policy coordination, and ethical oversight. Cost considerations remain a major factor in determining the feasibility of universal versus targeted screening approaches, with emerging data suggesting that both strategies offer cost-effective benefits depending on implementation context. Additionally, disparities in access to follow-up care and interventions raise important questions about health equity. Current efforts by some states to include cCMV in newborn screening protocols are promising, but without consistent national guidance, large portions of affected infants will continue to be missed. Addressing cCMV effectively will require a multidisciplinary, systems-based approach that combines early detection with sustainable follow-up, robust policy frameworks, and ethical consideration for families navigating diagnosis and care.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104682"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879350","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}