American Journal of Otolaryngology最新文献

{"title":"An assessment of pharmacologic deep vein thrombosis prophylaxis on head and neck free flap outcomes","authors":"Robert E. Africa,&nbsp;Shahrukh R. Ali,&nbsp;Christopher File,&nbsp;Brian J. McKinnon,&nbsp;Orly M. Coblens,&nbsp;Felix Maldonado-Chapa,&nbsp;Viran J. Ranasinghe","doi":"10.1016/j.amjoto.2026.104879","DOIUrl":"10.1016/j.amjoto.2026.104879","url":null,"abstract":"<div><h3>Objective</h3><div>To compare head and neck free flap outcomes based on usage of pharmacologic deep vein thrombosis (DVT) prophylaxis.</div></div><div><h3>Study design</h3><div>Multicenter retrospective study including patients from January 1, 2010 to December 31, 2023.</div></div><div><h3>Setting</h3><div>Sixty-eight healthcare organizations in the United States.</div></div><div><h3>Methods</h3><div>Patients older than 18 years with head and neck cancer who underwent either non-bony or bony free flap reconstruction were grouped according to whether they received DVT prophylaxis or not on the same day of surgery or postoperatively. Primary outcomes were compared between the groups which included flap failure, the need for blood vessel repair, and flap revision.</div></div><div><h3>Results</h3><div>On the same day of surgery, there was no significant difference for non-bony reconstruction for flap failure (RR: 0.95; 95% CI: 0.75–1.20: <em>P</em>: 0.66), blood vessel repair (RR: 0.96; 95% CI: 0.82–1.12; <em>P</em>: 0.60), or flap revision (RR: 0.96; 95% CI: 0.84–1.09; <em>P</em>: 0.53). No differences were also observed for bony reconstruction. Postoperatively, there was an increased rate of flap failure and flap revision for both non-bony ([RR: 0.73; 95% CI: 0.69–0.79; <em>P</em>: &lt;0.0001], [RR: 0.71; 95% CI: 0.66–0.77; <em>P</em>: &lt;0.0001]) and bony reconstruction ([RR: 0.66; 95% CI: 0.59–0.75; <em>P</em>: &lt;0.0001], [RR: 0.66; 95% CI: 0.57–0.73; <em>P</em>: &lt;0.0001]) in the patient groups that did not get DVT chemoprophylaxis.</div></div><div><h3>Conclusion</h3><div>Pharmacologic DVT prophylaxis administration in the postoperative period for both bony and non-bony head and neck free flaps is associated with a decreased risk of flap failure and revision. Perioperative administration on the day of surgery had no impact on outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104879"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366559","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":"The inflammatory microenvironment in patients with advanced and relapsing hypopharyngeal squamous cell carcinoma","authors":"Anna-Rebekka Staufenberg,&nbsp;Matthias M. Gaida,&nbsp;Claudine Graf,&nbsp;Justus Kaufmann,&nbsp;Christoph Matthias,&nbsp;Haralampos Gouveris","doi":"10.1016/j.amjoto.2026.104871","DOIUrl":"10.1016/j.amjoto.2026.104871","url":null,"abstract":"<div><div>Hypopharyngeal squamous cell carcinoma (HPSCC) is frequently diagnosed at an advanced stage and is associated with limited therapeutic options and poor prognosis. Increasing evidence highlights the relevance of the tumour microenvironment (TME), particularly inflammatory cell populations, for tumour progression and treatment response. Tumour-associated macrophages (TAMs), especially CD68-positive subsets, have emerged as potential diagnostic and prognostic markers. Factor X (FX), a key component of the coagulation cascade with additional immunomodulatory functions, may contribute to macrophage recruitment and influence TME composition. This study aimed to characterise the inflammatory landscape of advanced HPSCC with a focus on FX_CD68-positive TAMs and to explore associations with clinical outcome.</div><div>Histopathological and immunohistochemical analyses were performed on tumour samples from 31 patients with advanced HPSCC. Acute inflammation was graded based on neutrophil infiltration, while chronic inflammation was assessed through lymphoid aggregates and overall inflammatory cell density. FX_CD68-positive macrophages were quantified and correlated with clinical data including stage, treatment modality, and relapse.</div><div>All tumours demonstrated pronounced acute and chronic inflammation. Most patients (<em>n</em> = 29) presented with UICC stage II–IV disease. Eleven patients (35%) developed a relapse, typically showing stronger chronic inflammation in the primary tumour. Recurrent tumours displayed heterogeneous densities of FX_CD68-positive TAMs, whereas specimens obtained after radio(chemo)therapy exhibited reduced inflammatory infiltration.</div><div>These findings indicate that HPSCC is a highly immunogenic tumour entity. Components of the TME, particularly FX_CD68-positive TAMs, may represent promising biomarkers for risk stratification and could support the development of personalised therapeutic strategies.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104871"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325404","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":"Epistaxis burden in hereditary hemorrhagic telangiectasia: Validation and refinement of the NOSE-HHT","authors":"Ole Jakob Jørgensen,&nbsp;Johan Edvard Steineger,&nbsp;Amy Østertun Geirdal,&nbsp;Sinan Dheyauldeen","doi":"10.1016/j.amjoto.2026.104876","DOIUrl":"10.1016/j.amjoto.2026.104876","url":null,"abstract":"<div><h3>Background</h3><div>Epistaxis is the most common and burdensome manifestation of hereditary hemorrhagic telangiectasia (HHT). Bleeding severity measures do not capture the functional and emotional impact of recurrent epistaxis, highlighting the need for symptom-specific patient-reported outcome measures. This study translated and validated the Nasal Outcome Score for Epistaxis (NOSE-HHT) for Norwegian-speaking patients and evaluated whether a shortened version could be developed.</div></div><div><h3>Methods</h3><div>In this cross-sectional validation study, adult patients with HHT were recruited from a national tertiary referral center between October 2024 and March 2025. Psychometric evaluation followed COSMIN guidelines and included assessment of internal consistency, test–retest reliability, structural validity, construct validity, responsiveness, and item-level performance. Participants were allocated to cohorts for cross-sectional validation and item reduction (<em>n</em> = 157), responsiveness (<em>n</em> = 31), and test–retest reliability (<em>n</em> = 47).</div></div><div><h3>Results</h3><div>A total of 235 patients were included (mean age 58.0 ± 13.5 years; 53% men). The Norwegian NOSE-HHT demonstrated excellent internal consistency (Cronbach's α = 0.955) and good test–retest reliability (ICC = 0.77; 95% CI, 0.63–0.87). Structural validity supported a single dominant underlying construct, and construct validity was confirmed by correlations with epistaxis severity and quality-of-life measures. Short-term responsiveness was limited despite improvement in bleeding-specific anchors. Item reduction yielded a 23-item version closely matching the full instrument (<em>r</em> = 0.995).</div></div><div><h3>Conclusion</h3><div>The Norwegian NOSE-HHT is a valid and reliable instrument for assessing epistaxis-related symptom burden in HHT. A shortened version reduces respondent burden and may facilitate use in clinical practice and future interventional studies.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104876"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366570","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":"Re: Sarcopenia and postoperative morbidity in head and neck cancer: a systematic review and meta-analysis","authors":"Erkan Topkan,&nbsp;Efsun Somay,&nbsp;Ugur Selek","doi":"10.1016/j.amjoto.2026.104880","DOIUrl":"10.1016/j.amjoto.2026.104880","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104880"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148373691","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":"Rethinking indications for prophylactic central neck dissection in papillary thyroid microcarcinoma: A real-world retrospective study","authors":"Lei Gong,&nbsp;Ping Li,&nbsp;Ziyang Zhang,&nbsp;Mengying Cao,&nbsp;Yan Liu,&nbsp;Jun Chen,&nbsp;Xinghong Guo,&nbsp;Weili Liang,&nbsp;Nan Liu,&nbsp;Bin Lv,&nbsp;Kai Liang","doi":"10.1016/j.amjoto.2026.104884","DOIUrl":"10.1016/j.amjoto.2026.104884","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of unifocal papillary thyroid microcarcinoma (PTMC) remains controversial. The study analyzed preoperative clinical characteristics and postoperative pathologic features of unifocal PTMC to provide new insights into whether prophylactic central neck dissection (pCND) should be performed in PTMC.</div></div><div><h3>Methods</h3><div>A total of 1475 patients with clinical lymph node-negative (cN0) unifocal PTMC who underwent thyroid lobectomy and pCND were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of central lymph node metastasis (CLNM). The decision tree model was used to identify the risk for CLNM in PTMC patients and indications for pCND.</div></div><div><h3>Results</h3><div>Age, gender, tumor size and location were risk factors for CLNM in cN0 unifocal PTMC patients. The root node of the decision tree model revealed location was the main factor affecting CLNM, and the potential risk of CLNM was the lowest in the intraglandular lesion regardless of gender, age, and tumor size. If lesions located in subcapsular/isthmus lesion, the potential risk was higher and was associated with age, gender, and tumor size.</div></div><div><h3>Conclusion</h3><div>For patients with cN0 unifocal PTMC, regardless of gender, age, or tumor size, the risk of CLNM is the lowest when the lesion is located within the gland. In contrast, the potential risk of CLNM is higher when the lesion is subcapsular or located in the isthmus. In such cases, the decision to perform pCND should be made by integrating the patient's gender, age, and tumor size.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104884"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387082","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":"Prophylactic endoluminal vacuum therapy after total laryngectomy or laryngopharyngectomy: a retrospective propensity score-matched cohort study","authors":"Eun Kyung Jung,&nbsp;Juwon Hwang,&nbsp;Hyunjun Jung,&nbsp;Hye-Bin Jang,&nbsp;Joon Kyoo Lee","doi":"10.1016/j.amjoto.2026.104889","DOIUrl":"10.1016/j.amjoto.2026.104889","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of prophylactic endoluminal vacuum-assisted closure (EndoVAC) on pharyngocutaneous fistula (PCF) incidence and duration of hospitalization following total laryngectomy (TL) or laryngopharyngectomy (LP).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients who underwent TL or LP at a single tertiary center between May 2006 and August 2025. PCF was defined based on clinical evidence of salivary leakage and/or radiologic confirmation using contrast-enhanced computed tomography or pharyngoesophagography. Multivariable logistic regression and 1:1 nearest-neighbor propensity score matching (PSM) were performed using age, defect size, flap type, and preoperative radiotherapy as covariates. Duration of hospitalization was analyzed using multivariable linear regression.</div></div><div><h3>Results</h3><div>Among 114 patients, PCF occurred in 38 patients (33.3%). Prophylactic EndoVAC use was not significantly associated with PCF incidence in multivariable analysis (adjusted OR, 0.50, 95% CI, 0.12–2.05; <em>p</em> = 0.336). In the propensity score-matched cohort (<em>n</em> = 34), PCF occurred in 47.1% of the EndoVAC group and 29.4% of controls (OR, 2.13, 95% CI, 0.52–8.76; <em>p</em> = 0.481). However, prophylactic EndoVAC use was independently associated with a significantly shorter duration of hospitalization (β = −25.8 days, 95% CI, −41.7 to −9.9; <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>Prophylactic EndoVAC was not associated with reduced PCF incidence after TL or LP. Although EndoVAC use was associated with shorter hospitalization, this finding should be considered exploratory and hypothesis-generating because of potential residual confounding and selection bias.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104889"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417637","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":"Socially awkward: An evaluation of otolaryngology residency pre- or post-interview social functions","authors":"Brandon D. Abell,&nbsp;Phillip Q. Richards,&nbsp;Ryan J. Lau,&nbsp;Cristina Cabrera-Muffly,&nbsp;Andrew P. Johnson","doi":"10.1016/j.amjoto.2026.104872","DOIUrl":"10.1016/j.amjoto.2026.104872","url":null,"abstract":"<div><h3>Objective</h3><div>As otolaryngology residency programs transition to in-person or hybrid interview and social activities following the COVID-19 pandemic, applicant opinions on what makes the most appealing and informative recruitment social events must be considered. The objective of this study was to determine which components of pre- or post-interview socials are most important to otolaryngology residency applicants.</div></div><div><h3>Design</h3><div>The survey was distributed to 347 applicants to the University of Colorado otolaryngology residency program during the 2024 Match, of which 65 responses were received. Survey responses were collected through an anonymous web-based survey and used to calculate descriptive statistics.</div></div><div><h3>Results</h3><div>In-person social events were unanimously preferred (100%), with rationale including interactions with residents and other applicants, and having a chance to see the city (“liked” by &gt;98.4%). Respondents were split on having attending physicians present (49% in-favor), but 71.4% of respondents preferred in-person social events because they liked interactions with attending physicians. Less important factors for preferring in-person social events included the dining experiences and opportunities to ask questions in a less-formal environment.</div></div><div><h3>Conclusions</h3><div>Although virtual events are flexible and inexpensive, most respondents preferred in-person social events and interviews for their ability to experience the culture and interpersonal working relationships within a department. While virtual social events can provide some information about a program, they have limited utility in conveying the culture and fit of a program and do not facilitate organic conversation. These survey responses provide insight into the ways that otolaryngology residency programs can create the most useful pre- or post-interview social events.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104872"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343812","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":"Rapid improvement of nasal obstruction after treatment with a non-vasoconstrictive osmotic nasal spray: A prospective observational study","authors":"Pietro De Luca,&nbsp;Arianna Di Stadio,&nbsp;Luca de Campora,&nbsp;Anna Sambito,&nbsp;Valerio Damiani,&nbsp;Angelo Camaioni,&nbsp;Matteo Simone","doi":"10.1016/j.amjoto.2026.104877","DOIUrl":"10.1016/j.amjoto.2026.104877","url":null,"abstract":"<div><h3>Background</h3><div>Nasal obstruction is a highly prevalent symptom that can significantly impair quality of life. Although topical decongestants provide rapid relief, their use is limited by potential adverse effects. Non-vasoconstrictive treatments represent a safer alternative, but data on their immediate effectiveness in clinical practice are limited.</div></div><div><h3>Objective</h3><div>To evaluate the short-term effects of a non-vasoconstrictive osmotic nasal spray on subjective symptoms and objective nasal airflow parameters in patients with nasal obstruction.</div></div><div><h3>Methods</h3><div>This prospective observational study included 83 adult patients presenting with nasal obstruction. Subjective symptoms were assessed using the Visual Analog Scale (VAS) and the I-NOSE questionnaire. Objective nasal patency was measured by active anterior rhinomanometry. Assessments were performed at baseline (T0) and 10 min after treatment (T1).</div></div><div><h3>Results</h3><div>Significant improvements were observed in all outcome measures. The mean VAS score decreased from 8.8 to 4.8 (mean difference − 4.0; 95% CI: −4.4 to −3.6; <em>p</em> &lt; 0.0001). The I-NOSE score decreased from 18.4 to 10.3 (mean difference − 8.1; 95% CI: −9.0 to −7.2; <em>p</em> &lt; 0.0001). Total nasal airway resistance decreased from 0.70 to 0.37 Pa/cm³/s (mean difference − 0.33; 95% CI: −0.39 to −0.27; p &lt; 0.0001). No adverse events were reported.</div></div><div><h3>Conclusions</h3><div>A single administration of a non-vasoconstrictive osmotic nasal spray produced rapid improvement in both subjective perception of nasal obstruction and objective airflow measurements. These findings suggest that osmotic therapy may represent a useful option for short-term relief of nasal obstruction.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 4","pages":"Article 104877"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366632","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":"The intriguing condition of eosinophilic sialodochitis: insights into an emerging type 2 disorder","authors":"Matteo Lazzeroni ,&nbsp;Eugenio De Corso ,&nbsp;Andrea De Lena ,&nbsp;Cristina Amaglio ,&nbsp;Emanuele Bizzi ,&nbsp;Giulia Gramellini ,&nbsp;Niccolò Cenzato ,&nbsp;Michele Gaffuri ,&nbsp;Antonino Maniaci ,&nbsp;Pasquale Capaccio","doi":"10.1016/j.amjoto.2026.104810","DOIUrl":"10.1016/j.amjoto.2026.104810","url":null,"abstract":"<div><h3>Background</h3><div>Eosinophilic sialodochitis is a rare and increasingly recognized inflammatory disorder of the salivary glands, characterized by eosinophil-rich mucus plugs, periductal eosinophilic infiltration, and frequent association with type 2 disorders.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on PubMed, Embase, Scopus, and Web of Science for papers reporting on eosinophilic sialodochitis. PRISMA 2020 guidelines were followed, and the study protocol was registered in PROSPERO with registration number CRD42023433994. Data was summarized descriptively and presented as percentages or medians with interquartile range.</div></div><div><h3>Results</h3><div>A total of 157 studies were identified and 21 met the inclusion criteria of the present review, comprising 179 patients. The majority were female (73%) and their ages ranged from 15 to 80 years old. Eosinophilic sialodochitis often presented with multiglandular involvement of the parotid glands. Allergic rhinitis (72%) and asthma (28%) were the most common associated type 2 comorbidities, while elevated serum IgE and blood eosinophil count were frequently reported. Diagnosis was based on different examinations, ranging from ultrasonography to MRI, fine-needle or core-needle biopsy, and conventional sialography. Therapeutic interventions included antihistamines, montelukast, and oral corticosteroids. Sialendoscopy and sialadenectomy were used in refractory cases, while biologics such as dupilumab, benralizumab and mepolizumab were employed only in 4 patients.</div></div><div><h3>Conclusions</h3><div>This review highlights the diagnostic complexity, therapeutic challenges, and potential role of targeted biologic therapies in managing eosinophilic sialodochitis.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 3","pages":"Article 104810"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832343","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 utility of tubomanometry for patulous eustachian tube: A comparative study","authors":"Xiaoling Shi ,&nbsp;Ren Zhou ,&nbsp;Yanbo Yin ,&nbsp;Yunfeng Wang","doi":"10.1016/j.amjoto.2026.104846","DOIUrl":"10.1016/j.amjoto.2026.104846","url":null,"abstract":"<div><h3>Purpose</h3><div>The current diagnosis of patulous Eustachian tube (PET) has limitations and cannot accurately assess its functional status. This study aims to validate tubomanometry (TMM) as an objective diagnostic tool for PET by analyzing pressure-specific R-values.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted involving 95 ears from 64 patients which were stratified into three groups: Definite PET (<em>n</em> = 26), Possible PET (<em>n</em> = 41), and Controls (<em>n</em> = 28). Diagnostic performance was evaluated by receiver operator characteristic (ROC) curve analysis to determine optimal R-value thresholds.</div></div><div><h3>Results</h3><div>The Definite PET group exhibited significantly lower R-values compared to the Possible PET and Control groups at all pressure levels (30 mbar: 0.27 ± 0.39 <em>vs</em> 0.40 ± 0.34 <em>vs</em> 0.99 ± 0.49, <em>p</em> &lt; 0.001; 40 mbar: 0.39 ± 0.55 <em>vs</em> 0.54 ± 0.44 <em>vs</em> 0.75 ± 0.31, <em>p</em> = 0.001; 50 mbar: 0.32 ± 0.33 <em>vs</em> 0.41 ± 0.33 <em>vs</em> 0.70 ± 0.32, <em>p</em> &lt; 0.001). The optimal diagnostic threshold was achieved at 30 mbar (R-value cutoff: 0.585; sensitivity: 75%, specificity: 77%, area under curve [AUC]: 0.802). Asymptomatic contralateral ears in unilateral PET cases exhibited R-values that were similar to healthy controls (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>TMM is a robust diagnostic tool for PET, with optimal clinical utility at 30 mbar. Pressure-specific R-value thresholds can differentiate the severity of PET and validate the status of asymptomatic ears in unilateral cases.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 3","pages":"Article 104846"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759875","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}