American Journal of Otolaryngology最新文献

{"title":"Modeling complex relationships in laryngeal pathologies: A structural equation analysis of dysphonia in Saudi Arabian patients","authors":"Omar Ibrahim Alanazi ,&nbsp;Sameer Al-bahkaly ,&nbsp;Feras Alkholaiwi ,&nbsp;Yousef Aljathlany ,&nbsp;Mohammed Khalid Alhussaini ,&nbsp;Omar Ahmed Alrashood ,&nbsp;Ahmed Ibrahim Alanazi ,&nbsp;Faisal A. Althwiny ,&nbsp;Khaled Eid Alotibi ,&nbsp;Alwaleed Abdullah Altamimi ,&nbsp;Abdulaziz Saleh Alobaid ,&nbsp;Abdullah Ahmed Alzamil ,&nbsp;Faisal Abohelaibah ,&nbsp;Faisal Alhussaini ,&nbsp;Ahmed Y. Azzam","doi":"10.1016/j.amjoto.2025.104690","DOIUrl":"10.1016/j.amjoto.2025.104690","url":null,"abstract":"<div><h3>Introduction</h3><div>Dysphonia is a prevalent laryngological condition that impairs communication and quality of life in several cases, however the interplay between risk factors and specific laryngeal pathologies remains poorly understood. Previous studies often lack structured modeling of these multifactorial interactions. We utilized structural equation modeling (SEM) in a large Saudi-based cohort to investigate the direct and indirect pathways linking demographic factors, behavioral variables, as well as the types of laryngeal pathologies.</div></div><div><h3>Methods</h3><div>Our retrospective cohort study retrieved and analyzed the relevant data from dysphonia patients at a tertiary-care hospital in Riyadh, Saudi Arabia. Laryngeal pathologies were categorized into structural, inflammatory, neurological, and functional types. Our proposed SEM framework has assessed both of the direct and indirect pathways from risk factors to these categories, including cross-pathology links and moderation effects.</div></div><div><h3>Results</h3><div>Our study cohort has included a total of 998 eligible dysphonia patients. Structural pathologies were most prevalent (33.9 %). The SEM demonstrated excellent fit (CFI = 0.961, RMSEA = 0.049) and identified significant pathways: female gender strongly predicted structural (β = 0.412) and functional pathologies; increasing age associated positively with inflammatory, neurological, and functional types; smoking strongly predicted inflammatory pathologies (β = 0.338); occupational voice use predicted structural (β = 0.356) and functional (β = 0.297).</div></div><div><h3>Conclusions</h3><div>This SEM-based etiological model reveals peculiar and significant important dysphonia pathways with clear demographic signatures in a Saudi-based population. Findings highlight specific high-risk groups (as female voice professionals, older smokers) and important progression patterns (inflammatory-to-neurological, structural-to-functional). This framework helps to offer a more precise risk profiling, supporting targeted screening protocols and tailored preventive interventions based on specific risk factors and interconnected pathology development.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104690"},"PeriodicalIF":1.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262529","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":"Relationship between ultra-high-resolution computed tomography score of oval window region involvement and audiometry in otosclerosis","authors":"Heyu Ding ,&nbsp;Wei Wei ,&nbsp;Ning Xu ,&nbsp;Ruowei Tang ,&nbsp;Zhengyu Zhang ,&nbsp;Chen Yang ,&nbsp;Jing Xie ,&nbsp;Shusheng Gong ,&nbsp;Zhenchang Wang ,&nbsp;Pengfei Zhao","doi":"10.1016/j.amjoto.2025.104684","DOIUrl":"10.1016/j.amjoto.2025.104684","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the relationship between the ultra-high-resolution computed tomography (U-HRCT) score of oval window region (OWR) involvement and audiometry in otosclerosis.</div></div><div><h3>Methods</h3><div>This study enrolled patients with clinically suspected otosclerosis who underwent U-HRCT examination. The analysis included 71 ears from 50 patients (mean age, 38.0 [34.0–49.8] years). The ears were divided into the conductive hearing loss group (group A, 20 ears) and mixed hearing loss group (group B, 51 ears). The CT scores of bone involvement around the oval window (0, none; 1, &lt;25 %; 2, 25 %–50 %; 3, 50 %–75 %; 4, &gt;75 %) and stapes footplate involvement (0, none; 1, &lt;50 %; 2, &gt;50 %) were evaluated and summed to obtain the CT score of OWR involvement. The Mann–Whitney <em>U</em> test was used to compare the difference in the distribution of the CT score of OWR involvement between groups A and B. Spearman's rank correlation analysis was performed to evaluate the association between the CT score of OWR involvement and the mean air conduction (AC), bone conduction (BC) and air-bone gap (ABG).</div></div><div><h3>Results</h3><div>The CT score of OWR involvement in group B was significantly higher than that in group A (<em>p</em> = .014). The correlation coefficients between the CT score of OWR involvement and the mean AC, BC, and ABG threshold were 0.74 (<em>p</em> &lt; .001), 0.52 (p &lt; .001), and 0.48 (p &lt; .001).</div></div><div><h3>Conclusion</h3><div>U-HRCT possesses the ability to clearly depict the OWR in otosclerosis. The U-HRCT-derived OWR involvement score of otosclerosis could reflect the type and degree of hearing loss.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104684"},"PeriodicalIF":1.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270376","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":"Diagnosis and treatment of cerebrospinal fluid rhinorrhea with intracranial hypertension","authors":"Zheng Wang,&nbsp;Erpeng Zhang,&nbsp;Lei Shi,&nbsp;Bing Li,&nbsp;Hongbo Gu,&nbsp;Zhiyu Zhang,&nbsp;Shudong Yu,&nbsp;Mingqiang He,&nbsp;Guanggang Shi,&nbsp;Xiaoming Li","doi":"10.1016/j.amjoto.2025.104663","DOIUrl":"10.1016/j.amjoto.2025.104663","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to evaluate the impact of intracranial pressure on the prognosis of cerebrospinal fluid (CSF) rhinorrhea repair surgeries, identify critical diagnostic considerations for CSF rhinorrhea associated with intracranial hypertension, and provide insights into developing effective, individualized treatment strategies for these patients.</div></div><div><h3>Methods</h3><div>We analyzed the clinical data of 16 confirmed and 5 suspected cases of CSF rhinorrhea with intracranial hypertension treated at our hospital from 2015 to 2021. We documented trends in intracranial pressure before and after surgical intervention, assessed clinical manifestations, and investigated the influence of CSF shunting on patient outcomes.</div></div><div><h3>Results</h3><div>Among the CSF rhinorrhea patients, 8 cases experienced relapse, 18 achieved full recovery, and 3 succumbed to their conditions. All three deceased patients had severe craniocerebral trauma complicated by intracranial infections, hydrocephalus, or pneumocephalus both before and after surgery. These patients underwent multiple relapses and repeated surgical interventions. Two cases of traumatic CSF rhinorrhea with intracranial hypertension were associated with intracranial infection and hydrocephalus. Both were successfully treated with surgery following preoperative lumbar drainage. The remaining five relapsed patients (three iatrogenic and two traumatic cases) underwent CSF shunting to control intracranial pressure and were subsequently cured through additional conservative or surgical interventions. The six confirmed and five suspected cases of spontaneous CSF rhinorrhea were managed with routine lumbar drainage and continuous intracranial pressure monitoring until stabilization. All these patients were successfully treated with surgery.</div></div><div><h3>Conclusion</h3><div>Intracranial hypertension plays a critical role in the pathogenesis and surgical failure of CSF rhinorrhea. In cases of severe craniocerebral trauma with hydrocephalus and dilated ventricles, modifying CSF circulation before surgery is essential for effective management. Spontaneous CSF rhinorrhea strongly correlates with intracranial hypertension. Precise evaluation and appropriate management of intracranial hypertension are vital for improving patient outcomes in CSF rhinorrhea cases.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104663"},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184653","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":"Unmasking salivary stone masqueraders: A case series and discussion on salivary gland pathologies mimicking sialadenitis with sialolithiasis","authors":"Davis Sungwoo Chong ,&nbsp;Jackson Mark King ,&nbsp;Lane Darwin Squires","doi":"10.1016/j.amjoto.2025.104680","DOIUrl":"10.1016/j.amjoto.2025.104680","url":null,"abstract":"<div><h3>Objective</h3><div>Sialadenitis with sialolithiasis is a common pathology affecting the salivary glands which may present with classic peri-prandial symptoms. However, other calcific pathologies can similarly obstruct the salivary ducts or mimic the imaging characteristics of sialolithiasis. These impersonators may cause the initial diagnosis or the subsequent therapeutic offerings more difficult. This case series will walk through an exhaustive, case-based review of overlapping disease presentations that similarly present with calcifications within the major salivary glands. In compiling this diverse case series concerning salivary stone mimickers, we hope to provide the comprehensive otolaryngologist with a better understanding of the subtle differences in the signs and symptoms of sialolithiasis mimickers and improve their differential diagnosis formation when non-classic calcifications are seen.</div></div><div><h3>Methods</h3><div>A multi-institution retrospective review.</div></div><div><h3>Results</h3><div>Five cases initially concerning for sialadenitis with imaging confirming presence of calcification were initially worked up for sialolithiasis due to presentation. Further workup in each case diagnosed a variety of calcification-producing salivary gland pathologies unrelated to obstructive sialolithiasis.</div></div><div><h3>Conclusions</h3><div>While sialadenitis secondary to sialolithiasis is a common diagnosis with distinct symptoms, it is still important for the comprehensive otolaryngologist to distinguish nuances in the patient's symptoms and imaging characteristics of non-sialolithiasis calcifications.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104680"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184650","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":"Comparative outcomes between endoscopic and microscopic approaches in pediatric type-1 tympanoplasty","authors":"Nicole Kim ,&nbsp;Evette A. Ronner ,&nbsp;Angela S. Zhu ,&nbsp;Matthew P. Partain ,&nbsp;Ryan A. Bartholomew ,&nbsp;Krish Suresh ,&nbsp;Daniel J. Lee ,&nbsp;Michael S. Cohen","doi":"10.1016/j.amjoto.2025.104677","DOIUrl":"10.1016/j.amjoto.2025.104677","url":null,"abstract":"<div><h3>Objectives</h3><div>Type-1 tympanoplasty is a surgical procedure employed to repair the tympanic membrane, when ossicular reconstruction is not required. Historically, this was performed via a microscopic approach utilizing either a transcanal, endaural, or postauricular incision. Recently, there has been a growing shift toward the use of transcanal endoscopic ear surgery (TEES), eliminating the need for an endaural or postauricular incision. This study seeks to evaluate and compare outcomes between TEES and non-TEES type-1 tympanoplasty in a pediatric population, specifically tympanic membrane closure rates and post-operative audiometric results.</div></div><div><h3>Methods</h3><div>A retrospective review of all pediatric patients who underwent type-1 tympanoplasty at a tertiary care hospital between 2016 and 2020 was performed. Differences in tympanic membrane perforation closure rates and audiometric results between patients who underwent TEES vs. non-TEES were tested using Fisher's Exact and Mann-Whitney <em>U</em> tests. Logistic regression with stepwise selection and linear regression were used to compare factors among groups.</div></div><div><h3>Results</h3><div>118 patients underwent type-1 tympanoplasty (85 TEES, 33 non-TEES). Rate of closure was higher for patients who underwent TEES (91.76 %, 78/85) compared to non-TEES (69.7 %, 23/33) (Fisher's exact <em>p</em> = 0.006). Patients who underwent TEES had a greater reduction in post-operative PTA (median = −9 dB, IQR = −15 to −3 dB, <em>n</em> = 74) than those who underwent non-TEES (median = −5 dB, IQR = −11 to 3 dB, <em>n</em> = 31) (Mann Whitney <em>p</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>In the study population, closure rates and audiometric outcomes were superior in patients who underwent type-1 tympanoplasty using TEES compared to non-TEES.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104677"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131181","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":"Patient factors associated with tracheoesophageal prosthesis complications: A retrospective TriNetX study","authors":"Sandhya Ganesan ,&nbsp;Sofia A. Finestone ,&nbsp;Sana Smaoui ,&nbsp;Timothy Brandon Shaver ,&nbsp;Jennifer Schottler ,&nbsp;Punam Thakkar ,&nbsp;Arjun Joshi","doi":"10.1016/j.amjoto.2025.104681","DOIUrl":"10.1016/j.amjoto.2025.104681","url":null,"abstract":"<div><h3>Introduction</h3><div>Tracheoesophageal puncture (TEP) with voice prothesis placement is a common method for voice restoration following total laryngectomy (TL). This study aims to determine patient factors associated with the need for more frequent TEP changes and maintenance in addition to TEP-associated complications.</div></div><div><h3>Methods</h3><div>Patients who underwent TEP procedure were identified in the TriNetX Research Network. Cohorts were stratified by comorbidities, including diabetes, GERD, esophageal stricture, hypo/hyperthyroidism, tobacco and alcohol use, radiation history, and primary versus secondary TEP. Kaplan-Meier analyses assessed time to prosthesis change, and risks of complications, including fistula formation, local infection, prosthesis leak, aspiration pneumonia, and dysphagia, were calculated.</div></div><div><h3>Results</h3><div>Among 4145 patients identified, diabetes was associated with increased risk of prosthesis leak and dysphagia. Hypothyroidism, GERD, and esophageal strictures were linked to higher rates of fistula formation, infection, prosthesis leak, aspiration pneumonia, and dysphagia. Primary TEP was associated with increased fistula and infection rates compared to secondary TEP. Radiation and tobacco use were significantly associated with dysphagia, and tobacco and alcohol use with higher infection and aspiration risks. Average time to TEP change was 72 days. Patients with GERD (HR 1.17, 95 % CI [1.06–1.29]) and esophageal stricture (HR 1.13, 95 % CI [1.02–1.26]) required more frequent prosthesis changes.</div></div><div><h3>Conclusions</h3><div>Understanding factors that affect TEP function and longevity can help optimize patient selection for TEP following TL. Patients at increased risk for complications resulting in the need for more frequent TEP changes should be carefully counseled during the discussion of voicing options following TL.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104681"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168553","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":"Exploration of risk factors affecting hearing loss in patients with granulomatosis with polyangiitis: A single-center retrospective study","authors":"Chen Li ,&nbsp;Zhijin Han ,&nbsp;Mengyao Xie ,&nbsp;Qi Tang ,&nbsp;Shuyi Wang ,&nbsp;Zhiyuan Wu ,&nbsp;Shu Wang ,&nbsp;Hua Yang","doi":"10.1016/j.amjoto.2025.104679","DOIUrl":"10.1016/j.amjoto.2025.104679","url":null,"abstract":"<div><h3>Introduction</h3><div>Granulomatosis with polyangiitis (GPA) commonly affects the ears, leading to irreversible hearing loss and impacting patients' quality of life. This study aims to explore and summarize the risk factors associated with hearing loss in GPA patients, providing value for early diagnosis and improved prognosis.</div></div><div><h3>Materials and methods</h3><div>We collected information from patients during their hospitalization at this center from 2013 to 2023, including 19 patients with normal hearing and 89 patients with hearing impairment which is divided into four groups furtherly. Information on basic characteristics, laboratory tests, clinical manifestations, and treatment methods was collected. Initial univariate analysis was conducted for variable selection, followed by multivariate analysis to further verify if the selected factors are risk factors causing hearing impairment and to explore further.</div></div><div><h3>Results</h3><div>In different subgroups of hearing loss, it was found that age, levels of p-ANCA, ear involvement, eye involvement, and concurrent facial paralysis significantly exacerbate the level of hearing loss. Conversely, the levels of proteinase 3 anti-neutrophil cytoplasmic antibodies (PR3-ANCA), treatment with rituximab (RTX), and the level of hearing loss are negatively correlated. Through multifactor analysis, age, ear involvement, eye involvement, and facial palsy were identified as risk factors for more severe hearing loss. Furthermore, we analyzed the distribution of types of hearing loss in different severity groups and observed that the more severe the hearing loss, the higher the proportion of sensorineural hearing loss.</div></div><div><h3>Conclusion</h3><div>This study found that age, ear involvement, eye involvement, and facial palsy are four factors that contribute to irreversible hearing loss in patients with granulomatosis with polyangiitis (GPA). The occurrence of hearing loss in GPA patients appears to progress from conductive hearing loss to sensorineural hearing loss, indicating some mechanisms behind the hearing loss in GPA patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104679"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123583","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":"Comparison of tympanostomy tube insertion with and without radiofrequency ablation eustachian tuboplasty for treating chronic otitis media with effusion","authors":"Chao Fang,&nbsp;Jingfeng Wang","doi":"10.1016/j.amjoto.2025.104678","DOIUrl":"10.1016/j.amjoto.2025.104678","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to compare the effect and complication of tympanostomy tube insertion (TTI) alone and radiofrequency ablation (RFA) tuboplasty combined with TTI for the treatment of chronic otitis media with effusion (COME) with chronic eustachian tube dysfunction (CETD) in adult.</div></div><div><h3>Material and methods</h3><div>The patients with COME and CETD who met the inclusion criteria were allocated to TTI alone group and TTI + RFA tuboplasty group. Primary outcomes were tube retention success and total ETDQ-7score. Secondary outcomes were TT premature extrusion, recurrence, hearing improvement, perforation closure, and complications.</div></div><div><h3>Results</h3><div>The Tube retention success rates were 78.6 % in the TTI alone group and 95.2 % in the TTI + RFA group (<em>P</em> &lt; 0.05). Postoperative 6 months total ETDQ-7 score was significantly reduced in the TTI alone group and TTI + RFA group, whereas the total score in the TTI + RFA group was significantly lower than that in the TTI alone group (<em>P</em> &lt; 0.05). The TT premature extrusion rates were 21.4 % in the TTI alone group and 4.7 % in the TTI + RFA group (<em>P</em> &lt; 0.05). The OME recurrence rates in the TTI alone was significantly higher than that in the TTI + RFA group (21.4 % vs 2.4 %, P &lt; 0.05). Postoperative ET inflammation scale or IT hypertrophy grading significantly decreased in TTI + RFA groups (<em>P</em> &lt; 0.001), whereas scale in the TTI alone group had no significant change (<em>P</em> = 0.065). The complete aeration of the middle ear and mastoid rates in the TTI + RFA group was significantly higher than that in the TTI alone group after a followup period of 12 months (<em>P</em> = 0.040). Stenosis/scar of anterior-post wall in the ET orifice was seen in 3 patients in the TTI + RFA group.</div></div><div><h3>Conclusions</h3><div>TTI combined with RFA tuboplasty is effective and safe for COME in adult. Compared with simple TTI, application of RFA tuboplasty can effectively improve the tube retention and reduce the OME recurrence.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104678"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222026","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 machine learning approach to predicting postoperative recurrence in pediatric chronic rhinosinusitis: identification of key metabolic biomarkers","authors":"Shenghao Cheng,&nbsp;Sijie Jiang,&nbsp;Shaobing Xie,&nbsp;Benjian Zhang,&nbsp;Hua Zhang,&nbsp;Junyi Zhang,&nbsp;Zhihai Xie,&nbsp;Weihong Jiang","doi":"10.1016/j.amjoto.2025.104676","DOIUrl":"10.1016/j.amjoto.2025.104676","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric chronic rhinosinusitis (CRS) is a common chronic inflammatory disease with a high recurrence rate after surgery. This study aimed to construct and validate a machine learning-based predictive model to predict the risk of postoperative recurrence of pediatric CRS and to identify potential biomarkers.</div></div><div><h3>Methods</h3><div>One hundred and fifteen pediatric patients who underwent functional endoscopic sinus surgery were included. The dataset was divided into training and testing sets (7:3 ratio). Demographic characteristics and laboratory data of were collected and used as features in the predictive models. Eight machine learning algorithms, including Random forest (RF), were applied to construct predictive models. Feature selection was performed, and hyperparameters were optimized using a grid search with 10-fold cross-validation. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and F1 score.</div></div><div><h3>Results</h3><div>The Random Forest model performed best in predicting the postoperative recurrence of CRS in children, with AUC of 0.830. Feature selection analyses showed that metabolic markers, such as DBIL, Glu, and TBIL, had an important role in predicting CRS recurrence. In the test set, the AUC of the RF model reached 0.864 and an F1 score of 0.9, showing good stability and generalization ability.</div></div><div><h3>Conclusion</h3><div>In this study, we successfully constructed a model to predict the postoperative recurrence of pediatric CRS. The predictive model indicated that key metabolites were significantly associated with disease outcomes, and individualized management of postoperative pediatric CRS.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104676"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069773","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":"Enhanced recovery in unilateral vestibular hypofunction: The synergistic effect of medication and vestibular rehabilitation training","authors":"Hanyue Zhu ,&nbsp;Jianbin Li ,&nbsp;Liheng Li ,&nbsp;Qingyin Zheng ,&nbsp;Jianchu Wei","doi":"10.1016/j.amjoto.2025.104675","DOIUrl":"10.1016/j.amjoto.2025.104675","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare the efficacy of medication combined with personalized vestibular rehabilitation training (VRT) versus medication alone in unilateral vestibular hypofunction (UVH) and identify predictors of long-term symptom progression.</div></div><div><h3>Methods</h3><div>Forty-eight UVH patients were randomized into a VRT group (<em>n</em> = 23, medication combined with personalized VRT) and a control group (<em>n</em> = 25, medication alone). Bithermal caloric tests, Dizziness Handicap Inventory (DHI), Vestibular Rehabilitation Benefit Questionnaire (VRBQ), Visual Analog Scale (VAS), Activities-specific Balance Confidence Scale (ABC), and Self-Rating Anxiety Scale (SAS) were assessed at baseline, 2 weeks, and 4 weeks. Symptom progression was tracked over 6 months post-intervention.</div></div><div><h3>Results</h3><div>Both groups improved significantly (<em>P</em> &lt; 0.05), but the VRT group showed faster unilateral weakness (UW) reduction (30.43 % vs. 43.20 % at 4 weeks, <em>P</em> = 0.012) and greater symptom relief (DHI: 6.70 vs. 23.68, <em>P</em> &lt; 0.001). Logistic regression identified abnormal UW (≥ 25 %) as an independent predictor of symptom recurrence (OR = 7.237, 95 % CI:1.43–36.58, <em>P</em> = 0.017), while DHI scores showed no significant association (<em>P</em> = 0.925).</div></div><div><h3>Conclusion</h3><div>Personalized VRT combined with medication accelerates symptom resolution and vestibular recovery compared to medication alone. Persistent abnormal caloric results, even with symptom relief, indicate a need for extended treatment and active lifestyle maintenance to mitigate recurrence.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104675"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089080","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}