Otolaryngology Research Articles

Does acute isolated sphenoidal sinusitis meet the criteria of the recent acute sinusitis guidelines, EPOS2020?

Isolated sphenoidal sinusitis (ISS) is a rare disease with non-specific symptoms and a potential for complications. Diagnosis is made clinically, endoscopically, and with imaging like CT scans or MRIs. This study aimed to evaluate if ISS meets the EPOS 2020 criteria for diagnosing acute rhinosinusitis and if new diagnostic criteria are needed. The study analyzed 193 charts and examination records from 2000 to 2022 in patients diagnosed with isolated sphenoidal sinusitis at the Ziv Medical Center in Safed, Israel. Of the 193, 57 patients were excluded, and the remaining 136 patients were included in the final analysis. Patients were evaluated using Ear, Nose and Throat (ENT), neurological and sinonasal video endoscopy, radiological findings, demographic data, symptoms and signs, and laboratory results. All these findings were reviewed according to the EPOS 2020 acute sinusitis diagnosis criteria and were analyzed to determine if ISS symptoms and signs fulfilled them. The patients included 40 men and 96 women, ranging in age from 17 to 86years (mean ± SD, 37 ± 15.2years). A positive endoscopy and radiography were encountered in 29.4%, and headache was present in 98%; the most common type was retro-orbital headache (31%). The results showed that there is no relationship between the symptoms of isolated sphenoidal sinusitis and the criteria for diagnosing acute sinusitis according to EPOS 2020. ISS is an uncommon entity encountered in clinical practice with non-specific symptoms and a potential for complications. Therefore, the condition must be kept in mind by clinicians, and prompt diagnosis and treatment must be initiated. This kind of sinusitis does not fulfill the standard guidelines for acute sinusitis diagnosis criteria.

P-83 Primary thyroid lymphoma presented with hypercalcemia and rapidly growing neck mass

Abstract Introduction Primary thyroid lymphoma is an uncommon malignancy, accounting for 1% to 2% of extranodal lymphomas and 1% to 5% of thyroid malignancies. Large B-cell lymphoma is the most prevalent form of primary thyroid lymphoma. Here, we present a patient with hypercalcemia and a rapidly growing neck lesion who was diagnosed with diffuse large B-cell lymphoma of the thyroid gland. Clinical Case A 75-year-old patient presented to the emergency room with loss of appetite and decreased oral intake over the previous five days, as well as abdominal pain and inability to pass gas and feces. The nausea and vomiting symptoms began simultaneously with the abdominal discomfort. Inspection revealed a distinct, palpable, and erythematous mass in the patient's neck, which the patient reported developing within the previous three months. After noticing the growing mass and consulting her primary care physician, she was referred to an ENT specialist; a biopsy was conducted and the results were pending. Her preliminary laboratory results revealed hypercalcemia and renal failure with depressed parathyroid hormone levels. The following were the initial laboratory results: creatinine 2,14 mg/dL, Ca 13,5 mg/dL, Albumin: 4,2 g/dL, P 2,9 mg/dL, Mg:1 mg/dl, parathormone 11.6 ng/dL procalcitonin 0.04% ng/mL and hemoglobin 10.2% g/dl. Abdominal CT revealed a contracted gallbladder with stone formations in the lumen, but no other abnormalities. The patient was admitted to the internal medicine ward with an initial diagnosis of hypercalcemia and prerenal acute kidney failure as a result of decreased oral intake. The patient's hypercalcemia was determined to be PTH-independent, and malignancy was suspected due to a 4-month history of progressive neck lesion. The thyroid gland was 49×40×87mm in the right and 38×40×62mm in the left, and the isthmus was 50mm thick with lobulated outlines on contrast enhanced cervical MR. The signal intensity of parenchyma was heterogeneous. 18F-FDG PET/CT uncovered a bilateral, distinct increase in the size of the thyroid gland with protrusions to the hyoid bone in superior sequences. The solid mass was found to have diffusely increased FDG uptake and a hypermetabolic pattern, both of which are indicative of malignant characteristics. The lesions encompass the trachea and there are reports of invasion of the cricoid cartilage and thyroid cartilage. A second main malignant disease concern was raised when small intestine FDG uptake and wall thickening suggested malignancy. The patient was re-evaluated by the endocrinology clinic, and additional workup tests were ordered due to the suspicion of Riedel Struma, which was based on the control sedimentation rate of 93 mm/h and the firmness of the gland upon palpation. An open surgical biopsy was performed. The pathology report concluded that it is consistent with diffuse large B-cell lymphoma that is CD20-positive. The hematology department has scheduled chemotherapy treatment for the patient.

Detection of Helicobacter pylori using Giemsa staining in chronic tonsillitis patients: cross-sectional study

BackgroundHelicobacter pylori (H. pylori) is a well-known bacteria that is recognized as the most prevalent infection in humans and is present in the majority of people in the world.AimTo investigate the presence of an extragastric reservoir of Helicobacter pylori in tonsillectomy specimens to ascertain whether it is an etiologic factor in the development of chronic tonsillitis.Subjects and methodsThe study included 100 patients of both sexes with chronic tonsillitis who visited the ENT (ear, nose, and throat) outpatient department and tested positive for H. pylori antigen in stool and tonsillectomy materials. Giemsa stain was used. The population was patients with chronic tonsillitis who had been diagnosed based on physical examination and history-taking at the (Oto-Rhino-Laryngology) outpatient clinic.ResultsIt is shown that patients with positive H. pylori had considerably more acute tonsillitis attacks per year than those with negative H. pylori. Examining the patients with Giemsa modification staining revealed 40% of them to be positive.ConclusionH. pylori was found in the tonsil tissue of 40% of the patients with chronic tonsillitis using the Giemsa modification staining method, suggesting that H. pylori may be contributing etiologic factors in the development of chronic tonsillitis.

Management and clinical features of extranodal tuberculosis: About 7 cases

Extranodal tuberculosis is a rare pathology in ear nose and throat (ENT) sphere. It remains a worldwide health problem despite the development seen.

Patient journey in gastroesophageal reflux disease: real-world perspectives from Italian gastroenterologists, primary care physicians, and ENT specialists.

Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs. We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs. Retrospective observational study. A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated. A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the highest negative impact on quality of life (p < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs. Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey

BackgroundAcute peripheral facial paralysis may be diagnosed and treated by different specialists. ObjectiveThe aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. MethodsAn anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). Results1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). ConclusionThere is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

A Virtual Reality Anatomy Model of the Temporal Bone in ORL Residency Training-Gain or Gadget?

Virtual reality (VR) appears to be a promising educational tool for otorhinolaryngology (ORL) residency training, as it allows for safe and effective practice immediate feedback and potential improvements in patient outcomes. Despite these advantages, VR has not yet been incorporated into residency training in ORL, which may be due to limited availability or validation and skepticism toward incorporation of new training methods. This study investigates whether a VR model of the temporal bone improves learning success for ORL residents in comparison to standard plastic models and whether it depends on surgeon's experience. We also included a subjective evaluation of the learning experience with both models. ORL residents and specialists at 2 German university hospitals were tested on their knowledge of temporal bone anatomy after training with either VR or standard plastic models. In addition, we compared knowledge of the temporal bone anatomy before- and after-VR training. Lastly, a subjective survey on the benefits and limitations of VR was conducted to assess participants' views on this new technology. About 85% of the participants considered VR to be better than conventional models and agreed that VR was a useful tool for teaching complex anatomy. Objective evaluation showed significant improvement in knowledge after using VR (before/after comparison), especially in participants with a higher level of preexisting knowledge. Direct comparison to conventional plastic models showed no superiority of the VR model. VR models in ORL are not only appealing and motivating for residents, but also objectively improve their anatomical knowledge, especially in advanced residency. In addition, VR-in contrast to the plastic model-offers opportunities for further development and optimization.

A novel framework for quantitative rhinoplasty evaluation by ResNet convolutional neural network

Rhinoplasty is a popular surgical operation, so proposing trustworthy assessment methods is crucial. Previous studies often utilized traditional or non-automatic methods for rhinoplasty evaluation, overlooked the aesthetic harmony of the nose with other facial features, and provided limited descriptions of facial beauty without detailed explanations. To address these limitations, we have developed a deep learning-based system for quantitative and qualitative facial beauty assessment and rhinoplasty results based on the random preoperative and postoperative color photographs of 376 patients, differentiating male and female faces. The quantitative evaluation includes automatically extracting 3D facial key points from frontal and lateral views, developing a novel mathematical 3D facial model, applying seven criteria from rhinoplasty literature, and assigning related scores. The qualitative evaluation comprises the design of a questionnaire, the extraction of facial features using a unique CNN-based algorithm, and the assignment of scores based on the questionnaire's results. Our method calculates the success percentage of rhinoplasty and provides precise and comprehensive quantitative and qualitative beauty scores. The accuracy of the proposed facial feature extraction network is 71 %, which is considered acceptable according to the complexity of defining beauty and the novelty of this work. All procedures and outcomes are verified by an ENT (Ear, Nose, and Throat) specialist. In particular, based on the presented extensive tables and histograms, some patients have lower postoperative scores than preoperative ones in some instances, which caused negative success scores. For this reason, individuals' appearance may occasionally worsen following rhinoplasty instead of improving. Therefore, preoperative assessments of facial features are crucial, and our proposed system facilitates this process. Our research also impacts individual self-assessment and surgeons' awareness significantly.

Otorhinolaryngological (ORL) and Cervicofacial Injuries Resulting from Road Accidents within the Otorhinolaryngology (ORL) Department of the Regional Hospital of Mamou

Otorhinolaryngological (ORL) and Cervicofacial Injuries Resulting from Road Accidents within the Otorhinolaryngology (ORL) Department of the Regional Hospital of Mamou

Post Graduate Program of ORL in Pakistan

Otorhinolaryngology (ORL) plays a crucial role in healthcare addressing variety of conditions affecting head and neck. Globally, various postgraduate training programs are in vogue for ORL training aimed for patient and population needs. Like other countries, in Pakistan, the quality of postgraduate training of ORL significantly impacts the standard of patient care services. The perception of postgraduate trainees about satisfactory learning and evaluation process has significant impact on achieving goals.

A Critical Analysis of CTRI Registered Ayush Studies for Oral Submucous Fibrosis with special reference to Sarvasara Mukharoga .

Introduction The mouth is an anatomically complex space comprising of structures of different natures and functions including buccal mucosa. The diagnosis and treatment of mucosal lesions of the mouth, including the gums, always remain challenging for most ENT specialists and dentists because of the vast array of conditions presenting with similar-appearing lesions. Oral submucous fibrosis is a chronic debilitating condition of the oral cavity that progresses to fibrosis of the submucosal tissues and inflammation. Many clinical trials are registered with CTRI in the AYUSH system, giving the opportunity and future direction to study the AYUSH interventions in detail. Materials method All clinical trials registered with CTRI are searched using keywords like Sarvasara / Mukhapaka / Oral Submucous Fibrosis. Apart from these, AYUSH/ Ayurveda / Naturopathy / Siddha / Unani / Homoeopathy / Nutraceuticals / Dentistry in different stages and blends were also searched. These results were analyzed and presented in terms of general characteristics of the study, preventive trials, recovery trials, etc. Results There are a total of 40 studies which were analyzed. Most of these studies are registered from the Ayurveda stream [n-23], and recovery studies are more of a primary aim [n-36]. AYUSH study settings were utilized in 22 studies, and Government agencies sponsored studies are 18. Single-site studies are more in Ayurveda [n-39]. Conclusion The present review is an attempt to analyze the CTRI-registered OSMF clinical trials, which show the general characteristics of trials along with study design and setups. The contribution of AYUSH can be highlighted through this review compared to the dentistry branch for studying OSMF.

Ab. No. 15 Efficacy of ADL-Based Dynamic Postural Stability Exercises After Canalith Repositioning Maneuver in Benign Paroxysmal Positional Vertigo Patients

Introduction: CRP produces short-term effects, not sufficient to reactivate postural control in BPPV. Most studies prescribe balance training which is not well incorporated with ADL activities. Hence, this study aimed to find out the effectiveness of ADL-based dynamic postural stability exercises. Benign paroxysmal positional vertigo is a common peripheral vestibular disorder. Canalith repositioning manoeuvre is considered to be the gold standard method of treatment. Even after CRP 2/3rd of patients has postural instabilities, especially in dynamic conditions such as walking, sitting to standing, and in performing daily activities, which was not given attention in studies and treatment programs. Methods: 100 BPPV patients (50 each in interventional and control group) aged between‹18–60 years, positive for Dix Hallpike test/supine roll test confirmed by an ENT specialist and treated with CRP by random sampling. All patients were evaluated by the Berg balance scale, POMA (gait scale), and Dizziness Handicap Inventory on the third day of CRP. The control group received CRP with conventional balance training whereas the interventional group received ADL-based dynamic postural stability exercises (with more challenging environments involving various sensory inputs with postural strategies) along with CRP for 2 weeks. Data was analyzed using SPSS version 23; the Mann-Whitney U test (between group analysis) and Wilcoxon Signed Rank test (within group analysis) were used. Result: In the interventional group, there was greater improvement in balance in dynamic conditions, functional ability, and reduction in dizziness (p value‹0.05) in ADL activities. Conclusion: ADL-based exercises are beneficial for the improvement of balance, reduction in dizziness, and improving functional activities after CRP in BPPV patients. As this postural instability/residual dizziness has an impact on ADL in BPPV patients even after CRP, if untreated may lead to compensatory strategies that delay functional recovery. Hence, this instability period should be managed with ADL-based dynamic postural stability exercises.

PERIPHERAL FACIAL PARALYSIS: BENEFIT OF EARLY TREATMENT, A RETROSPECTIVE STUDY ABOUT 47 CASES

Introduction: Peripheral facial paralysis is a relatively common pathology which concerns both the general practitioner and the ENT specialist, the ophthalmologist, the neurologist and the pediatrician. The difficulty in therapeutic management lies in the lack of randomized and controlled studies. The functional and aesthetic after-effects can be the source of psychological suffering. Material and method: This is a retrospective study, carried out within the ENT and CCF department of the Avicenne Military Hospital in Marrakech over a period of 5 years from January 2016 to December 2020. Data collection was carried out from the medical records of 47 patients hospitalized in the department during the study period. The texts were entered using the MICROSOFT OFFICE WORD2007 software and the graphics were entered using the MICROSOFT OFFICE EXCEL 2007 software. Results: The age of our patients varied between 10 to 69 years, with a clear predominance of the age group of 45-60 years and an average age of 42 years, the majority of these patients, i.e. 87% were male. The monthly distribution showed a greater frequency in Winter. As for the antecedents, diabetes is the most common (34% of cases) followed by recurrence of PFP in 17% of cases. Regarding the severity diagnosis, the majority of our patients had stage IV (45% of our PFP). Although the etiologies are multiple, in our study, refrigerated PFs dethroned them with more than 68% of cases, followed by herpetic PFs which were recorded in 11% of cases. As for the pick-up time, it is 55.3% in the first three days, and fortunately so. The bases of therapy were corticosteroid therapy and facial physiotherapy. Regarding the evolution of our patients, 35 cases had a complete recovery, 9 patients had an incomplete recovery including 3 with synkinesias and spasms and 3 cases did not recover. Our results showed that this same good development is correlated with the precocity of treatment. Conclusion: PFPs are certainly often benign, they always require rapid and appropriate treatment. This pathology unfortunately causes functional, aesthetic and undoubtedly psychological after-effects requiring continuous long-term monitoring.

Transoral laser microsurgery for supraglottic carcinomas: results of a prospective multicenter trial (SUPRATOL).

A limited number of single institutions have published retrospective cohort studies on transoral laser microsurgery for supraglottic laryngectomy (TLM-SGL). These studies have shown that the oncologic outcomes of TLM-SGL are comparable to those of open SGL. However, there is limited information available regarding swallowing rehabilitation and quality of life (QoL). SUPRATOL is a prospective, multicenter trial assessing the functional outcomes of TLM-SGL +/- adjuvant radio-(chemo)-therapy. The primary endpoint was aspiration-free swallowing at 12 months, as established using fibreoptic endoscopic evaluation of swallowing (FEES) and defined as a grade < 6 on the penetration-aspiration scale. Secondary endpoints were swallowing- and voice-related QoL, the prevalence of temporary and permanent tracheostomy and percutaneous gastrostomy, local control, laryngectomy-free survival, overall survival, and disease-free survival, as well as the influence of treatment centers on outcomes. From April 2015 to February 2018, 102 patients were recruited from 26 German Otorhinolaryngology (ORL) hospitals. All patients had TLM-SGL and 96.1% underwent uni- or bilateral, mostly selective neck dissection. To 47.0% of patients, adjuvant radio-(chemo)-therapy (R(C)T) was administered. The median follow-up period was 24.1 months. At 12-month follow-up, completed by 84.3% of patients, 98.2%, 95.5%, and 98.8% were free of aspiration when tested with saliva, liquid, or pulp. Adjuvant R(C)T, pT category, and type of resection had no significant influence on swallowing rehabilitation. A total of 40.2% of patients had been tracheotomized, and in 46.1% of patients, a PEG tube was inserted. At the 24-month follow-up, 5.3% of patients still required a tracheostomy, and 8.0% continued to use a percutaneous endoscopic gastrostomy (PEG) tube. Deterioration of swallowing- and voice-related QoL was observed immediately after treatment, but patients recovered, and baseline values were reached again. The Kaplan-Meier 2-year rates for local control, laryngectomy-free survival, overall survival, and disease-free survival were 88%, 92%, 93%, and 82%, respectively. Our prospective multicenter trial shows that, at 12 months post-TLM-SGL +/- R(C)T, 95.5%-98.8% of patients achieved aspiration-free swallowing. Morbidity was higher than previously reported. The rates of permanent tracheostomy and gastrostomy tube placement correspond to previous cohort studies. The 2-year oncologic outcomes are within the reported range. https://drks.de/search/en/trial/DRKS00004641, identifier (DRKS00004641).

Effects of remote ear-nose-and-throat specialist assessment screening on self-reported hearing aid benefit and satisfaction

Objective To explore the impact of remote versus in-person ear-nose-and-throat (ENT) specialist screening before hearing treatment on self-reported hearing aid (HA) benefit and satisfaction among adult first-time HA users. Design Participants were randomised to either remote or in-person ENT assessment before treatment initiation. Hearing ability, hearing quality, and treatment satisfaction were assessed pre- and post-HA treatment using the SSQ12, IOI-HA, and selected items from the 2021 Danish national Patient-Reported Experience Measures. Average daily HA usage was also recorded. Study sample 751 adult potential first-time HA users with self-reported hearing impairment were included; 501 participants were remotely assessed in private or public audiological clinics, and 250 control group participants were assessed in-person by private ENT specialists. Of the 658 participants who completed the entire trial, 454 received HAs. Results No significant post-treatment HA benefit differences were found between groups. Remotely assessed HA recipients in private clinics expressed slightly higher staff and waiting time satisfaction. Participants with normal hearing and mild/moderate hearing loss reported higher pre-treatment hearing ability and quality. No significant difference in average daily HA usage was observed between groups. Conclusions Findings suggest that remote screening does not compromise patient-reported HA benefit and satisfaction when compared to in-person screening.

Diagnosis dan Penatalaksanaan Penyakit Meniere

ABSTRACT&#x0D; Background: Meniere's disease is the third leading cause of vertigo after Benign Paroxysmal Positional Vertigo and vestibular neuritis. Meniere's disease is also known as endolymphatic hydrops. Acute symptoms of Meniere's disease are characterized by triad of vertigo, tinnitus and hearing loss. This disease is a challenge for ENT specialist in making a diagnosis and determining the right and optimal management. Objective: Provides knowledge about the diagnosis and management of Meniere's disease, so that it can be handled appropriately. Literature Review: Meniere's disease is an inner ear disorder characterized by spontaneous vertigo attacks, fluctuating low-tone sensorineural hearing loss, aural fullness and tinnitus. The most consistent finding and still being used as the basic mechanism of Meniere's disease to date is the discovery of endolymphatic hydrops. Diagnostic tests to diagnose Meniere's disease include audiometry, glycerol test, caloric test and electrocochleography. Meniere's disease can significantly affect quality of life and generally managed with dietary modifications such as a low-salt diet, medical therapy such as diuretics and surgery such as intratimpani injection and endolymphatic sac surgery. Conclusion: Meniere's disease is characterized by a triad of vertigo symptoms, low-tone sensorineural hearing loss and tinnitus. Making the diagnosis requires a detailed history with a complete audiology and vestibular examination. The management of Meniere's disease consists of dietary modifications, medical therapy and surgery.&#x0D; Keywords: meniere’s disease, endolymphatic hydrops, diuretics, intratimpani injection, endolymphatic sac surgery

CHARACTERISTICS OF ACQUIRED OBSTRUCTION OF LACRIMAL PATHWAYS IN PATIENTS WITH CHRONIC TYPE 2 DIABETES AND COMBINED CONSERVATIVE AND SURGICAL TREATMENT INVOLVING ENT SPECIALISTS

Pathological changes in the lacrimal system such as dry eye syndrome in patients with diabetes are well described in modern literature, but no sufficient attention is paid to the problem of the lacrimal system in this group of patients. Currently, the established protocol for treating chronic dacryocystitis involves collaborative endoscopic endonasal dacryocystorhinostomy conducted by ophthalmic surgeons and ENT specialists. However, in patients with type 2 diabetes, there is a need to investigate the clinical effectiveness of this surgical approach.&#x0D; Purpose of this study is to evaluate the effectiveness of conservative and surgical treatment in patients with chronic dacryocystitis depending on the presence of type 2 diabetes and to determine the features of the postoperative period.&#x0D; Materials and methods. The study included 30 patients with chronic dacryocystitis and type 2 diabetes (main group) and 30 patients with chronic dacryocystitis without diabetes (control group), who underwent endoscopic endonasal dacryocystorhinostomy according to the standard technique. The results of the operation were evaluated in 2 months, 6 months and 2 years following the surgical interventions.&#x0D; Endoscopic endonasal dacryocystorhinostomy was considered as an effective technique for restoring unobstructed lacrimal drainage when it lead to the alleviation of tearing, and preventing re-infection of the lacrimal sac. Alongside conventional ophthalmological examinations, the assessment involved nasopharyngeal and lacrimal suction tests, reflux tests, lacrimal duct lavage, lacrimal canal probing, computer tomography, and endoscopic examination of the nasal cavity.&#x0D; Results and discussion. The effectiveness of surgical treatment in 2 months after the operation in patients of the main group (70% of patients) was 1.3 times, after 6 months (63.3% of patients) was 1.4 times, and in the remote period in 2 years (50% of patients) was 1.6 times lower than in patients of the control group (р&lt;0.05). Analyzing the presence of the main symptoms of chronic dacryocystitis in the dynamics of observation, it was noted that after endoscopic endonasal dacryocystorhinostomy the most frequent symptom was lacrimation, but its frequency in patients of the main group after 2 months (30% of patients) was 4.5 times, after 6 months (36.7% of patients) - 2.8 times, after 2 years (50% of patients) - 2.5 times higher than in patients of the control group (р&lt;0.05 ).&#x0D; The efficacy of surgical treatment's in 2 month following the operation in the main group patients (70%) was 1.3 times, after 6 months (63.3%) was 1.4 times, and in the long-term, 2 years post-operation (50%), was 1.6 times lower than in the control group patients (p&lt;0.05). Analyzing the dynamics of chronic dacryocystitis symptoms during observation, it was observed that following endoscopic endonasal dacryocystorhinostomy, lacrimation emerged as the most common symptom. However, its frequency in the main group patients was notably higher after 2 months (30%), being 4.5 times, after 6 months (36.7%) it was 2.8 times higher, and after 2 years (50%) it was 2.5 times higher compared to the control group (p&lt;0.05).&#x0D; Conclusions. In patients with type 2 diabetes, the clinical effectiveness of conservative and surgical treatment for chronic dacryocystitis is lower than in patients without diabetes, and the postoperative period has its own characteristics.

Comparative Analysis of Various Materials Used for Mastoid Cavity Obliteration in Canal Wall Down Mastoid Surgery.

To study the surgical result and efficacy of different methods of mastoid obliteration with cavity care. This prospective study included 60 patients who had cholesteatoma, conducted in the Department of Ear Nose and Throat (ENT), Institute of Medical Sciences, Banaras Hindu University, Varanasi from July 2015 to July 2017. The mastoid cavity was obliterated with either muscle flap/bone dust/hydroxyapatite. detailed history otoscopic examination was done pre-operatively and follow up were recorded at 1month and 3months in postoperative period. 60 patients were included, who underwent canal wall down mastoid surgery. each group muscle flap (group 1), bone dust (group 2) and hydroxyapatite (group 3) included 20 patients, age group 31-40year with its maximum incidence of 43.3%, Preop PTA value were almost equal in all group but on comparison at 1month in postoperative period significant improvement was present in group 1 versus 2(0.021) and group 2 versus 3(0.003) but not in group 1 versus 3. Although at 3month there were significant improvement was present in all groups. The incidence of pain, discharge, giddiness and wax formation were markedly reduced and healing of cavities was early and better in obliterated cavities done by muscle flap and bone dust material as compared to hydroxyapatite cavities, at the end of 3months. outcome and quality of life was better and almost equal in muscle flap and bone dust material group as compared to hydroxyapatite group.

Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children.

The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM). We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years. Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001). Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.

ChatGPT Versus Consultants: Blinded Evaluation on Answering Otorhinolaryngology Case-Based Questions.

Large language models (LLMs), such as ChatGPT (Open AI), are increasingly used in medicine and supplement standard search engines as information sources. This leads to more "consultations" of LLMs about personal medical symptoms. This study aims to evaluate ChatGPT's performance in answering clinical case-based questions in otorhinolaryngology (ORL) in comparison to ORL consultants' answers. We used 41 case-based questions from established ORL study books and past German state examinations for doctors. The questions were answered by both ORL consultants and ChatGPT 3. ORL consultants rated all responses, except their own, on medical adequacy, conciseness, coherence, and comprehensibility using a 6-point Likert scale. They also identified (in a blinded setting) if the answer was created by an ORL consultant or ChatGPT. Additionally, the character count was compared. Due to the rapidly evolving pace of technology, a comparison between responses generated by ChatGPT 3 and ChatGPT 4 was included to give an insight into the evolving potential of LLMs. Ratings in all categories were significantly higher for ORL consultants (P<.001). Although inferior to the scores of the ORL consultants, ChatGPT's scores were relatively higher in semantic categories (conciseness, coherence, and comprehensibility) compared to medical adequacy. ORL consultants identified ChatGPT as the source correctly in 98.4% (121/123) of cases. ChatGPT's answers had a significantly higher character count compared to ORL consultants (P<.001). Comparison between responses generated by ChatGPT 3 and ChatGPT 4 showed a slight improvement in medical accuracy as well as a better coherence of the answers provided. Contrarily, neither the conciseness (P=.06) nor the comprehensibility (P=.08) improved significantly despite the significant increase in the mean amount of characters by 52.5% (n= (1470-964)/964; P<.001). While ChatGPT provided longer answers to medical problems, medical adequacy and conciseness were significantly lower compared to ORL consultants' answers. LLMs have potential as augmentative tools for medical care, but their "consultation" for medical problems carries a high risk of misinformation as their high semantic quality may mask contextual deficits.