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This systematic review aims to synthesise findings from randomised, controlled trials and assess the efficacy and safety of radiofrequency ablation in treating allergic rhinitis.
Methods
A thorough search was conducted across PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, Chinese Scientific Journal, and Chinese Biomedical Literature databases from their inception until October 2023. The primary outcome measure was the total effective rate, with secondary outcomes including adverse events.
Results
This review included 15 randomised, controlled trials involving 1430 patients. The pooled analysis revealed a statistically significant effect on the total effective rate (odds ratio = 3.27, 95 per cent confidence interval = 2.37 to ~4.51). However, no statistical significance was observed in adverse events (odds ratio = 1.18, 95 per cent confidence interval = 0.67 to ~2.08).
Conclusions
Based on the analytical results, radiofrequency ablation emerges as an efficacious and safe treatment modality for allergic rhinitis. Given the constraints posed by a limited sample size, it is imperative that forthcoming clinical trials adhere rigorously to the gold standard of randomised, controlled trials for the purpose of corroborating these conclusions.
Dysphagia can lead to morbidity including weight loss and aspiration pneumonia. Effective triage of patients and streamlining of pathways to expedite diagnosis and treatment is therefore imperative.
Objectives
The goals of this research were to measure the referral to treatment time for dysphagia patients in a newly established pathway and compare with existing UK national and local referral to treatment times, and to evaluate patient feedback.
Methods
Speech and language therapy advanced clinical practitioners were trained in nasendoscopy and assessment of swallow. Referral to treatment times were measured and patient satisfaction questionnaires completed.
Results
A decrease in triage to treatment time (from 24 to 6 weeks). Patients reported high understanding of the condition and minimal discomfort during assessments. Radiation exposure was reduced (2 per cent of patients undergoing soluble contrast swallows, previously 100 per cent).
Conclusion
The new pathway expedites treatment and achieves high patient satisfaction. It empowers speech and language therapy in efficiently managing low-complexity cases and supports multidisciplinary care for dysphagia patients.
Recurrent respiratory papillomatosis is a rare disease characterised by growth of papilloma within the respiratory tract. The disease course is variable but can require frequent surgical interventions alongside adjuvant medical treatments. There is no definitive curative treatment or gold-standard guidelines for management. We aimed to evaluate current and potential future adjuvant treatments and propose a management guideline for adult patients.
Methods
Relevant articles were identified through searching databases, reference lists and grey literature.
Results
Systemic bevacizumab appears to be the most effective adjuvant treatment currently available. However, intralesional cidofovir also achieves a high complete-response rate in adults and the Gardasil vaccine demonstrates preventative and therapeutic value. The INO-3107 DNA vaccine is a promising potential future adjuvant treatment.
Conclusions
This review provides a detailed examination of current and potential future adjuvant treatments. Based on the literature, we have developed a management guideline for adult patients with recurrent respiratory papillomatosis.
This study evaluated the relationship between frontal pain as a symptom in chronic frontal sinusitis and radiological and endoscopic findings, quality of life and disease severity. The aim was to determine its utility as a marker in chronic frontal sinusitis and in surgical decision-making.
Method
This was a prospective study of 51 consecutive patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Patients ranked their frontal pain score on a numerical rating scale from 0 to 10. Facial pain or pressure, Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation score, Lund–Mackay score and modified Lund–Kennedy score were also collated. Statistical analysis was performed using analysis of variance and Pearson correlation coefficient.
Results
Frontal pain scores were low and demonstrated no correlation with the extent of frontal sinus disease radiologically or the severity of overall sinus disease endoscopically. Higher frontal pain scores significantly correlated with poorer quality-of-life.
Conclusion
This study does not support the use of frontal pain as a sensitive or specific marker of chronic frontal sinus disease.
Temporal bone osteoradionecrosis is a rare but significant complication of radiation for head and neck malignancies. Various management techniques have been described, but no clear protocol exists.
Methods
A retrospective case review of patients with temporal bone osteoradionecrosis managed over 15 years was carried out to highlight multidisciplinary team (MDT) management. The review findings were compared with the published literature and a protocol was derived for the management of future cases.
Results
A total of 20 patients were included. The sites of osteoradionecrosis included the external auditory canal, the middle ear and the lateral skull base, presenting with features including recalcitrant pain, infection, neuropathies and intracranial sepsis. Treatments included hyperbaric oxygen, antibiotics, debridement and, in advanced cases, lateral temporal bone resection with vascularised tissue transfer. Post-operative and long-term outcomes were discussed.
Conclusion
Early temporal bone osteoradionecrosis may be managed conservatively. Refractory osteoradionecrosis can be life-threatening because of intracranial complications and sepsis. Such cases need an MDT approach with radical skull-base surgery for removal of necrotic foci and reconstruction using vascularised tissue transfer.
Our centre (Freeman Hospital, Newcatle Upon Tyne NHS Trust) has favoured primary surgery over chemoradiotherapy for specific advanced laryngeal cancer patients (e.g. large-volume tumours, airway compromise, significant dysphagia, T4 disease). This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management to determine whether this approach improves survival.
Method
Retrospective analysis of patient data over a seven-year period from a tertiary cancer centre.
Results
In total, 121 patients were identified with T3 (n = 76) or T4 (n = 45) laryngeal cancer (mean follow up 2.9 years). In the cohort treated with curative intent (n = 104, 86.0 per cent), the 2- and 5-year estimated disease-specific survival rates were 77.9 and 64.1 per cent. chemoradiotherapy had the highest 2-year disease-specific survival (92.5 per cent), followed by surgery with adjuvant therapy (81.8 per cent), radiotherapy alone (75 per cent) and surgery alone (72.4 per cent).
Conclusion
For a centre favouring primary surgery for certain advanced laryngeal cancers, the disease-specific survival appears no higher than that found in the published literature. To enhance survival, future research should focus on precision medicine to define treatment pathways in this disease.
This retrospective study comprehensively assesses clinical characteristics, management, outcomes, and complications of deep neck space infections in adults at a UK ear, nose and throat tertiary centre.
Methods
Adult deep neck space infection patients from April 2019 to March 2021 were retrospectively reviewed using health records and picture archiving and communication system data. Demographics, presentation, microbiology, treatment, complications, and outcomes were analysed.
Results
Fifty-three patients (mean age: 53.8 years, M:F ratio 1.5:1) were studied. Deep neck space infections were polymicrobial in 29.4 per cent, with Streptococcus milleri group (64.7 per cent) occurring most frequently. Complications occurred in 20.8 per cent, including mediastinitis (13.2 per cent) and Lemierre's syndrome (7.5 per cent). Mortality was 5.7 per cent. Treatment included intensive care admission (32.1 per cent), tracheostomy (15.1 per cent), medical management alone (39.6 per cent), bedside peritonsillar abscess drainage (18.9 per cent), transcervical drainage (28.3 per cent), transoral drainage (13.2 per cent), and hot tonsillectomy (5.7 per cent). Patient age correlated with length of stay.
Conclusion
The study highlights deep neck space infection complexity, emphasising tailored management, effective antibiotics, and frequency and severity of complications. Comprehensive understanding of deep neck space infections can improve care and outcomes.
This study aimed to determine if a history of tinnitus is associated with the risk of developing dementia.
Method
A nationwide population-based case–control study including all eligible adults in Taiwan.
Results
A total of 15 686 patients were included in the study, with 7843 individuals making up each of the case and control groups. Patients with a history of tinnitus were associated with a statistically significant higher risk of being diagnosed with dementia before reaching 65 years old (50 years ≤ age <65 years) (adjusted odds ratio 2.68, 95 per cent confidence interval (CI) 1.19–6.05, p = 0.017). No statistical significance was found among those 65 years and older (adjusted odds ratio 1.17, 95 per cent CI 0.90–1.51, p = 0.235).
Conclusion
A history of tinnitus was associated with a 168 per cent increased risk of being diagnosed with dementia in those aged 50–65 years old. This association was not significant in those older than 65 years.
The aim of this study is to identify the prognostic factors that may have an effect on the outcome of post-coronavirus disease 2019 acute invasive fungal sinusitis in order to help optimise diagnosis and management.
Methods
This retrospective study involved 60 patients with post-coronavirus disease 2019 acute invasive fungal sinusitis. We identified and studied several factors that may have an effect on the prognosis. These factors included patient-related factors, disease-related factors, and treatment-related factors.
Results
Comorbidities especially renal impairment, previous intensive care unit admission, skin involvement, and intracranial spread of infection are associated with significantly poorer outcomes. Early aggressive surgical debridement is an independent factor associated with better prognosis.
Conclusion
Identifying prognostic factors may have a role in prevention of invasive fungal sinusitis, predicting prognosis, and tailoring patient-specific treatment protocols.