ORL 2022-01-12

Machine Learning Algorithms as a Computer-Assisted Decision Tool for Oral Cancer Prognosis and Management Decisions: A Systematic Review

Publication date 12-01-2022


Introduction: Despite multiple prognostic indicators described for oral cavity squamous cell carcinoma (OCSCC), its management still continues to be a matter of debate. Machine learning is a subset of artificial intelligence that enables computers to learn from historical data, gather insights, and make predictions about new data using the model learned. Therefore, it can be a potential tool in the field of head and neck cancer.
Methods: We conducted a systematic review.
Results: A total of 81 manuscripts were revised, and 46 studies met the inclusion criteria. Of these, 38 were excluded for the following reasons: use of a classical statistical method (N = 16), nonspecific for OCSCC (N = 15), and not being related to OCSCC survival (N = 7). In total, 8 studies were included in the final analysis.
Conclusions: ML has the potential to significantly advance research in the field of OCSCC. Advantages are related to the use and training of ML models because of their capability to continue training continuously when more data become available. Future ML research will allow us to improve and democratize the application of algorithms to improve the prediction of cancer prognosis and its management worldwide. ORL

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High Mobility Group Box-1 Protein and Interleukin 33 Expression in Allergic Rhinitis

N Zhong,Q Luo,X Huang,J Yu,J Ye,J Zhang

Publication date 03-01-2022


Background: Allergic rhinitis (AR) is characterized by an inflammatory reaction. High mobility group box 1 (HMGB1) protein and interleukin (IL)-33 are damage-associated molecular pattern molecules and have many characteristics similar to pro-inflammatory cytokines. However, the role of IL-33 and HMGB1 in AR remains unclear. The aim of this study is to explore the role of HMGB1 and IL-33 in AR.
Methods: Twenty patients with AR (AR group) and 10 normal controls (normal group) were enrolled in this study. HMGB1 and IL-33 expression were analyzed by immunohistochemistry in epithelial cells of the inferior turbinate mucosa samples. Then, the human nasal mucosa epithelial cells (HNECs) were cultured in vitro, and the house dust mite allergen (Derp1) was used to stimulate the cells. Quantitative real-time PCR and ELISA assay were performed to detect HMGB1 and IL-33 expression in HNECs.
Results: The expression of HMGB1 and IL-33 in the nasal mucosa was higher in the AR group than in the normal group, with a statistically significant difference (p #x3c; 0.05). In HNECs of AR, the expression of both HMGB1 and IL-33 in stimulated groups was higher than that in non-stimulated groups. The differences were statistically significant (p #x3c; 0.05). In addition, they increased gradually with the prolonging time and the concentration of the added Derp1.
Conclusions: The expression of HMGB1 and IL-33 were both increased in AR. HMGB1 and IL-33 may have a close relationship in AR. ORL

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Incidence of Head and Neck Cancers before and after 9/11 in New York City and New York State

R Machado,T Tham,D Zhu,A Wong,D Hiltzik,A Roche

Publication date 27-12-2021


Introduction: The incidence of cancers in New York State (NYS) before and after 9/11 including lung, colorectal, and renal cancers has been previously described. To date, the incidence of head and neck cancers (HNCs) before and after 9/11 has not been described.
Methods: Cancers involving the oral cavity and oropharynx; the nose, nasal cavity, nasopharynx, and middle ear; larynx; and thyroid were identified using the New York State Cancer Registry (NYSCR). Age-adjusted incidence and rates per 100,000 residents from 1987 to 2015 were analyzed using joinpoint regression. Trends in incidence using annual percent changes are presented.
Results: The overall rate of HNC increased slightly by 0.7% (p #x3c; 0.001) from 1987 to 2003 in NYS. From 2003 to 2008, the rate increased by 5.73% (p #x3c; 0.001), and from 2008 to 2015, the rate increased by 1.68% (p #x3c; 0.001). The rate of thyroid cancer increased by 6.79% (p #x3c; 0.001) from 1987 to 2003, by 9.99% (p #x3c; 0.001) from 2003 to 2009, and by 2.41% (p = 0.001) from 2009 to 2015. The rate of thyroid cancer was higher in women at all time points. In a subset analysis of HNCs excluding thyroid cancer, the rate decreased by 2.02% (p #x3c; 0.001) from 1991 to 2001, followed by a nonsignificant increase of 0.1% (p = 0.515) from 2001 to 2015. The rate of oropharyngeal (OP) cancer significantly increased from 1999 to 2015 (2.65%; p #x3c; 0.001). The rate of oral cavity cancer significantly decreased from 1987 to 2003 (1.97%; p #x3c; 0.001), with no significant change after 2003. The rate of laryngeal cancer decreased significantly by 2.43% (p #x3c; 0.001) from 1987 to 2015, as did the rate of nasal cavity/nasopharyngeal cancer (0.33%; p = 0.03).
Conclusions: In NYS, OP cancer and thyroid cancer rates increased significantly during the study period. The rate of thyroid cancer was higher in women. The rate of combined HNC increased significantly after 9/11 compared to before 9/11; however, in a subset analysis of all HNC patients excluding thyroid cancer, the rate decreased significantly prior to 9/11 and then nonsignificantly increased afterward. This suggests that the increase in thyroid cancer accounts for the increase in combined HNC in NYS. The impact of 9/11 on rates of HNC requires further research. ORL

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Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis

M Chen,M Xu,X Lei,B Zhang

Publication date 20-12-2021


Objectives: Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression.
Methods: Forty-six patients were divided into group A and group B according to a random number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item Sino Nasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up.
Results: Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, p #x3c; 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, p #x3c; 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, p #x3c; 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, p #x3c; 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, p #x3c; 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B.
Conclusions: FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term. ORL

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Cortical Atrophy, White Matter Lesions, and Bulb Configuration in Patients with Idiopathic Olfactory Loss and Other Causes of Olfactory Loss

AW Fjaeldstad,T Ovesen,RB Dalby

Publication date 08-12-2021


Introduction: While magnetic resonance imaging (MRI) is not included in the current guidelines for diagnosing olfactory disorders in the most recent position paper on olfactory dysfunction, both 1.5T and 3T MRI are commonly used in the diagnostic workup of many patients with olfactory loss. Often, MRI is used to rule out intracranial tumours, but other useful information may be obtained from MRI scans in these patients. The potential of MRI in olfactory loss depends on sufficient knowledge of structural changes in different aetiologies of olfactory loss. We present common clinical MRI findings in olfactory loss and evaluate the usefulness of structural integrity scores in differentiating between aetiologies.
Methods: In this study, we investigated if white matter hyperintensities (WMHs, measured by Fazekas score), global cortical atrophy (GCA), and medial temporal lobe atrophy (MTA) are more common in patients with idiopathic olfactory loss than in patients with acquired olfactory loss due to other aetiologies. Furthermore, we compared olfactory bulb (OB) configurations in different olfactory loss aetiologies.
Results: In 88 patients with olfactory loss, WMHs, GCA, and MTA were not more significant findings on MRI in idiopathic olfactory loss (n = 51) compared with other causes of acquired olfactory loss (Fazekas score p = 0.2977; GCA score p = 0.6748; MTA score p = 0.7851). Bulb configurations differed in patients suffering from post-traumatic olfactory loss and may aid in identifying the underlying aetiology in patients where trauma is among the suspected causes of olfactory loss.
Conclusion: We recommend that structural MRI with an OB sequence is included in the diagnostic evaluation of olfactory loss with suspected congenital and post-traumatic aetiology and should be considered in idiopathic olfactory loss with suspected central aetiology (e.g., tumour). ORL

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Unilateral Choanal Atresia: Indications of Long-Term Olfactory Deficits and Volumetric Brain Changes Postsurgically

C Georgiopoulos,M Postler,P Rombaux,V Gudziol,N Abolmaali,T Hummel

Publication date 26-11-2021


Background: Very few studies have investigated whether unilateral choanal atresia is associated with permanent olfactory deficits.
Objective: This study aimed to evaluate the olfactory performance of patients with unilateral choanal atresia postsurgically.
Methods: Three patients with unilateral atresia were examined in terms of olfactory performance with the Sniffin’ Sticks test (odor identification, threshold, and discrimination), size of the olfactory bulb, and volumetric brain changes.
Results: All patients demonstrated significantly lower olfactory performance in terms of odor threshold on the same side with the choanal atresia. Grey matter reductions were found ipsilaterally in the hippocampus.
Conclusions: This pilot study indicates that persistent olfactory deficits and volumetric brain changes are present in patients with unilateral choanal atresia. ORL

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Contents Vol. 83, 2021

Publication date 25-11-2021


ORL 2021;83:I–VI

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Acknowledgement to Reviewers

Publication date 25-11-2021


ORL 2021;83:483–484

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Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up

R Landsberg,M Masalha,A Margulis,Y Rosman,S Schneider

Publication date 08-11-2021


Background: Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA).
Methods: The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment.
Results: Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months–11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA.
Conclusions: EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs. ORL

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Perfusion-Decellularized Larynx as a Natural 3D Scaffold in a Rabbit Model

JO Park,HY Park,SC Shin,DH Lee,BJ Lee

Publication date 04-11-2021


Introduction: Decellularized larynges could be used as scaffolds to regenerate the larynx. The purpose of this study was to establish a perfusion decellularization protocol to produce a 3-dimensional whole laryngeal extracellular matrix (ECM) scaffold in a rabbit model.
Methods: The larynges of 20 rabbits assigned to the study group were harvested and decellularized using a perfusion decellularization protocol, while the larynges of 10 rabbits in the control group were harvested and untreated. Macroscopic and microscopic morphological analyses, a molecular analysis, a cellular content analysis, and scanning electron microscopy were performed.
Results: A histological analysis showed the absence of cellular components, the presence of the ECM, and an intact cartilage structure filled with chondrocytes. The mean total DNA amounts of the native larynx, decellularized larynx, and decellularized cartilage-free larynx were 1,826.40, 434.70, and 41.40 μg/µL, respectively; those for the decellularized larynx and decellularized cartilage-free larynx were significantly lower (p #x3c; 0.001 and p #x3c; 0.001, respectively). The total amount of DNA in the decellularized sample was significantly lower compared to that in the native sample, at 57.2% in cartilage (p #x3c; 0.001), 2.4% in the thyroid gland (p #x3c; 0.001), 2.7% in muscle (p #x3c; 0.001), 1.6% in vessels (p #x3c; 0.001), and 4.8% in the vocal cords (p #x3c; 0.001).
Conclusion: Our perfusion decellularization protocol is feasible and reproducible to produce a 3-dimensional whole laryngeal ECM scaffold in a rabbit. ORL

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