Lin Chen

Background: To compare outcomes of the combined transcervical–submandibular and transoral endoscopic approach versus the open transcervical parotid approach and transoral endoscopic surgery alone, and to clarify the indications and advantages of the combined technique. Methods: This retrospective observational study was conducted at a tertiary academic hospital in China between January 2013 and December 2024. A total of 114 consecutive patients with histologically confirmed benign parapharyngeal space tumors underwent the open transcervical parotid approach ( n = 48), transoral endoscopic surgery alone ( n = 42), or the combined transcervical‐submandibular and transoral endoscopic approach ( n = 24). Tumor size, intraoperative blood loss, hospitalization duration, tracheotomy rates, en‐bloc resection rates, and surgery‐related complications were compared among the three groups. Results: The combined surgery group had significantly larger tumors and a lower incidence of surgery‐related complications. No statistically significant differences were observed among the three approaches in tracheostomy rates, intraoperative blood loss, operative duration, or hospitalization duration. Conclusions: The combined approach appears effective in reducing complications associated with resection of large, anatomically complex benign parapharyngeal tumors, particularly those involving critical neurovascular structures. This technique shows clinical value and warrants broader application.

Importance: Tinnitus, affecting 10% to 15% of the global population, is a debilitating condition often linked to hearing loss and neurological disorders. While air pollution is a known risk factor for respiratory and cardiovascular diseases, its association with tinnitus remains underexplored. Objective: This study investigates the association between air pollution, polygenic risk score (PRS), and tinnitus prevalence. Design: Cross-sectional analysis. Setting: UK Biobank (UKB) population-based cohort. Participants: Seventy-nine thousand two hundred seventy-seven individuals from the UKB with available tinnitus, air pollution, and genetic data. Exposures: Air pollution measures (PM _2.5 , PM _2.5–10 , PM ₁₀ , NO ₂ , and NO _x ). A composite air pollution score was calculated, and PRS was derived from 6 tinnitus-associated single-nucleotide polymorphisms. Main outcome measures: Prevalence, frequency, and severity of tinnitus. Logistic regression models were used, adjusting for sociodemographic, health, and hearing-related covariates. Results: Each interquartile range increase in air pollution score was associated with higher odds of current tinnitus (OR = 1.06, 95% CI: 1.03-1.08, P < .001), particularly transient tinnitus (OR = 1.04, P = .008). PRS was independently associated with prevalent tinnitus ( P < .001), and higher OR were observed among individuals with both high air pollution exposure and high PRS (OR = 1.34, 95% CI: 1.18-1.52, P < .001). Individual pollutants showed weaker associations. Conclusion: A joint association of air pollution exposure and genetic susceptibility with tinnitus prevalence was observed in this cross-sectional analysis, highlighting the importance of integrated environmental and genetic assessments in auditory health. Relevance: Our findings emphasize the potential value of integrating environmental and genetic factors for risk stratification of tinnitus in populations.

Laryngeal squamous cell carcinoma (LSCC) is typically diagnosed at advanced stages, highlighting the critical need for early intervention. By integrating single-cell and bulk RNA-seq data from LSCC, vocal cord leukoplakia (VCL), and LSCC precursors, we characterized dynamic remodeling of the tumor microenvironment during LSCC pathogenesis. We identified transcriptional program gene modules that reflect malignant epithelial cells (maEpCs). The infiltration of POSTN⁺ fibroblasts progressively increases from normal tissue to VCL and further to LSCC, accompanied by enhanced intercellular communication. These fibroblasts interact with maEpCs and endothelial cells via ligands such as MIF, promoting epithelial-mesenchymal transition, cancer stemness, and angiogenesis. Blocking MIF reversed cancer-associated fibroblast-driven invasion and angiogenesis. Here, we further revealed that an immunosuppressive microenvironment arises as early as the precancerous stage, with VCL exhibiting CD8⁺ T cell exhaustion and abundant LAMP3⁺ dendritic cells that correlate positively with Tregs and exhausted CD8⁺ T cells, promoting early immune escape. Additionally, LSCC was uniquely enriched for a pro-tumor SPP1⁺ macrophage subset with low phagocytic activity and high angiogenic potential, linked to poor prognosis. Our findings uncover key mechanisms driving LSCC malignant progression, offer insights for early diagnosis and prognosis assessment, and highlight MIF as a promising therapeutic target.

Background: To evaluate the effect of bilateral elective node dissection on the prognosis of patients with T3N0M0 glottic carcinoma. Methods: This retrospective cohort study enrolled two cohorts: patients screened from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute, and those treated at the First Affiliated Hospital of Sun Yat‐sen University. Patients screened from the SEER database were divided into untreated, radiotherapy (RT), surgery, and concurrent systemic therapy (ST)/RT groups. Patients from our center were divided into unilateral and bilateral groups based on lymph node dissection. Propensity score‐matching (PSM) was applied to eliminate baseline variations. Kaplan–Meier analysis was used to assess different treatment method effects. Results: This study retrieved 2027 and 133 patients from the SEER database and our center, respectively, from 2014 to 2022. After PSM, overall survival (OS) and cancer‐specific survival (CSS) improved in the ST/RT (both p < 0.001) and surgery (both p < 0.001) groups versus the RT group, with no differences between groups (OS, p = 0.45; CSS, p = 0.84). Patients who underwent elective node dissection (END) had better OS ( p = 0.025) and CSS ( p < 0.001) than those without END. No significant difference was observed in OS ( p = 0.110) between the END and ST/RT groups; however, the END group showed significant improvement in CSS ( p = 0.007). Patients who underwent bilateral neck dissection had better progression‐free survival than the unilateral group after PSM ( p = 0.024). Conclusion: Surgery combined with bilateral node dissection can bring better survival prognosis for patients with T3N0M0 glottic carcinoma.

Background: The optimal therapeutic strategy for patients with T2‐3N0‐3 M0 or T1N1‐3 M0 hypopharyngeal squamous cell carcinoma (HPSCC) and the use of postoperative radiotherapy with or without systemic therapy for patients with T1‐2N1M0 HPSCC remain controversial. We aimed to determine whether these additional treatments improve the prognosis in HPSCC. Methods: We retrospectively analyzed the databases held by the SEER (surveillance, epidemiology, and end results) program and a tertiary referral center in China to evaluate the survival outcomes of surgical intervention for T2‐3N0‐3 M0 and T1N1‐3 M0 HPSCC and of postoperative radiotherapy for T1‐2N1M0 disease. Results: The SEER contained data for 1235 patients with T2‐3N0‐3 M0 or T1N1‐3 M0 HPSCC, of whom 220 underwent surgery as their first treatment and 737 received non‐surgical treatment. There was no statistically significant difference in overall survival (OS) between these two groups. Data were also available for 30 patients in the SEER who were treated by surgery alone ( n = 11), surgery plus postoperative radiotherapy ( n = 7), or surgery plus postoperative radiotherapy with systemic therapy ( n = 12). Similarly, 23 patients at our hospital were identified to have been treated by surgery alone ( n = 7), surgery plus postoperative radiotherapy ( n = 10), or surgery plus postoperative radiotherapy with systemic therapy ( n = 6). The SEER data indicated that postoperative radiotherapy improved OS (hazard ratio 0.281, 95% confidence interval 0.079–0.998; p = 0.036). This finding was supported by the data from our hospital, although the improvement in OS was not statistically significant (hazard ratio 0.360, 95% confidence interval 0.057–2.261; p = 0.224). Postoperative radiotherapy with systemic therapy seemed not to improve OS beyond that achieved by postoperative radiotherapy alone. Conclusions: There was no significant difference in OS in patients with T2‐3N0‐3 M0 or T1N1‐3 M0 HPSCC according to whether or not they underwent surgery as first‐line treatment. Surgery plus postoperative radiotherapy was associated with a more favorable prognosis than surgery alone in patients with T1‐2N1M0 HPSCC.

Importance: Tinnitus is a prevalent condition among noise-exposed workers, with significant implications for hearing health and quality of life. Identifying associated factors can inform prevention and management strategies. Objectives: To identify factors associated with tinnitus prevalence among noise-exposed workers and assess the effectiveness of hearing protection in mitigating tinnitus. Design: Cross-sectional study. Setting: Data from the National Health and Nutrition Examination Surveys database. Participants: This study included 4931 noise-exposed workers (mean age 48.9 ± 0.3 years). Participants were categorized into speech-frequency hearing loss (SFHL; n = 1032, mean age 67.2 ± 0.4 years) and high-frequency hearing loss (HFHL; n = 1634, mean age 62.9 ± 0.3 years) groups based on hearing threshold levels. Intervention or Exposures: Noise exposure duration, hearing loss severity, demographics, and medical history. Hearing protection usage was assessed for its effectiveness in preventing tinnitus. Main Outcome Measures: Primary outcome: tinnitus prevalence. Associations were analyzed using logistic regression, with factors including self-reported noise exposure, hearing loss severity, demographics, and medical history. Result: Tinnitus prevalence was 32.85% in the group with SFHL and 29.99% in the group with HFHL. Prolonged noise exposure and greater hearing loss severity were associated with tinnitus in both groups. Hearing protection usage was potentially linked to a lower tinnitus prevalence in HFHL but not in SFHL. For SFHL, univariate analysis showed lower tinnitus prevalence in older age and females, while Caucasian ethnicity and higher income were associated with higher prevalence. Multivariate analysis indicated that older age was positively associated with tinnitus ( P < .05). In HFHL, factors such as higher BMI, higher educational level, and elevated Patient Health Questionnaire-9 (PHQ9) scores were significantly associated with tinnitus prevalence. Conclusions: Prolonged noise exposure and hearing loss severity among noise-exposed workers were associated with tinnitus prevalence in SFHL and HFHL. Hearing protection showed tendency to reduce tinnitus prevalence in HFHL but had a limited effect in SFHL. Higher BMI, higher education levels, and elevated PHQ9 scores were significantly associated with tinnitus in HFHL, warranting further research into protective strategies. Relevance: Future studies should explore alternative protective strategies for SFHL patients and refine tinnitus prevention approaches in noise-exposed workers.

Objective This study aimed to evaluate the therapeutic efficacy of cervical lymph node dissection in patients with T2N0M0 glottic squamous cell carcinoma. Methods Among 260,068 head and neck cancer patients, 861 cases of T2N0M0 glottic squamous cell carcinoma were selected, of which 113 underwent selective lymph node dissection, and 748 did not receive dissection. The overall survival rates and disease-specific survival rates were compared between the two groups to assess efficacy. Results There was no significant difference in overall survival rates (median survival time of 57 months vs. 62 months, p = 0.34) and disease-specific survival rates (p = 0.79) between the two groups. Patients aged ≥ 60 years were at a higher risk, whereas neck dissection, gender, and degree of differentiation did not show significant risk differences in this study. Conclusion Cervical lymph node dissection in patients with T2N0 glottic squamous cell carcinoma did not demonstrate a significant advantage in survival rates.

Background: Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF.Methods: We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non‐TNPT groups. The 2 years overall survival (OS) was compared through the log‐rank test.Results: There were 18 patients in the TNPT group and 29 in the non‐TNPT group. There was no significant between‐group difference in the healing rate (chi‐square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non‐TNPT group. The 2‐year OS rate was significantly higher in the TNPT group (p = 0.0473, log‐rank test).Conclusion: TNPT promoted wound healing after surgery for PCF and improved the 2‐year OS rate. This tool is worthy of clinical application and promotion.