Category: Statistics

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-63141-7. Online ahead of print.

ABSTRACT

The prevalence of metabolic syndrome has increased significantly, and visceral obesity is closely associated with non-alcoholic fatty liver disease. This study aimed to investigate the association between inflammatory indices derived from blood cell counts and to investigate the association between inflammatory indices, metabolic syndrome, and NAFLD in Sabzevar, Iran, in 2025. This case-control study used data from a large adult cohort. A total of 1500 participants with metabolic syndrome were selected as the case group, and for each case, one control without metabolic syndrome was randomly selected from the same cohort. All participants were subsequently evaluated for the presence or absence of non-alcoholic fatty liver disease and, additionally, for liver fibrosis using the Fibrosis-4 (FIB-4) index. Data were analyzed using SPSS version 16, and a p-value < 0.05 was considered statistically significant. In this study, the mean age was 51.01 ± 8.3 years in the metabolic syndrome group and 46.9 ± 8.2 years in the healthy group. In the metabolic syndrome group, 621 participants were male and 879 were female. Overall, no significant associations were observed between metabolic syndrome and inflammatory indices, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index, hemoglobin level, or liver fibrosis classification based on the Fibrosis-4 (FIB-4) index. In contrast, metabolic syndrome was significantly associated with demographic factors, anthropometric measures, metabolic parameters, non-alcoholic fatty liver disease, and the monocyte-to-high-density lipoprotein cholesterol ratio. Non-alcoholic fatty liver disease showed no significant association with the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, hemoglobin level, or systemic inflammatory response index. Still, it was significantly associated with demographic characteristics, anthropometric indices, metabolic factors, the platelet-to-lymphocyte ratio, systemic immune-inflammation index. Liver fibrosis classification based on the FIB-4 index was not significantly associated with several metabolic and inflammatory variables; however, it showed significant associations with age, sex, anthropometric measures, selected inflammatory indices, and hemoglobin level. Given that imaging methods are costly and not readily accessible for all patients, the findings of this study may provide a basis for identifying more cost-effective and easily accessible approaches for the diagnosis of this disease.

PMID:42472984 | DOI:10.1038/s41598-026-63141-7

Neurosurg Rev. 2026 Jul 20;49(1):484. doi: 10.1007/s10143-026-04405-8.

ABSTRACT

Chronic subdural hematoma (CSDH) is increasingly common in older adults and in patients receiving antithrombotic therapy. Although burr-hole drainage is generally safe and effective, perioperative mortality remains a concern, and reliable preoperative predictors are incompletely defined. We aimed to identify independent preoperative predictors of in-hospital mortality after burr-hole drainage for CSDH, with explicit characterization of causes of death, comorbidity burden, and the discriminative performance of candidate predictors. This single-center retrospective cohort study included 121 consecutive adult patients surgically treated for CSDH between January 2015 and December 2024. Preoperative variables included demographics, Glasgow Coma Scale (GCS) score, hematoma thickness, midline shift (MLS), cerebral edema on CT, antithrombotic use, and a comprehensive set of comorbidities (chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, diabetes mellitus, dementia, malignancy). Intensive care unit admission and postoperative complications were also recorded. The primary outcome was in-hospital mortality. Causes of death were systematically categorized. Associations were evaluated using Firth penalized logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis with bootstrap confidence intervals. A prespecified exploratory interaction analysis between cerebral edema and significant midline shift was performed. In-hospital mortality was 12.4% (15/121). The principal cause of death was cerebral herniation (9/15, 60.0%); extracranial complications (respiratory, septic, cardiac) accounted for 6/15 (40.0%). In the original multivariable Firth model, GCS ≤ 13 (adjusted OR 11.71, 95% CI 2.82-48.61, p < 0.001) and cerebral edema (adjusted OR 8.90, 95% CI 1.93-40.98, p = 0.005) were independently associated with mortality. In an extended model incorporating comorbidities, chronic kidney disease (OR 23.78, p = 0.025) and congestive heart failure (OR 42.39, p = 0.043) emerged as additional independent predictors, while cerebral edema (OR 61.89, p = 0.008) and GCS ≤ 13 (OR 5.80, p = 0.032) retained their associations. Combined model discrimination was excellent (Model 1: AUC 0.920; Model 2 with comorbidities: AUC 0.958). Subgroup analysis demonstrated a marked mortality gradient: 0% in patients with neither cerebral edema nor significant midline shift (n = 59), versus 72.2% in patients with both findings (n = 18). The exploratory interaction term (cerebral edema × midline shift ≥ 5 mm) was directionally consistent with synergy but did not reach statistical significance (OR 39.19, 95% CI 0.26-∞, p = 0.152), reflecting limited statistical power. Preoperative neurological impairment and cerebral edema are independently associated with in-hospital mortality after burr-hole drainage for CSDH. The coexistence of cerebral edema and significant midline shift identifies a clinically recognizable high-risk phenotype that may warrant heightened perioperative attention. Renal and cardiac comorbidities further contribute to mortality risk. These findings are hypothesis-generating and require validation in larger, prospective cohorts before incorporation into clinical risk stratification.Clinical trial number: not applicable.

PMID:42472980 | DOI:10.1007/s10143-026-04405-8

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10458-8. Online ahead of print.

ABSTRACT

OBJECTIVE: It is known that both adenoid hypertrophy (AH) and allergic rhinitis (AR) can cause obstructive sleep apnea (OSA), but their relative importance, especially when tonsil size is considered, remains unclear. This study aimed to compare the independent contributions of AR, AH, and tonsil hypertrophy to OSA severity and to determine the primary contributing factor.

METHOD: A total of 177 children aged 3 to 6 were included in the study. They were divided into four groups based on adenoid size (nasal endoscopic obstruction ≥ 75%) and AR (serum total IgE, inhalant-specific IgE, or clinical diagnosis): Group A (AH alone, n = 39), Group B (mixed factors, n = 63), Group C (AR alone, n = 53), and Group D (control, n = 22). OSA severity was assessed using the apnea-hypopnea index (AHI) measured by polysomnography. Intergroup comparisons were performed using the Kruskal-Wallis test. Spearman’s correlation analysis was used to evaluate the correlation between total IgE and AHI. A multivariate linear regression model was employed to identify independent predictors of ln_AHI.

RESULT: The AHI in Group B was significantly higher than that in Groups A, C, and D (P < 0.05). Total IgE showed a weak but significant positive correlation with AHI (r_s = 0.15, P = 0.042). AR was the strongest independent predictor of ln_AHI (standardized β = 0.258, 95% CI: 0.095-0.311, P < 0.0001), followed by tonsil size, BMI, adenoid size and gender, while age was not statistically significant.

CONCLUSION: Among preschool children, AR is the strongest independent predictor of OSA severity, followed by the size of the adenoid and tonsil. Clinically, for preschool children with OSA, assessing allergic status should be prioritized alongside evaluation of adenotonsillar anatomy, and anti‑allergic therapy should be considered as a key component of OSA management, either as a stand‑alone treatment in mild cases or as an adjunct to adenotonsillectomy in more severe cases.

PMID:42472964 | DOI:10.1007/s00405-026-10458-8

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10442-2. Online ahead of print.

ABSTRACT

INTRODUCTION: In adult cochlear implant users, conventional frequency (CF) mapping is standard practice. Tonotopic fitting (TF) refers to a programming strategy in which the frequency allocation of the speech processor is matched as closely as possible to the natural tonotopic organization of the cochlea. Whether TF mapping improves outcomes over CF remains uncertain.

METHODS: We searched PubMed, Embase, and Cochrane for randomized controlled trials comparing tonotopic versus conventional mapping in adult cochlear implant users. Random-effects meta-analysis was performed using RevMan 5.4. Continuous outcomes were analyzed using standardized mean difference (SMD) with 95% confidence intervals (CIs), and heterogeneity was assessed with I². A two-tailed P-value < 0.05 was considered statistically significant. We created an effect-direction plot for selected outcomes to provide a visual summary of the direction and consistency of effects across studies.

RESULTS: A total of five publications were included, representing four trials (n = 109). There was no significant difference between TF and CF mapping in speech understanding in quiet (SMD = -0.07; 95% CI -0.82, 0.68; P = 0.86; I² = 79%) and in noise (SMD = 0.51; 95% CI -0.44,1.46; P = 0.30; I² = 93%). The sensitivity analysis for speech understanding in noise favored TF. Also music perception favored TF on the effect direction plot, while sound quality showed variable outcomes.

CONCLUSION: TF mapping may have potential benefits over CF mapping for speech understanding in noise and music perception. Larger randomized trials are needed to establish the clinical significance of TF mapping.

PMID:42472950 | DOI:10.1007/s00405-026-10442-2

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10396-5. Online ahead of print.

ABSTRACT

PURPOSE: This systematic review and meta-analysis aim to evaluate the efficacy and safety of Ciprofloxacin compared to alternative treatments for managing PTTO.

METHODS: A comprehensive search was carried out in PubMed, MEDLINE, Springer, and Embase. Randomized controlled trials and interventional studies were included if they assessed Ciprofloxacin in children (0-18 years) with PTTO following tympanostomy tube insertion. The primary outcomes analyzed were clinical resolution of otorrhea, time to resolution, recurrence rates, and adverse effects. For the meta-analysis, only studies comparing Ciprofloxacin to placebo were included to minimize heterogeneity, and outcomes were analyzed using a random effects model with risk ratios and 95% confidence intervals via RevMan 5.4 software.

RESULTS: Out of 704 identified records, four randomized controlled trials met the inclusion criteria, comprising a total of 1,025 pediatric patients aged 6 months to 14 years. These studies evaluated Ciprofloxacin, either as topical drops or sustained-release intratympanic injections, against a placebo for the prevention or treatment of PTTO. All studies reported that Ciprofloxacin significantly reduced the incidence of otorrhea compared to placebo, with relative risk reductions ranging from approximately 46% to 66%. The pooled meta-analysis of 892 participants demonstrated a statistically significant reduction in otorrhea with Ciprofloxacin treatment (risk ratio 0.53; 95% confidence interval 0.35 to 0.79; p = 0.002), with no observed heterogeneity (I² = 0%).

CONCLUSION: This systematic review and meta-analysis demonstrated that ciprofloxacin, whether administered as topical drops or sustained-release formulations, reduces post-tympanostomy tube otorrhea in children without significant safety concerns.

PMID:42472949 | DOI:10.1007/s00405-026-10396-5

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10447-x. Online ahead of print.

ABSTRACT

PURPOSE: Presence of toxic heavy metals such as lead (Pb) and chromium (Cr) and also low or high levels of essential heavy metals such as zinc (Zn) and copper (Cu) have detrimental health effects. However, malignant salivary gland tumours (MSGTs) have not been considered in this context. The etiopathogenesis of MSGTs and toxicity of heavy metals involve common mechanisms such as oxidative damage and chronic inflammation. The aim of this study was to investigate the possible relationship between MSGTs and heavy metals.

METHODS: A total of 60 participants (30 patients with MSGTs and 30 matched healthy controls) were investigated. Data including both serum and saliva heavy metal levels of patients and healthy controls were statistically compared. Standard solutions of the elements to be analysed (Fe, Zn, Cu, Mn, Cr, Pb) were prepared using increasing concentrations of 2% nitric acid solution. An inductively coupled plasma mass spectrometer was used for analysis.

RESULTS: In both serum and saliva, Fe levels were not different between patients and controls (p > 0.05), but significantly lower Zn (p < 0.001) and Cu (p ≤ 0.011) and higher Pb (p < 0.001) levels were found in patients compared to controls. Also, in saliva, significantly higher Mn (p < 0.001) and Cr (p < 0.001) levels were found in the patients compared to the controls.

CONCLUSIONS: This study revealed that patients with MSGTs are associated with lower levels of Zn and Cu, but higher levels of Pb in both serum and saliva. Furthermore, these cancers are associated with higher levels of Mn and Cr in saliva.

PMID:42472942 | DOI:10.1007/s00405-026-10447-x

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10439-x. Online ahead of print.

ABSTRACT

PURPOSE: To assess the association between smoking behaviors, including cigarettes, shisha, and vaping, and self-reported voice handicap among medical trainees.

METHODS: A cross-sectional study was conducted between November 2024 and August 2025 at Jordan University Hospital, Amman, Jordan. Medical students, interns, and residents completed an anonymous online survey assessing demographics, smoking behaviors, and vocal health using the validated Arabic version of the Voice Handicap Index-10 (VHI-10). Smoking exposure was standardized using cigarette-equivalent measures and pack-year history. Group differences and associations between smoking variables and VHI-10 scores were analyzed using nonparametric statistical methods.

RESULTS: A total of 326 medical trainees participated (49.7% male). Current smokers comprised 23.9% of the sample, with vaping being the most commonly used product. The median total VHI-10 score was 1 (interquartile range, 0-4). There were no significant differences in total VHI-10 scores or abnormal VHI-10 classification across smoking status groups, and pack-year history was not significantly associated with VHI-10 scores. Male participants had significantly higher total and physical VHI-10 scores compared with females. Lower household income was associated with higher perceived voice handicap. Neither age group nor training level was significantly associated with VHI-10 outcomes.

CONCLUSION: Among young medical trainees, smoking and vaping behaviors were not associated with self-reported voice handicap. However, gender and socioeconomic disparities in perceived vocal impairment were observed. These findings suggest that if early laryngeal effects of smoking and vaping occur in this population, they are not detected by the VHI-10, which demonstrates a significant floor effect in young healthy adults, and support the need for preventive strategies and longitudinal studies incorporating objective voice assessment.

PMID:42472938 | DOI:10.1007/s00405-026-10439-x

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10416-4. Online ahead of print.

ABSTRACT

PURPOSE: To compare the use of L-PRF versus absorbable gelatin sponge as middle ear packing in type I tympanoplasty, in terms of perforation closure and complication rates.

METHODS: We retrospectively analyzed data from patients who underwent type 1 tympanoplasty for tympanic membrane perforation between January 2013 and Decembre 2022, performed by a single surgeon. After reviewing these 10 years, the two cohorts were highly asymmetrical in size, so we extended data collection to earlier cases for the smaller group (back to 1997), to achieve comparable cohort sizes (n = 115). Confounding factors including perforation type, middle ear mucosa status and graft type were compared between groups. Postoperative success and complication rates were also analyzed. A multivariable logistic regression model was used to adjust the results for relevant confounding factors.

RESULTS: Both groups exhibited similar confounding factors, except for graft type, with temporalis fascia being predominant in the Spongostan^® group and cartilage in the L-PRF group (p < 0.01). Success rates were high in both groups, with perforation closure rates of 91% in the L-PRF group and 95% in the Spongostan^® group. After adjustment for confounding factors, the chance of closure appeared, on average, higher with Spongostan^®; however, the 95% confidence interval was wide, and the difference was not statistically significant (p-value 0.094). The complication rate (otorrhea, granuloma) was low and comparable between groups.

CONCLUSION: L-PRF is an autologous material that can be successfully used as middle ear packing in type I tympanoplasty.

PMID:42472936 | DOI:10.1007/s00405-026-10416-4

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10426-2. Online ahead of print.

ABSTRACT

PURPOSE: Hyperuricemia is a common metabolic condition with established systemic effects; however, its potential association with auditory dysfunction has not been clearly defined. This study aimed to evaluate hearing thresholds and cochlear outer hair cell function in individuals with hyperuricemia using subjective and objective audiological assessments.

METHODS: A comparative cross-sectional study was conducted involving 130 participants aged 30-55 years, comprising 65 hyperuricemic subjects and 65 age- and gender-matched normouricemic controls. Pure Tone Audiometry (PTA) was performed at frequencies from 250 to 8000 Hz. Distortion Product Otoacoustic Emissions (DPOAE) were recorded at 1000, 2000, 4000, 6000, and 8000 Hz, and signal-to-noise ratio (SNR) values were analyzed. Statistical analysis included Student’s t-test, Mann-Whitney U test, and Chi-square test, with p < 0.05 considered statistically significant.

RESULTS: Mean PTA thresholds were higher in hyperuricemic subjects across all tested frequencies compared to controls, with statistically significant differences (p < 0.001). Mild sensorineural hearing loss was more frequently observed in the hyperuricemic group. DPOAE analysis demonstrated significantly reduced SNR values, particularly at higher frequencies, and a higher proportion of absent emissions in hyperuricemic subjects. No significant association was observed between hearing loss and age or duration of symptoms.

CONCLUSION: The findings suggest an association between hyperuricemia and early cochlear dysfunction. Objective measures such as DPOAE may be useful for identifying subclinical auditory involvement in this population.

PMID:42472927 | DOI:10.1007/s00405-026-10426-2

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10445-z. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic tinnitus is a prevalent condition associated with significant distress and functional impairment. Despite various therapeutic attempts, there is currently no curative treatment. Although clinical management has advanced in recent years, overall outcomes remain unsatisfactory. Cognitive behavioral therapy (CBT) and sound therapy (ST) are established interventions; however, the efficacy of their combination (CBT + ST) relative to monotherapies or standard care remains uncertain. This systematic review and meta-analysis aims to evaluate the efficacy of combined CBT and ST for adults with chronic tinnitus.

METHODS: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library databases for relevant randomized controlled trials (RCTs) and cohort studies published up to 12 December 2025. Studies involving adults with chronic subjective tinnitus receiving combined CBT + ST were included. Statistical analysis was performed using R software with a random-effects model. Continuous outcomes were analyzed as mean differences (MD) or standardized mean differences (SMD), and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics.

RESULTS: Our review included four RCTs and one cohort with 610 participants. CBT + ST was associated with a statistically significant reduction in tinnitus-related handicap assessed by THI (MD = -8.72, 95% CI -13.23 to -4.20) with substantial heterogeneity, which resolved upon RCT-only analysis. Pooled sensitivity analysis of RCTs only showed that CBT + ST significantly reduced THI scores (MD = -11.19, 95% CI -14.67 to -7.70), exceeding the minimal clinically important difference (MCID) compared to ST alone. Our results yielded significant change in Tinnitus Functional Index (TFI) (MD = -5.11, 95% CI -8.14 to -2.09), yet not clinically meaningful. No significant difference was found for subjective loudness assessed by Visual Analogue Scale/Numeric Rating Scale (VAS/NRS) (SMD = -0.29, 95% CI -0.62 to 0.03).

CONCLUSION: Our findings indicate that combined CBT and sound therapy might provide meaningful reductions in tinnitus-related distress and handicap (exceeding MCID thresholds for THI) in comparison to sound therapy alone. Benefits appear confined to distress and functional outcomes, with no significant effect on perceived loudness. These findings should be considered preliminary given the small number of studies, clinical heterogeneity, the inclusion of one retrospective cohort, and the absence of individual-level responder data. Future large-scale RCTs with larger sample sizes are needed to validate these findings.

PMID:42472924 | DOI:10.1007/s00405-026-10445-z