Tag: statistics

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

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10449-9. Online ahead of print.

ABSTRACT

PURPOSE: Electrically evoked compound action potentials (ECAPs) represent summation of action potentials generated by neurons of the auditory nerve in response to electrical stimulation. The slope of the ECAP amplitude growth function (AGF) reflects responsiveness or survival of neurons proximal to the stimulating electrode. Goals of the present study were to characterize the magnitude of the AGF slope by electrode site and over time in a cohort of pediatric CI users and measure the degree of correlation of slopes with auditory assessment results.

METHODS: 23 CI users participated in the study, ranging in age from 3 to 12 years. All implanted with 31.5 mm electrode array, full insertion. ECAP AGF slopes measured with all active electrodes intra-operatively, device switch-on, 3-, 6-, 9-, and 12-months post switch-on. Auditory assessments administered at 3-, 6-, 9-, and 12-months post-implantation. Analysis performed by electrode as well as intracochlear electrode site (basal, middle, and apical).

RESULTS: AGF slopes significantly increased according to a basal-to-apical gradient. Slopes were more than twice as large at the apical-most electrode compared to the basal-most (43.1 vs. 20.3 µV/nC). AGF slopes stimulated from basal electrodes significantly increased over time, while those stimulated from apical electrodes significantly decreased over time. No statistically significant correlations were observed between AGF slopes and the test results of any auditory assessment at any timepoint.

CONCLUSION: Observations demonstrate AGF slopes vary substantially, both across the array and over time. No significant associations were observed between AGF slopes and auditory perception skills in this cohort. Due to our relatively small sample size and the heterogeneity of the data, no definitive conclusions regarding these associations can be made here.

PMID:42472922 | DOI:10.1007/s00405-026-10449-9

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10415-5. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate sound localization is essential for children’s communication, safety, and learning. While noise stimuli are commonly used in directional hearing tests in clinical settings, speech stimuli may offer more child-friendly assessments.

OBJECTIVES: This study aimed to compare sound localization performance using noise and word stimuli across several groups of children with different types of hearing.

METHODS: A total of 108 children participated in the study: 31 normal-hearing children aged 6-10 (Ref_6-10), 32 children aged 6-10 with hearing aids (HA_6-10), and 45 children aged 11-17 with hearing aids (HA_11-17). Participants completed a sound localization task using five speakers placed at horizontal angles (± 90°, ± 45°, 0°). They localized broadband noise bursts or one of four German words, presented randomly at different sound levels. Localization accuracy was measured using root mean square error (RMSE). Linear mixed-effects models analysis was conducted with Stimulus and Angle as within-subject factors and Group as a between-subject factor.

RESULTS: No significant differences have been found in the comparison between stimuli regarding the RMSE between the groups. A weakly significant difference between stimulus types was found only in the HA_6-10 group at 0°, where noise stimuli were localized more accurately than words (p = 0.03). CONCLUSIONS: Both noise and word stimuli are suitable for assessing directional hearing in children. However, noise stimuli are more economical, as they require fewer presentations. In contrast, word stimuli are more time and resource-demanding due to the need for multiple presentations of each word to obtain statistically reliable results.

PMID:42472921 | DOI:10.1007/s00405-026-10415-5

Environ Sci Pollut Res Int. 2026 Jul 19. doi: 10.1007/s11356-026-38061-8. Online ahead of print.

ABSTRACT

While plant bioassays are widely used for acute genotoxicity, transgenerational effects are predominantly studied in animal models. A comprehensive literature review revealed a critical gap in plant-based transgenerational cytogenotoxicity studies. To bridge this gap, I propose the TAGT-v1 (Transgenerational Assessment of Genotoxicity in Plants, version 1) protocol as the first proposed standardized transgenerational plant bioassay framework. TAGT-v1 evaluates intergenerational genotoxic effects via seed-to-seed transfer (F0 → F1 → F2 → F3) following a single-point exposure in the F0 generation. The protocol employs short-life-cycle species (Hordeum vulgare, Rapid-cycling Brassica rapa, Brachypodium distachyon, and Arabidopsis thaliana) and excludes clonally reproducing models. Offering an ethical, cost-effective, and ecologically relevant alternative to animal testing, TAGT-v1 assesses both acute F0 effects and heritable genomic damage in the F3 generation-operationally defined as the first fully independent generation after F0 seed exposure, provided that chemical carry-over is excluded by LC-MS/MS. By overcoming the limitations of single-generation approaches, TAGT-v1 enables a more realistic evaluation of the long-term, population-level impacts of environmental pollutants. Future research will focus on the experimental validation of this protocol.

PMID:42472909 | DOI:10.1007/s11356-026-38061-8

Clin Oral Investig. 2026 Jul 20;30(8):349. doi: 10.1007/s00784-026-07032-1.

ABSTRACT

OBJECTIVES: This study aimed to evaluate asprosin, adropin, and irisin levels in gingival crevicular fluid (GCF) across different periodontal conditions and to analyze their relationship with clinical periodontal parameters.

MATERIALS AND METHODS: A total of 122 systemically healthy participants (25-60 years) were divided into four groups: healthy periodontium (n = 30), gingivitis (n = 30), Stage I-II periodontitis (n = 32), and Stage III-IV periodontitis (n = 30). Clinical parameters recorded included probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI). GCF samples were collected, and asprosin, adropin, and irisin levels were measured by ELISA. Statistical analyses included ANOVA/Kruskal-Wallis with post hoc tests, Pearson correlations, and receiver operating characteristic (ROC) analysis.

RESULTS: Asprosin levels were significantly higher in Stage III-IV periodontitis compared with other groups (p < 0.05). Adropin and irisin levels were higher in the healthy group, although not statistically significant. Asprosin correlated positively with PI, PD, CAL, and BOP, while irisin correlated negatively with PI. ROC analysis indicated that asprosin had diagnostic potential for distinguishing between advanced periodontitis and other conditions.

CONCLUSIONS: Elevated GCF asprosin levels were found to be associated with periodontitis severity, whereas adropin and irisin were related to periodontal health. More research is needed to understand the role of irisin, asprosin, and adropin in periodontal pathogenesis.

CLINICAL RELEVANCE: This study provides novel insights into the potential role of asprosin, adropin, and irisin as biomarkers of periodontal status. Elevated GCF asprosin levels were associated with advanced periodontitis, reflecting the inflammatory burden of the disease. Conversely, higher levels of adropin and irisin were associated with better periodontal health, suggesting protective or homeostatic functions. These findings indicate that GCF asprosin, adropin, and irisin levels may serve as promising adjunctive diagnostic indicators for distinguishing between periodontal health and disease. Future longitudinal studies are needed to validate their prognostic value and to clarify their mechanistic involvement in periodontal pathogenesis.

PMID:42472908 | DOI:10.1007/s00784-026-07032-1

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-62885-6. Online ahead of print.

ABSTRACT

Soil fertility variability is a major constraint to agricultural productivity in Ethiopian highlands, yet uniform nutrient management persists due to inadequate characterization of spatial heterogeneity. This study addressed the need for site-specific nutrient management zones (MZs) in Aroressa district, Sidama region. One hundred fifty-four soil samples (77 disturbed, 77 undisturbed) were collected from 0 to 20 cm depth. Analysis included pH, organic carbon (OC), total nitrogen (TN), available phosphorus (av.P), exchangeable cations (K, Ca, Mg), cation exchange capacity (CEC), and bulk density (BD). Geostatistical analysis with semi-variogram modeling and ordinary kriging mapped spatial distribution. Principal component analysis (PCA) reduced dimensionality, and Fuzzy C-Means (FCM) clustering delineated MZs, validated by ANOVA. Soils were strongly to moderately acidic (mean pH 5.19), with critically low TN (0.19%), moderate OC (2.40%), and highly heterogeneous K (CV 62.2%) and av.P (CV 32.8%). Semi-variogram models showed moderate to strong spatial dependence for most nutrients (range: 19.7-317 m). PCA retained three components explaining 71.73% variance. Five optimal MZs were delineated, significantly differentiating all soil properties (p < 0.01). MZ delineation reduced within-zone variability substantially: K (74.2%), CEC (51.0%), OC (49.3%), BD (54.7%), and av.P (40.2%). The PCA-FCM approach effectively captured soil fertility gradients, with Zone 5 showing highest fertility (CEC 35.3 cmol(+)/kg, K 1.33 cmol(+)/kg) and Zone 4 the most acidic (pH 4.66). Results support transitioning from uniform to site-specific nutrient management, with variable-rate K and P fertilization, targeted liming, and zone-specific organic matter restoration strategies.

PMID:42472905 | DOI:10.1038/s41598-026-62885-6

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-59791-2. Online ahead of print.

ABSTRACT

Patients with seronegative spondyloarthropathies (SpA) have an increased risk of kidney involvement. The aim of the study was to assess early kidney injury markers (EKIMs) in SpA patients without clinically recognized kidney disease compared with control group (CG), and to analyze associations with SpA subtypes and therapy. In this cross-sectional study, 125 SpA patients (ankylosing spondylitis, psoriatic arthritis, non-radiographic axial SpA) and 53 GC were included. Serum and urinary NGAL, KIM-1, RBP4, FGF23, NAG, and IL-18 were measured. Our findings indicate subclinical kidney involvement in SpA. Serum and urinary KIM-1 levels were elevated in SpA patients compared to CG (serum: p = 0.039; urine: p = 0.024). Urinary RBP4 was higher in SpA patients (p = 0.005), while serum RBP4 was lower (p < 0.001) compared to CG. Urinary FGF23 concentrations were higher in SpA patients than in CG (p < 0.001). Serum NAG levels differed between SpA and CG (p = 0.018). While no overall differences were observed for urinary NGAL or IL-18 between the SpA group and CG, subgroup analyses revealed specific differences. Psoriatic arthritis patients showed distinct profiles, including lower serum FGF23 (p = 0.028 vs. nr-axSpA and CG), lower serum NAG (p = 0.013 vs. CG), and higher urinary IL-18 (p = 0.012 vs. CG) compared to CG. Levels of most EKIMs did not significantly differ between patients on first-line versus second-line therapies, except for serum FGF23, which was lower in patients receiving bDMARDs/tsDMARDs (p = 0.018). SpA patients without overt kidney disease demonstrate subclinical tubular injury and altered biomarker profiles, supporting the potential role of EKIMs in early renal assessment.

PMID:42472898 | DOI:10.1038/s41598-026-59791-2