Publication date 24-03-2023
Jiye Chen, Jianping Dou, Zhiyu Han, Ping Liang
Publication date 24-03-2023
As to some cases of arteriovenous malformations, those are not good candidates for surgery and embolization; microwave ablation may be a promising alternative method to treat.
Maxillofacial arteriovenous malformation located in the sensitive parts of the nose and lips has been an arduous challenge for doctors to meet a balance between resection and aesthetics in one time. In this report, one patient with a giant arteriovenous malformation covering the forehead, the nose, the lip, and bilateral cheeks and resulting in the appearance of the face like a lions face, can not meet satisfactory outcomes by other therapeutic methods. We successfully reduced the size of vascular lesion using low-power and short-duration microwave ablation under real-time ultrasound guidance. In the two-year follow-up, the patients face almost recovered to normality. Microwave ablation is expected to be a new alternative therapy for the treatment of maxillofacial arteriovenous malformations. Laryngoscope, 2023
Rong‐San Jiang, Karen Yan, Yi‐Fang Chiang, Pei‐Jung Chiang
Publication date 24-03-2023
Chinese herbal medicine has been implemented as a form of treatment for olfactory dysfunction. Our results show that adding a tailored Guizhi decoction to OT conferred a limited benefit to the olfactory function of patients experiencing traumatic anosmia.
Objective Chinese herbal medicine (CHM) has been implemented as a form of treatment for olfactory dysfunction. In this study, we aimed to use a tailored Guizhi decoction for the treatment of traumatic olfactory dysfunction.
Methods Patients who had lost olfactory function after experiencing head trauma and whose olfactory function was anosmic were selected. The eligible patients were randomly assigned to two groups. In the CHM group, a tailored Guizhi decoction was prescribed, with patients also undergoing olfactory training (OT). In the OT group, patients performed OT only. The olfactory function of each patient was evaluated by both the phenyl ethyl alcohol (PEA) odor detection threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test (TC-UPSIT), at both 3 and 6 months after the completion of treatment.
ResultsA total of 38 patients in the CHM group and 40 in the OT group completed the study. The TC-UPSIT scores of patients slightly rose after treatment in both the CHM and OT groups. Nevertheless, there were no significant differences in TC-UPSIT scores before and after treatment in both groups. However, the PEA thresholds improved significantly in both CHM and OT groups (p = 0.005 and 0.016, respectively). Of note, there were no significant differences in threshold or identification scores between the CHM and OT groups.
Conclusion Our results show that adding a tailored Guizhi decoction to OT conferred a limited benefit to the olfactory function of patients experiencing traumatic anosmia.
Level of Evidence2 Laryngoscope, 2023
Kavita Dedhia, Yun Li, Virginia A. Stallings, John Germiller, Terri Giordano, Julia Dailey, Maria Kong, Alexandra Durkin, Ibikari Legg‐Jack, Sarah Nessen, Marilyn M. Schapira
Publication date 24-03-2023
Objective The objective of this study was to explore diet patterns in children with tympanostomy tube placement (TTP) complicated by postoperative tympanostomy tube otorrhea.
Study Design Cross-sectional survey and retrospective cohort study.
Methods Caregivers of children (0–12 years old), at a tertiary-care pediatric hospital who underwent TTP within 6 months to 2 years prior to enrollment were included. Children with a history of Down syndrome, cleft palate, craniofacial syndromes, known immunodeficiency, or a non-English-speaking family were excluded. Our primary outcome variable was the number of otorrhea episodes. The primary predictor was diet patterns, particularly dessert intake, which was captured through a short food questionnaire.
ResultsA total of 286 participants were included in this study. The median age was 1.8 years (IQR, 1.3, 2.9). A total of 174 (61%) participants reported at least one episode of otorrhea. Children who consumed dessert at least two times per week had a higher risk of otorrhea compared to children who consumed one time per week or less (odds ratio OR, 3.22, 95% Confidence Interval CI: 1.69, 6.12). The odds ratio increase continued when considering more stringent criteria for otorrhea (multiple episodes or one episode occurring 4 weeks after surgery), with a 2.33 (95% CI: 1.24, 4.39) higher odds of otorrhea in children with dessert intake at least 2 times per week.
Conclusions Our pilot data suggest that episodes of otorrhea among children with TTP were associated with more frequent dessert intake. Future studies using prospectively administered diet questionnaires are necessary to confirm these findings.
Level of Evidence4 Laryngoscope, 2023
Inbal Hazkani, Maeve A. Serino, Dana M. Thompson, Jennifer Lavin
Publication date 24-03-2023
Background Our institution implemented a post-anesthesia care unit (PACU) extended-stay model (Grey Zone model), where the post-operative level of care for high-risk adenotonsillectomy patients (general care vs. intensive care unit) was decided based on the clinical course of 2–4 h of PACU admission.
Objective To assess the correlation between post-tonsillectomy respiratory compromise and the need for respiratory support during an extended stay at PACU. To identify comorbidities associated with a need for intensive care after extended observation.
MethodsA retrospective cohort study of high-risk children who underwent adenotonsillectomy and were admitted to the Grey Zone following surgery.
Results274 patients met inclusion criteria. 262 (95.6%) met criteria for general care unit transfer (mean oxygen saturation 94.4 ± 5.1%). Twelve (4.4%) patients were transferred from the PACU to the ICU due to respiratory distress (mean oxygen saturation 86.8 ± 11%). Of the patients admitted to general care, 4 (1.5%) secondarily developed respiratory compromise, requiring escalation of care. Three of these maintained oxygen saturation ≥95% throughout the PACU period. There was no difference between the groups with respect to demographic data, rates of morbid obesity, and severity of obstructive sleep apnea. Neuromuscular disease, chronic lung disease, seizure disorder, and gastrostomy-tube status were more prevalent in those requiring ICU level of care compared to the general care unit.
Conclusions The Grey Zone model accurately identifies patients requiring ICU-level care following adenotonsillectomy, allowing for a safe reduction in the utilization of ICU resources. Due to rare delayed respiratory events, overnight observation in this cohort is recommended.
Level of Evidence4 Laryngoscope, 2023
Sarah N. Bowe, Randall A. Bly, Mark E. Whipple, Stacey T. Gray
Publication date 23-03-2023
Within this study, the depth and breadth of the literature on otolaryngology residency selection have been synthesized. Additionally, baseline data on selection practices within our specialty has been captured. With an informed understanding of our past and present, we can look to the future. Built upon the principles of person-environment fit theory, our proposed framework can guide research and policy discussions regarding the design of selection systems in otolaryngology, as we work to achieve more effective, efficient, and equitable outcomes.
Objectives To examine the otolaryngology residency selection process, including past experiences based on the medical literature and survey analysis of our present practices to generate recommendations for future selection system design.
MethodsA mixed-methods study, including a scoping review and a cross-sectional survey, was completed. Four databases were assessed for articles on otolaryngology residency selection published from January 1, 2016 through December 31, 2020. A 36-question survey was developed and distributed to 114 otolaryngology program directors. Descriptive and thematic analysis was performed.
Results Ultimately, 67 of 168 articles underwent data abstraction and assessment.
Three themes surfaced during the analysis: effectiveness, efficiency, and equity. Regarding the survey, there were 62 participants (54.4% response rate).
The three most important goals for the selection process were: (1) to fit the program culture, (2) to make good colleagues, and (3) to contribute to the programs diversity. The three biggest ‘pain points’ were as follows: (1) Large volume of applications, (2) Lack of reliable information about personal characteristics, and (3) Lack of reliable information about a genuine interest in the program.
Conclusions Within this study, the depth and breadth of the literature on otolaryngology residency selection have been synthesized. Additionally, baseline data on selection practices within our specialty has been captured. With an informed understanding of our past and present, we can look to the future. Built upon the principles of person-environment fit theory, our proposed framework can guide research and policy discussions regarding the design of selection systems in otolaryngology, as we work to achieve more effective, efficient, and equitable outcomes.
Level of evidenceN/A Laryngoscope, 2023
Thomas J. Hudson, Rayane Ait Oubahou, Luc Mongeau, Karen Kost
Publication date 23-03-2023
This study aimed to assess a computational fluid dynamic model in its ability to predict clinical respiratory distress based on a case–control study design. It demonstrated that the computed resistances were significantly related to patients who required urgent airway management. This type of model could be used to develop risk assessment models for future clinical use.
Background Obstructive upper airway pathologies are a great clinical challenge for the airway surgeon. Protection against acute obstruction is critical, but avoidance of unnecessary tracheostomy must also be considered. Decision-making regarding airway, although supported by some objective findings, is largely guided by subjective experience and training. This investigation aims to study the relationship between clinical respiratory distress and objective measures of airway resistance in laryngeal cancer as determined by computational fluid dynamic (CFD) and morphometric analysis.
Methods Retrospective CT and clinical data were obtained for series of 20 cases, defined as newly diagnosed laryngeal cancer patients who required admission or urgent airway surgery, and 20 controls. Cases and controls were matched based on T-staging. Image segmentation and morphometric analysis were first performed. Computational models based on the lattice Boltzmann method were then created and used to quantify the continuous mass flow, rigid wall, and constant static pressure inlet boundary conditions.
Results The analysis demonstrated a significant relationship between airway resistance and acute obstruction (OR 1.018, 95% CI 1.001–1.045). Morphometric analysis similarly demonstrated a significant relationship when relating measurements based on the minimum cross-section, but not on length of stenosis. Morphometric measurements also showed significance in predicting CFD results, and their relationship demonstrated that airway pressures increase exponentially below 2.5 mm. Tumor subsite did not show a significant difference, although the glottic subgroup tended to have higher resistances.
Conclusion Airway resistance analysis from CFD computation correlated with presence of acute distress requiring emergent management. Morphometric analysis showed a similar correlation, demonstrating a radiologic airway assessment technique on which future risk estimation could be performed.
Level of Evidence4 (case–control study) Laryngoscope, 2023
Alexandra E. Tunkel, Daniel Gorelik, Hengameh K. Behzadpour, Md Sohel Rana, Tracey Ambrose, Eve Kronzek, Diego A. Preciado, Brian K. Reilly
Publication date 21-03-2023
Objectives The purpose of this study is to evaluate for discrepancies in diagnostic auditory brainstem responses (ABR) between Childrens National Hospital (CNH), a pediatric medical center, and outside facilities (OSF) that referred patients to CNH for confirmatory evaluation. Such discrepancies impact early hearing detection and intervention (EHDI) timelines.
MethodsA retrospective chart review was conducted from an internal database of patients who underwent diagnostic ABR from 2017 to 2021. Only patients with ABR results from both CNH and OSF were analyzed. Demographic data, external and internal test results, and intervention data were obtained. Hearing loss (HL) severity was graded on a scale of 0 to 8, where 0 indicated normal hearing and 8 indicated profound. Each ear was analyzed separately.
Results Forty-nine patients met the inclusion criteria, and each ear was evaluated separately. Median HL severity was 1.0 0.0, 4.3 at CNH compared to 3.0 1.8, 6 at OSF (p = 0.004). Forty-seven ears (48.0%) showed lower severity at CNH. Twenty-seven patients (55%) received hearing amplification devices. The median age at time of hearing intervention was 220 days.
Conclusion Our results showed statistical significance in the median severity of HL between CNH and OSF. A substantial proportion (70%) of children in our dataset who received amplification via cochlear implant or hearing aids were shown to have discrepancies in ABR findings from CNH and OSF. These findings have implications with regards to the appropriate usage of health care resources and maintaining EDHI timelines.
Level of Evidence4 (Retrospective Cohort Study) Laryngoscope, 2023
Harrison Cash, Tanya K. Meyer, Zain H. Rizvi
Publication date 21-03-2023
Dana Naomi Eitan, Lisa Danielle Grunebaum, Brittany Emma Howard
Publication date 21-03-2023
One of the most common aesthetic treatments performed is dermal filler injection; however, in addition to creating aesthetic benefits, it can cause false positive results in positron emission tomography (PET) imaging of cancer patients. We present a case of PET positivity in an angiosarcoma patient following hyaluronic acid facial augmentation and a literature review. Awareness of the appearance of injectable filler on PET imaging is important for patient counseling prior to procedures and for the interpretation of imaging results.
Objective To discuss a case of hyaluronic acid filler displaying as PET avid resulting in a false positive for local recurrence and review of the literature of how filler presents on PET.
Study Design Case report and literature review.
Methods Retrospective case review of a patient with angiosarcoma with PET-MRI positivity after hyaluronic acid filler injection. Review of the literature was performed.
ResultsA 49-year-old female with low grade angiosarcoma of the right cheek pT1N0M0 was treated with wide local excision and staged reconstruction with cervicofacial advancement flap with subsequent adjuvant radiation therapy. Surveillance PET/MRI scans were conducted every 3 months. After one year without recurrence, HA injectable filler was offered to correct resultant right facial soft tissue defect. The patient proceeded with HA filler and was counseled on the risk of local increased SUV on imaging. Her PET/MRI 3 months later revealed postsurgical changes in the right premaxillary soft tissues with associated low-grade hypermetabolism with max SUV 1.8, which elevated from prior max SUV 0.9. Contralateral left maxillary soft tissues revealed max SUV 0.8. Biopsy was initially favored for concern of local recurrence until the potential for filler to be associated with elevated SUV was discussed. Further evaluation with MRI showed diffusely increased T2 signal with some trace enhancement in the region of PET activity, confirming that findings were consistent with HA filler augmentation per the neuroradiologist team.
Conclusions Fillers, including hyaluronic acid, are associated with elevated SUV on PET-CT. Otolaryngologists should be aware of these features to improve patient counseling, avoid unnecessary procedures, and reduce patient anxiety. Laryngoscope, 2023
Akihito Watanabe, Yuki Kimura, Shinji Tsukamoto, Masanobu Taniguchi, Suguru Ito
Publication date 20-03-2023
Objective Oncological reconstruction of the recurrent laryngeal nerve (RLN) is sometimes necessary for RLN invaded by thyroid cancer. There have been no case reports of RLN reconstruction using artificial nerve conduits, which are often used for peripheral nerves. In this study, we retrospectively evaluate the feasibility, safety, and efficacy of a collagen conduit with collagen filaments for RLN reconstruction cases at our hospital.
Methods Artificial nerve conduits were used in seven cases of RLN reconstruction. Two patients had preoperative unilateral vocal cord paralysis with severe vocal cord atrophy, and two had vocal cord paresis without atrophy. The remaining three patients had functional vocal cords before surgery that had to be resected via surgery due to thyroid cancer infiltration of the RLN. Reconstruction was performed using RENERVE®, which is a collagen conduit. Voice examination and laryngeal endoscopy were performed 1, 3, and 12 months after surgery.
Results There was no improvement in the phonetics of the two patients with vocal cord atrophy before surgery. In the remaining five cases, three with functional vocal cords improved to preoperative values, and two with vocal cord paresis improved to greater than preoperative values.
Conclusion We report the first case series using an artificial nerve conduit for human RLN reconstruction. In cases of RLN resection when the patient has good voice quality pre-operatively, reconstruction of the RLN using an artificial nerve may be a favorable option in cases where direct anastomosis or ansa cervicalis to RLN anastomosis cannot be performed.
Level of Evidence Level 4 Laryngoscope, 2023
Richard D. Hubbell, Joonas Toivonen, Kosuke Kawai, H. Jeffrey Kim, Carrie L. Nieman, Bryan K. Ward, Dennis S. Poe
Publication date 17-03-2023
Objective Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors.
Methods Consecutive patients at three academic centers undergoing BDET (January 2014–November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures.
ResultsBDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7–78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio RR = 3.26; 95% confidence interval CI: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent.
ConclusionBDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication.
Level of Evidence4 Laryngoscope, 2023
Ian Sunyecz, Norman Orabi, Steven Coutras
Publication date 17-03-2023
Emphysematous epiglottitis is a rare manifestation of epiglottitis wherein free air accumulates within the epiglottis, potentially leading to rapid upper airway obstruction. Physicians should be familiar with the diagnosis and treatment of this life-threatening condition.
Epiglottitis is a bacterial infection of the upper respiratory tract that can be rapidly progressive and life-threatening. Though predominantly seen in unvaccinated children, there seems to be a shift with the incidence of adult cases rising following the Haemophilus Influenza B (HiB) vaccine. There are several reports of epiglottitis manifesting as an abscess, but few cases report on the formation of an emphysematous abscess. Additionally, little is known on the bacterial etiology of such infections. Here, we present a case of a patient found to have acute emphysematous epiglottis managed with fiberoptic intubation, drainage, and culture of the abscess. Laryngoscope, 2023
Christine C. Little, Stephen Russell, Chaewon Hwang, Leanne Goldberg, Sarah Brown, Diana Kirke, Mark Courey
Publication date 15-03-2023
Telehealth is a rapidly expanding and increasingly important component of patient care that has the potential to expand the reach of speech, language, and swallow services to historically underserved patient populations. The present study found telehealth to be a viable option for speech-language therapy across a variety of patient populations and is associated with high patient satisfaction regardless of gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy. Age and number of televisits were found to significantly impact patient satisfaction with televisits, highlighting the need for clinicians to adapt teleservices to the unique needs of older populations and encourage continued follow-up visits.
Objectives The study aimed to evaluate patient satisfaction with speech-language therapy televisits and to identify factors influencing the level of satisfaction.
Methods Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech-language therapy with a speech-language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7-item survey. Demographic characteristics of participants were collected from a review of patient charts.
Results65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans-female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy.
Conclusion Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits.
Lay Summary Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in-person therapy.
Level of Evidence4 Laryngoscope, 133:895–900, 2023
Anirudh Saraswathula, J. Matthew Austin, Carole Fakhry, Peter S. Vosler, Rajarsi Mandal, Wayne M. Koch, Marietta Tan, David W. Eisele, Kevin D. Frick, Christine G. Gourin
Publication date 15-03-2023
There is a strong volume-outcome relationship for laryngectomy, with reduced mortality and morbidity associated with higher surgeon and higher hospital volumes. Observed associations between hospital volume and operative morbidity and mortality are mediated by surgeon volume, suggesting that surgeon volume is an important component of the favorable outcomes of high-volume hospital care.
Objective To examine the relationship between surgeon volume and operative morbidity and mortality for laryngectomy.
Data Sources The Nationwide Inpatient Sample was used to identify 45,156 patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal cancer between 2001 and 2011. Hospital and surgeon laryngectomy volume were modeled as categorical variables.
Methods Relationships between hospital and surgeon volume and mortality, surgical complications, and acute medical complications were examined using multivariable regression.
Results Higher-volume surgeons were more likely to operate at large, teaching, nonprofit hospitals and were more likely to treat patients who were white, had private insurance, hypopharyngeal cancer, low comorbidity, admitted electively, and to perform partial laryngectomy, concurrent neck dissection, and flap reconstruction. Surgeons treating more than 5 cases per year were associated with lower odds of medical and surgical complications, with a greater reduction in the odds of complications with increasing surgical volume. Surgeons in the top volume quintile (>9 cases/year) were associated with a decreased odds of in-hospital mortality (OR = 0.09 0.01–0.74), postoperative surgical complications (OR = 0.58 0.45–0.74), and acute medical complications (OR = 0.49 0.37–0.64). Surgeon volume accounted for 95% of the effect of hospital volume on mortality and 16%–47% of the effect of hospital volume on postoperative morbidity.
Conclusion There is a strong volume-outcome relationship for laryngectomy, with reduced mortality and morbidity associated with higher surgeon and higher hospital volumes. Observed associations between hospital volume and operative morbidity and mortality are mediated by surgeon volume, suggesting that surgeon volume is an important component of the favorable outcomes of high-volume hospital care. Laryngoscope, 133:834–840, 2023
Robert Brinton Fujiki, Maia Braden, Susan L. Thibeault
Publication date 15-03-2023
This study examined the effects of voice therapy in 129 children diagnosed with benign vocal fold lesions. Significant improvements were observed in auditory-perceptual assessments, jitter, Noise-to-Harmonic Ratio (NHR), and cepstral peak prominence (CPP) on sustained vowels, as well as CPP and Low-to-High Ratio (LHR) on connected speech. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech. These findings demonstrate the value of CPP as a tool in assessing pediatric voice therapy outcomes and support the efficacy of voice therapy for children presenting with benign vocal fold lesions.
Purpose This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions.
MethodsA retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech.
Results Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post-therapy.
Conclusions Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions.
Level of Evidence4 Laryngoscope, 133:977–983, 2023
Kotaro Tsutsumi, Khwaja H. Ahmed, Khodayar Goshtasbi, Sina J. Torabi, Ahmed Mohyeldin, Frank P.K. Hsu, Edward C. Kuan
Publication date 15-03-2023
The objective of this study was to use the National Cancer Database to characterize clinical factors associated with esthesioneuroblastoma treatment delays and the impact of these delays on overall survival. We subsequently found that delays during, and prolongation of radiotherapy for esthesioneuroblastoma appears to be associated with decreased survival.
Objectives To characterize clinical factors associated with esthesioneuroblastoma treatment delays and determine the impact of these delays on overall survival.
Study Design Retrospective database analysis.
Methods The 2004–2016 National Cancer Database was queried for patients with esthesioneuroblastoma managed by primary surgery and adjuvant radiation. Durations of diagnosis-to-treatment initiation (DTI), diagnosis-to-treatment end (DTE), surgery-to-RT initiation (SRT), radiotherapy treatment (RTD), and total treatment package (TTP) were analyzed. The cohort was split into two groups for each delay interval using the median time as the threshold.
ResultsA total of 814 patients (39.6% female, 88.5% white) with mean ± SD age of 52.6 ± 15.1 years who underwent both esthesioneuroblastoma surgery and adjuvant radiotherapy were queried. Median DTI, DTE, SRT, RTD, and TTP were 34, 140, 55, 45, and 101 days, respectively. A significant association was identified between increased regional radiation dose above 66 Gy and decreased DTI (OR = 0.54, 95% CI 0.35–0.83, p = 0.01) and increased RTD (OR = 3.94, 95% CI 2.36–6.58, p < 0.001) durations. Chemotherapy administration was linked with decreased SRT (OR = 0.64, 95% CI 0.47–0.89, p = 0.01) and TTP (OR = 0.59, 95% CI 0.43–0.82, p = 0.001) durations. Cox proportional-hazards analysis revealed that increased RTD was associated with decreased survival (HR = 1.80, 95% CI 1.26–2.57, p < 0.005), independent of age, sex, race, regional radiation dose, facility volume, facility type, insurance status, modified Kadish stage, chemotherapy status, Charlson-Deyo comorbidity index, and surgical margins.
Conclusions Delays during, and prolongation of radiotherapy for esthesioneuroblastoma appears to be associated with decreased survival.
Level of Evidence4 Laryngoscope, 133:764–772, 2023
Veronica Drozdowski, Deema Martini, Steven Charous
Publication date 15-03-2023
Objective Medullary thyroid cancer (MTC) is a neuroendocrine tumor that comprises 3–5% of all thyroid cancers in the United States. Vocal cord paralysis (VCP) may be due to involvement of the recurrent laryngeal nerve (RLN) preoperatively, or nerve sacrifice during surgery. The purpose of this study was to demonstrate the incidence of VCP in MTC and evaluate whether VCP has an impact on overall survival.
Methods This was a retrospective chart review of patients with MTC treated at Loyola University Medical Center from 2007 to 2021. Information on demographics, cancer diagnosis and treatment, laboratory data, and survival were collected.
ResultsA total of 79 patients were included in our study. 47 (59.5%) patients were female. The average age at the time of diagnosis was 51.3 years (SD 13.58). VCP was identified in 13 out of 79 (16.5%) patients. There were 71 patients with at least 1-year follow-up with median (Q1, Q3) years of 7.2 (3.9, 11.0). Those with VCP within 1 year had 7.2 (95% CI: 2.3, 22.7) times the risk of death compared to those without (p < 0.001).
ConclusionMTC is a rare thyroid cancer, however, its incidence is on the rise. Our study suggests that the incidence of VCP in these patients appears to be higher than seen in other thyroid malignancies, and VCP is associated with a statistically significant negative impact on survival.
Level of Evidence3 Laryngoscope, 133:890–894, 2023
Christine K. Raj, Ian Kim, Francis Reyes Orozco, Harrison J. Ma, Kevin Herrera, Kevin Hur
Publication date 15-03-2023
Among general otolaryngology patients, age affected health-related quality of life differently in men compared with women. Female gender had a protective effect until the age of 35 years after which women experienced a greater decrease in health-related quality of life compared with men.
Objectives The combined effects of age and gender on health-related quality of life (HRQoL) in otolaryngology patients are unclear. This study tested the hypothesis that the effect of age on HRQoL differs by gender in otolaryngology patients.
Methods Patients seen in a general otolaryngology clinic were included in this retrospective chart review. HRQoL was measured by the SF-6D score. Patient characteristics, including demographics and category of chief otolaryngology complaint, were extracted from medical records. A multivariable linear regression analysis was used to analyze the combined effect of age and gender on HRQoL. The model was adjusted for race, ethnicity, number of complaint categories, and number of medications.
Results The study included 728 patients (age mean = 52, SD = 18; 48% male). Multivariable linear regression models found a significant interaction effect between age and gender (β = 0.213, p < 0.05). For younger patients, female gender was protective; however, at age greater than 35 years, female gender was a risk factor for decreased HRQoL. Compared to Black patients, Asian and other race patients reported significantly greater HRQoL (β = 0.207, p < 0.05 for Asian; β = 0.126, p < 0.05 for other races). Additionally, an antagonistic interaction effect was found between age and number of category of otolaryngology complaints in moderating HRQoL (β = 0.468, p < 0.001).
Conclusion Age affects HRQoL differently in men than in women. Among otolaryngology patients, women experience a greater decrease in HRQoL as they age.
Level of Evidence4 Laryngoscope, 133:801–806, 2023
Erin M. Wynings, Nathaniel Breslin, Rebecca L. Brooks, Ashley F. Brown, Candice H. Bailey, Cindy Whitney, Yann‐Fuu Kou, Romaine F. Johnson, Stephen R. Chorney
Publication date 15-03-2023
Accidental decannulations among pediatric tracheostomy patients can be a worrisome complication. A prospective study determined that the rate of these events is about 5 per 1000 tracheostomy days and that most events result in minor harm. This information can be used to design patient safety and quality improvement initiatives for this vulnerable population.
Objectives To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events.
Study Design Prospective cohort.
Methods All tracheostomy patients (≤18 years) admitted at a tertiary childrens hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days.
Results One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2–10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p = 0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7–5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2–7.7) to 3.7 events (95% CI: 2.5–5.0) per 1000 tracheostomy-days (p = 0.04).
ConclusionsAD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications.
Level of Evidence3 Laryngoscope, 133:963–969, 2023
Hagit Shoffel‐Havakuk, Yonatan Lahav, Yoni Shopen, Yonatan Reuven, Gideon Bachar, Yaniv Hamzany
Publication date 15-03-2023
DISCO (Dilation, Steroid injection and post-operative Cough Exercise) is a novel protocol for correcting posterior glottic stenosis. Post-op cough acts as physical-therapy to improve motion and flexibility. It can restore mobility and expand glottic airway without insufficiency.
Objective To describe the DISCO protocol (Dilation, Steroid injection, and post-operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post-operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery.
MethodsA retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018–2020.
DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post-operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post-operatively.
Results Seventeen patients were included; PGS etiology was post-intubation (n = 10), post-irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy-dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub-mucosal arytenoidectomy in 10. The mean follow-up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878).
Conclusions The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency.
Level of Evidence4 Laryngoscope, 133:883–889, 2023
Katherine Z. Xie, Andrew Jay Bowen, Bradley A. Richards, Aisha Aden, Joshua Wiedermann, Amy L. Rutt, Robert Vassallo, Eric S. Edell, Semirra L. Bayan, Jan L. Kasperbauer, Dale C. Ekbom
Publication date 15-03-2023
The first study to evaluate proximal scar progression in idiopathic subglottic stenosis (iSGS) patients who have undergone CO2 laser wedge excision demonstrates a baseline glottic involvement rate of 4.5% in iSGS and low risk of glottic involvement resulting from the procedure.
Objective To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE).
MethodsA retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL), and distance from the glottis to superior-most aspect of scar (DGS). Rates (in mm/procedure) of DΔL, reflecting an increase in length, and D−ΔGS, reflecting proximal migration, were calculated by dividing DΔL and D−ΔGS by the number of LWE procedures.
Results213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS. Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively.
Conclusion There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients.
Level of Evidence4 Laryngoscope, 133:875–882, 2023
Jasper Han, Sachin S. George, Ted Mau
Publication date 15-03-2023
In patients diagnosed with unilateral vocal fold hypomobility, semi-automated analysis of laryngoscopic videos revealed differences in the vocal fold angular velocity or range of motion between the two vocal folds in a substantial subset, but not a large majority, of the patients. Other visual cues in a laryngoscopic exam likely contribute to the perception of unilateral vocal fold hypomobility.
Objectives The clinical determination of vocal fold (VF) hypomobility based on laryngoscopy is subjective. Previous studies point to VF motion anomaly as the most commonly reported factor in the diagnosis of hypomobility. This study tested the hypotheses that VF angular velocities and angular range of motion (ROM) differ between the two VFs in cases of unilateral VF hypomobility.
Study Design Retrospective.
Methods Semi-automated analysis of laryngoscopic videos of 18 subjects diagnosed with unilateral VF hypomobility and 13 subjects with normal VF mobility was performed to quantify/compare the VF angular velocity and ROM between the two VFs during /i/−sniff and laugh.
Results In the hypomobile VF group, 7 out of 15 (47%) videos with /i/−sniff and 5 out of 8 (63%) with laugh had a statistically significant difference in the angular velocities between the VFs in either abduction or adduction. For VF ROM, 8 out of 15 (53%) /i/−sniff videos and 4 out of 8 (50%) with laughter had a statistically significant difference between VFs. In the group without the diagnosis of VF hypomobility, 9 out of 13 subjects (69%) had no difference in VF angular velocity and ROM during either /i/−sniff or laugh.
Conclusions Differences in VF angular velocity or ROM are measurable in a substantial subset of subjects diagnosed with unilateral VF hypomobility. Clinicians ability to gauge VF motion goes beyond what can be extracted from frame-by-frame analysis. Other visual cues, in addition to VF angular velocity and ROM, likely contribute to the perception of unilateral VF hypomobility.
Level of Evidence3 Laryngoscope, 133:866–874, 2023
Aru Panwar, Trevon McGill, Daniel Lydiatt, Oleg Militsakh, Robert Lindau, Andrew Coughlin, Harlan Sayles, Russell Smith, William Lydiatt
Publication date 15-03-2023
Kaplan-Meier Survival Curve Modeled for Time to Death from Enrollment stratified by Primary Outcome of Moderate or Greater Depression.
Objective To study the association between the development of moderate or greater depression during curative-intent therapy and overall survival (OS) in patients with stages II-IV head and neck cancer (HNC).
Methods In this secondary analysis of a randomized double-blind placebo-controlled trial, of 148 eligible participants diagnosed with stages II-IV HNC but without baseline depression, 125 were evaluable and were randomly allocated to prophylactic escitalopram oxalate (n = 60) or placebo (n = 65). Participants were followed for development of moderate or greater depression, using Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR, range 0–27, score ≥11 indicated moderate or greater depression), and were stratified by demographics; cancer site and stage; and primary treatment modality (surgery with or without radiotherapy vs. radiotherapy with or without chemotherapy). Single variable and multivariable Cox proportional-hazard models were used to evaluate differences in OS.
Results Clinically significant depression developed in 22 of 125 patients (17.6%) during HNC treatment. The mean follow-up was 5.0 years (SD 2.4). OS was similar for patient groups, when stratified by development of moderate or greater depression (HR 0.54 CI, 0.21–1.43) or use of prophylactic antidepressant (HR 0.64 CI, 0.34–1.21).
Conclusion There was no significant association between OS and development of moderate or greater depression in patients being treated for stages II-IV HNC, or between OS and use of prophylactic antidepressant escitalopram. Prophylactic antidepressant may be considered in patients with HNC for prevention of clinically significant depression and may offer improved quality of life outcomes.
Level of Evidence2 Laryngoscope, 133:856–862, 2023
Michal Plocienniczak, Krishna Madhav Sambhu, J. Pieter Noordzij, Lauren Tracy
Publication date 15-03-2023
Our retrospective cohort study identified that Black patients comprised the greatest proportion of patients with iatrogenic laryngotracheal stenosis. Of all etiologies, the iatrogenic form of stenosis had the highest incidence of temporary tracheostomy and tracheostomy dependence.
Objective Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency.
Methods Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit.
Results129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only.
Conclusion This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study.
Level of Evidence3 Laryngoscope, 133:908–913, 2023
Juliana Bonilla‐Velez, Kathryn B. Whitlock, Sheila Ganti, Giri M. Shivaram, Randall A. Bly, John P. Dahl, Scott C. Manning, Jonathan A. Perkins
Publication date 15-03-2023
This report evaluates treatment outcomes in head and neck lymphatic malformations (HNLMs). It presents a relative risk analysis of whether delaying invasive therapy reduces treatment number and risk. Delaying treatment in grade 1 HNLMs reduces invasive treatment number, but in grade 2 malformations this strategy does not reduce number of treatments.
Objectives Large (De Serres stage IV–V) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number.
Materials Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0–18 years.
MethodsITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs.
Treatment effectiveness categorized by IT number: optimal (0–1), acceptable (2–5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ2). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT).
Results Median age at HNLM diagnosis was 1.3 months (interquartile range IQR 0–45 m) with 107/199(54%) male. HNLM were stage I–III (174 88%), IV–V (25 13%). Initial treatment was observation (70 35%), invasive (129 65%). Treatment outcomes were optimal (137 69%), acceptable (36 18%), and suboptimal (26 13%).
Suboptimal outcome associations: EXIT procedure, stage IV–V, oral location, and tracheotomy (p < 0.001). Stage I–III HNLMs were initially observed compared with stage I–III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk (i.e., >1 IT, RR = 0.09, 95% CI 0.02–0.36, p < 0.001). Stage I–III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV–V (RR = 0.47, 95% CI 0.33–0.66, p < 0.001).
Conclusion Observation and delayed IT in stage I–III HNLM (“Grade 1”) is safe and reduces IT (i.e., ≤1 IT). Stage IV–V HNLMs (“Grade 2”) with early IT have a greater risk of multiple ITs.
Level of Evidence4 Laryngoscope, 133:956–962, 2023
Takeaki Hidaka, Kentaro Tanaka, Hiroki Mori
Publication date 15-03-2023
A state-of-the-art AI facial recognition system was applied to the symmetry evaluation of the faces underwent mandibular reconstruction surgery with free vascularized fibular flaps. Temporomandibular joint reconstruction with fibular bone was found to match the original joint in terms of symmetry as well as function.
Objective Management of the temporomandibular joint (TMJ) following condylar resection remains challenging in the field of mandibular reconstruction. A simple reconstruction of the TMJ with a contoured end of a fibular graft placed into the joint space is a potential option, but its efficacy is unknown partly because there are only few objective assessment systems for aesthetic outcome. This study aimed to develop an artificial intelligence (AI)-based aesthetic outcome evaluation system for the simple TMJ reconstruction method and evaluate its functional outcomes.
Methods Patients who underwent segmental mandibular resection and reconstruction with fibular flaps at our institution between 2011 and 2020 were retrospectively reviewed. The mandibular asymmetry value was introduced as a primary aesthetic outcome measure, calculated for each patients photograph using facial recognition AI. The outcomes of the simple TMJ reconstruction method were compared with those of cases in which the native condyle was preserved.
Results Ten patients underwent condylar resection followed by simple TMJ reconstruction, while the native condyle was preserved in 18 patients. No significant difference was observed in the postoperative mandibular asymmetry value between the two treatment groups. No significant differences were found in the functional outcomes of deglutition and speech.
Conclusion The AI-based asymmetry evaluation system was useful as an aesthetic outcome measure in mandibular reconstruction. Simple TMJ reconstruction with a fibular end seemed to be a promising option, as there were no significant differences in both aesthetic and functional outcomes between this method and those cases in which the native condyle was preserved. Laryngoscope, 133:841–848, 2023
Andi Liebowitz, Daniel B. Spielman, Rodney J. Schlosser, Michael G. Stewart, David A. Gudis
Publication date 15-03-2023
Objective Demographic minorities are underrepresented in clinical trials. For the approval of new drug applications (NDAs), the Food and Drug Administration (FDA) has asserted that clinical trial enrollment should represent the demographics of patients likely to receive the trial drug. The aim of this study is to assess the demographics of clinical trials included in NDAs and biologics license applications (BLAs) approved by the FDA since 1990 for allergic rhinitis (AR), a condition whose demographic prevalence mirrors the US population.
Methods Federal Freedom of Information Act requests were submitted to the US government to obtain documents related to all relevant NDAs and BLAs. The Drugs@FDA database was queried for all clinical trial documentation. Demographic data were extracted from clinical trials used to inform FDA approval for AR pharmacotherapies. Demographics were analyzed relative to national US Census data.
Results Since 1990, 22 drugs have been approved for AR. The racial, ethnic, and sex composition of all included study populations differed significantly (p < 0.05) from the demographics of AR and from US Census data. Most NDAs and BLAs included overrepresentation of White participants and underrepresentation of Black, Asian, Pacific Island, Native American, and Hispanic participants.
Conclusion The patients enrolled in clinical trials used to inform FDA approval for AR pharmacotherapeutics do not represent the demographics of the United States or the demographics of AR. The clinical significance of unrepresentative demography between study and treatment populations has been examined for several medical disorders, but has not been studied for AR.
Level of Evidence4 Laryngoscope, 133:755–763, 2023
Hugo G. B. Nijmeijer, Hans M. M. Groenewoud, Emmanuel A. M. Mylanus, André Goedegebure, Wendy J. Huinck, Gert Jan Wilt
Publication date 15-03-2023
The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61–80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness. Based on its outcomes, the described expansion appears to constitute a cost-effective use of healthcare resources. However, it would require a significant increase in diagnostic, operative and rehabilitative capacity. These quantitative estimates can serve as a basis for wider societal deliberation on the question wheter such an increase can and should be pursued.
Objectives Eligibility criteria for cochlear implantation (CI) are shifting due to technological and surgical improvements. The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61–80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness.
MethodsA dynamic population-based Markov model was constructed mimicking the Dutch population in three age categories over a period of 20 years. Health states included severe HL (61–80 dBHL), profound HL (>81 dBHL), CI recipients, and no-CI recipients. Model parameters were based on published literature, (national) databases, expert opinion, and model calibration.
Results If persons with severe HL would qualify and opt for CI similar to those with profound HL now, this would lead to a 6–7 times increase of new CI recipients and an associated increase in costs (€550 million) and QALYs (54.000) over a 20-year period (incremental cost utility ratio: 10.771 euros/QALY 2.5–97.
5 percentiles: 1.252–23.171). One-way-sensitivity analysis indicated that model outcomes were most sensitive to regaining employment, utility associated with having a CI, and costs of surgery and testing.
Conclusion Our findings suggest that expanding eligibility for CI to persons with severe HL could be a cost-effective use of resources. Clearly, however, it would require a significant increase in diagnostic, operative, and rehabilitative capacity. Our quantitative estimates can serve as a basis for a wider societal deliberation on the question whether such an increase can and should be pursued.
Level of EvidenceNA Laryngoscope, 133:924–932, 2023
Trung N. Le, Wendy Oakden, Subhendu Mukherjee, Zannatul Ferdous, Maya Kuroiwa, Violet M. Liu, Zhifen Zhang, Yumai Situ, Brandon Paul, Greg Stanisz
Publication date 15-03-2023
This is the first study to magnetically target gadolinium contrast to the inner ear as an effective, minimally-invasive, local delivery technique that can be tracked by magnetic resonance imaging (MRI). Better accumulation of gadolinium contrast allows better visualization and quantification of endolymphatic hydrops.
Objectives1. Determine the feasibility and efficiency of local magnetic targeting delivery of gadolinium (Gad) contrast to the inner ear in rodents. 2. Assess any potential ototoxicity of magnetic targeting delivery of Gad in the inner ear. 3. Study the utility of magnetic targeting delivery of Gad to visualize and quantify endolymphatic hydrops (EH) in a transgenic mouse model.
Study Design Controlled in vivo animal model study.
Methods Paramagnetic Gad was locally delivered to the inner ear using the magnetic targeting technique in both rat and mouse models. Efficiency of contrast delivery was assessed using magnetic resonance imaging (MRI). Ototoxicity of Gad was examined with histology of the cochlea and functional audiological tests. The Phex mouse model was used to study EH, hearing loss, and balance dysfunction. Magnetic targeting delivery of Gad contrast was used in the Phex mouse model to visualize the effects of EH using MRI.
Results Magnetic targeting improved the delivery of Gad to the inner ear and the technique was reproducible in both rat and mouse models. The delivery method did not result in microstructural damage or any significant hearing loss in a normal animal. Magnetic targeting of Gad in the Phex mouse model allowed detailed visualization and quantification of EH.
Conclusion This study provided the first evidence of the effectiveness and efficiency of the local magnetic targeting delivery of gadolinium contrast to the inner ear and its application to the visualization and quantification of EH. Laryngoscope, 133:914–923, 2023
Aaron D. Friedman, Isabelle Gengler, Mekibib Altaye, Meredith E. Tabangin
Publication date 15-03-2023
Eighty-one percent of patients with early stage glottic carcinoma are treated with radiation therapy (alone or in combination with surgery), according to the United States National Cancer Database. Radiation therapy (vs. surgery) is significantly more likely with advancing tumor stage, treatment at a non-academic facility, shorter distance to a treatment facility, and treatment outside the Western region of the United States.
Objective Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC.
Methods The NCDB was queried for all cases of T1-2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume.
Results34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 95%CI: 2.3, 2.7), treatment at non-academic facilities (OR 2.8, 95%CI: 2.6, 3.0), and shorter travel distances to treatment centers (OR 2.2, 95%CI: 2.0, 2.4). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model.
Conclusion Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics.
Level of Evidence4 Laryngoscope, 133:901–907, 2023
Ian Schonman, Pamela A. Mudd, Ryan Ivancic, Marisa A. Ryan, Julina Ongkasuwan, Jeremy Prager, Marshall E. Smith, Steven L. Goudy, Md Sohel Rana, Gregory J. Wiet, Nancy M. Bauman
Publication date 15-03-2023
Objective To explore patient-reported outcome measures of pediatric paradoxical vocal fold motion through a multi-institutional study of geographically diverse United States medical facilities to assess long-term management and outcomes.
Methods Eligible participants >8 years of age diagnosed with PVFM over a 10-year period from 7 tertiary pediatric hospitals were invited to complete a survey addressing study objectives.
Results65 participants completed the survey, of whom 80% were female, 75% reported a 3.5 grade point average or better, and 75% identified as competitive athletes or extremely athletic individuals. Participants rated their perceived efficacy of 13 specific treatments. Only five treatments were considered effective by a majority of the participants who tried them. The treatments that participants tried most often were breathing exercises (89.2%), bronchodilator treatments (45%), and allergy medications (35.4%). 78.8% of participants reported receiving more than one treatment and 25% reported receiving a combination of bronchodilators, anticholinergics, and steroids. At the time of PVFM diagnosis, 38% of participants had no idea when their symptoms would completely resolve. 23.3% of participants did not experience symptom resolution until greater than 1 year after diagnosis.
Conclusions Traditional management tools such as breathing exercises and biofeedback treatments may not provide the long-term benefit that providers anticipate. In addition to these commonly used management strategies, highly efficacious techniques such as counseling and lifestyle management should be incorporated into the long-term management of patients whose symptoms are refractory to traditional care.
Level of Evidence4 Laryngoscope, 133:970–976, 2023
Meredith M Lamb, Mark M Mims, J. Madison Clark
Publication date 15-03-2023
Effective treatment of auricular hematomas can be a challenging problem for both the otolaryngologist and the patient. Recurrence rates are high even with proper drainage and bolstering. The hole-punch technique is a powerful tool to address the difficult problem of recurrent auricular hematomas and avoid disfiguring deformities of the ear. Laryngoscope, 133:814–817, 2023
Pubmed PDF WebJacquelyn K. Callander, Karolina Plonowska‐Hirschfeld, Arushi Gulati, Jolie L. Chang, William R. Ryan
Publication date 15-03-2023
In this prospective cohort study, the Chronic Obstructive Sialadenitis Symptoms questionnaire is used to evaluate patient-reported symptoms after sialendoscopy-assisted salivary duct surgery at 1-year post-operatively and at approximately 6-years post-operatively, with the aim of assessing the durability of symptom resolution as well as risk factors for persistent symptoms. Overall, our data suggest that approximately 6-years after sialendoscopic-assisted salivary duct surgery for sialadenitis, the majority of patients have durable symptom improvement. The presence of sialolithiasis is associated with long-term symptom resolution, whereas the presence of stenosis on sialendoscopy, non-distal stenoses, and parotid gland involvement were risk factors for persistent sialadenitis symptoms.
Objective The objective is to evaluate the long-term impact of sialendoscopic-assisted salivary duct surgery (SASDS) on sialadenitis symptoms using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire.
Methods The COSS questionnaire, which scores symptoms on a 0–100 scale, was administered prospectively to adult patients pre-operatively, 1-year, and 6-years post-operatively. We examined COSS scores and categories representing complete (<10), partial (10–25), and no (>25) resolution of symptoms with attention to factors significantly associated with incomplete resolution (≥10).
Results Approximately 6-years after SASDS, 111 patients reported scores for 128 symptomatic glands (72 with sialolithiasis, 56 without sialolithiasis). For glands with sialolithiasis, the median COSS score pre-SASDS was 27.5 (interquartile range IQR: 13.5–43), which was significantly reduced to 1.0 (IQR: 0–5.5) at 1-year and 1.5 (IQR 0–5) at 6-years postoperatively. Glands without sialolithiasis had a median COSS score of 40.5 (IQR: 23–52.5) preoperatively, that significantly reduced to 13.5 (IQR 5–21) at 1-year and 14 (IQR 6.5–25.5) at 6-years post-operatively. There was no significant difference in scores from 1- to 6-years. Intraoperative presence of sialolith, absence of stenosis, stenosis in the distal duct, and submandibular gland involvement were significant predictors of complete resolution of symptoms at 6-years.
Conclusion Approximately 6-years after SASDS for sialadenitis, the majority of patients have durable symptom improvement. The sialolithiasis group had higher rates of complete resolution compared to the non-sialolithiasis group. Presence of ductal stenosis on sialendoscopy, non-distal stenoses, and parotid gland involvement were risk factors for persistent long-term sialadenitis symptoms. Laryngoscope, 133:792–800, 2023
Caroline L. Cole, Victoria X. Yu, Sarah Perry, Anisa Seenauth, Ellen A. Lumpkin, Michelle S. Troche, Michael J. Pitman, Yalda Moayedi
Publication date 15-03-2023
Somatosensory feedback from upper airway structures is essential for swallowing and airway defense but little is known about the identities and distributions of human upper airway sensory neurons, or if these structures are modified with age. In this study, we analyzed healthy human biopsies from five distinct anatomical regions of the upper airway for density of all neurons, myelinated putative mechanosensory neurons, and chemosensory structures using immunohistochemistry and densitometry. We describe the architecture of healthy adult sensory innervation and found age-related decline in arytenoid innervation density, suggesting that sensory afferent denervation may contribute to presbyphagia.
Objective Somatosensory feedback from upper airway structures is essential for swallowing and airway defense but little is known about the identities and distributions of human upper airway neurons. Furthermore, whether sensory innervation modifies with aging is unknown. In this study, we quantify neuronal and chemosensory cell density in upper airway structures and correlate with age.
Methods Participants underwent biopsies from base of tongue, lateral and midline pharyngeal wall, epiglottis, and arytenoids (N = 25 13 female/12 male; 20–80 years, mean 51.4 years without clinical diagnosis of dysphagia or clinical indication for biopsy). Tissue sections were labeled with antibodies for all neurons, myelinated neurons, and chemosensory cells. Densities of lamina propria innervation, epithelial innervation, solitary chemosensory cells, and taste buds were calculated and correlated with age.
Results Arytenoid had the highest density of innervation and chemosensory cells across all measures compared to other sites. Taste buds were frequently observed in arytenoid and epiglottis. Base of tongue, lateral pharynx, and midline posterior pharynx had minimal innervation and few chemosensory cells. Epithelial innervation was present primarily in close proximity to chemosensory cells and taste buds. Overall innervation and myelinated fibers in the arytenoid lamina propria decline with aging.
Conclusion Findings establish the architecture of healthy adult sensory innervation and demonstrate the varied distribution of laryngopharyngeal innervation, necessary steps toward understanding the sensory basis for swallowing and airway defense. We also document age-related decline in arytenoid innervation density. These findings suggest that sensory afferent denervation of the upper airway may be a contributing factor to presbyphagia.
Level of EvidenceNA Laryngoscope, 133:773–784, 2023
Clare M. Richardson, David A. Zopf, Allison K. Ikeda, Adam Horn, Katheryn Cohen, Zahra Nourmohammadi, Michel Nassar, Jason S. Park, Kaalan E. Johnson
Publication date 15-03-2023
This study describes creation and validation of a simulator utilizing 3D printed models for endoscopic laryngeal cleft repair, as well as a novel OSATS for endoscopic laryngeal suturing. Confidence, technical skills, and completion times improved with use of the model across a variety of participants.
Objectives Endoscopic laryngeal cleft repair (ELCR) with endolaryngeal suturing is an advanced surgical skill. This study objective was to assess the validity of 3-dimensionally (3D) printed laryngeal suturing simulator for ELCR.
Study Design Development and validation of a simulator for ELCR.
Methods An ELCR model was developed using 3D printed and readily available materials. Participants were surveyed before and after a simulation session using five-point Likert scale questions. Performance data was assessed using blinded expert video review and rated using a novel objective structured assessment of technical skills (OSATS) for endoscopic laryngeal suturing.
Results Twenty-one participants ranging from residents to attendings completed the simulation session. Survey respondents reported on a five-point Likert scale that the model was “easy to use” and “quite realistic” (both mean of 4). Confidence improved significantly in 86% of participants (p < 0.01). Overall OSATS scores (out of a total of 55) showed a median improvement in technical skills of 11.7 points (p = 0.004). OSATS demonstrated good intra-rater (κ = 0.689 and 0.677) and moderate inter-rater (κ = 0.573) reliability. Completion times improved from the first to the last suture by a median time of 512 to 350 s (decrease of 202 s, p = 0.002). Participants with no prior ELCR experience improved more than those with in vivo experience.
Conclusion This study demonstrates the validity of a simulator utilizing 3D printed larynges for ELCR. A novel OSATS for endoscopic laryngeal suturing was successfully implemented. Confidence, technical skills, and completion times improved with the use of the model across a variety of participants. Laryngoscope, 133:785–791, 2023
Feiran Li, Chiyao Hsueh, Huiying Huang, Hongli Gong, Lei Tao, Liang Zhou, Ming Zhang
Publication date 15-03-2023
This study is the first to establish and validate a nomogram based on five critical predictors, including tumor differentiation degree (DD), T classification, metastatic lymph node size (LS), number of lymph node metastases (NOL), and cervical nodal necrosis (CNN), to predict the response of metastatic lymph nodes after induction chemotherapy (ICT) for hypopharyngeal carcinoma patients. Our nomogram yielded relatively good accuracy in predicting the regional ICT response, which will be a useful tool to assist clinicians in future decision-making.
Background For hypopharyngeal carcinoma, metastatic neck nodes with a low response to induction chemotherapy (ICT) should not be managed with concomitant chemoradiotherapy (CCRT), and the prediction of chemosensitivity before ICT could prevent adverse events from occurring during chemotherapy. In this study, we developed a nomogram to predict the regional response to ICT.
MethodsA total of 153 hypopharyngeal carcinoma patients with regional metastasis treated with ICT in our institution from January 2010 to September 2020 were retrospectively studied. According to ICT response evaluated by RECIST 1.1, patients were divided into chemo-insensitive (PR < 70%/SD/PD) (group 1) and chemosensitive (CR/PR ≥ 70%) (group 2) groups. Patients clinical, image, and hematologic data before ICT were collected. The nomogram was built based on multivariate analysis and stepwise logistic regression and was evaluated from the aspects of discrimination and calibration.
ResultsA nomogram based on five critical predictors, namely, tumor differentiation degree, T classification, metastatic lymph node size, number of lymph node metastases, and cervical nodal necrosis, was developed. The areas under the curve (AUC) values were 0.76 and 0.70 after adjusting the results using bootstrap methods. The calibration curve showed relatively good agreement between the predicted and observed probabilities.
Conclusions Our nomogram yielded good accuracy in predicting the regional ICT response and will be a useful tool to assist clinicians in decision making.
Level of Evidence4 Laryngoscope, 133:849–855, 2023
Ashley L. Miller, Roy Xiao, Vinay K. Rathi, Annette A. Wang, Michael J. Rutter, Christopher J. Hartnick, Rosh K. V. Sethi
Publication date 15-03-2023
Objectives Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures.
Methods We performed a cross-sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer-specific prices for M&T and T&A. We additionally characterized the extent of variation in payer-specific prices both across and within hospitals.
Results Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across-center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.
80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.
82 versus 90th percentile: $9,209.88). Median within-center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure.
Conclusion The majority of hospitals serving pediatric patients were non-compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer-specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions.
Level of Evidence3 Laryngoscope, 133:948–955, 2023
Charles J. Limb, Jonathan Mo, Patpong Jiradejvong, Nicole T. Jiam
Publication date 15-03-2023
CI users face significant difficulty with music perception, which negatively impacts sound quality and music appreciation. Our study demonstrates commercially available vocal boost software can be used to improve the perception of musical sound quality appraisals among CI users, which may contribute positively to quality of life. Given these findings, front-end vocal manipulations and settings should be considered as an adjunct to current methods of hearing accessibility and accommodations for CI music listening experiences.
Objective To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals.
Methods An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with −9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise (“anchor”), and an unaltered version (“hidden reference”). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt.
Results Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62–21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64–38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76–40.7, p = 0.028).
ConclusionsCI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users.
Level of Evidence2 (Individual cohort study) Laryngoscope, 133:938–947, 2023
Kayla J. Krause, David Goldrich, John Gniady
Publication date 15-03-2023
A 61-year-old male patient presented with refractory RRP following multiple surgical excisions. His disease course improved substantially when benralizumab was added to his asthma regimen. This case may represent a novel application of benralizumab as an adjuvant treatment for patients with RRP and comorbid asthma.
Recurrent respiratory (RRP) or laryngeal papillomatosis is the result of human papillomavirus-mediated benign tumor growth on the larynx and is challenging to manage. Benralizumab is a monoclonal antibody targeted against the alpha subunit of the IL-5 receptor on eosinophils. A 61-year-old male patient presented with refractory RRP following multiple surgical excisions. His disease course improved substantially when benralizumab was added to his asthma regimen. There is no clear mechanistic role suggested for benralizumab directly treating RRP. This case may represent a novel application of benralizumab as an adjuvant treatment for patients with RRP and comorbid asthma. Laryngoscope, 133:863–865, 2023
Morcos N. Nakhla, Phillip Q. Richards, Jessa E. Miller, David Afework, Daniel Manzoor, Yi‐Ling Lin, Tara Aghaloo, Keith E. Blackwell, Maie A. St. John
Publication date 15-03-2023
Ghost cell odontogenic carcinoma (GCOC) is an exceptionally rare malignant odontogenic neoplasm with a significant potential for aggressive growth. Although the literature on this tumor is limited, its high recurrence rates suggest that early and multimodal intervention may be beneficial. This study reports a case of GCOC of the mandible that was successfully treated with surgical resection, reconstruction, and radiation. A comprehensive literature review was performed, and the relevant genomic and histopathological characteristics of this malignancy were determined. Laryngoscope, 133:830–833, 2023
Pubmed PDF WebEric Anderson, Michael Luu, Allen S. Ho, Zachary S. Zumsteg
Publication date 15-03-2023
Jeong‐Whun Kim, Sung‐Woo Cho
Publication date 15-03-2023
Penelope Neocleous, Julie E. Strychowsky, Peng You, Murad Husein, Lily H. P. Nguyen, Evan Propst, Nikolaus Wolter, M. Elise Graham, on behalf of the primary authors of the Pediatric Bronchoscopy Working Group
Publication date 15-03-2023
Masoumeh Hosseinpoor, Mona Kabiri, Mehdi Bakhshaee
Publication date 15-03-2023
Seamus Boyle, Michael Fitzsimons, Colleen Heffernan
Publication date 15-03-2023
Luigi Angelo Vaira, Giacomo De Riu, Paolo Boscolo‐Rizzo, Claire Hopkins, Jerome R. Lechien
Publication date 15-03-2023
This is a commentary on the article by Hosseinpoor et al.
Pubmed PDF WebSuresh Mani, Smriti Panda, Rajeev Kumar, Chirom A Singh
Publication date 15-03-2023
Merih Onal, Ozkan Onal
Publication date 15-03-2023
Samuel H. Selesnick
Publication date 15-03-2023
Publication date 15-03-2023
Publication date 15-03-2023
Jonathan C. Pang, Milind Vasudev, Amy T. Du, Madeline M Nottoli, Katherine Dang, Edward C. Kuan
Publication date 15-03-2023
Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms. The present systematic review and meta-analysis demonstrates that compared to placebo, anticholinergic treatment significantly reduced rhinorrhea severity and duration in allergic and non-allergic rhinitis patients, albeit with significantly greater adverse event risk for epistaxis. Intranasal anticholinergics are a relatively safe, accessible, and effective option for patients suffering from rhinorrhea secondary to allergic or non-allergic rhinitis and is most optimally used in a symptom-specific role.
Objective Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non-allergic rhinitis symptom severity and duration.
MethodsA search encompassing the Cochrane Library, Pub Med/MEDLINE, and Scopus databases was conducted. Primary studies describing rhinorrhea, nasal congestion, and/or postnasal drip outcomes in rhinitis patients treated with an anticholinergic spray were included for review.
Results The search yielded 1,029 unique abstracts, of which 12 studies (n = 2,024) met inclusion criteria for qualitative synthesis and 9 (n = 1,920) for meta-analysis. Median follow-up was 4 weeks and ipratropium bromide was the most extensively trialed anticholinergic. Compared to placebo, anticholinergic treatment was demonstrated to significantly reduce rhinorrhea severity scores (standardized mean difference 95% CI = −0.77 −1.20, −0.35; −0.43 −0.72, −0.13) and duration (−0.62 −0.95, −0.30; −0.29 −0.47, −0.10) in allergic and non-allergic rhinitis patients respectively. Benefit was less consistent for nasal congestion, postnasal drip, and sneezing symptoms. Reported adverse effects included nasal mucosa dryness or irritation, epistaxis, headaches, and pharyngitis, though comparison to placebo found significantly greater risk for epistaxis only (risk ratio 95% CI = 2.19 1.22, 3.93).
Conclusion Albeit treating other symptoms with less benefit, anticholinergic nasal sprays appear to be safe and efficacious in reducing rhinorrhea severity and duration in both rhinitis etiologies. This evidence supports their continued use in the treatment of rhinitis-associated rhinorrhea.
Level of Evidence1 Laryngoscope, 133:722–731, 2023
Zuwei Cao, Feifan Chen, Emad M. Grais, Fengjuan Yue, Yuexin Cai, De Wet Swanepoel, Fei Zhao
Publication date 15-03-2023
ML approaches analysing TM images can diagnose MED with high levels of sensitivity, specificity and AUC. To further enhance applications of ML approaches, the use of an advanced neural network for multi-label classifiers trained using larger training datasets may lead to robust classification results.
Objective To systematically evaluate the development of Machine Learning (ML) models and compare their diagnostic accuracy for the classification of Middle Ear Disorders (MED) using Tympanic Membrane (TM) images.
Methods Pub Med, EMBASE, CINAHL, and CENTRAL were searched up until November 30, 2021. Studies on the development of ML approaches for diagnosing MED using TM images were selected according to the inclusion criteria. PRISMA guidelines were followed with study design, analysis method, and outcomes extracted. Sensitivity, specificity, and area under the curve (AUC) were used to summarize the performance metrics of the meta-analysis. Risk of Bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool in combination with the Prediction Model Risk of Bias Assessment Tool.
Results Sixteen studies were included, encompassing 20254 TM images (7025 normal TM and 13229 MED). The sample size ranged from 45 to 6066 per study. The accuracy of the 25 included ML approaches ranged from 76.00% to 98.26%. Eleven studies (68.8%) were rated as having a low risk of bias, with the reference standard as the major domain of high risk of bias (37.5%). Sensitivity and specificity were 93% (95% CI, 90%–95%) and 85% (95% CI, 82%–88%), respectively. The AUC of total TM images was 94% (95% CI, 91%–96%). The greater AUC was found using otoendoscopic images than otoscopic images.
ConclusionsML approaches perform robustly in distinguishing between normal ears and MED, however, it is proposed that a standardized TM image acquisition and annotation protocol should be developed.
Level of EvidenceNA Laryngoscope, 133:732–741, 2023
Do Hyun Kim, Sung Won Kim, Se Hwan Hwang
Publication date 15-03-2023
Multiple patient-, disease-, and surgery-related factors are risk factors for pharyngocutaneous fistula. In particular, postoperative hypoproteinemia could be a good predictive factor for pharyngocutaneous fistula in patients undergoing total laryngectomy.
Objectives To assess the predictive value of various risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy.
Methods The characteristics of each study were collected from six databases up to January of 2022. Risk for bias was assessed using the QUADAS-2 tool.
ResultsA total of 58 studies in 9845 patients were included in the analysis. The incidence of PCF was 21.69%, 95% confidence intervals (CI) 0.20; 0.24 in the included studies. Age (OR = 1.33, 95% CI 1.12; 1.58), postoperative anemia (OR = 2.29, 95% CI 1.47; 3.57), diabetes mellitus (OR = 1.81, 95% CI 1.20; 2.71), tumor site (above or below the glottis) (OR = 1.47, 95% CI 1.15; 1.88), previous radiation therapy (OR = 2.06, 95% CI 1.56; 2.72), previous tracheostomy (OR = 1.26, 95% CI 1.04; 1.53), surgery timing (salvage vs. primary) (OR = 2.08, 95% CI 1.46; 2.97), extended total laryngectomy (including pharyngectomy) (OR = 1.96, 95% CI 1.28; 3.00), primary tracheoesophageal puncture (OR = 0.61, 95% CI 0.40; 0.93), and postoperative hypoproteinemia (OR = 9.98, 95% CI 3.68; 27.03) were significantly associated with the occurrence of PCF. In view of predictive ability, postoperative hypoproteinemia showed the highest accuracy (sensitivity = 51%, specificity = 90%, area under the curve = 0.84).
Conclusion Multiple patient-, disease-, and surgery-related factors are risk factors for PCF. In particular, postoperative hypoproteinemia could be a good predictive factor for PCF in patients undergoing total laryngectomy. Laryngoscope, 133:742–754, 2023
Wesley H. Stepp, Eva J. Stein, Michael W. Canfarotta, Jeyhan Wood, Eva Vandoros, Margot Stein, Renie Daniel, William W. Shockley, Joseph Madison Clark, Amelia F. Drake
Publication date 15-03-2023
Adults with orofacial clefts are at a higher risk of developing conditions associated with appearance. In this study, we examine the role that orofacial clefts have on the incidence on Body Dysmorphic Disorder in a US cohort.
Objectives Facial dysmorphic disorder (FDD), a variant of body dysmorphic disorder, occurs when individuals are preoccupied with perceived defects in their facial appearance. Cleft lip and/or palate (CL/P) requires many clinical interventions and has significant psychological impacts on a patients perception of appearance. This study identified psychological burdens related to living as an adult with CL/P and characterizes the degree of FDD symptoms in an adult craniofacial population.
Methods This was a prospective, single-center, cross-sectional case–control study using semi-structured interviews and symptom assessments at a university-based craniofacial center. Patients without CL/P undergoing non-cosmetic facial surgery were recruited as controls (n = 20). Patients with an orofacial cleft (n = 30) were recruited from medical and dental providers at the University of North Carolina. Body Dysmorphic Disorder-Yale Brown Obsessive Compulsive Scale (BBD-YBOCS) scores were collected from a control population and patients with CL/P to assess FDD severity.
Results Demographic factors such age, biological sex, and ethnicity had no significant impact on FDD symptom scores. Patient with CL/P were more likely to have significant FDD symptoms (BDD-YBOCS greater than 16) than patients without CL/P (OR 10.5, CI95 2.7–41.1), and had a mean difference in FDD symptoms scores of 10.04 (p < 0.0001; CI95 5.5–14.6). Patients with CL/P seen by a mental health provider in the past 3 months had 3-fold lower overall FDD symptom scores (OR 0.081; CI95 0.0085–0.77).
Conclusions Adults with CL/P would benefit from treatment for cleft-specific needs and psychological support as they face unique stressors related to their appearance, including an increase in FDD-associated symptoms. This study emphasizes the importance of recognizing psychological symptoms and providing ongoing multidisciplinary care to adults with CL/P.
Level of Evidence3; Individual case–control study Laryngoscope, 133:818–821, 2023
Nir Ben‐Shlomo, Albert Mudry, James Naples, Jarrett Walsh, Timothy R. Smith, Edward R. Laws, C. Eduardo Corrales
Publication date 15-03-2023
In the current era, the most common approach to pathology affecting the sellar and parasellar region involves an exclusively endonasal (extracranial) transnasal transsphenoidal approach using either microscopic or endoscopic techniques. Two pioneering Viennese otolaryngologists, building on each others expertise, were instrumental in the development of the exclusively extracranial transnasal transsphenoidal approach to the pituitary gland: Markus Hajek and Oskar Hirsch.
Objective To evaluate the historical descriptive origins of the extracranial transnasal transsphenoidal route to the sphenoid sinus and sella turcica focusing on the works of two otolaryngologists: Markus Hajek (1861–1941) and Oskar Hirsch (1877–1965).
Data SourcesA collection of primary references of author publications, and contemporary references and textbooks.
Review Methods Primary references were reviewed with specific focus on surgical routes to the sphenoid sinus and sella turcica. Chronology was cross-referenced with contemporary publications by contemporaries. Translations from German were conducted by author AM when necessary.
Results Markus Hajek elegantly described the surgical approach to the posterior ethmoids and sphenoid sinus in 1904 using a transnasal route. Building on this foundation, Oskar Hirsch described the fully extracranial endonasal transethmoid transsphenoidal approach in 1909. He was first to describe surgical entrance to the sella using this exclusively unilateral endonasal route, which he demonstrated on a cadaver. He reports performing this procedure on a live patient in April, 1910, under local anesthesia in stages over 5 weeks. For better exposure, Hirsch consolidated his method with Killians submucosal window resection of the posterior nasal septum allowing for bilateral access to the sphenoid sinus and sella, and completed a single stage procedure on a patient in June 1910.
Conclusion Oskar Hirsch was the first to describe and perform a stepwise surgical approach to the sella using an exclusively extracranial, endonasal, transethmoid, and transsphenoidal approach. He built upon his mentor Markus Hajeks approaches to the posterior ethmoid cells and sphenoid sinus.
Level of EvidenceNA: Background information, synthesis from multiple sources emphasizing factual information Laryngoscope, 133:807–813, 2023
Nathan D. Cass, Nathan R. Lindquist, Marc L. Bennett, David S. Haynes
Publication date 15-03-2023
Monopolar electrosurgery is felt to be unsafe in the setting of indwelling cochlear implants (CIs). We describe 35 CI patients who experienced 63 unique monopolar electrosurgery events, none of which have resulted in known adverse effects.
Objective To evaluate safety of monopolar electrosurgery (MES) in patients with cochlear implants (CIs) by reporting outcomes of a series of patients who underwent MES after CI.
Study Design Retrospective case series.
Setting Tertiary referral center.
Patients Patients with indwelling CI subsequently undergoing surgery with operative note specifically detailing MES use.
Main Outcome Measures Adverse outcomes in post-operative audiology/otolaryngology documentation; speech recognition scores.
Results Thirty-five patients (10 with bilateral CI) experienced 63 unique MES exposure events, 85.7% below and 14.3% above the clavicle. No adverse events or decreased performance due to MES use were reported for any patient. Pre- and immediate postoperative speech recognition scores were not significantly different for patients using either consonant-nucleus-consonant (CNC; n = 23, 68%–66%, p = 0.80) or Az Bio (n = 15, 82%–88%, p = 0.60). For individual CNC performance, 21 (91%) patients demonstrated stability, 1 improved >15%, and 1 declined >15%, although this patient had become a non-user due to magnet issues and, after resolution of these issues, exceeded baseline pre-operative score. For individual Az Bio performance, 12 (80%) patients demonstrated stability, 3 improved >15%, and none declined >15%.
Conclusions No adverse events resulted from MES use in CI patients. Given the increased prevalence and expansion of indications for CIs, and widespread utility of MES, we suggest clarification and improved guidance from device manufacturers regarding safety and use of MES for patients with these devices. We hope that data regarding electrosurgery exposure events will better inform clinician decision-making with regards to relative benefits and risks for MES use for CI patients.
Level of Evidence4 Laryngoscope, 133:933–937, 2023
Nikhit Kethidi, Sudeepti Vedula, Dhvani Shihora, Rushi Patel, Richard C. W. Park
Publication date 15-03-2023
Our study informs physicians and patients on the survival outcomes of undergoing operation for follicular thyroid cancer particularly when using clinical T staging as a stratification method. Similar survival between thyroidectomy versus lobectomy emphasizes that decisions on extent of surgery should take into careful consideration future quality of life as total thyroidectomy requires lifelong pharmacotherapy and higher risk of injury to adjacent structures whereas lobectomy poses higher risk of recurrence. Our findings suggest that demographic factors may ultimately play a bigger role in deciding extent of thyroid resection surgery given similar rates of survival.
Objectives To examine the association between the extent of surgery and overall survival in follicular thyroid cancer (FTC) patients.
Study Design Retrospective analysis of the National Cancer Database (NCDB).
Methods Patients who underwent surgical intervention for FTC from 2004 to 2015 were selected. Patients were >18 years old, with tumor size 1–4 cm, no other malignancies, and >0 follow up time.
Patients were divided into two cohorts based on extent of surgery: lobectomy (≥1 lobe resected) and thyroidectomy (total or near total resection). Pearsons chi-squared analysis was used to compare cohorts. Kaplan–Meier survival and Cox hazards models were utilized to determine overall survival between two cohorts with p < 0.05 used for significance.
ResultsA total of 6871 patients were identified with FTC, of which 1507 patients underwent lobectomy and 5364 patients underwent total thyroidectomy. There were no significant differences in patient demographics, comorbidity index, local spread, or tumor grade. Patients undergoing lobectomy had mean survival of 12.94 versus 12.71 years for those undergoing thyroidectomy. Extent of surgery was not associated with a significant difference in survival (5 years OS = 96% in lobectomy and 95.5% in total thyroidectomy, p = 0.08). Stratification by tumor grade resulted in no significant difference in survival between lobectomy and thyroidectomy.
Conclusion Survival time was not significantly different in patients with more extensive resection of FTC.
Level of Evidence3 Laryngoscope, 133:993–999, 2023
Leonard E. Estephan, Sarah Sussman, Matthew Stewart, Tingting Zhan, Adam Thaler, Maurits Boon, Patrick Hunt, Colin Huntley
Publication date 15-03-2023
This randomized controlled trial suggests that OSA patients undergoing upper airway surgery with total intravenous anesthesia as compared to inhalational anesthesia experience reductions in recovery time. Additional recovery advantages include lessened oxygen supplementation requirements and a more rapid return to alertness. Future work toward developing optimized anesthetic guidelines for OSA patients is merited.
Objective Specific guidelines regarding an optimal general anesthesia (GA) approach to obstructive sleep apnea (OSA) patients remain undefined. Literature comparing the efficacy of total intravenous anesthesia (TIVA) and inhalational anesthesia in this population is sparse. We hypothesize that OSA patients receiving TIVA will experience reduced recovery times and other improved post-surgical outcomes.
Study Design Randomized controlled trial.
Methods Adult OSA patients undergoing upper airway surgery (hypoglossal nerve stimulation HNS, nasal, or palate surgery) from February 2020–December 2020 were included. A post-anesthesia care unit (PACU) nursing survey documented patients alertness, pain, oxygen supplementation, and postoperative nausea and vomiting from PACU arrival to 2 hours. Perioperative timepoints from the electronic medical record (EMR) and a nurse-estimated Phase I recovery time were collected.
Results One hundred eleven patients were included (46 TIVA and 65 inhalational anesthesia). Per EMR-recorded timepoints, TIVA patients undergoing HNS and palate surgery experienced Phase I Time reductions of 12.5 min (p = 0.042) and 27.5 min (p = 0.016), respectively. Per the PACU survey, TIVA patients undergoing any surgery, HNS, or palate surgery experienced nurse-estimated Phase I Time reductions of 16.5 min (p = 0.004), 12.5 min (p = 0.031), and 38.5 min (p = 0.024), respectively. Overall, TIVA patients experienced higher alertness and pain ratings, and lower oxygen supplementation requirements from PACU arrival to 30 min (p < 0.05).
Conclusion Patients with OSA receiving TIVA for GA maintenance during upper airway procedures experienced reduced recovery times and oxygen supplementation requirements, and a more rapid return to alertness. Future work toward developing optimized anesthetic guidelines for OSA patients is merited.
Level of Evidence3 Laryngoscope, 133:984–992, 2023
Karim Ahmed Sakran, Min Wu, Khaled Alkebsi, Mubarak Ahmed Mashrah, Remsh Khaled Al‐Rokhami, Yan Wang, Abdo Ahmed Mohamed, Sadam Ahmed Elayah, Hesham Mohammed Al‐Sharani, Hanyao Huang, Bing Shi
Publication date 15-03-2023
This study was conducted to estimate the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following Sommerlad–Furlow modified palatoplasty technique. The Sommerlad–Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes.
Objective To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad–Furlow modified palatoplasty technique.
Study Design Retrospective cohort.
MethodsA total of 429 patients with cleft palate, who received Sommerlad–Furlow modified technique between 2011–2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected.
Results Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42–4) years, and the average cleft width was 10.15 ± 2.95 (4–27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p = 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p ˂ 0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve = 0.611, p = 0.002) was the cutoff value for predicting the incidence of VPI.
Conclusions The Sommerlad–Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes.
Level of Evidence4 Laryngoscope, 133:822–829, 2023
Marc Levin, Jeffrey H. Spiegel
Publication date 15-03-2023
Zachary H. Douglas, Jay F. Piccirillo, John Schneider, Lauren T. Roland, Nyssa Fox Farrell
Publication date 15-03-2023
Samuel H. Selesnick
Publication date 15-03-2023
Ciersten A. Burks, Elisabeth E. Hansen, Jowan Watson, Regan W. Bergmark
Publication date 15-03-2023
Steven J. Eliades, Joji Tsunada
Publication date 15-03-2023
Objectives Hearing plays an important role in our ability to control voice, and perturbations in auditory feedback result in compensatory changes in vocal production. The auditory cortex (AC) has been proposed as an important mediator of this behavior, but causal evidence is lacking. We tested this in an animal model, hypothesizing that AC is necessary for vocal self-monitoring and feedback-dependent control, and that altering activity in AC during vocalization will interfere with vocal control.
Methods We implanted two marmoset monkeys (Callithrix jacchus) with bilateral AC electrode arrays. Acoustic signals were recorded from vocalizing marmosets while altering vocal feedback or electrically stimulating AC during random subsets of vocalizations. Feedback was altered by real-time frequency shifts and presented through headphones and electrical stimulation delivered to individual electrodes. We analyzed recordings to measure changes in vocal acoustics during shifted feedback and stimulation, and to determine their interaction. Results were correlated with the location and frequency tuning of stimulation sites.
Results Consistent with previous results, we found electrical stimulation alone evoked changes in vocal production. Results were stronger in the right hemisphere, but decreased with lower currents or repeated stimulation. Simultaneous stimulation and shifted feedback significantly altered vocal control for a subset of sites, decreasing feedback compensation at some and increasing it at others. Inhibited compensation was more likely at sites closer to vocal frequencies.
Conclusions Results provide causal evidence that the AC is involved in feedback-dependent vocal control, and that it is sufficient and may also be necessary to drive changes in vocal production.
Level of EvidenceN/A Laryngoscope, 133:1–10, 2023
Publication date 15-03-2023
Publication date 15-03-2023
Anaïs Rameau, Katerina Andreadis, Alexander German, Mark S. Lachs, Tony E. Rosen, Michael S. Pitzrick, Laurel B. Symes, Holger Klinck
Publication date 15-03-2023
We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds.
Objective/Hypothesis We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology.
Study Type/Design Prospective interventional study.
Methods Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures.
Results Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: −0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2, SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: −0.31, p = 0.04) and peak power density (coefficient: −0.35, p = 0.02).
Conclusions Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds.
Level of Evidence3 Laryngoscope, 133:S1–S14, 2023
Publication date 15-03-2023
Publication date 15-03-2023
Norman R. Friedman, Thanh Nguyen, Lisa McLeod
Publication date 13-03-2023
Proshad Efune, Peter Szmuk, Ron Mitchell
Publication date 13-03-2023
Neel K. Bhatt, David Garber, Hans Baertsch, Lynly Beard, J. P. Giliberto, Tanya K. Meyer, Albert L. Merati, Cara Sauder
Publication date 13-03-2023
This purpose of this systematic review was to assess high-quality studies that compare treatments for age-related vocal atrophy.
Objective Age-related vocal atrophy (ARVA) can dramatically affect voice, communication, and quality of life. The objectives of this systematic review were to (1) determine whether treatments for ARVA were superior to controls (2) compare the relative efficacy of procedural and behavioral treatments (3) review the various types of outcome measures, and (4) evaluate the quality of studies.
Review Methods The literature was searched using strategies designed by a medical librarian (2/18/21, updated 3/9/22). Studies investigating treatments for bilateral vocal atrophy were included. Studies involving unilateral atrophy, presbyphonia (without endoscopic findings), or an absent comparator group were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was used to guide this study.
Results After applying the inclusion/exclusion criteria, 8 articles remained, including 4 randomized trials and 4 cohort studies, and a narrative synthesis was performed. Surgical and behavioral treatments for ARVA appeared to be superior to control groups, based on specific outcome measures. However, the superiority of these treatments over controls was not uniformly observed across multiple outcome measures. When comparing different treatments, superiority could not be established based on the quality and completeness of the studies included in the systematic review. Outcome measures also varied between individual studies. Finally, the risk of bias was analyzed and scored. Consistent point deductions among reviewed studies were noted.
Conclusions When comparing treatments for ARVA. Surgery and voice therapy were both superior to control groups based on specific outcome measures from different domains. Superiority of one treatment could not be established.
Level of EvidenceN/A Laryngoscope, 2023
Anthony Ghanem, Elie Alam, Jessica Aoun
Publication date 13-03-2023
Sinonasal lymphoma is a rare clinical entity. B-cell lymphoma usually presents in the paranasal sinuses and is less aggressive than T-cell or NK/T-cell lymphomas. We present a case of an aggressive form of B-cell lymphoma presenting as a nasal septal perforation.
Sinonasal lymphoma is a rare clinical entity. Three main subtypes exhibit different clinical patterns and treatment outcomes. We report the first case of a B-cell lymphoma in a patient without any previous history of nasal surgery, trauma or drug use, who presented to our center with a nasal septal perforation. Laryngoscope, 2023
Patrick Scheffler, Dana Eitan, Rupali Drewek, Sharon Gnagi
Publication date 13-03-2023
Saartje Uyttebroek, Lieven Dupont, Mark Jorissen, Laura Van Gerven
Publication date 13-03-2023
The introduction of CFTR modulators has changed the landscape in cystic fibrosis. The aim of this study was to evaluate the burden of sinus disease in adult patients with cystic fibrosis in the era of CFTR modulators, including the impact on the quality of life and objective extent of the disease. Summarized, the diagnosis of CF-related chronic rhinosinusitis was made in 83% of the patients and despite the presence of sinonasal complaints in almost half of them, patient-reported scores were usually low and did not correlate with objective disease severity. CFTR modulators are promising as significantly lower CT scores and fewer bacterial colonization were observed in the subgroup of patients treated with modulators.
Objectives Chronic rhinosinusitis (CRS) is prevalent in people with cystic fibrosis (PwCF) and is often refractory to treatments. Uncontrolled CRS might negatively impact the lower airways and the quality of life. The aim of this study is to evaluate the burden of cystic fibrosis (CF)-related CRS in the era of CF transmembrane conductance regulator (CFTR) modulators.
Methods Adult PwCF were asked to fill in a questionnaire on sinonasal complaints, they underwent a nasal endoscopy, bacteriological sampling, and a CT scan. Afterwards, these outcome measures were compared between patients treated with and without modulators.
Results In the 122 included patients, CRS was present in 83%. CFTR modulators were prescribed in 48% of the patients, with a median of 10 months since the start of the treatment. Subjectively, the median SNOT-22 score was 16/110. Objectively, a median Lund-Kennedy score of 6/12 and modified Lund-Mackay score of 10/24 were observed. No correlation could be found between SNOT-22 score and other outcome measures including endoscopy and radiology. Altogether, 21% of the patients had controlled disease. When comparing patients treated with and without modulators, significantly lower CT scores (p = 0.0018) and less bacterial colonization (p = 0.0082) were observed in patients receiving modulators.
ConclusionCF-CRS is highly prevalent in our cohort and only the minority of PwCF has a well-controlled disease. A multidisciplinary ENT-pneumology clinic would be beneficial, as there is a high discrepancy between patient-reported symptoms and the extent of the disease. CFTR modulators are promising, as lower CT scores and less bacterial colonization were observed in the modulator group.
Level of Evidence Level 3 Laryngoscope, 2023
Dana N. Eitan, Lisa D. Grunebaum, Brittany E. Howard
Publication date 13-03-2023
Actinomyces infection postoperatively in a rhinoplasty patient has only be reported once previously in the literature. However, Actinomyces infection may be more common than its rare description would suggest; we present three cases of Actinomyces infection post-rhinoplasty. A high index of suspicion for Actinomyces infection must be maintained as it is difficult to culture, requires prolonged treatment with antibiotics, and untreated can cause tissue loss with fistulization.
Objective To discuss a case series of Actinomyces infection post-rhinoplasty and review the literature for correct diagnosis and management.
Study Design Case series with chart review.
Methods Three cases are presented of patients with a history of recurrent infectious symptoms post revision rhinoplasty later being diagnosed as Actinomyces.
Results Three patients were identified having undergone revision rhinoplasty and later being diagnosed with Actinomyces infection. They initially presented with underwhelming physical exams, mild erythema, slight swelling, yet extreme pain. They also had periods of recurrent infection once antibiotics were stopped. Aerobic, anaerobic, fungal, and Actinomyces cultures were sent to pathology and returned positive for Actinomyces. Treatment typically involved a combination of prolonged antibiotics, incision and drainage, and/or surgical debridement.
Conclusions Awareness of Actinomyces as a possible cause of infection post-rhinoplasty is significant as this pathogen can lead to extensive tissue destruction and fistula formation which could be detrimental for a rhinoplasty. Duration of treatment is beyond typical lengths for other infections and a specific culture for Actinomyces is required to be sent as it isnt captured in standard aerobic/anaerobic cultures. Therefore, a high index of suspicion is required by physicians to ensure that patients are evaluated thoroughly. Laryngoscope, 2023
Eelam A. Adil, Sarah Francisco, Ella Morgan, Kosuke Kawai, Michael J. Cunningham
Publication date 10-03-2023
Juvenile nasopharyngeal angiofibroma (JNA) are rare, locally aggressive lesions. Given their rarity, most research has been limited to small case series. In this study we use national data from the PHIS database to review the demographics of JNA in the US and found surgical revision rates and the need for post-operative mechanical ventilation are lower at high volume institutions.
Objective To evaluate the management of juvenile nasopharyngeal angiofibroma (JNA) from a national perspective with outcomes comparison based on hospital volume.
Study Design Ten-year Pediatric Health Information Systems (PHIS) data analysis.
Methods The PHIS database was queried for the diagnosis of JNA. Data regarding demographics, surgical approach, embolization, length of stay, charges, readmission, and revision surgery was collected and analyzed. Hospitals were classified as low volume if fewer than 10 cases and high volume if greater than or equal to 10 cases during the study period. A random effects model compared outcomes based on hospital volume.
ResultsA total of 287 JNA patients were identified with a mean age of 13.8 (± 2.7) years. Nine hospitals were classified as high volume, accounting for a total of 121 patients. The mean length of hospitalization, blood transfusion rate, and 30-day readmissions did not differ significantly by hospital volume. Patients cared for at high-volume institutions were less likely to require postoperative mechanical ventilation (8.3% vs. 25.0%; adjusted RR = 0.32; 95% CI 0.14–0.73; p < 0.01) or return to the operating room for residual disease than patients admitted to low-volume hospitals (7.4% vs. 20.5%; adjusted RR = 0.38; 95% CI 0.18–0.79; p = 0.01).
Conclusions The management of JNA is complex from both an operative and perioperative management standpoint. Over the past decade, nearly half (42.2%) of JNA patients have been managed at nine institutions in the United States. These centers have significantly lower rates of postoperative mechanical ventilation and the need for revision surgery.
Level of Evidence3 Laryngoscope, 2023
Iman Baharmand, Sara Sheikh‐Oleslami, Athenea Pascual Rodríguez, Juan Carlos Hernaiz‐Leonardo, Bader M. Alim, Amin R. Javer
Publication date 10-03-2023
Our study suggests that pulmonary function does improve as a result of nasal surgery but the high heterogeneity observed in the meta-analyses indicates that the evidence supporting this conclusion is low. The current criteria indicate that a 12% improvement in FEV1 or FVC following bronchodilator use is a clinically significant improvement. Based on this, the included studies showed combinations of statistically and/or clinically significant improvements in spirometry measures post-surgery.
ObjectiveA deviated nasal septum (DNS) can result in an anatomical obstruction and impact lung function through prolonged suboptimal inspiration. Given the improvements in respiration reported by patients following septoplasty or septorhinoplasty (with or without inferior turbinate reduction), our study investigated the effect of these procedures on pulmonary function through a systematic review and meta-analysis.
Data Sources Medline, Embase, Cochrane Databases, Web of Science, and Google Scholar.
Review Methods The review was registered with PROSPERO CRD42022316309. The study population was composed of adult patients (18–65) who were symptomatic with confirmed DNS. Extracted outcomes (pre-operative versus postoperative) included the six-minute walk test (6MWT) and pulmonary function tests (FEV1, FVC, FEV1/FVC, FEF25-75, PEF). Meta-analyses were performed using a random-effects model.
Results Three studies included measures of the 6MWT in meters and all three found a statistically significant increase in the distance walked after surgery with a mean difference of 62.40 m (95% CI 24.79–100.00). Statistically significant improvements in PFT outcomes were observed with a standard mean difference of 0.72 for FEV1 (95% CI 0.31–1.13), 0.63 for FVC (95% CI 0.26–1.00), and 0.64 for PEF (95% CI 0.47–0.82). Of the twelve studies which measured PFT outcomes, six showed statistically significant improvements, three studies showed mixed results, and three studies found no difference in PFT outcomes between pre-and post-surgery testing.
Conclusions The present study suggests that pulmonary function does improve after nasal surgery for DNS, but the high heterogeneity observed in the meta-analyses indicates that the evidence supporting this conclusion is low. Laryngoscope, 2023
Hye Jun Kim, Seogsong Jeong, Kyung Jin Roh, Yun Hwan Oh, Michelle J. Suh
Publication date 10-03-2023
The present large-scale study aimed to investigate the risk of new-onset depression in Korean older adults with and without hearing impairment using a nationwide longitudinal dataset spanning 16 years of follow-up. The results indicate that older adults with hearing impairment have a higher risk of incident depression than those without hearing impairment, even after controlling for all confounding factors. We also discovered that hearing impairment had a greater impact on incident depression in those aged <65 years than in those aged ≥65 years.
Background Accumulating evidence suggests that hearing impairment is associated with the onset of depression. However, large-scale epidemiological studies are required to define this association more clearly. We aimed to investigate the risk of new-onset depression in Korean older adults with and without hearing impairment.
Methods From the National Health Insurance Service-Senior Cohort, which is a retrospective-prospective hybrid database, we analyzed data for 254,466 older adults enrolled in the Korea National Health Insurance Service-Senior Cohort who underwent at least one health screening between 2003 and 2019. A Cox proportional hazards regression model was used to evaluate the association between hearing impairment and the risk of incident depression, which was presented as adjusted hazard ratios (aHR) with 95% confidence intervals (CIs). All participants were followed up until the date of incident depression, death, or December 31, 2019.
Results During 3,417,682 person-years of follow-up investigation, hearing impairment was associated with a higher risk of incident depression (vs. no hearing impairment) in the final adjusted model (aHR, 1.11; 95% CI, 1.01–1.21; p = 0.033). Stratified analyses revealed a significant interaction among age, hearing impairment, and the risk of depression. Participants aged <65 years had a higher risk of depression (aHR, 1.29; 95% CI, 1.12–1.50; p < 0.001) than those aged 65 or above (aHR, 1.15; 95% CI, 1.01–1.30; p = 0.032).
Conclusions Hearing impairment is independently associated with a higher risk of depression among older adults. The prevention and treatment of hearing impairment may aid in mitigating the risk of incident depression.
Level of Evidence Level 3 Laryngoscope, 2023
Sophia Dang, Terral Patel, Isabella Lao, Shaum S. Sridharan, Mario G. Solari, Seungwon Kim, Umamaheswar Duvvuri, Robert Ferris, Mark Kubik
Publication date 10-03-2023
Discharge disposition of patients after head and neck cancer surgery with reconstruction affects time to adjuvant radiation therapy and treatment package time. Discharge disposition also affects readmissions.
Objectives Head and neck cancer patients that require major reconstruction often have advanced-stage disease. Discharge disposition of patients can vary and impact time to adjuvant treatment. We sought to examine outcomes in patients discharged to skilled nursing facilities (SNF) compared to those discharged home, including the impact on adjuvant therapy initiation and treatment package time (TPT).
Methods Patients with head and neck squamous cell carcinoma treated with surgical resection and microvascular free flap reconstruction from 2019 to 2022 were included. Retrospective review was conducted to evaluate the impact of disposition on time to radiation (RT) and TPT.
Results230 patients were included, with 165 (71.7%) discharged to home and 65 (28.3%) discharged to SNF. 79.1% of patients were recommended adjuvant therapy. Average time to RT was 59 days for patients discharged to home compared to 70.1 days for patients discharged to SNF. Disposition was an independent risk factor for delays to starting RT (p = 0.03). TPT was 101.7 days for patients discharged to home versus 112.3 days for those who discharged to SNF. Patients discharged to SNF had higher rates of readmission (p < 0.005) compared to patients discharged home in an adjusted multivariate logistic regression.
Conclusions Patients discharged to an SNF had significantly delayed time to initiation of adjuvant treatment and higher rates of readmission. Timeliness to adjuvant treatment has recently been established as a quality measure, thus identifying delays to adjuvant treatment initiation should be a priority.
Level of Evidence3 Laryngoscope, 2023
Michael Ghiam, Ashutosh Kacker
Publication date 10-03-2023
Do Hyun Kim, Sung Won Kim, Geun‐Jeon Kim, Mohammed A. Basurrah, Se Hwan Hwang
Publication date 09-03-2023
The minimally invasive thyroidectomy approaches were not inferior to conventional thyroidectomy in terms of operative outcomes or perioperative complications, and provided high cosmetic satisfaction.
Objectives Minimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta-analysis could not provide comparative data between new techniques. This network meta-analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods.
Data Sources The Pub Med, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar.
Review methods The nine interventions included minimally invasive video-assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo-breast-approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro-auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta-analyses were performed.
ResultsEO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding.
Conclusion It was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 2023
Jay W. Meisner, Shawn Izadi, Ali Kamran, Hester F. Shieh, C. Jason Smithers, John Bennett, Farokh R. Demehri, Somala Mohammed, Claire Lawlor, Sukgi S. Choi, Benjamin Zendejas
Publication date 09-03-2023
In brief, this manuscript highlights the substantial prevalence of vocal fold movement impairment (VFMI) in the pediatric population undergoing complex esophageal and airway surgery. Furthermore, it appears that symptoms alone are an unreliable screening modality. Hence, given the magnitude of the problem and the implications of VFMI, we suggest routine screening with flexible nasolaryngoscopy of such at-risk patients, regardless of symptoms or clinical presentation.
Introduction Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients.
Objective Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms.
MethodsA single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms.
Results We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI.
Conclusion Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube.
Level of Evidence Level III Laryngoscope, 2023
Michael P Wu, Lauren E Miller, Charles D Meyer, Allen L Feng, Jeremy D Richmon
Publication date 08-03-2023
This study highlights the most popular online search topics related to total laryngectomy: post-laryngectomy speech, laryngectomy comparison to tracheostomy, stoma and stoma care, survival/recurrence, and post-laryngectomy eating. The popularity of these topics may reflect a need for further patient counseling and education related to these topics.
Objective To identify the most frequently asked questions regarding “laryngectomy” through an assessment of online search data.
Methods Google Search data based on the search term “laryngectomy” were analyzed using Google Trends and Search Response. The most common People Also Ask (PAA) questions were identified and classified by the concept. Each website linked to its respective PAA question was rated for understandability, ease of reading, and reading grade level.
Results Search popularity for the term “laryngectomy” remained stable between 2017 and 2022. The most popular PAA themes were post-laryngectomy speech, laryngectomy comparison to tracheostomy, stoma and stoma care, survival/recurrence, and post-laryngectomy eating. Of the 32 websites linked to the top 50 PAAs, eleven (34%) were at or below an 8th grade reading level.
Conclusion Post-laryngectomy speech, eating, survival, the stoma, and the difference between laryngectomy and tracheostomy are the most common topics searched online in relation to “laryngectomy.” These are important areas for both patient and healthcare provider education.
Level of EvidenceN/A Laryngoscope, 2023
Ivana Fiz, Marta Filauro, Claudio Sampieri, Alessandro Ioppi, Alberto Vallin, Francesco Fiz, Jan Costantin Koelmel, Davide Lancini, Cesare Piazza, Christian Sittel, Giorgio Peretti
Publication date 08-03-2023
The gold standard treatment for advanced laryngotracheal stenosis is partial crico-tracheal or tracheal resection and anastomosis. These procedures are potentially burdened by high postoperative complication rates. In the present study, the patterns of complications and their predictors are investigated in a multicentric cohort.
Objectives The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort.
Methods We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications.
ResultsA total of 267 patients were included in the study (130 females; mean age, 51.46 ± 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 ± 10.9 vs. 11.3 ± 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications.
ConclusionPCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications.
Level of evidence4 Laryngoscope, 2023
Claire A. Abijay, W. Craig Kemper, An Pham, Romaine F. Johnson, Ron B. Mitchell
Publication date 08-03-2023
Children with SCD referred for PSG are at risk for severe OSA. Compared to the non-SCD group, most children were African American with lower rates of obesity and lower AHIs but longer periods of nocturnal hypoxemia. Likelihood for severe OSA decreased with increasing age for the SCD group.
Objective Obstructive sleep apnea (OSA) is prevalent in children with sickle cell disease (SCD). We compared the demographic, clinical, and polysomnographic characteristics of children with and without SCD.
Methods This retrospective chart review included children with SCD (n = 89) and without SCD (n = 192) ages 1–18 years referred for polysomnography (PSG) for OSA.
Results Children with SCD were predominantly African American when compared to the non-SCD group (95% vs. 28%, p < 0.001). The non-SCD group had a higher BMI z-score (1.3 vs. 0.1, p < 0.001) and a higher percentage of patients classified as obese (52% vs. 13%, p < 0.001). In children with SCD, 43% had severe OSA and 5.6% had no OSA. In the non-SCD group, 67% had severe OSA and 4.7% had no OSA. The SCD compared to the non-SCD group had a lower mean apnea-hypopnea index (AHI) (13.6 vs. 22.4, p = 0.006) but a higher percent sleep time below 90% oxygen saturation (10.5% vs. 3.5%, p < 0.001). Predicted probability for severe OSA in children with SCD decreased with increasing age (OR = 0.81, 95% CI: 0.70–0.93).
Conclusion Children with SCD referred for PSG are at risk for severe OSA. Compared with the non-SCD group, most children were African American with lower rates of obesity and lower AHIs but longer periods of nocturnal hypoxemia. Likelihood for severe OSA decreased with increasing age for the SCD group.
Level of Evidence Level III, retrospective comparative study Laryngoscope, 2023
"Maartje Leemans, Ylenia Longobardi, Richard Dirven, Jimmie Honings, Lucia DAlatri, Jacopo Galli, Michiel Brekel, Claudio Parrilla, Klaske E. Sluis"
Publication date 08-03-2023
This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants’ baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The moldable adhesives lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enables more laryngectomized patients to use hands-free speech more regularly.
Objective This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients.
Methods Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability.
Results The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline.
The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8–144 h) and improved comfort, fit, and ease of speech.
Conclusion The moldable adhesives lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly.
Level of Evidence4 Laryngoscope, 2023
Ryan J. Huang, Amanda Del Risco, Kristal M. Riska, Matthew W. Cooper, Nicholas W. Clark, Samantha J. Kaplan, David Kaylie, Howard W. Francis
Publication date 07-03-2023
Despite its relatively high prevalence, our understanding of the natural clinical course of acute low-tone hearing loss without vertigo remains incomplete. This scoping review found that the majority of patients presenting with acute low-tone hearing loss without vertigo experience hearing improvement. Recurrence and/or fluctuation are common and progression to Menieres disease occurs in a small proportion of patients.
Objective Despite its relatively high prevalence, our understanding of the natural clinical course of acute low-tone hearing loss (ALHL) without vertigo remains incomplete. The purpose of this study is to summarize the findings of studies that evaluated recovery from hearing loss (HL), recurrence and/or fluctuation of HL, and progression to Menieres Disease (MD) of patients presenting with ALHL without vertigo.
MethodsA scoping review of the English literature was performed. On May 14, 2020 and July 6, 2022, MEDLINE, Embase, and Scopus were searched to identify articles related to the prognosis of ALHL. To be included, articles had to present outcomes that were clearly distinguishable for patients with ALHL without vertigo. Two reviewers evaluated articles for inclusion and extracted data. Disagreements were adjudicated by a third reviewer.
Results Forty-one studies were included. There was extensive heterogeneity between studies in regard to defining ALHL, treatment methods, and time of follow-up. Most of the cohorts (39 out of 40) reported partial or complete recovery of hearing in the majority (>50%) of patients, although reports of recurrence were relatively common. Progression to MD was infrequently reported. Shorter time from onset of symptoms to treatment predicted better hearing outcomes in 6 of 8 studies.
Conclusion The literature suggests that although the majority of patients with ALHL experience hearing improvement, recurrence and/or fluctuation are common, and progression to MD occurs in a minority of patients. Additional trials utilizing standardized inclusion and outcome criteria are needed to determine the ideal treatment for ALHL.
Level of EvidenceNA Laryngoscope, 2023
Arthur W. Wu, Akaber M. Halawi, Elisa A. Illing, Dennis M. Tang, Philip G. Chen, Edward C. Kuan, Jonathan Y. Ting, Daniel A. Norez, Stacey A. Kim, Dhruv Sharma, Douglas D. Reh, Sanjeet V. Rangarajan, Kent K. Lam, Randall A. Ow, J. Wesley Sublett, Thomas S. Higgins
Publication date 03-03-2023
The Post-Operative Polyp Scale (POPS) is a new endoscopic grading instrument for the evaluation of polyp recurrence in CRSwNP patients who have had standard ESS. We demonstrate that the POPS is easy to use and has good inter- and intra-rater reliability. The POPS more accurately describes polyp recurrence in the postoperative state, which may be useful in the future for measuring the efficacy of various medical and surgical interventions.
Objective Commonly used endoscopic grading scales, such as the nasal polyp scale, inadequately describe the degree of polyposis found postoperatively in the paranasal sinus cavities. The purpose of this study was to create a novel grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities, the Postoperative Polyp Scale (POPS).
MethodsA modified Delphi method was utilized to establish the POPS using consensus opinion among 13 general otolaryngologists, rhinologists, and allergists. Postoperative endoscopy videos from 50 patients with chronic rhinosinusitis with nasal polyps were reviewed by 7 fellowship-trained rhinologists and scored according to the POPS. Videos were rated again 1 month later by the same reviewers, and scores were assessed for test–retest and inter-rater reliability.
Results Overall inter-rater reliability for the first and second reviews of the 52 videos was Kf = 0.49 (95% CI 0.42–0.57) and Kf = 0.50 (95% CI 0.42–0.57) for the POPS. Intra-rater reliability showed near-perfect test–retest reliability for the POPS with Kf = 0.80 (95% CI 0.76–0.84).
Conclusion The POPS is an easy-to-use, reliable, and novel objective endoscopic grading scale that more accurately describes polyp recurrence in the postoperative state which will be useful in the future for measuring the efficacy of various medical and surgical interventions.
Level of Evidence5 Laryngoscope, 2023
Ryan H. Belcher, Giju Thomas, Parker A. Willmon, Jean‐Nicolas Gallant, Naira Baregamian, Monica E. Lopez, Carmen C. Solόrzano, Anita Mahadevan‐Jansen
Publication date 03-03-2023
Parathyroid glands have been shown to have near infrared auto-fluorescence that is different than the surrounding tissues. Previous studies have shown near-infrared-autofluorescence (NIRAF) can be reliably used intraoperatively for label-free parathyroid identification, but all prior studies have been performed in adult patients. Our findings from this study indicate that NIRAF detection can potentially be a valuable and non-invasive technique to identify PGs during neck operations in the pediatric population.
Objectives Compared to adult patients undergoing thyroid surgery, pediatric patients have higher rates of hypoparathyroidism often related to parathyroid gland (PG) inadvertent injury or devascularization. Previous studies have shown that near-infrared-autofluorescence (NIRAF) can be reliably used intraoperatively for label-free parathyroid identification, but all prior studies have been performed in adult patients. In this study, we assess the utility and accuracy of NIRAF with a fiber-optic probe-based system to identify PGs in pediatric patients undergoing thyroidectomy or parathyroidectomy.
Methods All pediatric patients (under 18 years of age) undergoing thyroidectomy or parathyroidectomy were enrolled in this IRB-approved study. The surgeons visual assessment of tissues was first noted and the surgeons confidence level in the tissue identified was recorded. A fiber-optic probe was then used to illuminate tissues-of-interest with a wavelength of 785 nm and resulting NIRAF intensities from these tissues were measured while the surgeon was blinded to results.
ResultsNIRAF intensities were measured intraoperatively in 19 pediatric patients. Normalized NIRAF intensities for PGs (3.63 ± 2.47) were significantly higher than that of thyroid (0.99 ± 0.36, p < 0.001) and other surrounding soft tissues (0.86 ± 0.40, p < 0.001). Based on the PG identification ratio threshold of 1.2, NIRAF yielded a detection rate of 95.8% (46/48 pediatric PGs).
Conclusion Our findings indicate that NIRAF detection can potentially be a valuable and non-invasive technique to identify PGs during neck operations in the pediatric population. To our knowledge, this is the first study in children to assess the accuracy of probe-based NIRAF detection for intraoperative parathyroid identification.
Level of Evidence Level 4 Laryngoscope, 2023
Alessandro Vinciguerra, Tommaso Saccardo, Benjamin Verillaud, Philippe Herman
Publication date 02-03-2023
Endoscopic pre-lacrimal medial maxillectomy involving the resection of the antero-medial maxillary sinus wall is a novel expanded procedure that allows the management of far lateral or antero-medial benign pathologies of the maxillary sinus, without increasing peri-operative morbidity. Laryngoscope, 2023
Pubmed PDF WebJialu Wang, Xuexi Zhang, Nian Sun, Qiaoyin Liu, Yanzhen Li, Yun Peng, Xiaoling Cheng, Jie Zhang, Yuanhu Liu, Guoshuang Feng, Zhiyong Liu, Tingting Ji, Xiaodan Li, Yuwei Liu, Shengcai Wang, Xin Ni
Publication date 02-03-2023
Our study found that both sildenafil and sirolimus can cause some patients with LMs to experience a decrease in size or reported symptom improvement and proved that the efficacy of sirolimus is better than that of sildenafil (p < 0.05). In terms of safety, both two drugs in the treatment of LMs have fewer side effects and can be tolerated.
Objectives To explore the differences in the efficacy and safety of oral sirolimus and sildenafil in the treatment of pediatric intractable lymphatic malformations (LMs).
Methods From January 2014 to May 2022, we retrospectively enrolled children with intractable LMs treated with oral drugs (sirolimus or sildenafil) and divided the patients into sirolimus and sildenafil groups from Beijing Childrens Hospital (BCH). Clinical features, treatment, and follow-up data were collected and analyzed. The indicators were the ratio of reduction in lesion volume pre and posttreatment, the number of patients with improved clinical symptoms, and adverse reactions to the two drugs.
Results Twenty-four children in the sildenafil group and 31 children in the sirolimus group were included in the present study. The effective rate in the sildenafil group was 54.2% (13/24), with a median lesion volume reduction ratio of 0.32 (−0.23, 0.89) and clinical symptoms improved in 19 patients (79.2%). On the contrary, the effective rate in the sirolimus group was 93.5% (29/31), with a median lesion volume reduction ratio of 0.68 (0.34, 0.96), and clinical symptoms improved in 30 patients (96.8%). There were significant differences (p < 0.05) between the two groups. Regarding safety, four patients in the sildenafil group and 23 patients in the sirolimus group with mild adverse reactions were reported.
Conclusion Both sildenafil and sirolimus can reduce the volume of LMs and improve clinical symptoms in partial patients with intractable LMs. Sirolimus is more effective than sildenafil and the adverse reactions associated with both drugs are mild and controllable.
Level of EvidenceIII Laryngoscope, 2023
Gerald B. Healy
Publication date 01-03-2023
Orna Katz Kadosh, Ivanna Nebor, Matthew M. Smith, Catherine K. Hart, Meredith E. Tabangin, Kaulini Burra, Jennifer L. Kasten, Debora I. Sinner, Alessandro Alarcon
Publication date 01-03-2023
Edwige Gombert, Francois Gorostidi, Kishore Sandu
Publication date 01-03-2023
Review of patients with congenital cricoid cartilage malformation in function of morphological type. Study describes demographics, surgical treatment and functional results. It highlights importance of endoscopic diagnosis and of adapting surgery depending on the malformation.
Objectives To review treatment and outcomes in patients with congenital cricoid cartilage malformation.
Methods Retrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes.
Results Twenty-nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V-shape posterior cricoid plate. Twenty-four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age-appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow-up showed an age-appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice.
Conclusion Endoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis.
Level of Evidence4 Laryngoscope, 2023
Çağrı Becerik, Çiğdem T. Karaca, Zühal Özcan, Selim Kul, Sema Z. Toros
Publication date 01-03-2023
New medication that can be used in allergic rhinitis: Aprepitant.
Objective Substance P is a peptide from the tachykinin family, which is found in peripheral and central nervous systems, causing vasodilation and increased secretion in the nasal mucosa. In this study, we aimed to investigate whether the experimental model of allergic rhinitis will cause allergic changes in the larynx and to compare the effects of aprepitant, a substance P antagonist, on nasal symptoms in allergic rhinitis, and histopathological changes in the nasal and laryngeal mucosa with antihistamine and leukotriene receptor antagonists (LTRA).
Study Design An experimental animal study.
Method The study was carried out on 34 healthy 8–12 weeks old female Sprague Dawley rats in 5 groups. The rats in which an experimental allergic rhinitis model was created with ovalbumin were scored by observing their nasal symptoms, and nasal and laryngeal mucous membranes included in the study were evaluated histopathologically after medications.
Results As a result of the analysis of the data obtained from the study, antihistamine and LTRA significantly reduced the symptoms of nose scratching and sneezing, while aprepitant did not affect nasal symptoms. In the histopathological examination of the larynx, effects that would make a significant difference were found in the allergy group when compared to the control group. On the larynx, aprepitant reduced pseudostratification significantly compared to the allergy group.
Conclusion Aprepitant provides histopathological changes in the treatment of allergic rhinitis, but does not have sufficient effect on nasal symptoms. The effect of aprepitant on the larynx has not been clearly demonstrated.
Level of EvidenceNA Laryngoscope, 2023
Brooke C Braman, Khalid Amin, Sobia F Khaja
Publication date 01-03-2023
Blastomycosis is a fungal infection known to mimic many disease processes, including malignancy. This report describes the case of a 70-year-old man presenting with an enlarging neck mass, initially concerning for a salivary gland neoplasm with metastasis but ultimately found to be disseminated blastomycosis.
Blastomycosis is a fungal infection known to mimic many disease processes, including malignancy. A 70-year-old man presented with an enlarging neck mass and, incidentally found on preliminary imaging, a lung mass. The initial biopsy of the neck mass demonstrating cytologic atypia and mitotic figures was suggestive of malignancy. Whole body positron emission tomography (PET)/CT revealed hypermetabolic lesions in multiple sites, including the neck, lung, and soft tissue, raising concern for metastatic disease. Repeat sampling from multiple lesions, however, demonstrated granuloma. Microbiological studies were collected, and Blastomyces dermatitidis was isolated in culture. The diagnosis of disseminated blastomycosis was made, and the patient received antifungal therapy with good response. A high degree of suspicion for blastomycosis in endemic areas is required to ensure patients receive appropriate and timely treatment. Laryngoscope, 2023
Daša Gluvajić, Janhvi Jayesh Bhate, Kishore Sandu
Publication date 01-03-2023
Objectives Outcome measures of revision open airway surgery in pediatric laryngotracheal stenosis (LTS) are reported.
Methods Data on 46 pediatric LTS patients undergoing revision open airway surgery were collected retrospectively. The measured outcomes were decannulation rate, time to decannulation, postoperative complications, additional surgery to achieve decannulation, and functional results.
Results The most common revision surgery was partial cricotracheal resection (PCTR) in 21/46, followed by extended PCTR (ePCTR) in 20/46, and laryngotracheal reconstruction (LTR) in 5/46 patients. A 90.7% overall decannulation rate (ODR) and a 74.4% operation-specific decannulation rate (OSDR) were achieved. Delayed decannulation was identified in children aged 5 years or less (p = 0.038) and in patients with previous primary open airway surgery (p = 0.039). Complications were observed in 52.2% of patients. To achieve optimal airway patency, additional open or endoscopic airway surgeries were necessary in 30.4% and 47.7% of patients, respectively. Age 5 years or less (p = 0.034), multiple comorbidities (p = 0.044), revision ePCTR (p = 0.023), and laryngeal stenting (p = 0.018) were risk factors requiring additional open surgery to achieve age-appropriate airway. Failed primary open airway surgery (p = 0.034) and comorbidities (p = 0.044) were risk factors for a higher rate of additional endoscopic surgeries. Postoperatively 63.0% of patients achieved normal breathing, 82.2% were dysphonic and 91.1% were orally fed.
Conclusions In this report, the patients age under 5 years, previous primary open airway surgery, medical comorbidities, and laryngeal stenting had a significant negative impact on revision open airway surgery outcomes.
Level of Evidence Level 4 Laryngoscope, 2023
Austin Baker, Patrick Tassone, Laura M. Dooley, Tabitha I. Galloway, Robert P. Zitsch
Publication date 24-02-2023
Objectives Compare the rates of post-operative chyle leak following therapeutic lateral neck dissection during treatment of papillary thyroid carcinoma (PTC) versus squamous cell carcinoma (SCC) of the head and neck.
MethodsA retrospective analysis of 226 consecutive neck dissections in 201 patients who underwent therapeutic neck dissection involving at least levels II-IV with a final pathologic diagnosis of mucosal SCC of the head and neck or PTC from 2010 to 2020. Specific cases of chyle leak were reviewed. Surgical factors associated with chyle leak were analyzed using logistic regression analysis. Duration of chyle leak was assessed by the Kaplan–Meier curve, and time-to-resolution was analyzed by Cox proportional hazard analysis.
Results Postoperative chyle leak was encountered in 15 (6.6%) neck dissections, eight (12.3%) in PTC, and seven (4.3%) in SCC. High-volume chyle leak and chyle leak requiring operative intervention were only encountered in neck dissections performed for PTC. Chyle leak was significantly associated with PTC on univariable analysis (OR 3.08, p = 0.037), but not on multivariable analysis (OR 1.35, p = 0.711). High-volume chyle leak and the need for operative intervention were associated only with PTC patients (OR 23.6, p = 0.006; OR 18.09, p = 0.023 respectively). Median duration of chyle leak was 12.1 days among patients with SCC, and 20.5 days among patients with PTC (p = 0.089).
Conclusions Among 201 patients undergoing therapeutic neck dissection, chyle leak was associated with PTC pathology on univariable but not multivariable analysis. However, high-volume leaks and leaks requiring operative intervention only occurred among patients with PTC.
Level of evidencelevel III Laryngoscope, 2023
Daogong Zhang, Yafeng Lyu, Zhaomin Fan, Haibo Wang
Publication date 23-02-2023
There is currently no satisfactory treatment for otolith dysfunctions. Here, we propose a novel surgical method, vestibule plugging (VP), and the results confirm its effectiveness and safety in treatment of otolith dysfunction. Laryngoscope, 2023
Pubmed PDF WebKatie Liu, Christopher Liu
Publication date 23-02-2023
Merih Onal, Ozkan Onal
Publication date 23-02-2023
Samir A. Ballestas, Julio Hidalgo Lopez, Adam M. Klein, Conor Steuer, Dong M. Shin, Marin Abousaud, Nicole C. Schmitt, Yong Teng, Nabil F. Saba, Andrew T. Tkaczuk
Publication date 23-02-2023
Twenty-three patients with known recurrent Respiratory Papillomatosis who have been receiving off-label systemic bevacizumab were included in this study. There appears to be a reduction in the frequency of surgery required while patients are receiving this medication.
Objective The clinical course of recurrent respiratory papillomatosis (RRP) varies from spontaneous remission to severe airway obstruction with wide variability in recurrence. Standard treatment involves debulking to improve voice and/or breathing. Non-surgical therapies are emerging in hopes of non-operative disease control. This retrospective review analyzes long-term safety, efficacy, and durability of clinical control in the largest reported series of parenteral bevacizumab in adults with RRP.
Methods Twenty-three patients with known RRP who have been receiving off-label systemic bevacizumab were included. Dosage, infusion interval, number of cycles, debulking requirements, subjective outcomes, adverse events, and reasons for treatment termination were investigated.
Results Patients have been followed for an average of 791.43 (21–1468) days. The most common starting dosing regimen was 15 mg/kg at 3 weeks in 11 followed by 10 mg/kg at 6 weeks intervals in 6 individuals. Long-term maintenance dosage varied with the least intensive regimen being 10 mg/kg at 14-week intervals. Subjective improvement of voice and/or breathing was reported in 18/23 subjects. The median time for patients that needed a procedure after treatment was 634 days. Procedures after infusions decreased from 3.08 ± 2.48 procedures in the year prior to 0.52 ± 1.12 during systemic Bevacizumab, and to 0.86 ± 2.05 after stopping bevacizumab. Therapy termination occurred in 8 subjects where only 3 were due to adverse events.
Conclusion Parenteral bevacizumab remains a well-tolerated treatment for patients with recalcitrant RRP. There appears to be a durable reduction in the frequency of debulking surgery requirements although on a maintenance regimen. Laryngoscope, 2023
Michele Fiorella, Maria Armache, Elizabeth Scott, Julianna Rodin, Maurits Boon, Colin Huntley
Publication date 23-02-2023
Objective Continuous Positive Airway Pressure (CPAP) is the typical first treatment for Obstructive Sleep Apnea (OSA); however, patient adherence is often suboptimal. Expansion Sphincter Pharyngoplasty (ESP) is an alternative treatment option for patients with OSA who demonstrate signs of palatal and lateral pharyngeal collapse. The aim of this study is to compare therapeutic outcomes, using the mean disease alleviation concept, for patients who underwent ESP to patients undergoing CPAP therapy.
Data Sources Single-institution retrospective cohort study.
Methods All patients who underwent ESP from 2018 to 2021 or were prescribed CPAP from December to June 2021 at our institution were assessed for inclusion. ESP patients who had pre- and post-operative sleep studies available and CPAP patients who followed up at our institutions sleep clinic were included for analysis. Charts were reviewed for demographic information and sleep study results, and treatment outcomes were measured by calculating mean disease alleviation.
Results There were 77 patients in the ESP group and 107 patients in the CPAP group. AHI reduction was greater in the CPAP group (p = 0.016); however, mean disease alleviation was similar between groups (p = 0.076). One-way ANCOVA demonstrated similar MDA between groups when controlling for patient age, BMI, gender, and pre-operative AHI (F 1,177 = 2,931.6, p = 0.104).
ConclusionCPAP therapy provided superior reduction in AHI compared to ESP; however, overall treatment efficacy as measured by mean disease alleviation was similar for both groups.
Level of Evidence3 Laryngoscope, 2023
Fatemeh Ramazani, Erin D Wright, Derrick R Randall, Jun R Lin, Caroline C Jeffery
Publication date 23-02-2023
Background Microlaryngoscopy is a basic technical skill in Oto-HNS. It is essential for residency programs to have a competency-based assessment tool to evaluate residents performance of this procedure. An Objective Structured Assessment of Technical Skills (OSATS) is a procedure-specific assessment, which consists of the following: (a) Operation-Specific Checklist and (b) Global Rating Scale (GRS).
Objective The objective of this study was to create an OSATS for adult microlaryngoscopy.
Methods This was a prospective study, with an initial qualitative phase for OSATS development (Phase I), and a clinical pilot phase (Phase II). In Phase I, interviews were conducted with three laryngologists to establish a stepwise description of adult microlaryngoscopy and review a previously validated GRS for relevance to microlaryngoscopy. Responses were used to create a framework for the OSATS. The OSATS was then presented to Oto-HNS residents and laryngologists in an alternating fashion, for review of clarity and relevance. A pilot study was then performed to evaluate the resident performance of adult microlaryngoscopy. Multiple regression analysis was carried out to investigate whether training level, case complexity, and previous OSATS exposure could predict participant scores.
Results Phase I of this study led to the creation of a 34-item OSATS. The pilot study (N = 28 procedures) revealed that training level was significantly correlated with increased OSATS scores. There was no statistically significant correlation between case complexity and resident scores. Assessors reported the perceived utility of the OSATS and intent for use in residency training.
Conclusion Application of the proposed OSATS will allow for competency-based assessment of the resident performance of microlaryngoscopy.
Level of EvidenceN/A Laryngoscope, 2023
Christopher Liu, Katie Liu
Publication date 23-02-2023
Ozkan Onal, Merih Onal
Publication date 23-02-2023
"Simon Youn, Marshall Ge, Karla ODell, Sean Wightman, Raymond Kung"
Publication date 23-02-2023
Cervical necrotizing fasciitis (CNF) is a destructive soft tissue infection that can lead to significant morbidity and mortality due to the involvement of critical anatomical structures, namely the upper aerodigestive tract and large vessels. CNF-associated tracheal defects are repaired primarily if possible; however, larger defects in patients with complex comorbidities may require alternative or adjunctive methods of repair. We describe a critically ill CNF patient who underwent a complex repair of a large tracheal defect but had a persistently exposed innominate artery that was treated successfully with an acellular dermal matrix endotracheal graft.
Severe infections of the neck can lead to life-threatening consequences when not treated promptly and correctly. This case report is the first to illustrate the successful use of an acellular dermal matrix to repair a tracheal defect in the setting of a severe neck infection. Laryngoscope, 2023
Hong‐Ho Yang, Tara J. Wu, Jeffrey D. Suh, Marilene B. Wang, Michael Holliday, Daniel Beswick, Huan Zhang, Christine Wells, Justin McCormick, Tom Maxim, Aviva Regev, Zachariah K. Chandy, Jivianne T. Lee
Publication date 22-02-2023
Ozkan Onal, Merih Onal
Publication date 22-02-2023
Yiying Zhang, Chang Liu, Xin He, Zhaohui Tang, Qulian Guo, Changsheng Huang
Publication date 22-02-2023
We describe an unusual case of post-operative conversion aphonia in a pediatric patient. It indicates the importance of discussing its presentation, and amplifies the need for emotional support in the immediate post-operative period for young patients with heightened anxiety.
We describe an unusual case of post-operative conversion aphonia in a pediatric patient. It indicates the importance of discussing its presentation, and amplifies the need for emotional support in the immediate post-operative period for young patients with heightened anxiety. Laryngoscope, 2023
Marta Kulich, Gabriel Gomez, Daniel Kwon
Publication date 21-02-2023
This is a case of a 4-year-old patient with large fibromatosis colli who failed conservative treatment as well as surgical release and ultimately underwent complete excision and reconstruction with innervated vastus lateralis free flap. We describe a novel application of this free flap for a difficult clinical scenario.
Fibromatosis colli (FC) is a fibroblastic contracture of the sternocleidomastoid muscle, often presenting as a neck mass and torticollis. The vast majority of cases resolve with conservative measures; for persistent disease, surgical tenotomy is offered. This is a case of a 4-year-old patient with large FC who failed conservative treatment as well as surgical release and ultimately underwent complete excision and reconstruction with innervated vastus lateralis free flap. We describe a novel application of this free flap for a difficult clinical scenario. Laryngoscope, 2023
Alice E. Huang, Erik P. Chan, Christopher M. Stave, Zara M. Patel, Peter H. Hwang, Michael T. Chang
Publication date 21-02-2023
This scoping review aims to analyze the growing body of literature on the utilization of social media in otolaryngology. Myriad studies demonstrate the application of social media to patient education, professional networking, study recruitment, and obtaining cross-sectional data. However, there remains a paucity of well-controlled studies delineating the benefits and limitations of social media for these various indications.
Objective Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable.
Data Sources and MethodsA scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen.
Results171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n = 37 21%), and within subspecialties of otology (n = 38 22%) and rhinology/allergy (n = 25 15%). Facebook was most frequently used for study recruitment (n = 23 13.5%), You Tube for patient education (n = 15 14.6%), and Twitter for professional networking (n = 16 9.4%).
ConclusionSM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 2023
Neeraja Konuthula, Sherise Epstein, Xing Wang, Mark E. Whipple, Randall A. Bly, Sarah N. Bowe
Publication date 16-02-2023
The objective of this study was to analyze racial/ethnic and gender disparities in the Otolaryngology match. White men were accepted at a higher rate than White women and most other racial/ethnic and gender groups who applied and matched to Otolaryngology.
Objectives Racial, ethnic, and gender disparities in the otolaryngology-head and neck surgery (OHNS) match have been described individually, but not intersectionally. Intersectionality recognizes how multiple forms of discrimination (e.g., sexism, racism) can have a combined effect. The objective of this study was to analyze racial, ethnic, and gender disparities in the OHNS match using an intersectional approach.
Methods Cross-sectional evaluation of data from otolaryngology applicants from the Electronic Residency Application Service (ERAS) and of corresponding otolaryngology residents from the Accreditation Council for Graduate Medical Education (ACGME) from 2013 to 2019. Data were stratified by race, ethnicity, and gender. The Cochran-Armitage tests assessed trends over time in the proportions of applicants and corresponding residents. Chi-square tests with Yates continuity correction were performed to evaluate differences between the aggregate proportions of applicants and corresponding residents.
Results The proportion of White men in the resident pool was increased compared to the applicant pool (ACGME 0.417, ERAS 0.375; Δ + 0.042; 95% CI 0.012 to 0.071; p = 0.03). This was also the case for White women (ACGME 0.206, ERAS 0.175; Δ + 0.031; 95% CI 0.007 to 0.055; p = 0.05). In contrast, there was a smaller proportion of residents compared to applicants among Multiracial men (ACGME 0.014, ERAS 0.047; Δ − 0.033; 95% CI −0.043 to −0.023; p < 0.001) and Multiracial women (ACGME 0.010, ERAS 0.026; Δ − 0.016; 95% CI −0.024 to −0.008; p < 0.001).
Conclusion The findings of this study imply that White men have a persistent advantage, while several racial, ethnic, and gender minorities are disadvantaged in the OHNS match. Further research is necessary to examine why these differences exist in residency selection, including evaluation during the screening, reviewing, interviewing, and ranking stages. Laryngoscope, 2023