Evan J. Patel, Meleha Ahmad, Brian S. Schwartz, Annemieke van Zante, Robert Kersten, Patricia Loftus
Publication date 23-04-2024
We describe a case of acute invasive fungal sinusitis (AIFS) in an immunocompetent, non-diabetic patient after endoscopic sinus surgery. The patient presented with retro-orbital pain progressing to vision loss and was treated with surgical debridement, systemic antifungal therapy, and transcutaneous retro-bulbar injection of amphotericin B resulting in resolution of her symptoms and improvement in her vision. To our knowledge, this is the first report of AIFS in an immunocompetent patient presumed to be secondary to a combination of local immune suppression via topical steroids and mucosal trauma.
Acute invasive fungal sinusitis (AIFS) classically presents as an aggressive fungal infection that can spread beyond its origin in the sinuses in immunocompromised patients. Although there have been reports of AIFS in immunocompetent, non-diabetic patients, it is extremely rare and the true mechanism behind it is unknown. A thirty-eight year old immunocompetent, non-diabetic woman underwent bilateral ESS for chronic rhinosinusitis with nasal polyps at a tertiary care center and post-operatively developed AIFS. Patient underwent uncomplicated ESS, was packed with foam containing triamcinolone and discharged on steroid rinses and a prednisone taper. Surgical pathology demonstrated left-sided colonization with non-invasive fungal elements consistent with a mycetoma. She presented on post-operative Day 11 with headache and left-sided retro-orbital pain. A culture of her left nasal cavity grew Rhizopus spp and MRI demonstrated evidence of invasive fungal infection of left sphenoid mucosa as well as inflammatory changes in the left orbit centered at the orbital apex. She was started on amphotericin and underwent a left-sided debridement with biopsies which demonstrated angioinvasive fungal disease. Her vision in her left eye worsened to 20/800 and she was treated with transcutaneous retrobulbar injection of amphotericin B. After stable interval imaging she was discharged on a long-term course of antifungals. Extensive immunologic work-up was unremarkable. We describe a case of an immunocompetent patient who developed AIFS after sinus surgery for CRS and a mycetoma likely as a result of local immune suppression and post-surgical trauma. Laryngoscope, 2024
Sabri El‐Saied, Amit Amar, Daniel M. Kaplan, Rivka Shitrit, Benyamin M. Kaminer, Aharon Keshet, Eli C. Lewis
Publication date 23-04-2024
In the current investigation, the application of alpha1-antitrypsin (AAT) to mice with acute tympanic membrane perforation accelerated the healing process, leading to earlier expression of growth factors such as VEGF, TGFβ, and collagen-5A1. AAT also increased IL-10 expression levels and decreased IL-6 levels in the treated mice. These findings suggest that AAT may promote tissue repair in a mouse model of acute traumatic TM perforation and support its potential as a therapeutic agent for accelerating wound healing.
Background Most tympanic membrane (TM) perforations heal spontaneously, but 10%–20% remain chronic and might lead to impaired hearing and recurrent middle ear infections. Alpha1-antitrypsin (AAT) is a circulating tissue-protective protein that is elevated under inflammatory conditions and is currently indicated for genetic AAT deficiency. Recently, AAT has been shown to promote tissue remodeling and inflammatory resolution.
Objective This study aimed to examine the effects of local clinical-grade AAT treatment on tissue repair in a mouse model of acute traumatic TM perforation.
Methods Wild-type mice underwent unilateral TM perforation and were either left untreated or treated locally with human AAT (9 × 10−3 mL at 20 mg/mL on days 0, 1, and 2; n = 15/group). The perforations were evaluated macroscopically on a serial basis. Mice were sacrificed on various days post-injury, and TMs were excised for gene analysis by RT-PCR.
Results There were no adverse reactions in hAAT-treated ears throughout the study period. Compared with untreated animals, TM closure occurred earlier in the treated group (days until full closure, median: 4 and 9, respectively). According to gene expression analysis, VEGF, TGFβ, and collagen-5A1 were induced earlier in AAT-treated mice (day 4–5 compared with day 9). Additionally, IL-10 expression levels were higher and IL-6 levels were lower in treated versus untreated mice.
ConclusionA local tissue environment rich in AAT promotes early tissue repair in a perforated TM model both macroscopically and molecularly. Studies are underway to examine TM functionality and recombinant AAT formulations for micro-dosing in the format of a single local application.
Level of EvidenceNA Laryngoscope, 2024
Amirpouyan Namavarian, Alexander Gabinet‐Equihua, Yangqing Deng, Shuja Khalid, Hedyeh Ziai, Konrado Deutsch, Jingyue Huang, Ralph W. Gilbert, David P. Goldstein, Christopher M.K.L. Yao, Jonathan C. Irish, Danny J. Enepekides, Kevin M. Higgins, Frank Rudzicz, Antoine Eskander, Wei Xu, John R. de Almeida
Publication date 23-04-2024
Few validated risk prediction models in head and neck cancer exist for length of stay after surgery. Comparison of ACS-NSQIP calculator, machine learning, and statistical models for length of stay was made. All models were superior to ACS-NSQIP with fair performance. Machine learning model slightly outperformed all other models. Creatinine, surgery duration, and intraoperative fluid volume were emphasized in predicting length of stay.
Objective Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Programs (ACS-NSQIP) calculator in predicting LOS following surgery for OCC.
Materials and MethodsA retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy.
Results Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 SD years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculators performance (0.23, 59%).
Conclusion We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice.
Level of Evidence Level 3 Laryngoscope, 2024
Tice R. Harkins, Vasiliki Triantafillou, Everett Seay, Alan R. Schwartz, Raj C. Dedhia
Publication date 23-04-2024
A 47-year-old male patient diagnosed with severe obstructive sleep apnea (OSA) sought alternatives to positive airway pressure, prompting evaluation with drug-induced sleep endoscopy (DISE). He underwent a specialized DISE with nasal airflow and pharyngeal pressure monitoring. During obstructive apneas, airflow and pressure signals demonstrated dynamic, multilevel upper airway collapse, with shifting sites of airflow obstruction as respiratory effort increased. This case report illustrates how quantitative airflow and pressure measurements can complement the standard DISE exam and aid in surgical decision-making.
A 47-year-old male patient diagnosed with severe obstructive sleep apnea (OSA) sought alternatives to positive airway pressure, prompting evaluation with drug-induced sleep endoscopy (DISE). He underwent a specialized DISE with nasal airflow and pharyngeal pressure monitoring. During obstructive apneas, airflow and pressure signals demonstrated dynamic, multilevel upper airway collapse, with shifting sites of airflow obstruction as respiratory effort increased. This case report illustrates how quantitative airflow and pressure measurements can complement the standard DISE exam and aid in surgical decision-making. Laryngoscope, 2024
Ashley Young, Krupa Patel, Kiona Allen, Saied Ghadersohi, Matthew Rowland, Inbal Hazkani
Publication date 23-04-2024
Bronchoscopy in pediatric ECMO patients should be performed judiciously, with special attention to patient selection. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.
Background We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support.
MethodsA retrospective cohort study of children on ECMO between 1/2018 and 12/2022.
ResultsA total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not.
Conclusion Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.
Level of Evidence4 Laryngoscope, 2024
Amiti Jain, Zachary N. Goldberg, Erin Briggs, Dev R. Amin, Zachary D. Urdang, Richard A. Goldman, David M. Cognetti, Joseph M. Curry
Publication date 23-04-2024
The primary aim of this study is to understand and validate the capacity of the modified frailty index (mFI-5) to predict outcomes for patients undergoing transoral robotic surgery for head and neck cancer. The results of this study provide compelling evidence of the link between increased frailty as defined by mFI-5 and various postoperative complications, including mortality, infection, and pneumonia better predicted than by age alone.
Objective The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.
Methods Retrospective study utilizing the Tri NetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI-5 = 0.
ResultsA total of 9,081 patients were included in the final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5-year mortality were 1.93 (p = 0.0003) for mFI-5 = 2 and 1.90 (p = 0.0002) for mFI-5 = 3. Odds of 2-year mortality were 1.25 (p = 0.0125) for mFI-5 = 1, 1.58 (p = 0.0002) for mFI-5 = 2, and 1.87 (p = 0.003) for mFI-5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI-5 = 2 and 1.78 (p = 0.05) for mFI-5 = 3. Two-year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI-5 = 2 and 2.84 (p < 0.0001) for mFI-5 = 3. Two-month odds of pneumonia were 1.50 (p = 0.0259) for mFI-5 = 2 and 2.55 (p = 0.0037) for mFI-5 = 3. mFI-5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R2 = 0.99), mFI-5 scores better predicted survival than age alone.
Conclusion This study demonstrates that mFI-5 predicts mortality, pneumonia, and postoperative infection independently of age.
Level of Evidence4 Laryngoscope, 2024
Mohammad Bilal Alsavaf, Moataz D. Abouammo, Govind S. Bhuskute, Shuai Sun, Majd Issa, Nolan B. Seim, Kyle K. VanKoevering, Priyanka Bhateja, Marcelo Bonomi, Ricardo L. Carrau
Publication date 23-04-2024
This systematic review underscored the importance of early detection and optimization of treatment as key modifiable factors that would enhance outcomes in Nasolacrimal SCC. It also highlights the potential role to enhance outcomes and minimize the necessity for eye exenteration by utilizing adjuvant therapy.
Objective To comprehensively analyze reported cases of nasolacrimal squamous cell carcinoma (NLSCC), focusing on risk factors, treatment modalities, and outcomes. Additionally, investigate the impact of human Papillomavirus (HPV) status and histopathological subtypes impact on prognosis.
Data Sources Pubmed, Embase.
Review Methods We conducted a systematic literature review to identify relevant studies reporting cases of NLSCC. The review methods adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The final update was performed on May 31, 2023.
Results The 72 studies included a total of 313 participants (mean age: 55; 60% male). Longer symptom duration (44.1 ± 59.2 months) correlated with recurrence (p = 0.004), and males exhibited higher mortality rates (19.6% vs. 2.4% in females, p = 0.01). The overall survival (OS) rate among all patients was 87.1%. Basaloid NLSCC had a worse death outcome (p ≤ 0.001). HPV-positive cases showed comparable OS, recurrence, and metastasis rates to the general population (p = 0.917, 0.851, 0.07, respectively). Comparing treatment approaches (surgery, surgery with adjuvant radiation, chemoradiotherapy CRT followed by surgery), no significant differences in 5 and 10-year OS rates or recurrence were observed (p = 0.4, 0.24, respectively), but 5-year metastasis events were significant (p = 0.024). Eye exenteration rates were 31.1%, 20%, and 0% for the respective treatments (p = 0.089). Induction chemotherapy saved four cases from potential exenteration with favorable prognosis.
Conclusion Early detection and diagnosis are of utmost importance in the management of NLSCC. Regardless of the treatment approach, HPV-related NLSCC demonstrated similar outcomes to the general population. Basaloid histology represents the worst subtype in terms of prognosis. Limited adjuvant CRT cases showed improved outcomes and induction chemotherapys importance was emphasized in recent literature and our shared experience. Laryngoscope, 2024
Jessa E. Miller, Eugene Oh, Aastha Khatiwada, Stephen M. Humphries, Alexandra Wilson, Eszter K. Vladar, David A. Lynch, Jennifer L. Taylor‐Cousar, Daniel M. Beswick
Publication date 22-04-2024
Leonardo Franz, Ingrid Inches, Salvatore Fermo, Alessandro Matarazzo, Cosimo de Filippis, Gino Marioni
Publication date 22-04-2024
Pneumo-membranous labyrinth is an almost unique condition, in which air extends into the membranous labyrinth, filling the endolymphatic sac through the vestibular aqueduct. In this manuscript, we describe and discuss a case of pneumo-membranous labyrinth, with air bubbles extending also to the endolymphatic sac, resulting in anacusis, following hyperbaric oxygen therapy for sudden sensorineural hearing loss. The patient was successfully rehabilitated with a cochlear implant, obtaining a pure-tone average of 30 dB, with a speech discrimination score of 100% at 70 dB.
Pneumo-membranous labyrinth is an almost unique condition, in which air extends into the membranous labyrinth, filling the endolymphatic sac through the vestibular aqueduct. In this manuscript, we describe and discuss a case of pneumo-membranous labyrinth, with air bubbles extending also to the endolymphatic sac, resulting in anacusis, following hyperbaric oxygen therapy for sudden sensorineural hearing loss. The patient was successfully rehabilitated with a cochlear implant, obtaining a pure-tone average of 30 dB, with a speech discrimination score of 100% at 70 dB. Laryngoscope, 2024
Daniel M. Beswick, Christine M. Liu, Jonathan B. Overdevest, Anna Zemke, Aastha Khatiwada, David A. Gudis, Jessa E. Miller, Adam Kimple, Jeremy P. Tervo, Emily DiMango, Jennifer L. Goralski, Claire Keating, Brent Senior, Amanda L. Stapleton, Patricia H. Eshaghian, Jess C. Mace, Karolin Markarian, Jeremiah A. Alt, Todd E. Bodner, Naweed I. Chowdhury, Anne E. Getz, Peter H. Hwang, Ashoke Khanwalker, Jivianne T. Lee, Douglas A. Li, Meghan Norris, Jayakar V. Nayak, Cameran Owens, Zara M. Patel, Katie Poch, Rodney J. Schlosser, Kristine A. Smith, Timothy L. Smith, Zachary M. Soler, Jeffrey D. Suh, Grant A. Turner, Marilene B. Wang, Milene T. Saavedra, Jennifer L. Taylor Cousar
Publication date 18-04-2024
This investigation pooled data from four prospective studies of people with cystic fibrosis (PwCF) and chronic rhinosinusitis across 10 U.
S. centers to determine the factors that predicted improvement in 22-question Sino Nasal Outcome Test (SNOT-22) scores following highly effective modulator therapy (HEMT), and to corroborate the SNOT-22 minimal clinically important difference (MCID) in PwCF. Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater SNOT-22 score improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF was calculated to be 8.5 points, similar to non-CF individuals with CRS pursuing sinus surgery.
Objectives The 22-question Sino Nasal Outcome Test (SNOT-22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT-22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT-22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF).
Methods Prospective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMTs impact on CRS. For participants enrolled prior to HEMT initiation, SNOT-22 scores were obtained at baseline and after 3–6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbachs alpha and four distribution-based methods were used to assess internal consistency and calculate the MCID of the SNOT-22.
ResultsA total of 184 PwCF participated with mean baseline SNOT-22 scores ranging from 18.1 to 56.7. Cronbachs alpha was ≥0.90 across sites. Participants at sites with pre- and post-HEMT data reported improvement in SNOT-22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT-22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02–1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14–18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39–20.11) were associated with greater SNOT-22 improvement. The mean MCID calculated via distribution-based methods was 8.5.
Conclusion Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF is 8.5 points, similar to non-CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT-22 has strong internal consistency in PwCF.
Level of Evidence3 Laryngoscope, 2024
Youssef Lakhdar, Salah‐Eddine Youbi, Omar Oulghoul, Mohammed Chehbouni, Othmane Benhoummad, Youssef Rochdi, Abdelaziz Raji
Publication date 16-04-2024
The petrosquamosal sinus (PSS) is a rare and almost unknown emissary vein of the temporal bone. It traverses the middle cranial fossa along the petrosquamosal fissure and connects dural sinuses with extracranial venous networks. It is known to undergo normal involution during fetal and early postnatal life, and therefore is rarely found in humans. When encountered during surgery, it can be a significant source of bleeding hindering proper visualization of important surgical landmarks. Here we report the case of a PSS, encountered in a child during cochlear implantation surgery. We discuss its clinical significance and impact on the surgical approach.
The petrosquamosal sinus is a rare and almost unknown emissary vein of the temporal bone. It traverses the middle cranial fossa along the petrosquamosal fissure and connects dural sinuses with extracranial venous networks. It is known to undergo normal involution during fetal and early postnatal life, and therefore is rarely found in humans. When encountered during surgery, it can be a significant source of bleeding hindering proper visualization of important surgical landmarks. Here we report the case of a PSS, encountered in a child during cochlear implantation surgery. We discuss its clinical significance and impact on the surgical approach. Laryngoscope, 2024
Wenwei Luo, Xiao Fu, Hongming Huang, Peina Wu, Yanmei Wang, Zhifeng Liu, Shiqi He, Limin Pang, Dongdong Ren, Yong Cui
Publication date 13-04-2024
We demonstrated the presence of PCP in the ET epithelium, which manifested as uniform alignment of motile cilia and asymmetrical localization of PCP proteins. This is the first study of polarization in the epithelial lining of the mouse ET, and the findings provide insights concerning diseases of the ET and middle ear.
Objectives Planar cell polarity (PCP) signaling, essential for uniform alignment and directional beating of motile cilia, has been investigated in multiciliated epithelia. As a complex structure connecting the middle ear to the nasopharynx, the eustachian tube (ET) is important in the onset of ear–nose–throat diseases. However, PCP signaling, including the orientation that is important for ciliary motility and clearance function in the ET, has not been studied. We evaluated PCP in the ET epithelium.
Study Design Morphometric examination of the mouse ET.
Methods We performed electron microscopy to assess ciliary polarity in the mouse ET, along with immunohistochemical analysis of PCP protein localization in the ET epithelium.
Results We discovered PCP in the ET epithelium. Motile cilia were aligned in the same direction in individual and neighboring cells; this alignment manifested as ciliary polarity in multiciliated cells. Additionally, PCP proteins were asymmetrically localized between adjacent cells in the plane of the ET.
Conclusions The multiciliated ET epithelium exhibits polarization, suggesting novel structural features that may be critical for ET function.
Level of EvidenceNA Laryngoscope, 2024
Evan J. Propst, Jennifer M. Siu, Nikolaus E. Wolter
Publication date 13-04-2024
A 15-year-old male with previous open tracheoesophageal fistula (TEF) repair presented with a large, short recurrent TEF. The TEF was denuded with cautery on the tracheal side and the patient was intubated with a cuffed endotracheal tube. Suspension microesophagoscopy allowed excellent exposure of the TEF from the esophageal side, which was cauterized. Four sutures were placed endoscopically from the esophageal side, and the TEF remained closed 6 months postoperatively. Laryngoscope, 2024
Pubmed PDF WebZahir Mughal, Keshav Kumar Gupta, Justin Jui Yuan Yeo, Christopher Metcalfe, Matthew Weller
Publication date 13-04-2024
This meta-analysis investigates the prevalence of post-tonsillectomy bleeding (PTB) associated with abscess tonsillectomy for quinsy. Analyzing 18 eligible studies, the pooled PTB rate was 6.65%, with a higher incidence noted in bipolar technique compared to cold steel dissection. Our study draws attention to abscess tonsillectomy as a safe treatment option for quinsy.
Objective Abscess tonsillectomy is performed during an active episode of quinsy. Apprehensions regarding an elevated bleeding risk have hindered its widespread acceptance. This study aims to assess the prevalence of post-tonsillectomy bleeding (PTB) associated with abscess tonsillectomy.
Data SourcesA search was performed on August 27, 2023 in Medline, Embase, Pub Med, Cochrane CENTRAL, and Web of Science databases.
Review Methods The systematic review was conducted in adherence to the PRISMA guidelines. Pooled PTB rate was determined using a meta-analysis of proportions. The JBI tool was used to assess the quality of the included studies.
Results Of the 525 search records, 18 studies met the eligibility criteria for final analysis. These comprised of retrospective single-center analyses. The pooled prevalence of PTB was 6.65% (95% C.
I. 4.01–9.81), and the return-to-theatre rate was 2.35% (95% C.
I. 1.48–3.37). There was no difference in PTB rate between unilateral and bilateral tonsillectomy. However, the bipolar technique was associated with a higher PTB rate compared to cold steel dissection. The overall quality of the body of evidence was moderate.
Conclusion Our study highlights the complications associated with abscess tonsillectomy. These findings contribute valuable insights into this potential treatment option for quinsy.
Level of EvidenceN/A Laryngoscope, 2024
Carolyn A. Wilson, Taylor L. Jamil, Preetha S. Velu, Jessica R. Levi
Publication date 11-04-2024
Objective To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment.
Methods This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors.
Results Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant.
ConclusionA majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC.
Level of EvidenceIV Laryngoscope, 2024
Vikram Vasan, Christopher P. Cheng, David K. Lerner, Karen Pascual, Amanda Mercado, Alfred Marc Iloreta, Marita S. Teng
Publication date 11-04-2024
Introduction Letters of recommendation (LORs) are a highly influential yet subjective and often enigmatic aspect of the residency application process. This study hypothesizes that LORs do contain valuable insights into applicants and can be used to predict outcomes. This pilot study utilizes natural language processing and machine learning (ML) models using LOR text to predict interview invitations for otolaryngology residency applicants.
MethodsA total of 1642 LORs from the 2022–2023 application cycle were retrospectively retrieved from a single institution.
LORs were preprocessed and vectorized using three different techniques to represent the text in a way that an ML model can understand written prose: Count Vectorizer (CV), Term Frequency-Inverse Document Frequency (TF-IDF), and Word2Vec (WV). Then, the LORs were trained and tested on five ML models: Logistic Regression (LR), Naive Bayes (NB), Decision Tree (DT), Random Forest (RF), and Support Vector Machine (SVM).
Results Of the 337 applicants, 67 were interviewed and 270 were not interviewed. In total, 1642 LORs (26.7% interviewed) were analyzed. The two best-performing ML models in predicting interview invitations were the TF-IDF vectorized DT and CV vectorized DT models.
Conclusion This preliminary study revealed that ML models and vectorization combinations can provide better-than-chance predictions for interview invitations for otolaryngology residency applicants. The high-performing ML models were able to classify meaningful information from the LORs to predict applicant interview invitation. The potential of an automated process to help predict an applicants likelihood of obtaining an interview invitation could be a valuable tool for training programs in the future.
Level of EvidenceN/A Laryngoscope, 2024
Michael J. Warn, Sina J. Torabi, Benjamin F. Bitner, Daniella Chan, Theodore V. Nguyen, Edward C. Kuan
Publication date 10-04-2024
The variation in complexity of patients treated between physicians is understudied. According to Medicare metrics and HCC risk, rhinologists with greater years in practice and full professorial rank treat less complex patients and are reimbursed more per service than junior colleagues.
Introduction Current data regarding reimbursement trends in Medicare services and the complexity of patients treated as physicians progress in their academic career are conflicting. In otolaryngology, there are no data examining these metrics.
Methods Medicare services, reimbursement, and patient complexity risk scores (based on hierarchical condition category coding) of US rhinology fellowship-trained faculty were stratified and compared by rank and years in practice.
ResultsA cohort of 209 rhinologists were included. Full professors were reimbursed more per service than assistant professors ($791.53 $491.69–1052.46 vs. $590.34 $429.91–853.07 p = 0.045) and had lower risk scores (1.37 1.26–1.52 vs. 1.49 1.29–1.68, p = 0.013). Full professors had similar risk scores to associate professors (1.47 1.25–1.64, p = 0.14). Full professors ($791.53 $491.69–1,052.46, p < 0.001), associate professors ($706.85 $473.48–941.15, p < 0.001), and assistant professors ($590.34 $429.91–853.07, p < 0.001) were all reimbursed more per service than non-ranked faculty ($326.08 $223.37–482.36). As a cohort, significant declines in risk scores occurred within the 10th–14th year of practice (p = 0.032) and after the 20th year (p = 0.038). Years in practice were inversely correlated with risk score (R = −0.358, p < 0.001).
Conclusion Full professors were reimbursed more per service and treated less comorbid Medicare patients than junior academic colleagues. Patient comorbidity was correlated negatively with years in practice, with significant drops in mid and late career. Rhinologists employed at academic institutions had greater total reimbursement and reimbursement per service than non-ranked faculty.
Level of EvidenceN/A Laryngoscope, 2024
Constantin A. Hintschich, Cindy Ma, Antje Hähner, Thomas Hummel
Publication date 10-04-2024
Olfactory exposure results in a notable decrease in olfactory sensitivity, observable in both the exposed and contralateral sides. This habituation effect was more pronounced in older subjects compared to young individuals.
Objectives Olfactory habituation is a transient decrease in olfactory sensitivity caused by prolonged odor exposure, aiding in the discernment of new olfactory stimuli against the background. We explored the impact of subclinical olfactory impairment on odor habituation using age as a proxy.
Methods Before the actual experiment, the individual olfactory threshold for the rose-like odorant phenylethyl alcohol (PEA) was assessed separately for the left and right nostril using the “Sniffin’ Sticks” test, and ratings for odor intensity and pleasantness were collected. After applying a nasal clip continuously delivering PEA odor to one nostril for 10 min and 2 h, respectively, threshold, intensity, and pleasantness were reassessed immediately after clip removal.
Results In the group of 80 participants (younger adults-mean age 27.7 ± 4.5 years; older adults-mean age 61.5 ± 4.7 years), olfactory thresholds were already significantly elevated after just 10 min, and this habituation was even more pronounced after 2 h. This effect could be observed bilaterally even though significantly more distinct on the exposed side. Older participants generally exhibited a more pronounced habituation on the exposed side after 2 h compared to the younger participants.
Conclusion The results indicate that older people experience more notable habituation after extended exposure to odors. This is most likely due to the compromised olfactory function in age. Although older and younger subjects scored in the normosmic range when tested with standardized olfactory tests, the stress on the system after exposure to an odor clearly revealed the lower functionality of the aging sense of smell.
Level of Evidence3 Laryngoscope, 2024
Makoto Hosoya, Shuta Tomisato, Nobuharu Matsumoto, Haruna Yabe, Takuji Takaoka, Hiroyuki Ozawa, Takeyuki Kono
Publication date 10-04-2024
Pemphigus Vulgaris (PV) is a rare autoimmune disease that could cause laryngeal lesions; however, only a few studies have described the localization of the laryngeal lesions associated with this disease owing to its rarity. We revealed that the arytenoid area was the most frequently affected site in the larynx. We proposed a novel classification system for laryngeal findings in patients with PV and a systematic observation method.
Objective Pemphigus Vulgaris (PV) is a rare autoimmune disease that could cause laryngeal lesions; however, only a few studies have described the localization of the laryngeal lesions associated with this disease owing to its rarity. Therefore, this study aimed to determine the localization of laryngeal lesions in patients with PV.
Methods Fourteen patients with PV accompanied by laryngeal or pharyngeal lesions, who underwent flexible laryngeal endoscopy performed by laryngologists, were examined retrospectively.
Results The arytenoid area was the most frequently affected site in the larynx, followed by the epiglottis and aryepiglottic folds. Vocal folds and ventricular bands were the least affected.
Conclusion Lesions in the arytenoid area were observed more frequently in this study than in previous studies. This result suggests that a more careful inspection of arytenoid lesions in patients with PV is required under laryngeal fiber observation. Moreover, we proposed a novel classification system for laryngeal findings in patients with PV and a systematic observation method. This novel classification and method would be useful not only for determining the lesions but also for careful inspection in this field.
Level of Evidence Level 4 Laryngoscope, 2024
Büşra Kaplan, Büşra Altın, Mehmet Umut Akyol, Songül Aksoy
Publication date 10-04-2024
This is the precious study to evaluate the relationship between OME and balance disorders and the effects of ventilation tube insertion on balance using Computerized Dynamic Posturography. Furthermore, this study is the first to examine the relationship between a static clinical test and Computerized Dynamic Posturography.
Background Otitis media with effusion (OME) frequently leads to vestibular symptoms in children. However, young children face difficulty expressing their symptoms due to their limited language abilities.
Methods The balance of study and patient group evaluated with computer dynamic posturography, single-leg stance test with eyes closed and regular Head Impulse Test. The study group was assessed once again after the insertion of a ventilation tube two months later.
Results In the Sensory Organization Test, the scores for conditions 5, 6, and composite equilibrium of the preoperative patient group were notably lower compared with both the control and postoperative patient groups (p < 0.05). Additionally, a significant correlation was found between single-leg stance test with eyes closed results and conditions 5, 6, and composite equilibrium scores.
Conclusion The impact of OME on the vestibular system is negative. This effect can be objectively assessed using Computer Dynamic Posturography and following tube insertion, there is a notable improvement in vestibular function. Furthermore, the single-leg stance (SLS) test with eyes closed has shown its reliability in assessing balance disorders, notably in children with OME.
Level of Evidence Level 2 Laryngoscope, 2024
Eri Takatsuki, Takeyuki Kono, Shuta Tomisato, Hiroyuki Ozawa
Publication date 10-04-2024
This is a case report of a patient with refractory tracheal recurrent respiratory papilloma (RRP) who underwent low-dose cisplatin combined with de-escalated radiotherapy. RRP effectively disappeared and achieved complete remission without any adverse events, suggesting low-dose cisplatin is considered an effective and safe treatment alternative for RRP.
Recurrent respiratory papilloma (RRP) often presents multiple lesions in the respiratory tract and sometimes becomes fatal because of severe airway obstruction. We report the case of a 69-year-old woman who had juvenile-onset RRP in the trachea that was refractory to surgical treatment, and complete remission was achieved by low-dose cisplatin combined with de-escalated radiotherapy without any side effects. This case report is the first to illustrate the data on low-dose cisplatin for refractory benign RRP, and our experience reinforces the opinion that low-dose cisplatin combined with de-escalated radiotherapy can be an effective and safe treatment alternative for uncontrollable and lethal RRP. Laryngoscope, 134:2335–2337, 2024
Patrick Scheffler, Dana Eitan, Rupali Drewek, Sharon Gnagi
Publication date 10-04-2024
Introduction Obstructive sleep apnea (OSA) is common amongst patients with cerebral palsy in part due to significant hypotonia. Hypoglossal nerve stimulation (HGNS) is a novel tool used to treat sleep apnea when there is failure with CPAP. To our knowledge, the literature has not discussed HGNS as a treatment option for severe OSA in patients with cerebral palsy.
Methods Case report and literature review.
ResultsA 28-year-old male with cerebral palsy, neuromuscular deformity, proximal junction kyphosis, and developmental delay presented with severe obstructive sleep apnea and was intolerant to CPAP and BiPAP. After HGNS implantation, a sleep study revealed improved ventilation and oxygenation at 2.4 V; AHI decreased from baseline of 112 to 12 events per hour with only mild intermittent snoring. The patients family reported increased utilization compared with previous CPAP use.
ConclusionHGNS can be a safe and effective treatment modality for OSA in this patient population. Laryngoscope, 134:2478–2479, 2024
Alessandro Vinciguerra, Sarah Atallah, Francesco Boaria, Joffrey Molher, Benjamin Verillaud, Florian Chatelet, Philippe Herman
Publication date 10-04-2024
Medial petrous apex cholesterol granuloma is a benign lesion which treatment is generally based on a trans-nasal marsupialization. When the artificial ostium is created, it is usually kept open with local flaps, like the septal nasopharyngeal “kite flap”, a reliable local vascularized flap. Laryngoscope, 134:2111–2114, 2024
Pubmed PDF WebKachorn Seresirikachorn, Lu Hui Png, Richard J. Harvey
Publication date 10-04-2024
For otolaryngologists, single-port endoscopic removal of forehead osteoma draws upon a familiar skill set and is a robust technique for complete tumor removal with excellent cosmesis. Laryngoscope, 134:2194–2197, 2024
Pubmed PDF WebHasan Canakci, Mustafa U. Akbas, Erhan Arslan, Kamil G. Tulaci, Hasmet Yazici
Publication date 10-04-2024
In this case report, 60-year-old patient who aspirated total dental prosthesis into the postcricoid region was presented with patients history, clinical findings, radiologic examinations and surgical treatment with comparison of literature data. To our literature knowledge, this is the first total dental prosthesis detected in postcricoid region. This was unusual because it did not cause any respiratory disorders such as laryngospasm and asphyxia, although it led to mucosal abrasions in a wide area of esophageus. Laryngoscope, 134:2331–2334, 2024
Pubmed PDF WebNikhil T. Vettikattu, Georges E. Daoud, Kartik Viswanathan, Azeem S. Kaka
Publication date 10-04-2024
A patient with chronic submandibular sialolithiasis underwent conservative treatment and multiple biopsies that continually revealed chronic inflammation. Due to continued symptoms, the patient underwent eventual excision and final pathology revealed salivary mucinous adenocarcinoma, which is a rare and poorly understood salivary malignancy. More attention and research on this specific entity can help future clinicians better diagnose and treat patients with similar presentations.
A patient with chronic submandibular sialolithiasis underwent conservative treatment with appropriate imaging and multiple biopsies that continually revealed chronic inflammation. Due to continued symptoms, the patient underwent eventual excision and finaly pathology revealed salivary mucinous adenocarcinoma, which is a rare and poorly understood salivary malignancy. Persistent diagnostic workup and a high suspicion for salivary gland lesions is important for appropriate diagnosis and treatment. More attention and research on this specific entity can help future clinicians better diagnose and treat patients with a similar presentation. Laryngoscope, 134:2258–2261, 2024
"N. J. McInerney, F. Timon, N. OKeeffe, A. Nae, C. Timon"
Publication date 10-04-2024
Xiaoru Sun, Jia Ren, Bo Li, Shixi Liu, Jian Zou, Fei Chen, Haiyang Wang
Publication date 10-04-2024
Our case highlights that in cases where conventional methods are unsuitable for retrieving fragile and mushy laryngeal FBs, our novel technique using a modified endoscopic injection needle offers a safe and effective alternative for timely extraction.
Foreign body (FB) aspiration requiring prompt intervention to prevent severe complications. The endoscopic injection needle, commonly employed for intramucosal injections in the gastrointestinal tract and respiratory tract, while with no previous reports of used for FB extraction. Here we report a case of a pea impacted in the laryngeal ventricle of an adult patient, which became lodged in her right laryngeal ventricle. Conventional methods, such as flexible forceps and baskets, were deemed unsuitable for retrieving this fragile and mushy FB. Therefore, we introduce a novel technique using a modified endoscopic injection needle, which proved successful in removing the foreign body. Laryngoscope, 134:2338–2340, 2024
Nicolas Cornu, Daniele Marchioni, Andrew Green, Charlotte Hautefort, Benjamin Verillaud, Philippe Herman, Romain Kania
Publication date 10-04-2024
To report the case of the simultaneous treatment of otosclerosis and malleus fixation (OMF) through an entirely endoscopic transcanal approach. A targeted transcanalar epitympanotomy with annular bony ridge conservation was planned preoperatively, with 3D CT localization of the fixed part of the malleus head. The upper part of the malleus head and the superior ossified ligament of the malleus were drilled. A 0.6 mm stapedotomy was performed and a piston inserted.
To report the case of the simultaneous treatment of otosclerosis and malleus fixation through an entirely endoscopic transcanal approach. A targeted transcanalar epitympanotomy with annular bony ridge conservation was planned preoperatively, with 3D CT localization of the fixed part of the malleus head. The upper part of the malleus head and the superior ossified ligament of the malleus were drilled. A 0.6 mm stapedotomy was performed and a piston inserted. The patients recovery was uneventful, with closure of the air-bone gap on her postoperative audiogram, associated with an overclosure in 500Hz, 1k Hz, 2 k Hz and 4 k Hz. Laryngoscope, 134:2411–2414, 2024
Samuel H. Selesnick
Publication date 10-04-2024
Publication date 10-04-2024
Publication date 10-04-2024
Adam McCann, Neha Garg, Eric Fei, Meryem Guler, Ryan Heffelfinger
Publication date 10-04-2024
Ellen L. Ferraro, Conrad K. Blunck, Michael S. Benninger, Robert R. Lorenz, Rebecca Chota Nelson, William S. Tierney, Paul C. Bryson
Publication date 10-04-2024
Post intubation phonatory insufficiency (PIPI) describes posterior glottic insufficiency (PGI) caused by prolonged intubation causing medial arytenoid ulceration, mucosal scarring, and incomplete cricoarytenoid joint adduction. This scoping review highlights the diagnostic criteria for PIPI and reports 45 cases of management and outcomes. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts.
Objectives Post intubation phonatory insufficiency (PIPI) or posterior glottic diastasis describes posterior glottic insufficiency (PGI) caused by prolonged intubation causing medial arytenoid ulceration, mucosal scarring, and incomplete cricoarytenoid joint adduction. The purpose of this review is to showcase diagnostic findings, surgical rehabilitation, and gaps in our treatment algorithm of PIPI.
Data Sources Embase, Pub Med, Scopus, Web of Science.
Review Methods Two independent reviewers completed a systematic search of the literature studying PIPI. Reported intubation history, laryngeal defect, clinical symptoms, surgical intervention, and outcomes were gathered from included studies.
Results Nine studies met our inclusion criteria for full review, (45 patients) all of which were case reports/series. All patients had posterior glottic defects, most commonly loss of medial arytenoid tissue, causing varying degrees of PGI. Eleven patients had vocal fold (VF) immobility or hypomobility. Treatment interventions were observation (1), speech therapy (2), VF or posterior glottic injection augmentation (15), medialization laryngoplasty (4), arytenoid repositioning (6), endoscopic (19) or open (3) posterior cricoid reduction, local mucosal rotation flap (11), or free mucosal graft (2) to fill the glottic defect. Observation, voice therapy, and augmentation or type 1 laryngoplasty failed to improve symptoms. Other surgical techniques improved symptoms with varying outcomes.
ConclusionPIPI is a difficult injury to diagnosis and treat. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts. Future investigation is needed to better define the diagnosis and successful treatment algorithm. Laryngoscope, 134:2048–2058, 2024
Zachary A. Valley, Avrohom Karp, David Garber
Publication date 10-04-2024
Type I medialization thyroplasty (MT) continues to be the gold standard treatment for unilateral vocal fold paralysis and is generally considered a safe procedure. In this systematic review, we analyzed 46 primary research articles with a total of 2426 patients who underwent MT and found that the surgery continues to be a safe, well-tolerated procedure. The literature also suggests that same-day discharge following MT resulted in no significant increase in complication rate.
Introduction Unilateral vocal fold paralysis or paresis (UVFP) is a condition that causes significant morbidity due to dysphonia, dysphagia, and aspiration. Type I medialization thyroplasty (MT) is the current mainstay surgical treatment for UVFP. Though widely considered a safe procedure, concerns exist over possible airway complications which can lead to overnight observation. Herein, we report a systematic review of the safety and adverse events of MT to aid in determining the safety of same-day discharge.
Data Sources Pub Med and Embase databases.
Review Methods Our search identified studies investigating complications associated with MT. Articles were selected if published between January 1, 1989 and March 15, 2023. Abstracts were screened, and data were extracted from included studies. Only Type I MT procedures were included; case reports were excluded. Participant characteristics, intervention details, results, and adverse events were extracted.
Results The database query identified 751 abstracts, of which 46 studies met eligibility criteria. A total of 2426 patients underwent MT. The most common implant was Silastic (n = 898, 37.0%) followed by Gore-Tex (n = 664, 27.4%). There were 254 (10.5%) total complications reported; 110 (4.5%) were considered major. The most common complication was nonobstructive hematoma (n = 59, 2.4%) followed by hemorrhage (n = 36, 1.5%). Implant extrusion (n = 24, 0.99%) or displacement (n = 15, 0.62%) occurred mostly in Silastic and Gore-Tex implants. Same-day discharge occurred with 429 patients and was not associated with adverse events.
ConclusionsUVFP can be reliably improved by MT with a low risk of complications. Outpatient MT is a promising treatment with a favorable safety profile. Laryngoscope, 134:1994–2004, 2024
Bianca Maria Festa, Andrea Costantino, Gian Marco Pace, Gerardo Petruzzi, Flaminia Campo, Raul Pellini, Giuseppe Spriano, Armando De Virgilio
Publication date 10-04-2024
Our study showed that adjuvant radiotherapy may improve the outcomes of patients affected by oral cavity cancer with perineural invasion by reducing the risk of disease recurrence or progression. Other patient and tumor characteristics, other than treatment objectives, should be considered in the decision-making.
Objective Current guidelines indicate postoperative radiotherapy (PORT) in oral squamous cell carcinoma (OSCC) with perineural invasion (PNI), however, its real benefit has never been proven. The aim of our study is to investigate the benefit of PORT in OSCC patients with PNI in terms of survival and disease control.
Data Sources The Pubmed/MEDLINE, Cochrane Library, and Scopus databases.
Review Methods Patients with PNI + OSCC treated with primary surgery were extracted from the included studies. The pooled logHR was calculated by comparing patients who underwent PORT to those who underwent only observation for overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional control (LRC).
Results About 690 patients with primary OSCC and PNI were included from nine studies. 374 (54.2%) patients underwent PORT, while 316 (45.8%) underwent observation. Analyses showed non-significant difference between the two groups for OS (HR: 1.01; 95% CI: 0.38–2.69), DSS (HR: 2.03; 95% CI: 0.54–7.56), and LRC (HR: 0.89; 95% CI: 0.53–1.50). They showed a significant difference in terms of DFS (HR: 0.86; 95% CI: 0.77–0.97).
Conclusion The real benefit of PORT in OSCC patients with PNI is still unclear, although it may have a positive impact on DFS. Clinicians should consider individual patients characteristics, tumor factors, and treatment goals when deciding whether to recommend PORT. Further studies are needed to clarify which entity of PNI really benefits from PORT.
Level of EvidenceNA Laryngoscope, 134:2019–2027, 2024
Dimitrios Spinos, Georgios Geropoulos, Georgios Vavoulis, Georgios Georgountzos, Manthia Papageorgakopoulou, Nina Rafailia Karela, Panagiotis Varoutis, Kyriacos Evangelou, Wai Sum Cho
Publication date 10-04-2024
This is a systematic review and meta-analysis on the impact of increased body mass index (BMI) in the presentation and outcomes of spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base. Reviewing the current literature, there is no evidence of adverse outcomes of surgical repair on patients with high BMI, nor do they have more extensive disease on their initial presentation. There is not enough evidence supporting the routine use of lumbar drains in either group of patients.
Objective We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair.
Data SourcesA Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library.
Review Methods The research algorithm included the following keywords: “spontaneous CSF leak,” “lateral skull base,” “temporal bone,” “meningocele,” “encephalocele,” and “otorrhea.” We also manually searched the references of included studies, to identify possible studies missed during our literature search.
Results More than two-thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post-operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non-obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow-up (89.6%), which was not affected by obesity.
Conclusion Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone.
Level of EvidenceNA Laryngoscope, 134:2012–2018, 2024
Do Hyun Kim, Sung Won Kim, Mohammed Abdullah Basurrah, Se Hwan Hwang
Publication date 10-04-2024
Objectives To conduct a systematic review and meta-analysis of published articles to assess the impact of inferior turbinate/meatus augmentation in patients diagnosed with empty nose syndrome (ENS).
Data Sources Pub Med, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar.
Review Methods Six databases were searched to December 2022. We retrieved studies evaluating improvements in refractory ENS-related symptoms based on various patient-reported outcome measures after inferior turbinate/meatus augmentation.
Results As a result of meta-analysis, Sinonasal Outcome Test, Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and depression scores were measured at 1 week; 1, 3, and 6 months; and later than 12 months after intervention for patients with ENS. All scores revealed significant symptom improvement. By reference to the minimal clinically important difference of the ENS6Q (6.25), inferior turbinate/meatus augmentation relieved the nasal symptoms of ENS in the long term. Although the improvements in anxiety scores at 1 week (0.4133 −0.3366; 1.1633, 0.00, I2 = NA) and 1 month (0.4525 −0.0529; 0.9579, I2 = 0.0%) were not statistically significant, the scores differed significantly at 3 months (0.7351 0.4143; 1.0559, I2 = 28.4%), 6 months (0.8297 0.6256; 1.0337, I2 = 37.2%), and longer than 12 months (0.7969 0.4768; 1.1170, I2 = 0.0%).
Conclusion These data and analysis suggest that performing inferior turbinate/meatus augmentation on ENS patients may improve not only nasal symptom scores but also accompanying psychological problems such as anxiety and depression. Laryngoscope, 134:2005–2011, 2024
Yasmine Kamhieh, Robin Mitra, Thomas Burnett, Hugh Jones, Graham Roblin, Andrew Hall
Publication date 10-04-2024
Objective This study is a systematic review and meta-analysis of the efficacy and safety of sirolimus in the management of pediatric cervicofacial lymphatic malformations (LMs).
Data SourcesEMBASE, Medline, Scopus, and Cochrane databases were searched, along with the reference list of all included articles.
Review Methods The study protocol was registered with PROSPERO and a systematic literature search strategy was designed and conducted with the aid of a medical librarian. All studies including case reports were included, with pooled analysis of raw data. A meta-analysis was conducted of magnetic resonance imaging (MRI), clinical, and airway outcomes.
Results Thirteen case series and five individual case reports were included. Meta-analysis showed 78% (95% CI 57%–94%) of 62 patients had a reduction in LM volume, on MRI criteria, by 20% or more, and 32% (95% CI 11%–57%) had a reduction of 50% or more. Further meta-analysis showed 97% (95% CI 88%–100%) of 78 patients reported some clinical improvement on sirolimus. Sirolimus may be of particular value in management of airway LMs; out of 27 tracheostomy-dependent patients, meta-analysis showed 33% (95% CI 1%–78%) were decannulated after starting sirolimus. Individual patient meta-analysis on 24 individuals showed a statistically significant better response to sirolimus when initiated under the age of 2 years.
Conclusion This review and meta-analysis support the efficacy of sirolimus in pediatric LMs of the head, neck, and airway. A large multi-center trial is needed to further explore its role and limitations. Laryngoscope, 134:2038–2047, 2024
Brendon K. Warner, Frederick G. Durrant, Shaun A. Nguyen, Ted A. Meyer
Publication date 10-04-2024
This study is a systematic review and meta-analysis examining the changes in otitis media incidence as a result of national lockdowns due to the COVID-19 pandemic. A total of 26 out of 1004 studies were included from 11 countries. The results show that there was a significant decrease in otitis media incidence and antibiotic prescription for otitis media during national COVID-19 lockdowns.
Objective The aim was to analyze the global impact of the COVID-19 pandemic and national lockdowns on the incidence of otitis media (OM), a common otolaryngologic disease.
Data Sources Pub Med, Scopus, and CINAHL.
Review MethodsA systematic review and meta-analysis were performed using PRISMA reporting guidelines. OM incidence (measured as newly diagnosed OM cases over total patients seen over a time period), OM antibiotic prescriptions (OM cases for which antibiotics were prescribed over total OM cases), and tympanostomy tube surgeries (all tympanostomy tube surgeries over total surgical cases) were extracted. Meta-analysis of proportions and comparison of proportions were performed.
Results Of 1004 studies screened, 26 studies in 11 countries met inclusion criteria. The percentages of OM cases pre- and during-lockdown were 6.67%, 95% CI 4.68%, 8.99%, and 2.63% 2.02%, 3.31%, respectively, with an OR of 0.31 favoring during-lockdown 0.25, 0.39 (p < 0.00001). Antibiotic prescriptions per all OM episodes pre- and during-lockdown were 1.61% 0.17%, 8.46% and 0.62% 0.07%, 3.32%, with an OR of 0.37 favoring during-lockdown (0.35, 0.40, p < 0.00001). Tympanostomy tube surgery proportions pre- and during-lockdown were 31.64% 6.85%, 64.26% and 29.99% 4.14%, 66.55%, with an OR of 0.94 favoring neither during- nor pre-lockdown 0.45, 2.00 (p = 0.88).
Conclusion The incidence of OM decreased significantly following international lockdowns due to the COVID-19 pandemic, with antibiotic prescriptions for OM episodes showing a corresponding decrease. Despite these reductions, numbers of tympanostomy tube procedures did not change significantly. These reductions are likely due to social distancing, decreased exposure through high transmission facilities such as day cares, decreased health care utilization, and even possibly decreased air pollution. Laryngoscope, 134:2028–2037, 2024
Siddhant H. Tripathi, Susie Min, Alexander S. Cody, Geet Shukla, Firas A. Houssein, John S. Howard, Alex Hu, Melissa J. Previtera, Katie M. Phillips, Ahmad R. Sedaghat
Publication date 10-04-2024
Objective Best practices for calculation of the minimal clinically important difference (MCID) of outcome measures include the use of complementary methodologies (broadly classified as anchor-based and distribution-based) and reporting of the MCIDs predictive ability. We sought to determine MCID calculation and reporting patterns within the otolaryngology literature.
MethodsA systematic search strategy of Embase, Pub Med, and Web of Science databases was developed and implemented to identify studies reporting the determination of an MCID for an outcome measure. Studies specifically within the otolaryngology literature (defined as journals classified as “otorhinolaryngology” in the Journal Citation Reports database) were included. All those journals were additionally searched for relevant articles.
Results There were 35 articles that met the inclusion criteria. Of these studies, 88.6% reported MCID of a patient-reported outcome measure and the remainder were for objective outcome measurements. Anchor-based methods were used by 82.9% of studies and distribution-based methods were used by 68.6% of studies. Of all studies, 31.4% utilized anchor-based methods alone, 17.1% utilized distribution-based methods alone, and 51.4% used both methods. Only 25.7% of studies reported the sensitivity (median: 60.8%, range: 40.5%–86.7%) and specificity (median: 80.4%, range: 63.5%–88.0%) of the MCID to detect patients experiencing clinically important change.
Conclusion Deviation from best practices in MCID calculation and reporting exists within the otolaryngology literature, with almost half of all studies only using one method of MCID calculation and almost three-quarters not reporting the predictive ability (sensitivity/specificity) of the calculated MCID. When predictive ability is reported, however, MCIDs appear to be more specific than sensitive.
Level of EvidenceNA Laryngoscope, 134:2059–2069, 2024
Niels C. Kokot, Ryan J. Davis
Publication date 10-04-2024
Pingping Yang, Jiuliang Jiang
Publication date 10-04-2024
Richard H. Law, Katherine A. Larrabee, Andrew J. Stefan, Daniel L. Quan, Edward L. Peterson, Michael C. Singer
Publication date 10-04-2024
Objective The primary goal of this study was to determine in patients with normohormonal primary hyperparathyroidism (NHHPT) what percent reduction in post-excision intraoperative parathyroid hormone (IOPTH) from baseline would yield a rate of cure comparable to that in patients with classical primary hyperparathyroidism (PHPT).
Methods This is a retrospective cohort study of patients who underwent parathyroidectomy between July 2013 and February 2020. Demographic data, preoperative, intraoperative, and postoperative metrics were collected. Patients with NHHPT were compared to those with classical PHPT. Subgroup analyses were performed.
Results Of the 496 patients included in the study, 66 (13.3%) were of the normohormonal variant based on preoperative intact parathyroid hormone (PTH) levels and 28 (5.6%) based on baseline IOPTH levels. The cure rates in the two normohormonal groups were not significantly different from their classical counterparts (98.4% and 100.0% vs. 97.1%, p = 1.000). The median percent decline in post-excision IOPTH from baseline that achieved cure in the normohormonal groups were 82.6% and 80.4% compared to their respective controls at 87.3%, p = 0.011 and p = 0.001. Although the rate of multiglandular disease was higher in one of the normohormonal variant groups, this difference was due to a higher rate of double adenomas, not four-gland hyperplasia.
Conclusion Patients with NHHPT undergoing parathyroidectomy can expect cure rates similar to that in patients with classical PHPT. The results of this study indicate that achieving an 80% drop or more in IOPTH levels predicts a high likelihood of cure. This is true irrespective of whether the patient is deemed normohormonal based on preoperative or intraoperative testing.
Level of Evidence3 Laryngoscope, 134:2480–2484, 2024
Dalia N. Mitchell, Dylan R. Beams, Stephen R. Chorney, Yann‐Fuu Kou, Pamila Liu, Helene Dabbous, Romaine F. Johnson
Publication date 10-04-2024
Our study aimed to investigate the impact of neighborhood socioeconomic disadvantage on long-term outcomes after pediatric tracheostomy. Analyzing a cohort of 260 children, we found no significant association between neighborhood socioeconomic disadvantage and decannulation, mortality, or the presence of severe neurocognitive disability, suggesting that these outcomes are less dependent on socioeconomic factors within individual communities. These findings contribute to understanding the role of socioeconomic factors in pediatric tracheostomy outcomes and have implications for resource allocation and clinical practice.
Objectives To determine whether long-term outcomes after pediatric tracheostomy are impacted by neighborhood socioeconomic disadvantage.
MethodsA prospective cohort of children with tracheostomies was followed at an academic pediatric hospital between 2015 and 2020. Patients were grouped into low or high socioeconomic disadvantage using their neighborhood area deprivation index (ADI). Survival and logistic regression analyses determined the relationship between ADI group, decannulation, and mortality.
ResultsA total of 260 children were included with a median age at tracheostomy of 6.6 months (interquartile range IQR, 3.9–42.3). The cohort was 53% male (N = 138), 55% White race (N = 143), and 35% Black or African American (N = 90). Tracheostomy was most frequently indicated for respiratory failure (N = 189, 73%). High neighborhood socioeconomic disadvantage was noted for 66% of children (N = 172) and 61% (N = 158) had severe neurocognitive disability. ADI was not associated with time to decannulation (HR = 0.90, 95% confidence interval 95% CI: 0.53–1.53) or time to death (HR = 0.92, 95% CI: 0.49–1.72).
Conclusions Neighborhood socioeconomic disadvantage was not associated with decannulation or mortality among children with a tracheostomy. These findings suggest that long-term outcomes after pediatric tracheostomy are less dependent on socioeconomic factors in an individual community.
Level of Evidence3 Laryngoscope, 134:2415–2421, 2024
Fatih Gul, Ozgenur Kocak, Mehmet A. Babademez
Publication date 10-04-2024
Objectives To assess the influence of different soft palate surgeries for obstructive sleep apnea (OSA) on eustachian tube function symptoms, considering various potential factors.
MethodsA prospective, cohort study was conducted on patients who underwent isolated palatal surgeries for OSA at a single academic medical center between 2017 and 2022. Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were assessed at baseline, 1-month, 2-month, and 3-month time points.
Patients with retropalatal obstruction underwent tailored surgeries: anterior palatoplasty (AP), expansion sphincter palatoplasty (ESP), or barbed palatoplasty (BP). Baseline OSA severity between baseline and follow-up time points were also examined.
Results In this study, 96 patients with OSA were enrolled and allocated to three surgical groups: AP (n = 30), ESP (n = 32), and BP (n = 34). The mean age was 44.3 ± 10.2 years, with 86% male participants. No significant differences were found between the groups in terms of age, sex, and BMI. A two-way repeated measures ANOVA revealed a significant main effect of time on ETDQ-7 scores (p < 0.001), but no significant main effect of groups (p = 0.109) or interaction between time and groups (p = 0.082). Subgroup analysis showed a significant interaction for the 3-month change in ETDQ-7 scores by OSA severity (p = 0.046). In post hoc analysis, the BP group exhibited a higher mean ETDQ-7 score compared with the AP group at the 3-month follow-up.
Conclusion This study highlights the importance of considering individual patient factors, such as OSA severity and eustachian tube function symptoms, when selecting the most appropriate surgical treatment to optimize outcomes.
Level of Evidence4 Laryngoscope, 134:2471–2477, 2024
Bartholomew J. Bacak, Michael S. Castle, Chantal Barbot, Luxman Srikantha, Noah A. Stern, Nathan D. Vandjelovic
Publication date 10-04-2024
We attempted to characterize the presentation of patients with non-angiotensin converting enzyme inhibitor (ACEI) induced angioedema with a retrospective chart review of 181 patients. We determined that symptoms of dysphonia, changes in the diastolic blood pressure, mean arterial pressure, specific anatomic location of edema, and the presence of edema at multiple subsites are associated with airway intervention and a higher level of care in non-ACEI-induced angioedema and can be useful in risk assessment in patient management.
Objectives Characterize the presentation of patients with non-angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema and determine risk factors associated with patient disposition and possible need for airway intervention.
Methods The medical records of adult patients in the Emergency Department (ED) and diagnosed with non-ACEI-induced angioedema over 4.5 years were included. Demographics, vital signs, etiology, timeline, presenting symptoms, physical exam including flexible laryngoscopy, medical management, and disposition were examined. Statistical analyses were conducted using SPSS V 23.0 software calculating and comparing means, standard deviations, medians, and correlation of categorical and ordinate variables.
ResultsA total of 181 patients with non-ACEI-induced angioedema were evaluated with flexible laryngoscopy by otolaryngology. Notably, 11 patients (6.1%) required airway intervention and were successfully intubated. Statistically significant factors (p ≤ 0.05) associated with airway intervention included the diastolic blood pressure (DBP) and mean arterial pressure (MAP) (p = 0.006 and 0.01 respectively), symptoms of dysphonia (p = 0.018), the presence of oropharyngeal, supraglottic, and hypopharyngeal edema (p ≤ 0.001 for each site), and the number of edematous anatomic subsites documented on physical exam (p < 0.001). Other patient demographics, prior history of angioedema, heart rate, systolic blood pressure, symptom onset, number of symptoms at presentation, and medication administered in the ED did not correlate with airway intervention.
Conclusion Dysphonia, DBP, MAP, anatomic location of edema and edema in multiple sites are associated with airway intervention and a higher level of care in non-ACEI-induced angioedema and can be useful in risk assessment in patient management.
Level of Evidence4 Laryngoscope, 134:2282–2287, 2024
Saad Elzayat, Hesham Lasheen, Ibrahim Gehad, Mohamed E. El‐Deeb, Islam Soltan, Mohammad M. Aouf, Ahmed Elgendy
Publication date 10-04-2024
Objectives To assess the efficacy and safety of budesonide as an intrapolyp injection in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison to control and systemic steroids.
Method In a prospective double-blinded controlled randomized clinical trial, 150 patients with CRSwNP were divided into 3 groups in a ratio 1:1:1 where group (A) was given oral prednisolone 1 mg/kg tapered daily for 2 weeks, group (B) was given budesonide intrapolyp injection weekly for 5 consecutive weeks, and group (C) was given intrapolyp injection with saline as the control group. Patients were assessed upon Sinonasal Outcome Test (SNOT-22) score, Total Nasal Polyp score (TNPS), Serum IgE, absolute eosinophilic count, and morning cortisol level before treatment, 1 week and 6 months after completing their treatment protocol.
ResultsSNOT 22 score improved significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was much greater than the control group (P2 < 0.001), (P3 < 0.001), and the same trend concerning TNPS score (P2 < 0.001), (P3 < 0.001) but with no significant change in the control group.
Conclusion Intrapolyp steroid injection is considered a safe and effective method in nasal polyposis with limited side effects in comparison to systemic steroids. Using Budesonide as an agent for intrapolyp injection appears to be promising. Its advisable in patients with multiple relapses or high-risk patients to avoid repeated courses of oral steroids.
Level of Evidence2 Laryngoscope, 134:2085–2092, 2024
Tommy Jacob, Moshe Leshno, Narin Nard Carmel‐Neidermann, Liyona Kampel, Anton Warshavsky, Joubran Mansour, Nidal Assadi, Nidal Muhanna, Gilad Horowitz
Publication date 10-04-2024
How does tonsillectomy compare with antibiotic treatment for the management of recurrent tonsillitis in adults? This Markov analytical model demonstrated that adult patients with a history of more than 3 bouts of tonsillitis over at least a 2-year period gained quality-adjusted life years (QALY) compared to repeat antibiotic treatment.
Objective To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT).
MethodsA Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment.
Results Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD.
Conclusion Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges.
Level of EvidenceNA Laryngoscope, 134:2153–2161, 2024
Dongmei Huang, Jingzhu Zhao, Pengfei Gu, Jinming Zhang, Yigong Li, Xiangqian Zheng
Publication date 10-04-2024
Our study showed that EALND was safe and feasible compared with COLND. The incision was more aesthetically satisfactory, which makes EALND a surgical approach for PTC patients with lateral LNM.
Background Currently, endoscopic-assisted lateral neck dissection (EALND) is performed to reduce postoperative scarring of the anterior neck. This study aimed to compare surgical outcomes between EALND and conventional open lateral neck dissection (COLND) for papillary thyroid carcinoma (PTC) with lateral lymph node metastases (LNM).
Methods The study reviewed 103 PTC patients who were classified on the basis of surgical type and statistically compared using propensity score matching analysis.
Results The mean operation time is longer, and the cost of surgery is higher in the EALND group than COLND group (all p < 0.05). The numbers of retrieved and positive level II LNs, the rate of level II LNs detection between two groups do not differ significantly (all p > 0.05). The incidence of postoperative neck numbness is lower, and patients are more satisfied with postoperative neck scarring in the EALND group than COLND group (all p < 0.05). The common complications of two groups are transient recurrent laryngeal nerve injury and transient hypoparathyroidism.
ConclusionsEALND is safe and feasible compared with COLND. The incision is more aesthetically satisfactory, which makes EALND a surgical approach for PTC patients with lateral LNM.
Level of Evidence3 Laryngoscope, 134:2221–2227, 2024
Arian Ghanouni, Nikitha Jona, Hyder A. Jinnah, Gamze Kilic‐Berkmen, Sandeep Shelly, Adam M. Klein
Publication date 10-04-2024
Adult-onset idiopathic laryngeal dystonia (LD) can be associated with risk of spread to muscles in other regions of the body. Subjects with extralaryngeal onset of dystonia have been shown to exhibit spread to the larynx. Patients with dystonia elsewhere in the body should be counseled on the possibility of spread to larynx, and vice versa.
Objectives Adult-onset idiopathic laryngeal dystonia (LD) can be associated with the risk of spread to muscles in the body. Subjects with extralaryngeal onset of dystonia have exhibited spread to the larynx. Previous studies analyze the spread of other dystonias but emphasis has not been placed on LD. The objective was to identify demographic and clinical factors contributing to the spread of dystonia to and from the larynx.
Methods Data were obtained from the Dystonia Coalition (DC)-patients from 49 international clinical centers. Clinical and demographic data was taken from 143 out of 409 patients with diagnosed LD. Patient criteria included adult-onset LD diagnosed on exam with no co-morbid neurologic conditions and no dystonia in other locations.
Results Among the 143 patients, 94 (65.7%) patients were diagnosed with focal laryngeal onset, with the remainder having extralaryngeal onset. Family history and age at study were statistically significant indicators of a patient developing laryngeal versus extralaryngeal onset of dystonia. Among the laryngeal onset group, 21 cases (22.3%) had an average time of 5.81 ± 5.79 years to spread from diagnosis, most commonly to neck (61.9%). Among extralaryngeal onset patients, mean time of larynx spread was 7.92 ± 7.737 years, most commonly to neck (22.7%).
Conclusions Our data indicates approximately a quarter of patients with laryngeal-onset dystonia will exhibit spread. There were no demographic or clinical factors that were statistically predictive of the likelihood of spread from larynx. Patients with dystonia elsewhere in the body should be counseled on the possibility of spread to larynx, and vice versa.
Level of Evidence4 Laryngoscope, 134:2295–2299, 2024
Rebecca Leonard, Anna Miles, Lise Bakker, Jacqueline Allen
Publication date 10-04-2024
This novel fluoroscopic measure of pharyngeal shortening is reliable and demonstrates quantitative changes in vertical pharyngeal displacement in healthy and swallow-impaired adults related to sex, size, and bolus type.
Background Little is known about pharyngeal shortening (PShort) during swallowing. This observational study measured PShort during swallowing in healthy adults and compared it to patients with swallowing impairments of different aetiologies.
Methods275 healthy volunteers (19–99 years) and 75 dysphagic patients (25 with head and neck cancer, 25 with Parkinsons, 25 with stroke) underwent videofluoroscopy. A novel quantitative measure of PShort for 1, 3, and 20 mL thin liquid barium and 3 mL paste boli was determined and compared across age, sex, bolus type and patient cohort.
ResultsPShort ranged from 1.05 to 4.41 cm across bolus types with larger displacements for 20 mL (M: 2.52 cm) and paste (M: 2.43 cm) compared with 1 mL (M: 2.36 cm) and 3 mL (M: 2.41 cm). PShort correlated with sex, height, and cohort but not age. Inter-rater reliability for three raters was substantial (intraclass correlation >0.80).
Conclusions This novel fluoroscopic measure of PShort is reliable and demonstrates quantitative changes in vertical pharyngeal displacement in healthy and swallow-impaired adults related to sex, size, and bolus type.
Level of Evidence3 Laryngoscope, 134:2121–2126, 2024
Drew C. Gottman, Michaele Francesco Corbisiero, Ruba Sus, Daniel S. Fink
Publication date 10-04-2024
Our study investigates the impact of tracheal stenosis on distal airway pressure during Low-Frequency Jet Ventilation (LFJV) to minimize the risk of ventilator-induced lung injury (VILI) in surgical settings. We found a significant reduction in distal airway pressure when using a subglottiscope compared to a laryngoscope, but stenosis size had no significant impact on distal airway pressure. The study also reveals that inlet pressure plays a pivotal role, directly correlating with distal airway pressure irrespective of stenosis size, providing key insights for ventilation management in the presence of tracheal stenosis.
Objective This study investigates the effects of tracheal stenosis on distal airway pressure during low-frequency jet ventilation (LFJV) in tracheal stenosis resection procedures, focusing on variables like stenosis size, depth, scope type, and inlet pressure.
MethodsA 3D-printed human airway model was employed, featuring inserted tracheal stenoses of varied sizes and depths. Distal airway pressure was measured with 16 pressure transducers, and data were processed via MATLAB. The study varied stenosis size, depth, scope type, and inlet pressure during five sequential jet bursts under LFJV.
Results Using a subglottiscope resulted in significantly reduced distal airway pressure compared to a laryngoscope. Interestingly, neither stenosis size nor depth significantly influenced distal airway pressure. However, increased distance between the scope and stenosis raised normalized pressure. A linear rise in normalized distal airway pressure was noted with increased inlet pressure, regardless of stenosis dimensions.
Conclusion In this model, scope type and inlet pressure were noted to be significant determinants of distal airway pressure, while stenosis size and depth were not. The distance between the scope and the stenosis did influence distal pressures. These findings may have clinical implications for managing airway pressures in patients undergoing LFJV, potentially reducing the risk of ventilator-induced lung injury.
Level of EvidenceNA (Basic Research) Laryngoscope, 134:2300–2305, 2024
Richard A. Raad, Rachel Akers, Samer Al‐Khudari, Kerstin Stenson, Mihir K. Bhayani
Publication date 10-04-2024
Fibromatoses are a rare group of benign, locally aggressive tumors that infrequently arise in the head or neck region. In the largest cohort to date, we describe the patient characteristics, treatment patterns, and survival associated with these tumors.
Background Head and neck fibromatoses (HNFs) are a rare, diverse group of soft tissue tumors characterized by an abnormal proliferation of fibroblasts. Available literature on these tumors is limited to case reports and small single-institutional studies.
Objective We aim to provide demographic, socioeconomic, tumor-related, and treatment characteristics of HNFs.
Design Retrospective cohort analysis using the National Cancer Database (NCDB).
Methods The NCDB was queried for fibromatosis-related histologic codes located within the head and neck region. Various factors were analyzed. Univariate and multivariate survival analyses were performed.
Results Between 2004 and 2016, 130 patients were included in the analyses. Average age was 57.4 years old with a predominance of White (83.6%) males (61.5%). Non-desmoid HNFs accounted for 60%–70% of the tumors. The salivary gland was the most common location (38.5%) and more than half of the tumors were high grade. The majority were treated surgically (90.8%) and 25% had positive margins. Mean and median overall survival (OS) were 98.9 and 135.4 months, respectively. Surgery is associated with better OS than nonsurgical alternatives. Addition of adjuvant treatments was not associated with differences in survival.
Conclusion In the largest study to date, we describe demographic, socioeconomic, tumor-related, and treatment patterns of patients with this rare disease. These tumors are most frequently present in middle-aged males with high-grade histology. Most are treated surgically and positive surgical margins are common. Surgery has better OS than nonsurgical alternatives. While adjuvant radiation has become more common, we found no difference in survival compared to surgery alone.
Level of Evidence4 Laryngoscope, 134:2228–2235, 2024
Yanyi Tu, Tianjiao Jiang, Yisha Wu, Jinfeng Luo, Shujuan Sun, Chuanping Liu, Peng Yu, Aiping Chen, Hongzhi Ji, Yuzhu Wan, Liang Yu, Li Shi
Publication date 10-04-2024
Antrochoanal polyp (ACP) is a polypoid lesion that often originates from the maxillary sinus and extends towards the choana. We found that adult ACP patients (≥18 years old) are different from children (<18 years old) in comorbidities and immunopathological characteristics.
Objective This study aims to find the difference in clinical and immunopathological characteristics between children and adults with antrochoanal polyps (ACPs) in the Chinese population.
Methods The clinical data of 69 patients diagnosed with ACPs were retrospectively analyzed. Cytokine levels in 16 controls and 40 ACPs tissues were determined by quantitative real-time polymerase chain reaction (qPCR). The expression of matrix metalloproteinase (MMP)-9 was measured using qPCR, immunofluorescent staining, and western blot.
Results There were 51 (73.9%) children (<18 years old) and 18 (26.1%) adults (≥18 years old). The sex ratio differed significantly between the two groups (p = 0.0032). There were no significant differences in the nasal side of ACPs and approaches to surgery between the two groups. In both groups, the most common symptom was nasal obstruction, followed by nasal discharge. As for associated nasal diseases, there was a significant difference between the two groups in septal deviation (p = 0.0223). Adult patients showed significantly higher expression of IL-8 mRNA than children (p = 0.0424). The mRNA and protein levels of MMP-9 were also significantly higher in adult patients than in children (p = 0.0498 and 0.0009, respectively).
Conclusion In the Chinese population, the comorbidities and immunopathological characteristics of adult ACP patients are different from those of children. The level of IL-8 and MMP-9 was significantly higher in ACPs of adults than in children, which may contribute to the more severe tissue remolding in adult ACP patients.
Level of Evidence3 Laryngoscope, 134:2093–2099, 2024
Kaori Nishikubo‐Tanaka, Rie Asayama, Kazutaka Kochi, Masahiro Okada, Keiko Tanaka, Hiroyuki Yamada, Naohito Hato
Publication date 10-04-2024
In this study, we revealed that the SP sequence mode was correlated with oral intake difficulty and aspiration pneumonia. Our findings are useful in understanding pathophysiology and severity of dysphagia. Furthermore, they may also facilitate timely and appropriate nutritional management and selection of rehabilitation techniques for patients with dysphagia.
Objective The sequential generation of swallowing pressure (SP) from the nasopharynx to the proximal esophagus is important for the bolus to pass from the oral cavity to the esophagus. The purpose of this study was to investigate the correlation of the SP sequence mode on high-resolution manometry (HRM) with oral intake difficulty and aspiration pneumonia.
Methods Consecutive patients with dysphagia who were admitted to our dysphagia clinic between November 2016 and November 2020 were enrolled in this cross-sectional study. We classified the HRM pressure topography data according to the SP sequence mode into type A, normal; B, partially decreased; C, totally decreased; and D, sequence disappeared, and according to the upper esophageal sphincter (UES) during pharyngeal swallowing into type 1, flattening and 2, non-flattening. Clinical dysphagia severity was determined based on oral intake difficulty and aspiration pneumonia.
Results In total, 202 patients with dysphagia (mean standard deviation age, 68.3 14.5 years; 140 69.8% male) were enrolled. Type C (odds ratio OR, 10.48; 95% confidence interval CI, 2.89–51.45), type D (OR, 19.90; 95% CI, 4.18–122.35), and type 2 (OR, 6.36; 95% CI, 2.88–14.57) were significantly related to oral intake difficulty. Type C (OR, 3.23; 95% CI, 1.08–11.12) and type 2 (OR, 4.18; 95% CI, 1.95–9.15) were significantly associated with aspiration pneumonia.
Conclusion The failure of sequential generation of SP was associated with higher risk of oral intake difficulty and aspiration pneumonia. These assessments are useful in understanding the pathophysiology and severity of dysphagia and in selecting safety nutritional management methods.
Level of Evidence4 Laryngoscope, 134:2127–2135, 2024
Katherine L. Marks, Kimberly L. Dahl, Cara E. Stepp
Publication date 10-04-2024
Expert listeners rated speakers with dysphonia who either had or did not have a foreign language accent. Despite the possibility of bias, the presence of a foreign language accent had no effect on expert listeners auditory-perceptual evaluations for dysphonic speakers.
Introduction Auditory-perceptual evaluations of dysphonia, though essential for comprehensive voice evaluation, are subject to listener bias. Knowledge of an underlying voice disorder can influence auditory-perceptual ratings. Accented speech results in increased listener effort and delays in word identification. Yet, little is known about the impact of foreign language accents on auditory-perceptual ratings for dysphonic speakers. The purpose of this work was to determine the impact of a foreign language accent on experts auditory-perceptual ratings of dysphonic speakers.
Methods Twelve voice-specializing SLPs who spoke with a General American English (GAE) accent rated vocal percepts of 28 speakers with a foreign language accent and 28 with a GAE accent, all of whom had been diagnosed with a voice disorder. Speaker groups were matched based on sex, age, and mean smoothed cepstral peak prominence. Four linear mixed-effects models assessed the impact of a foreign language accent on expert auditory-perceptual ratings of the overall severity of dysphonia, roughness, breathiness, and strain.
Results The twelve raters demonstrated good inter- and intra-rater reliability (ICC3, k = .89; mean ICC = .89). The linear mixed-effects models revealed no significant impact of foreign language accent on ratings of overall severity of dysphonia, roughness, breathiness, or strain.
Conclusion Despite the possibility of increased listener effort and bias, foreign language accent incongruence had no effect on expert listeners auditory-perceptual evaluations for dysphonic speakers. Findings support the use of auditory-perceptual evaluations for voice disorders across sociolinguistically diverse populations.
Level of Evidence3 Laryngoscope, 134:2272–2276, 2024
Lane B. Donaldson, Robert H. Deeb, Suhael Momin, Jacob G. Eide, John R. Craig
Publication date 10-04-2024
The anterior ethmoidal artery (AEA) flap was first described in 2011 and has been highly successful for repairing nasal septal perforations. The AEA branches are often published in a vertical orientation, however our study demonstrates a consistent non-vertical orientation. Based on cadaver and CT analysis, the AEA flap is a random transposition flap with a mean flap length of 6–7 cm.
Background The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flaps axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width.
Methods Ten fresh latex-injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally.
Results From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1–1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm.
Conclusions Based on the non-vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0–2.3 cm.
Level of EvidenceNA Laryngoscope, 134:2100–2104, 2024
Can Doruk, Valentina Mocchetti, Hal Rives, Paul Christos, Anaïs Rameau
Publication date 10-04-2024
Anxiety/depression may increase dysphagia in people with normal swallowing function.
Objective An increased prevalence of mood and anxiety disorders in patients with dysphagia has been noted previously, but whether dysphagia severity may be exacerbated by anxiety and depression has never been studied before. The purpose of this study is to identify the effect of pre-existing diagnosis of anxiety and/or depression (anxiety/depression) on the Eating Assessment Tool (EAT-10), a validated patient-reported outcome measure for dysphagia. We hypothesized that patients with dysphagia and normal instrumental evaluation have higher EAT-10 score in the presence of pre-existing anxiety and depression.
MethodsA retrospective chart review was conducted of patients seen at the multi-disciplinary dysphagia clinic of an urban academic institution. EAT-10 scores and pre-existing diagnoses of anxiety/depression were collected at the first visit with laryngologists. The two-sample t-test was used to compare mean EAT-10 scores between the anxiety/depression and no anxiety/depression groups, stratified by swallowing dysfunction etiology.
Results The study included 290 consecutive patients seen starting in January 2018. In this cohort, 60 (21%) had pre-existing anxiety, 49 (17%) depression, and 36 (12%) both. Overall, 59 patients had normal swallowing based on instrumental swallowing testing (flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, esophagram, or esophagoscopy). Among those, mean EAT-10 score was significantly higher in patients with anxiety and/or depression (n = 30) (14.63, SD = 11.42) compared to those with no anxiety and/or depression (n = 29) (8.93, SD = 6.59) (p = 0.023).
Conclusion While anxiety/depression may aggravate dysphagia in patients with normal swallowing function, this correlation may not hold in those with objective swallowing dysfunction.
Level of Evidence4 Laryngoscope, 134:2115–2120, 2024
Derek J. Vos, Khashayar Arianpour, Michael A. Fritz, Stephen Hadford, Sara W. Liu, Brandon L. Prendes, Peter J. Ciolek
Publication date 10-04-2024
Objectives To describe our technique, review indications, and evaluate the outcomes of the minimal access approach for recipient vessel identification in microvascular tissue transfer.
Methods Retrospective chart review of all patients who underwent microvascular reconstruction using the minimal access technique between 2015 and 2021.
Results We report 236 cases, comprising 214 patients with a mean age of 60.2 years (3–88). The most common primary defect sites were the mandible (22.6%), cranium (14%), maxilla (13.2%), skull base (12.8%), and nose/nasal cavity (10.6%). Indications for free flap reconstruction included head and neck cancer extirpation (32.2%), osteoradionecrosis (29.7%), acquired deformity (14.0%), chronic wound (11.9%) and oral motor dysfunction (7.2%). Free flap donor sites used were the anterolateral thigh (84.3%), fibula (7.2%), and radial forearm (6.4%). Vessels utilized include superficial temporal (49.8%), facial (38.3%), angular (11.1%), and transverse cervical (0.4%). The overall complication rate was 14% (n = 33), with surgical complications at the recipient site accounting for 67.6% (n = 25). Flap failure occurred in 3.4% of procedures. Prior head and neck surgery and free flaps were associated with an increased risk of major recipient site complications (n = 20, p = 0.0257 and n = 14, p = 0.0117, respectively).
Conclusion Minimal access techniques allow consistent recipient vessel identification for microvascular-free tissue transfer. These approaches may be utilized in reconstructing a broad range of head and neck defects, are low morbidity, and contribute to an overall shorter length of stay.
Level of Evidence2 Laryngoscope, 134:2177–2181, 2024
Alisa Timashpolsky, Ashna Aggarwal, Ryan Ruiz, Conor Devine
Publication date 10-04-2024
Patients with Trisomy 21 have a more challenging postoperative recovery course from tonsillectomy and adenoidectomy. Intracapsular tonsillectomy in these patients leads to quicker recovery, decreased length of stay, and fewer postoperative respiratory complications. Intracapsular tonsillectomy is as effective at improving obstructive sleep apnea in the short term as total tonsillectomy in this patient population.
Objectives Intracapsular tonsillectomy and adenoidectomy (iTA) has become a popular alternative to extracapsular tonsillectomy and adenoidectomy (TT) for the treatment of pediatric obstructive sleep apnea (OSA) due to improved recovery and fewer complications. The objective of this study was to compare surgical recovery and impact on OSA of iTA versus TT in patients with Trisomy 21 (T21).
Methods This is a case series with chart review of all T21 patients who underwent iTA or TT at our institution between July 1, 2015 and August 15, 2022. Data collected included demographics, comorbidities, preoperative sleep studies, intraoperative data, complications and recovery, postoperative sleep studies, and follow-up data.
Results There were 62 (21.7%) patients who underwent iTA and 224 (78.3%) patients who underwent TT. The iTA group had significantly lower pain scores (p < 0.001), decreased use of narcotics (p < 0.001), shorter length of stay (p = 0.003), and faster return to oral intake (p = 0.01) during their postoperative hospital admission, and fewer 30-day complications (p = 0.009) compared to the TA group. Both groups showed significant improvements in their sleep studies. For 41 (66.1%) of iTA patients who had follow-up, median follow-up was 1.8 years and for 169 (75.4%) TT patients, median follow-up was 2.6 years. At follow-up, 21 of 41 (51.2%) iTA patients and 83 of 169 (49.1%) TT patients exhibited OSA symptoms (p = 0.084) and tonsillar regrowth was not significantly different between the two groups (p = 0.12).
Conclusion Patients with T21 experience less pain and fewer postoperative respiratory complications from iTA than from TT. The short-term impact of iTA versus TT on OSA, as measured by poysomnography, does not differ between the two techniques.
Level of Evidence3 Laryngoscope, 134:2430–2437, 2024
Tanya Chen, Harley H. L. Chan, John de Almeida, David P. Goldstein, Ralph W. Gilbert, Christopher M. K. L. Yao, Jonathan C. Irish, Joel C. Davies
Publication date 10-04-2024
Reconstruction in advanced mandibular defects due to head and neck cancer is challenging. The use of three-dimensional pre-bent plates is useful in improving precision and accuracy of contour.
Objective(s)The purpose of this study was to compare computer-assisted mandibular plating to conventional plating using quantitative metrics.
Methods Patients scheduled to undergo mandibular reconstruction were randomized to three-dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate-to-bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre- and post-operative scans were calculated.
Results Twenty patients were included with a mean age of 57.8 years (standard deviation SD = 13.6). The mean follow-up time was 9.8 months (range = 1.6–22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three-dimensional models compared to freehand bending (93.9 ± 7.7% vs. 78.0 ± 19.9%, p = 0.04). There was improved overall plate-to-bone distance (3D model: 0.7 ± 0.31 mm vs.
conventional: 1.3 ± 0.8 mm, p = 0.06). Total intraoperative time was non-significantly decreased with the use of a model (3D model: 726.5 ± 89.1 min vs.
conventional: 757.3 ± 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications.
Conclusion Computer-assisted mandibular plating can be used to improve the accuracy of plate contouring.
Level of Evidence2 Laryngoscope, 134:2182–2186, 2024
Ángel Ramos de Miguel, Isaura Rodriguez Montesdeoca, Juan Carlos Falcón González, Silvia Borkoski Barreiro, Andrzej Zarowski, Morgana Sluydts, Nadia Falcón Benitez, Angel Ramos Macias
Publication date 10-04-2024
We analyze in this research the possible beneficial “crosstalk” during cochlear implant stimulation on otolith end organs has been hypothesized. The aim of this study is to analyze the effect of electrical cochlear stimulation on the vestibule (otolith end organ), when using a cochleo-vestibular implant.
Objectives Possible beneficial “crosstalk” during cochlear implant stimulation on otolith end organs has been hypothesized. The aim of this case–control study is to analyze the effect of electrical cochlear stimulation on the vestibule (otolith end-organ), when using a cochleo-vestibular implant, comparing vestibular stimulation (VI) and cochlear stimulation (CI).
Methods Four patients with bilateral vestibulopathy were included. A double electrode array research implant was implanted in all cases. Dynamic Gait Index (DGI), VOR gain measured by using vestibular head impulse test (vHIT), acoustic cervical myogenic responses (cVEMP) recordings, and electrical cVEMP were used in all cases. Trans-impedance Matrix (TIM) analysis was used to evaluate the current flow from the cochlea to the vestibule.
Results While patients did not have any clinical vestibular improvement with the CI stimulation alone, gait metrics of the patients revealed improvement when the vestibular electrode was stimulated. The average improvement in the DGI was 38% when the vestibular implant was activated, returning to the normal range in all cases. Our findings suggest that any current flow from the cochlear space to the otolith organs was insufficient for effective cross-stimulation. The functional results correlated with the data obtained in TIM analysis, confirming that there is no current flow from the cochlea to the vestibule.
Conclusion The only way to produce effective electrical otolith end-organ stimulation, demonstrated with this research implant, is by direct electrical stimulation of the otolith end organs. No effective cross-stimulation was found from cochlear electrode stimulation.
Level of Evidence4 Laryngoscope, 134:2349–2355, 2024
Manu Shrivastava, Beatrice Emmanouil, Rajeev Mathew, Dorothy Halliday, Allyson Parry, Jane Halliday, Samuel Mackeith
Publication date 10-04-2024
This study follows 81 cases of vestibular schwannoma in patients with NF2-related schwannomatosis which are treated with stereotactic radiosurgery or fractionated radiotherapy. Overall actuarial control rate (where cases did not experience excess growth or further treatment) was 77% and 71% at 5 and 10 years, Actuarial long term serviceable hearing preservation was 69% at 5 years and 52% at 10 years.
Objectives To determine the long-term control rates and hearing outcomes for growing vestibular schwannoma in NF2-related schwannomatosis (NF2) treated with stereotactic radiosurgery (SRS) and fractionated radiotherapy (FRT).
Methods Retrospective review of all patients treated with SRS/FRT between 1986 and2021 from a tertiary NF2 unit.
Overall tumor control was defined as: (1) growth control (growth failure was defined as growth in any dimension of 3 millimetres or more from baseline post-SRS/FRT), and (2) treatment control (no need for further intervention). Loss of serviceable hearing was defined as a drop in speech discrimination score below 50% after SRS/FRT.
Results There were 81 cases, with a mean duration of follow-up of 125 months. Overall control rate was 72% (58/81), with 80% (65/81) growth control and 74% (60/81) treatment control. There was a 5-year actuarial survival of 77% and 10-year survival of 71%. Forty-three percent (30/69) of cases did not have serviceable hearing at baseline. Of those remaining, 49% (19/39) preserved serviceable hearing during follow-up at a mean of 106 months. Actuarial survival for preservation of serviceable hearing at 5 and 10 years was 69% and 53%. There were poorer outcomes with increasing genetic severity, and with baseline tumor size >3 cm. No cases of SRS/FRT-related malignancy were identified at a mean follow-up of 10 years.
Conclusion Stereotactic radiosurgery/fractionated radiotherapy are an effective option to treat growing vestibular schwannoma in patients with NF2 with the potential for hearing preservation in a proportion of patients.
Level of Evidence4—Case Series Laryngoscope, 134:2364–2371, 2024
Dan Zhou, Li‐Kuan Wang, Hai‐Yin Wu, Guo‐Li Xiong, Xu‐Dong Yang
Publication date 10-04-2024
Objectives This study evaluated the use of lidocaine spray for acute postsurgical pain control after posterior pharyngeal flap surgery.
Methods Fifty patients aged 4 to 14 years who were scheduled to undergo elective posterior pharyngeal flap surgery were randomized to receive 2.4% lidocaine spray (Group L) or an identical volume of placebo spray (Group C) on the surgical field at the end of the surgery. The primary outcome was the maximum postoperative pain score in the postanesthesia care unit.
Results The maximum pain score in Group L was significantly lower than that in Group C (p = 0.001). The incidence of moderate-to-severe pain in the postanesthesia care unit was significantly lower in Group L than that in Group C (p < 0.001). In the postanesthesia care unit, more patients in Group C were prescribed rescue analgesics (p < 0.001). The time to the first rescue analgesic was also significantly shorter in Group L (p < 0.001). The incidence and maximum score of emergence agitation were lower in Group L than in Group C. Compared with Group C, Group L showed earlier postoperative fluid intake (p = 0.001). Moreover, the score for parental satisfaction with pain control was higher in Group L than in Group C (p < 0.001).
Conclusions Our findings indicated that the use of 2.4% lidocaine aerosol spray on the surgical site at the end of the surgery could produce good analgesia for acute postoperative pain, reduce the incidence and severity of EA, and shorten the time to restore fluid intake.
Level of Evidence2 Laryngoscope, 134:2438–2443, 2024
Richard H. Law, Lorenzo Cena, Alec Sporn, Adva Buzi, Mark D. Rizzi, Ryan L. Ruiz, Sabrina Fedrigo, Terri Giordano, Alexander N. Fahmy, Kavita Dedhia
Publication date 10-04-2024
Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures.
Objective Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures.
Methods This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures.
Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™.
Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups.
Results The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0).
Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels.
Conclusion Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel.
Level of Evidence3 Laryngoscope, 134:2444–2448, 2024
Minah Park, Sung‐In Jang, Kyungduk Hurh, Eun‐Cheol Park, Seung Hoon Kim
Publication date 10-04-2024
Objectives This study investigated the association between sudden sensorineural hearing loss (SSNHL) and the risk of cardio-cerebrovascular disease (CCVD) among older adults in South Korea.
Methods Data from 38,426 patients in the Korean National Health Insurance Service-Senior Cohort from 2002 to 2019 were collected. The risk of CCVD includes both stroke and acute myocardial infarction. Propensity score matching (1:1) was used to identify pairs of individuals with and without SSNHL (n = 19,213 for cases and controls). Cox proportional hazards regression models were used to analyze the associations between variables.
Results Patients with SSNHL had a higher risk of CCVD (hazard ratio HR = 1.17, 95% confidence interval CI = 1.11–1.24) compared to those without. The risk of CCVD was higher among those who experienced a stroke than those who did not (HR = 1.17 95% CI = 1.10–1.25). Compared to their matched controls, patients with SSNHL were 1.69 times (HR = 1.69 CI = 1.46–1.94) more likely to have CCVD during the first 12 months of the follow-up period.
Conclusion Older patients with SSNHL are at an increased risk of CCVD. Hence, a more attentive approach featuring aggressive monitoring of patients with SSNHL is required to lessen their risk of CCVD.
Level of Evidence3 Laryngoscope, 134:2372–2376, 2024
Eyal Yosefof, Nir Tsur, Ofir Zavdy, Noga Kurman, Dean Dudkiewicz, Moshe Yehuda, Gideon Bachar, Thomas Shpitzer, Aviram Mizrachi, Sharon Tzelnick
Publication date 10-04-2024
Regional spread of oral cavity cancer appears to be a by far worse prognostic factor among patients younger than 40 years old compared with older patients. Comprehensive treatment approach among these patients, including neck dissection and chemo-radiotherapy appears to achieve a high survival and loco-regional control rate.
Background Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC.
MethodsA retrospective comparison between patients 40 years old or younger, 41–69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary-care center.
Results279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty-six (12.9%) were 40 years old or younger, 101 (36.2%) were 41–69 years and 142 (50.9%) were 70 years or older. Five-year overall survival and disease-specific survival (DSS) were significantly better among patients younger than 40 compared to the mid-age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log-rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log-rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41–69 and 70+ age groups (death of any cause-OR = 23, p-value = 0.008, OR = 2.6, p-value = 0.026, OR = 2.4, p-value = 0.13, respectively. Death of disease-OR = 23, p-value = 0.008, OR = 2.3, p-value = 0.082, OR = 4.1, p-value = 0.001, respectively). In univariate analysis, regional metastasis was associated with disease-free survival only among patients younger than 40 (p-value = 0.04).
Conclusions Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post-treatment follow-up.
Level of Evidence3 Laryngoscope, 134:2212–2220, 2024
Gabriel Raab, Christopher Babu, Yao Yu, Babak Givi, Richard J. Wong, Nancy Y. Lee, Kaveh Zakeri
Publication date 10-04-2024
We found that a substantial subset of older patients receive inadequate adjuvant radiation doses for head and neck cancer. Understanding the incidence and factors associated with inadequate radiation dose could help guide interventions to increase treatment completion. To our knowledge, our study is the first to look at factors associated with incomplete radiation dosing. We found that older age, non-intensity-modulated radiation therapy (IMRT), and living in a lower income zip code were associated with inadequate radiation dosing.
Objective To determine the rate of inadequate radiotherapy and identify risk factors associated with inadequate adjuvant radiotherapy for head and neck cancer among older adults.
MethodsA retrospective review of the National Cancer Database (NCDB) was performed to identify patients diagnosed with squamous cell cancer of the head and neck between 2004 and 2017. Patients with a single malignancy, negative surgical margins, no extranodal extension, and receipt of adjuvant radiation without systemic therapy were included in the study cohort. The main outcome of interest was the adjuvant radiation dose received. Participant data were compared using univariable, multivariable, and correlation analyses to evaluate risk factors for inadequate radiation therapy (RT) dosing.
Results Among 7608 patients, 1010 patients (13.3%) received an inadequate radiation dose and 6598 (86.7%) received an adequate dose. Patients living in a higher income zip-code, younger age, and those who received intensity-modulated RT (IMRT) were more likely to receive an adequate radiation dose (p < 0.05). Patients older than 70 and 80 years old had a greater likelihood of receiving an inadequate radiation dose (≥70 vs. <70: 16.9% vs. 12.5%; p < 0.05 and ≥80 vs. <80: 20.6% vs. 13.0%%; p < 0.05). Similarly, increasing age was negatively correlated with radiation dose (correlation coefficient: −0.05; p < 0.001).
ConclusionA substantial proportion of older patients receiving adjuvant radiation do not complete the full treatment. Older age, year of diagnosis, non-IMRT, and living in a lower-income zip code were associated with early termination of RT. Future studies should examine strategies to improve tolerance of adjuvant RT so that more patients complete the full treatment.
Level of Evidence3; Cohort Study Laryngoscope, 134:2206–2211, 2024
Salina H. Goff, Kaci Pickett‐Nairne, Thanh Nguyen, Kyle O. Rove, Norman R. Friedman
Publication date 10-04-2024
Lower socioeconomic status (SES) and being a member of a racial or ethnic minority group are known risk factors for obstructive sleep disordered breathing. However, there is limited research into the role of health disparities in adenotonsillectomy outcomes. We sought to analyze the effect that social vulnerability has on post?operative respiratory status and discharge planning to rectify this specific health care gap.
Objective To determine if children with greater social vulnerability are more likely to experience a prolonged oxygen requirement (POR) following adenotonsillectomy to inform the need for overnight monitoring prior to discharge.
MethodsA previously published prospective study assessing children observed overnight following adenotonsillectomy for obstructive sleep-disordered breathing was reanalyzed including social vulnerability index (SVI). The outcome was POR beyond 3 h following extubation. Logistic regression was used to assess the association of SVI components with POR. SVI components were assessed as quartiles of cohort values. Final adjusted models included race, asthma, Down syndrome, and pre-operative SpO2.
ResultsA total of 462 children had SVI data available and were included. 354 (76.6%) were > = 3 years of age. Overall, 351 (76%) did not have a POR. The median overall SVI percentile was 26.5 (Q1 10.4, Q3 60.1). When categorized by SVI quartiles, there was a statistically significant difference with POR for overall SVI percentile (p = 0.007), SVI household composition percentile (p = 0.033), and median SVI housing/transportation percentile (p = 0.005). Individuals with an overall SVI in the 4th quartile (greatest vulnerability) were 2.63 times more likely to experience a POR than those in the 1st quartile (lowest social vulnerability) in adjusted logistic regression (95% OR CI 1.23–5.62; p = 0.01).
Conclusions There is a significant association between greater neighborhood-level social vulnerability and a POR following adenotonsillectomy. We propose that a childs SVI be considered when planning for the perioperative course following adenotonsillectomy.
Level of Evidence3 Laryngoscope, 134:2449–2454, 2024
Yujie Ke, Xin Ma, Yuanyuan Jing, Tongxiang Diao, Lisheng Yu
Publication date 10-04-2024
The BLB changes dynamically after noise exposure. After noise exposure, the increased BLB permeability makes it easier for drugs to enter the inner ear from blood. 1–8 days after noise exposure may be the best intervention time for systemic administration.
Purpose This study aimed to investigate dynamic change of permeability of blood-labyrinth barrier (BLB) after noise exposure and its effect on the drug delivery efficiency of systemic administration.
Methods Gadopentetate dimeglumine (Gd-DTPA) and dexamethasone (DEX) were used as tracers, and magnetic resonance imaging (MRI) and immunofluorescence were used to observe the change of the BLB after strong noise exposure in guinea pigs. High-performance liquid chromatography-mass spectrometry (LC–MS) was used to observe the effect of the breakdown of BLB after noise exposure on the drug delivery efficiency of intravenous DEX.
The guinea pigs were divided into 6 groups: normal group (N), 1, 3, 5, 8, and 12 days after noise exposure groups (P1, P3, P5, P8, P12), with 5 animals in each group.
Results The BLB changes dynamically after noise exposure. Increased permeability of the blood-endolymph barrier, the endolymph-perilymph barrier, and the blood-nerve barrier was observed at days 1–3, 1–5, and 1–8, respectively, after noise exposure in guinea pigs. Higher drug concentration in the cochlear tissue was obtained by intravenous administration of DEX in guinea pigs during the time window of increased permeability of the BLB.
Conclusion After noise exposure, the increased BLB permeability makes it easier for drugs to enter the inner ear from blood. In guinea pigs, 1–8 days after strong noise exposure, the drug delivery efficiency of systemic administration increased. After 8 days, the efficiency gradually returned to normal level. 1–8 days after noise exposure may be the best intervention time for systemic administration.
Level of EvidenceNA Laryngoscope, 134:2377–2386, 2024
Sang‐Yoon Han, Young Ho Kim
Publication date 10-04-2024
Hearing aids could improve social networks and reduce depressive symptoms in patients with hearing impairment. Since hearing aid did not improve social relationships and depressive mood in the low economics impaired patients with low economic status have difficulty in improving social relationships and depressive mood, it is important to provide comprehensive and multidirectional support for hearing rehabilitation for these patients.
Objectives Hearing impairment affects social networks and mental health. Hearing aids (HA) can improve these deficits. However, their effects might be affected by various factors such as economic status (ES). This study aimed to identify how ES could moderate the effects of HA on social networks, depressive mood, and cognition.
MethodsA prospective cohort for new HA users was established and classified into two groups based on their ES: a low ES group (LES group) and a medium to high ES group (MHES group). Audiological examination, Lubben social network scale-18 (LSNS-18), Short form of Geriatric Depression Score, Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet, and surveys for satisfaction with HA were conducted before and at six months after wearing HA.
Results Post-HA application LSNS-18 scores were not improved in the LES group whereas they revealed significant improvement in the MHES group (p = 0.003). The LES group showed lower LSNS-18 score (p = 0.020) and its change (p = 0.042) than the MHES group. Additionally, patients with depressive moods in the MHES group showed better improvements than those in the LES group (p = 0.048). The effects of wearing HA on cognition and satisfaction with HA were not significantly different between the two groups.
ConclusionsHA did not improve social relationships and depressive moods in the LES group. Comprehensive and multidirectional support as well as hearing rehabilitation may be important for patients with LES.
Level of Evidence3 (Nonrandomized controlled cohort/follow-up study) Laryngoscope, 134:2387–2394, 2024
Catherine H. Frenkel, Erin E. Donahue, Daniel Brickman, Steven Hong, Zvonimir L. Milas
Publication date 10-04-2024
This study evaluates Enhanced Recovery After Surgery in 83 cancer patients after laryngectomy. ERAS did not improve length of stay, major postoperative complication rate, or oncologic outcomes, but it conferred health quality benefits by positively influencing secondary endpoints.
Objective Patients undergoing laryngectomy are particularly vulnerable to postoperative complications secondary to social and nutritional barriers, substance abuse, and prior cancer treatment. Enhanced Recovery After Surgery (ERAS) programs may mitigate this vulnerability and improve postoperative complications and oncologic outcomes. The objective of this study is to evaluate the postoperative complication rate and oncologic outcomes of patients undergoing laryngectomy before and after ERAS program implementation.
MethodsA historic cohort of 50 patients who underwent laryngectomy at the Levine Cancer Institute, Charlotte, North Carolina from 2014 to 2019 (pre-ERAS) was compared to 33 patients who underwent laryngectomy after ERAS implementation from 2019 to 2020. The primary outcomes included length of stay (LOS), Clavien-Dindo postoperative complications through 30 days following discharge, overall survival (OS), and recurrence-free survival between pre-ERAS and ERAS groups.
Results Demographic characteristics between the two groups were similar. ERAS pathway implementation led to core care element consistency and improvement in the clinical perioperative course, including preoperative nutritional intervention (p = 0.009), postoperative ventilator independence (p = 0.0004), and refractory nausea/emesis (p = 0.18). Severe (≥ grade 3) complications (p = 0.49) and LOS (p = 0.68) were similar between groups. No significant difference in Cox proportional modeling of OS (p = 0.60) or recurrence-free survival (p = 0.17) was noted.
ConclusionsERAS did not improve LOS, major postoperative complications, or oncologic outcomes in this cohort of patients who underwent laryngectomy. However, ERAS positively influenced secondary endpoints within the laryngectomy perioperative course, conferring qualitative health care benefits.
Level of Evidence3 Laryngoscope, 134:2262–2268, 2024
Mateus M. Aires, Karine V. G. de Oliveira, Jônatas B. do Amaral, Marcos Mônico‐Neto, João Roberto M. Martins, Aline L. Santiago, Noemi G. De Biase
Publication date 10-04-2024
Exposure of adult female rats to androgen therapy resulted in hypertrophy of the thyroarytenoid (TA) muscle and increased expression of androgen receptors in the vocal folds. The TA muscle seems to be the primary target of testosterone action in the larynx, and the up-regulation of androgen receptors may contribute to the permanent deepening of the voice.
Objective To analyze the effects of androgen therapy on the thyroarytenoid (TA) muscle, expression of androgen receptors (ARs) and hyaluronic acid (HA) concentration in the vocal folds (VFs) of adult female rats.
Methods Twenty-one adult female Wistar rats were divided into experimental and control groups. The experimental group received weekly intramuscular injections of nandrolone decanoate for 9 weeks. Following euthanasia and dissection of the VFs, histomorphometric analysis of the TA muscle, immunohistochemical evaluation of ARs, and measurement of HA concentration using the ELISA-like fluorimetric method were performed.
Results The experimental group exhibited a significantly larger mean fiber cross-sectional area in the TA muscle compared to the control group (434.3 ± 68.6 μm2 versus 305.7 ± 110.1 μm2; p = 0.029), indicating muscle hypertrophy. There was no significant difference in the number of muscle fibers. The experimental group showed higher expression of ARs in the lamina propria (62.0% ± 30.3% versus 22.0% ± 22.8%; p = 0.046) and in the TA muscle (45.0% ± 22.6% versus 18.3% ± 9.8%; p = 0.024). There was no significant difference in the concentration of HA.
Conclusion Exposure of adult female rats to androgen therapy resulted in hypertrophy of the TA muscle and increased expression of ARs in the VFs. The TA muscle seems to be the primary target of testosterone action in the VF, and the up-regulation of ARs might contribute to the persistent deepening of the voice.
Level of EvidenceNA Laryngoscope, 134:2316–2321, 2024
Chien‐Chia Huang, Ping Hsueh Sun, Pei‐Wen Wu, Chi‐Che Huang, Po‐Hung Chang, Chia‐Hsiang Fu, Ta‐Jen Lee
Publication date 10-04-2024
Our results showed no significant difference in sinus opacification according to the mLM CT score between the preoperative and postoperative evaluations. In addition, the anterior airspace diameters were significantly associated with the ENS6Q score, SNOT-25 scores, sleep symptom domain, psychological domain, and empty nose symptom domain of the SNOT-25.
Objective We aimed to evaluate computed tomography (CT) images of patients with empty nose syndrome (ENS), investigate the impact of reconstruction surgery on sinus inflammation, and identify the optimal airspace diameter after surgery.
Methods We conducted a retrospective case series analysis, identifying and enrolling patients with ENS with perioperative CT findings. The clinical characteristics of the participants were collected, and the modified Lund-Mackay (mLM) CT scores were determined. The anterior airspace diameter was evaluated by measuring the distance between the septum and the lateral nasal wall on the coronal plane at the level of the nasolacrimal duct.
Results Twenty patients with ENS and perioperative CT images were enrolled. The mean total mLM CT score and all subsite scores showed no significant changes after surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) score, Sino-nasal Outcome Test-25 (SNOT-25) score, sleep symptoms domain, psychological domain, and empty nose symptoms domain were significantly associated with anterior airspace diameter in the regression analysis.
Conclusion There was no significant difference in sinus inflammation between preoperative and postoperative CT evaluations. The anterior airspace diameters were significantly associated with ENS6Q and SNOT-25 scores.
Level of Evidence4 Laryngoscope, 134:2105–2110, 2024
Richard Heyes, Charles H. Adler, Claire Yee, David G. Lott, William E. Karle
Publication date 10-04-2024
This is a study of 32 patients with adductor spasmodic dysphonia who underwent transcutaneous laryngeal botulinum toxin injection. All participants received injection without anesthesia, with lidocaine, and with the use of a vibrating instrument. Patients were randomized to the order of receiving these treatments. Nearly two-thirds of patients preferred injection without lidocaine. There was no difference in pain between analgesic techniques.
Objectives There is an absence of data in the literature regarding methods to improve the patient experience during the performance of awake in-office laryngeal injections. This study sought to evaluate whether the use of local anesthetic or a vibrating instrument decreased overall pain experienced by patients with laryngeal dystonia, frequently referred to as spasmodic dysphonia (SD), undergoing transcervical botulinum toxin injections.
Methods This was an unblinded, prospective randomized control trial with a crossover design where each patient received transcutaneous transcricothyroid injection of botulinum toxin with alternating use of no anesthesia, local anesthesia (2% lidocaine in 1:100,000 epinephrine), and vibrating instrument in three consecutive laryngeal injections to treat adductor SD. Patients were randomized to the order they received these treatments. Patients measured pain on a 0–10 visual analogue scale (VAS) and selected their preferred technique after receiving all three analgesic modalities.
Results Thirty-two patients completed the study. There was no statistically significant difference in pain between the three analgesic techniques (p = 0.38). The most preferred analgesic technique was the vibrating wand (44% (14/32)). Lidocaine was the second most preferred (37% (12/32)) and 19% (6/32) of patients preferred nothing. When combining the wand and nothing groups, 63% of patients preferred one of these two methods (95% exact CI: 44%–79%).
Conclusion There was no statistically significant difference in median pain experienced by patients during laryngeal botulinum toxin injection between these different analgesic modalities. More than half of the patients selected a preference for a technique that did not include lidocaine. This data supports individualization of analgesia during transcutaneous laryngeal injections.
Level of Evidence2 Laryngoscope, 134:2277–2281, 2024
Ralph Hohenberger, Philipp Endres, Irina Salzmann, Peter K. Plinkert, Frank Wallner, Ingo Baumann, Janes Alt, Frank Riedel, Burkard M. Lippert, Olcay Cem Bulut
Publication date 10-04-2024
Septorhinoplasty patients show a high prevalence of symptoms of body dysmorphic disorder, anxiety, and depression. These patients show a smaller increase in postoperative quality of life. Therefore, rhinoplasty surgeons must be aware of the disorders and discuss respective concerns with the patients.
Objectives Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL.
MethodsA multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire—aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17).
Results In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.
7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels.
ConclusionsSRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist.
Level of Evidence3 Laryngoscope, 134:2187–2193, 2024
Beth L. Ladlie, Hannah F. Case, Priyanka Perisetla, Andrew W. Austin, Emily C. Craver, Erica Engelberg‐Cook, Amy L. Rutt
Publication date 10-04-2024
This manuscript takes a glance at gender parity in otolaryngology by examining authorship of research publications and presentations, awards, research grants, leadership and membership in related organizations. While the proportion of women receiving awards and holding leadership positions is increasing, the percentage continues to lag. Efforts should be made to promote diverse-gender professional networks in otolaryngology that increase womens representation.
Objective The aim was to evaluate representation of women in otolaryngology by examining authorship of research publications and presentations, awards, research grants, leadership, and membership in related organizations.
Methods Authorship was reviewed from articles published in three otolaryngology journals from 2000 through 2021 to assess the frequency and percentages of female and combination of male and female gender authorship. Gender was evaluated for poster and scientific abstract presentations from 2007 to 2021. Gender representation was reviewed for institutional and society leadership positions, award, and grant recipients in the American Laryngological Society (ALA). Changes in the frequency of female and combination of male and female gender authorship over time were examined with Cochran-Armitage test for trend.
ResultsA total of 16,921 articles, 1,017 presentations, 480 leadership positions, 129 president positions, and 1,137 awards and grants were studied. Women were first authors in 4,153 (24.9%) and last authors in 2,935 (17.8%) published articles for which gender could be determined. Women were first authors in 372 (37.4%) presentations and last authors in 199 (20.2%). Most presentations had a combination of male and female presentation authorship (630, 68%). Women held 69 (14.4%) leadership positions. Of the award and grant recipients, 327 (28.8%) were female. Significant trends were observed for increasing female representation (first authorship publications increased 69.9% from 2000 to 2020, first authorship presentations increased 73.9% from 2007 to 2013, p < 0.001; leadership and awards from 3% to 18% representation, p = 0.02).
Conclusion The proportion of women receiving awards and holding leadership positions is increasing. Efforts that promote gender diversity may further increase representation of women in otolaryngology literature and among the grant and award winners.
Level of EvidenceNA Laryngoscope, 134:2144–2152, 2024
Renee E. King, Josef Rademacher, Ella T. Ward‐Shaw, Rong Hu, Andrea Bilger, Simon Blaine‐Sauer, Megan E. Spurgeon, Susan L. Thibeault, Paul F. Lambert
Publication date 10-04-2024
In humans, human papillomaviruses that cause recurrent respiratory papillomatosis can spread to the larynx from other tissue sites (secondary infection), and to the larynx of infants from genitally infected mothers (vertical infection). We examined larynges of over 430 immunocompetent adult and juvenile mice infected with mouse papillomavirus MmuPV1 in tissues other than the larynx or born to infected mothers, respectively, and found no evidence of secondary or vertical laryngeal MmuPV1 infection. These results have clinically important implications regarding laryngeal vulnerability to HPV infection.
Objective Mouse papillomavirus MmuPV1 causes both primary and secondary infections of the larynx in immunocompromised mice. Understanding lateral and vertical transmission of papillomavirus to the larynx would benefit patients with recurrent respiratory papillomatosis (RRP). To test the hypothesis that the larynx is uniquely vulnerable to papillomavirus infection, and to further develop a mouse model of RRP, we assessed whether immunocompetent mice were vulnerable to secondary or vertical laryngeal infection with MmuPV1.
Methods Larynges were collected from 405 immunocompetent adult mice that were infected with MmuPV1 in the oropharynx, oral cavity, or anus, and 31 mouse pups born to immunocompetent females infected in the cervicovaginal tract. Larynges were analyzed via polymerase chain reaction (PCR) of lavage fluid or whole tissues for viral DNA, histopathology, and/or in situ hybridization for MmuPV1 transcripts.
Results Despite some positive laryngeal lavage PCR screens, all laryngeal tissue PCR and histopathology results were negative for MmuPV1 DNA, transcripts, and disease. There was no evidence for lateral spread of MmuPV1 to the larynges of immunocompetent mice that were infected in the oral cavity, oropharynx, or anus. Pups born to infected mothers were negative for laryngeal MmuPV1 infection from birth through weaning age.
Conclusion Secondary and vertical laryngeal MmuPV1 infections were not found in immunocompetent mice. Further work is necessary to explore immunologic control of laryngeal papillomavirus infection in a mouse model and to improve preclinical models of RRP.
Level of EvidenceNA Laryngoscope, 134:2322–2330, 2024
Hamed Emami, Behrooz Amirzargar, Yasaman Nemati, Negin Rahimi
Publication date 10-04-2024
In this clinical trial, we compared the outcomes and complications of endoscopic versus microscopic stapedotomy in patients with otosclerosis. Despite various studies comparing endoscopic and microscopic stapedotomy, only one randomized clinical trial has been conducted specifically for this purpose, and our study was the second one. We found no significant difference in terms of hearing outcomes between the two groups. However, the pain scores in the endoscopic group were lower compared to those in the microscopic group. Therefore, we emphasize the role of endoscopic stapes surgery as a favorable alternative to conventional microscopic stapedotomy due to its advantages of providing a better visual field and fewer complications.
Objective To determine the outcomes and complications of endoscopic versus microscopic stapes surgery in patients with otosclerosis.
Study Design Randomized, single-blinded clinical trial.
Methods Patients with otosclerosis who underwent either trans-canal microscopic or endoscopic stapedotomy at a tertiary care hospital were compared. Thirty-two patients were randomly divided into two groups using blocked randomization. Group A consisted of 16 patients who underwent trans-canal microscopic stapedotomy, and group B consisted of 16 patients who underwent trans-canal endoscopic stapedotomy. Postoperative vertigo, ear pain, and complications such as tympanic membrane perforation or chorda tympani nerve injury were evaluated. Three months postoperatively, patients were assessed for dysgeusia and hearing improvement.
Results The mean pre-operative air-bone gap (ABG) in the microscopic and endoscopic groups was 32.81 ± 6.82 and 30.00 ± 7.96, respectively. The mean improvement in the ABG was 25.45 ± 11.21 dB in the microscopic group and 23.21 ± 10.68 dB in the endoscopic group. Although both techniques showed improvement in auditory outcomes (p-value <0.001), there were no statistical differences between the endoscopic and microscopic groups in the pre-operative, post-operative, and mean improvement of ABG (p-value >0.05). There were no significant differences between the two methods in chorda tympanic nerve injury, vertigo scores, and the mean operating time (p-value >0.05), but the mean pain score was higher in the microscopic group (2.56 ± 1.55 in the microscopic group versus 1.31 ± 0.70 in the endoscopic group) (p-value = 0.003).
Conclusions Endoscopic stapes surgery can be a preferable alternative to conventional microscopic stapedotomy, as it yields similar hearing outcomes and lower pain scores.
Level of Evidence2 Laryngoscope, 134:2395–2400, 2024
Kayla B. Hicks, Kevin D. Brown, A. Morgan Selleck, Matthew M. Dedmon, Nicholas J. Thompson
Publication date 10-04-2024
The Osia 2 device is a type of transcutaneous bone conduction hearing aid. A modification to the recommended surgical technique for the implantation of this device including incision placement, implant location, and double layered closure improves ease of procedure and decreases operative times without an increase in complications. This technique is also safe in children, despite decreased scalp thickness.
Objective To detail a modified surgical technique for implantation of the Osia 2 Bone Conduction Hearing Aid (BCHA) system and to assess intra- and postoperative outcomes of this technique.
MethodsA retrospective review was performed for cases undergoing implantation of an Osia 2 BCHA at a tertiary academic medical center.
Modifications were made to the surgical procedure including: horizontal or curvilinear incisions, placement of the osseointegrated screw slightly superior to the plane of the external auditory canal, and double layer wound closure. Data regarding outcomes including demographics, incision type, surgical time, drilling requirements, and complications were collected using the electronic medical record.
ResultsA total of twenty-eight cases were evaluated with 57.1% and 42.9% utilizing horizontal and curved incisions, respectively. The median age for recipients was 43.1 years with six pediatric cases included in the study. Median operative time was 58 min (43–126 min). The majority of cases required minimal (60.7%) or no drilling (28.6%) with a significant increase in operative time for those requiring moderate drilling versus minimal to no drilling (F = 8.02, p = 0.002). There were no intraoperative complications. One (3.6%) postoperative seroma occurred which resolved with conservative management.
Conclusion The proposed modified surgical technique is a safe and effective method for implantation of the transcutaneous BCHA system with a low complication rate. Keys include incision design, implant placement, and two-layered closure to minimize wound tension. These modifications can improve ease of the procedure and reduce operative time. These techniques also appear to be applicable to the pediatric population.
Level of Evidence3 Laryngoscope, 134:2401–2404, 2024
Junsheng Hong, Zhenlin Wang, Dawei Wu
Publication date 10-04-2024
Objectives Self-reported olfactory dysfunction is an assessment component criterion for chronic rhinosinusitis (CRS) disease control of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). No studies have objectively explored olfactory function across different psychophysical olfactory domains among patients with uncontrolled CRS. We aimed to investigate the patterns of olfactory impairment in patients with uncontrolled CRS with Sniffin Sticks test.
MethodsA total of 79 patients with CRS were prospectively recruited and assessed for disease control based on the EPOS criteria. Sniffin Sticks test scores, olfactory cleft computed tomography (CT) scores, olfactory cleft endoscopy scale (OCES), questionnaire of olfactory disorders-negative statements (QOD-NS), and sinonasal outcome test-22 (SNOT-22) were obtained. Multiple logistic regression was applied to explore risk factors of uncontrolled CRS.
Results Twenty-six percent of patients with CRS presented with uncontrolled status. The odor threshold (OT) (p = 0.005), odor identification (OI) (p = 0.041), and thresholds-discrimination-identification (TDI) (p = 0.029) scores were significantly lower in patients with uncontrolled CRS when compared with patients with controlled CRS. Furthermore, patients with uncontrolled CRS presented with a significantly increased percentage of anosmia (p = 0.014), olfactory cleft CT score (p = 0.038), OCES (p = 0.016), QOD-NS(p = 0.008), and SNOT-22 (p < 0.001) scores than patients with controlled CRS. After adjusting for patient demographics, as for the subdomain of olfaction, only the OT score was an independent risk factor for uncontrolled CRS (odds ratio = 0.604; p = 0.030). The OT scores less than 5.950 were the best predictor of uncontrolled CRS.
Conclusion Patients with uncontrolled CRS demonstrated distinct patterns of olfactory impairment, and a reduced olfactory threshold was highly associated with uncontrolled CRS.
Level of Evidence3 Laryngoscope, 134:2341–2348, 2024
Isabelle Fournier, Camille Caron, C. Meghan McMurtry, Annie Lapointe, Chantal Giguere, Marie‐Joëlle Doré‐Bergeron, Mathieu Bergeron
Publication date 10-04-2024
Objective Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patients quality of life (QoL) and parents satisfaction.
Study Design Prospective single-center study.
Setting Tertiary pediatric academic center.
Methods Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale FLACC, Childrens hospital of Eastern Ontario Pain Scale CHEOPS) were completed pre-procedure, during the first tympanostomy and second tympanostomy, and post-procedure, as well as 1 week postoperatively. General health-related QoL (PedsQL) and QoL specific to otitis media (OM-6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale.
ResultsLA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05).
Conclusions Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress-reducing strategies are critical. Shared decision-making with families is essential.
Level of Evidence3 Laryngoscope, 134:2422–2429, 2024
Jivianne T. Lee, Gregory M. Abbas, Daniel D. Charous, Mandy Cuevas, Önder Göktas, Patricia A. Loftus, Nathan E. Nachlas, Elina M. Toskala, Jeremy P. Watkins, Detlef Brehmer
Publication date 10-04-2024
In a prospective, single-arm study, 129 chronic rhinitis patients at 16 centers (United States, Germany) were treated with minimally invasive temperature-controlled radiofrequency neurolysis of the posterior nasal nerve. Clinical (rTNSS) and quality of life (MiniRQLQ) outcomes were significantly improved over pretreatment baseline at 3 months and sustained through 2 years posttreatment. These improvements were accompanied by a substantial decrease in medication burden.
Objective To assess the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), a minimally invasive treatment for chronic rhinitis.
MethodsA prospective, single-arm study of 129 patients at 16 centers (United States, Germany) was conducted. Patient-reported outcome measures were the 24-h reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). Postnasal drip and cough symptoms were assessed using a 4-point scale.
Results The mean pretreatment rTNSS was 7.8 (95% CI, 7.5–8.1). The significant rTNSS treatment effect at 3 months (−4.2 95% CI, −4.6 to −3.8; p < 0.001) was sustained through 2 years (−4.5 95% CI, −5.0 to −3.9; p < 0.001), a 57.7% improvement. At 2 years, the proportion of patients with a minimal clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0% (95% CI, 71.4%–86.5%). Individual postnasal drip and cough symptom scores were significantly improved from baseline through 2 years. The proportion of patients who reached the MCID for the MiniRQLQ (≥0.4-point improvement) at 2 years was 77.4% (95% CI, 68.5%–84.3%). Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at 2 years. No device/procedure-related serious adverse events were reported throughout 2 years.
ConclusionTCRF neurolysis of the PNN resulted in sustained improvements in chronic rhinitis symptom burden and quality of life through 2 years, accompanied by a substantial decrease in medication burden.
Level of Evidence4 Laryngoscope, 134:2077–2084, 2024
Michael J. Hutz, Eric Thuler, Crystal Cheong, Chau Phung, Marianna Evans, John Woo, Brendan T. Keenan, Raj C. Dedhia
Publication date 10-04-2024
Recent evidence suggests that environmental factors impact craniofacial development. This study found that in a series of 93 patients, a correlation was noted between a narrow, high-arched palate and degree of septal deviation.
Objectives Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation.
MethodsA prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high-arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height-to-width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing.
Results Ninety-three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter-premolar palatal height and the degree of septal deviation at the inter-molar region. No significant correlation was observed between palatal dimensions and NOSE score.
Conclusion This study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures.
Level of Evidence4 Laryngoscope, 134:2464–2470, 2024
Ollivier Laccourreye, Dominique Garcia, Fabienne Haroun, Dac H. Nguyen, Philippe Giraud, Haitham Mirghani
Publication date 10-04-2024
Analysis of an observational inception cohort of 531 patients with isolated untreated endolaryngeal cT3-4M0 SCC consecutively managed with primary TL at an academic tertiary referral care center (94% of patients were followed until death or for a minimum of 10 years). The 10-year actuarial local control estimate was 89.7%. Local recurrence was salvaged in 11% of cases(resulting in 92% overall local control), and significantly reduced nodal control, distant metastasis control, and survival.
Objectives To document 10-year oncologic outcome of primary total laryngectomy (TL) for patients with cT3-4M0 endolaryngeal squamous cell carcinoma (SCC).
Study Design Observational inception cohort of 531 patients with isolated untreated endolaryngeal cT3-4M0 SCC review over 40 years using STROBE guideline. 94% of patients were followed until death or for a minimum of 10 years.
Setting Academic tertiary referral care center.
Methods All patients underwent primary TL. Prior tracheotomy, induction chemotherapy, thyroid gland resection, level II-IV neck dissection, level VI dissection, and postoperative radiation therapy were associated in 6%, 40%, 43%, 89%, 47%, and 74% of cases, respectively: The main objective was to determine the 10-year actuarial local control estimate. Accessory objectives comprised screening for clinical variables increasing the risk of local recurrence, and analysis of long-term oncologic consequences of local recurrence.
Results The 10-year actuarial local control estimate was 89.7%. Local recurrence was salvaged in 11% of cases, resulting in 92% overall local control. On multivariate analysis, none of the study variables correlated with local recurrence. Local recurrence resulted in significantly reduced nodal control, distant metastasis control, and survival. Postoperative complications, persistent index SCC, intercurrent disease, and metachronous second primary cancer accounted for respectively 3%, 37%, 33%, and 28% of the 334 deaths noted during the 10 years following TL.
Conclusion The present study underscored the long-term oncologic efficacy of primary TL, the dangers of local recurrence, the key role of local control for survival, and the importance of a long-term oncologic watch policy.
Level of Evidence3 Laryngoscope, 134:2288–2294, 2024
Anton Warshavsky, Raz Rubin, Narin Nard Carmel‐Neidermann, Adi Brenner, Genady Shendler, Liyona Kampel, Elena Izkhakov, Nidal Muhanna, Gilad Horowitz
Publication date 10-04-2024
The results of this study show that four-dimensional computerized-tomography (4DCT) enhances pre-operative imaging capabilities to localize parathyroid adenomas in cases of discordant or non-localizing ultrasonography (US) and Technetium-99 sestamibi (MIBI) scans.
Objective To evaluate the accuracy of four-dimensional computerized-tomography (4DCT) for localizing parathyroid adenomas (PTAs) in cases with discordant or non-localizing ultrasonography (US) and Technetium-99 sestamibi (MIBI) scans.
Data Sources Retrospective case series and systematic review.
Review MethodsA case series and meta-analysis of patients diagnosed with primary hyperparathyroidism and discordant US and MIBI scans who underwent 4DCT prior to surgery. A comprehensive search for all relevant publications in the English literature between December 2006 and March 2022 was conducted for the meta-analysis. Patients undergoing parathyroidectomy between January 2015 and December 2021 were identified from the institutional electronic database for the case series. All studies were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 4DCT adenoma localization capabilities.
Results Thirteen retrospective studies that included 379 patients and one case series that included 37 patients were identified and analyzed. A per-patient analysis revealed sensitivity for lateralization to the correct side (n = 181) ranging from 80% to 100% with a fixed effects model of 89% (95%confidence interval CI: 82%–93%) and a PPV for lateralization ranging from 63%–95% with a random effects model of 87% (95% CI: 77%–95%). Sensitivity of localization to the correct quadrant (n = 172) ranged from 53% to 100% with a random effects model of 90.4% (95% CI: 76%–99%), and the PPV for localization ranged from 52% to 100% with a random effects model of 82% (95% CI: 73%–89%).
Conclusion4DCT enhances imaging capabilities of localizing PTAs in cases of discordant or non-localizing US and MIBI scans.
Level of EvidenceNA Laryngoscope, 134:2198–2205, 2024
"Mattea E. Miller, Ioan Lina, Karla ODell, Lee M. Akst"
Publication date 10-04-2024
Qualitative semi-structured interviews were conducted with patients diagnosed with retrograde cricopharyngeal dysfunction (RCPD) who had been treated with botulinum toxin injection into the cricopharyngeus muscle. The lived experience of patients with RCPD significantly impacts quality of life and is often met with diagnostic barriers in the medical community. Although social media plays a significant role in increasing awareness of RCPD, physician education about the impact of RCPD is essential to improve diagnosis and treatment.
Objectives Retrograde cricopharyngeal dysfunction (RCPD) is a newly described condition resulting from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension that results in the inability to burp. Patients perspectives on symptom experiences, barriers to care, and treatment benefits were investigated.
Study Design Qualitative semi-structured interviews were conducted with patients diagnosed with RCPD who had been treated with botulinum toxin injection into the cricopharyngeus muscle. Interview questions centered on their experience living with RCPD. Conventional content analysis was performed on interview transcripts.
Results Thematic saturation was reached with 13 participants. All participants were diagnosed with RCPD by an otolaryngologist and underwent botulinum toxin injection into the cricopharyngeus muscle with or without dilation of the upper esophageal sphincter in the operating room. Participants described having no memories of ever being able to burp, and all started experiencing RCPD symptoms during adolescence. Patients with RCPD experienced increased social isolation, lost productivity, and worsened mental health. Unanimously, participants first learned about RCPD on social media. All patients were seen by physicians in non-otolaryngology specialties regarding their symptoms prior to learning about their RCPD diagnosis and undergoing treatment by an otolaryngologist. Dilation and chemodenervation resulted in complete resolution of RCPD symptoms for 84.6% of participants. Participants emphasized a desire for more health providers to learn about RCPD and the impact it has on quality-of-life.
Conclusion(s)The lived experience of patients with RCPD significantly impacts quality of life and is often met with diagnostic barriers in the medical community. Although social media plays a significant role in increasing awareness of RCPD, physician education about the impact of RCPD is essential to improve diagnosis and treatment.
Level of Evidence4 Laryngoscope, 134:2136–2143, 2024
Ronald S. Wang, Michael S. Chow, Alex J. Gordon, Michele Santacatterina, Alec E. Vaezi, Moses M. Tam, Babak Givi
Publication date 10-04-2024
This study investigated the impact of adjuvant radiotherapy in isolated locally advanced oral cavity cancers without adverse features, which the NCCN guidelines recommend. Adjuvant radiotherapy was found to improve survival in this patient cohort, yet a significant proportion of these patients did not receive adjuvant radiotherapy, suggesting a need to increase compliance with evidence-based care.
Objective To investigate the impact of adjuvant radiotherapy in isolated locally advanced oral cavity cancers (pT3N0M0) without adverse features.
Methods We selected all patients from the National Cancer Database (2004–2019) who underwent surgical treatment where the final pathology was T3N0M0 with negative margins. Demographics, details of treatment, and outcomes were abstracted. The impact of radiotherapy on survival was assessed with univariable, multivariable, and propensity score-matched analyses.
Results We identified 571 patients in our survival cohort. Most were male (348, 60.9%), and median age was 65. Less than one-third (176, 30.8%) received adjuvant radiotherapy. The median length of follow-up was 29 months. Overall, adjuvant radiotherapy was associated with improved survival (87.2% vs. 77.7%, at 2 years, p < 0.01). On multivariable analysis controlling for age and comorbidities, this survival difference persisted (HR: 0.62, 95% CI: 0.43–0.90, p = 0.01). In a propensity score-matched population of 278 patients matched on age and comorbidities, adjuvant radiotherapy was still associated with longer survival (87.4% vs. 78.5%, p = 0.014).
Conclusion In our study, adjuvant radiotherapy was associated with improved survival in completely excised locally advanced oral cavity tumors (T3N0M0). However, a significant proportion of patients do not receive adjuvant radiotherapy. These findings highlight the need for continued efforts to promote guideline-recommended care.
Level of Evidence3 Laryngoscope, 134:2236–2242, 2024
"Kevin Renz Ambrocio, Reagan Ramsey, Ashli ORourke, Jonathan Beall, Kendrea L. Garand"
Publication date 10-04-2024
Objective Cricopharyngeal dysfunction is a common potential cause of pharyngoesophageal dysphagia. Contextual factors (i.e., personal demographics and bolus properties) appear to impact upper esophageal sphincter (UES) function but have yet to be assessed collectively in a large-scale study using psychometrically sound swallow task procedures. Using a standardized and validated videofluoroscopic approach, we investigated the collective effects of age, sex, and swallow task on UES opening duration (UESOdur) and UES maximum distension (UESmax) in a large sample of healthy adults.
MethodsUESOdur and UESmax data were analyzed from existing videofluoroscopic images of 195 healthy adults (21–89 years old) across seven swallow tasks (thin liquid to viscous liquids, puree, and a solid). Generalized estimating equation modeling captured the effects of the aforementioned contextual factors (α = 0.05).
ResultsUESOdur significantly increased with age, while UESmax had an inverse relationship. Females had significantly wider UESmax. UESOdur of 5 mL thin liquid was significantly shorter than all other liquid swallow tasks, while solid had an inverse effect. Compared to 5 mL thin liquid, all other swallow tasks resulted in significantly wider UESmax. Mildly and moderately thick liquid significantly increased UESOdur when isolating viscosity. UESmax was significantly wider with mildly and moderately thick liquid and puree than thin liquid. When isolating volume, cup sip thin liquid increased both measures significantly relative to 5 mL.
Conclusion Age, sex, and swallow task can influence the normal timing and extent of UES movement. These collective effects contribute to normal variability in UES function and should be considered for clinical decision-making.
Level of Evidence4 Laryngoscope, 134:2306–2315, 2024
Xiaoyao Tao, Xu Zhao, Hairui Liu, Jinqiao Wang, Chunhui Tian, Longsheng Liu, Yujie Ding, Xue Chen, Yehai Liu
Publication date 10-04-2024
This study aims to establish an AI algorithm based on YOLO-V5 for image recognition in laryngoscope images, to assist clinicians in efficiently identifying fish bone foreign bodies in the throat.
Background Fish bone impaction is one of the most common problems encountered in otolaryngology emergencies. Due to their small and transparent nature, as well as the complexity of pharyngeal anatomy, identifying fish bones efficiently under laryngoscopy requires substantial clinical experience. This study aims to create an AI model to assist clinicians in detecting pharyngeal fish bones more efficiently under laryngoscopy.
Methods Totally 3133 laryngoscopic images related to fish bones were collected for model training and validation. The images in the training dataset were trained using the YOLO-V5 algorithm model. After training, the model was validated and its performance was evaluated using a test dataset. The models predictions were compared to those of human experts. Seven laryngoscopic videos related to fish bone were used to validate real-time target detection by the model.
Results The model trained in YOLO-V5 demonstrated good generalization and performance, with an average precision of 0.857 when the intersection over union (IOU) threshold was set to 0.5. The precision, recall rate, and F1 scores of the model are 0.909, 0.818, and 0.87, respectively. The overall accuracy of the model in the validation set was 0.821, comparable to that of ENT specialists. The model processed each image in 0.012 s, significantly faster than human processing (p < 0.001). Furthermore, the model exhibited outstanding performance in video recognition.
Conclusion Our AI model based on YOLO-V5 effectively identifies and localizes fish bone foreign bodies in static laryngoscopic images and dynamic videos. It shows great potential for clinical application.
Level of Evidence3 Laryngoscope, 134:2162–2169, 2024
Ryan M. Carey, Aman Prasad, Kimberly Wei, Jason A. Brant, Robert M. Brody, Jason M. Leibowitz, Francisco J. Civantos, Larissa Sweeny
Publication date 10-04-2024
Retrospective population-based cohort study of patients presenting with metastatic oropharyngeal squamous cell carcinoma comparing survival for treatment with systemic therapy alone or in combination with local surgery or curative dose radiation. Curative dose local radiation is associated with improved overall survival when added to systemic therapy, but there is not a significant survival benefit for including local surgery in the treatment algorithm.
Objectives Determine if intensive local therapy (i.e., local surgery or radiation) has a survival benefit for patients presenting with distantly metastatic oropharyngeal squamous cell carcinoma (OPSCC).
Methods Retrospective population-based cohort study of patients in the National Cancer Database presenting with distantly metastatic OPSCC. Overall survival (OS) was compared for patients receiving systemic therapy alone or in combination with local surgery or curative dose radiation, controlling for various clinicodemographic factors.
Results Between 2010 and 2015, 627 patients presented with newly diagnosed, metastatic OPSCC and an initial treatment course including systemic chemotherapy. Multivariable analysis demonstrated that local radiation therapy was independently associated with improved OS (OR 0.64, CI 0.51–0.81); local surgery was not independently associated with improved OS (OR 0.99, CI 0.65–1.53). Higher T stages were associated with worse OS (OR 1.69, CI 1.14–2.50 for T3 and OR 1.77, CI 1.22–2.58 for T4 compared to T1). HPV-positive (HPV+) tumors were associated with improved OS compared to HPV- (OR 0.79, CI 0.64–0.97). Multiagent chemotherapy was associated with improved OS compared to single-agent (OR 0.78, CI 0.62–1.00). The best survival for the entire cohort and for HPV+ patients was for radiation with systemic therapy and the worst survival for systemic therapy alone.
Conclusions Curative dose local radiotherapy in addition to systemic therapy is associated with improved OS compared to systemic therapy alone in patients presenting with distantly metastatic OPSCC. There is not a significant survival benefit for local surgery in addition to systemic therapy in this patient population, regardless of HPV status.
Level of Evidence3 Laryngoscope, 134:2243–2251, 2024
Xiaolong Zhang, Tao Shi, Jin Li, Xiaonan Wu, Kaili Wu, Danyang Li, Dayong Wang, Jing Guan, Hongyang Wang
Publication date 10-04-2024
The authors guidelines indicate that a graphical abstract is not deemed necessary. We sincerely apologize for mistakenly including it during the submission process, and we hope to delete the graphical abstract. If the inclusion of a graphical abstract is requested in the article, we would appreciate the opportunity to resubmit it.
ObjectiveKCNQ4 is one of the most common disease-causing genes involved in autosomal dominant non-syndromic hearing loss. We previously found that patients with KCNQ4 p.
G285S exhibited a much more rapid deterioration in hearing loss than those with other KCNQ4 variants. To determine the rate of hearing loss and assess the disease for further analysis, we performed a long-term follow-up of these patients and generated patient-derived induced pluripotent stem cells (iPSCs), and a mouse model.
Methods Patients with KCNQ4 p.
G285S from a five-generation family with hearing loss were followed up from 2005 to 2022. iPSCs were generated by stimulating peripheral blood mononuclear cells from the proband, and their pluripotency was determined. The Kcnq4 p.
G286S mouse model was generated using CRISPR/Cas9, and its genotype and phenotype were identified.
Results(1) The annual rates of hearing loss at the frequencies of speech were 0.96 dB for the proband and 0.87 dB for his father during the follow-up period, which were faster than patients with other KCNQ4 variants. (2) The patient-derived iPSC line carrying KCNQ4 p.
G285S, possessed the capacity of differentiation and pluripotency capacities. (3) Mutant mice with Kcnq4 p.
G286S exhibited hearing loss and outer hair cell loss at 1 month of age.
Conclusion Patients with KCNQ4 p.
G285S variant exhibited significantly accelerated progression of hearing loss compared to those with other reported variants. Awareness of the natural history of hearing loss associated with KCNQ4 p.
G285S is beneficial for genetic counseling and prognosis. The generation of the iPSCs and mouse model can provide a valuable foundation for further in-depth analyses.
Level of Evidence4 Laryngoscope, 134:2356–2363, 2024
Holly Cordray, Emily A. Wright, Chhaya Patel, Nikhila Raol, Kara K. Prickett
Publication date 10-04-2024
Our team piloted a child-focused mobile application, “Ready for Tonsillectomy,” to support accessible, interactive, cost-efficient perioperative education for families. Patients, caregivers, and otolaryngologists endorsed the intervention; it showed high feasibility and fidelity.
Objective Patient education is central to Enhanced Recovery After Surgery protocols, but child-focused materials are lacking. We developed and piloted a mobile application to support accessible, interactive patient and caregiver education about pediatric tonsillectomy.
Methods Thirty children ages 5–12 who were preparing for tonsillectomy, their caregivers, and six attending otolaryngologists participated in a user-testing trial of a web-based prototype. The trial measured feasibility, fidelity, and patient-centered outcomes. Patients and caregivers rated usability/likeability on the m Health App Usability Questionnaire. Otolaryngologists rated quality on the Mobile App Rating Scale. The full mobile application, “Ready for Tonsillectomy,” was then developed for iOS and Android.
Results Enrollment was 88.2%, retention was 90.0%, and use was 96.3%. Mean (SD) patient ratings for usability/likeability were 6.3 (1.1) out of 7; caregiver ratings were 6.5 (1.1). In common themes from open-ended feedback, patients described the application as helpful and appealing, and caregivers described it as informative, easy to understand, calming, and easy to use. Among caregivers who used the application during recovery, 92.3% reported that it helped them manage their childs pain. Providers would recommend the application to many or all of their patients (mean SD: 4.7 0.5 out of 5). Mean provider ratings for domains of engagement, functionality, aesthetics, information quality, subjective quality, and app-specific value ranged from 4.1 to 4.8 out of 5.
Conclusion Feasibility and fidelity were high. Families and otolaryngologists endorsed the resource as an engaging, informative tool that supports positive coping. Our mobile application offers a patient-centered solution readily scalable to other surgeries.
Level of EvidenceNA Laryngoscope, 134:2455–2463, 2024
Mahmoud Seif‐Elnasr, Emad A. Magdy, Ethan Fung, Neal S. Deot, Mark F. Marzouk
Publication date 10-04-2024
Both the Robot-Assisted Sialolithotomy and Sialendoscopy (RASS) and Intraoral Microscopic-Assisted Sialolithotomy (IMAS) techniques were comparable in terms of safety and efficacy, with no permanent lingual paresthesia encountered. IMAS was significantly shorter in duration.
Objective Sialendoscopy has remained the standard of treatment for sialolithiasis; however, large stones impacted in the submandibular gland hilum often require an intra-oral combined approach.
Methods Patients treated for submandibular hilar sialolithiasis from 2015 to 2021 at two tertiary centers were stratified into two groups based on the surgical technique: Intraoral Microscopic-Assisted Sialolithotomy (IMAS) versus Robot-Assisted Sialolithotomy and Sialendoscopy (RASS). We compared the characteristics of retrieved stones, surgical success rate, operative time, and post-operative complications in both techniques. True surgical success was defined as successful stone extraction without reoccurrence within 12 months.
Results The RASS technique was attempted in 60 patients and successful in 56 (93.3%) cases whereas the IMAS technique was performed in 52 patients and successful in 48 (92.3%) cases. The longest dimension of the predominant retrieved calculi was 9.6 ± 3.1 mm (range, 5–18 mm) for the robotic technique and 10 ± 4.8 mm (range, 5–30 mm) for the microscopic technique. The operative time for the robotic technique excluding robot setup time was 70.6 ± 24.8 min compared to 61.9 ± 42.4 min for microscopic technique (p = 0.018). No major adverse outcomes were reported; however, temporary lingual paresthesia was found in ten robotic (16.7%) and five microscopic (9.6%) cases.
Conclusion The two techniques were comparable in terms of efficacy and safety for large stones. The robot has the advantage of intraoral high dynamic maneuverability and improved surgeon posture while the microscopic technique has the advantage of intraoral tactile feedback. The procedure was significantly shorter in duration with the microscope.
Level of Evidence3 Laryngoscope, 134:2170–2176, 2024
Eduardo Martin‐Sanz, Marta Chaure‐Cordero, Juan Riestra‐Ayora, Rocío González‐Marquez, Irene Mármol‐Szombathy, Jonathan Esteban‐Sanchez
Publication date 10-04-2024
Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder encountered in ENT clinical practice. Recurrent episodes of vertigo triggered by head movements characterize this pathology. The detachment of crystals called otoliths inside the inner ear cause the BPPV. The most frequently affected area of the inner ear is the posterior semicircular canal, but there are rare variants affecting other locations that are more difficult to detect. This article describes the usefulness of the diagnostic maneuver called the Bow and Lean Test to identify these less frequent patterns.
Objective The objective of this study was to assess the clinical significance of the Bow and Lean Test (BLT) for the diagnosis of different variants of vertical canal Benign Paroxysmal Positional Vertigo (BPPV). BLT is commonly used for diagnoses of lateral semicircular canal (LSC) BPPV. However, vertical nystagmus in the BLT may indicate the presence of other variants such as PSC-BPPV.
Methods567 patients with vertical canal BPPV were recruited. Patients with anterior semicircular canal (ASC) or PSC-BPPV were weekly examined until the negativization of BPPV. Nystagmus characteristics during BLT were analyzed.
Results Of 567 patients with vertical canal BPPV, 1.4% had ASC-BPPV. BLT was positive in 155 patients, showing patterns like down-beating nystagmus in bowing and no nystagmus in leaning (15.52% of patients), and down-beating in bowing and up-beating in leaning (6.17%), which was predominantly present in PSC-canalolithiasis. Statistically significant differences were observed in the direction of nystagmus provoked by BLT in PSC-BPPV subtypes. No significant differences were found in nystagmus latency or duration during BLT positions. Among BPPV subtypes, there was a significant difference in nystagmus duration and latency, especially between cupulolithiasis and other variants. BLTs sensitivity was 0.93 in bowing and 1 in a leaning position, while specificity was 0.93 and 0.82 respectively.
Conclusion Beyond the LSC, the BLT has expanded to other variants. However, study results differ likely due to variations in patient characteristics and test execution. Currently, no specific features for ASC have been found to differentiate it from PSC-BPPV limiting the tests use for this variant.
Level of Evidence3, according to Oxford Center for Evidence-Based Medicine Laryngoscope, 134:2405–2410, 2024
Melissa Sangubol, Kornkiat Snidvongs, Saranath Lawpoolsri, Kittichai Mongkolkul, Patlada Kowatanamongkon, Wirach Chitsuthipakorn
Publication date 10-04-2024
The preoperative HUS in Thai patients with CRS generally increased to near-perfect values after the ESS. The increased HUS reflecting the improved general quality of life was demonstrated at three and up to six months after ESS.
Background Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.
Methods Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22-items sinonasal outcome test, endoscopic score, and CT score were recorded.
The HUS was evaluated using four methods: the Euro QoL-5 Dimension-5 level (EQ-5D-5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade-off (TTO); at baseline, three months and six months post-operation.
Results Data from 60 patients were analyzed. The mean baseline HUS scores by EQ-5D-5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12–0.27 points. Among the four methods, VAS showed the lowest HUS at all time points.
Conclusion The preoperative HUS in Thai patients with CRS generally increased to near-perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS.
Level of Evidence4 Laryngoscope, 134:2070–2076, 2024
Ryan J. Davis, Oluwatobiloba Ayo‐Ajibola, Matthew E. Lin, Mark S. Swanson, Tamara N. Chambers, Daniel I. Kwon, Niels C. Kokot
Publication date 10-04-2024
We graded an AI-based chatbots accuracy of oropharyngeal cancer information. Responses were impressive, but some had information that could poorly educate or misinform patients. Thus, oropharyngeal cancer patients should be cautious while consuming chatbot medical information.
Objective With burgeoning popularity of artificial intelligence-based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence-based chatbots oropharyngeal cancer-related information for accuracy.
Methods Fifteen oropharyngeal cancer-related questions were developed and input into ChatGPT version 3.5. Four physician-graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5-point Likert scales. Responses graded lower than three were then critiqued by physician-graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL) scales.
Results Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment-related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment-related, then diagnosis-related questions. Posttreatment-related questions scored significantly higher than diagnosis-related questions in all three domains (p < 0.01).
Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level—higher than the 6th grade level recommended for patients.
Conclusion ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life-altering diagnoses, and treatments, they should be cautious when consuming chatbot-generated medical information.
Level of EvidenceNA Laryngoscope, 134:2252–2257, 2024
Christopher Harryman, Stephen Park, Samuel Oyer
Publication date 10-04-2024
Xin Huang, Haoyue Tan, Jieyu Zhou, Zhentao Wang
Publication date 09-04-2024
Our innovation lies in a case report that hepatoid adenocarcinoma occurred in the esophagus and thyroid. The clinical manifestations of rare hepatoid adenocarcinoma have a high degree of heterogeneity, that the combination of chemotherapy and immunotherapy may be a promising therapeutic tool for this rare tumor, which contributes to understanding the mechanism of tumor from a comprehensive perspective and the personalized treatment of this rare malignancy.
Rare hepatoid adenocarcinomas are highly heterogeneous. In this case, hepatoid adenocarcinoma occurred in both the esophagus and thyroid, and the combination of chemotherapy and immunotherapy may be a promising therapeutic tool for rare tumors. Laryngoscope, 2024
Yashes Srinivasan, Juan Briano, Sara Czaja, Mark S. Lachs, Anthony E. Rosen, Michael G. Stewart, Anaïs Rameau
Publication date 08-04-2024
Objective To describe types and outcomes of elective otolaryngological surgeries undergone by patients ≥90 years of age and to assess whether very old age is an independent risk factor for postsurgical complications and death.
Methods The National Surgical Quality Improvement Program, a validated national prospective surgical outcomes database, was used to identify all patients aged 65 years and older who underwent elective otolaryngological procedures from 2011 to 2020. Study outcomes included minor complications, major life-threatening complications, and 30-day mortality. Predictors of outcomes, including frailty, were identified using univariable analyses and age was added into the final logistic regression models with stepwise selection.
ResultsA total of 40,723 patients met inclusion criteria; 629 (1.5%) patients were ≥90 years of age. Of the 63,389 procedures, head and neck (67.6%) and facial plastics and reconstructive (15.0%) procedures were most common. The overall incidence of major life-threatening complications, minor complications, and death was 2.0%, 3.5%, and 0.4%, respectively. Age ≥90 was significantly associated with an increased risk for 30-day mortality, but not with major or minor postoperative complications. A high modified frailty index was significantly associated with an increased risk for major postoperative complications and death amongst patients ≥90 years.
Conclusions Elective otolaryngological surgery can be safe in relatively healthy nonagenarians and centenarians, though there is a small increased risk of 30-day mortality. Although older age can predispose patients to other comorbidities, age alone should not deter surgeons and patients from considering elective otolaryngological procedures. Frailty may be a better predictor for surgical outcomes.
Level of Evidence Level IV Laryngoscope, 2024
Karolina A. Plonowska‐Hirschfeld, Yasmin Eltawil, Daniel Soroudi, Neil N. Patel, Andrea M. Park, P. Daniel Knott
Publication date 08-04-2024
Objectives To use portable colorimetry to quantify color differences between facial skin and potential three head and neck microvascular free tissue transfer (MFTT) donor sites—radial forearm (RF), anterolateral thigh (ALT), and fibula (FF)—and compare these differences by pigmentation of the donor site skin and self-identified race.
Methods In this cross-sectional cohort study, healthy volunteers consented to handheld colorimeter measurements at the three potential MFTT donor sites (RF, ALT, FF) to quantify color match to the facial skin using the CIE color space (DeltaE). The comparison of ipsilateral to contralateral cheek served as control for measurements. Cross-sectional measurements in healthy volunteers were then compared to measurements obtained in postoperative head and neck MFTT patients.
Results DeltaE measurements were obtained for 128 healthy controls and 24 postoperative patients (N = 152). With increasing lightness (decreased pigmentation) of the skin at the donor site, the color match significantly worsened (higher DeltaE) across all potential MFTT donor sites (all p < 0.05). DeltaE from healthy controls closely approximated postoperative color match measurements in patients who underwent cervicofacial MFTT (DeltaE RF: 5.3 vs. 6.0, p = 0.432; DeltaE ALT: 6.2 vs. 6.4, p = 0.822; DeltaE FF: 6.0 vs. 6.4, p = 0.806).
Conclusion Patients with decreased skin pigmentation who are undergoing head and neck MFTT may experience worse color discrepancy between cervicofacial skin and the transferred skin paddle than those with more pigmented skin. Portable colorimetry may identify patients who could benefit from interventions such as dermis-resected free tissue reconstruction with skin grafting to improve postoperative appearance.
Level of Evidence3 Laryngoscope, 2024
Bastien A. Valencia‐Sanchez, Matthew T. Brigger, Vijay A. Patel
Publication date 08-04-2024
The work illustrates a step-by-step surgical approach to demonstrate technical feasibility of a single-stage endoscopic repair for bilateral choanal atresia with adjuvant bioabsorbable steroid-eluting stent placement to safely mitigate unique perioperative challenges in the pediatric population. Laryngoscope, 2024
Pubmed PDF WebJennifer E. Douglas, Kimberly Wei, Kush Panara, Daniel J. Lee, Michael A. Kohanski, Rabie M. Shanti, Neeraj Panchal, James N. Palmer, Nithin D. Adappa
Publication date 06-04-2024
Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches.
Pubmed PDF WebJordyn A. Hurly, Anna Christina Clements, Marisa A. Ryan, Megan Ballard, Carolyn Jenks, Laura M. Sterni, David E. Tunkel, Jonathan M. Walsh
Publication date 06-04-2024
Postoperative outcomes in very severe obstructive sleep apnea syndrome is not well studied in pediatric patients. In a retrospective analysis, we show that very severe OSAS (OAHI >40) as determined by preoperative polysomnography parameters, including OAHI, oxygen saturation nadir, and hypercarbia is associated with an increased risk of respiratory complications following adenotonsillectomy or tonsillectomy. However, there does not appear to be a linear association with increasing severity of OAHI on regression analysis or an increase in postoperative complications overall.
Objective To determine if increasing obstructive sleep apnea syndrome (OSAS) severity, as determined by preoperative polysomnography data, is an independent risk for respiratory complications and level of follow-up care after adenotonsillectomy or tonsillectomy.
MethodsA retrospective analysis of patients ≤21 years of age with severe OSAS (obstructive apnea–hypopnea index OAHI >10) undergoing adenotonsillectomy or tonsillectomy. Patients were categorized based on preoperative polysomnography data (PSG). Outcome measures including respiratory complications were collected via chart review. Logistic regression was used in the analysis of all parameters, and Wilcoxon Rank Sum tests were used for analysis of both OAHI and oxygen saturation nadir as continuous variables. All surgeries were performed at Johns Hopkins Hospital, a tertiary care center.
Results We identified 358 patients with severe OSAS who had adenotonsillectomy or tonsillectomy. OAHI >40 and oxygen saturation nadir <80% were significantly associated with postoperative respiratory complications. Increasing OAHI and O2 saturation <80% was each associated with unplanned continuous positive airway pressure (CPAP) initiations postoperatively. There was no association between hypercarbia and presence of any complications.
Conclusion Patients with very severe OSAS (preoperative OAHI ≥40) as determined by preoperative PSG may be at higher risk of developing respiratory complications postoperatively. However, there does not appear to be a linear association with increasing severity of OAHI on regression analysis. Further research is needed to understand factors associated with complications in severe and very severe OAHI.
Level of Evidence4 Laryngoscope, 2024
Jacob G. Eide, Rijul S. Kshirsagar, Chris Wen, Anas Qatanani, Jacob Harris, Lauren Sellers, Eric H. Abello, Jennifer E. Douglas, James N. Palmer, Nithin D. Adappa, Edward C. Kuan
Publication date 06-04-2024
Objective Surgical frailty estimates a patients ability to withstand the physiologic stress of an intervention. There is limited data regarding the impact of frailty on endoscopic cerebrospinal fluid (CSF) leak repair.
Methods Patients undergoing CSF leak repair at two tertiary academic skull base programs were retrospectively reviewed. Demographic, treatment, and postoperative outcomes data were recorded. Frailty was calculated using validated indices, including the American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), and the Modified 5-Item Frailty Index (mFI-5). Outcomes included 30-day medical and surgical complications and readmission.
ResultsA total of 185 patients were included with 128 (69.2%) female patients and average age of 54 ± 14 years. The average body mass index was 34.6 ± 8.5. The most common identified etiology was idiopathic intracranial hypertension (IIH) in 64 patients (34.6%). A total of 125 patients (68%) underwent perioperative lumbar drain placement (primarily to measure intracranial pressures and diagnose IIH). Most patients were ASA class 3 (48.6%) with mean CCI 2.14 ± 2.23 and mFI-5 0.97 ± 0.90. Three patients had postoperative CSF leaks, with an overall repair success rate of 98.4%. There was no association between increased frailty and 30-day medical outcomes, surgical outcomes, or readmission (all p > 0.05).
Conclusions Endoscopic CSF leak repair in a frail population, including lumbar drain placement and bed rest, was not associated with an increased rate of complications. Previous data suggests increased complications in open craniotomy procedures in patients with significant comorbidities. This study suggests that the endoscopic approach to CSF leak repair is well tolerated in the frail population.
Level of EvidenceIV Laryngoscope, 2024
Rumi Sekine, Anna Kristina Hernandez, Clara Overbeck, Marlise K. Hofer, Eri Mori, Antje Hähner, Thomas Hummel
Publication date 05-04-2024
This study aimed to determine the characteristics of patients with parosmia and phantosmia and whether individuals with parosmia exhibit increased sensitivity to odorants that have been previously reported as triggers, compared to those with quantitative olfactory dysfunction only. Parosmia and phantosmia patients have distinct characteristics and this may provide clinicians with a better understanding of possible olfactory outcomes in these patients. The higher olfactory sensitivity of all groups to trigger odors compared to PEA raises interesting points about parosmia triggers and odors in the context of warning for danger, in relation to the pathophysiology of parosmia that may be worth exploring in future studies.
Objectives This study aimed to determine the characteristics of patients with qualitative olfactory dysfunction (qualOD) and whether individuals with parosmia exhibit increased olfactory sensitivity to previously reported odorous triggers of parosmia.
Methods This study included individuals aged ≥18 years, divided into quantitative OD only, parosmia, and phantosmia groups.
Data collected included: clinical-demographic data, “Sniffin’ Sticks” scores, questionnaires (depression scale, importance of olfaction), and information about parosmia and phantosmia. A proportion of patients underwent trigger odor threshold testing for 2-Furfurylthiol FFT found in coffee and 2,6-nonadienal Nonadienal found in cucumber.
Results Those with parosmia were typically younger women, with shorter OD duration due to post-viral OD (PVOD), hyposmic/normosmic, and experienced parosmia more severely. Parosmia was 3.5 times more likely in PVOD. Those with phantosmia were older, with longer OD duration due to idiopathic OD, hyposmic/anosmic, and experienced phantosmia less severely. There were no significant differences between FFT and Nonadienal threshold scores in patients with parosmia, phantosmia, or only quantitative OD, but all groups had significantly increased olfactory sensitivity for trigger odors compared to phenyl ethyl alcohol (PEA).
Conclusion Parosmia and phantosmia patients have distinct characteristics. This may provide clinicians with a better understanding of possible olfactory outcomes in these patients. The higher olfactory sensitivity of all groups to trigger odors compared to PEA raises interesting points about parosmia triggers and odors in the context of warning for danger, in relation to the pathophysiology of parosmia that may be worth exploring in future studies.
Level of Evidence3 Laryngoscope, 2024
Amritpal Singh, Amrita Bhat, Jasmeet Saroya, Jolie Chang, Megan L. Durr
Publication date 03-04-2024
This scoping review explores the sociodemographic and healthcare system barriers to access and utilization of Positive Airway Pressure (PAP)-alternative treatments for obstructive sleep apnea (OSA). Our study reveals a complex interplay of challenges influencing treatment decisions including sociodemographic factors, economic factors, institutional factors, and individual factors, emphasizing the need for a comprehensive approach to address barriers and ensure equitable access to OSA treatments.
Objective To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA).
Data Sources Pub Med, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA.
Review Methods Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently.
Results Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.
Conclusion Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 2024
Akshay Warrier, Rohan Singh, Afash Haleem, Haider Zaki, Jean Anderson Eloy
Publication date 02-04-2024
Objectives Evaluate and compare the ability of large language models (LLMs) to diagnose various ailments in otolaryngology.
Methods We collected all 100 clinical vignettes from the second edition of Otolaryngology Cases—The University of Cincinnati Clinical Portfolio by Pensak et al. With the addition of the prompt “Provide a diagnosis given the following history,” we prompted ChatGPT-3.5, Google Bard, and Bing-GPT4 to provide a diagnosis for each vignette. These diagnoses were compared to the portfolio for accuracy and recorded. All queries were run in June 2023.
Results ChatGPT-3.5 was the most accurate model (89% success rate), followed by Google Bard (82%) and Bing GPT (74%). A chi-squared test revealed a significant difference between the three LLMs in providing correct diagnoses (p = 0.023). Of the 100 vignettes, seven require additional testing results (i.e., biopsy, non-contrast CT) for accurate clinical diagnosis. When omitting these vignettes, the revised success rates were 95.7% for ChatGPT-3.5, 88.17% for Google Bard, and 78.72% for Bing-GPT4 (p = 0.002).
Conclusions ChatGPT-3.5 offers the most accurate diagnoses when given established clinical vignettes as compared to Google Bard and Bing-GPT4. LLMs may accurately offer assessments for common otolaryngology conditions but currently require detailed prompt information and critical supervision from clinicians. There is vast potential in the clinical applicability of LLMs; however, practitioners should be wary of possible “hallucinations” and misinformation in responses.
Level of Evidence3 Laryngoscope, 2024
Dong‐Jin Lim, Brenton T. Bicknell, Nicholas Rivers, Martin P. Jones, Adithya J. Menon, Olivia J. Kelly, Daniel Skinner, Shaoyan Zhang, Bradford A. Woodworth, Do‐Yeon Cho
Publication date 02-04-2024
The high-dose ciprofloxacin–azithromycin stent provides sustained drug release within the rabbit maxillary sinus at levels that would provide efficacious treatment of recalcitrant infections without measurable toxicity. This sinus stent is highly translatable to human studies and could be a revolutionary new treatment for recalcitrant bacterial chronic rhinosinusitis.
Objectives Previously, we developed a novel double-coated sinus stent containing ciprofloxacin (inner layer) and azithromycin (outer layer) (CASS), but released drug concentrations were found to be insufficient for clinical usage. Our objectives are to improve drug release of CASS and assess safety and pharmacokinetics in rabbits.
Methods Dip coating was used to create the CASS with 2 mg ciprofloxacin and 5 mg azithromycin. A uniformed double coating was assessed with scanning electron microscopy (SEM), and the release patterns of both drugs and lactate dehydrogenase (LDH) assay were evaluated over 14 days in vitro. Safety, tolerability, and pharmacokinetics of the CASS were tested in rabbits through insertion into the maxillary sinus and evaluated with nasal endoscopy, CT scans, histology, blood counts and chemistries, and in vivo drug release.
ResultsSEM confirmed the uniformity of the dual coating of ciprofloxacin and azithromycin, and thickness (μm) was found to be 14.7 ± 2.4 and 28.1 ± 4.6, respectively. The inner coated ciprofloxacin showed a sustained release over 14 days (release %) when soaked in saline solution (day 7, 86.2 ± 3.4 vs. day 14,99.2 ± 5.1). In vivo analysis showed that after 12 days, 78.92 ± 7.67% of CP and 84.12 ± 0.45% of AZ were released into the sinus. There were no significant differences in body weight, white blood cell counts, and radiographic changes before and after CASS placement. No significant histological changes were observed compared to the contralateral control side.
Conclusion Findings suggest that the CASS is an effective method for delivering therapeutic levels of antibiotics. Further studies are needed to validate efficacy in a preclinical sinusitis model.
Level of EvidenceN/A Laryngoscope, 2024
Ezer H. Benaim, Cameron P. Worden, Surekha Bantumilli, Vikram G. Ramjee, Carlton J. Zdanski
Publication date 30-03-2024
This article presents a rare case of a large hairy polyp, a developmental malformation causing a benign tumor, within the nasopharynx. The patient, born with the polyp obstructing the airway, required immediate intubation and a combined transnasal-transoral surgical approach for excision. The case underscores the challenges in diagnosing and managing such polyps, emphasizing the importance of imaging for surgical planning, and the consideration of multiple approaches to ensure complete resection and prevent recurrence.
This article presents a rare case of a large hairy polyp, a developmental malformation causing a benign tumor, within the nasopharynx. The patient, born with the polyp obstructing the airway, required immediate intubation and a combined transnasal-transoral surgical approach for excision. The case underscores the challenges in diagnosing and managing such polyps, emphasizing the importance of imaging for surgical planning, and the consideration of multiple approaches to ensure complete resection and prevent recurrence. Laryngoscope, 2024
Peter L. Friedland, Simon Tucker
Publication date 30-03-2024
Phase II randomized double-blinded placebo-controlled trial of 20 doses of 0.5% povidone-iodine nasal spray (Nasodine) eliminated SARS-CoV-2 viral shedding in the nose after 4 days and after 5 days in the throat based on quantitative viral cultures.
ObjectiveA Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice-manufactured 0.5% povidone-iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID-19 by reducing viral shedding and prevention of transmission of SARS-CoV-2. The aim was to confirm the results from a human single-dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS-CoV-2 from adult subjects with confirmed COVID-19.
MethodsA multicenter, randomized, double-blinded, placebo-controlled Phase II clinical trial involving adults with early COVID-19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS-CoV-2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post-dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture.
Results Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2–4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity.
ConclusionA total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS-CoV-2 virus in the nasal passages of COVID-19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone-iodine on viral shedding in COVID-19 subjects. Nasal disinfection may diminish viral transmission to others.
Level of Evidence Level 2 Laryngoscope, 2024
Jacquelyn K. Callander, Nazineen Kandahari, Madeleine P. Strohl, Steven W. Cheung, Jolie L. Chang
Publication date 30-03-2024
Impaired laryngopharyngeal sensation has been implicated in obstructive sleep apnea (OSA) and may play an important pathophysiological role. We evaluated sensory function in OSA by examining the laryngeal adductor reflex (LAR) response rate and temporal profile to awake tactile stimulation. The OSA group exhibited reduced LAR response rates, affirming laryngeal hyposensitivity, and correlation of the LAR sensorimotor temporal dynamics with OSA disease severity.
Introduction Impaired laryngopharyngeal sensation has been implicated in obstructive sleep apnea (OSA) and may play an important pathophysiological role. We evaluated sensory function in OSA by examining the laryngeal adductor reflex (LAR) response rate and temporal profile to tactile stimulation.
Methods Laryngeal sensation testing was performed in awake adults with and without diagnosed OSA by stimulating the medial aryepiglottic fold or arytenoid using 30-mm 5–0 and 4–0 nylon Cheung-Bearelly monofilaments. Video analysis by two independent reviewers evaluated for the presence of the LAR in response to satisfactory stimuli and LAR latency to vocal fold adduction.
Results Twenty-six OSA and 12 control subjects were tested with 270 satisfactory stimuli. The mean full LAR response rate to 4–0 stimulation was 38.3% in OSA vs 86.9% in control subjects (p <0.001) and to 5–0 stimulation was 27% in OSA vs 63.9% in control subjects (p <0.001). The mean LAR latency to vocal fold closure in OSA was 123.7 ms (SD 35.8) vs 156.4 ms (SD 44.3) in control (p = 0.04) subjects. OSA LAR latency was positively correlated with the apnea-hypopnea index (r = 0.30; p = 0.008).
Conclusion The OSA group exhibited reduced LAR response rates and shortened LAR latency, where latency was correlated with disease severity. Laryngeal hyposensitivity was affirmed and changes to LAR sensorimotor temporal dynamics were revealed. These pathophysiological alterations to the LAR may be accounted for by decreased somatosensory receptor sensitivity, increased sympathetic tone, and reorganized brain stem function in OSA.
Level of Evidence3 Laryngoscope, 2024
Giuseppe Magliulo, Giannicola Iannella, Manuele Casale, Claudio Vicini, Annalisa Pace
Publication date 30-03-2024
Kevin Herrera, Miti Parikh, Sahiti Vemula, Kevin Hur
Publication date 30-03-2024
Objectives To investigate whether hormone replacement therapy (HRT) impacts health care resource utilization in the management of chronic rhinosinusitis (CRS) in older women.
Methods Using the Tri NetX US health record database, women 55 years or older with a diagnosis of CRS were included and followed for 3 years.
The cohort was stratified into two groups: women who received HRT at the beginning of the study were compared to women who did not receive HRT. The groups were matched by age, race, ethnicity, history of asthma, and history of nasal polyps. Outcomes included whether the patient underwent endoscopic sinus surgery (ESS) and frequency of antibiotic use. Measures of association, Kaplan–Meier analysis, and cohort descriptive statistics were calculated.
Results Of the 65,400 women included, the mean age was 66.9 years. 27.0% and 3.6% of patients had a history of asthma or nasal polyps, respectively. Overall, 2.0% of CRS patients underwent ESS, with the HRT group less likely to undergo ESS OR: 0.28; 95% CI: (0.25–0.32) compared to patients who did not receive HRT. When stratified by polyp status, HRT patients with nasal polyps had a greater decrease in ESS rates compared to control than HRT patients without nasal polyps. The HRT group had a higher mean number of antibiotic prescriptions compared to the non-HRT group.
ConclusionHRT is associated with decreased utilization of ESS to treat CRS, with a greater effect size for ESS among CRSwNP patients. However, HRT was associated with higher antibiotic utilization.
Level of Evidence Level 3 Laryngoscope, 2024
Katherine Wang, Emily K. Gjini, Sarah Kooper‐Johnson, Michael I. Cooper, Collyn Gallant, Kathryn Y. Noonan
Publication date 30-03-2024
Intralabyrinthine schwannomas are rare tumors that originate from the inner ear and can cause significant hearing loss and dizziness. In this scoping review, we attempt to summarize hearing outcomes in patients with these tumors who have undergone cochlear implantation either after tumor resection or no resection.
Objective To evaluate the literature and summarize cochlear implantation (CI) outcomes after intralabyrinthine schwannoma (ILS) excision and tumor observation with CI.
Data SourcesOVID Medline, Embase, Web of Science; conception to 2024.
Review MethodsA literature review was performed using subject headings, MeSH terms, and keywords. Abstracts and full texts were reviewed by two independent reviewers and adjudicated by a third. Inclusion criteria included studies with ILS and CI with reported audiologic outcomes. Subjects were analyzed into two groups, ILS resection with CI and in situ ILS with CI. Patients with NF2 were included. The main outcome of interest was CI audiometric performance level, with secondary outcomes of CI user status and open-set speech attainment.
Results There were 29 articles with a total of 93 patients who met inclusion criteria. The resection group had 17% low performers, 44% intermediate performers, and 38% high performers. The in situ group had 40% low performers, 32% intermediate performers, 27% high performers. The resection group had 69 patients with 97% maintaining user status and 92% with open-set speech recognition. The observation group had 24 patients, with 87% user rate and 86% achieving open-set speech recognition. There was a greater percentage of NF2 diagnosis seen in the in situ group.
Conclusion There is a paucity of literature on CI and ILS. Patients are managed with both resection of tumor and implantation in situ. Early data are limited, with improvement in hearing outcomes and high user rates in both populations.
Level of EvidenceN/A Laryngoscope, 2024
Quynh‐Chi L. Dang, Seckin Ulualp, Ron B. Mitchell, Romaine F. Johnson
Publication date 29-03-2024
This study found that weight gain following adenotonsillectomy in pediatric patients correlates with higher rates of residual obstructive sleep apnea (OSA). It highlights the need for weight management counseling before the procedure to improve OSA outcomes.
Objective(s)The first-line treatment for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy. Post-operative weight gain is a well-documented phenomenon. We hypothesized that higher peri-adenotonsillectomy delta weight correlates with lower rates of OSA resolution in pediatric patients.
Methods This was a retrospective cohort study consisting of 250 patients from 2 to 17 years of age at a tertiary academic medical center between January 2021 and December 2022. Polysomnography results and body mass index (BMI) changes were collected through the electronic health record. Univariate and multivariate logistical regression analyses were performed, adjusting for confounding factors.
Results Perioperative delta weight and pre-operative baseline AHI values were significant predictors of residual OSA. For every 1-kilogram gain in weight, the odds of residual OSA (AHI >5) increase by 6.0% (OR = 1.06, 95% CI = 1.02–1.10, p < 0.002), and the odds of residual severe OSA (AHI > 10) increase by 8% (OR = 1.08, 95% CI = 1.04–1.12, p < 0.001). Increased AHI, Black/African American race, and male sex were also factors associated with incomplete OSA resolution.
Conclusions Increased peri-adenotonsillectomy delta weight is associated with higher rates of residual OSA in children. Patients and families should be counseled about appropriate weight loss and control methods before adenotonsillectomy.
Level of EvidenceIV Laryngoscope, 2024
Jérôme R. Lechien, Lisa G. De Marrez, Camille Finck, Sven Saussez
Publication date 29-03-2024
RSA-10 is a new instrument for documenting signs of reflux.
Objective To develop and validate the Reflux Sign Assessment-10 (RSA-10) for documenting the physical findings of laryngopharyngeal reflux disease (LPRD).
Methods Patients with LPRD at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring and asymptomatic individuals were consecutively recruited from two European hospitals. Three experienced otolaryngologists rated RSA-10 in patients and controls for assessing internal validity. RSA-10 was rated within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbachs α in patients and controls. Convergent validity was evaluated through a correlation analysis between RSA-10 and Reflux Finding Score (RFS). Interrater reliability was evaluated by comparing the RSA-10 evaluations of the three otolaryngologists through Fleiss kappa. Pre- to posttreatment change of RSA-10 was evaluated to assess responsiveness to change. The RSA-10 thresholds were examined by receiver operating characteristic analysis.
Results Fifty-five patients completed the pre- to posttreatment evaluations from January 2020 to December 2023. A total of 115 asymptomatic individuals completed the study. RSA-10 reported high internal consistency reliability (α = 0.822) and test-retest reliability (r s = 0.725). The RSA-10 scores of patients were significantly higher than those of controls (p = 0.001), suggesting high internal validity. RSA-10 was significantly correlated with the RFS (r s = 0.771). The interrater reliability was adequate for sub- and total RSA-10 scores (k = 0.708). RSA-10 significantly improved from baseline to 3-month posttreatment (p = 0.001). An RSA-10 > 13 may be suggestive of LPRD. Both RSA-10 > 13 and Reflux Symptom Score-12 > 11 were associated with a sensitivity of 92.7% and a specificity of 97.3%.
Conclusion The RSA-10 is a reliable and valid clinical instrument for documenting the most prevalent laryngeal and extra-laryngeal findings associated with LPRD.
Level of Evidence3 Laryngoscope, 2024
Matthew Maksimoski, Anisha Rhea Noble, David F. Smith
Publication date 28-03-2024
Artificial intelligence software has become incredibly popular, but this study showed that it answered otolaryngology questions correctly 45% of the time, and only 37% of the time for questions based on clinical practice guidelines. Practitioners and patients should exercise caution when asking medical information from software such as ChatGPT, especially since sources are not cited for the information it presents.
Objective Investigate the accuracy of ChatGPT in the manner of medical questions related to otolaryngology.
MethodsA ChatGPT session was opened within which 93 questions were asked related to otolaryngology topics. Questions were drawn from all major domains within otolaryngology and based upon key action statements (KAS) from clinical practice guidelines (CPGs). Twenty-one “patient-level” questions were also asked of the program. Answers were graded as either “correct,” “partially correct,” “incorrect,” or “non-answer.”Results Correct answers were given at a rate of 45.5% (71.4% correct in patient-level, 37.3% CPG); partially correct answers at 31.8% (28.6% patient-level, 32.8% CPG); incorrect at 21.6% (0% patient-level, 28.4% CPG); and 1.1% non-answers (% patient-level, 1.5% CPG). There was no difference in the rate of correct answers between CPGs published before or after the period of data collection cited by ChatGPT. CPG-based questions were less likely to be correct than patient-level questions (p = 0.003).
Conclusion Publicly available artificial intelligence software has become increasingly popular with consumers for everything from story-telling to data collection. In this study, we examined the accuracy of ChatGPT responses to questions related to otolaryngology over 7 domains and 21 published CPGs. Physicians and patients should understand the limitations of this software as it applies to otolaryngology, and programmers in future iterations should consider giving greater weight to information published by well-established journals and written by national content experts.
Level of EvidenceN/A Laryngoscope, 2024
Samuel H. Selesnick
Publication date 28-03-2024
Ashley L. Soaper, Carol Li, Jay Paul Willging
Publication date 28-03-2024
"Jason S. Chwa, Elizabeth A. Shuman, Karla ODell"
Publication date 28-03-2024
Objective Anastomotic complications after tracheal resection/cricotracheal resection (TR/CTR), such as granulation tissue formation, can lead to severe morbidity. The off-label use of nebulized ciprofloxacin-dexamethasone (Ciprodex) for granulation tissue prophylaxis has anecdotally been used after TR/CTR, especially in pediatric patients. However, its use in the adult population, and its safety and side effect profile post-TR/CTR has not been reported. This study aims to characterize the incidence of adverse side effects associated with nebulized Ciprodex in post-TR/CTR patients.
MethodsA retrospective review of all patients who underwent TR/CTR from June 2015 to July 2023 was performed. The use of nebulized Ciprodex (1 mL ciprofloxacin-dexamethasone 0.3%–0.1% otic suspension in 4 mL normal saline) while inpatient was evaluated. Potential side effects were defined as oral thrush, ageusia, arthralgia, and allergic reaction, and were recorded for all patients.
Results Seventy-three patients underwent TR/CTR from June 2015 to July 2023. Of these, 53 (72.6%) had documented Ciprodex administration during their postoperative course. One (1.9%) patient reported at least one side effect, including one instance of skin rash (1.9%) and one instance of allergic reaction (1.9%). There were no other side effects attributed to Ciprodex use.
Conclusions The incidence of side effects related to the use of nebulized Ciprodex is felt to be minimal in post-TR/CTR. Although Ciprodex may have the potential to treat granulation tissue in the airway, further studies are needed to verify its efficacy and safety.
Level of Evidence4 Laryngoscope, 2024
Jiajia Zi, Zhaoxia Wei, Lin Wang, Xudong Yan, Shengnan Zhang, Lijuan Zhao, Danyang Li, Zihui Dong, Longgang Yu, Yan Jiang
Publication date 28-03-2024
Among the several phases of SNIP, the late stage exhibited a considerable increase in the expression of autophagy-related genes and HMGB1 in comparison with the early stage. At various phases, HMGB1 and genes linked to autophagy may provide novel prediction targets for SNIP.
Objectives Sinonasal inverted papilloma (SNIP) is a noncancerous tumor that develops in the mucous membrane of the nasal sinuses. Many malignancies are tightly linked to autophagy, an intracellular self-degradation mechanism. HMGB1 has demonstrated its ability to modulate autophagy in many pathological conditions. This work investigates how HMGB1 and other genes involved in autophagy contribute to SNIP.
Material and Methods The study included 45 patients with SNIP and a control group consisting of 28 individuals. In each group, qPCR was employed to examine the mRNA expression levels of genes correlated with autophagy and HMGB1. HMGB1 and genes associated with autophagy were examined for protein expression levels via Western Blot and immunohistochemical staining assays. At the same time, the association between HMGB1 and genes involved in autophagy was discovered through correlation analysis. Furthermore, Krouse staging was utilized for investigating the expression levels of HMGB1 and other autophagy-related genes at various stages in clinically staged SNIP patients.
ResultsLC3B, ATG5, and Beclin1 autophagy-related genes and HMGB1 were substantially expressed in SNIP. Additionally, there was a positive correlation between HMGB1 and these genes. During various phases of SNIP, the levels of HMGB1 expression and autophagy-related genes were notably elevated at stage T4 compared with stage T2.
Conclusion Clinical staging in SNIP is correlated with HMGB1 expression in conjunction with autophagy-related genes LC3B, ATG5, and Beclin1, suggesting the possibility of novel prognostic indicators.
Level of EvidenceNA Laryngoscope, 2024
Shengyang Liu, Rui Wang, Li Shi, Aiping Chen
Publication date 28-03-2024
This report details the diagnosis of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in a 65-year-old female patient presenting with persistent bilateral epistaxis. Comprehensive diagnostic evaluations revealed this rare underlying condition, highlighting the importance of thorough investigation in cases of recurrent epistaxis unresponsive to standard treatments. The case emphasizes the necessity for clinicians to consider a broad differential diagnosis in such scenarios.
We present a rare case of Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia (LPL/WM) diagnosed in a 65-year-old female initially presenting with recurrent bilateral epistaxis. Despite multiple cauterizations and a history of ineffective conventional treatments, comprehensive evaluations led to the diagnosis, underscoring the critical need for thorough investigation in persistent epistaxis cases, particularly when standard approaches fail. This case emphasizes the importance of considering indolent lymphomas in the differential diagnosis of recurrent epistaxis and showcases the diagnostic pathway leading to successful identification and treatment of a rare etiology. Laryngoscope, 2024
Jang Wook Gwak, Don‐Han Kim, Yong Ju Jang
Publication date 28-03-2024
The treatment of empty nose syndrome remains challenging despite the increasing attention to its clinical impact. Herein, we introduce our experience of applying a newly developed “3D-printed nasal plug” as an alternative conservative treatment modality.
Objective Empty nose syndrome (ENS) is commonly treated by surgery, albeit with limited success. Herein, we introduce our experience of applying a newly developed “3D-printed nasal plug” as an alternative conservative treatment modality.
Methods This retrospective study included 20 patients (14 males, 6 females; mean age 46.5 ± 13.5 years) with ENS who underwent the application of the 3D-printed nasal plug at Asan Medical Center between June 2022 and May 2023. Symptom improvement was assessed by Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) before and after applying the nasal plug. Clinical results, such as duration and frequency of plug use, discomfort, and level of satisfaction, were investigated.
Results The mean follow-up duration was 40.3 ± 24.2 weeks. The average duration of nasal plug usage was 10.8 h per day and 5.3 days a week. The ENS6Q scores improved from 19.6 ± 4.6 to 6.8 ± 5.1 (mean reduction 12.8 ± 5.9) after 30 minutes of wearing. Symptom “nose feelings too open” was improved most by a score of 3.0 ± 1.5 (p < 0.001). Thirteen patients (65.0%) reported that the effectiveness of the plug, initially confirmed at the first wearing, was well maintained during the entire follow-up. Four patients (20.0%) wore the nasal plug uninterruptedly throughout the week, whereas nine patients (45.0%) wore it intermittently as needed. Frequently reported complaints with plug usage were ‘displacement of the plug’ and ‘cosmetic concerns’ about the visible hook portion.
ConclusionA 3D-designed nasal plug can be a useful conservative treatment option for ENS patients.
Level of Evidence4 Laryngoscope, 2024
Alice C. Yu, Myungjun Ko, Albert Y. Han, Maie St. John, Dinesh K. Chhetri
Publication date 28-03-2024
Cervical chordoma is a rare tumor that often presents with speech and swallowing dysfunction. Here, we detail clinical characteristics that predispose patients to developing dysphonia or dysphagia. Moreover, we analyze the cases of two patients with diverging clinical courses to understand which interventions may improve outcomes.
Objectives Cervical chordoma is a rare, low-grade primary bone tumor occurring in the axial skeleton. Due to challenges in surgical exposure caused by anatomic location, patients may experience dysfunction in speech and swallowing. The objective of this study was to characterize speech and swallowing outcomes for patients undergoing surgical resection of cervical chordoma. Moreover, we detail in-depth two cases with similar initial presentations to compare prognostic factors and management strategies.
Methods Eleven patients with histologically confirmed cervical chordoma treated between 1993 and 2020 were included in this retrospective case series. Outcomes measured included overall survival, disease-free survival, need for enteral feeds, as well as results of modified barium swallow study (MBSS) and fiberoptic laryngoscopy.
Results The mean age at diagnosis was 55.9 years. The patient population was 81.8% male. Mean survival after diagnosis was 96 months. Four (36.4%) patients required post-operative MBSS and demonstrated aspiration. All four of these patients presented with tumors in the superior cervical spine and received surgeries utilizing anterior approaches. Of the four, 2 required enteral feeds long-term. Four (36.4%) patients endorsed dysphonia. One patient developed post-operative right vocal fold paresis. The remaining three patients experienced stable dysphonia pre- and post-operatively. Additionally, three (27%) patients required tracheostomy placement, two of which remained in place long-term.
Conclusions Dysphagia is a common side effect of cervical chordoma resection. It is associated with the use of an anterior approach during resection and with tumors located in the superior cervical spine. Patients with postoperative dysphagia should receive early multidisciplinary swallow rehabilitation.
Level of Evidence4 Laryngoscope, 2024
Alexandra E. Tunkel, Tatiana Ferraro, Timothy B. Shaver, Weston L. Niermeyer, Esther Lee, Arjun S. Joshi
Publication date 26-03-2024
Transoral sialolithotomy performed in-office under local anesthesia is routinely performed for distal submandibular stones. We demonstrate the senior authors novel practice of in-office transoral sialolithotomy for hilar and intraglandular stones. A review of cases performed by the senior author revealed similar rates of complication and stone recurrence as those reported in the literature from removal under general anesthesia. Laryngoscope, 2024
Pubmed PDF WebFatih Öner, Muhammet Recai Mazlumoğlu, Osman Kurt, Nezahat Kurt, Harun Ücüncü
Publication date 26-03-2024
Cigarette smoke contains harmful heavy metals. This study measured heavy metal levels in smokers and nonsmokers nasal turbinate tissues using Inductively Coupled Plasma-Mass Spectrometry. Smoking causes nasal and sinus problems. As smoking harms the mucociliary system and mucosa and heavy metals from cigarettes damage nasal tissues, nearly all heavy metals in nasal turbinate tissues increase in this study.
Objectives Cigarette smoke is known to contain toxic heavy metals. In this study, heavy metal levels in the nasal turbinate tissues of smokers and nonsmokers were measured and compared with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).
Methods Forty patients who come to the Otorhinolaryngology outpatient clinic due to nasal obstruction and are given an appointment for partial turbinate reduction operation due to inferior turbinate hypertrophy, according to their smoking status, were divided into two groups: those who had smoked one pack/day for at least 10 years and those who had never smoked. The levels of heavy metals (Al, As, Ba, Cd, Cr, Co, Cu, Pb, Mn, Hg, Ni, Se, and Ag) were compared by ICP-MS in nasal turbinate tissues.
Results Al (p = 0.002), Cr (p < 0.001), Co (p < 0.001), Ni (p = 0.001), Cu (p < 0.001), As (p < 0.001), Se (p < 0.001), Ag (p < 0.001), Cd (p = 0.001), Ba (p = 0.008), Hg (p < 0.001), and Pb (p < 0.001) values in the smoker group were found to be significantly higher than the values of nonsmokers. Although the Mn level was high in smokers, no significant difference was observed (p = 0.299).
Conclusions Smoking can cause nasal and sinus problems. In this study, we observed that the smoking group had significantly higher levels of almost all the heavy metals investigated in the nasal turbinate tissues. As smoking damages, the mucociliary system and the mucosa, heavy metals from cigarettes may accumulate further and cause harm to the nasal tissues.
Level of Evidence Level 3 Laryngoscope, 2024
M. Ángeles Sánchez Roldán, Héctor Duque, Bernat Masso, Dulce Moncho, Ramón Vilallonga, Manuel Armengol, Óscar González
Publication date 26-03-2024
The laryngeal adductor reflex (LAR) is a brainstem reflex that closes the vocal fold and constitutes a new method for continuously monitoring the vagus and laryngeal nerves during different surgeries. Previous reports concluded that topical lidocaine in spray inhibited LAR responses. However, topical anesthesia in the upper airway may be necessary in awake intubation. We present six patients who underwent neck endocrine surgery due to an intrathoracic goiter that compromised the airway. Before awake intubation, a nebulization of lidocaine 5% was applied for at least 10 min. The intubation procedure was well tolerated, and bilateral LAR with suitable amplitudes for monitoring was obtained in all cases. In our series, the nebulization of lidocaine 5% did not affect the laryngeal adductor reflex.
The laryngeal adductor reflex (LAR) is a brainstem reflex that closes the vocal fold and constitutes a new method for continuously monitoring the vagus and laryngeal nerves during different surgeries. Previous reports concluded that topical lidocaine in spray inhibited LAR responses. However, topical anesthesia in the upper airway may be necessary in awake intubation. We present six patients who underwent neck endocrine surgery due to an intrathoracic goiter that compromised the airway. Before awake intubation, a nebulization of lidocaine 5% was applied for at least 10 min. The intubation procedure was well tolerated, and bilateral LAR with suitable amplitudes for monitoring was obtained in all cases. In our series, the nebulization of lidocaine 5% did not affect the laryngeal adductor reflex. Laryngoscope, 2024
Matthew J. Marget, Alexander Gelbard
Publication date 26-03-2024
We present a case report detailing the experience of our patient, a 47-year-old woman with multiple metallic tracheal stents placed at an outside facility for the treatment of tracheal stenosis. The report illustrates the harms of metal tracheal stents.
Introduction With its introduction in 1986, the use of metal tracheal stents gained favor due to relative ease of deployment and reduced risk of stent migration and mucus plugging. However, adverse events associated with metal stenting led the FDA to publish a recommendation against its use for benign airway stenosis in 2005. We present a case which illustrates the difficulty in removal of a metal stent from the airway.
Case Report Our patient is a 47-year-old woman with a history of postintubation tracheal stenosis. She underwent multiple interventions with Thoracic Surgery at an outside facility, including stenting with an Ultraflex expandable metal stent. Her course was complicated by recurrent intraluminal granulation tissue, which led to placement of additional metal stents, as well as a tracheostomy due to obstructive proximal granulation tissue. On presentation at our institution, removal of the stents was recommended due to recurrent tracheitis and proximity of stent fragments to the innominate artery on CT imaging. She underwent direct microlaryngoscopy and bronchoscopy, and stent fragments were removed using a hemostat through the trach stoma. Postoperative imaging has confirmed retained stent fragments, and additional procedures have been required for further removal.
Discussion/Conclusion Removal of metal stents from the trachea is challenging for several reasons. Neoepithelization of respiratory mucosa makes identification of fragments difficult. Furthermore, growth of granulation tissue through the metal lattice framework, as well as the stents tendency to fracture, complicates extraction. This case illustrates the dangers of metal stenting for benign airway stenosis. Laryngoscope, 2024
Lucy Revercomb, Aman M. Patel, Om B. Tripathi, Andrey Filimonov
Publication date 26-03-2024
In this study, we evaluate the relationship between the relative citation ratio and National Institutes of Health funding and provide relative citation ratio benchmark data for the field of academic otology. The h-index has a strong relationship with NIH funding in academic otology. The mean relative citation ratio may correct some of the deficiencies of time-dependent bibliometrics and promote representation of women in otology.
Objectives Bibliometrics, such as the Hirsch index (h-index) and the more recently developed relative citation ratio (RCR), are utilized to evaluate research productivity. Our study evaluates demographics, research productivity, and National Institutes of Health (NIH) funding in academic otology.
Methods Academic otologists were identified, and their demographics were collected using institutional faculty profiles (N = 265). Funding data were obtained using the NIH Research Portfolio Online Reporting Tools Expenditures and Reports Database. The h-index was calculated using Scopus and mean (m-RCR) and weighted RCR (w-RCR) were calculated using the NIH i Cite tool.
ResultsH-index (aOR 1.18, 95% CI 1.10–1.27, p < 0.001), but not m-RCR (aOR 1.50, 95% CI 0.97–2.31, p = 0.069) or w-RCR (aOR 1.00, 95% CI 0.99–1.00, p = 0.231), was associated with receiving NIH funding. Men had greater h-index (16 vs. 9, p < 0.001) and w-RCR (51.8 vs. 23.0, p < 0.001), but not m-RCR (1.3 vs. 1.3, p = 0.269) than women. Higher academic rank was associated with greater h-index and w-RCR (p < 0.001). Among assistant professors, men had greater h-index than women (9.0 vs. 8.0, p = 0.025). At career duration 11–20 years, men had greater h-index (14.0 vs. 8.0, p = 0.009) and w-RCR (52.7 vs. 25.8, p = 0.022) than women.
Conclusion The h-index has a strong relationship with NIH funding in academic otology. Similar h-index, m-RCR, and w-RCR between men and women across most academic ranks and career durations suggests production of similarly impactful research. The m-RCR may correct some deficiencies of time-dependent bibliometrics and its consideration in academic promotion and research funding allocation may promote representation of women in otology.
Level of EvidenceN/A Laryngoscope, 2024
Raymond J. So, Christopher Rayle, Henry H. Joo, Emily Y. Huang, Tanguy Y. Seiwert, Eric H. Raabe, Simon R. Best
Publication date 25-03-2024
Adjuvant agents to limit disease recurrence and thereby decrease surgical frequency are critically needed in the management for recurrent respiratory papillomatosis (RRP). In this study, we show that systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response.
Objectives Medical therapies to limit disease recurrence are critically needed for recurrent respiratory papillomatosis (RRP). Systemic bevacizumab is emerging as an exciting adjuvant therapy toward this end, but uptake has been poor due to the lack of experience and awareness of best prescribing practices. The objective of this study was to describe a single tertiary care academic medical centers experience using systemic bevacizumab for the treatment of RRP.
MethodsA retrospective review was performed to identify patients with RRP on systemic bevacizumab. Demographic and clinical characteristics, findings on imaging reports, and disease response at all anatomic subsites involved in papilloma were documented.
Results Of the 17 RRP patients on systemic bevacizumab, 9 (52.9%) were male, and 12 (70.6%) were diagnosed with juvenile-onset RRP. The total lifetime number of surgeries was high, with more than half (n = 9; 52.9%) undergoing more than 50 surgeries. Following induction of systemic bevacizumab, a significant reduction in patients with laryngeal (n = 15; 94.1% vs. n = 7; 41.2%, p < 0.001) and tracheal (n = 11; 64.7% vs. n = 5; 29.4%, p = 0.04) RRP was noted. Surgical frequency was significantly lower following systemic bevacizumab (2.5 vs. 0.5 surgeries per year; p < 0.001). The most common complications were new-onset hypertension (n = 4; 23.5%) and proteinuria (n = 5; 29.4%).
Conclusion Systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response.
Level of Evidence4 Laryngoscope, 2024
Matthew R. Naunheim, Elliana K. DeVore, Molly N. Huston, Phillip C. Song, Ramon A. Franco Jr, Neil Bhattacharyya
Publication date 25-03-2024
Voice problems are increasing nationally. This may be related to COVID-19, although more research is required.
Objective To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders.
Methods The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence.
Results29.9 million Americans (95%CI28.3–31.5) annually report a voice problem, representing 12.2% of the population (95%CI11.7–12.8%). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI4.3–6.0%) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI50.9–55.1%). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI13.7–15.1 and 9.3–10.7, respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI18.9–23.5% and 11.1–12.1%, respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI12.0–22.1 and 11.0–14.8, respectively).
Conclusions Voice problems affect approximately 1 in 8 adults in the U.
S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders.
Level of Evidence3 Laryngoscope, 2024
Wenying Zhu, Haifeng Liang, Faya Liang, Renhui Chen, Shibei Zheng, Wenting Liang, Zhong Guan, Qian Cai
Publication date 25-03-2024
In this study, the repair effects of the platysma myocutaneous flap (PMF) and ribbon myocutaneous flap (RMF) on postoperative voice quality of patients were compared to provide a reference for selecting a repair method conducive to improving postoperative voice quality. We found that the PMF group was superior to the RMF group for voice quality assessed by voice acoustics, aerodynamics, and subjective perceptual evaluation. The PMF can provide more tissue (including ribbon muscle under the flap) for padding; therefore, supraglottic compression rarely occurs, and the reconstructed glottic closure is improved after PMF repair. Moreover, the cortical adipose tissue of the PMF can function as the Reinkes space of the vocal cord, and thus, the cortex can produce good vibration during pronunciation, with PFVWs generated in some patients, thereby achieving good voice quality after surgery.
Objective Numerous methods and materials are available for vertical partial laryngectomy. In this study, the reparative effects of the platysma myocutaneous flap (PMF) and ribbon myocutaneous flap (RMF) on the postoperative voice quality of patients were compared to provide a reference for selecting a method conducive to improving postoperative voice quality.
MethodsA retrospective analysis was performed on patients with unilateral T2-3 glottic carcinoma. Following vertical partial laryngectomy, the defect was repaired with a PMF or simple RMF. Twelve months after surgery, voice quality was assessed according to voice acoustics, aerodynamics, and subjective perceptual evaluation, and glottic morphology was recorded using a laryngeal stroboscopy.
ResultsA total of 70 patients were identified, including 54 in the PMF group and 16 in the RMF group. The PMF group was superior to the RMF group in terms of voice quality assessed by voice acoustics, aerodynamics, and subjective perceptual evaluation. In the PMF group, 72.2% of patients performed phonation with their vocal cords, and approximately 27.8% of patients were affected by supraglottic compression. In the RMF group, 81.3% of patients were affected by supraglottic compression. No significant difference was found in the 5-year survival rate between the two groups.
Conclusion For defect repair following vertical partial laryngectomy, a PMF can allow better postoperative voice quality to be achieved than an RMF because a PMF can provide more tissue (including strap muscle under the flap) for padding, which enables the glottic portion corresponding to the vocal cord to close well.
Level of Evidence Level 3 Laryngoscope, 2024
Chia‐Hsiang Fu, Chien‐Cheng Chen, Chi‐Che Huang, Po‐Hung Chang, Yi‐Wei Chen, Ya‐Cheng Tang, Ta‐Jen Lee
Publication date 23-03-2024
Empty Nose Syndrome (ENS) is a clinically significant but underdiagnosed condition linked to severe rhinologic and psychiatric symptoms. In a study of 54 ENS patients, the relationship between remnant inferior turbinate volume (ITV) and morphological phenotypes was investigated, revealing a positive correlation between ITV and symptom severity in specific phenotypes. These findings underscore the importance of investigating the role of ITV in ENS and suggest that the effectiveness of surgical reconstruction may be tied more to restoring nasal morphology than volume alone.
Objectives Empty nose syndrome (ENS) is an underdiagnosed but burdensome clinical condition. Studies that have addressed the impact of remnant inferior turbinate volume (ITV) on ENS are scarce. We aimed to evaluate the impact of ITV and phenotyping on the severity and presentation of ENS.
Methods All the enrolled patients underwent the following subjective assessments: the ENS 6-Item Questionnaire (ENS6Q), Sino-Nasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). The ITV was obtained from finely cut (1-mm-thick slices) sino-nasal computed tomography scan images and analyzed using ImageJ. The correlation between ITV, subjective measurements, and morphology of inferior turbinates was evaluated. ENS was categorized as torpedo type (balanced tissue volume) or pistol type (posterior dominance) based on the morphology.
Results Overall, 54 patients met the inclusion criteria. The ITV was positively correlated with the ENS6Q score and domain of ENS symptoms in SNOT-25. Neither BDI-II nor BAI scores had a significant correlation with ITV. Based on their morphological classification, the torpedo type exhibited diverse manifestations in the SNOT-25 analysis in response to changes in ITV, while the pistol type demonstrated an elevated rhinologic symptom burden and ENS-specific symptoms as their ITV increased. Nasal resistance did not correlate with the ITV in either type of ENS.
Conclusions Symptoms were paradoxically worse in ENS patients with greater remnant ITV, and distinct morphological phenotypes in the nasal cavities may result in different presentations. Further investigation into the correlation between remnant inferior turbinates and nerve function is warranted.
Level of Evidence3 Laryngoscope, 2024
Debayan Bhattacharya, Benjamin Tobias Becker, Finn Behrendt, Dirk Beyersdorff, Elina Petersen, Marvin Petersen, Bastian Cheng, Dennis Eggert, Christian Betz, Alexander Schlaefer, Anna Sophie Hoffmann
Publication date 23-03-2024
Computer Aided Diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts.
Objective Computer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts.
Methods This study uses Hamburg City Health Study (HCHS) a large, prospective, long-term, population-based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C-reactive protein, allergies).
Results The evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy.
Conclusion The study demonstrates a 3D CNNs ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies.
Level of Evidence3 Laryngoscope, 2024
Yi Cai, Yixuan James Zheng, Chloe M. Cheng, Kingman P. Strohl, Ashley E. Mason, Jolie L. Chang
Publication date 22-03-2024
In OSA patients well-established on hypoglossal nerve stimulator therapy, a 1-week therapy withdrawal period led to worsened sleep symptom scores. In this pilot study of seven participants, changes in OSA-related sleep symptoms correlated with select sleep-related metrics, as measured by a wearable consumer sleep technology.
Objectives Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA-related symptoms.
Methods In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an effective treatment response for an 8-week study using a wearable CST. Participants started with “HGNS-on,” were randomized to turn off HGNS therapy during either week 4 or 5 (“HGNS-off”), followed by a return to therapy, “HGNS-resume.” Participants completed validated symptom questionnaires assessing sleepiness, insomnia symptoms, functional status, and overall sleep health (Satisfaction, Alertness, Timing, Efficiency, and Duration, SATED) each week. CST metrics and survey scores were compared between HGNS treatment phases. Associations between CST metrics and survey scores were assessed.
Results Seven participants with a total of 304 nights of CST data showed no statistically significant changes in total sleep time (TST), wake time after sleep onset, or sleep efficiency (SE) across the study periods. During HGNS-off, survey scores indicated significantly worsened OSA-related symptom scores. Two participants had significantly higher heart rate variability (HRV) during HGNS-off (by 3.3 and 6.3 ms) when compared to HGNS active therapy periods. Amongst CST metrics, SATED scores correlated with TST (r = 0.434, p < 0.0001), HRV (r = −0.486, p < 0.0001), and SE (r = 0.320, = 0.0014). In addition, FOSQ-10 scores correlated with average HR during sleep (r = −0.489, p < 0.001).
ConclusionA 1-week HGNS therapy withdrawal period impacted OSA-related sleep symptoms. Sleep-related metrics measured by a wearable CST correlated with symptom scores indicating potential value in the use of CSTs for longitudinal sleep-tracking in OSA patients.
Level of Evidence4 Laryngoscope, 2024
Rafal Nowak, Izabela Nowak‐Gospodarowicz, Marek Rękas, Mohammad J. Ali
Publication date 21-03-2024
This is the first report on use of virtual reality and mixed reality for powered endoscopic DCR in extremely complex congenital and post-traumatic nasolacrimal duct obstructions.
Objective To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions.
MethodsA prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes.
Results The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeons view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds.
Conclusion Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs.
Level of Evidence Level 4 Laryngoscope, 2024
Reena Dhanda Patil, Stacey L. Ishman, Jolie L. Chang, Erica Thaler, Maria V. Suurna
Publication date 21-03-2024