Mihai A. Bentan, Graham Pingree, Lawrance Lee, Thomas Fitzpatrick, Theodore Schuman
Publication date 17-09-2024
Objective To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).
Methods The Tri NetX Research Network database was queried for each m Abs market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-m Ab controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.
Results All m Abs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, p = 0.005).
Conclusion Although all m Abs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of m Abs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.
Level of EvidenceNA Laryngoscope, 2024
Yuke Dong, Junbo Zhang, Yujie Li, Wei Huang, Yanwei Dang, Tao Li, Lianfang Xu, Xiao Shen, Hongyan Li, Lijie Huang, Beiying Li
Publication date 17-09-2024
The application of the water sac dilation method in endoscopy-assisted transoral resection of parapharyngeal space benign tumor effectively attenuated intraoperative injury, improved surgical efficiency, and accelerated postoperative recovery.
Objectives To evaluate the effectiveness of employing the water sac dilation (WSD) method during endoscopy-assisted transoral resection of parapharyngeal space benign tumor (PSBT).
Methods Between February 2017 and January 2022, a total of 32 patients diagnosed with PSBT were included in this prospective study and were randomly allocated into two groups: the WSD group and the control group. Tumors of the WSD group patients were all dissected using the WSD method.
Results The final numbers of studied patients in WSD group and control group were 17 and 15, respectively. The basic information was comparable between these two groups of patients. All these patients successfully underwent tumor resection via transoral approach. The operation time, intraoperative blood loss, drainage volume on the first postoperative day, drainage duration, and the total drainage volume in the WSD group patients were significantly lower than those in the control group patients (all p < 0.05). No surgical complications occurred, and no residual tumor or recurrence could be identified at 6 months after surgery in both groups of patients.
Conclusion The application of the WSD method in endoscopy-assisted transoral resection of PSBT effectively attenuated intraoperative injury, improved surgical efficiency, and accelerated postoperative recovery.
Level of Evidence3 Laryngoscope, 2024
Christine M. Clark, Yeo Eun Kim, Lucian Sulica
Publication date 16-09-2024
This study compares patients with unilateral to those with bilateral pseudocysts for insights into pathogenesis. Unilateral pseudocysts are more likely to occur in the presence of paresis and in a significantly higher proportion of men.
Background Unilateral vocal fold pseudocysts have been hypothesized to result from vocal fold paresis, but no explanation has been proposed for bilateral lesions. This study compares patients with unilateral to those with bilateral pseudocysts for insights into pathogenesis.
Methods Adults with unilateral and bilateral pseudocysts evaluated between 2018 and 2023 were retrospectively studied. Patient demographics, laryngeal stroboscopic findings, management strategies employed, and treatment outcomes were recorded. Fishers exact and students t-tests were performed to assess unilateral and bilateral cohorts for differences.
Results One hundred ninety-six patients (109 with bilateral and 87 with unilateral pseudocysts) were studied. The average age was 29 years (bilateral: 29 years, unilateral: 30 years; p = 0.3846). The groups differed with respect to sex (172 females: 105 bilateral, 67 unilateral; 24 males: 4 bilateral, 20 unilateral; p < 0.0001) and clinical diagnosis of paresis (bilateral: 13.8%, unilateral: 34.5%; p = 0.0010). Treatment was similar between cohorts for rates of voice therapy (bilateral: 67.0%, unilateral 63.2%; p = 0.6511) and surgery (bilateral: 12.8%, unilateral 17.2%; p = 0.4228). There were a total of six recurrences (bilateral: 2, unilateral: 4; p = 0.3898).
Conclusions Bilateral pseudocysts occur almost exclusively in women and with a relative absence of paresis. Unilateral pseudocysts are more likely to occur in the presence of paresis and in a significantly higher proportion of men. This suggests that unilateral and bilateral disease evolve in different clinical conditions, although they may share glottic insufficiency as a predisposing factor.
Level of EvidenceIII Laryngoscope, 2024
Jessica M.L. Pagel, Rachel H. Jonas, James J. Daniero, Patrick O. McGarey Jr
Publication date 14-09-2024
Posterior glottic insufficiency (PGI) can be a challenging condition to diagnose and treat. We present the case of a speaking voice professional who presented with dysphonia and intermittent coughing with liquids. He was diagnosed with PGI from suspected interarytenoid muscle atrophy and treated with a definitive endoscopic laser-assisted posterior glottic inversion flap with a satisfactory outcome.
The report describes the novel use of an endoscopic CO2 LASER assisted posterior glottic rotation flap in a professional voice user with non-intubation related posterior glottic insufficiency. The 78-year-old patient presented with progressive dysphonia and dyspnea with speaking with stroboscopy findings of posterior glottic insufficiency.
After several empiric voice treatments without improvement, the described surgery was performed to correct posterior glottic insufficiency. After surgery, VHI-10 improved from 25 to 9, overall CAPE-V from 69 to 6.5. The patient resumed public speaking and lecturing with maintained improvement in vocal quality and function at last follow-up six months postoperatively. Laryngoscope, 2024
Daniel D. Ghaderi, Matthew R. Aronson, Amrita Mehta, Ryan M. Friedman, Kendra S. McDaid, Terri Giordano, Ian N. Jacobs, Riccardo Gottardi
Publication date 14-09-2024
Azithromycin is a frequently prescribed antibiotic to pediatric patients with subglottic stenosis; however, the indication for this administration is infection prevention or resolution. In this work, we show that azithromycin not only has strong antifibrotic activity but also a protective effect against subglottic stenosis development in mice.
Objective Pediatric subglottic stenosis (SGS) is characterized by subglottic narrowing which occurs when pathological fibroblasts deposit extracellular matrix that reduces airway patency. Recent clinical observations have suggested that azithromycin may have favorable impacts on SGS reduction while treating airway infections; furthermore, our recent work in mice demonstrated that the airway microbiome influences SGS. In this work, we characterize the protective effect of azithromycin as an immunomodulatory and antibacterial therapeutic against subglottic stenosis.
Methods Immunomodulatory and antifibrotic effects of azithromycin were assessed on TGF-β1-stimulated airway fibroblasts at 10 μg/mL for 5 days. Changes in gene expression were quantified by RT-qPCR and myofibroblast differentiation by α-SMA immunostaining. Murine airways were pretreated (2-weeks) with intranasal azithromycin before SGS injury by a twisted wire brush. Disease severity and immune response were characterized by histology and immunostaining for immune cells.
Results In vitro, azithromycin treatment of TGF-β1-stimulated fibroblasts exhibited strong reductions in extracellular matrix (COL1A1, LOX) and myofibroblast-related gene expression (ACTA2). Notably, there was a significant reduction in pro-fibrotic expression, which was observed with 10 μg/mL azithromycin. Immunostaining of fibroblasts for α-SMA revealed strong reductions in the number of positive-staining cells and the intensity of each positive cell. In vivo, azithromycin exhibited a significant decrease in lamina propria thickness indicative of reduced stenosis with associated changes in T-cell infiltration.
Conclusions Overall, we show azithromycin prevents pro-fibrotic gene expression and myofibroblast differentiation and can help protect mice from developing SGS. This introduces azithromycin as a potential treatment for SGS.
Level of EvidenceNA Laryngoscope, 2024
Gary Gartling, Lea Sayce, Zachary Zimmerman, Alysha Slater, Lizzie Hary, Wenqing Yang, Michele Santacatterina, Bernard Rousseau, Ryan C. Branski
Publication date 14-09-2024
Glucocorticoids (GCs) are commonly prescribed for laryngeal indications due to their potent anti-inflammatory properties, but effects on vocal fold (VF) epithelial morphology and barrier function following injury is overlooked. Acutely, GCs did not alter TEER and did not alter epithelial depth compared to saline treatment, indicating alignment with natural healing responses. At 60-days, GCs exhibited varying degrees of TEER restoration and epithelial hyperplasia, possibly due to distinct pharmacodynamic profiles.
Introduction Glucocorticoids (GCs) are commonly prescribed for laryngeal indications due to their potent anti-inflammatory properties. However, GCs effect on vocal fold (VF) epithelial morphology and barrier function following injury is overlooked and may be key to efficacy. In this study, the effects of GCs on epithelial morphology and barrier function were quantified in injured VFs. We seek to increase our understanding of biochemical processes underlying GC mechanisms to refine therapeutic strategies.
Methods Microflap injury was induced in 65 rabbits. Seven days after injury, animals received bilateral 20 μL intracordal injections of saline, dexamethasone, methylprednisolone, or triamcinolone (n = 15 per condition). Five rabbits in each condition were euthanized 1, 7, or 60 days following treatment. An additional five animals served as non-injured/untreated controls. To quantify transepithelial electrical resistance (TEER), 1 mm epithelial biopsies were placed in an Ussing chamber. The contralateral VF was processed for transmission electron microscopy and epithelial depth analysis.
Results At 60 days, GC treatment maintained TEER levels similar to non-injured/untreated controls. However, triamcinolone reduced TEER compared with saline-treated conditions. Acutely, epithelial hyperplasia typically persisted in all injured VFs. At 60 days, only dexamethasone and triamcinolone increased epithelial depth in injured VFs; all GCs increased epithelial depth compared with non-injured/untreated controls.
Conclusion Acutely, GCs did not alter TEER. Additionally, GCs did not alter epithelial depth compared with saline treatment, indicating alignment with natural healing responses. At 60 days, GCs exhibited varying degrees of TEER restoration and epithelial hyperplasia, possibly due to distinct pharmacodynamic profiles.
Level of EvidenceNA Laryngoscope, 2024
Karan Gandhi, Freeman Paczkowski, Leigh Sowerby
Publication date 13-09-2024
We conducted a systematic review to analyze the efficacy of three common nasal irrigation methods, saline, PVP-I, and INCS at reducing SARS-CoV-2 nasopharyngeal viral load (NVL). The majority of saline nasal irrigation studies (9/10) showed that this could reduce NVL compared with control. The results for PVP-I were mixed, with 4/7 studies showing improved SARS-CoV-2 NVL clearance compared with control, and unfortunately, no studies on INCS met inclusion criteria.
Objective Nasal irrigation is a common treatment for sinonasal disorders; however, it is unknown if it can reduce SARS-CoV-2 nasopharyngeal viral load (NVL). This systematic review investigated the efficacy of nasal irrigation with saline, povidone iodine (PVP-I), and intranasal corticosteroids (INCS) at reducing SARS-CoV-2 NVL and transmissibility.
Data Sources Databases including Embase, MEDLINE, Web of Science, and Clinical Trials.gov.
Review MethodsA systematic review was completed with pre-defined search criteria using keywords related to nasal irrigation and COVID-19 from 1946 through January 2024. This review followed PRISMA reporting guidelines and was registered on PROSPERO. Only in-vivo studies testing nasal irrigation with either saline, PVP-I, or INCS for reducing NVL were included.
Results Nine out of ten studies on saline-based solutions reported positive effects in reducing NVL, with benefits noted in earlier time to negative nasopharyngeal PCR and a greater decline in NVL during early study time points, compared with controls. Isotonic and hypertonic saline mediums were found to be effective with three studies demonstrating enhanced efficacy with additives. Four out of seven studies on PVP-I showed a positive effect on reducing NVL, but results were heterogenous. Four studies demonstrated reduction of transmission with saline or PVP-I. No studies were found on INCS.
Conclusion Saline nasal irrigation showed the best efficacy in reducing SARS-CoV-2 NVL. Additives to saline may have a clinical benefit, but further studies are needed to elucidate their isolated impacts on NVL. Data on PVP-I is inconclusive and further studies are warranted to determine the ideal concentration for irrigation. Laryngoscope, 2024
Serena Pu, Spencer Johnson, Lily Martin, Benjamin Laitman, Mark Courey
Publication date 13-09-2024
This scoping review summarizes the literature on the presence of sex steroid hormones (estrogen, progesterone, testosterone) in human and animal vocal folds. The effects of such hormones on the vocal folds are also explored, with future directions for research outlined.
Objective Steroid sex hormones (SSH) target cell nuclei to affect transcription. Although laryngeal tissue is theorized to be hormonally responsive, SSH receptor presence and cellular effects on the vocal folds are not well-established. A scoping review of this literature might inform future research.
Data Sources Medline, Embase, Scopus, and Web of Science were searched.
Review Methods This review followed JBI and PRISMA-ScR Guidelines. Two independent reviewers screened each title/abstract and full text according to eligibility criteria. Exclusion criteria included primary outcomes based on subjective interpretation and secondary effects on the vocal folds (e.g., voice).
Results Three hundred and sixty one articles were screened at the title/abstract level, 83 at the full-text level, and 32 met inclusion criteria. Fourteen studies were performed in humans and 15 in animals; 3 were review articles. In studies directly examining receptors (n = 17), estrogen receptors (ER) were found in 10 of 15 studies, progesterone receptors (PR) in 6/10, and androgen receptors (AR) in 6/9. When the effects of SSH on vocal folds were studied (n = 16), estrogen had effects in 10/13, progesterone in 3/3, and androgens in 4/5. ER and PR were mostly identified in epithelium and fibroblasts of lamina propria (LP) while AR was found in muscle, lamina propria, and epithelium.
Conclusions Existing evidence variably supports the presence of SSH receptors in vocal fold tissue; therefore, further clarification is needed. Estrogen and progesterone were most identified in mucosal tissue, where they decrease fibrosis and help maintain the epithelial barrier. Androgens appear to be pro-fibrotic in epithelium and hypertrophic in muscle. Laryngoscope, 2024
Priya Arya, Yansy Salmerón, Alexandra E. Quimby, Kevin Wong, Jason A. Brant, Tiffany P. Hwa
Publication date 13-09-2024
This study assesses the current landscape of the literature regarding ototoxic effects relating to the usage of monoclonal antibodies. Where available, audiometric data are discussed and a proposed mechanism of action for otologic effect is provided.
Objective To ascertain trends in ototoxicity observed with monoclonal antibodies (mABs) and understand the impact they may have on hearing function.
Data Sources Pub Med, Embase, Scopus.
Review MethodsA systematic review was performed following PRISMA guidelines. Data were reviewed for demographics, utilized mABs with respective indication and dosing, audiometric outcomes, and treatment for otologic effects.
Results Of 757 studies reviewed, a total of 44 were included, encompassing 18,046 patients treated with mABs. Mean age of the sample was 57.8 years old. The search yielded 18 agents of ototoxicity, with reported symptoms of ototoxicity such as hearing loss, tinnitus, and/or aural fullness occurring in 1079 of total patients. Main agents causing ototoxicity were teprotumumab (n = 17/44 studies), nivolumab (n = 10/44), ipilimumab (n = 9/44), pembrolizumab (n = 5/44), and rituximab (n = 4/44). Thirty-one of 44 studies encompassing eight agents reported audiometric data for ototoxic agents, showing sensorineural hearing loss primarily in the high-frequency range. Only two articles performed ultrahigh-frequency audiograms.
Conclusion Monoclonal antibody usage is expanding, but the vast majority of studies lack substantial audiometric data. Where reported, study design and inclusion criteria vary greatly. Future studies would benefit from rigid inclusion of audiometric data, prospective study design, and consideration of formal ototoxicity screening. Otolaryngologists should be aware of the cochlear immune response and potential impact of this expanding medication class on hearing function. Laryngoscope, 2024
Gulce Kirazli, Fidan Balayeva, Melis Kacan Yilmaz, Isa Kaya, Tayfun Kirazli, Figen Gokcay, Nese Celebisoy
Publication date 13-09-2024
Prominent percentage of correct answers (CA%) drop in functional head impulse test (fHIT) by the use of an optokinetic background (OB) was the main finding in patients with vestibular migraine (VM). This discriminative feature was not correlated with anxiety scores. Difficulty in resolving the conflict between visual and vestibular inputs seem to be the underlying mechanism.
Objective Impairment in the integration of different vestibular stimuli is the proposed mechanisms in vestibular migraine (VM). In this study, it was aimed to assess the vestibulo-ocular reflex (VOR) and dynamic visual acuity (DVA) in patients with VM and to compare the results with migraine without vestibular symptoms (MwoV), and persistent postural-perceptual dizziness (PPPD) to find out if there are discriminative differences and search for a correlation with the levels of anxiety.
Methods Twenty-two patients with MwoV, 23 patients with VM, 22 patients with PPPD, and 23 healthy controls (HC) were studied. Video head impulse test (vHIT) and functional head impulse test (fHIT) without and with an optokinetic background (OB) were performed. Percentage of correctly identified optotypes (CA%) was considered for the fHIT test. Beck anxiety inventory (BAI) was used to assess anxiety.
Results Lateral canal vHIT gain of the patient groups were not different from the healthy controls (p > 0.05). fHIT and fHIT/OB CA% results of all patient groups were lower than the HC (p < 0.005), and VM patients had the lowest scores for both tests. BAI scores of the PPPD patients were the highest and a correlation between anxiety levels, and fHIT results could not be identified (p > 0.05).
Conclusion Prominent CA% drop by the use of an OB was the main finding in patients with VM. This discriminative feature was not correlated with anxiety scores. Difficulty in resolving the conflict between visual and vestibular inputs seem to be the underlying mechanism.
Level of Evidence3 Laryngoscope, 2024
Tanner J. Diemer, Douglas P. Nanu, Shaun A. Nguyen, Badr Ibrahim, Ted A. Meyer, Mohamed Abdelwahab
Publication date 12-09-2024
This systematic review examined the effects of maxillomandibular advancement (MMA) on obstructive sleep apnea (OSA) patients with obesity, including 14 studies with 143 subjects. Significant improvements were observed in apnea-hypopnea index (AHI), lowest oxygen saturation (LSAT), and Epworth Sleepiness Scale (ESS), with surgical success and cure rates at 85.6% and 39.2%, respectively. Notably, patients with class 3 obesity showed a significantly greater percent reduction in AHI compared to those with class 1 and 2 obesity.
Objective To systematically review polysomnographic and cephalometric data in obstructive sleep apnea (OSA) patients with obesity (body mass index BMI ≥30 kg/m2) treated with maxillomandibular advancement (MMA).
Data Sources Scopus, Pub Med, CINAHL, and The COCHRANE Library.
Review MethodsA search was performed from inception until April 3, 2024, in each database.
ResultsA total of 14 studies (143 subjects) were included. The mean age was 44.3 years (range: 17–69), 80.2% males (95% CI: 72.5–86.5), mean BMI of 35.3 (95% CI: 33.1–37.5), and mean duration to follow-up post-MMA was 13.7 months (95% CI: 10.1–17.3). All objective outcomes improved significantly; overall, apnea-hypopnea index (AHI) decreased by −57.3 (95% CI: −71.5 to −43.2, p < 0.0001) lowest oxygen saturation (LSAT) increased by 14.1% (95% CI: 9.9 to 18.3, p < 0.0001), and Epworth Sleepiness Scale (ESS) decreased by −9.4 (95% CI: −13.5 to −5.2, p < 0.0001). Surgical cure was 39.2% (95% CI: 20.3–60.0), and surgical success was 85.6% (95% CI: 77.8–91.5). Comparing percent reduction in class 3 obesity (−92.9%) as compared to class 1 (−85.5%) and class 2 (−83.6%) exhibited a significant difference (1 vs 3 p = 0.0012, 2 vs 3 p = 0.015).
Conclusions Our findings suggest that MMA significantly improves subjective and objective outcomes in OSA amongst patients with obesity with results comparable to the overall population. Success rates remained above 80% in studies with the highest mean BMI. In addition, patients with class 3 obesity yielded a significantly increased benefit based on percent reduction in AHI compared with class 1 and 2.
Level of Evidence1 Laryngoscope, 2024
"Naomi Tesema, Taylor G. Lackey, Mackenzie OConnor, Paul E. Kwak, Aaron M. Johnson, Milan R. Amin"
Publication date 12-09-2024
We seek to find patient factors associated with improvement after a single in-office VFSI. We found improvement in videostroboscopy in about half of the patients, and recency from injury a likely predictor of success, offering some optimism that a low-risk procedure may provide some benefit. These partially negative results are valuable as they offer insight into counseling patients about who may benefit from in-office VFSI.
Objective This study aims to evaluate the clinical outcomes of patients receiving in-office vocal fold steroid injections (VFSI), highlighting relatively new measures around vocal pitch.
Methods Patients with a diagnosis of vocal fold scar who received in-office VFSI from 2013 to 2024 were evaluated. Pre- and post-steroid Voice Handicap Index (VHI-10) scores, stroboscopic vibratory parameters, acoustic measures of cepstral peak prominence (CPP), and fundamental frequency coefficient of variation (F0CoV) during sustained phonation were analyzed using Wilcoxon signed-rank tests and Mc Nemars tests.
Results Twenty-two patients had follow-up data 1–3 months after steroid injection. The median decrease in VHI-10 after one injection was 4 points (p = 0.02). We found no difference in CPP and F0CoV measures at follow-up. Forty-five percent of patients improved in mucosal wave and amplitude of at least one vocal fold. Earlier presentation from vocal injury was associated with improvement in mucosal wave and amplitude of the left vocal fold (p = 0.03). We found no difference in sex, tobacco smoking history, singing status, secondary diagnosis, and baseline VHI-10 score between patients who improved in vibratory parameters and those who did not.
Conclusion This single-center study is one of the largest exploring patient outcomes following in-office VFSI. Though patients reported modest improvement in voice use after VFSI, this may not be as impactful as previously believed. Improvement in videostroboscopy is expected in about half of the patients, with recency from vocal injury a likely predictor of success. These partially negative results provide insight into counseling patients regarding benefits from in-office VFSI.
Level of Evidence4 Laryngoscope, 2024
Thomas Zheng Jie Teng, Pei Yuan Fong, Issam Al Jajeh, Andy Jian Kai Chua
Publication date 12-09-2024
Benign cutaneous apocrine sweat gland adenomas in the nose are rare. We present the novel case of a nasal ala cutaneous sweat gland lesion. A 43-year-old male presents with a one year history of a right nostril mass with intermittent clear discharge, triggered by periods of hot weather and increased humidity. Histopathological analysis post-excision revealed a solid-cystic lesion of bi-layered ducts, with snouts suggestive of apocrine secretions. Given the close relationship of tumour enlargement with heat and expression of clear liquid upon direct pressure, we postulate that the intermittent tumescence represents sweat production and accumulation within the lesion. Laryngoscope, 2024
Pubmed PDF WebArtur K. Schuster, Nevra K. Yilmaz, Tomotaka Shimura, Sebahattin Cureoglu, Rafael da Costa Monsanto, Joel Lavinsky
Publication date 12-09-2024
A comparative study distinguishing histopathologic patterns of inner ear changes between meningogenic and otogenic routes in meningitis cases. Otogenic cases displayed a higher prevalence of changes in the spiral ligament and signs of early ossification, whereas meningogenic cases associated with a higher degree of vestibular damage. Our findings emphasize the importance of considering the infection route and its implications in meningitis.
Objective To distinguish the patterns of inner ear changes between meningogenic and otogenic routes in meningitis cases. Our hypothesis is that pinpointing distinct patterns linked to each route could aid in the development of diagnostic strategies and targeted therapies.
Methods Temporal bones (TBs) from patients with a history of meningitis and histopathological evidence of labyrinthitis were divided into two groups (otogenic and meningogenic). Inner ear histopathological examination was performed to identify qualitative and semi-quantitative changes. This assessment encompassed inflammation patterns, indications of early ossification, hair cell loss, and alterations in the lateral wall, round window membrane, cochlear aqueduct and vestibular aqueduct.
Results Thirty-six TBs were included in the study (otogenic, 21; meningogenic, 15). Generalized labyrinthitis was more common in otogenic cases (100% vs. 53%, p < 0.001). Early signs of cochlear ossification were exclusively observed in otogenic cases (9 TBs). The spiral ligament of otogenic cases has shown a uniform loss of fibrocytes across all cochlear turns, while meningogenic cases showed more severe loss in the apical turn. Otogenic cases exhibited a higher prevalence of severe inflammation of the cochlear aqueduct and endolymphatic sac. Meningogenic cases showed more severe loss of vestibular hair cells in the otolithic organs.
Conclusion Otogenic cases displayed a higher prevalence of changes in the spiral ligament and signs of early ossification, whereas meningogenic cases were associated with a higher degree of vestibular damage. Our findings emphasize the importance of considering the infection route and its implications for timely diagnosis and development of pathology-oriented treatment strategies.
Level of EvidenceNA Laryngoscope, 2024
Alexander Treble, Jennifer M. Siu, Yasmine Madan, Suzanne Breton, Jackie Chiang, Blake C. Papsin, Evan J. Propst, Nikolaus E. Wolter
Publication date 12-09-2024
Of 1000 survey respondents, 37.7% (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. Nuts (65.7%) are the most common food-related foreign body retrieved from a total of 265 emergency bronchoscopies over a 21-year period.
Objectives National guidelines advise delaying initiation of solid foods until after 4–6 months of age and avoiding “high-risk” foods under the age of 4 years. However, foreign body aspiration of food remains a common preventable pediatric emergency. Our primary aim was to investigate public knowledge regarding the safe age of introduction of different foods to children and determine if demographic factors affect this knowledge.
Methods An online survey was designed following a literature review and consultation with an expert panel. This was distributed via social media platforms. A review of our institutional data of bronchoscopy/foreign body retrievals was performed to identify trends.
Results There were 1000 survey responses: 79.4% of respondents cared for children and 21.5% were medical professionals; 37.7% of respondents (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. At our institution nuts (65.7%) were the most common food-related foreign body retrieved from a total of 265 over 21 years. Notably, 80% of respondents (n = 800) would offer whole nuts to children <4 years. Respondents with medical training were more likely to hold off on introducing nuts to children until a later age.
Conclusion Although the public has an overall appreciation of food safety, a significant proportion would feel comfortable offering high-risk foods to children under 2 and 3 years. There is a poor understanding of the danger of nuts and the appropriate age of introduction. Further research into effective public education strategies on safe food introduction in children are warranted.
Levels of EvidenceV Laryngoscope, 2024
Alberto Deganello, Tommaso Gualtieri, Gabriele Testa, Vittorio Rampinelli, Giulia Berretti, Alberto Paderno, Cesare Piazza
Publication date 12-09-2024
This article, accompanied by technical notes and video, presents a case of an 85-year-old patient with a cT2N0 laryngeal squamous cell carcinoma treated using CO2 transoral laser exoscopic surgery (TOLES). The procedure achieved en bloc tumor removal with negative margins, preserving laryngeal and swallowing functions, demonstrating TOLES as a viable alternative to traditional microsurgery with enhanced visualization and ergonomics. Laryngoscope, 2024
Pubmed PDF WebDavid Liao, Mark Lee, Andre Shomorony, Rachel Weitzman, Anthony P. Sclafani
Publication date 12-09-2024
Using Google Trends and Joinpoint regression analysis, this study found an increase in public interest for facial plastic procedures that persisted beyond COVID-19 associated lockdowns in contrast to body plastic procedures. These findings lend support for the “Zoom Boom” as a real phenomenon related to increased attention to ones face as one would expect similar sustained increase in interest for body plastic procedures if the findings were merely due to increased time and disposable income.
Objective To understand post-pandemic interest in plastic surgery procedures via Joinpoint analysis of Google Trends search data.
Methods Google Trends was used to quantify search volumes from January 2019–December 2022 for select cosmetic face and body procedures in the United States. A keyword analytic tool (Keywords Everywhere) extracted absolute search volumes (average monthly searches). Joinpoint analysis assessed search trends over time reported as monthly percentage change (MPC).
Results All procedures queried, including a non-cosmetic control (cataract surgery), demonstrated expected declines at the start of the COVID-19 pandemic. Blepharoplasty, face lift, neck lift, and Botox demonstrated statistically significant increase in search volumes that remained elevated relative to pre-pandemic levels. Rhinoplasty, fillers, and abdominoplasty interest increased initially followed by return to pre-pandemic levels by the end of 2022. The remainder of search terms did not show a clear temporal associated with COVID-19 lockdowns.
Conclusion The “Zoom Boom” appears to be a real phenomenon reflected by sustained increase in public interest in relation to facial plastic procedures.
Level of EvidenceNA Laryngoscope, 2024
Publication date 11-09-2024
M. Elise Graham, Emily Aleksa, Agnieszka Dzioba, Edward Madou, Tanya Chen, Julie E. Strychowsky, Amanda Hu, Yvonne Chan, Natashia M. Seemann
Publication date 11-09-2024
Women in otolaryngology are responsible for a disproportionate amount of domestic tasks within the home relative to their men colleagues. This may affect willingness and ability to take on leadership roles, increase burnout, and affect advancement.
Objectives Female otolaryngologist-head and neck surgeons (OHNS) confront unique barriers. This study examines the influence of home life, especially gendered division of household labor, on leadership, productivity, and burnout.
MethodsA survey was distributed through social media and national society list-serv. Demographics, responsibility for household roles, and Maslach Burnout Inventory for Medical Personnel were included. Participants were invited to participate in semi-structured interviews, employing purposive sampling, with qualitative thematic analysis.
Results Response rate was 26.4% (145 of 550 of eligible participants; 38.7% women, 60.7% men). Significantly fewer women were married (64.3% vs. 92% of men, p < 0.001), and significantly more were childless (21.4% of women vs. 9.1% of men, p = 0.037). More men reported exclusive/major responsibility for five duties, including yard work and home maintenance (all p < 0.03). More women reported exclusive/major responsibility for 15 duties, including meal planning and coordinating childcare (all p < 0.03). Women had higher Emotional Exhaustion on univariate analysis (p = 0.015). Across 27 interviews, two main themes were identified, each with three associated subthemes: Theme one, “division of duties,” with subthemes (1) the way household duties were divided, (2) traditional gender norms, and 3. changing duties over time/unexpected circumstances. Theme two, “impact of domestic duties,” with subthemes (1) professional, (2) financial, and (3) burnout/life satisfaction.
Conclusions Women OHNS disproportionately manage domestic responsibilities, possibly altering career trajectory for some OHNS. Burnout, especially emotional exhaustion, may be elevated due to inequitable labor. Future research should focus on identifying ways to improve equity for this group.
Level of EvidenceN/A Laryngoscope, 134:S1–S12, 2024
Jeffrey Koempel
Publication date 11-09-2024
Rahul Alapati, Bryan Renslo, Sarah F. Wagoner, Omar Karadaghy, Aisha Serpedin, Yeo Eun Kim, Maria Feucht, Naomi Wang, Uma Ramesh, Antonio Bon Nieves, Amelia Lawrence, Celina Virgen, Tuleen Sawaf, Anaïs Rameau, Andrés M. Bur
Publication date 11-09-2024
This study evaluated the reporting quality of machine learning (ML) algorithms in head and neck oncology literature using the TRIPOD-AI criteria, with sources including Pub Med and other databases. We found a need for better reporting practices, such as detailed dataset descriptions and sharing of models and data. To improve clinical application and trust, we suggest ML developers should offer open access to their models, code, and data, and engage with community feedback to refine and update ML algorithms.
Objective This study aimed to assess reporting quality of machine learning (ML) algorithms in the head and neck oncology literature using the TRIPOD-AI criteria.
Data SourcesA comprehensive search was conducted using Pub Med, Scopus, Embase, and Cochrane Database of Systematic Reviews, incorporating search terms related to “artificial intelligence,” “machine learning,” “deep learning,” “neural network,” and various head and neck neoplasms.
Review Methods Two independent reviewers analyzed each published study for adherence to the 65-point TRIPOD-AI criteria. Items were classified as “Yes,” “No,” or “NA” for each publication. The proportion of studies satisfying each TRIPOD-AI criterion was calculated. Additionally, the evidence level for each study was evaluated independently by two reviewers using the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Discrepancies were reconciled through discussion until consensus was reached.
Results The study highlights the need for improvements in ML algorithm reporting in head and neck oncology. This includes more comprehensive descriptions of datasets, standardization of model performance reporting, and increased sharing of ML models, data, and code with the research community. Adoption of TRIPOD-AI is necessary for achieving standardized ML research reporting in head and neck oncology.
Conclusion Current reporting of ML algorithms hinders clinical application, reproducibility, and understanding of the data used for model training. To overcome these limitations and improve patient and clinician trust, ML developers should provide open access to models, code, and source data, fostering iterative progress through community critique, thus enhancing model accuracy and mitigating biases.
Level of EvidenceNA Laryngoscope, 2024
Tice R. Harkins, Vasiliki Triantafillou, Everett Seay, Alan R. Schwartz, Raj C. Dedhia
Publication date 10-09-2024
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, 134:4418–4420, 2024
Laurence Gascon, Sarah Benyo, Rebecca C. Nelson
Publication date 10-09-2024
Immune checkpoint inhibitors (ICIs) have demonstrated remarkable efficacy in the treatment of various advanced and metastatic malignancies in recent years and have proven to be pivotal in contemporary oncological strategies. As the utilization of ICIs expands, so does the recognition of adverse effects, highlighting the need for vigilance in monitoring and reporting outcomes. We present a case series of two cases of supraglottitis in patients treated with ICIs, including management strategies, thus adding a novel dimension to the respiratory implications of these agents.
Objective To report a series of two cases of unusual airway complications with immunotherapy.
Method Case series and review of literature.
Results We report two cases of significant supraglottitis in patients treated with immunotherapy. The first patient is a 62-year-old male receiving treatment for a stage 4 melanoma with Nivolumab and Relatlimab. He presented in Otolaryngology clinic for subacute dysphonia and dysphagia. Flexible laryngoscopy showed significant airway edema, mucopurulent secretions, and inflammation. He was admitted inpatient and treated with high dose systemic steroids and intravenous antibiotics. Daily airway examination with flexible laryngoscopy showed improvement with this medical management. The patient was discharged with antibiotics and a steroid taper. Treatment with immunotherapy was held due to this severe and potentially life-threatening complication. The second patient is a 76-year-old male with bladder cancer treated with Pembrolizumab. Four months after beginning treatment, he experienced hoarseness and throat discomfort. His laryngoscopic examination showed diffuse supraglottic swelling. He was treated inpatient with high dose systemic steroids, intravenous antibiotics, and antifungals, which resulted in improvement of supraglottic swelling. He remained on his immunotherapy treatment. Repeat examination demonstrated persistent supraglottic swelling without airway obstruction. Regarding airway-related complications with immunotherapy, the literature reports three other cases of tracheitis related to immune checkpoint inhibitors.
Conclusion This is the first case series of supraglottitis in patients treated with immune checkpoint inhibitors. This adds to the emerging literature of the potential respiratory implications of these medications. Laryngoscope, 134:4304–4306, 2024
Bastien A. Valencia‐Sanchez, Matthew T. Brigger, Vijay A. Patel
Publication date 10-09-2024
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, 134:4414–4417, 2024
Pubmed PDF WebJohn Loh Ming Ren, Naomi Huang Wenya, Tan Toh Hui Leonard, Pang Cui‐Ying Maria
Publication date 10-09-2024
We report a case of upper parapharyngeal abscess arising from progression of a central skull base osteomyelitis, in a patient with poorly controlled diabetes mellitus. Our case is unusual for its presentation in an upper parapharyngeal location, involvement of the skull base, and poor response to medical treatment, hence requiring transnasal endoscopic surgical drainage to achieve definitive treatment. Here, we share our experience with a safe and effective technique of transnasal endoscopic drainage of a parapharyngeal abscess. Laryngoscope, 134:4274–4277, 2024
Pubmed PDF WebMihnea Cristian Trache, Johannes Köntopf, Katharina Stölzel, Sophia Marie Häußler
Publication date 10-09-2024
We describe the case of a patient who presented with sudden onset vertigo and bilateral deafness while under immune checkpoint therapy for metastatic lung cancer. The diagnostic workup confirmed bilateral sensorineural deafness and bilateral loss of vestibular function, while imaging revealed enhancement of the vestibulocochlear nerve. Initially, immunotherapy with PD-L1 antibody atezolizumab was the assumed cause of the described symptoms. However, further findings strengthened the suspicion of meningeosis neoplastica.
We describe the case of a patient who presented with sudden onset vertigo and bilateral deafness while under immune checkpoint therapy for metastatic bronchial carcinoma. Extensive audiologic assessment and vestibular function testing, as well as cranial magnetic resonance imaging (cMRI) and lumbar puncture was performed. The diagnostic workup confirmed bilateral sensorineural deafness and bilateral loss of vestibular function, while imaging revealed enhancement of the vestibulocochlear nerve. Initially, immunotherapy with PD-L1 antibody atezolizumab was the assumed cause of the described symptoms. However, further findings strengthened the suspicion of meningeosis neoplastica. The differential diagnoses of hearing loss and vestibulopathy in the context of platin-based chemotherapy, checkpoint inhibitor therapy and metastatic disease should be kept in mind for appropriate workup and therapy. Laryngoscope, 134:4347–4350, 2024
Evan J. Patel, Meleha Ahmad, Brian S. Schwartz, Annemieke van Zante, Robert Kersten, Patricia Loftus
Publication date 10-09-2024
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, 134:4213–4216, 2024
Alexandra T. Bourdillon, Jeffrey D. Sharon
Publication date 10-09-2024
A case of unilateral conductive hearing loss and normal acoustic reflexes and vestibular testing.
The cause of sudden conductive loss in the absences of other vestibulo-audiologic abnormalities can be isolated to specific subsites of the ossicular chain using audiometric testing. In the absence of such abnormalities, a rare etiology may be the cause after an inciting trauma. Laryngoscope, 134:4344–4346, 2024
Jennifer Siu, Clare M. Richardson, D. Michael McMullan, Matthew Files, Seth Friedman, Sanjay Parikh, Kaalan Johnson
Publication date 10-09-2024
This protocol describes the method for creating 3D-printed trachea models for use in high-fidelity simulation-based training and advanced surgical planning for pediatric patients undergoing slide tracheoplasty. The goal is to provide a template and methodology to allow for replicability and more widespread dissemination of these models to improve clinical training and patient care. Laryngoscope, 134:4409–4413, 2024
Pubmed PDF WebPublication date 10-09-2024
Saikrishna Ananthapadmanabhan, Yijin J. Gan, Akshay Kudpaje, Dinesh Raju, Mark Smith, Faruque Riffat, Daniel Novakovic, Murray Stokan, Carsten E. Palme
Publication date 10-09-2024
Objectives Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) has demonstrated utility in extending the apneic window in the perioperative setting. Its benefits in facilitating tubeless anesthesia are recognized during elective laryngotracheal surgeries. The use of THRIVE and administering higher fractional inspired oxygen concentrations in laser laryngeal surgery (LLS) remains controversial due to the theoretical risk of airway fires. A scoping review of the literature describing institutional experiences with THRIVE during LLS was conducted.
Data Sources and Review MethodsA systematic scoping review of the literature was performed including Pub Med, Medline, Embase, Scopus, JBI EBP Database, and Cochrane Library from inception to April 2023.
Results From the 472 articles identified in our review, nine articles were included representing 271 cases. THRIVE was used for preoxygenation and to maintain apneic oxygenation during LLS. Different institutional practices related to THRIVE parameters and intraoperative modifications during lasing were described in the literature, including cessation of THRIVE, reduction of FiO2 to 30%, and continuous 100% FiO2 oxygenation. One study described a brief ignition of the coating of a KTP laser fiber without injury to the patient. No adverse patient outcomes have been documented in the literature with THRIVE during LLS.
ConclusionTHRIVE is a safe and effective form of tubeless anesthesia and apneic oxygenation during LLS, with no adverse patient safety events reported in the literature. Key determinants to maintain safety include optimal patient and team selection, effective surgeon-anesthetist cooperation, and institutional protocols that govern intraoperative practice. Laryngoscope, 134:4203–4212, 2024
Zahir Mughal, Keshav Kumar Gupta, Justin Jui Yuan Yeo, Christopher Metcalfe, Matthew Weller
Publication date 10-09-2024
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, 134:4186–4195, 2024
Zara Sragi, Vikram Vasan, Benjamin M. Laitman, Gabriel Rivera‐Rivera, Ann Powers, Daniel R. Dickstein, Diana N. Kirke, Mark S. Courey
Publication date 10-09-2024
The laryngotracheal region hosts a unique microbial community influenced by both benign and malignant conditions. Many lesions remain unexplored, underscoring the need for future studies encompassing diverse laryngotracheal conditions.
Introduction Microbiome research has predominantly focused on the oral cavity and oropharynxs role in disease, while the upper airway, specifically the larynx and trachea, has been relatively overlooked. Examining the microbial communities in these regions can shed light on how dysbiosis influences diseases and their management. This review evaluates laryngotracheal microbial compositions in both healthy and diseased patients.
Methods We conducted a systematic review in EMBASE, MEDLINE, and Cochrane Central databases, yielding 1383 studies in the initial search. Inclusion criteria involved participants aged over 18 years and the use of next-generation 16s ribosomal sequencing methods.
Results We included 10 studies—seven focused on larynx sequencing and four on trachea sequencing (one investigated both sites). In a healthy larynx, diverse species such as Streptococcus, Cloacibacterium, Prevotella, and Helicobacter were found. Benign laryngeal diseases exhibited reduced microbial diversity, mainly dominated by Streptococcus. Subglottic stenosis patients showed diminished diversity in both idiopathic and iatrogenic scars. Laryngeal squamous cell carcinoma displayed increased diversity, primarily featuring Fusobacterium. Among non-respiratory-compromised surgery patients, the tracheal microbiome was more diverse in diabetics and those later developing lower respiratory infections. Pneumonia patients exhibited an abundance of Prevotella and Streptococcus, linked to an increased 28-day survival rate, while Streptococcus and Haemophilus abundance correlated with successful extubation.
Conclusions The laryngotracheal region hosts a unique microbial community influenced by both benign and malignant conditions. Many lesions remain unexplored, underscoring the need for future studies encompassing diverse laryngotracheal conditions. Clinical trials assessing microbiome modifications may unveil novel therapeutic avenues.
Level of EvidenceNA Laryngoscope, 134:4167–4175, 2024
Doreen Lam, Alex Fahmy, Alisa Timashpolsky, Neel Sangal, Ganesh Chandrasekaran, Melanie Cedrone, Kavita Dedhia
Publication date 10-09-2024
Objectives Systematically review of literature characterizing health-related quality of life (HRQoL) impact of surgery in pediatric otitis media (OM) patients, and meta-analysis of studies using the OM-6 questionnaire.
Data Sources Pubmed, EMBASE, Cochrane Library, Scopus.
Review MethodsA systematic review of literature of studies evaluating HRQoL outcomes for OM patients managed by surgery. Two investigators independently reviewed abstracts and full-length articles. Risk of bias was assessed using the MINORS criteria and Cochrane Risk of Bias 2 tool.
Results The search yielded 1272 studies, 50 underwent full-text review and 23 met inclusion criteria. Non-randomized studies were of moderate to good quality, while randomized trials had a high risk of bias. Age ranged from 6 months to 15 years. Race and socioeconomic factors were inconsistently reported. There were 11 HRQoL outcome measure instruments of which four were disease-specific. Eleven studies used OM-6 and nine were included in the meta-analysis. Pooled analysis of five studies showed a mean OM-6 change of 1.79 (95% CI: 1.53–2.06; 95% PI: 0.92–2.67; I2 = 68%) 4–6 weeks after surgery; a mean change of 1.87 (95% CI: 1.15–2.58; 98%) after 6 months across two studies; and a mean change of 1.64 (1.02 to 2.27; −6.35 to 9.64; 98%) after 9–13 months across three studies.
Conclusions There is no consistency in HRQoL instruments used to evaluate pediatric OM surgery outcomes in current literature with few RCTs. Meta-analysis showed a clinically significant large improvement in HRQoL 4–6 weeks after tympanostomy tube placement.
Level of EvidenceN/A Laryngoscope, 134:4176–4185, 2024
Ayesha Punjabi, Sthefano Araya, Grace Amadio, Theresa Webster, Sudeep Mutyala, Meagan Wu, Huaquing Zhao, Stephanie Roth, Adam Walchak, Sameer A. Patel
Publication date 10-09-2024
Chimeric flaps and multiple flaps are two techniques used for reconstructing complex head and neck defects, but they have not been extensively compared. In this large-scale meta-analysis, both approaches showed equivalent flap survival, as well as similar outcomes in terms of diet and speech resumption, rates of fistulization, and general complications. However, multiple flap patients had higher rates of operating room take-backs for anastomotic issues and longer hospital stays. Despite limitations in the literature, both chimeric and multiple flaps appear to be viable options for composite oral cavity defects.
Objectives Complex head and neck defects involving composite defects can be reconstructed using chimeric flaps or multiple flaps with separate anastomoses. Limited comparisons exist between chimeric and multiple flap reconstructions. We compare outcomes between chimeric and multiple flap reconstructions in oral cavity reconstruction.
Data Sources Pub Med (NLM), Embase (Elsevier), Web of Science (Clarivate Analytics), and Cochrane CENTRAL (Wiley).
MethodsA systematic review was conducted, including English articles reporting outcomes of oral cavity reconstruction with either chimeric flaps or multiple flaps. Data extraction included patient characteristics, flap type, and outcomes such as flap survival, partial flap loss, operating room time, hospital length of stay, and postoperative complications.
Results Forty-seven articles comprising 1435 patients were included. Notably, 552 patients underwent multiple flaps, while 883 received chimeric flaps. Meta-analysis revealed no statistically significant difference in flap survival between chimeric and multiple flap patients (98% vs. 99%, p = 0.198). Multiple flap patients had higher rates of operating room take-backs for anastomotic issues and longer hospital stays compared with chimeric flap patients. There were no significant differences in partial flap failure, resumption of diet and speech, need for subsequent flaps, fistula formation, or general complications.
Conclusion This large-scale meta-analysis demonstrates equivalent flap survival between chimeric and multiple flaps in the reconstruction of composite oral cavity defects. Both approaches appear to be safe and acceptable, with comparable outcomes in terms of diet and speech resumption, rates of fistulization, and general postoperative complications. Multiple flap patients had higher rates of operating room take-backs and longer hospital stays.
Level of EvidenceNA Laryngoscope, 134:4196–4202, 2024
Elena Cantone, Paolo Pezzella, Mario Brandon Russo
Publication date 10-09-2024
Marisa Dorling, Juan Carlos Hernaiz‐Leonardo, Athenea Pascual, Arif Janjua, Andrew Thamboo, Amin R. Javer
Publication date 10-09-2024
Amiti Jain, Zachary N. Goldberg, Erin Briggs, Dev R. Amin, Zachary D. Urdang, Richard A. Goldman, David M. Cognetti, Joseph M. Curry
Publication date 10-09-2024
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, 134:4278–4283, 2024
Jennifer M Siu, Shaunak N. Amin, Jessica Colyer, Cassie Horner, Aarti Bhat, Lyubomyr Bohuta, Titus Chan, John P. Dahl, Jennifer Fridgen, Kaalan Johnson, Caitlin Yip, Sanjay R. Parikh
Publication date 10-09-2024
Early results show that injection medialization is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery.
Background Unilateral vocal fold immobility (VFI) is a known cause of morbidity amongst children following congenital heart surgery. Injection medialization (IM) provides medial distraction and improves glottic closure. Limited objective data is available for the effect of IM in young children (<2 years-old) with VFI.
Methods Retrospective case series of infants <2 who underwent IM for VFI after congenital cardiac surgery. Primary outcome was objective reduced risk of aspiration based on Dysphagia and Outcome Severity Scores (DOSS) on Video swallow study (VFSS) performed prior to and within 4 weeks following IM. Secondary analysis included perioperative complications and number of children who were able to avoid NG or G tube placement.
Results17 children <2 years of age had unilateral VFI after congenital cardiac surgery and underwent IM. The median age at time of initial cardiac surgery was 6 days (IQR 3–7). There was no intraoperative or postoperative stridor or associated complications. All 17 patients had preoperative aspiration noted on VFSS. Average swallowing outcomes on VFSS improved after IM with an increase in DOSS score (preop score 3 (IQR 2–4) to postop score 6.5 (IQR 5–7) P = 0.001). At 2 months following IM, of the patients who had improvement in swallowing function, 50% (n = 6) were able to feed completely orally, 25% (n = 3) were fed orally with an NG wean, and 3 (25%) had a G tube placed.
Conclusion Initial results suggest that IM is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery.
Level of Evidence4 Laryngoscope, 134:4396–4401, 2024
Brian Hondorp, Nihal Punjabi, David Macias, Yuan Liu, Ethan Frank, Paul D. Kim, Jared C. Inman
Publication date 10-09-2024
While pathologic staging is considered the gold standard in head and neck cancers, clinical staging guides initial treatment plans and patient counseling. This study aims to identify specific stages and primary tumor subsites where discordance between clinical and pathologic staging is high. We found that T2 Oral Cavity, T2 Oropharynx, T3 Larynx, and N1 Lymph Node had the highest discordance while T1 Larynx, T4 Oropharynx, N0 Lymph Node, and N3 Lymph Node had the lowest.
Objective To enhance understanding in patterns of discordance between clinical and pathological T and N staging in multiple sites of head and neck squamous cell cancer.
MethodsA retrospective cohort of 580 newly diagnosed and surgically treated head and neck squamous cell carcinoma patients from a single institution over a 10-year period are presented. Clinical and pathologic staging are compared.
Results Notably, 33% of cases had staging discordance. Overall Cohens kappa agreement was κ = 0.55 (moderate agreement). Highly discordant site stages with κ < 0.
45 included: T2 oral cavity, T2 oropharynx, T3 larynx, and N1 lymph node. T2-4 oral cavity cancers were often overstaged, and more than one-third of T3 larynx cancers were understaged. Highly concordant site stages with κ>0.
65 included: T1 larynx, T4 oropharynx, N0 lymph node, and N3 lymph node.
Conclusion There exists a quantifiable and, in certain sites, clinically relevant pattern of discordance between clinical and pathologic staging. Tumor board multidisciplinary evaluation can highlight these discrepancies and aide in limiting effects on treatment decisions. However, discordant staging can affect the interpretation and application of prognostication, treatment, and data accuracy. Further investigation is warranted to improve clinical staging accuracy in areas of highest discordance.
Level of Evidence3 Laryngoscope, 134:4284–4291, 2024
Yan Huang, Mimi Xu, Xiaoli Sheng, Xixiang Gong, Bei Zhang, Shuling Huang, Liangsi Chen
Publication date 10-09-2024
CSCS, though uncommon, presents distinct regional involvement along with pathognomonic clinical and pathological features. CSCS is marked by a pale skin streak extending superiorly from the orifice—a diagnostic “skin streak sign.” Complete surgical excision constitutes an effective treatment modality for CSCS.
Objectives We encountered patients with a congenital cutaneous sinus tract in the sternoclavicular joint region, which we designate as “congenital sternoclavicular sinus (CSCS).” The aim of this investigation is to enhance recognition of this subtle yet noteworthy entity and develop standardized protocols for its management.
Patients and Methods Between 2013 and 2023, 172 patients, including 78 males and 94 females, were referred to our institution for the management of CSCS. Clinical charts were retrospectively reviewed.
Results The majority of patients (60.5%) were young children below 3 years of age, with only six adult patients and a median age of 27.5 months. The left side was implicated in 157 cases (91.3%). In 146 cases (84.9%), a faint skin streak was noted above the orifice. Yet, no pharyngeal sinus tracts were detected, either through barium swallow studies or direct laryngoscopy. All skin lesions featured a diminutive orifice near the sternoclavicular joint, with the tract extending deeply into the subcutaneous tissue and terminating blindly, short of entering the joint, after a distance of 10 mm (ranging from 5 to 21 mm). Histopathological analysis revealed that the epithelial lining predominantly consisted of stratified squamous epithelium (87.8%), with ciliated columnar epithelium accounting for the remaining 12.2%.
ConclusionsCSCS, though infrequent, presents with distinctive pathological and clinical features. The condition predominantly affects the left sternoclavicular joint region, with the notable “skin streak sign” aiding in diagnosis. We considered CSCS as one disease entity of branchial arch anomalies. Complete surgical excision offers a definitive cure.
Level of Evidence4 Laryngoscope, 134:4402–4408, 2024
Dedi Kong, Wei Li, Pei Zhou, Yibo Zhang, Chunfu Dai
Publication date 10-09-2024
A novel classification of FBCAs based on the relationship between lesions and the facial nerve in term of radiographic imaging findings was defined, and the corresponding surgical managements was introduced.
Objective To define a novel classification of first branchial cleft anomalies (FBCAs) based on the relationship between lesions and the facial nerve in terms of radiographic imaging findings and to introduce the corresponding surgical managements.
Methods The clinical data were retrospectively reviewed. Novel classification was proposed according to the head–neck MRI findings and surgical records. FBCAs limited in the cartilaginous segment of external auditory canal (EAC) or superficial parotid gland capsule were classified as type A. Lesions close to the FN and(or) involved into the parotid gland with no scar formation and no previous parotidectomy were classified as type B. FBCAs adhered to the FN and(or) invaded the parotid gland with scar formation due to previous surgery were classified as type C. Appropriate surgery approaches was also described, which was correlated with classification.
Results Fifty-one patients were included, and one patient suffered from bilateral lesions. Thirty-one, twelve, and nine lesions were classified as type A, type B, and type C FBCAs, respectively. One type A patient (1.92%) suffered from recurrence during follow-up. Temporary facial palsy (House-Brackmann II) was identified in 2 type C patients (3.85%) after surgery and recovered to normal within 2 months. One type B patient (1.92%) suffered from facial paralysis due to the FN injury and underwent facial nerve graft simultaneously. No patients with type C complained of hearing loss postoperatively.
Conclusion This novel classification clearly illustrates definitely relationship between lesion and the facial nerve and appropriate surgical strategies were proposed based on the novel classification.
Level of Evidence4 Laryngoscope, 134:4246–4251, 2024
Sul G. Kim, Mark M. Mims, Denna C. Menapace, Taylor Stack, William W. Shockley, J. Madison Clark
Publication date 10-09-2024
Functional rhinoplasty surgical techniques continue to evolve to address nasal valve compromise (NVC), but less is known about its underlying causes. This study found decreased glycosaminoglycan and increased collagen in the dorsal septal articulation cartilage of patients diagnosed with NVC.
Introduction Nasal valve compromise is a common issue for patients presenting to an otolaryngologist. Anatomically, the dorsal septal cartilage (DSA) articulates with the upper lateral nasal cartilage (ULC). When the ULC weakens, it is prone to collapse and may result in nasal obstruction. Our objectives were to analyze histological differences between quadrangular and DSA nasal cartilages and compare histological composition of these tissues among patients with diagnosis of nasal valve compromise (NVC) versus those without NVC (no NVC).
Methods Prospective cross-sectional study of nasal cartilages from seventy-three (73) live donors. Quadrangular cartilage (QC), and DSA from patients undergoing septorhinoplasty were collected. Safranin O histochemical staining was used to observe glycosaminoglycans (GAGs) content and cell count. Massons Trichrome staining was used to assess collagen content in these nasal cartilages.
Results Mean GAG content was lower in DSA compared with QUAD cartilage (68.18% vs. 87.22%, p < 0.0001), and was lowest in DSA of patients with NVC (59.07%). Mean collagen content was higher in DSA compared with QUAD cartilage, (65.43% vs. 46.65%, p = 0.0002), and was highest in DSA of patients with NVC (74.86%).
Conclusion The DSA showed decreased GAG and increased collagen content compared with quadrangular cartilage. Within the DSA subsite, patients with presurgical NVC had the lowest GAG and highest collagen levels. This observation suggests that the biochemical composition of the DSA may contribute to its weakening, potentially resulting in its inability to withstand minor trauma and/or the effects of aging, ultimately leading to NVC.
Level of EvidenceN/A Laryngoscope, 134:4252–4258, 2024
Dorsa Mousa‐Doust, Anat Bahat Dinur, Sena Turkdogan, J. Scott Durham, Donald Anderson, Eitan Prisman
Publication date 10-09-2024
This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flapdonor site using the Patient-Observer Scar Assessment Scale and Michigan Hand Outcome Questionnaire. In total, 81 patients participated in the study (39 STSG patients and 42 hatchet flap patients). STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure.
Background This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site.
Methods Patients with RFFF (2015–2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ).
Results198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165).
ConclusionsSTSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure.
Level of Evidence3 Laryngoscope, 134:4266–4273, 2024
Laura Mafla, Raymond J. So, Samuel L. Collins, Yee Chan‐Li, Ioan Lina, Kevin M. Motz, Alexander T. Hillel
Publication date 10-09-2024
Large animal models are needed to assess novel therapies for laryngotracheal stenosis (LTS) prior to human translation. In this manuscript, we describe a large ovine model for LTS and show that airway stenosis can be reliably and safely produced via combined chemo-mechanical injury. We additionally show that stent placement is feasible and safe.
Objectives Animal models for laryngotracheal stenosis (LTS) are critical to understand underlying mechanisms and study new therapies. Current animal models for LTS are limited by small airway sizes compared to human. The objective of this study was to develop and validate a novel, large animal ovine model for LTS.
Methods Sheep underwent either bleomycin-coated polypropylene brush injury to the subglottis (n = 6) or airway stent placement (n = 2) via suspension microlaryngoscopy. Laryngotracheal complexes were harvested 4 weeks following injury or stent placement. For the airway injury group, biopsies (n = 3 at each site) were collected of tracheal scar and distal normal regions, and analyzed for fibrotic gene expression. Lamina propria (LP) thickness was compared between injured and normal areas of trachea.
Results No mortality occurred in sheep undergoing airway injury or stent placement. There was no migration of tracheal stents. After protocol optimization, LP thickness was significantly increased in injured trachea (Sheep #3: 529.0 vs. 850.8 um; Sheep #4: 933.0 vs. 1693.2 um; Sheep #5: 743.7 vs. 1378.4 um; Sheep #6: 305.7 vs. 2257.6 um). A significant 62-fold, 20-fold, 16-fold, 16-fold, and 9-fold change of COL1, COL3, COL5, FN1, and TGFB1 was observed in injured scar specimen relative to unaffected airway, respectively.
Conclusion An ovine LTS model produces histologic and transcriptional changes consistent with fibrosis seen in human LTS. Airway stent placement in this model is safe and feasible. This large airway model is a reliable and reproducible method to assess the efficacy of novel LTS therapies prior to clinical translation.
Level of EvidenceN/A Laryngoscope, 134:4239–4245, 2024
Sung Jun Han, Sung Kyun Kim, Seok Min Hong
Publication date 10-09-2024
This was the first study investigating small non-coding RNAs in human acquired cholesteatoma using NGS technique. We were able to identify new miRNAs and pathways related to cholesteatoma.
Objectives/Hypothesis The pathophysiology of cholesteatoma is not precisely understood, and research on the associated microRNAs (miRNAs) is also deficient. We demonstrated the expression of miRNA in normal skin and middle ear cholesteatoma by next-generation sequencing (NGS) technology. The profiles of miRNA and relevant molecular interaction pathways were investigated.
Study Design Case–control experimental study.
Methods Middle ear cholesteatoma and post-auricular skin tissue specimens were collected from 13 adult patients. Total RNA was extracted, and miRNA expression profiles were analyzed by NGS technology. Functional gene classification to predict target genes and relevant biological pathways was performed using DIANA-microT-CDS and the Kyoto Encyclopedia Gene and Genome database (KEGG) pathways.
Results The expression of 2588 miRNAs from middle ear cholesteatoma and skin tissue samples was analyzed. The expression of 76 upregulated and 128 downregulated miRNAs was identified in the cholesteatoma samples compared to normal skin (FC ≥2 and p < 0.05). Ninety-nine differentially expressed miRNAs (FC ≥4 and p < 0.05) were used to explore the biological pathways involved in the etiopathogenesis of cholesteatoma. The most predicted pathway in cholesteatoma in the upregulated miRNA group was the ErbB signaling pathway and it was extracellular matrix (ECM)–receptor interaction in the downregulated miRNA group.
Conclusions This was the first study investigating small miRNAs in human acquired cholesteatoma using NGS technique. We were able to identify new miRNAs and pathways related to cholesteatoma. The results of this study are expected to be helpful in revealing new pathophysiologies of cholesteatoma.
Level of EvidenceN/A Laryngoscope, 134:4374–4382, 2024
Sharon Tzelnick, John R. de Almeida, Christopher M.K.L. Yao, Seth Kibel, Nathan Kuehne, Rajan Grewal, Marcus O Butler, Sam Saibil, Anna Spreafico, Alexandra Easson, David P Goldstein
Publication date 10-09-2024
Objective Stage 3 patients with clinically positive nodal metastasis are treated with therapeutic neck dissection and adjuvant systemic therapy. The aim of our study was to examined the predictability of pre-operative CT as a nodal drainage assessment tool.
Methods Retrospective review of all patients with clinically positive head and neck cutaneous melanoma between 2010 and 2019. Clinical disease was diagnosed as radiological suspicious, biopsy-proven node. A pre-operative CT evaluation for nodal metastasis was compared to pathology report.
ResultsA total of 53 patients were included. Forty patients (75.5%) were males with a mean age of 59 (SD 15.52). The majority of patients (26.4%) had an unknown primary site. The most common sites for primary were the cheek in eight patients (15.1%) followed by forehead (9.4%) and lateral neck (9.4%). Preoperative CT predicted nodal disease in 84.6% of cases. The primary region that mainly failed from the previously described clinical prediction was the upper anterior neck with 83.3% parotid involvement. A total of 10 patients (18.9%) were diagnosis with non-clinical nodes on pathology with a median non-clinical node of 1 (range 1–2). Of them, 9 (90%) were in the same clinical levels detected by CT. Pre-operative CT was associated with a neck level accuracy of 98.1%.
Conclusion Stage 3 head and neck melanoma with clinically positive nodal metastasis that are eligible for an adjuvant systemic treatment, may benefit from a highly selective neck dissection according to their pre-operative imaging studies. This should be further evaluated in a large-scale clinical trial.
Level of Evidence3 Laryngoscope, 134:4292–4297, 2024
Gianluca Sampieri, John Tran, Allen L. Feng, Anne Agur, Joel Davies
Publication date 10-09-2024
The medial sural artery perforator flap (MSAP) is a versatile free flap used for reconstruction of oral cavity defects. However, anatomy of the cutaneous perforators has not been well studied. Anatomical characterization of the MSAP flap using 3D analysis can assist reconstructive surgeons in understanding the relevant anatomy and optimizing the surgical technique for MSAP flap harvest.
Objectives The medial sural artery (MSA) perforator flap is a versatile free flap. However, the cutaneous perforators are not well characterized.
The objectives of this pilot anatomical study were to: (1) visualize in three-dimensions, as in-situ, the origin, course, and distribution of the cutaneous perforators, (2) characterize the number and frequency of the perforators, and (3) quantify mean pedicle length.
Methods Thirteen cadaveric specimens were dissected, digitized, and modeled in 3D. Three-dimensional models and dissection photographs were used to determine the origin, course, number, distribution, and pedicle length of MSA perforators.
Results The most common pattern consisted of three perforators (39% of specimens). The maximum number of perforators identified was four (23%). The majority of specimens (92%) had a cutaneous perforator originating from the lateral branch of the MSA and coursed most frequently in the second (43%) and third (37%) quartiles of the length of the tibia. Mean pedicle length was 19.1 ± 6.9 cm. Perforators originating from the medial branch of the MSA were significantly (p < 0.05) shorter than those from the lateral branch and were found to course only in the first quartile.
Conclusion The 3D models constructed in this study provide a comprehensive overview of the location and course of the perforators, enabling measurement of parameters in 3D-space. Anatomical characterization of the MSA perforator flap using 3D analysis can assist reconstructive surgeons in understanding the relevant anatomy and optimizing the surgical technique for flap harvest.
Level of EvidenceN/A Laryngoscope, 134:4298–4303, 2024
Zao M. Yang, Ronit Malka, Dylan Z. Erwin, Gregory Postma
Publication date 10-09-2024
Thyroarytenoid myomectomy demonstrated significant improvement in patient reported outcomes from bilateral vocal fold immobility while not significantly altering glottal structure. Data from this study suggest thyroarytenoid myomectomy improves dyspnea symptoms in patients with bilateral vocal fold immobility without impairing voice.
Introduction Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice.
Methods Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre- and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t-tests when normality was confirmed with Shapiro–Wilk test and otherwise with Wilcoxon signed-rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC).
Results Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index-10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83–0.95).
ConclusionsTAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice.
Level of Evidence4 Laryngoscope, 134:4307–4312, 2024
Khodayar Goshtasbi, Theodore V. Nguyen, Karthik R. Prasad, Ellen M. Hong, Naya Sterritt, Katelyn K. Dilley, Konrad Kozlowski, Alexis Ha, Brian J.F. Wong
Publication date 10-09-2024
Chondrocyte viability was similar between 1 mm diced cartilage, scaled cartilage, and positive control samples. Conversely, pate cartilage samples had significantly less viability compared to positive controls, diced samples, and scaled samples, and it had similar chondrocyte viability compared to negative controls. On computational modeling, cartilage viability decreased to 50%, 26%, and 11% as the diced sample was cut from 1 mm edge length to 0.7–0.8 mm, 0.55–0.65, and 0.4–0.5. Similarly, cartilage viability decreased to 26% at 0.55–0.65 mm, 11% at 0.4–0.5 mm, and <5% at <0.4 mm edge length.
Introduction The physical modification of cartilage grafts during rhinoplasty risks chondrocyte death at the margins where the tissue is cut. This study compares chondrocyte viability between diced, scaled, and pate samples in human models, and further computes percent chondrocyte viability as a function of sequential dicing size in a computational model.
Methods Septal cartilage from 11 individuals was prepared as follows: diced (1 mm cubic), scaled (shaved to <1 mm thickness ~ translucent), pate (0.02 g of scraped cartilage surface), positive control (2 × 2 mm diced), and negative control (2 × 2 mm diced soaked in 70% EtOH). Viability analysis was performed using Live/Dead assay™ and confocal microscopy. Numerical simulation of cartilage dicing in 0.05 mm increments was performed using MATLAB assuming 250 chondrocytes/mm3 with each average chondrocyte size of 65 μm2.
Results Chondrocyte viability was similar between 1 mm diced cartilage, scaled cartilage, and positive control samples (p > 0.05). Conversely, pate samples had significantly less viability compared to positive controls, diced samples, and scaled samples (all p < 0.01 after Bonferroni correction). Pate samples had similar chondrocyte viability compared to negative controls (p = 0.36). On computational modeling, cartilage viability decreased to 50% as the diced sample was cut from 1 mm edge length to 0.7–0.8 mm. Similarly, cartilage viability decreased to 26% at 0.55–0.65 mm, 11% at 0.4–0.5 mm, and <5% at <0.4 mm edge length.
Conclusion Modifying septal cartilage grafts into 1 mm diced or scaled samples maintains ideal chondrocyte viability whereas pate preparations result in significant chondrocyte death. According to computational analysis, chondrocyte viability sharply decreases as the cartilage is diced below 0.7–0.8 mm.
Level of EvidenceN/A Laryngoscope, 134:4259–4265, 2024
M. Matthijs Fockens, Yousif Dawood, Mika J. Zwart, Daniël Docter, Jaco Hagoort, Frederik G. Dikkers, Bernadette S. de Bakker
Publication date 10-09-2024
Micro-CT of the trachea in Down syndrome and non-Down syndrome fetuses showed that morphology is similar between 13 and 21 weeks of gestation. The narrowed tracheal diameter characteristic for Down syndrome may occur later in fetal development or results from postnatal intubation trauma. The narrowest part of the trachea is in majority of fetuses the middle third.
Objectives Down syndrome (DS) is associated with airway abnormalities including a narrowed trachea. It is uncertain whether this narrowed trachea in DS is a consequence of deviant fetal development or an acquired disorder following endotracheal intubation after birth. This study aimed to compare the tracheal morphology in DS and non-DS fetuses using microfocus computed tomography (micro-CT).
Methods Twenty fetal samples were obtained from the Dutch Fetal Biobank and divided into groups based on gestational age. Micro-CT images were processed to analyze tracheal length, volume, and cross-sectional area (CSA).
Results Mean tracheal length and tracheal volume were similar in DS and non-DS fetuses for all gestational age groups. Mean, minimum, and maximal tracheal CSA were statistically significantly increased in the single DS fetus in the group of 21–24 weeks of gestation, but not in other gestational age groups. In 90% of all studied fetuses, the minimum tracheal CSA was located in the middle third of the trachea.
Conclusion Tracheal development in DS fetuses was similar to non-DS fetuses between 13 and 21 weeks of gestation. This suggests that the narrowed tracheal diameter in DS children may occur later in fetal development or results from postnatal intubation trauma. The narrowest part of the trachea is in majority of DS and non-DS fetuses the middle third.
Level of Evidence3 Laryngoscope, 134:4389–4395, 2024
Jeffrey R. Bellinger, Minhie W. Kwak, Gabriel A. Ramos, Jeffrey S. Mella, Jose L. Mattos
Publication date 10-09-2024
This study is the first to quantitatively analyze and compare the treatment of epistaxis, chronic sinusitis, sinus infection, allergic rhinitis, allergies, and nasal polyps across chatbots ChatGPT, ChatGPT Plus, Google Bard, and Microsoft Bing. The responses were analyzed on domains of readability, quality, understandability, actionability, accuracy, and comprehensiveness. On aggregate of the tested domains, our results suggest ChatGPT Plus and Google Bard are the most patient-friendly chatbots for the treatment of common pathologies in rhinology.
Objectives Understanding the strengths and weaknesses of chatbots as a source of patient information is critical for providers in the rising artificial intelligence landscape. This study is the first to quantitatively analyze and compare four of the most used chatbots available regarding treatments of common pathologies in rhinology.
Methods The treatment of epistaxis, chronic sinusitis, sinus infection, allergic rhinitis, allergies, and nasal polyps was asked to chatbots ChatGPT, ChatGPT Plus, Google Bard, and Microsoft Bing in May 2023. Individual responses were analyzed by reviewers for readability, quality, understandability, and actionability using validated scoring metrics. Accuracy and comprehensiveness were evaluated for each response by two experts in rhinology.
Results ChatGPT, Plus, Bard, and Bing had FRE readability scores of 33.17, 35.93, 46.50, and 46.32, respectively, indicating higher readability for Bard and Bing compared to ChatGPT (p = 0.003, p = 0.008) and Plus (p = 0.025, p = 0.048). ChatGPT, Plus, and Bard had mean DISCERN quality scores of 20.42, 20.89, and 20.61, respectively, which was higher than the score for Bing of 16.97 (p < 0.001). For understandability, ChatGPT and Bing had PEMAT scores of 76.67 and 66.61, respectively, which were lower than both Plus at 92.00 (p < 0.001, p < 0.001) and Bard at 92.67 (p < 0.001, p < 0.001). ChatGPT Plus had an accuracy score of 4.39 which was higher than ChatGPT (3.97, p = 0.118), Bard (3.72, p = 0.002), and Bing (3.19, p < 0.001).
Conclusion On aggregate of the tested domains, our results suggest ChatGPT Plus and Google Bard are currently the most patient-friendly chatbots for the treatment of common pathologies in rhinology.
Level of EvidenceN/A Laryngoscope, 134:4225–4231, 2024
Alexandra E. Quimby, Jason A. Brant, Jeffrey P. Staab, Michael J. Ruckenstein
Publication date 10-09-2024
We describe the development and validation of a questionnaire for the assessment of quality of life in Menieres disease, the MenQOL. The MenQOL is a simple, valid patient-reported outcome measure, which may be used to assess the effects of treatment on disease-specific quality of life in patients with Menieres disease.
Objective To design and validate a disease-specific quality of life instrument for Menieres disease.
Methods We used a sequential process of expert input, patient focus groups, and analyses of responses to draft questionnaires to create a 24-item Menieres disease quality of life (MenQOL) instrument. The MenQOL and the SF-36v2 were administered to a cohort of 50 patients with Menieres disease and 60 comparison patients with tinnitus, vertigo, or hearing loss from other causes identified at a tertiary academic center. We performed exploratory factor analysis, Cronbachs α, between group comparisons of total MenQOL scores, and regression analyses between the MenQOL and SF-36v2 to evaluate the instruments factor structure, internal consistency, face validity, and external validity. Segregation of the instrument into domains was assessed by exploratory factor analysis.
Results Exploratory factor analysis revealed that the MenQOL has a single domain. Cronbachs α = 0.914 indicated high internal consistency for the instrument as a whole. Mean MenQOL scores showing significantly worse quality of life among patients with Menieres disease than comparison participants (52.5 ± 15.8 vs. 43.2 ± 12.6; p = 0.0051), indicating good construct validity. Significant inverse relationships in bivariate linear regressions between total MenQOL scores and SF-36v2 physical (slope = −0.94, p < 0.0001) and mental (slope = −1.16, p < 0.0001) composite scores showed acceptable concurrent validity.
Conclusions We have described the initial development of the MenQOL, a simple, valid patient-reported outcome measure that, subject to further study, may be used to assess the effects of treatment on disease-specific quality of life in patients with Menieres disease.
Level of Evidence3 Laryngoscope, 134:4351–4357, 2024
Ivette Cejas, David H. Barker, Esteban Petruzzello, Christina M. Sarangoulis, Alexandra L. Quittner
Publication date 10-09-2024
This study estimated costs of severe to profound hearing loss, including costs and cost-savings associated with cochlear implantation. The estimated lifetime cost of an individual born with severe to profound hearing loss is $484,274 with costs being lower for those who received a cochlear implant before 18 months of age compared to those who did not receive an implant. The annual societal costs for the US population with severe to profound hearing loss were estimated to be $37 billion.
Objective To estimate costs of severe to profound hearing loss, including costs and cost-savings associated with cochlear implantation.
Methods Data was obtained from the National Health Interview Survey, the National Health and Nutrition Examination Survey and national Medicare rates.
We used continuous time state transition models with individual patient simulations to estimate the costs of severe to profound hearing loss (SPHL) across the lifespan. The model included four states, normal hearing, severe to profound hearing loss, cochlear implantation, and death.
Results The estimated lifetime cost of an individual born with SPHL is $489,274 377,518; 616,519. Costs are lower for those who received a cochlear implant before 18 months of age $390,931 311,976; 471,475, compared to those who are not implanted $608,167 442,544; 791,719. For individuals with a later onset of hearing loss (60 years old) lifetime costs were $154,536 7,093; 302,936. The annual societal costs for the US population were estimated to be $37 8; 187 billion.
ConclusionsSPHL is a costly condition, with the primary driver being lost productivity. Medical costs were higher for cochlear implantation, however, the higher income earnings offset the higher medical costs. Overall, early implantation substantially reduced lifetime costs. Access to hearing health care and technology is critical given the documented benefits for language, education, and quality of life. Government and insurance policies should be modified to allow for equal access and coverage for hearing technology, which will ultimately reduce lifetime and societal costs.
Levels of Evidence: N/A The current study used existing nationally representative datasets. Thus, these levels of evidence do not apply. Laryngoscope, 134:4358–4365, 2024
Haoyang Wu, Wenting Deng, Yuelian Luo, Yaodong Xu, Hao Xiong
Publication date 10-09-2024
(1) This study is the pioneering effort employing Mendelian Randomization (MR) analysis to elucidate the relationship between lipids, statins, and sensorineural hearing loss (SNHL). (2) Our findings establish a causal link between elevated triglyceride levels and an increased risk of SNHL. (3) Although statins have demonstrated potential in reducing the risk of SNHL, their primary mechanism of action might not solely hinge on lowering triglycerides.
Background Recent insights suggest that lipids and statin medication play a role in the development of sensorineural hearing loss (SNHL), yet the exact role remains controversial. This research applied Mendelian randomization (MR) to assess whether lipids and statin medication are associated with an increased risk of SNHL.
MethodsA two-sample MR was used in this study. Genetic instruments were constructed from variants associated with risk factors. Data for lipids and statin medication were obtained from the IEU OpenGWAS project, and for SNHL from the Finngen research project, which comprises 32,487 individuals with SNHL and 331,736 control individuals.
Results Genetically predicted higher levels of triglycerides were associated with an increased risk of SNHL. The use of genetically predicted atorvastatin was associated with a lower risk of SNHL. Rosuvastatin has demonstrated potential in treating SNHL, yet further investigations are warranted to elucidate its relationship with SNHL. Insufficient evidence was available to suggest that the genetically predicted level of high-density lipoprotein cholesterol or low-density lipoprotein cholesterol or the use of simvastatin were associated with SNHL.
Conclusions The study provides genetic evidence suggesting that increased levels of triglycerides in the blood could be a risk factor for SNHL and that the use of certain statin medications, including atorvastatin and rosuvastatin, could reduce the risk of SNHL. These results align with findings from previous observational studies that have linked hyperlipidemia with the risk of SNHL.
Level of Evidence According to the Oxford Centre for Evidence-Based Medicine 2011 levels of Evidence, the study has a third level of Evidence Laryngoscope, 134:4366–4373, 2024
Ann‐Kathrin Frenken, Matti Sievert, Bharat Panuganti, Marc Aubreville, Till Meyer, Agmal Scherzad, Thomas Gehrke, Matthias Scheich, Stephan Hackenberg, Miguel Goncalves
Publication date 10-09-2024
This study aimed to evaluate the feasibility of using optical biopsy with confocal laser endomicroscopy to distinguish between benign and malignant mucosa during endoscopic sinonasal surgery. Our results demonstrated that healthy and inflamed mucosa could be differentiated from malignant lesions with an accuracy of 84.1%, a sensitivity of 85.4%, and a specificity of 83.1%, along with substantial interrater agreement (Fleiss κ = 0.62).
Objective Confocal laser endomicroscopy (CLE) is an optical imaging technique that allows in vivo, real-time, microscope-like assessment of superficial lesions. Although there is substantial data on CLE use in the upper GI tract, there is limited information regarding its application in the nasal cavity and paranasal sinuses. This study aims to assess the feasibility and diagnostic metrics of CLE in the nasal cavity and paranasal sinuses regarding differentiation between healthy/benign and malignant tissue. These structures show, however, a wider variety of frequent and concomitant benign and malignant pathologies, which could pose an increased challenge for optical biopsy by CLE.
Methods We performed CLE on a case series of six patients with various findings in the nose (three chronic rhinosinusitis, adenocarcinoma, meningoenzephalozele, esthesionneuroblastoma). Forty-two sequences (3792 images) from various structures in the nasal cavity and/or paranasal sinuses were acquired. Biopsies were taken at corresponding locations and analyzed in hematoxylin and eosin staining as a standard of reference. Three independent examiners blinded to the histopathology assessed the sequences.
Results Healthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss κ = 0.62).
Conclusion This technique shows, despite its limitations, potential as an adjunctive imaging technique during sinus surgery; however, the creation of a scoring system based on reproducible and defined characteristics in a larger more diverse population should be the focus of further research to improve its diagnostic value and clinical utility.
Level of EvidenceNA Laryngoscope, 134:4217–4224, 2024
Lirit Levi, Shany Havazelet, Anner Moskovitz, Ethan Soudry
Publication date 10-09-2024
Some post-radiotherapy patients experience complete obliteration of the sphenoid or frontal sinuses, supposedly posing a risk for sinusitis or mucocele development. The objective is to comprehensively assess the natural history and outcomes of radiation-induced complete isolated sinus opacification. Our study revealed that a substantial number of post-radiation patients develop complete isolated sinus opacification, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up.
Objective Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO).
MethodsA retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients medical records. Only patients with at least 12 months of follow-up and available imaging for review were included.
Results Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification.
Conclusion Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up.
Level of Evidence4 Laryngoscope, 134:4232–4238, 2024
Alexander S. Homer, Viknesh S. Kasthuri, Benjamin J. Homer, Rishubh Jain, Emily K. Gall, Kathryn Y. Noonan
Publication date 10-09-2024
Objectives The effect of Medicaid expansion as a part of the Affordable Care Act on vestibular schwannoma (VS) incidence overall and in marginalized populations has not yet been elucidated. The goal of this study was to determine if Medicaid expansion was associated with increases in VS incidence overall, as well as in patients of non-white race or in counties of low socioeconomic status (SES).
Methods We performed a difference-in-difference (DiD) analysis from January 1st 2010–December 31st 2017 utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Our DiD method compared the change in VS rate between counties that did and did not expand Medicaid among patients of white and non-white race, in low and high SES counties, before and after expansion.
Results The study included 17,312 cases across 1020 counties. Medicaid expansion was associated with a 15% increase (incidence rate ratio 95% CI: 11%, 19) in VS incidence. White populations saw a 10% increase (CI: 1.06, 1.19), Black populations saw a 20% increase (CI: 1.10, 1.29), and patients of other races saw a 44% increase in incidence associated with expansion (CI: 1.21, 1.70). Low SES counties saw an increase in incidence 1.12 times higher than that of high SES counties (CI:1.04, 1.20).
Conclusion Medicaid expansion was associated with increases in VS incidence across populations. Furthermore, this increase was more evident in disadvantaged populations, such as patients of non-white race and those from low SES counties. These findings emphasize the impact of Medicaid expansion on healthcare utilization for VS diagnosis.
Level of Evidence3—Retrospective Cohort Study Laryngoscope, 134:4383–4388, 2024
Cheng‐Wei Tie, De‐Yang Li, Ji‐Qing Zhu, Mei‐Ling Wang, Jian‐Hui Wang, Bing‐Hong Chen, Ying Li, Sen Zhang, Lin Liu, Li Guo, Long Yang, Li‐Qun Yang, Jiao Wei, Feng Jiang, Zhi‐Qiang Zhao, Gui‐Qi Wang, Wei Zhang, Quan‐Mao Zhang, Xiao‐Guang Ni
Publication date 10-09-2024
In our study, we trained a multi-instance learning (MIL)-based artificial intelligence (AI) model on multi-center white light imaging (WLI) and narrow band imaging (NBI) images. This model aims to assist in distinguishing the benign or malignant nature of vocal fold leukoplakia (VFL).
Objectives Vocal fold leukoplakia (VFL) is a precancerous lesion of laryngeal cancer, and its endoscopic diagnosis poses challenges. We aim to develop an artificial intelligence (AI) model using white light imaging (WLI) and narrow-band imaging (NBI) to distinguish benign from malignant VFL.
MethodsA total of 7057 images from 426 patients were used for model development and internal validation. Additionally, 1617 images from two other hospitals were used for model external validation. Modeling learning based on WLI and NBI modalities was conducted using deep learning combined with a multi-instance learning approach (MIL). Furthermore, 50 prospectively collected videos were used to evaluate real-time model performance. A human-machine comparison involving 100 patients and 12 laryngologists assessed the real-world effectiveness of the model.
Results The model achieved the highest area under the receiver operating characteristic curve (AUC) values of 0.868 and 0.884 in the internal and external validation sets, respectively. AUC in the video validation set was 0.825 (95% CI: 0.704–0.946). In the human-machine comparison, AI significantly improved AUC and accuracy for all laryngologists (p < 0.05). With the assistance of AI, the diagnostic abilities and consistency of all laryngologists improved.
Conclusions Our multicenter study developed an effective AI model using MIL and fusion of WLI and NBI images for VFL diagnosis, particularly aiding junior laryngologists. However, further optimization and validation are necessary to fully assess its potential impact in clinical settings.
Level of Evidence3 Laryngoscope, 134:4321–4328, 2024
Zufei Li, Jinghui Lu, Baiwen Zhang, Joshua Si, Hong Zhang, Zhen Zhong, Shuai He, Wenli Cai, Tiancheng Li
Publication date 10-09-2024
The current diagnosis and treatment of vocal cord leukoplakia is relatively chaotic, lacking effective high-risk assessment methods. This study established and validated a model for vocal cord leukoplakia risk stratification, it not only has high accuracy, but also has been developed into a public prediction platform, which can be used and tested by everyone, and has strong practicality. This study may provide significant assistance to otolaryngologists in the treatment of vocal cord leukoplakia.
Objective To extract texture features from vocal cord leukoplakia (VCL) images and establish a VCL risk stratification prediction model using machine learning (ML) techniques.
MethodsA total of 462 patients with pathologically confirmed VCL were retrospectively collected and divided into low-risk and high-risk groups. We use a 5-fold cross validation method to ensure the generalization ability of the model built using the included dataset and avoid overfitting. Totally 504 texture features were extracted from each laryngoscope image. After feature selection, 10 ML classifiers were utilized to construct the model. The SHapley Additive ex Planations (SHAP) was employed for feature analysis. To evaluate the model, accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were utilized. In addition, the model was transformed into an online application for public use and further tested in an independent dataset with 52 cases of VCL.
ResultsA total of 12 features were finally selected, random forest (RF) achieved the best model performance, the mean accuracy, sensitivity, specificity, and AUC of the 5-fold cross validation were 92.2 ± 4.1%, 95.6 ± 4.0%, 85.8 ± 5.8%, and 90.7 ± 4.9%, respectively. The result is much higher than the clinicians (AUC between 63.1% and 75.2%). The SHAP algorithm ranks the importance of 12 texture features to the model. The test results of the additional independent datasets were 92.3%, 95.7%, 90.0%, and 93.3%, respectively.
Conclusion The proposed VCL risk stratification prediction model, which has been developed into a public online prediction platform, may be applied in practical clinical work.
Level of Evidence3 Laryngoscope, 134:4329–4337, 2024
Margaret Nurimba, Megha Sheth, Mark Swanson, Tamara Chambers
Publication date 10-09-2024
This cross-sectional study of differentiated thyroid carcinoma patients in the National Cancer Database demonstrates significant racial differences in disease presentation, treatment, and survival outcomes. The Affordable Care Act Medicaid was associated with improved survival outcomes.
Objective To assess the impact of race and the Affordable Care Act (ACA) of 2010 on disease presentation and overall survival for patients with well-differentiated thyroid carcinoma.
Study Design Cross-sectional study of patients (n = 51,078) who underwent partial or total thyroidectomy with or without postoperative radioactive iodine (RAI) for well-differentiated thyroid carcinoma between 2004 and 2018 in the National Cancer Database (NCDB).
Methods Cumulative survival (CS) was assessed with Cox proportional hazard regression analyses.
Results There were significant disparities in disease presentation at the time of diagnosis, with Black, Asian/Pacific Islander (API), and Hispanic patients were more likely to have metastatic disease (p < 0.001) and higher TNM stage (p < 0.001) at the time of diagnosis compared to White patients. Black patients had significantly increased risk of death (HR 1.147, 95%CI 1.021–1.289) but API patients had improved CS (HR 0.730, 95% CI 0.608–0.877) compared to White patients. Passage of the ACA was associated with lower risk of mortality, regardless of whether patients lived in states that did not expand Medicaid (HR 0.866, 95% CI 0.823–0.910) or whether they lived in expansion states (HR 0.818, 95% CI 0.758–0.884).
Conclusion Racial disparities significantly impact thyroid carcinoma diagnosis and treatment in the United States but have improved over time. Both expansion and non-expansion states had improved survival outcomes over time, and suggesting analysis of the ACAs long-term impact and ability to address health inequities is still warranted.
Level of Evidence3 Laryngoscope, 134:4421–4430, 2024
Estephania Candelo, Peter C. Belafsky, Mauricio Corrales, D. Gregory Farwell, Luis F. Gonzales, Maciej Grajek, Dominik A. Walczak, Marshall Strome, Robert R. Lorenz, Luis F. Tintinago, Maria A. Velez, William Victoria, Martin Birchall
Publication date 10-09-2024
Laryngeal transplantation is a complex procedure with significant morbidity but offers improved quality of life for selected patients with end-stage laryngeal disorders. An international registry is recommended for better quality pooled data. Future advancements may expand its application.
Background The loss of laryngeal function affects breathing, swallowing, and voice, thus severely compromises quality of life. Laryngeal transplantation has long been suggested as a solution for selected highly affected patients with complete laryngeal function loss.
Objective To obtain insights regarding the advantages, weaknesses, and limitations of this procedure and facilitate future advances, we collected uniform data from all known laryngeal transplants reported internationally.
MethodologyA case series. Patients were enrolled retrospectively by each institutional hospital or clinic. Eleven patients with complete loss of laryngeal function undergoing total laryngeal transplantation between 1998 and 2018 were recruited.
Results After a minimum of 24 months follow-up, three patients had died (27%), and there were two graft explants in survivors, one total and one partial, due to chronic rejection. In the remaining cases, voice was functional in 62.5% and 50% achieved decannulation. Swallowing was initially restricted, but only one patient was gastrostomy-dependent by 6 months and all had normal or near-normal swallowing by the end of year two after transplantation. Median follow-up was 73 months. Functional (voice, swallowing, airway) recovery peaked between 12 and 24 months.
Conclusions Laryngeal transplantation is a complex procedure with significant morbidity. Significant improvements in quality of life are possible for highly selected individuals with end-stage laryngeal disorders, including laryngeal neoplasia, but further technical and pharmacological developments are required if the technique is to be more widely applicable. An international registry should be created to provide better quality pooled data for analysis of outcomes of any future laryngeal transplants.
Level of Evidence4 Laryngoscope, 134:4313–4320, 2024
"Elizabeth M. Mastoloni, Evan French, Daniel H. Coelho, on behalf of the N3C consortium, Adam B. Wilcox, Adam M. Lee, Alexis Graves, Alfred Jerrod Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E. Williams, Andrew Southerland, Andrew T. Girvin, Anita Walden, Anjali A. Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, Caleb Alexander, Carolyn Bramante, Cavin Ward‐Caviness, Charisse Madlock‐Brown, Christine Suver, Christopher Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A. Eichmann, Diego Mazzotti, Don Brown, Eilis Boudreau, Elaine Hill, Elizabeth Zampino, Emily Carlson Marti, Emily R. Pfaff, Evan French, Farrukh M Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold Lehmann, Heidi Spratt, Hemalkumar Mehta, Hongfang Liu, Hythem Sidky, J.W. Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Richard Harper, Jessica Islam, Jin Ge, Joel Gagnier, Joel H. Saltz, Joel Saltz, Johanna Loomba, John Buse, Jomol Mathew, Joni L. Rutter, Julie A. McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie Rebecca Bradwell, Kellie M. Walters, Ken Wilkins, Kenneth R. Gersing, Kenrick Dwain Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Allan Pyles, Leonie Misquitta, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M. Bissell, Marshall Clark, Mary Emmett, Mary Morrison Saltz, Matvey B. Palchuk, Melissa A. Haendel, Meredith Adams, Meredith Temple‐OConnor, Michael G. Kurilla, Michele Morris, Nabeel Qureshi, Nasia Safdar, Nicole Garbarini, Noha Sharafeldin, Ofer Sadan, Patricia A. Francis, Penny Wung Burgoon, Peter Robinson, Philip R.O. Payne, Rafael Fuentes, Randeep Jawa, Rebecca Erwin‐Cohen, Rena Patel, Richard A. Moffitt, Richard L. Zhu, Rishi Kamaleswaran, Robert Hurley, Robert T. Miller, Saiju Pyarajan, Sam G. Michael, Samuel Bozzette, Sandeep Mallipattu, Satyanarayana Vedula, Scott Chapman, Shawn T. ONeil, Soko Setoguchi, Stephanie S. Hong, Steve Johnson, Tellen D. Bennett, Tiffany Callahan, Umit Topaloglu, Usman Sheikh, Valery Gordon, Vignesh Subbian, Warren A. Kibbe, Wenndy Hernandez, Will Beasley, Will Cooper, William Hillegass, Xiaohan Tanner Zhang"
Publication date 10-09-2024
Objective Although olfactory dysfunction is one of the most common presenting signs of COVID-19 infection, little is known about which populations are most susceptible. The aim of this study is to evaluate the risk of COVID-19-induced chemosensory dysfunction in malnourished individuals.
Methods The N3C database was queried for adults having positive COVID-19 test result, diagnosis of chemosensory dysfunction within 2 weeks of positive test date, and overnutrition or undernutrition (i.e., deficiency or excess of micro- and macronutrients) related diagnoses prior to COVID-19 infection. Individuals previously diagnosed with chemosensory dysfunction were excluded. COVID-19-positive adults without olfactory dysfunction were similarly analyzed. Statistical analysis was performed using odds ratio calculations (95% confidence interval CI).
Results Of 3,971,536 patients with COVID-19, 73,211 adults were identified with a diagnosis of undernutrition and 428,747 adults were identified with a diagnosis of overnutrition prior to infection. Of those with undernutrition, 264 (0.36%) individuals were identified with a diagnosis of olfactory dysfunction within 2 weeks of infection. Of those with overnutrition, 2851 (0.66%) individuals were identified with a diagnosis of olfactory dysfunction within 2 weeks of infection. The calculated odds ratio for undernutrition and olfactory dysfunction was 0.731 (p < 0.0001, 95% CI 0.0647, 0.0825). The calculated odds ratio for overnutrition and olfactory dysfunction was 1.419 (p < 0.0001, 95% CI 1.3359, 1.5081).
Conclusion Overnutrition may increase the risk of COVID-19-related olfactory dysfunction, while undernutrition may slightly protect. While reasons are unclear, baseline differences in metabolic, inflammatory, and structural biochemistry deserve closer inspection.
Level of Evidence3 Laryngoscope, 134:4338–4343, 2024
Ameya A. Asarkar, Roger Bui, Jason Calligas, M. Boyd Gillespie, Cherie‐Ann O. Nathan
Publication date 10-09-2024
Elizabeth Mastoloni, Evan French, Daniel H. Coelho
Publication date 09-09-2024
Luigi A. Vaira, Giacomo De Riu, Antonino Maniaci, Miguel Mayo‐Yáñez, Alberto M. Saibene, Carlos M. Chiesa‐Estomba, Jerome R. Lechien
Publication date 09-09-2024
Zi‐Yue Fu, Da‐Peng Li, Chuan‐Lu Shen, Jian‐Peng Wang, Yan‐Xun Han, Shan‐Wen Chen, Zhao Ding, Lei Zhang, Bing‐Yu Liang, Si‐Yue Yin, Yi‐Pin Yang, Yu‐Lin Zhang, Yan Li, Ye‐Hai Liu, Hai‐Feng Pan, Kai‐Le Wu, Yu‐Chen Liu
Publication date 07-09-2024
This meta-analysis demonstrates that narrow-band imaging (NBI) exhibits superior diagnostic performance compared to traditional white light endoscopy detection methods for posttreatment monitoring of head and neck cancer patients. It has the potential to enhance doctors diagnostic and treatment capabilities, as well as improve recurrence detection in future diagnosis and treatment follow-up. Therefore, NBI holds promise for clinical application in enhancing the survival rate and quality of life of patients.
Objective The purpose of this study was to assess the diagnostic performance of narrow-band imaging (NBI) in monitoring patients with head and neck carcinomas posttreatment and to compare it with that of white light endoscopy (WLE).
Data Sources Pub Med, Embase, Web of Science (WOS), Cochrane Library, China Biology Medicine disc (CBM disc), China National Knowledge Internet (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), Chinese Clinical Trial Register.
Review Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), literature published before July 2024 was searched. Patients who underwent surgery, radiotherapy (RT), or chemo-RT for head and neck carcinomas with posttreatment follow-up using NBI were analyzed. The main outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR) for NBI and WLE in posttreatment follow-up.
Results The sensitivity, specificity, and DOR for NBI and WLE in posttreatment follow-up for head and neck carcinomas were 95% (95% confidence interval CI: 88%–98%), 96% (95% CI: 92%–98%), 433 (95% CI: 120–1560) and 72% (95% CI: 49%–87%), 72% (95% CI: 4%–99%), 7 (95% CI: 0–191). Additionally, the area under the curve (AUC) values for NBI and WLE were 0.99 (95% CI: 0.97–0.99) and 0.75 (95% CI: 0.71–0.79), respectively. The number of lesions and patients, treatment modality, follow-up time, disease, and endoscopic system might be sources of heterogeneity.
Conclusion Compared to WLE, NBI demonstrated superior diagnostic performance in follow-up patients with head and neck carcinoma posttreatment. NBI offers technical support and a clinical foundation for early detection of head and neck carcinoma recurrence.
Level of EvidenceNA Laryngoscope, 2024
Ellen L. Ferraro, Nicholas Zura, Basem B. Abdelmalak, Ursula Galway, Michael S. Benninger, Paul C. Bryson
Publication date 07-09-2024
Introduction High-flow nasal oxygen (HFNO), or transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), is a technique providing apneic oxygenation and a degree of ventilation during microlaryngeal surgery. Its use with laser has been questioned due to concern for airway fire. For fire to occur, a triad of ignition source, oxidizer, and fuel source must be present. By using HFNO and eliminating an endotracheal tube (fuel source), it is hypothesized that airway fire risk is minimal. We tested this theory with human cadavers using HFNO with increasing levels of FiO2 while performing microlaryngeal laser surgery.
MethodsHFNO was placed on two cadavers, and oxygen was administered at incrementally increasing fraction of inspired oxygen (FiO2) concentrations (30%–100%). Laryngeal microsurgery was conducted with CO2 and KTP lasers applied for 30 s. Oxygen readings were taken at several anatomic locations along the body assessing oxygen concentrations in correlation with increasing FiO2 administration.
Results The use of CO2 and KTP laser on cadaveric vocal folds produced char but no spark or airway fire at any of the tested oxygen concentrations. Apart from the mouth, there was minimal increase in oxygen levels at the surrounding anatomic sites despite elevating FiO2 levels.
ConclusionHFNO may be safe to use during microlaryngeal laser surgery. By eliminating the endotracheal tube as a fuel source, risk of airway fire may be negligible. Our study safely applied CO2 and KTP lasers for an uninterrupted 30 s with HFNO at 70 L/min and 100% FiO2 producing no spark or fire.
Level of EvidenceNA Laryngoscope, 2024
J.B. Eyring, Wesley P. Allen, Leith O. Bayazid, Brandon M. Hemeyer, Stephen Walker, Quinn T. Orb, J. Fredrik Grimmer, John Rampton, Jeremy D. Meier
Publication date 06-09-2024
Fetal imaging can guide airway management planning in cases of micrognathia. This study found that the utility of the inferior facial angle and Jaw Index in predicting otolaryngology intervention was unclear; however, intervention was strongly associated with lower gestational age.
Objective Fetal imaging often identifies signs of upper airway obstruction due to micrognathia that may require airway intervention at delivery. This study investigated the role of quantitative fetal imaging measurements in predicting the need for otolaryngology consultation and intervention within a multidisciplinary Fetal Center.
Methods Data were retrospectively collected from expectant mothers attending a multidisciplinary Fetal Center from January 2017 to October 2023. Cases of fetal micrognathia associated with potential upper airway obstruction were analyzed, focusing on prenatal ultrasound and magnetic resonance imaging (MRI) findings, genetic testing results, and interventions at birth.
Results Among 25 pregnancies identified, diverse prenatal diagnoses were observed. Post hoc quantitative fetal ultrasound/MRI measurements included inferior facial angle, anteroposterior diameter, biparietal distance, and Jaw Index. Otolaryngology teams were present at delivery for a subset of cases, with various interventions performed, including tracheostomy and intubation. Lower gestational age at birth, rather than more severe quantitative measurements, was associated with the need for intervention. Intubation failure due to airway difficulty was also predicted by lower gestational age.
Conclusion While certain quantitative fetal imaging measurements are often used for clinical decision-making regarding airway management at birth, they did not clearly predict the need for airway intervention in our sample. Gestational age is an important consideration in decision-making for fetal teams and should be considered in preterm fetuses to plan for airway difficulties. The findings highlight the complexity of fetal micrognathia management and highlight the need for further research to refine predictive models and optimize clinical decision-making in this challenging clinical scenario.
Level of Evidence Level 3 Laryngoscope, 2024
Dean Dudkiewicz, Eyal Yosefof, Thomas Shpitzer, Aviram Mizrachi, Moshe Yehuda, Hagit Shoffel‐Havakuk, Gideon Bachar
Publication date 04-09-2024
Our study investigates the prognostic value of surgical margin distance in oral cavity squamous cell carcinoma (OCSCC). By analyzing margin distances as a continuous variable, we developed a predictive model that estimates each patients survival probability based on their specific margin distance. This model significantly enhances the precision of predicting survival and locoregional control, providing a robust tool for personalized treatment planning in OCSCC.
Objective The traditional categorical division of surgical margins using a 5 mm cutoff in oral cavity squamous cell carcinoma (OCSCC) is controversial. The primary aim of this study was to investigate the presence of an optimal cutoff point or, alternatively, assess the potential improvement in predictive value by considering the surgical margins as a continuum.
Methods Retrospective analysis of OCSCC patients at a tertiary medical center in 1995–2020. Clinical, pathological, and surgical data were evaluated for effect on survivability by regression analyses.
Results The cohort included 266 patients (48.1% male, mean age 65.4 ± 17.7). Patient stratification by categorical margin status yielded no significant between-group differences in survival (p = 0.54). Significance was achieved when margin distance was reevaluated as a continuous variable (p = 0.0018). Similar results were shown in local control (categorical p = 0.59 vs. continuous p = 0.06). Multivariate model excluded possible confounders. A predictive model was created to provide a more accurate prediction of survival.
Conclusions The continuum spectrum of margin distance better predicts survival outcomes and locoregional control in OCSCC.
Level of Evidence3 Laryngoscope, 2024
Imaal Ahmed, Michelle Yu, Vitoria Chaves, Ruiyang Xu, Andréane Lavallée, Jennifer M. Warmingham, Morgan Firestein, Margaret H. Kyle, Kaylee Fisher, Emma T. Merriman, Cynthia Rodriguez, Westin Mace, Cristina Fernandez, Dani Dumitriu, Anil K. Lalwani
Publication date 04-09-2024
Pregnant women comprise a vulnerable patient population, susceptible to viral infections that can lead to congenital deficits in exposed newborns, including hearing loss. This study investigates the risk that intrauterine SARS-CoV-2 exposure may confer on neonatal hearing screen failure and childhood hearing loss up to 3 years of age.
Objective Given the prevalence of neonatal hearing loss (HL) associated with intrauterine viral exposures, the goal of this study is to provide information on neonatal HL in the context of the COVID-19 pandemic.
Methods Data were drawn from the COVID-19 Mother Baby Outcomes (COMBO) Initiative. 1007 participants completed the newborn hearing screen as part of routine clinical care (COMBO-EHR cohort) and 555 completed the National Survey of Childrens Health (NSCH) at 2 and/or 3 years of age for research purposes (COMBO-RSCH cohort). Maternal SARS-CoV-2 infection status during pregnancy was determined through electronic health records and maternal-reported questionnaires.
Results In adjusted multivariate logistic regression models covarying for newborn age at assessment, mode of delivery, and gestational age at delivery, there was no significant association between intrauterine SARS-CoV-2 exposure and newborn hearing screening failure (OR = 1.05, 95% CI = 0.39–2.42, p = 0.91) in the COMBO-EHR cohort. In the COMBO-RSCH cohort, there were similar non-significant associations between intrauterine exposure to SARS-CoV-2 and maternal-reported concern for HL on the NSCH (OR = 1.19 95% CI = 0.30–4.24, p = 0.79).
Conclusion There is no association between intrauterine exposure to SARS-CoV-2 and failed hearing screen in neonates. Similarly, based on the NSCH, there is no association between intrauterine exposure to SARS-CoV-2 and maternal-reported concern for hearing in toddlers. These results offer reassurance given the widespread nature of this pandemic with tens of millions of fetuses having a history of intrauterine exposure.
Level of Evidence Level 4 Laryngoscope, 2024
Thomas M. Kaffenberger, Colin Huntley, Maurits Boon, Ryan J. Soose, Rachel L. Whelan, Andrew Postol, Patrick J. Strollo Jr, Charles W. Atwood Jr, Mazen El Ali, Blair Stone, Julianna Rodin
Publication date 03-09-2024
The study aimed to understand the training and employment outcomes of otolaryngologists who completed sleep-focused fellowships, including hybrid, sleep medicine, and sleep surgery programs. A survey of 19 respondents revealed that most completed hybrid fellowships, with common surgeries being hypoglossal nerve stimulators, pharyngoplasty, and nasal surgeries. Graduates had strong job prospects, with an average of 2.4 job offers, a high return rate to residency institutions, and a significant presence in academia.
Objective Since 2011, otolaryngologists aiming to become certified in sleep medicine have had to complete an ACGME accredited sleep medicine fellowship. In addition to standard sleep medicine and sleep surgery fellowships, several institutions have developed hybrid ACGME sleep medicine programs that incorporate sleep surgery training. Our primary aims were to understand the balance between sleep medicine and surgical training requirements and the surgical volume of recent graduates across the three pathways. Our secondary aim was to assess their employment post-graduation. An improved understanding of the current state of sleep surgeon training could better inform both applicants and programs and be used to guide fellowship curriculum development.
Methods Between 2017 and 2023, we identified 26 surgeons who completed a sleep focused fellowship. An anonymous survey was developed and emailed to them. The survey assessed clinic and operating balance, procedures completed during fellowship, and comfort with these procedures as attendings. Finally, the survey assessed the job prospects of graduates. Data were analyzed with Prism 10.
Results There were 19 respondents with 52.6% completing a hybrid fellowship, 21.3% completing a sleep medicine fellowship, and 31.6% completing a sleep surgery fellowship. Approximately 84.8% completed ACGME accredited otolaryngology training prior to fellowship. The three most common surgeries were hypoglossal nerve stimulators, pharyngoplasty, and nasal surgeries. Respondents on average received 2.4 job offers, 55% returned to their residency institution, and 89.5% were in academics.
Conclusion Our survey demonstrates a wide variability in sleep-focused fellowships for surgeons, but the employment market for these trainees is robust.
Level of EvidenceN/A Laryngoscope, 2024
Vasiliki Triantafillou, Kevin Leahy
Publication date 03-09-2024
We describe a case of pembrolizumab-associated bullous pemphigoid (BP) with laryngeal involvement. Presentation and latency of symptom onset is variable, and multidisciplinary management and close airway surveillance are necessary. Awareness of this exceedingly rare adverse effect is important, particularly as immunotherapy becomes standard of care for an increasing number of malignancies.
Pembrolizumab is a monoclonal antibody with increasing use in many malignancies. We describe a case of pembrolizumab-associated bullous pemphigoid (BP) with laryngeal involvement in a 69-year-old male patient. Diagnosis was made after 2 months of symptoms via biopsy of concurrent, easily accessible cutaneous lesions. Pembrolizumab was discontinued and the patient was started on steroids and dupilumab with ultimate resolution of his cutaneous and laryngeal lesions while on immunosuppression. This case report describes the third case of pembrolizumab-associated laryngeal pemphigoid to increase awareness of this rare immune-related adverse effect. Laryngoscope, 2024
Martin Nue Møller, Debbie Berthelsen, Malene Svahn
Publication date 31-08-2024
Introduction Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction. A new indication for a larger group of patients has emerged, which is characterized by barochallenge only, which affects even more patients. Given the recent validation of the balloon dilation, we set out to explore if this procedure could be useful in treating this specific sub-group of patients in an in-office setting.
Methods Balloon dilation was performed using inly nasal cottonoids soaked in 2% tretracainephenylephrine combined with xylocaine nasal spray and lidocaine/prilocaine gel and a mild oral sedative. The effect of eustachian tube balloon dilation on the function of the eustachian tube was evaluated by using the eustachian tube dysfunction questionnaire-7 (ETDQ-7) and a VAS score. The questionnaires were completed beforehand and 3 months and 12 months postoperatively to determine subjective surgical success.
Results Two hundred and forty-six balloon dilation were performed in 132 participants. The results from the ETDQ-7 questionnaire and VAS scores showed a significant improvement in symptoms during pressurization after eustachian tube balloon dilation (p = 0.0001). A mean pain score during procedure in local anesthesia was 3.4 on a scale from 1 to 10.
Conclusion Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction during non-physiological pressure, which was determined by ETDQ-7 and Vas scores. Additionally, we found that the procedure is well suited for private practice or the outpatient clinic, using local anesthetics and a mild sedative.
Level of Evidence4 Laryngoscope, 2024
Kayla C. Coleman, Hengameh K. Behzadpour, Tracey Ambrose, Irene Sideris, Claire Buxton, Juan Alfonso Preciado, Brian K. Reilly, Diego A. Preciado, Tommie L. Robinson Jr
Publication date 31-08-2024
Timely hearing (re)habilitation may be delayed due to limited access to health care resources, hindering the ability to meet the guidelines set by Early Hearing Detection Intervention (EHDI) and Joint Committee on Infant Hearing (JCIH). Inability to meet the recommendations imposed by the EHDI guidelines can further prolong the adverse effects of pediatric hearing loss, fundamentally impacting a childs speech, language, and social outcomes. Identifying disparities in hearing health care and rehabilitation will prove vital in facilitating an expedited and equitable pathway to receiving hearing aids.
Introduction Pediatric hearing loss can significantly impact speech, language, social, and educational development. Providing access to speech and environmental sounds using amplification devices, such as hearing aids, can help improve developmental outcomes. However, timely rehabilitation and intervention may be delayed due to limited access to resources, further prolonging the adverse effects of childhood hearing loss. The aim of this study was to investigate socioeconomic barriers in time to dispensing hearing aids in a diverse pediatric patient population.
Methods Data from an existing internal database from a tertiary pediatric hospital were analyzed from January 2020 through August 2022 for barriers associated with hearing aid (HA) dispensing delays. Demographic and clinical characteristics were obtained. Multivariate regression and survival analysis statistics were used to identify factors associated with delayed time to dispensing hearing aids.
Results Of the 121 patients who had been appropriately diagnosed and fit, 108 (89.3%) had received hearings aids and 13 (10.7%) had not at the time of the study. Of those who had received HA, time to dispensing was not significantly impacted by sex, race, ethnicity, language, or income level. Insurance was found to be an influencing factor in time to receiving the HA.
Conclusion Factors such as insurance and hearing loss laterality contribute to delays in receiving hearing aids. Identifying these specific barriers and disparities in hearing rehabilitation services will prove vital in facilitating an expedited and equitable pathway to receiving hearing aids.
Level of Evidence3 Laryngoscope, 2024
Amrita Bhat, Jolie L. Chang, Megan L. Durr
Publication date 29-08-2024
Obstructive sleep apnea (OSA) affects up to 4% of the adult population. Hypoglossal nerve stimulation (HNS) was approved by the FDA in 2014 as a treatment option for patients with moderate to severe OSA who cannot tolerate CPAP and, since that time, studies have focused on predicting response to this therapy. This review summarizes the relevant literature assessing factors that predict HNS success including therapeutic response and device adherence.
Pubmed PDF WebHans Van der Wall, Leticia Burton, Michelle Cooke, Gregory L. Falk, David Tovmassian, James J. Conway
Publication date 29-08-2024
The article is a description of a new scintigraphic test that uses nuclear medicine images fused with CT to demonstrate the various manifestations of extra-esophageal reflux disease. It provides a good assessment for cough, recurrent sinusitis, and pulmonary disease. It also monitors various therapeutic interventions for reflux disease.
Objectives There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GERD). The current suite of diagnostic tests principally assesses reflux events in the esophagus. A new scintigraphic technique has been developed and validated against reference standards. It allows direct visualization of refluxate in the laryngopharynx and lungs.
Methods Fifty patients were assessed by scintigraphy before and after fundoplication at a single nuclear medicine facility. Standardized reflux symptom indices (RSIs) were obtained from each patient before and after surgery. Patients were scanned after oral 99 m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck, and lungs. ANOVA, Spearman correlation, and the Students t-test were utilized for analysis.
Results The study population (35F, 15 M) had a mean age of 63.9 years. Mean BMI was 26.8 with 67% being overweight or obese. All patients had significant reflux. SPECT/CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 preoperatively and in 36/50 and 20/50 postoperatively, respectively. The RSI, cough, and throat clearing indices showed a significant fall postoperatively (p < 0.001). Frequency of scintigraphic reflux events was reduced from a mean of 4.5 in 30 min to 2.9 (t = 9.1, p = 0.004).
Conclusion The novel scintigraphic test detects esophageal and extra-esophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. It correlates well with symptoms of reflux in the esophagus and extra-esophageal structures and the response to therapy.
Level of Evidence Although prospective, the study did not randomize patients and in effect each patient became their own control following an intervention (fundoplication). Thus, the study is Level 3 evidence Laryngoscope, 2024
Yufei Pan, Yuanyuan Lu, Huili Huang, Chao Wang, Xiao Han, Huiying Hu, Kai Sun, Jing Li, Yonghui Zhang, Kai Liu, Zhenkun Yu
Publication date 29-08-2024
This study developed a new method to measure the effectiveness of Bevacizumab (Bev) in treating Recurrent Respiratory Papillomatosis (RRP) and assessed its safety. Using ImageJ software, standardized lesion volumes from laryngoscopic images were compared with Derkay scores in a retrospective cohort of 21 patients. The results showed a strong positive correlation between the new method and the Derkay score, with a higher reduction rate after the first treatment. This confirms that systemic Bev treatment is both safe and effective for RRP, and the new evaluation method is valuable for assessing Bevs efficacy.
Objectives To develop and validate a novel method for quantifying the efficacy of Bevacizumab (Bev) in treating Recurrent Respiratory Papillomatosis (RRP), and to evaluate the clinical outcomes of a three-dose Bev induction therapy followed by surgical intervention.
Methods Twenty-one RRP patients treated with a three-dose Bev regimen were included. A novel efficacy evaluation method using ImageJ software was developed to calculate the standardized lesion volume from laryngoscopic images. This was compared with the Derkay score. Clinical outcomes, including reduction rate, cumulative reduction rate, efficacy grading, recurrence, and adverse reactions, were analyzed.
Results In the study cohort, the reduction rate was significantly higher after the first treatment compared with subsequent treatments. The overall response rate increased from 75% after the first treatment to 100% after the third. Among patients with localized lesions who underwent surgery, 76% experienced recurrence with a mean recurrence time of 114.23 days. Most recurrent lesions were smaller than at baseline. Adverse reactions included increased blood pressure in seven patients, which resolved without intervention. The new method showed a significant positive correlation with the Derkay score.
Conclusion In conclusion, based on the above findings, systemic Bev treatment for RRP is a safe and effective therapeutic approach, though further research is needed. Moreover, the new efficacy evaluation method we developed can significantly aid in studying the effectiveness of Bev treatment for RRP.
Level of Evidence2 Laryngoscope, 2024
Benjamin R. Johnson, Margaret T. Dillon, Nicholas J. Thompson, Margaret E. Richter, Andrea B. Overton, Meredith A. Rooth, Amanda G. Davis, Matthew M. Dedmon, A. Morgan Selleck, Kevin D. Brown
Publication date 29-08-2024
This study assessed the outcomes of cochlear implant (CI) use for older adults ≥65 years of age with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL). Older adults with UHL/AHL experienced significant improvements (p < 0.001) with CI use on CNC words, sound source localization, and Az Bio sentence recognition in noise for the So Ncontra configuration. Participants also reported significant benefits (p < 0.001) with CI use on the SSQ and reduced tinnitus severity on the THI.
Objective(s)FDA-approved indications for cochlear implantation include patients with severe-to-profound unilateral hearing loss (UHL) or asymmetric hearing loss (AHL); however, these indications are not covered for Medicare beneficiaries. We assessed the outcomes of cochlear implant (CI) use for older adults with UHL or AHL.
Methods Eighteen older adults (≥65 years of age at surgery) with UHL/AHL participated in a prospective, longitudinal investigation evaluating outcomes of CI use. Speech recognition for the affected ear was evaluated with consonant-nucleus-consonant (CNC) words. Spatial hearing was assessed with measures of sound source localization and sentence recognition in noise. The target sentence was presented from the front and the masker was either co-located with the target (So No), presented toward the affected ear (So Nci) or contralateral ear (So Ncontra). Perceived benefit was assessed with the Speech, Spatial, and Qualities of Hearing scale (SSQ) and the Tinnitus Handicap Inventory (THI).
Results Participants experienced significant improvements with CI use for CNC words (mean SD; preop: 8% 10%, 1 yr: 51% 22%, 5 yr: 50% 19%), masked sentence recognition (So Ncontra preop: 5% 6%, 1 yr: 22% 15%, 5 yr: 41% 14%), and localization (preop: 76° 18°, 1 yr: 40° 11°, 5 yr: 41° 14°), and reported significant improvements in hearing abilities (SSQ Spatial Hearing preop: 3 1, 1 yr: 6 2, 5 yr: 6 2) and tinnitus severity (THI preop: 16 18, 1 yr: 4 14, 5 yr: 6 12).
Conclusion Older adults with UHL/AHL experience significant improvements in speech recognition, spatial hearing, and subjective perceptions (e.g., hearing abilities and tinnitus severity) with a CI as compared to pre-operative abilities.
Level of EvidenceIV Laryngoscope, 2024
Nilam Patel, Isabel Held, Anna Trzcinska, Jay Wasman, Kumar N. Alagramam, Nancy L. Oleinick, Nicole Maronian, Nelson S. Howard
Publication date 29-08-2024
Pc 4, a photosensitizing agent, may be a promising treatment of human recurrent respiratory papillomatosis or laryngeal leukoplakia by targeted direct injection. Animal safety and histopathologic changes from direct mucosal injection of Pc 4 into buccal and vocal fold mucosae of five rabbits were studied. Rabbit mucosa tolerated Pc 4 injection well with no gross changes and mild inflammatory histopathologic changes and may tolerate activation with photodynamic therapy.
Objective The silicon phthalocyanine Pc 4 is a photosensitizing agent previously shown to be a promising treatment for cutaneous neoplasms using photodynamic therapy (PDT). Based on prior preclinical studies, we believe Pc 4-PDT has potential as a targeted treatment of human recurrent respiratory papillomatosis or laryngeal leukoplakia by direct injection into mucosal surfaces.
Methods This was a proof-of-concept pilot study assessing direct mucosal injection of Pc 4 into buccal and vocal fold mucosae in a rabbit model. Five New Zealand white rabbits underwent tattooing of bilateral buccal mucosae to delineate injection sites, followed by submucosal injections of control and Pc 4 solutions. Rabbits were monitored for post-injection tolerance. Punch biopsies were obtained from injected mucosa and assessed histopathologically. Once the buccal mucosa was found to be tolerant, vocal folds of three rabbits were injected. The rabbits were then sacrificed, and laryngeal tissue was assessed histopathologically.
Results All rabbits tolerated injection of Pc 4 and control solutions into buccal mucosa with no evidence of gross visual inflammatory changes and no changes in behavior or masticatory function. Histopathologic analysis of Pc 4 injected buccal and control mucosal tissue revealed mild focal histological changes and no stigmata of diffuse inflammatory reactions. The histopathologic analysis of Pc 4 injected into laryngeal tissue revealed similar findings with addition of mild eosinophilia in one sample.
Conclusion Direct mucosal injection of Pc 4 in rabbit buccal and vocal fold mucosae appears to be well tolerated with no gross inflammatory changes, and only mild histopathologic inflammatory changes observed.
Level of EvidenceNA Laryngoscope, 2024
"Ezer H. Benaim, Samuel P. ORourke, Margaret T. Dillon"
Publication date 27-08-2024
This study investigated into the accessibility and quality of online information regarding cochlear implantation and cochlear implant devices through the lens of a Google search engine optimization tool. The study highlights popular topics and examines Google search responses to popular People Also Ask questions, finding that while these resources offer information, they often lack readability and transparency, potentially complicating decision-making for patients. The findings emphasize the importance of health care professionals in guiding patients effectively and ensuring that online medical information is not only accurate but also easily comprehensible.
Objective Identify the questions most frequently asked online about cochlear implants (CI) and assess the readability and quality of the content.
MethodsA Google search engine observational study was conducted via a search response optimization (SEO) tool. The SEO tool listed the questions generated by Googles “People Also Ask” (PAA) feature for the search queries “cochlear implant” and “cochlear implant surgery.” The top 50 PAA questions for each query were conceptually classified. Sourced websites were evaluated for readability, transparency and information quality, and ability to answer the question. Readability and accuracy in answering questions were also compared to the responses from ChatGPT 3.5.
Results The PAA questions were commonly related to technical details (21%), surgical factors (18%), and postoperative experiences (12%). Sourced websites mainly were from academic institutions, followed by commercial companies. Among all types of websites, readability, on average, did not meet the recommended standard for health-related patient education materials. Only two websites were at or below the 8th-grade level. Responses by ChatGPT had significantly poorer readability compared to the websites (p < 0.001). These online resources were not significantly different in the percentage of accurately answering the questions (websites: 78%, ChatGPT: 85%, p = 0.136).
Conclusions The most searched topics were technical details about devices, surgical factors, and the postoperative experience. Unfortunately, most websites did not meet the ideal criteria of readability, quality, and credibility for patient education. These results highlight potential knowledge gaps for patients, deficits in current online education materials, and possible tools to better support CI candidate decision-making.
Level of EvidenceNA Laryngoscope, 2024
Ryan J. Davis, Matthew Lin, Oluwatobiloba Ayo‐Ajibola, Diana D. Ahn, Payton A. Brown, John Parsons, Tiffany F. Ho, Janet S. Choi
Publication date 27-08-2024
We assessed primary care physicians perceptions, perceived roles, level of ownership, confidence in management, and knowledge surrounding over-the-counter hearing aids using a nationwide online survey. Our cohort held positive attitudes toward over-the-counter hearing aids and valued associated knowledge but displayed unfamiliarity. Continuing medical education courses and published guidelines on over-the-counter hearing aids may address the gap.
Objectives The expansion of over-the-counter (OTC) hearing aids has raised inquiries regarding primary care physicians (PCP) knowledge, perspective, and perceived roles. We aimed to understand PCP perspectives on OTC hearing aids via nationwide online surveys.
Methods Red Cap survey was distributed to PCPs via online forums and public mailing lists. Outcomes included PCPs attitudes toward, perceived role surrounding, confidence managing, and knowledge of OTC hearing aids. Regression analyses were performed to identify associated factors including demographics and practice characteristics.
Results Cohort included 111 PCPs primarily working in non-rural (83.8%) outpatient academic medical centers (47.5%), with a mean (SD) of 16.9 (11.6) years practicing. Most reported unfamiliarity (61.3%) with OTC hearing aids but viewed them positively (91.9%). They often perceived themselves as poor sources of OTC hearing aid information (63.1%) but desired involvement (90.1%) and believed associated knowledge is important (98.2%). Rural practice environment was associated with less familiarity toward OTC hearing aids (β = −0.72, 95% CI −1.40 to −0.04). Respondents answered 5.0 (2.4) of 10 OTC hearing aid knowledge questions correctly. Using 5-point Likert scale, participants reported most confidence recognizing signs/symptoms of hearing loss 3.71 (0.84), but less confidence educating 1.68 (0.96) about and determining candidacy 1.72 (1.05) for OTC hearing aids. Participants reported continuing medical education courses and published guidelines would effectively improve their OTC hearing aid knowledge.
ConclusionPCPs displayed positive attitudes toward OTC hearing aids and valued involvement. Addressing unfamiliarity/knowledge gaps surrounding OTC hearing aids through courses and published guidelines may help clarify misconceptions and promote hearing health care.
Level of EvidenceNA Laryngoscope, 2024
Rishi Suresh, Cheyenne Roohani, Cynthia S. Wang, Yann‐Fuu Kou, Romaine F. Johnson, Stephen R. Chorney
Publication date 27-08-2024
This prospective cohort study determined the incidence of subglottic stenosis after pediatric tracheostomy is estimated at 11.5 cases per 100 patients per year. Low birth weight and subglottic injury at the time of tracheostomy were associated with subglottic stenosis in this vulnerable population of children.
Objectives To determine the incidence of subglottic stenosis (SGS) in children after tracheostomy and identify risk factors for development.
Study Design Retrospective cohort.
Methods All patients (<18 years) undergoing tracheostomy at a tertiary childrens hospital between 2015 and 2020 were included. Patients with a direct laryngoscopy (DL) concurrent with tracheostomy and a subsequent DL were included. Medical records, including operative reports, were reviewed to identify subglottic stenosis and associated risk factors.
ResultsA total of 140 patients were included with mean age at tracheostomy of 2.4 years (standard deviation SD: 4.3) (median: 0.5 years, interquartile range IQR: 0.3–1.5 years) and gestational age of 33.8 weeks (SD: 5.9) (median: 36 weeks, IQR: 28–39 weeks). At initial DL, 24% (N = 34) had subglottic injury and 26% (N = 37) developed SGS. The incidence of SGS after tracheostomy was 11.5 cases per 100 patients per year. At tracheostomy, lower birth weight (1.8 vs. 2.3 kg, p = 0.005), shorter gestational age (31.8 vs. 34.6 weeks, p = 0.01), younger age (0.8 vs. 2.9 years, p = 0.01), lower weight (5.8 vs. 14.7 kg, p = 0.01), and subglottic injury (44% vs. 21%, p = 0.01) were associated with the development of SGS. Multivariable logistic regression analysis associated birth weight (odds ratio OR: 0.49, 95% confidence interval CI: 0.31–0.75, p = 0.001) and early subglottic injury (OR: 3.22, 95% CI: 1.31–7.88, p = 0.01) with SGS development.
Conclusions The incidence of SGS after pediatric tracheostomy is estimated at 11.5 cases per 100 patients per year. Low birth weight and subglottic injury at the time of tracheostomy were associated with SGS in this vulnerable population of children.
Level of Evidence3 Laryngoscope, 2024
John R. Craig, Alberto M. Saibene, Nithin D. Adappa, Jennifer E. Douglas, Jacob G. Eide, Giovanni Felisati, Michael A. Kohanski, Rijul S. Kshirsagar, Catherine Kwiecien, Daniel Lee, Chadi A. Makary, James N. Palmer, Amrita Ray, Carl Wilson, Edward C. Kuan
Publication date 27-08-2024
For odontogenic sinusitis (ODS) with frontal sinus involvement, maxillary antrostomy alone and complete endoscopic sinus surgery (ESS) both resulted in rapid and long-term symptomatic resolution. Complete ESS is not necessary for all ODS patients with frontal sinus extension, though may speed resolution in some cases.
Objectives Endoscopic sinus surgery (ESS) is often necessary when managing odontogenic sinusitis (ODS), but ESS extent for ODS with extramaxillary sinus involvement has been incompletely studied. This study compared outcomes after wide maxillary antrostomy (MA) alone versus complete ESS for ODS with frontal sinus involvement.
MethodsA multicenter prospective cohort study was conducted on patients with uncomplicated ODS (no extrasinus spread) who underwent ESS when computed tomography demonstrated maxillary, anterior ethmoid (AE), and frontal sinus opacification. Multiple preoperative and postoperative variables were recorded, including 22-item sinonasal outcome tests (SNOT-22) and endoscopic findings. Ultimate SNOT-22 and endoscopic resolution, and time to SNOT-22 and endoscopic resolution were compared between patients who underwent MA alone versus “complete” ESS (maxillary, ethmoid, frontal; not sphenoid).
Results Of 70 patients, mean age was 59.2 years, and 55.7% were male. Thirty-five underwent MA alone, and 35 had complete ESS. At first postoperative visits (mean 9.3 days), AE sinus purulence was more likely resolved after complete ESS compared with MA (97.1% vs. 71.4%, p = 0.006). However, time to resolution of AE purulence was comparable by 6 weeks postoperatively (p = 0.158). There were no significant differences in times to foul smell resolution and achieving ≥9 point SNOT-22 reduction (p > 0.05).
Conclusions For ODS with frontal sinus involvement, MA alone and complete ESS both resulted in rapid and long-term symptomatic resolution. While ultimate resolution of sinus purulence was equivalent between surgery groups, complete ESS did lead to faster resolution of frontoethmoidal purulence in a significant number of cases.
Level of Evidence2 Laryngoscope, 2024
Jordan J. Varghese, Matthew A. Shew, Amit Walia, Shannon M. Lefler, Nedim Durakovic, Cameron C. Wick, Amanda J. Ortmann, Jacques A. Herzog, Craig A. Buchman
Publication date 27-08-2024
Intraoperative electrocochleography (ECochG), an auditory evoked potential (AEP) of the cochlea, measured with a cochlear implant (CI) manufacturer research platform (Cochlear Corp CC), estimates postoperative CI speech perception scores. This intraoperative pilot study validated a dedicated AEP machine (Duet by Intelligent Hearing System IHS) through recording IHS-ECochG responses that strongly correlated in magnitude (r = 0.905, 95% confidence interval: 0.809 to 0.954) with established CC-ECochG responses. Future work will translate the IHS Duet system to the clinic for obtaining transtympanic ECochG as a preoperative parameter to estimate cochlear reserve and CI performance.
Objective To validate electrocochleography (ECochG) between an auditory evoked potential (AEP) machine and an established cochlear implant (CI) manufacturer ECochG system.
Methods Intraoperative validation study at a tertiary referral center. Patients included adults and children undergoing cochlear implantation. Intraoperative ECochG was measured with both the Intelligent Hearing Systems (IHS) Duet AEP machine and Cochlear Corporation (CC) ECochG platform. Recording electrodes captured extracochlear measurements through a standard facial recess. Tone-bursts were presented from 250 Hz to 2 k Hz (~110 dB SPL). A fast Fourier transform (FFT) of ECochG waveforms at key frequencies was summed into a total response (ECochG-TR). Pearsons correlation was utilized to evaluate the relationship between IHS-ECochG-TR and CC-ECochG-TR after confirming normality.
Results Thirty patients were enrolled with an average age of 67 years (SD 18.8). In the ear that was implanted, mean preoperative pure-tone average (PTA; 0.5, 1, 2, and 4 k Hz) was 87.4 dB HL (SD 19.3) and mean preoperative word-recognition scores (WRS) was 17.0% correct (SD 19.1). There was strong correlation (r = 0.905, 95% confidence interval: 0.809 to 0.954) between IHS-ECochG-TR (median 2.30 μV, range 0.1–148.26) and CC-ECochG-TR (median 3.00 μV, range 0.1–239.63). Four patients underwent transtympanic ECochG with the IHS system for feasibility evaluation and achieved similar responses.
Conclusion Extracochlear ECochG has been predictive of CI speech perception performance. The IHS duet system is a valid measure of extracochlear ECochG for the CI population. Future work will utilize this system for measuring transtympanic ECochG to improve preoperative estimation of CI performance.
Level of Evidence3 Laryngoscope, 2024
Yong‐Chao Chen, Xin Wang, Yi‐Shu Teng, Shang Yan, De‐Sheng Jia, Hong‐Guang Pan
Publication date 27-08-2024
Endoscopic percutaneous suture lateralization for bilateral vocal cord paralysis is a relatively simple, minimally invasive, non-destructive, safe, and effective procedure in newborns, which avoids the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords.
Purpose Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long-term results and the stability of the lateralization.
MethodsA review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded.
Results Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1–33 days). The maximum follow-up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedures efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long-term follow-up.
ConclusionEPSL for BVFP is a relatively simple, minimally invasive, non-destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords.
Level of Evidence Level 3: retrospective case series Laryngoscope, 2024
R. William Stout Jr, Nina Gallo, Sofia Torres‐Small, Okenwa Okose, Chenhao Zhao, Tristan Hayes, John Gleysteen, C. Burton Wood
Publication date 26-08-2024
This retrospective study examines the impact of socioeconomic status (SES) on the presentation and outcomes of cutaneous melanoma of the head and neck in 53,967 patients. Findings reveal that lower SES is significantly associated with a higher likelihood of presenting with late-stage disease, thicker tumors, and increased mortality. These results underscore the need for targeted interventions to address health disparities and improve early detection and treatment outcomes for this population.
Objective To determine the effects of socioeconomic status (SES) on cutaneous melanoma of the head and neck.
Data Source Surveillance Epidemiology and End Results (SEER) Program.
Review Methods We conducted a retrospective analysis of patients diagnosed with cutaneous melanoma of the head and neck from 2006 to 2018, utilizing population-based data including socioeconomic status (SES) assessed by the US-based Yost quintile index. SES quintiles ranged from Group 1 (lowest) to Group 5 (highest). We examined disease severity at diagnosis (stage, Breslow thickness, and spread) and survival outcomes (overall survival, cause-specific survival) to assess the impact of SES.
ResultsA total of 53,967 melanomas of the head and neck were identified (14,146 females; 39,821 males; 51,890 white; 125 black; 317 other). Group 1 patients had a significantly higher percentage of end-stage disease (stage IV) at diagnosis (n = 101; 3.2% vs. n = 280; 1.9%, respectively) (p < .001), increased Breslow thickness (.80 mm vs .60 mm, respectively) (p < .001), and higher percentage of distant disease (n = 152; 3.6% vs. n = 431; 2.1%, respectively) (p < .001). Group 1 patients experienced a higher death rate from melanoma than group 5 patients (n = 585; 14% vs n = 1,753; 8.6%). Survival increased with SES.
Conclusions When evaluating cutaneous melanoma of the head and neck, low SES is related to more severe disease at diagnosis and worse survival outcomes. Addressing the underlying causes of this relationship could lead to more equitable management and survival outcomes.
Level of EvidenceIII Laryngoscope, 2024
Akari Kimura, Mohammed Imran Khan, Meena Easwaran, Joanne Soo, Amirbahador Golchin, Elizabeth Erickson‐DiRenzo
Publication date 24-08-2024
We created a method to study the wound healing of vocal fold surgical injuries in mice. We found that we can create injury with commonly available laboratory supplies. This study provides the foundation to study mechanisms of vocal fold repair and regeneration following injury.
Objective Animal models of vocal fold (VF) surgical injury and scar formation provide insight into the wound healing process. The purpose of this study was to establish an alternative model of surgical injury to the mouse VF using materials commonly available in most research laboratories or for purchase and to investigate wound healing of the epithelium (EP) and lamina propria (LP).
Methods Mice were anesthetized by isoflurane gas delivery and positioned on a platform so that the larynx could be observed using a laryngoscope and dissection microscope. Unilateral VF injury was created using a wire brush. Mice were euthanized and the larynx evaluated 1-, 3-, 5-, 7-, 14-, and 28-days following injury. Histological and immunofluorescent analysis was used to evaluate thickness of the EP, LP area, proliferative (Ki67+) and basal cells (p63+) in the EP, and collagen III content in the LP.
Results The depth of injury reached the superficial thyroarytenoid muscle on Day 1. The thickness of the EP of the injured VF was increased on Days 3 and 5, and the LP area was increased on Days 3, 5, and 7 as compared with the uninjured VF. Ki67+ and p63+ cells were increased on Day 3 and collagen III content was increased on Days 5 and 28 as compared with the uninjured VF.
Conclusion We successfully established an alternative method of creating unilateral VF injury in the mouse. This method will be useful for future research regarding VF surgical injury and wound healing.
Level of EvidenceN/A Laryngoscope, 2024
Arash Abiri, Ellen M. Hong, Katelyn K. Dilley, Theodore V. Nguyen, Mandy K. Salmon, Elysia M. Grose, Siddhant H. Tripathi, Sanjena Venkatesh, Yohan Kim, Daniel J. Lee, Jennifer E. Douglas, Jacob G. Eide, Rijul S. Kshirsagar, Katie M. Phillips, Ahmad R. Sedaghat, John M. Lee, Charles C.L. Tong, Nithin D. Adappa, James N. Palmer, Edward C. Kuan
Publication date 24-08-2024
In this multi-institutional longitudinal study of 373 inverted papilloma patients, surgical resection significantly improved quality of life (QOL) within 1 month of surgery, which improved in a durable manner at 3 months postoperatively and stabilized across 12 months. QOL outcomes were largely driven by nasal, sleep, and otologic/facial symptoms.
Objectives There is growing interest in assessing patient quality of life (QOL) following treatment of sinonasal tumors, including inverted papilloma (IP). We aimed to elucidate the natural history of postoperative QOL outcomes in IP patients treated with surgery.
Methods Cases of sinonasal IP treated surgically at 4 tertiary academic rhinology centers were retrospectively reviewed. SNOT-22 scores were used to evaluate QOL preoperatively and postoperatively (1, 3, 6, 12 months). Repeated-measures ANOVA assessed for differences in mean scores over time. Linear regression identified factors associated with QOL longitudinally.
Results373 patients were analyzed. Mean preoperative SNOT-22 score was 20.6 ± 20.4, which decreased to 16.3 ± 18.8 (p = 0.041) and 11.8 ± 15.0 (p < 0.001) at 1 and 3 months postoperatively, respectively. No further changes in SNOT-22 scores occurred beyond 3 months postoperatively (p > 0.05). When analyzed by SNOT-22 subdomains, nasal, sleep, and otologic/facial subdomain scores (all p < 0.05) demonstrated improvement at 12-month follow-up compared with preoperative scores; this was not observed for the emotional subdomain score (p = 0.800). Recurrent cases were associated with higher long-term SNOT-22 scores (β = 7.08; p = 0.017). Age, sex, degree of dysplasia, prior surgery, primary site, and smoking history did not correlate with symptoms (all p > 0.05).
ConclusionsQOL outcomes related to IP resection are largely driven by nasal, sleep, and otologic/facial subdomains, though patients appear to experience enduring improvement as early as 3 months postoperatively. Recurrent disease is a major driver of negative QOL.
Level of Evidence4 Laryngoscope, 2024
James A. Curtis, Crystal Diaz, Theresa Lee, Anaïs Rameau
Publication date 23-08-2024
Findings from this study suggest that the low-cost generic pressure testing manometer used in this study has the potential to be a valid substitute for the IOPI and MicroRPM for measurement of lingual, facial, and respiratory muscle strength during clinical assessments of speech, cough, and swallowing.
Objective(s)The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)—the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)—the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)—an alternative, low-cost pressure testing manometer.
Methods Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lins concordance correlation, and Bland–Altman Plots. Agreement was interpreted as “poor” if ρc < 0.90, “moderate” if ρc = 0.90 – < 0.95, “substantial” if ρc = 0.95 – < 0.99, and “excellent” if ρc ≥ 0.99.
Results Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0–3.9 k Pa between the IOPI and DPM, and 4.5–9.8 cm H2O between the MicroRPM and DPM. Lins concordance revealed “substantial” agreement between the IOPI and DPM (ρc = 0.98) and the MicroRPM and DPM (ρc = 0.99).
Conclusion The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations.
Level of EvidenceNA Laryngoscope, 2024
Yuanyuan Yang, Feitian Li, Mengye Ma, Chunfu Dai
Publication date 23-08-2024
Objective To analyze the clinical features and surgical outcomes of patients with endolymphatic sac tumors (ELSTs).
Study Design Single institution retrospective cohort study.
Methods The clinical data of 29 patients with 30 ELSTs who underwent surgery were retrospectively reviewed. Information on patient demographics, tumor size and grade, intraoperative blood loss volume, hearing and facial nerve outcomes, and follow-up data was collected and analyzed.
Results The main symptoms were hearing loss in 26 ELSTs (86.7%) and tinnitus in 17 (56.7%). Twenty-four (80%) ELSTs were in advanced stages (Grade III). The median tumor volume was 6.35 cm3. The median intraoperative blood loss volume was 300 mL. Facial nerve function was well preserved in 21 patients. Among all patients with Grade III tumors, 12 patients underwent tension-free anterior facial nerve rerouting, and 11 patients (91.7%) maintained good facial nerve function postoperatively (HB I and HB II). Only one patient exhibited permanent vocal cord paralysis, and no patients experienced cerebrospinal fluid (CSF) leakage postoperatively. Gross total resection was achieved in 22 patients (73.3%), 5 patients (16.7%) experienced tumor recurrence, and 3 (10%) had residual tumors.
Conclusions Most ELSTs tend to be diagnosed in the advanced stage. Tension-free anterior facial nerve rerouting could maximally preserve facial nerve function. The intraoperative blood loss volume was associated with tumor size and stage. Tumor recurrence tends to occur at the posterior edge of the petrosal bone, internal auditory canal, and surface of the posterior fossa. Given the relatively high recurrence rate of ELSTs, long-term follow-up is recommended.
Level of Evidence4 Laryngoscope, 2024
Jenny B. Xiao, Jennifer M. Siu, Evan J. Propst, Nikolaus E. Wolter
Publication date 23-08-2024
Esophageal foreign body impaction in children is a common presentation, and severity of injury can vary based on the type of object ingested. We demonstrate that the national incidence of pediatric foreign body ingestion has increased significantly in the past two decades and there have been shifts in the types of objects ingested over time. Our results suggest that trends in pediatric foreign body ingestion are reflective of changes in the current consumer market and highlight the need for further development of prevention initiatives.
Objectives To evaluate epidemiological trends of pediatric esophageal foreign body (EFB) ingestion over two decades.
MethodsA retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) database for children <18 years who presented to a United States Emergency Department (ED) with EFB between 2003 and 2022. Number of cases and type of EFB were recorded. Rates of EFBs over time were analyzed via linear regression.
ResultsA total of 52,315 EFB cases were identified over the 20-year period, with a national estimate of 1,589,325 cases. The most frequently ingested objects were coins (37.6%), toys (13.5%), and batteries (6.8%). Overall incidence of EFB ingestion increased from 7.3 to 14.2/10,000 children from 2003 to 2022 (R2 = 0.8, p < 0.0001). Incidence of coin ingestion increased from 3 to 4.5/10,000 children (R2 = 0.06, p = 0.335) but represented a smaller proportion of all EFB over time (66% in 2003 versus 43% in 2022). Incidence of magnet, battery, and toy ingestion have increased from 0.3 to 1.0/10,000 (R2 = 0.9, p < 0.0001), 0.3 to 1/10,000 (R2 = 0.7, p < 0.0001), and 0.6 to 2.3/10,000 (R2 = 0.8, p < 0.0001) children, respectively, between 2003 and 2022. The proportion of magnet, battery, and toy ingestion have increased over time (3.2%, 6.5%, and 11.8%, respectively, in 2003 to 11.4%, 11.7%, and 22.2%, respectively, in 2022).
Conclusion Magnet, battery, and toy ingestion have increased significantly in the past two decades, while the proportion of coin ingestion has decreased. This trend may reflect shifts within the consumer market and increased availability of electronics concurrent with the adoption of digital currency.
Level of Evidence4 Laryngoscope, 2024
Fan Yang, Lan Xiao, Grace Paka Lubamba, Chang Cao, Jia‐Lu He, Xiao‐Yi Wang, ChunJie Li, Gui‐Quan Zhu
Publication date 23-08-2024
This study aimed to report our experience about endoscopic neck dissection through a post-auricular hairline incision, followed by intraoral resection of oral cancer and free flap reconstruction. Laryngoscope, 2024
Pubmed PDF WebYi Fang, Changjiang Li, Min Chen, Jian Chen, Lei Cheng, Haitao Wu
Publication date 22-08-2024
The existing classifications of narrow band imaging (NBI) and morphology had achieved positive results in predicting pathology of vocal ford leukoplakia (VFL), and they also had certain defects that limit clinical application. We tried to establish a new classification based on combined IPCLs typing in NBI and morphological characteristics in WLI, which achieved higher prediction accuracy and consistency in pathology prediction of 182 VFL patients.
Objectives To establish a combined classification based on intrapapillary capillary loops (IPCLs) and morphological characteristics to improve the accuracy of pathological prediction of vocal fold leukoplakia (VFL).
Material and MethodsA prospective research was conducted of VFL patients diagnosed by IPCLs and morphology. The VFL cases were classified as Type I-III based on IPCLs and morphological characteristics. Type I referred to VFL with dendritic vessels but not IPCLs. Type II defined VFL without any IPCLs or vessels and classified by morphology into two subtypes as non-rough Type IIa and rough Type IIb. Type III referred to VFL with IPCLs and classified into two subtypes as Type IIIa with small IPCLs and Type IIIb with large IPCLs or vascular distortion in or around lesions. Predicting pathology accuracy was analyzed.
Results182 eligible patients were recruited. The prediction accuracy rates of VFL pathology were 81.5% according to the 2019 Ni classification. The combined classification includes 4 cases of Type I, 28 Type IIa, 35 Type IIb, 56 Type IIIa, and 59 Type IIIb VFLs. The prediction accuracy rate of combined classification ranged from 95.1% to 97.3% in three observers. The average sensitivity, specificity, positive predictive value, negative predictive value was 97.8%, 86.2%, 97.4%, 88.2%, respectively. The inter-observer agreement varied from 84.1% to 94.0%, and mean area under curve of receiver-operating curve analysis was 0.954.
Conclusions and Significance The new combined classification based on IPCLs and morphological characteristics could predict pathology of VFL accurately.
Level of Evidence4 Laryngoscope, 2024
"Antonino Maniaci, Paolo Bonacci, Stefania Stefani, Salvatore Cocuzza, Federico Merlino, Alberto Maria Saibene, Giuseppe Sangiorgio, Juan Maza‐Solano, Jerome R. Lechien, Ignazio La Mantia, Nicolo Musso"
Publication date 22-08-2024
SNP polymorphisms and chronic rhinosinusitis.
Objective(s)To conduct a preliminary investigation into the relationship between specific SNP variants, type II inflammation, and the effectiveness of dupilumab therapy and surgery in patients with CRS.
Methods In this prospective study, 48 subjects were enrolled, comprising 32 CRS patients and 16 healthy controls. The CRS patients were subjected to either dupilumab therapy or endoscopic surgery according to EPOS guidelines. SNP variants were identified using the Taq Man SNP genotyping technique. The identified SNP profiles were compared between the control group and CRS patients, and their potential influence on treatment outcomes was evaluated. Treatment responses were assessed based on symptom scores, such as SS-I, SNOT-22, disease progression using the NPS findings, and SNP profiles at a 6-month follow-up. The primary measures included the Nasal Polyp Score, Smell Identification Test (SIT) score, and SNOT-22 outcomes.
Results Dupilumab therapy and surgery significantly decreased NPS, with the last showing superior results. However, dupilumab therapy resulted in a significantly improved SIT score. Significant differences were observed in SNP profiles, particularly with rs1800629 (TNFA), rs2856838 (IL1a), rs17561 (IL1a), and rs1805011 (IL4R). In particular, the expression of rs2856838 and rs1805011 variants in the dupilumab group was associated with significantly better SIT and SNOT-22 outcomes than non-expressors. Also, the surgery group patients expressing the rs2856838 variant reported significant improvements in SNOT-22 scores.
Conclusion These preliminary findings suggest that SNP genotypes may guide personalized treatment strategies for CRS. Further larger prospective studies are required to confirm these initial observations.
Level of Evidence2 Laryngoscope, 2024
Mary Newland, Hänel Eberly, Cheng Ma, Jessyka G. Lighthall
Publication date 22-08-2024
The use of oxymetazoline 0.1% ophthalmic solution significantly improves MRD1 in patients with acquired blepharoptosis. Further studies comparing this treatment in other etiologies of acquired blepharoptosis should be conducted.
Objective Oxymetazoline hydrochloride has been shown to be effective in some studies for acquired blepharoptosis and for aesthetic upper eyelid elevation. This study aims to systematically review the literature on the use of topical oxymetazoline for treating acquired blepharoptosis.
Databases Reviewed Pub Med (U.
S. National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane.
MethodsA systematic review of studies published between 2013 and 2024 following PRISMA guidelines was performed using the Pub Med, Scopus, and Cochrane databases. Primary outcomes included pre- to posttreatment change in marginal reflex distance (MRD1) after treatment with topical oxymetazoline, and mean difference (pre-to-posttreatment) in MRD1 versus control.
Results Five articles included data from 458 patients for analysis. Meta-analysis demonstrated significant improvement in MRD1 measurements posttreatment with oxymetazoline (1.40 mm; 95% confidence interval, CI 0.41 mm, 2.40 mm). In addition, when compared to controls, patients treated with oxymetazoline demonstrated greater increase in MRD1 values (0.83 mm; 95% CI 0.10 mm, 1.55 mmm). Heterogeneity, measured by I2 statistic, was high in all studies (85%–95%).
Conclusion The use of oxymetazoline 0.1% ophthalmic solution significantly improves MRD1 in patients with acquired blepharoptosis. Further studies comparing this treatment in other etiologies of acquired blepharoptosis should be conducted. Laryngoscope, 2024
"Andrew S. Awadallah, Andrew J. Bowen, Hawa M. Ali, Thomas J. OByrne, Aisha A. Aden, Yousuf H. Khalil, Eric S. Edell, Matthew J. Koster, Semirra L. Bayan, Dale C. Ekbom"
Publication date 22-08-2024
Older age and birth control are associated with decreased recurrence rates in idiopathic subglottic stenosis. This may suggest an interplay between sex hormones—namely estrogen—and disease process.
Objective To evaluate the impact of age on disease recurrence in idiopathic subglottic stenosis (iSGS) patients.
Methods This was a retrospective chart review of iSGS patients treated with laser wedge excision. Patients did not have prior surgery. Survival rates free of recurrence were estimated using the Kaplan–Meier methods, and associations were evaluated using Cox Proportional Hazards models.
Results Eighty-five female patients were included in the study. Most patients (68%) were postmenopausal, had first period at or before 13 years of age, had at least one full-term pregnancy (82%), were not undergoing hormone replacement therapy (93%), were not using hormonal birth control (88%), and were either partially or completely compliant with triple therapy regime (80%). There was a statistically significant average reduction in risk of recurrence of 5% for every additional year of age (p < 0.0001). When compared to patients older than 65 years of age, patients less than 35 were nearly 10 times more likely to recur (p = 0.002), and patients 55–65 and 45–55 years of age were 8 and 5 times more likely to recur, respectively (p = 0.003 and 0.009). Additionally, females on birth control showed decreased risk of recurrence of 74% compared with their counterparts (p = 0.04).
Conclusion This is the first study to demonstrate an inverse relationship between age and disease recurrence in patients with iSGS following surgery. Using age as a surrogate for menopausal status, these results suggest that increased age and/or birth control provide a protective effect through decreased recurrence rates, possibly mediated by decreased estrogen levels.
Level of Evidence4 Laryngoscope, 2024
Sivakumar Chinnadurai, Cassandra Meyer, Brianne Roby, Andrew Redmann, Abby Meyer, Robert Tibesar, Luke Jakubowski, Timothy A. Lander, Michael Finch, Asitha D.L. Jayawardena
Publication date 22-08-2024
Objective Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic-associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention-deficit hyperactivity disorder ADHD, autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with recurrent acute otitis media (RAOM).
MethodsA retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic-associated conditions were defined using ICD-9 and ICD-10 codes.
Results The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 0.55, 0.68; p < 0.001), asthma (OR 0.8 0.74, 0.87; p < 0.001), allergic rhinitis (OR 0.72 0.65, 0.81; p < 0.001), and atopic dermatitis (0.78 0.71, 0.86; p < 0.001).
Conclusions and Relevance Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM.
Level of Evidence4 Laryngoscope, 2024
Maria K. Jauhiainen, Lari Pyöriä, Sanna Viitasalo, Leena‐Maija Aaltonen, Maria Söderlund‐Venermo, Jaana Hagström, Antti A. Mäkitie, Maria F. Perdomo, Saku T. Sinkkonen
Publication date 22-08-2024
HPV6 integration was observed in benign inverted papilloma, whereas HPV16 is present pre- and post-malignant transformation. Marked increase in viral diversity was present, supported by accumulation of mutations over time.
Objectives Sinonasal inverted papilloma (IP) has a locally destructive growth pattern, can relapse, and can undergo malignant transformation (IP-associated sinonasal squamous cell carcinoma (IP-SNSCC)). Human papillomaviruses (HPV)-6 and -16 are frequently detected in IPs. To clarify the possible roles of other DNA viruses in IPs, we explored viruses not studied in this context before. With the setting of pre- and post-malignant transformation samples, we investigated HPV genomes in depth to assess the integration of HPV into the human genome and the presence of minor intratypic variants.
Materials and Methods We analyzed 35 IP samples representing 28 individuals, of which six had IP-SNSCC. For virus screening, we applied qPCR to detect 16 different DNA viruses in three virus families, comprising herpesviruses, parvoviruses, and polyomaviruses. In addition, targeted next generation sequencing (NGS) was used for detailed HPV analysis.
Results We detected herpes-, parvo-, and polyomaviruses in 13/28 (46%) patients, with codetections of multiple viruses in six (21%) patients. NGS revealed HPV16 DNA in 2/6 IP-SNSCC and in their respective earlier benign IP samples, as well as in a plasma sample from one of these patients. HPV6 was detected in two IP samples without subsequent malignant transformation. We identified sequence reads containing junctions of HPV6 and HPV16 and host genome suggestive of viral integration. HPV6 and HPV16 minor intratypic variants were present across pre- and post-malignant transformation, with mostly nonsynonymous mutations.
Conclusions Multiple DNA viruses were present in IPs. HPV16 was detected only in IP-SNSCCs or in tumors that later underwent malignant transformation.
Level of Evidence3 Laryngoscope, 2024
Derek J. Lam, Andrea Hildebrand, Thuan Nguyen, Lourdes Quintanilla‐Dieck, Grace X. Tan, Chris A. Hargunani, Carol J. Macarthur, Henry A. Milczuk
Publication date 21-08-2024
This prospective cohort study of surgically naive children with obstructive sleep apnea (OSA) reports drug-induced sleep endoscopy (DISE) patterns of obstruction and the predictors of outcome of adenotonsillectomy (AT). Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes.
Objectives Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%–30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes.
Methods This was a prospective cohort study of children aged 2–18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes.
Results Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction.
Conclusions Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes.
Level of Evidence3 Laryngoscope, 2024
Ryan Sicard, Sarah Russel, David Jang, Ralph Abi Hachem, Dennis O. Frank‐Ito
Publication date 21-08-2024
Nasal vestibule notch size is correlated with airflow and resistance in different regions of the nasal airspace. This correlation with airflow is strongest in the anterior–inferior region of the airway.
Objectives Many individuals with healthy normal nasal anatomy and function exhibit a prominent notch indentation at the junction of the ala and sidewall, specifically around the anterior–superior region of the unilateral nasal vestibule up to the internal nasal valve. This study evaluates the influence of various sizes of notched indentations at the anterior nasal airway on local airflow pattern.
MethodsA retrospective study involving 25 healthy individuals, each exhibiting at least one unilateral notched indentation (40 total airways). Each individuals notched indentation was quantified after subject-specific three-dimensional nasal airway reconstruction from radiographic images. Computational fluid dynamics modeling was used to simulate nasal inspiratory airflow in each nasal airway at 15 L/min. Localized airflow distributions passing through the inferior, middle, and superior regions were calculated at 15 cross sections.
Results Notched indentation size ranged 1.75–86.84 mm2 (average = 22.37 mm2). At the anterior airway, notched size significantly correlated with inferior airflow volume (R = 0.32, p = 0.04) but not in the middle (R = 0.21, p = 0.20) or superior (R = 0.06, p = 0.70) regions, whereas middle and superior regional resistance values were significantly correlated with notched size (middle: R = 0.54, p < 0.001; superior: R = 0.41, p = 0.009). Medially, resistance at the middle region significantly correlated with notched size (R = 0.56, p < 0.001). At the posterior airway, airflow distributions through the inferior, middle, and superior regions demonstrated weak correlation with notched size (inferior: R = 0.24, p = 0.14, middle: R = 0.24, p = 0.13; superior:R = 0.03, p = 0.83), whereas resistance was significantly correlated in the middle and inferior regions (middle: R = 0.56, p < 0.001;inferior: R = 0.43, p = 0.006).
Conclusions Anterior nasal airway notched indentation size had significantly stronger influence on localized airflow volume through the anterior–inferior airway than other regions of the nasal passage.
Level of EvidenceN/A Laryngoscope, 2024
A.C. Kaufman, F. Fu, M.C. Martinez, N. Fischbein, G.R. Popelka, K. Butts Pauly, N.H. Blevins
Publication date 21-08-2024
Current MR imaging is insufficient to visualize the temporal bone. The use ultra-short echo time sequences can visualize bone allowing for improved surgical planning.
Objective The short T2 nature of cortical bone causes it to appear similar to air on MR, forcing clinicians to rely on computed tomography imaging, with its attendant ionizing radiation exposure, to define temporal bone structures. Through the use of novel MR sequences with ultra-short echo times (UTE), short T2 structures are now able to be visualized, allowing for improved understanding of anatomical relationships.
Methods Eight patients (50% female) undergoing MR imaging of the skull base for diagnostic purposes (62.5% for vestibular schwannoma surveillance) at a tertiary care center were enrolled to evaluate the safety and efficacy of UTE imaging. CT scans were completed in 37.5% of the patients as part of their workup and used for comparison purposes. The repetition time, short echo time, and long echo time for the UTE sequence were 11, 0.032, and 2.2 msec, respectively.
Results The protocol added 6 min to the total scanning time, and all patients tolerated the sequence without issue. The ossicles, mastoid air cells, antrum, and epitympanum were able to be seen and had a high Dice similarity coefficient when compared to CT (>0.5). UTE allowed for clear delineation of all segments of the facial nerve with a signal-to-noise ratio of 35 (although the BRAVO sequences had a superior ratio of 140). Vestibular schwannomas were able to be distinguished from normal brain parenchyma.
ConclusionsUTE is safe and effective for visualizing anatomic structures not normally seen on traditional MRI, potentially allowing for improved surgical planning in patients.
Level of EvidenceIII Laryngoscope, 2024
James R. Xu, Anish Kosanam, Khashayar Arianpour, Eric D. Lamarre, Christopher G. Hyland, Peter J. Ciolek
Publication date 21-08-2024
Large-scale studies have not directly assessed the relationship between preoperative hypoalbuminemia and postoperative complications in head and neck microvascular reconstruction surgery. In this study, we find that hypoalbuminemia is a risk factor for postoperative complications, and we discuss the specific complications that are increased. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients.
Introduction Hypoalbuminemia, a marker for poor nutritional status, has been associated with postoperative complications, including head and neck cancer surgery. This study investigates the impact of hypoalbuminemia on head and neck microvascular free tissue transfer reconstruction.
Methods This retrospective cohort study queried the 2005–2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available preoperative albumin, BMI, and age were included. Hypoalbuminemia was defined as a preoperative albumin <3.5 g/dL. Univariate and multivariable logistic regression were performed.
ResultsA total of 3,886 cases met the inclusion criteria, of which 835 (21.5%) had hypoalbuminemia. The hypoalbuminemia cohort was older, had lower BMI, had higher ASA classification, and had worse functional health status. Adjusted multivariable logistic regression showed that hypoalbuminemia was associated with unplanned return to the operating room within 30 days (OR: 1.36, p < 0.01), unplanned reoperation (OR: 1.36, p < 0.01), any complication (OR: 1.77, p < 0.01), surgical complications (OR: 1.94, p < 0.01), and medical complications (OR: 1.34, p = 0.01). Hypoalbuminemia was correlated with a longer hospital stay, superficial surgical site infection, wound dehiscence, transfusion, deep vein thrombosis, and acute renal failure.
Conclusion Hypoalbuminemia is a risk factor for postoperative complications after microvascular free tissue transfer for head and neck reconstruction. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients.
Level of Evidence3 Laryngoscope, 2024
Lauran K. Evans, Haidee Chen, Manwel Taki Labib, D. Alexander Cronkite, Alice C. Yu, Maya Ashendouek, David Elashoff, Wanxing Chai‐Ho, Deborah J. Wong, Maie St. John
Publication date 20-08-2024
Two-year overall survival in this anaplastic thyroid cancer cohort was 24%, and 5-year overall survival was 23%, with median survival time of 7.6 months. Cox proportional hazard analysis demonstrated that patients treated with immunotherapy or targeted therapy had a statistically significant increase in survival compared to patients who did not receive these therapies (p = 0.016).
Objectives Anaplastic thyroid cancer (ATC) is the most aggressive and fatal thyroid malignancy. Currently, there still exists a paucity of literature studying the relationship between available ATC-targeted therapy, immunotherapy, and survival. We aim to investigate how systemic therapies affect survival outcomes in ATC.
MethodsA single-tertiary-institution chart review of patients diagnosed with advanced-stage ATC, and who underwent surgery as part of their treatment, was performed between 2000 and 2023, with 41 patients included. Demographics, clinical characteristics, and survival data were collected and analyzed via Kaplan–Meier and Cox proportional hazards analyses.
Results54% of patients were female, and average age was 67.4 years old. The most common mutations identified were BRAF (15 patients), p53 (9 patients), and p63 (2 patients). A total of 18 patients utilized targeted or immunotherapy, with Trametinib and Dabrafenib (9 patients) as the most common agents used. Two-year overall survival was 24%, and 5-year overall survival was 23%, with median survival time of 7.6 months. Kaplan–Meier analysis demonstrated improved survival in patients who received chemotherapy (p = 0.048). Cox proportional hazards analysis demonstrated that patients treated with immunotherapy or targeted therapy had a statistically significant increase in survival compared with patients who did not receive these therapies (p = 0.016). Additionally, females and those with a p63 mutation demonstrated improved survival outcomes (p = 0.010, p = 0.001).
Conclusions Targeted therapy and immunotherapy use should be strongly considered when treating patients with ATC. Further studies into novel drugs targeting immune checkpoints and combination therapy are needed to better optimize treatment of patients with ATC.
Level of Evidence3 Laryngoscope, 2024
Philip R. Brauer, August A. Culbert, Emily Zhang, James R. Xu, Jamie A. Ku, Danielle M. Bottalico, Peter J. Ciolek, Dane J. Genther, Michael A. Fritz, Sara W. Liu, Brandon L. Prendes, Eric D. Lamarre
Publication date 20-08-2024
The percentage of free tissue transfer performed in patients from minority backgrounds with head and neck cancer has been increasing in the United States. Outcomes after head and neck microvascular reconstruction are similar when stratified by race. The findings of our study are encouraging and indicate that progress has been made, but further work is required to reduce racial disparities.
Objective To evaluate national trends in racial disparities for patients undergoing head and neck reconstructive surgery.
Methods Retrospective analysis using the 2008 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. Patients receiving microvascular free tissue transfer were eligible for inclusion. Pediatric patients and those treated by non-otolaryngologists were excluded. Outcomes were analyzed with univariate and multivariable models.
ResultsA total of 5831 head and neck free flap cases were analyzed, 4869 (83.5%) were White, 560 (9.6%) were Black or African American, and 402 (6.9%) were Asian, Native American, or other groups (ANAOG). The proportion of Black or African American patients and ANAOG patients undergoing free tissue transfer increased significantly over the time period (p = 0.047 and p = 0.010, respectively). However, there was a downtrend that started around 2017. In a multivariable model, Black or African American race was not associated with readmission (OR = 0.99 95% CI 0.74, 1.31, p > 0.05), returning to the operating room (OR = 1.20 95% CI 0.96, 1.49, p > 0.05), or any post-operative complication (OR = 0.83 95% CI 0.68, 1.01, p > 0.05). There were also no significant associations found in the ANAOG population on multivariate analysis (p > 0.05 for all).
Conclusion The percentage of free tissue transfer performed in patients from minority backgrounds with head and neck cancer has been increasing in the United States. Outcomes after head and neck microvascular reconstruction are similar when stratified by race. However, racial disparities remain and further work is necessary to reduce these disparities.
Level of Evidence Level IV Laryngoscope, 2024