\nNoémie Villemure‐Poliquin, \nRui Fu, \nKarolina Gaebe, \nJin Kwon, \nMarc Cohen, \nMarianne Ruel, \nKennedy Ayoo, \nAndrew Bayley, \nMadette Galapin, \nJulie Hallet, \nAntoine Eskander\n
Publicatie 02-01-2025
This study evaluates the impact of delayed postoperative radiotherapy (PORT) on overall survival in patients with head and neck cancers. The findings indicate that initiating PORT within 42 days significantly reduces mortality, emphasizing the importance of timely treatment. Further research is needed to explore the effects of different timing cutoffs and identify factors contributing to delays.ObjectivesTo evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).Data SourcesA systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.Review MethodsStudies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.ResultsOf the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio aHR: 1.04 1.03–1.06; I2 = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 1.01–1.20; I2 = 39%; N = 52,003; 5 studies).ConclusionsInitiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nKevin Hur, \nJaynelle Gao, \nAmila Adili, \nBenjamin Tam, \nKevin Herrera, \nDale Rice, \nBozena Wrobel, \nShinyi Wu\n
Publicatie 02-01-2025
There is a higher prevalence of surgical hesitancy observed among Chinese American patients with medically refractory chronic rhinosinusitis (CRS), despite the clinically significant improvement in SNOT-22 scores achieved surgically.ObjectiveThere has been limited research on the influence of race and ethnicity on treatment decision-making for chronic rhinosinusitis (CRS). This prospective study aims to investigate potential factors linked to treatment modality choice among patients with medically refractory CRS, distinguishing between Chinese American and non-Chinese American patients.MethodsCRS patients with persistent symptoms despite prior medical treatment were prospectively enrolled. These patients chose either to continue medical treatment or to undergo endoscopic sinus surgery (ESS) to alleviate CRS symptoms. Demographic and clinical characteristics were compared using bivariate analysis. The association between ethnicity and treatment modality choice was assessed using multivariable logistic regression.ResultsAmong the 134 patients (29.1% Chinese Americans) included, 79 patients (59.0%) elected to undergo ESS. No significant differences in demographics, nasal polyp status, comorbidities, Sinonasal Outcome Test (SNOT-22), Lund–Mackay, or modified Lund–Kennedy scores were found between the treatment groups. After adjusting for age, income, and SNOT-22 score, non-Chinese American patients were more inclined to select ESS (OR = 7.92; 95% CI: 2.95–21.28; p < 0.001) as opposed to Chinese American patients. Chinese American patients who underwent ESS had a clinically significant improvement in SNOT-22 scores at 1 month (−11.29 points) and 3 months (−16.29 points) postoperatively.ConclusionsChinese American patients with refractory CRS are less likely to opt for ESS compared to non-Chinese American patients. Surgical treatment is effective in improving quality of life, as measured by the SNOT-22, among Chinese American CRS patients. Further investigations are warranted to identify factors contributing to surgical hesitancy.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nSophia Marie Häußler, \nChristian S. Betz, \nMarta Della Seta, \nDennis Eggert, \nAlexander Schlaefer, \nDebayan Bhattacharya\n
Publicatie 02-01-2025
We introduce a novel model combining two Convolutional Neural Network (CNN) models for the detection of VS by deep learning aiming to improve performance of automatic segmentation. Sequential connection of UNets combined with spatial attention mechanisms enhances VS segmentation performance across state-of-the-art 2D, 2.5D, and 3D deep learning methods.ObjectiveAutomatic segmentation and detection of vestibular schwannoma (VS) in MRI by deep learning is an upcoming topic. However, deep learning faces generalization challenges due to tumor variability even though measurements and segmentation of VS are essential for growth monitoring and treatment planning. Therefore, we introduce a novel model combining two Convolutional Neural Network (CNN) models for the detection of VS by deep learning aiming to improve performance of automatic segmentation.MethodsDeep learning techniques have been employed for automatic VS tumor segmentation, including 2D, 2.5D, and 3D UNet-like architectures, which is a specific CNN designed to improve automatic segmentation for medical imaging. Specifically, we introduce a sequential connection where the first UNets predicted segmentation map is passed to a second complementary network for refinement. Additionally, spatial attention mechanisms are utilized to further guide refinement in the second network.ResultsWe conducted experiments on both public and private datasets containing contrast-enhanced T1 and high-resolution T2-weighted magnetic resonance imaging (MRI). Across the public dataset, we observed consistent improvements in Dice scores for all variants of 2D, 2.5D, and 3D CNN methods, with a notable enhancement of 8.86% for the 2D UNet variant on T1. In our private dataset, a 3.75% improvement was reported for 2D T1. Moreover, we found that T1 images generally outperformed T2 in VS segmentation.ConclusionWe demonstrate that sequential connection of UNets combined with spatial attention mechanisms enhances VS segmentation performance across state-of-the-art 2D, 2.5D, and 3D deep learning methods.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nMiles Weinberger\n
Publicatie 30-12-2024
\nAndre Isaac, \nAlaa Alanazi, \nCarolin Aizouki, \nJanelle Sloychuk, \nAmy Callaghan, \nEduard Eksteen, \nSheila Ennis\n
Publicatie 30-12-2024
\nJosef Madrigal, \nPeyman Benharash, \nMaie A. St. John\n
Publicatie 30-12-2024
\nFeng Lian Li, \nYuan Yan Bai\n
Publicatie 30-12-2024
\nVikash Yogaraj, \nCatherine Sinclair, \nAyden Tchernegovski, \nDebra Phyland\n
Publicatie 30-12-2024
This systematic review seeks to describe the prevalence of local symptoms in patients with benign thyroid disease. Dyspnoea was the most common symptom (29%), followed by dysphagia (23%) and dysphonia (18%). The findings of this review support the utility of questionnaires as a means of symptom assessment, where symptom prevalence was qualitatively higher in studies that used questionnaires, as compared with studies containing clinician-derived data.ObjectiveThis systematic review seeks to evaluate the prevalence of local symptoms in patients with benign thyroid disease as described in the literature.Data sourcesA literature search was conducted across PubMed, Embase, Medline, and Cochrane databases.Review MethodsCrude symptom prevalence was obtained by addition of data across studies that reported local symptoms, and adjusted symptom frequency was calculated using a random effects model. Subgroup analysis was conducted to explore heterogeneity.ResultsThe final review included 21 studies with 4063 patients, with adjusted symptom prevalence as follows: dyspnoea (29%), dysphagia (23%), dysphonia (18%). Globus and cosmetic concern were frequent in nodule subgroups (54% and 77%, respectively). Patients with goiter were significantly more likely to experience dyspnoea than those with solitary nodules. Symptom prevalence was qualitatively higher in studies that used questionnaires, as compared with studies containing clinician-derived data.ConclusionsLocal symptoms occur frequently in patients with benign thyroid disease, with dyspnoea being most common, followed by dysphagia and dysphonia. Additional large-scale studies with homogenous reporting of symptoms, and data pertaining to thyroid disease size and location, are required to further delineate the relationship between benign thyroid disease and local symptomatology. Furthermore, the disparity in symptom prevalence between questionnaire and clinician-derived data suggests the superiority of questionnaires as a means of symptom assessment, and their potential utility as an instrument to guide patient counseling and outcome expectations. Laryngoscope, 2024
Pubmed PDF Web\nLuke Stanisce, \nSophia Chryssofos, \nReshma Modi, \nShivani Raizada, \nHiroto Watanabe, \nKrystal Hunter, \nSaniya S. Godil, \nDonald H. Solomon\n
Publicatie 30-12-2024
A single-center retrospective review of 220 patients with acute temporal bone fractures with both inpatient and follow-up outpatient otolaryngology evaluation comparing otological outcomes. There was a significant decrease in the rates of hemotympanum, EAC injury, facial nerve weakness, and CSF otorrhea without changes in subjective hearing loss, tinnitus, or vertigo. Half of the subjects tested had audiometric hearing loss. Multivariate regression found age, concomitant intracranial bleeding, and lateral dural venous sinus thrombosis as predictors for hearing loss.Objective(s)To compare the incidence of acute and chronic complications of temporal bone fractures, and identify predictors for post-injury, audiometrically confirmed hearing loss.MethodsRetrospective cohort analysis of patients with acute temporal bone fractures who underwent both in-hospital and outpatient follow-up Otolaryngology evaluation at an academic, tertiary-care institution from January 2002 to January 2023. Otologic outcomes were compared between initial and follow-up evaluations. Logistic regression analysis was used to identify predictors of audiometric hearing loss.Results577 subjects with acute injuries were reviewed; 220 met inclusion criteria. Compared with initial evaluation, the incidence of hemotympanum (57% vs. 5%, p < 0.001), external auditory canal injury (18% vs. 8%, p = 0.01), facial nerve weakness (7% vs. 4%, p = 0.016), and cerebrospinal fluid otorrhea (6% vs. 0%, p < 0.001) significantly decreased at follow-up. There were no differences in rates of subjective hearing loss, tympanic membrane injury, or ossicular disruption. Formal audiograms were performed in 82 subjects. 47 (57%) demonstrated hearing loss, almost half of which were pure sensorineural. Multivariate regression identified age (Odds Ratio OR: 1.03, p = 0.036), intracranial bleeding (OR: 7.49, p = 0.004), and lateral dural venous sinus thrombosis (OR: 10.5, p = 0.039) as predictors for audiometric loss.ConclusionsTemporal bone fractures are complex injuries often associated with numerous intra-temporal and extra-temporal complications. Various otological sequelae persist upon hospital discharge. Yielding insight about the natural history of such injuries, these results aid in patient counseling, identifying subjects at risk for long-term problems, and necessitating follow-up.Level of EvidenceIV Laryngoscope, 2024
Pubmed PDF Web\nEllen M. Hong, \nMilind Vasudev, \nCecilia Nguyen, \nKhodayar Goshtasbi, \nSina J. Torabi, \nTheodore V. Nguyen, \nBrian J.F. Wong\n
Publicatie 28-12-2024
Repositioning and fixation of the posterior septal angle improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.ObjectiveRepositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.MethodsA retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.Results207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from “severe” to “mild.”ConclusionRepositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nTakeshi Hongo, \nYusuke Morinaga, \nHiroyoshi Kino, \nTakuma Hara, \nTakashi Kashiwagi, \nYasuhiro Tsunemi, \nMakoto Akutsu, \nTsuguhisa Nakayama, \nShuho Tanaka, \nHiroyoshi Akutsu\n
Publicatie 28-12-2024
In endoscopic endonasal surgery for anterior skull base lesions, maximizing the anterior sphenoidotomy in the superior part is crucial for direct visualization and creating a wide working corridor. Here, we describe a technique we devised that maximizes upper anterior sphenoidotomy while preserving the olfactory mucosa. Laryngoscope, 2024
Pubmed PDF Web\nJoseph Kidane, \nCassandra L. Thiel, \nKaiyi Wang, \nClark A. Rosen, \nSeema Gandhi\n
Publicatie 26-12-2024
This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls) use Life Cycle Assessment (LCAs) standardized methodology. Reusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation.IntroductionThere is increasing prevalence of single-use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls).MethodsThe ISO 14040 standardized Life Cycle Assessment (LCAs) was utilized to estimate the environmental footprint of SUD-L and R-L. Product and packaging material composition, energy and water consumption, and high-level disinfection products were tabulated from on-site observation, manufacturer data, and the Ecoinvent database. Global warming impacts were defined by greenhouse gas emissions (GHGs) quantified by kilograms of carbon dioxide equivalents (kgCO2-eq) and analyzed using the US EPAs TRACI and SimaPro software. Monte Carlo sensitivity analyses were additionally performed.ResultsAssuming a 6-year lifespan and 218 laryngoscopies/year, the R-L saves 804 kgCO2-eq compared to SUD-L (1816 vs 2619 kgCO2-eq). Notably 63% of the R-L total GHGs were due to personal protective equipment (PPE) production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, a R-L produces fewer lifespan GHGs than SUD-Ls after 82 uses.ConclusionReusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation. Providers should assess laryngoscope use frequency, site of use, and available resources to balance the environmental consequences. Further areas of sustainable optimization include reducing disposable PPE used in R-L reprocessing.Level of EvidenceN/A Laryngoscope, 2024
Pubmed PDF Web\nMilind Vasudev, \nAmir A. Hakimi, \nShannen Guarina, \nAshley R. Lonergan, \nSina J. Torabi, \nEllen Hong, \nAllison C. Hu, \nElaine C. Martin, \nNaveen D. Bhandarkar, \nEdward C. Kuan, \nBrian J.‐F. Wong\n
Publicatie 26-12-2024
In the present study, SMR and MFT performed in tandem with functional septorhinoplasty demonstrated both statistically and clinically significant improvements in nasal obstruction among 373 patients. Our findings demonstrate superior Nasal Obstruction Symptom Evaluation (NOSE) survey outcomes in patients undergoing MFT after 10+ months as compared to SMR. In male patients, superior NOSE score outcomes were seen as early as 4 months in the MFT cohort. These findings should complement surgeon preference and patient-specific pathology when selecting the appropriate approach for inferior turbinate reduction.ObjectivesTo compare longitudinal improvement in nasal obstruction quality-of-life outcomes between medial flap turbinoplasty (MFT) and inferior turbinate submucous resection (SMR) concurrently performed with functional septorhinoplasty.MethodsRetrospective review of a prospectively collected cohort of patients undergoing functional septorhinoplasty between 2015 and 2022 at a tertiary academic center. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire preoperatively and over 12 months postoperatively.Results373 patients were analyzed with longitudinal NOSE questionnaires. Of these, 298 underwent SMR and 75 underwent MFT. The proportion of concurrent intraoperative techniques including rim graft, spreader graft, auto-spreader graft, intradomal sutures, interdomal sutures, and alar spanning sutures were not significantly different between the two cohorts. Patients in all surgical groups had a statistically and clinically significant improvement in NOSE scores between their preoperative and postoperative follow-up visits (p < 0.001). MFT patients had higher NOSE scores 1 month postoperatively (40.0 ± 30.5 vs. 31.0 ± 27.97; p = 0.017), but lower scores after 10 months (15.2 ± 13.3 vs. 25.4 ± 23.5; p = 0.036). Similarly, patients in the MFT cohort in primary rhinoplasty procedures reported higher scores initially but lower after 10 months (p = 0.024). Men in the MFT cohort reported significantly better NOSE outcomes than the SMR cohort as early as 4 months post-surgery and sustained this improvement longitudinally throughout the follow-up period (10.6 ± 12.3 vs. 22.6 ± 21.4; p = 0.012).ConclusionMFT and SMR offer beneficial long-term nasal breathing outcomes among patients undergoing functional rhinoplasty, though further study in appropriate patient selection is indicated.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nCarolyn A. Chabuz, \nRenee M. Banakis Hartl, \nKenny Rodriguez, \nJoseph Gonzalez, \nStephen P. Cass, \nNathaniel T. Greene\n
Publicatie 24-12-2024
Inappropriate cochlear implant array positioning is associated with impaired speech perception, vertigo, and facial nerve stimulation. Tip fold-over is a subset of malpositioning that occurs more often with perimodiolar electrodes, but historically not been characterized due to lack of knowledge re: electrode movements within cochlea. This study characterized the mechanics of tip fold-over events and their associated insertion pressure profiles.ObjectivesCochlear implant array malpositioning is associated with impaired speech perception, vertigo, and facial nerve stimulation. Tip fold-over is a subset of malpositioning that occurs more often with perimodiolar electrodes, but historically it has not been characterized due to lack of knowledge regarding electrode movements of the electrode within the cochlea. The aim of this study was to characterize the mechanics of tip fold-over events and their associated insertion pressure profiles.MethodsCadaveric human heads were surgically prepared with a mastoidectomy and facial recess. Fiberoptic pressure sensors were inserted into the scala vestibuli and tympani to measure intracochlear pressures. Perimodiolar CI electrodes (Cochlear Slim-Modiolar, CI532) were inserted via round window under fluoroscopy.ResultsThree types of tip fold-over events were observed: anterior-posterior C-shaped, medial-lateral C-shaped, and S-shaped roll-overs. The largest transient pressures occurred with anterior-posterior and S-type roll-over, and were associated with rotation or twisting inside the cochlea.ConclusionsResults demonstrate at least three subtypes of tip fold-overs. Elevated pressure transients were noted before and during the tip fold-over event related to electrode twisting. The characterization of tip fold-over into subtypes is novel and may aid identification of tip fold-over events intraoperatively in the future. It remains important to identify tip fold-over events, and they should be recognized early using a multimodal verification system. Further investigation is still required to determine the significance of these changes and other possible patterns of intracochlear electrode movement.Level of EvidenceN/A: Cadaver study Laryngoscope, 2024
Pubmed PDF Web\nBeatrice Bacon, \nRhys Mendel, \nKatelin Keenehan, \nGaayathri Varavenkataraman, \nFrancesca Viola, \nMichele Carr\n
Publicatie 24-12-2024
This study described lacerations of the head and neck sustained among adult ice hockey players in the United States and reviewed current protective equipment requirements. Ice hockey pucks were the primary cause of lacerations in this cohort, and lacerations most commonly occurred on the face.ObjectiveThe goal of this study was to describe lacerations of the head and neck sustained among ice hockey players in the US.MethodsData on adult (20–65 years) ice hockey injuries were collected from the 2003–2022 National Electronic Injury Surveillance System (NEISS) database. Injuries of the head, neck, face, mouth, and ears were included, while those sustained as a spectator, coach, or on a non-ice surface were excluded. Frequencies and means were calculated. A one-way ANOVA and chi-squared tests were performed, with p < 0.05 indicating statistical significance.ResultsFive hundred ninety-three patients were included; 578 (97.5%) male, 15 (2.5%) female. Mean age was 31.3 (95% CI 30.5–32.2) years. Lacerations occurred on the face (N = 422, 71.2%), mouth (N = 124, 20.9%), head (N = 23, 3.9%), ear (N = 22, 3.7%), and neck (N = 2, 0.3%). One patient (0.17%) was admitted due to closed head injury; there were no deaths. Pucks were the primary cause of lacerations (N = 210, 35.4%), followed by sticks (N = 135, 22.8%), collisions (N = 56, 9.4%), and falls (N = 51, 8.6%). 3.4% (N = 20) of patients experienced a laceration caused by a skate blade, most often on the face (N = 17/20, 85.0%).ConclusionHockey pucks are the primary cause of lacerations in the head, face, and mouth, with neck lacerations being rare in this cohort. Full face protective gear would reduce the number of adult ice hockey head and neck lacerations.Level of EvidenceIV Laryngoscope, 2024
Pubmed PDF Web\nRaywat Noiphithak, \nJuan C. Yanez‐Siller, \nPataravit Rukskul, \nPornchai Yodwisithsak\n
Publicatie 24-12-2024
This prospective study investigated the use of intraoperative indocyanine green (ICG) angiography to assess nasoseptal flap vascularization during endoscopic skull base surgery. The research examined vascular pedicle characteristics, perfusion patterns, and their correlation with clinical outcomes in 126 patients. While ICG enhancement patterns did not significantly correlate with postoperative cerebrospinal fluid leaks, they showed a significant association with flap necrosis, suggesting potential value in improving surgical outcomes and reducing complications in nasoseptal flap reconstructions.ObjectivesTo investigate the characteristics of the vascular pedicle of the nasoseptal flap (NSF) and its perfusion patterns using intraoperative indocyanine green (ICG) angiography during endoscopic skull base surgery (ESBS), and examine the correlation between ICG perfusion patterns and clinical outcomes, including postoperative cerebrospinal fluid (CSF) leak and flap necrosis.MethodsThis study enrolled patients undergoing ESBS between January 2017 and December 2021. Intraoperative ICG angiography was performed to visualize the arterial supply of the nasal septum and evaluate NSF perfusion. Postoperative CT scans and clinical follow-ups were conducted to assess flap outcomes.ResultsA total of 126 patients were included in the study. The posterior septal artery (PSA) was most commonly identified in the middle third of the sphenoidal rostrum (63.5% right, 60.3% left). Three branching patterns were observed: single-branch (58.7% right, 64.3% left), double-branch (12.7% right, 11.1% left), and reticular-branch (26.6% right, 24.6% left). Among 72 patients who underwent NSF placement, ICG angiography showed full enhancement in 37 patients (51.4%), partial enhancement in 27 patients (37.5%), and no enhancement in eight patients (11.1%). Postoperative CSF leak occurred in eight patients (11.1%), with no significant correlation to ICG enhancement patterns (p = 0.07). Flap necrosis occurred in five patients (6.9%), all of whom had shown no ICG enhancement beyond the pedicle (p < 0.01).ConclusionsICG angiography is a valuable tool for visualizing the vascular supply of NSF during ESBS. While it does not correlate with postoperative CSF leak, ICG enhancement pattern showed a significant association with flap necrosis. This technique may contribute to improved surgical outcomes and reduced complications in NSF reconstructions.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nForrest W. Fearington, \nAndrew D. Pumford, \nAndrew S. Awadallah, \nJacob K. Dey\n
Publicatie 24-12-2024
Our study seeks to measure how layperson attention is directed to the face when assessing attractiveness. We leverage the power of a controlled eye-tracking study to determine the facial areas that receive the most visual attention when assessing for and rating facial attractiveness. We found that increased gaze at the mouth in females and eyes and hair in males is associated with significantly higher ratings of attractiveness by observers of the opposite sex.BackgroundObjective, controlled eye-tracking measurement of gaze patterns during layperson evaluation of facial attractiveness is currently lacking.ObjectivesTo objectively investigate (1) where on the face laypeople direct their attention when assessing attractiveness compared with a control group, and (2) whether increased fixation on certain facial regions is associated with high attractiveness ratings.MethodsLay observers viewed a cohort of 40 faces with a diverse age, sex, and racial distribution. Observers were either allowed to free-gaze without a specific task or rate facial attractiveness for 10 seconds per face while their gaze was recorded by an eye-tracking system.ResultsForty-seven observers assessed facial attractiveness (mean age 35.1 years (range 21–76), 62% female) and 57 observers free-gazed at the facial photos without a specific task (mean age 35.5 years (range 22–66), 54% female). Preliminary analysis showed that sex of both the face and observer substantially influence gaze-attractiveness associations (p < 0.05). Mixed effects analysis suggests that when males assessed female facial attractiveness, increased fixation time at the mouth correlated most strongly with high attractiveness (p = 0.001), whereas when females assessed male faces, increased fixation at the eyes (p < 0.001) and hair (p = 0.002) were most strongly associated with high ratings of attractiveness.ConclusionsIncreased gaze at the mouth in females and eyes and hair in males is associated with significantly higher ratings of attractiveness by observers of the opposite sex. Practitioners may want to pay special attention to these areas when designing an evidence-based aesthetic treatment plan.Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nPei‐Wen Wu, \nChi‐Che Huang, \nPo‐Hung Chang, \nTa‐Jen Lee, \nChien‐Yu Lin, \nJoseph Tung‐Chieh Chang, \nChien‐Chia Huang\n
Publicatie 23-12-2024
Proton therapy in patients with NPC induces sinus mucosal disease, which peaked at 3 months post-RT, decreased gradually with time, and became insignificant at 2 years post-RT.ObjectivePost-irradiation sinonasal mucosa disease (SMD) is observed in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT), leading to a detrimental impact on quality of life. This study aimed to assess the incidence, severity, and regression of the post-irradiation SMD among patients with NPC treated with proton therapy.MethodsNPC patients treated with proton therapy were retrospectively enrolled. The incidence of SMD was detected using scheduled follow-up magnetic resonance images. The severity of SMD was evaluated using the Lund–Mackay (L–M) staging system. Localized inflammation of the nasopharynx was measured with the endoscopy score.ResultsA total of 161 NPC patients were recruited. The incidence of SMD significantly increased from the third month to the first year after RT. The severity of SMD gradually decreased over time. Regression analyses showed that patients with pre-treatment SMD (OR = 1.75; p = 0.005) and lower serum total protein (OR = 0.16; p = 0.01) were associated with persistence of SMD at 2 years post-RT. Correlations were observed between post-RT L-M and endoscopy scores (rs = 0.239, p < 0.001). A high endoscopy score (cut-off value, 1.5 sensitivity, 87.5%; specificity, 49.2%) predicted the persistence of SMD.ConclusionsProton therapy in patients with NPC induces SMD, which peaked at 3 months post-RT, decreased gradually with time, and became insignificant at 2 years post-RT. Pre-existence of SMD and lower serum total protein levels were factors associated with the persistence of post-irradiation SMDs.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nMichael B. Gluth, \nRyan T. Judd, \nRichard K. Gurgel, \nJohn L. Dornhoffer, \nWalter Kutz, \nMatthew L. Carlson, \nJafri Kuthubutheen, \nRyan D. Anderson, \nDaniel E. Killeen, \nJason H. Barnes, \nWanda L. Fussell, \nChaithanya Jeganathan\n
Publicatie 23-12-2024
This is a clinical article that analyzed data from a large multi-institution database of ossiculoplasty outcomes to determine which ear environment risk factors independently are associated with postoperative hearing outcomes. The identified risk factors were utilized to create a novel ear environment risk-weighted grading scale with risk groupings the correlate with hearing outcomes. This new scale is proposed as a means of framing ear environment to meaningfully interpret future ossiculoplasty outcomes research.ObjectiveTo determine which ear environment risk factors impact ossiculoplasty hearing outcomes and to generate a statistically-valid grading system for ossiculoplasty outcome reporting.Study TypeRetrospective case series.MethodsA multi-institutional database was generated from cases performed between 2011 and 2019. Preoperative and postoperative hearing thresholds were recorded alongside potential ear environment risk factors. Multiple variable linear regression statistical analyses of risk factors were applied to determine independent association with postoperative pure tone average air-bone gap (PTA-ABG). Significant factors were used to generate a statistically-weighted grading scale of Ear Environment Risk (EER).Results1679 cases had a mean follow-up time of 33.6 months (SD 36.3) and a mean postoperative PTA-ABG of 21.2 (SD 12.8). Multiple revision status (p < 0.001), presence of canal wall down mastoidectomy cavity (p = 0.020), absent malleus (p < 0.001), absent stapes superstructure (p = 0.016), frequent otorrhea (p = 0.008), pediatric age (p < 0.001), and blunted/lateralized tympanic membrane (p = 0.003) were independently correlated with PTA-ABG. These factors were incorporated into an EER Scoring System with four distinct risk groups wherein each risk group was significantly correlated with PTA-ABG, and this grading system was better correlated with PTA-ABG (Kendalls τ = 0.193) than other existing published grading scales.ConclusionGrading environment risk according to a novel EER scoring system generates meaningful risk groupings that correlate with ossiculoplasty postoperative PTA-ABG, and this holds potential to frame reporting of hearing outcomes for future ossiculoplasty research.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nTrenton House, \nClare M. Richardson, \nDana Williams, \nMark E. Gerber, \nStuart Curtis, \nShauna Schroeder, \nLeyden Lozada, \nJames Woodward, \nAshley Ramirez, \nStacey Killeen, \nPatrick Scheffler\n
Publicatie 23-12-2024
ObjectivesTo investigate the relationship between social determinants of health and timeliness of management, adherence to follow-up, and outcomes of treatment with interarytenoid injection augmentation (IAIA).MethodsRetrospective cohort study of all pediatric patients treated with IAIA at a large pediatric institutions multidisciplinary aerodigestive clinic between August 2022 and February 2024. Retrieved demographic factors, dates of referral, consultation, treatment, and follow-up, as well as objective measures of dysphagia and aspiration via videofluoroscopic swallow study (VFSS) reports, using dysphagia outcome and severity scale (DOSS) scores and the greatest unsafe thickness, or ‘aspiration score’. These factors were analyzed for correlation with social determinants of health determined through the Area of Deprivation Index (ADI).ResultsA total of 120 patients, median age 15 months were included. All underwent IAIA for the indication of persistent pharyngeal dysphagia. The median national ADI score was 45. Patients experienced average improvement in laryngeal penetration and aspiration from an aspiration score of slightly thick preoperatively to thin postoperatively, and improvement in dysphagia from mild–moderate to mild. No correlation was identified between ADI, race and ethnicity, or sex and measures of timeliness of treatment, loss to follow-up, receipt of feeding therapy, or outcome of treatment.ConclusionAddressing persistent dysphagia in pediatric patients with IAIA seems to be equivalently efficacious across a wide population, and outcome did not vary significantly depending on patients race or socioeconomic contexts. This finding may be due in part to the utilization of a well-organized multidisciplinary center to treat these complex patients.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nEbraheem Albazee, \nAhmed Abu‐Zaid, \nMubarak Althaidy, \nMarwan Alqunaee\n
Publicatie 21-12-2024
This systematic review and network meta-analysis, encompassing eight clinical trials, indicates that intrapolyp steroid injections have a favorable safety and efficacy profile as a viable management option for CRSwNP. The injections showed comparable efficacy with oral steroids and demonstrated certain advantages over other treatments, such as nasal sprays and washes. Given these findings, intrapolyp steroid injections should be considered a viable alternative treatment for patients with CRSwNP. Further clinical trials with larger sample sizes and standardized protocols are needed to reinforce these conclusions.ObjectiveTo conduct a systematic review and network meta-analysis to evaluate the safety and efficacy of intrapolyp steroid injection compared with oral steroids, nasal steroid wash, nasal steroid spray, and a control group in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Data SourcesPubMed, Scopus, Web of Science, Embase, and CENTRAL.Review MethodsBoth randomized and non-randomized clinical trials were included. For risk of bias assessment, we used the RoB-2 and ROBINS-I tools. Our outcomes focused on safety and efficacy, including rates of visual disturbance and bleeding, as well as improvements in nasal polyps evaluated through three domains: endoscopic, radiologic, and patient-reported assessments. Safety data were pooled as events (%), while efficacy data were pooled as mean difference (MD) or standardized mean difference (SMD).ResultsEight clinical trials involving 579 patients were analyzed. The pooled analyses showed low event rates for visual disturbances (event rate = 0.64%, 95% CI 0.00%, 2.23%) and bleeding (event rate = 0.61%, 95% CI 0.00%, 2.25%). Additionally, intrapolyp steroid injections were found to be comparable with oral steroids, with no statistically significant differences. Moreover, intrapolyp steroid injections demonstrated some superiority over nasal sprays, nasal washes, and the control group.ConclusionThis network meta-analysis confirms that intrapolyp steroid injections have a favorable safety and efficacy profile as a viable management option for CRSwNP. The injections showed comparable efficacy with oral steroids and demonstrated certain advantages over other treatments, such as nasal sprays and washes. Further research with larger sample sizes and standardized protocols are needed. Laryngoscope, 2024
Pubmed PDF Web\nTian Wang, \nChuang Huang, \nJie Wang, \nTianci Tang, \nQiang Li, \nYi Li, \nXinmao Song\n
Publicatie 21-12-2024
In this study, we aimed to investigate the optimal number of cycles on chemotherapy for the treatment of adult head and neck rhabdomyosarcoma (HNRMS), the value of radiotherapy (RT) or surgical treatment for adult HNRMS and the optimal timing of surgery in adult HNRMS. Our results suggest surgery played a limited role in treating adult HNRMS, and patients who accepted 62.5Gy of radiation demonstrated the lowest all-cause motality. Eight cycles of chemotherapy are adequate for HNRMS in adults. Poor response to chemotherapy predicted an extreme worse outcome.Objective(s)Head and neck rhabdomyosarcoma (HNRMS) is a rare malignant tumor in adults. No standard treatment for adults with HNRMS currently exists.MethodsA retrospective study of 72 newly diagnosed consecutive adult patients with HNRMS was conducted at one institution between November 2010 and April 2023. The log-rank tests were used to compare the differences in survival between treatment groups, and overall survival (OS), local recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated using the Kaplan–Meier method. We used restricted cubic spline models fitted for Cox proportional hazards models to determine the association between chemotherapy cycles/radiotherapy dose and mortality.ResultsThe 2-year OS, PFS, LRFS, and DMFS rates for the entire cohort were 51.0%, 39.2%, 44.3%, and 47.3%, respectively. Radiotherapy significantly improved the OS (p < 0.01), PFS (p < 0.01), LRFS (p < 0.01), and DMFS (p < 0.01). Surgery had no effect on OS (49.3% vs. 53.0%, p = 0.62), PFS (36.9% vs. 41.8%, p = 0.31), LRFS (41.6% vs. 47.4%, p = 0.27), or DMFS (44.4% vs. 50.2%, p = 0.43). The restricted cubic spline showed that eight (HR = 1.002, 95% CI: 0.996–1.007) cycles of chemotherapy and 62.5Gy radiation therapy resulted in the lowest mortality.ConclusionFor HNRMS, eight cycles of chemotherapy and 62.5Gy of radiation might be sufficient. Poor response to chemotherapy predicted an extreme worse outcome. Surgery played a limited role in the treatment.Level of EvidenceIII Laryngoscope, 2024
Pubmed PDF Web\nRachel E. Weitzman, \nKarena Zhao, \nTejas Subramanian, \nAnthony P. Sclafani\n
Publicatie 20-12-2024
This study represents one of the largest reviews of cost and inpatient burden of mandible fractures. We found that presentation via transfer, traffic-related injuries, and 3 or more facial fractures were associated with significantly higher cost and longer length of hospitalization.ObjectiveTo evaluate characteristics associated with increased cost and length of hospitalization of mandible fracture management.Study DesignRetrospective chart review.MethodsDemographics, injury mechanism, associated injuries, treatment information, and associated costs were collected for all patients treated for mandible fracture treated at a single institution over a 14-year period. Univariable and multivariable analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization.ResultsWe identified 552 patients with 834 mandible fractures from 2008 to 2022. Patients mean age was 40 years, 67% were male, and 38% Caucasian. The median cost of treatment, adjusted for inflation, was $8,869.49, and median length of stay (LOS) was 3.0 days. Associated cranial/intracranial injury, transfer presentation, increased facial fractures, and traffic-related injuries resulted in a significant increase in both cost and LOS. LOS had a significant impact on cost, while age also significantly increased LOS for patients with mandible fractures.ConclusionsThis study represents one of the largest comprehensive databases of mandible fractures and one of the first to provide a descriptive cost and inpatient burden analysis of mandible fracture management. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to identify and mitigate factors that we identified as contributing to increased cost and length of hospitalization.Lay SummaryThis study represents one of the largest reviews of cost and inpatient burden of mandible fractures. We found that presentation via transfer, traffic-related injuries, and more facial fractures were associated with significantly higher cost and longer length of hospitalization.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nAkshay Warrier, \nRohan Singh, \nAfash Haleem, \nHaider Zaki, \nJean A. Eloy\n
Publicatie 20-12-2024
\nAntonino Maniaci, \nMario Lentini, \nPaolo Boscolo‐Rizzo, \nJerome R. Lechien\n
Publicatie 20-12-2024
\nSofia Torres‐Small, \nCamron Davies, \nFekede Asefa Kumsa, \nAndrew Maroda, \nArash Shaban‐Nejad, \nJohn P. Gleysteen, \nDavid L. Schwartz, \nC. Burton Wood\n
Publicatie 20-12-2024
Our objective was to examine how rural residence interacts with SES and race/ethnicity relative to HNSCC treatment delay and outcomes utilizing the SEER census tract database. We found risk for treatment delay increased with decreasing SES and was higher for patients with minoritized race/ethnicity status, and rurality was associated with a lower risk aRR: 0.917, 95% CI: 0.892, 0.946 of treatment delays, but was not predictive for patient survival (aTR: 1.019 0.978, 1.061). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this national registry sample.ObjectiveTo examine how rural residence interacts with SES and race/ethnicity relative to Head and neck squamous cell carcinoma (HNSCC) treatment delay and outcomes.MethodsThe SEER database was queried for patients aged ≥18 with HNSCC. Out of 164,337 cases, 126,052 remained after exclusions for missing data. Statistical tests performed included Chi-squared tests, log-binomial regression models, and parametric accelerated failure time (AFT) models, with a significance level of α < 0.05.ResultsAbout 38% of patients residing in lowest SES census tracts were rural, whereas over 98% of patients from highest SES tracts were urban. Delayed treatment was associated with shorter median survival aTR = 0.968, 95% confidence interval (CI): 0.939, 0.999. Risk for treatment delay increased with decreasing SES and was greater for those with minoritized race/ethnicity status. Rurality was associated with a lower risk aRR: 0.917, 95% CI: 0.892, 0.946 of treatment delays but was not predictive for patient survival (aTR: 1.019 0.978, 1.061). Cancer-specific mortality increased with decreasing SES and was higher in patients with minoritized race/ethnicity status.ConclusionRurality was associated with decreased risk for treatment delay but not with worse survival relative to urban residence, whereas low SES and minority status remained predictive for poor outcome regardless of geographic context (level of evidence: 4). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this sample. Confirmatory patient-level analysis should be prioritized to optimize support along the rural/urban divide.Level of EvidenceIV Laryngoscope, 2024
Pubmed PDF Web\nNicole T. Jiam, \nKamala Pullakhandam, \nD. Bradley Welling\n
Publicatie 19-12-2024
Facial nerve schwannomas (FNSs) eroding through the external auditory canal (EAC) are difficult to manage, particularly in patients with normal facial function. Observation with periodic cleaning remains the mainstay treatment option for patients with FNSs eroding through the EAC and are otherwise asymptomatic. In patients with complete EAC occlusion, eccentric tumor location on the facial nerve, and normal facial function after lidocaine infiltration, conservative debulking may be possible with intraoperative facial nerve monitoring and mapping of the facial nerve fibers through the tumor.Facial nerve schwannomas (FNSs) eroding through the external auditory canal (EAC) are unusual and present difficult management options.When facial nerve function is normal, observation is generally recommended.If the tumor completely obstructs the EAC creating a conductive hearing loss as in this case, mapping of the motor fibers of the facial nerve may be considered with partial resection to alleviate the conductive hearing loss.Test injection of a small volume of lidocaine did not cause facial paresis.Intraoperative mapping allow successful tumor debulking and wide patency of the EAC. Laryngoscope, 2024
Pubmed PDF Web\nXiaowu Tang, \nWeijie Ye, \nYongkang Ou, \nHongsheng Ye, \nXiran Zhu, \nDong Huang, \nJinming Liu, \nFei Zhao, \nWenting Deng, \nChenlong Li, \nWeiwei Cai, \nYiqing Zheng, \nJunbo Zeng, \nYuexin Cai\n
Publicatie 19-12-2024
The diagnosis of vertigo disease is still challenging with lack of objective evaluation tools. This study aims to investigate whether artificial intelligence (AI) can improve the diagnostic accuracy of vertigo related diseases, which may reduce the unnecessary and expensive magnetic resonance imaging (MRI) examination.PurposeThis study aims to investigate whether artificial intelligence can improve the diagnostic accuracy of vertigo related diseases.Experimental DesignBased on the clinical guidelines, clinical symptoms and laboratory test results were extracted from electronic medical records as variables. These variables were then input into a machine learning diagnostic model for classification and diagnosis. This study encompasses two primary objectives: Task 1 to distinguish between patients with Benign Paroxysmal Positional Vertigo (BPPV) and non-BPPV. In Task 2, further classifying non-BPPV patients into Ménières Disease (MD), Vestibular Migraine (VM), and Sudden Sensorineural Hearing Loss accompanied by Vertigo (SSNHLV). The sensitivity, precision, and area under the curve (AUC) metric is primarily used to assess the performance of the machine learning model development phase in a prospective validation cohort.ResultsIn our study, 1789 patients were recruited as the training cohort and 1148 patients as the prospective validation cohort. The comprehensive diagnostic performance of the XGBoost model surpasses that of traditional models. The sensitivity, accuracy, and AUC in task 1 were 98.32%, 87.03%, and 0.947, respectively. In task 2, the sensitivity values for MD, SSNHLV, and VM were 89.00%, 100.0%, and 79.40%, respectively. The precision values were 88.80%, 100.0%, and 80.00%, respectively. The AUC values were 0.933, 1.000, and 0.931, respectively. The model can significantly improve the accuracy of diagnosing vertigo diseases.ConclusionsThis system may enhance the accuracy of classification and diagnosis of vertigo diseases. It offers initial therapy or referrals to clinical doctors, particularly in resource-limited settings.Level of EvidenceN/A Laryngoscope, 2024
Pubmed PDF Web\nKristen Handal, \nJanet Koehnke, \nMaryrose McInerney, \nJoan Besing, \nAnil K. Lalwani\n
Publicatie 18-12-2024
Wearing surgical attire significantly impaired speech intelligibility. The use of the surgical bouffant cap and mask makes it more difficult to localize sound and understand speech in the presence of OR noise. This could lead to miscommunication and impact surgical outcome; thus, ear covering should be avoided.ObjectiveTo determine the effect of the surgical bouffant cap on hearing, sound localization, and speech intelligibility in the operating room (OR).BackgroundCovering of the ear during surgical procedures has been promoted to prevent surgical site infection (SSI) from ear pathogens. However, the potential impact of ear covering on hearing in the OR has not been studied.MethodsTwenty participants with normal hearing underwent auditory testing with and without surgical attire (bouffant cap and surgical mask). Auditory threshold testing was performed with warble tones in a sound-treated booth. In the speech intelligibility test, participants were instructed to identify the last word of Speech Perception in Noise (SPIN) sentences (high and low predictability) in OR background noise. In the sound source localization test, participants were asked to localize a speech source amidst OR background noise.ResultsThreshold measures showed no significant effect of wearing surgical attire on detection thresholds. Wearing surgical attire significantly impaired speech intelligibility (p < 0.05). Sound localization was not statistically significant.ConclusionsThe use of the surgical bouffant cap and mask makes it more difficult to understand speech in the presence of OR noise. This could lead to miscommunication and impact surgical outcome; thus, ear covering should be avoided.Level of EvidenceN/A Laryngoscope, 2024
Pubmed PDF Web\nOzkan Onal, \nMerih Onal\n
Publicatie 18-12-2024
\nJordyn Hurly, \nDavid Tunkel, \nJonathan Walsh\n
Publicatie 18-12-2024
\nNeil U. Parikh, \nMelissa Zheng, \nAlbert L Merati, \nMichael Johns III, \nElizabeth A. Shuman\n
Publicatie 18-12-2024
This study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050. As of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low-density areas.IntroductionThis study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050.MethodsA national database of fellowship-trained laryngologists (FTLs) and nonfellowship-trained laryngologists (nFTLs) practicing primarily laryngology was formed by identifying laryngologists via internet search, with validation by regional laryngologists and senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, institutional affiliation, and practice zip code. US Census Bureau population data and projections were grouped by hospital referral region (HRR), as defined by the Dartmouth Healthcare Atlas. The National Resident Matching Program (NRMP) provided annual fellowship match data from 2012 to 2022.ResultsAs of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. The median practice length for all laryngologists was 11 years. HRRs with the largest number of laryngologists were Manhattan, Boston, and Los Angeles, with 23, 16, and 14 respectively. One hundred and ninety-four of 306 (63%) HRRs did not have an active, primary laryngologist. The national median density of people per laryngologist including HRRs with at least one laryngologist was 645,160. Assuming a 35-year practice horizon prior to workforce exit and holding the 2018–2022 NRMP average of 18 fellows constant, the number of forecasted laryngologists by 2040 would be 568—an increase of 66%.ConclusionsTo date, no comprehensive database of practicing US laryngologists nor laryngology workforce forecast exists. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low-density areas.Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nFahd Al‐Shahrestani, \nAhmed Ehsan Al‐Khafaf, \nZain Asheer, \nJelena Jelicic, \nIman Chanchiri, \nCatharina E. Blocher, \nAnne Kathrine Aalling Sørensen, \nLars Møller Pedersen, \nLise Mette Rahbek Gjerdrum, \nSteffen Heegaard, \nPreben Homøe\n
Publicatie 17-12-2024
This is the first nationwide cohort study to investigate the epidemiology, incidence, survival rates, clinical features, and association with Sjögrens syndrome in parotid gland lymphoma patients in Denmark from 2000 to 2020.ObjectiveWe examined the epidemiology of parotid gland lymphomas (PGL), the incidence, survival rates, clinical features, and association with primary Sjögrens syndrome (pSS).MethodsThis retrospective nationwide cohort study analyzed data from Danish patients diagnosed with PGL between 2000 and 2020. Data were collected from medical records, the National Pathology Register, and the Danish lymphoma database. Statistical analyses included Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models.ResultsA total of 433 patients were included. The incidence rate was 0.39 per 100,000 person-years, with PGL constituting 1.9% of all non-Hodgkins lymphoma in Denmark. The average annual incidence was 2.7% (incidence rate ratio = 1.027, p < 0.01). Follicular lymphoma (FL) was the most common subtype with 154 cases (35.6%), followed by large B-cell lymphoma (LBCL) with 119 cases (27.5%), and extranodal marginal zone lymphoma (EMZL) with 84 cases (19.4%). The median overall survival (OS) for FL was 9.5 years (95% CI 6.9–10.2), with 5-year and 10-year OS rates of 70% and 44%, respectively. For LBCL, the median OS was 7.8 years (95% CI 5.0–8.8), with 5-year and 10-year OS rates of 59% and 33%. EMZL had a median OS of 12.8 years (95% CI 9.0–16.3), with 5-year and 10-year OS rate of 83% and 55%. EMZL was significantly associated with pSS, relative risk 21.97 (95% CI 2.81–171.53). Advanced age, B symptoms, and elevated LDH levels were significantly linked to poorer overall survival.ConclusionThis study offers new epidemiological, clinical, and prognostic insights, with a focus on their association with pSS.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nYasser M. Almansour, \nAbdulghafoor Alani, \nCarl P. Wilson, \nJacob G. Eide, \nJohn R. Craig\n
Publicatie 14-12-2024
One-hundred consecutive patients underwent medial flap turbinoplasty (MFT) with or without septoplasty for nasal obstruction, and were followed for at least one year postoperatively. Patients experienced significant long-term reductions in nasal obstruction, and none developed an ENS6Q≥11 postoperatively. Therefore MFT was unlikely to cause ENS.BackgroundEmpty nose syndrome (ENS) is a poorly understood condition that affects a minority of patients who undergo inferior turbinate (IT) surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) was validated to diagnose ENS following IT reduction, with an ENS6Q ≥ 11 being suggestive of ENS. Medial flap turbinoplasty (MFT) involves IT bone removal ± submucosal reduction (SMR) and is highly effective at surgically treating IT hypertrophy. This studys purpose was to determine the incidence of ENS following MFT by comparing ENS6Q scores preoperatively and postoperatively.MethodsA retrospective cohort study was conducted on consecutive patients who underwent bilateral MFT with or without septoplasty to address nasal obstruction. Preoperative and postoperative nasal obstruction and septoplasty effectiveness (NOSE, 0–20) and ENS6Q (0–30) scores were compared at a minimum 12 months postoperatively.ResultsOf 100 patients, mean age was 48.9 years and 53% were male. Mean follow-up was 25.0 months (range: 12–66 months). Patients underwent MFT with SMR in 70% of cases, whereas 30% had bone removal only, and 79% had septoplasty. NOSE scores decreased significantly postoperatively (mean 9-point reduction, p < 0.0001). Mean preoperative and postoperative ENS6Qs were 8.5 and 3.0, respectively, with a mean 5.6-point decrease postoperatively (p < 0.0001). While some patients developed elevated ENS6Q scores mainly in the first 3 months postoperatively, no patients had ENS6Q scores ≥11 at final follow-up.ConclusionsMFT ± septoplasty led to significant long-term reduction in nasal obstruction, with no patients ultimately developing ENS6Q ≥ 11 postoperatively. Therefore, MFT was unlikely to cause ENS.Level of EvidenceLevel 4 Laryngoscope, 2024
Pubmed PDF Web\nDoris Braunstein, \nHolly Jones, \nColleen Heffernan\n
Publicatie 12-12-2024
This case report investigates the laryngeal anomalies in a 20-month-old patient with Cri du Chat syndrome, a genetic disorder noted for its distinctive cry and systemic manifestations. Through diagnostic evaluations including videofluoroscopy and microlaryngobronchoscopy, we describe unusual laryngeal characteristics with the aim of enhancing clinical awareness and improving airway management for affected individuals.Laryngeal anatomical variations in Cri du Chat syndrome remain incompletely characterized in the medical literature, with few published photographic documentations. We present a case of a 20-month-old male with confirmed 5p15 deletion who presented with congenital inspiratory stridor and dysphagia. Videofluoroscopic evaluation at 13 months demonstrated aspiration of thin liquids.Microlaryngobronchoscopy revealed a Cormack-Lehane grade 3 view with a retroflexed epiglottis secondary to tight aryepiglottic folds, and laterally positioned false vocal cords resulting in broad, flat ventricles. Bilateral aryepiglottic fold division improved direct laryngoscopic visualization to Cormack-Lehane grade 1. This report provides detailed laryngeal characterization with photographic documentation, contributing to the understanding of airway variations in this syndrome. Recognition of these anatomical features is crucial for optimizing airway management strategies in this patient population. Laryngoscope, 2024
Pubmed PDF Web\nMichel L.H.T. Vaena, \nCaterina G. Alessio, \nKevin Sicalo, \nFelipe de Olveira Brito Queiroz, \nRoberta R. de Souza Albuquerque, \nDanielli R.L. da Silva\n
Publicatie 11-12-2024
Forehead flaps are the workhorse for reconstructing most nasal defects. However, a low hairline in the forehead may be an obstacle to their use in columellar reconstruction, considering the distal position of the defect. We present a technique designed for total columellar reconstruction using a two-staged forehead flap in a 9-year-old child. The method is particularly useful for patients with a low hairline, avoiding transfer of hair-bearing skin to the reconstructed columella.The nasal columella is considered by many to be the most difficult nasal aesthetic subunit to reconstruct, due to its delicate anatomy and central location. Full thickness columellar defects are particularly challenging. Being in the midline of the face, the nasal columella receives vascularization from terminal arterial branches, so adjacent local flaps have limited arcs of rotation or may be too bulky, thus withdrawing the options for reconstruction. Forehead flaps, due to their reliable vascularization and excellent aesthetic result, are the workhorse for reconstructing most nasal defects. However, a low hairline in the forehead may be an obstacle to their use in columellar reconstruction, considering the distal position of the defect. We present a technique designed for total columellar reconstruction using a two-staged forehead flap in a 9-year-old child. The method is particularly useful for patients with a low hairline, avoiding transfer of hair-bearing skin to the reconstructed columella. Laryngoscope, 135:118–120, 2025
Pubmed PDF Web\nMelissa Papuc, \nManikandan Sugumaran\n
Publicatie 11-12-2024
Intralesional steroid injections are commonly used to treat idiopathic subglottic stenosis and are believed to have minimal systemic effects. This case report presents an immunocompetent 67-year-old woman with idiopathic subglottic stenosis who developed Scedosporium apiospermum infection of the subglottis following in-office steroid injections, suggesting a potential risk for infection associated with this treatment. This highlights the need for further research to understand the impact of intralesional steroid injections on local and systemic immunocompetency to inform treatment protocols for idiopathic subglottic stenosis.Intralesional steroid injections are commonly used to treat idiopathic subglottic stenosis and are believed to have minimal systemic effects. This case report presents an immunocompetent 67-year-old woman with idiopathic subglottic stenosis who developed Scedosporium apiospermum infection of the subglottis following in-office steroid injections, suggesting a potential risk for infection associated with this treatment. This highlights the need for further research to understand the impact of intralesional steroid injections on local and systemic immunocompetency to inform treatment protocols for idiopathic subglottic stenosis. Laryngoscope, 135:241–242, 2025
Pubmed PDF Web\nAri D. Schuman, \nJulina Ongkasuwan\n
Publicatie 11-12-2024
Nonselective laryngeal reinnervation (NSLR) shows comparable voice results to thyroplasty after one year without permanent implants. In the rare case of a second ipsilateral vocal fold paralysis after NSLR, we present the first recorded revision NSLR. Case report. A 51 year old woman with a history of right NSLR in 2017 for vocal fold paralysis after an anterior cervical diskectomy and fusion (ACDF) presented for re-evaluation prior to a revision of her ACDF. Ipsilateral revision was recommended to reduce the risk of bilateral vocal fold paralysis. Post-operatively, she was noted to have vocal fold immobility. Her maximum phonation time at that time was 9 s. Her voice was moderately breathy and moderately asthenic. Fundamental frequency (F0) was 211 Hz. Jitter was 2.868%, and shimmer 14.429%. Noise to harmonic ratio was 0.366. Cepstral peak prominence was 2.689. After being offered thyroplasty or revision reinnervation, she opted for revision reinnervation due to a strong preference for her reinnervated voice. She underwent a revision cross-neck NSLR with a commercial nerve graft in September 2022. One year later, her MPT was found to be 7.6 s, with mild breathiness and asthenia. F0 was 190 Hz. Jitter decreased to 2.42%, shimmer to 6.478%, and NHR to 0.165. Cepstral peak prominence increased to 4.427. VHI decreased from 35 pre-operatively to 7 post-operatively. We present the first case of a revision NSLR. Notable improvement has been found in objective voice measures and patient-reported outcomes post-operatively, demonstrating feasibility in similar patients. Laryngoscope, 135:239–240, 2025
Pubmed PDF Web\nBailey Hassman, \nZuzan Cayci, \nStephanie Misono, \nRaluca Gray\n
Publicatie 11-12-2024
This case series examines seven patients diagnosed with cricoid chondronecrosis after intubation in the setting of COVID-19 and presents a novel “cricoid chondronecrosis computed tomography (CT) grading rubric” to standardize reporting of radiological findings. Application of this radiological grading rubric can improve communication among clinicians and radiologists and aid in prognosis determination of patients with cricoid chondronecrosis.This case series examines seven patients diagnosed with cricoid chondronecrosis after intubation in the setting of COVID-19 and presents a novel “cricoid chondronecrosis computed tomography (CT) grading rubric” to standardize reporting of radiological findings. Application of this radiological grading rubric can improve communication among clinicians and radiologists and aid in prognosis determination of patients with cricoid chondronecrosis. Laryngoscope, 135:251–256, 2025
Pubmed PDF Web\nVasiliki Triantafillou, \nKevin Leahy\n
Publicatie 11-12-2024
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, 135:243–246, 2025
Pubmed PDF Web\nMichael P. Wu, \nCody Sullivan, \nDaniel G. Deschler\n
Publicatie 11-12-2024
For total laryngectomy patients with tortuous tracheoesophageal puncture (TEP) tracts, anterograde placement of the voice prosthesis can be challenging. This article describes an updated and straightforward technique for in-office retrograde placement of the voice prosthesis in patients with such challenging TEP tracts. Laryngoscope, 135:121–123, 2025
Pubmed PDF Web\nMasato Nagaoka, \nKazuhiro Omura, \nTaisuke Akutsu, \nHaruyuki Hirayama, \nKatsuhiro Ishida, \nHiromi Kojima\n
Publicatie 11-12-2024
This study presents a pioneering report on an endoscopic assisted total maxillectomy that allows for en bloc resection without a facial skin incision. Laryngoscope, 135:124–129, 2025
Pubmed PDF Web\nPeter K. Moon, \nLauren Bloom, \nMelissa Tribble, \nAngela H. Ling, \nIram N. Ahmad, \nKristen Yeom, \nAlan G. Cheng\n
Publicatie 11-12-2024
Central hearing loss is caused by abnormalities of the auditory pathway. This is one of the first reports to describe a pediatric patient with central hearing loss.Sensorineural hearing loss is typically caused by dysfunction of the inner ear or auditory nerve. In pediatric patients diagnosed with sensorineural hearing loss, work-up often includes genetic testing and imaging studies of the auditory pathway. Here, we report a case of a pediatric patient with a history of sensorineural hearing loss following cisplatin and radiation therapy for brainstem medulloblastoma, developing symptoms and signs of central hearing loss based on audiometric and MRI/diffusion tensor imaging studies. Though rare, central hearing loss should be considered among the causes of sensorineural hearing loss in children. Laryngoscope, 135:452–456, 2025
Pubmed PDF Web\nStephanie Y.Y. Yeap, \nYew M. Chan, \nChun W. Yip, \nBrenda L.H. Sim\n
Publicatie 11-12-2024
We report a unique case of horizontal canal Benign Paroxysmal Positional Vertigo (BPPV) with spontaneously reversing nystagmus (SRN) at our institution. We further discuss the possible mechanisms with an original illustration, with an evaluation of the current literature and theories for this phenomenon.Direction-changing nystagmus on positional testing is classically ascribed to a central pathology. We herein report a case of a patient with Benign Paroxysmal Positional Vertigo (BPPV) who demonstrated the unusual phenomenon of spontaneously reversing nystagmus, and discuss the theorised mechanisms with a novel illustration. In left lateral position, our patients Videonystagmography (VNG) demonstrated an initially fast-phase geotropic nystagmus (leftward-beating, SPV 29°/s) which then paused for 8 s, then spontaneously reversed direction into a slow-phase ageotropic nystagmus (rightward-beating, SPV 7°/s). The rest of the neurootological examination and audiometry were normal. An MRI Brain scan also revealed no intracranial pathology. In subsequent reviews the vertigo resolved after repositioning manoeuvres for Left Horizontal Canal BPPV. With review of existing literature, this case may have exhibited coexistent left canalolithiasis and cupulolithiasis, resulting in simultaneous ampullopetal then ampullofugal forces in a single head position. Other posited theories include that of Endolymphatic Reflux and short-term central adaptation of the Vestibulo-Ocular Reflex. This case highlights a diagnostic challenge the otolaryngologists and neurologists may face with an atypical spontaneously reversing nystagmus in BPPV. However it remains a priority to rule out central pathologies first, and calls for specialists to take care in diagnosing horizontal canal BPPV by observing for a period of latency and spontaneous reversal of nystagmus first, so as to perform the appropriate repositioning manoeuvres. Laryngoscope, 135:373–376, 2025
Pubmed PDF Web\nFan Yang, \nLan Xiao, \nGrace Paka Lubamba, \nChang Cao, \nJia‐Lu He, \nXiao‐Yi Wang, \nChunJie Li, \nGui‐Quan Zhu\n
Publicatie 11-12-2024
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, 135:130–133, 2025
Pubmed PDF Web\nJessica M.L. Pagel, \nRachel H. Jonas, \nJames J. Daniero, \nPatrick O. McGarey Jr\n
Publicatie 11-12-2024
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, 135:247–250, 2025
Pubmed PDF WebPublicatie 11-12-2024
\nElliot Morse, \nAlexandra Li, \nSara Albert, \nLexa Harpel, \nAnaïs Rameau\n
Publicatie 11-12-2024
\nMary Newland, \nHänel Eberly, \nCheng Ma, \nJessyka G. Lighthall\n
Publicatie 11-12-2024
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.ObjectiveOxymetazoline 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 ReviewedPubMed (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 PubMed, 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.ResultsFive 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%).ConclusionThe 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, 135:8–14, 2025
Pubmed PDF Web\nNihal Punjabi, \nArjun Sharma, \nJamie Park, \nKari Kennedy, \nJared C. Inman\n
Publicatie 11-12-2024
Management of the contralateral N0 neck in tonsil cancer is dependent on knowing the rate of occult metastasis. This systematic review and meta-analysis found that the overall rate is 10%, but it is as high as 19% in T3/T4 tumors and as low as 1% in patients with no clinically significant nodes in the ipsilateral neck. These results may help guide patient education in decision-making for contralateral selective nodal sampling, elective neck dissection, or radiation treatment.ObjectiveTo determine the prevalence of occult contralateral nodal metastasis in tonsillar squamous cell carcinoma (TSCC) in patients who have undergone bilateral neck dissection.Data SourceA systematic review of English articles identified from PubMed, Embase, and Web of Science databases.Review MethodsSearch terms included “oropharynx,” “carcinoma,” “lymph node,” and “neck dissection.” Two reviewers independently screened abstracts, reviewed full texts, and extracted data from all studies that presented the prevalence of contralateral occult nodal metastasis in TSCC.ResultsThe overall prevalence of occult contralateral nodal metastasis was 10%. The prevalence was 8% for cT1/T2 tumors, 19% for cT3/T4, 1% for N0 in the ipsilateral neck, and 12% for N+. Occult contralateral lymph nodes were most frequently found in neck level II (81%) and level III (19%). No metastatic nodes were found in level I.ConclusionElective neck dissection of the contralateral neck in TSCC is controversial due the historic morbidity caused by the surgery. A widely accepted recommendation suggests performing an elective neck dissection when the prevalence of occult metastasis is between 15% and 20%. The results of this study suggest that elective contralateral neck dissection will identify occult positivity in 19% of patients with T3/T4 tonsil cancer. In T1/T2 or N0 tumors, the diagnostic yield would be considerably lower at 8% and 1%, respectively. Contralateral nodal sampling could be considered based on patient preference after adequate counseling on the risks/benefits of occult nodal detection. More research is needed on other nodal features to formulate treatment guidelines. Laryngoscope, 135:27–33, 2025
Pubmed PDF Web\nSrivatsa Surya Vasudevan, \nAdam Zulli, \nLindsay Olinde, \nJohn Pang, \nCherie‐Ann O. Nathan, \nAmeya A. Asarkar\n
Publicatie 11-12-2024
This systematic review signifies that TLM in T3 and T4a glottic and supraglottic tumors is a viable option with comparable oncologic and functional outcomes. TLM has comparatively better outcomes in T3 supraglottic compared to T3 glottic tumors in certain outcomes.ObjectiveTo critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3/T4a glottic and supraglottic squamous cell carcinoma (SCC).Data SourcesA comprehensive search of five major databases—PubMed, Embase, Scopus, ScienceDirect, and Web of Science—was conducted using a combination of relevant keywords and MeSH terms.Review MethodsSystematic review and meta-analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3/T4a glottic and supraglottic tumors. A random-effects meta-analysis model was employed.ResultsThe review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3/T4a glottic and supraglottic SCC. The cumulative 5-year disease-free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47–66%) and 62.8% (95% CI: 63–81%), while the 5-year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4–49.2%) and 32.9% (95% CI: 19.3–50.1%), respectively. T3 glottic tumors exhibited a 2.5-fold significantly higher odds of local recurrence post-TLM compared to their T3 supraglottic tumors (95% CI: 1.6–3.9, p < 0.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7–83.8%) and 88.4% (95% CI: 79.4–93.8%), respectively. Both groups showed comparable rates of tracheostomy (p = 0.48) and gastrostomy performed (p = 0.17).ConclusionsThis meta-analysis suggests that TLM is a viable larynx preservation approach in select patients with T3/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors.Level of EvidenceNA Laryngoscope, 135:15–26, 2025
Pubmed PDF Web\nZi‐Yue Fu, \nDa‐Peng Li, \nChuan‐Lu Shen, \nJian‐Peng Wang, \nYan‐Xun Han, \nShan‐Wen Chen, \nZhao Ding, \nLei Zhang, \nBing‐Yu Liang, \nSi‐Yue Yin, \nYi‐Pin Yang, \nYu‐Lin Zhang, \nYan Li, \nYe‐Hai Liu, \nHai‐Feng Pan, \nKai‐Le Wu, \nYu‐Chen Liu\n
Publicatie 11-12-2024
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.ObjectiveThe 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 SourcesPubMed, 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 MethodsUsing 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.ResultsThe 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.ConclusionCompared 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, 135:34–44, 2025
Pubmed PDF Web\nXiangming Meng\n
Publicatie 11-12-2024
\nChristopher M. Bell, \nAndrew V. Thamboo, \nEric Monteiro, \nJonathan Yip\n
Publicatie 11-12-2024
\nDiego M. Conti, \nEduardo J. Correa, \nJavier Gómez‐Hervás, \nEsteban Merino‐Galvez\n
Publicatie 11-12-2024
\nJacob G. Eide, \nWilliam Mason, \nHussein Mackie, \nBernard Cook, \nAmrita Ray, \nKaram Asmaro, \nAdam Robin, \nJack Rock, \nJohn R. Craig\n
Publicatie 11-12-2024
ObjectiveUnilateral thin clear rhinorrhea (UTCR) may represent a variety of pathologies including cerebrospinal fluid (CSF) rhinorrhea. Beta-2 transferrin (B2Tf) gel electrophoresis (GE) has become the preferred testing modality due to reportedly high sensitivity (87%–100%) and specificity (71%–100%). However, there have been relatively few studies assessing its diagnostic accuracy. The purpose of this single-institution study was to determine the accuracy of B2Tf GE in detecting CSF rhinorrhea.MethodsA single-center retrospective review was conducted from 2016 and 2024 for all patients who presented with UTCR and underwent B2Tf GE. Institutional review board approval was obtained. The gold standard for diagnostic confirmation of true and false positives (TP, FP) as well as false negatives (FN) was endoscopic exploration. The gold standard for true negative (TN) was response to medical therapy.ResultsA total of 105 patients underwent 149 B2Tf GE tests. 40 (38.1%) patients were diagnosed with CSF rhinorrhea. Of the 149 B2-Tf GE tests, there were 51 TPs, 72 TNs, 20 FPs, and 6 FNs yielding 89.5% sensitivity, 78.3% specificity, 71.8% positive predictive value, and 92.3% negative predictive value, respectively. Of the false results the most common causes for error were purulent sinusitis (n = 6, 23.1%), possible mucous contamination from nose-blowing during collection (n = 3, 11.5%), patient collection error (n = 3, 11.5%), and blood contamination (n = 1, 3.8%).ConclusionAlthough these single-institutional data demonstrate test accuracy within ranges previously reported in the literature, they also demonstrate diagnostic limitations. Future studies should explore reasons for erroneous B2Tf GE results and how these may change clinical decision-making.Level of Evidence4 Laryngoscope, 135:94–96, 2025
Pubmed PDF Web\nJoseph Bogart, \nTodd Otteson\n
Publicatie 11-12-2024
ObjectivesIndividuals with angioedema (AE) are at high risk for airway compromise and often require endotracheal intubation. Patient factors predisposing one to airway compromise are not well described. The objective of this study is to examine whether substance use disorder (SUD) in patients with AE is associated with need for airway intervention.MethodsThis population-based retrospective cohort study compared AE patients with SUD versus propensity-matched control groups. Outcomes were hospitalization, intubation, and tracheotomy. Using the TriNetX National Database, this study included 28,931 patients with SUD and 117,509 patients without SUD who presented with AE.ResultsAmong patients with AE, those with each subtype of SUD (alcohol, cannabis, cocaine, tobacco, and opioids) were found to have higher risk of severe AE compared to propensity-matched non-SUD cohorts. Rate of hospitalization after cohort matching ranged from 20.4% for tobacco use disorder to 30.4% for cocaine use disorder, all significantly higher than the 8.0% in a population without SUD. Each SUD subtype was associated with a higher rate of intubation compared with matched non-SUD groups, with cannabis use disorder having the highest relative risk (RR) of 3.67 (95% CI: 2.69–5.02). Tobacco (RR = 2.45, 95% CI: 1.79–3.34) and alcohol (RR = 2.82, 95% CI: 1.73–4.58) use disorders were both associated with significantly higher risk of tracheotomy.ConclusionThese data suggest that patients with SUD, regardless of subtype, and after propensity matching for demographics and comorbidities are at higher risk for adverse outcomes when presenting with AE. This study highlights clinically relevant predictors of airway compromise.Level of Evidence3 Laryngoscope, 135:45–49, 2025
Pubmed PDF Web\nYan Shi, \nXiao‐Ming Lyu, \nWei Wang, \nHan Yan, \nWen‐Jie Wu, \nMing‐Wei Huang\n
Publicatie 11-12-2024
We evaluated the usage of the superior thyroid artery perforator flap to cover the defects of oral cavity after surgery for oral cancer. We summarized the blood supply characteristics and application of the percutaneous branch flap of the superior thyroid artery.ObjectiveThe superior thyroid artery perforator flap (STAPF) was previously presented as a type of locoregional pedicled flap for lateral facial and temple defects. In this study, we aimed to present our clinical experience with this flap for the reconstruction of soft tissue defects after oral cancer surgery.MethodsFrom February 2019 to December 2022, 24 patients with oral cancers at the School and Hospital of Stomatology, Peking University were included. Among these patients, 10 had cancers located in the tongue, five in the cheek inside the oral cavity, three in the lower gingiva, two in the upper gingiva, two in the floor of the mouth, and two in the palate. All patients were treated with extended tumor resection, neck dissection, and STAPFs to reconstruct the soft tissue defects. The details of the flap, including the flap size, venous flow, vascular pedicle length, the attatched muscle, and operation time were evaluated.ResultsThe dimensions of the flap skin paddle ranged from 3 cm × 5 cm to 6 × 14 cm. Fourteen patients had a closely concomitant superior thyroid vein perforator. Ten patients had non-closely concomitant superior thyroid veins perforators which retrograde external jugular vein. The vascular pedicle length ranged from 5 to 9 cm. The infrahyoid muscle group or sternocleidomastoid muscle was included in the flaps in three patients. A total of 23/24 flaps were successful.ConclusionsThe STAPF is a viable reconstructive option for patients with oral cancers. It has the advantages of being robust, being thin, short operation time, and minor donor site complications.Level of Evidence4 Laryngoscope, 135:104–109, 2025
Pubmed PDF Web\nKhodayar Goshtasbi, \nDaniel Kim, \nSina J. Torabi, \nTheodore V. Nguyen, \nBrigitte A. Chung, \nEllen M. Hong, \nJohn Vu, \nJessica Salas, \nJustin S. Kim, \nBrian J.F. Wong\n
Publicatie 11-12-2024
Osteotomy fracture patterns positively correlated with the mallets KE more so than its p, suggesting that the mallets velocity has an increased impact effect than its mass. Clinically, a heavier mallet with a lower velocity will likely generate a smaller fracture length and fracture angle, indicating a more controlled and ideal fracture.IntroductionOsteotomies are routinely incorporated in rhinoplasty, however, the influence of mass, velocity, kinetic energy (KE), and momentum (p) of the mallet on fracture patterns has not been studied.MethodsAn experimental sledge guillotine setup was designed simulating a mallet strike with adjustable height and mass and 2 mm-thick Sawbone blocks. KE and p were calculated using KE = ½ mass × velocity2 and p = mass × velocity formulas. Fracture lengths and angles were measured.ResultsTen groups with varying mallet masses and drop heights were tested with 10 bones per group. Fracture length positively correlated with KE (R = 0.542, p < 0.001) and p (R = 0.508, p < 0.001). Fracture angle also positively correlated with KE (R = 0.367, p < 0.001) and p (R = 0.329, p < 0.001). In groups with similar KE, osteotomies with higher p (heavier mallet with slower velocity) had greater fracture lengths (29.31 ± 0.68 vs. 27.68 ± 2.12 mm, p = 0.013) but similar fracture angles (p = 0.189). In groups with similar p, osteotomies with higher KE (lighter hammer with faster velocity) had significantly greater fracture lengths (28.28 ± 1.28 vs. 20.45 ± 12.20 mm, p = 0.041) and greater divergent fracture angles (3.13 ± 1.97° vs. 1.40 ± 1.36°, p = 0.031). Regression modeling of the relationship between KE and fracture lengths and angles demonstrated that cubic followed by logarithmic regression models had the best fits.ConclusionOsteotomy fracture patterns positively correlated with the mallets KE more so than its p, suggesting that the mallets velocity has an increased impact effect than its mass. Clinically, a heavier mallet with a lower velocity will likely generate a smaller fracture length and fracture angle, indicating a more controlled and ideal fracture.Level of EvidenceNA Laryngoscope, 135:97–103, 2025
Pubmed PDF Web\nNashwa Nada, \nAmira Roshdy El‐Tabbakh, \nMai Mohammed Elgohary, \nAlaa Elsayed Mandour\n
Publicatie 11-12-2024
Although cognitive abnormalities are common among tinnitus sufferers, there is little research that uses an objective technique to investigate the nature of this impairment. Chronic tinnitus causes central auditory deficits. White-matter changes were recorded in patient with chronic tinnitus at multi-cortical level.ObjectivesIt was aimed at assessing the connection between tinnitus and central auditory dysfunction using both central auditory tests (CATs) and diffusion tensor imaging (DTI) for brain regions that are crucial for central auditory processing.MethodsThis prospective case–control study included 15 patients with persistent tinnitus and 20 healthy volunteers as controls. They underwent CATs for memory, attention, and DTI. The Tinnitus Handicap Inventory (THI) Questionnaire was applied as well. From several brain regions, the values of mean diffusivity (MD) and fractional anisotropy (FA) were determined.ResultsComparing both groups, the tinnitus group showed statistically worse values as regards the CATs (memory for content, sequence memory, speech perception in noise (SPIN) at different signal-to-noise ratios, “SNRs”) compared with the control group. As regards DTI, the tinnitus group showed decreased FA in several brain areas, including the cingulum, prefrontal-cortex (PFC), insula, and hippocampus. Furthermore, the tinnitus group showed significantly higher MD in the cingulum, BA-46, and amygdala compared with the control group. FA values of BA-46 were positively correlated with the SPIN-SNR−10 scores. Also, FA values of the middle cingulum were positively correlated with SPIN-SNRzero scores. MD values at BA-46 were negatively correlated with SPIN-SNR−10. THI scores were negatively correlated with FA at BA-46; however, they were positively correlated with MD at the amygdala.ConclusionsCentral auditory dysfunction may be linked to the underlying neurophysiological changes in chronic tinnitus.Level of Evidence2 Laryngoscope, 135:316–323, 2025
Pubmed PDF Web\nSophia Dang, \nBasil Hashimi, \nAnthony Tang, \nMark W. Kubik, \nMario G. Solari, \nShaum S. Sridharan\n
Publicatie 11-12-2024
A preoperative multidisciplinary conference improves operative efficiency and postoperative outcomes of head and neck microvascular free flap reconstructions. Planning ahead leads to shorter surgical times and reduced postoperative complications.IntroductionHead and neck oncologic resections with microvascular reconstruction are lengthy and complex procedures with inefficiencies in the operating room (OR) associated with increased complications and higher costs. Multidisciplinary care has become increasingly used to provide improved care for complex patients; however, the potential role of this has not yet been studied in head and neck microvascular free flap procedures.MethodsPatients between 2016 and 2022 treated before and after implementation of the conference were included. Primary outcome was total procedure time (TPT). Demographics, operative details, and postoperative complications were also collected.Results233 patients were included in the preconference group and 330 in the post-conference group. Preconference mean (SD) age was 61.6 (12) years versus 62.9 (12) years in the post-conference group. The post-conference group was associated with shorter mean (SD) TPT (629 117 vs. 719 134 minutes), less mean (SD) estimated blood loss (ESD) (230 201 mL vs. 306 211 mL), fewer prolonged lCU stays (>1 day), and fewer returns to the operating room (RTOR). The post-conference group was associated with TPT ≤9 h (p < 0.001) on multivariate analysis. Factors associated with TPT greater than 9 h include history of head and neck radiation (p = 0.003), bony reconstruction (p = 0.05), stage IVa (p = 0.009), and stage IVb cancer (p < 0.001).ConclusionsImplementation of the multidisciplinary conference in head and neck surgery was associated with reduced TPT and reduced OR return. Our study suggests preoperative planning conferences may improve surgical efficiency and outcomes in head and neck oncologic resections with microvascular free flap reconstruction.Level of Evidence3 Laryngoscope, 135:110–117, 2025
Pubmed PDF Web"\nDavid O. Danis III, \nRishubh Jain, \nBenjamin J. Homer, \nMonica OBrien, \nEmily K. Gall, \nKathryn Y. Noonan\n"
Publicatie 11-12-2024
Over the past two decades, there has not been a consistent downward trend in hearing loss in adult and elderly populations. When correcting for the aging population and gender, some pairwise analysis of years has been significant, suggesting there may be a decline; however, more investigation is needed. HL may be decreasing over time among adults 40–49 years old and with shorter education backgrounds.ObjectivesHearing loss (HL) is one of the most common chronic health conditions in the United States (US). This study aims to evaluate trends in HL prevalence among US adults over the past two decades.MethodsAudiometric data of adults from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were analyzed in 2-year intervals to evaluate changes in HL (defined as pure tone average greater than 25 dB in at least one ear) over time in using odds ratios (ORs). Multivariate logistic regression was used to control for age and sex, and linear regression was used to evaluate trends in HL prevalence over time.ResultsThe study included 13,468 participants. In adult participants (20–69 years old), HL remained stable over time, with some fluctuations ranging from 14.8% to 16.8%. In elderly participants (70-years and older), HL remained stable over time, with some fluctuations ranging from 71.7% to 77.1%. Based on univariate and linear regression analysis, there were no differences in HL rates in the adult and elderly cohorts. Subjects 40–49 years old and adults with education level of less than high school had significant downward trends in HL prevalence over two decades (p < 0.001 and p = 0.029).ConclusionsHL prevalence may be declining in the adult population when correcting for age and gender; however, there has not been a significant downward trend for the elderly population. HL may be decreasing over time among adults 40–49 years old and with shorter education backgrounds.Level of Evidence4 Laryngoscope, 135:277–285, 2025
Pubmed PDF Web\nHayato Matsumoto, \nHiromi Nagano, \nTakayuki Kyutoku, \nMasaru Yamashita\n
Publicatie 11-12-2024
The top 10 mutations in HNMUM are closer to those in OM than those in SKM. There was no significant difference in TMB values or survival rates with regard to the therapeutic effect of ICIs among the diseases, which suggests that current treatment of HNMUM with ICIs is appropriate.ObjectivesThe purpose of this study is to compare genetic mutations, tumor mutation burden (TMB), and the effects of molecular targeted drugs and immune checkpoint inhibitors (ICIs) in head and neck mucosal melanoma (HNMUM) with those in skin melanoma (SKM) and ocular melanoma (OM).MethodsData were analyzed for 72 consecutive patients with HNMUM, including 366 with SKM and 31 with OM, registered at the Japan National Cancer Center, Center for Cancer Genomics and Advanced Therapeutics (C-CAT) between June 2019 and October 2023. Genetic alterations and TMB were determined by FoundationOne CDx next-generation sequencing.ResultsThe top 10 mutations in HNMUM were RAD21 (47.2%), NBN (45.8%), MYC (40.3%), LYN (31.9%), NRAS (29.1%), IRF4 (23.6%), DAXX (22.2%), KIT (22.2%), NOTCH3 (20.8%), and DDR1 (19.4%), with 16.6 ± 0.8 (mean ± SEM) mutations/individual. In SKM, BRAF (p = 0.04) mutation was associated with a significantly better prognosis. The TMB values were 5.7 ± 2.1 (mean ± SEM) in HNMUM, 4.1 ± 0.2 in SKM, and 3.4 ± 0.9 in OM, with no significant differences among the three groups. The median survival time for patients with distant metastases was 803 (95% confidence interval: 539-NA) days for HNMUM, 1413 (831–2172) days for SKM, and 1138 (438-NA) days for OM.ConclusionsThe top 10 mutations in HNMUM are closer to those in OM than those in SKM. There was no significant difference in TMB values or survival rates with regard to the therapeutic effect of ICIs among the diseases, which suggests that current treatment of HNMUM with ICIs is appropriate.Level of Evidence3 Laryngoscope, 135:134–139, 2025
Pubmed PDF Web\nJasmeet Saroya, \nMax Humwell, \nAdam Gardi, \nRicky Chae, \nDaniel Wong, \nIsabel Allen, \nJeffrey D. Sharon\n
Publicatie 11-12-2024
This study utilized Ecological Momentary Assessment to analyze the daily occurrence and severity of symptoms in individuals with vestibular migraine (VM), providing detailed insight into the condition. Participants recorded their dizziness symptoms daily via an automated text system, and results showed no significant difference in the frequency of moderate to severe dizziness days between those diagnosed with VM and those with probable vestibular migraine. The findings indicate that VM has a chronic variant, in which patients experience some level of dizziness nearly every day and severe symptoms on more than half of the days each month.Objective(s)This study investigated the frequency and intensity of vestibular migraine (VM) symptoms using Ecological Momentary Assessment (EMA). This approach was intended to provide insights into the day-to-day experiences of individuals with VM, contributing to a more comprehensive understanding of this condition.MethodsParticipants reported symptoms to an automated text system, rating their dizziness over the prior 24 h as none, mild, moderate, or severe. Definitive Dizzy Days (DDDs) were defined as days with moderate or severe dizziness. A students independent group t-test was used to compare the number of DDDs between VM and probable VM subjects.ResultsSixty-six subjects were included, with an average of 29 days of pre-intervention data (SD = 1.4). The average number of days with no dizziness was 3.5 (SD = 6.5), mild dizziness was 9.1 (SD = 6.7), moderate dizziness was 11 (SD = 6.1), and severe dizziness was 5.4 (SD = 6.3). Out of the 66 patients, 52 were classified as VM and 14 as pVM. The average number of DDDs was not significantly different between VM (17.0, SD = 8.3) and pVM (15.3, SD = 10.0) patients, with a two-tailed p-value of 0.44.ConclusionWith EMA, we found that the average subject with VM had some degree of dizziness almost every day, and more than 15 DDDs per month.Level of Evidence3 Laryngoscope, 135:293–298, 2025
Pubmed PDF Web\nTomotaka Shimura, \nNevra Keskin Yilmaz, \nArtur Koerig Schuster, \nGrace Song, \nEmre Abdullah Cureoglu, \nSei Kobayashi, \nDilshan Rajan, \nRafael da Costa Monsanto\n
Publicatie 11-12-2024
The objective of this study is to assess and characterize the occurrence of round window (RW) involvement in otosclerosis cases. We selected archival temporal bones from donors with otosclerosis and studied otosclerotic foci. Among donors with RW involvement, ones with continuous, large lesions that extended from the oval window associated with complete RW obliteration, while ones with smaller degrees of obliteration had solitary foci scattered within the otic capsule.ObjectivesObliteration of the round window (RW) in cases of otosclerosis presents a significant clinical challenge due to its association with more severe hearing loss and a poorer prognosis for functional recovery after stapes surgery. The objective is to assess and characterize the occurrence of RW involvement in otosclerosis cases and to identify patterns of disease progression that may indicate a potential for RW obliteration.MethodsWe selected archival temporal bones from donors with otosclerosis. We evaluated the degree of RW obliteration using a semi-quantitative scale and the location of the foci within the temporal bone, and whether the foci were continuous or isolated.ResultsMost of the foci were located anteriorly to the oval window (89.2%), while RW area involvement was seen in 26.9% of the ears. In cases with fenestral foci, 68.1% directly involved and/or fixed the footplate. Among donors with bilateral otosclerosis, foci affected both ears in a similar pattern in 64.2%. Among donors with RW involvement, ones with continuous, large lesions that extended from the oval window associated with complete RW obliteration, while ones with smaller degrees of obliteration had solitary foci scattered within the otic capsule.ConclusionOur results demonstrate a high rate of RW involvement in cases of otosclerosis. Ears with continuous lesions extending from the oval window region to the RW area were more likely to present with complete RW obliteration. These results provide insights that could lead to better prognostic assessment of patients with otosclerosis in the future.Level of EvidenceNA Laryngoscope, 135:324–330, 2025
Pubmed PDF Web"\nAndrew S. Awadallah, \nAndrew J. Bowen, \nHawa M. Ali, \nThomas J. OByrne, \nHannah M. Padilla, \nYousuf H. Khalil, \nAisha A. Aden, \nEric S. Edell, \nMatthew J. Koster, \nSemirra L. Bayan, \nDale C. Ekbom\n"
Publicatie 11-12-2024
Limited data exist on treatment options for highly recurrent idiopathic subglottic (iSGS) stenosis patients. Our article explores the usage of methotrexate and rituximab for this patient population. Although initial results are promising, more work is needed to delineate drug candidacy and effectiveness.ObjectiveTo evaluate the impact of methotrexate and rituximab therapy on highly recurrent idiopathic subglottic stenosis (iSGS) patients with a negative antineutrophil cytoplasmic antibody titer cANCA(−).MethodsThis was a retrospective cohort study of highly recurrent iSGS patients who recurred within 1 year or less and were treated with methotrexate (MTX), and rituximab (RTX), or a combination of both at different time points (MTX/RTX). Average surgical durations before and after drug treatment were summarized, and the differences were calculated.ResultsA total of 21 female patients with median age of 62 years were included. Fifteen patients were treated with MTX, three were treated with RTX, and five treated with both. Patients treated with immunosuppressants showed a trend toward longer intervals between operations (mean pre-drug interval: 338; mean post-drug interval: 697 days) (p-value = 0.25). Three patients did not recur following drug initiation with median follow-up of 1265 days. All three treatment groups demonstrated a trend toward increased post-drug recurrence intervals (MTX: 444 days, RTX: 374 days, MTX/RTX: 55 days), that was not statistically significant. Patients with prior dilations demonstrated longer post-drug recurrence intervals (mean pre-drug interval: 341 days, mean post-drug interval 978 days) (p-value = 0.17). Four patients in the cohort with the highest recurring disease improved from mean 129 days between operations to 509 days with drug therapy. The most common drug side effect was nausea (16%).ConclusionMTX and RTX may be treatment options for some highly recurrent iSGS patients. Initial results are variable and demonstrate a need for further research on drug candidacy.Level of Evidence3 Laryngoscope, 135:168–175, 2025
Pubmed PDF Web\nRyan Sicard, \nSarah Russel, \nDavid Jang, \nRalph Abi Hachem, \nDennis O. Frank‐Ito\n
Publicatie 11-12-2024
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.ObjectivesMany 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.ResultsNotched 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).ConclusionsAnterior 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 EvidenceNA Laryngoscope, 135:50–58, 2025
Pubmed PDF Web\nFredrik Alm, \nErik Odhagen, \nOla Sunnergren, \nPia Nerfeldt\n
Publicatie 11-12-2024
This nationwide registry study on tonsil surgery patients presents the range of postoperative analgesic regimes used in clinical practices in Sweden and their effect on patient satisfaction. Multimodal analgesia including at least paracetamol and a COX inhibitor/NSAID was highly common, and the vast majority of patients were satisfied with their pain treatment. Still, there is room for improvement.ObjectiveTo describe postoperative analgesic regimens and patient-reported pain-related outcomes after tonsil surgery.MethodsCohort study including perioperative data (n = 9274) and patient-reported outcome measures (n = 5080) registered in the Swedish Quality Register for Tonsil Surgery during 2023.ResultsAfter tonsil surgery, 92.7% received at least paracetamol and a NSAID/COX inhibitor, while 6.8% received no NSAID/COX inhibitor. Opioids were prescribed after tonsillectomy to 62.9% of adults and less often to adolescents and children (13–17-year-olds: 48.2%, 6–12-year-olds: 8.8%, 0–5-year-olds: 4.0%). Clonidine was frequently prescribed to 0–5-year-olds after tonsillectomy (54.4%). Overall, 11.7% reported dissatisfaction with the pain treatment, with the highest dissatisfaction rate after tonsillectomy in adolescents (20.6%) and adults (20.0%), and the lowest after tonsillotomy in children (4.9–6.8%). The most common complaint among dissatisfied patients was analgesics not being sufficiently helpful. Adult patients who received addition of opioids were less dissatisfied with the pain treatment (15.9% vs. 25.9%, p < 0.001), but also reported more side effects (5.7% vs. 2.7%, p = 0.039), compared with patients who received only paracetamol and NSAID/COX inhibitors.ConclusionTonsil surgery patients in Sweden receive various analgesic regimens. Although most are satisfied with pain treatment, there is room for improvement, particularly among adolescents and adults undergoing tonsillectomy. Paracetamol and a NSAID/COX inhibitor seem advisable as basic treatment. However, many patients need more effective treatment. The addition of opioids in adults results in greater satisfaction with pain treatment, but safety issues with opioid prescriptions must be taken into consideration.Level of Evidence4 Laryngoscope, 135:140–147, 2025
Pubmed PDF Web\nErica McArdle, \nJohn Dewey, \nRuifeng Cui, \nConnor Hunt, \nAmani Kais, \nHussein Jaffal\n
Publicatie 11-12-2024
Little is known about age-related variations in sites and grade of sleep-dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep-disordered breathing (oSDB). A retrospective chart review was performed for surgically naïve children aged 0–18 years with OSA/oSDB who underwent DISE. Varying patterns of sleep-dependent airway obstruction should be expected across different age groups in children with OSA or oSDB.ObjectiveLittle is known about age-related variations in sites and grade of sleep-dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep-disordered breathing (oSDB). The objective was to compare sites and grade of obstruction on drug-induced sleep endoscopy (DISE) across different age groups of surgically naïve children with OSA or oSDB.MethodsA retrospective chart review was performed for surgically naïve children aged 0–18 years with OSA/oSDB who underwent DISE from July 2021 to August 2023. Participants were categorized into: infants (aged 0–1 years), younger toddlers (aged 1–2 years), older toddlers (aged 2–3 years), preschool (aged 3–5 years), younger school-aged (aged 5–10 years), and older school-aged (aged 10–18 years). On DISE, obstruction was rated 0 = none/mild, 1 = moderate, 2 = severe for inferior turbinates, adenoid, velum, palatine tonsils/lateral pharyngeal wall, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. A series of multiple regression analyses were used to identify age differences in the grade of obstruction across all sites combined and at each individual site separately.ResultsThe sample consisted of 252 children aged 1 month to 17 years with 57.9% males. Older patients had greater total obstruction scores (B = 0.42, SE = 0.10, p < 0.01) and greater number of sites that were severely obstructed (B = 0.11, SE = 0.05, p = 0.03). Older age groups had more obstruction at inferior turbinates (p = 0.02), adenoid (p < 0.01), palatine tonsils/lateral pharyngeal wall (p < 0.01), lingual tonsil (p < 0.01), and base of tongue (p < 0.01). Younger age groups had more obstruction at the supra-arytenoid tissue (p < 0.01).ConclusionVarying patterns of sleep-dependent airway obstruction should be expected across different age groups in children with OSA or oSDB.Level of Evidence3 Laryngoscope, 135:463–468, 2025
Pubmed PDF Web\nJacob G. Eide, \nEdward C. Kuan, \nNithin D. Adappa, \nJeremy Chang, \nDo‐Yeon Cho, \nRohit Garg, \nSatish Govindaraj, \nJessica Grayson, \nEunice Im, \nDavid Keschner, \nMichael Kohanski, \nTran Locke, \nJames N. Palmer, \nKevin C. Welch, \nBradford A. Woodworth, \nFrederick Yoo, \nJohn R. Craig\n
Publicatie 11-12-2024
There has been concern that middle turbinate resection could lead to empty nose syndrome. In this multi-institutional, prospective study we found no patients who developed empty nose syndrome following bilateral middle turbinate resection during endoscopic sinus surgery for nasal polyps.BackgroundEmpty nose syndrome (ENS) is a poorly understood, debilitating condition affecting a minority of patients who underwent nasal airway surgery, most commonly following inferior turbinate surgery. Few publications have demonstrated middle turbinate resection (MTR) causing ENS, but MTR is still considered a potential cause of ENS. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) is validated for ENS diagnosis, with ENS6Q ≥ 11 considered highly suggestive of ENS. The purpose of this multicenter study was to determine the incidence of patients with ENS6Q ≥ 11 following subtotal MTR during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) by comparing preoperative and postoperative ENS6Q scores.MethodsA multi-institutional prospective cohort study (8 US institutions) was conducted on patients who underwent bilateral subtotal MTR during ESS for CRSwNP. Preoperative and postoperative ENS6Q scores were compared after at least 12 months of postoperative follow-up.ResultsOf 110 patients, mean age was 51.6 years and 59.1% were male. Mean follow-up was 14.5 ± 2.5 months (range 12.1–22.3 months). Mean preoperative and postoperative ENS6Q were 7.7 and 2.2, respectively, demonstrating a mean 5.5 point decrease postoperatively (p < 0.0001). At final follow-up, no patient had an ENS6Q ≥ 11. Of note, 20% of patients had preoperative ENS6Q scores ≥11, but all decreased to <11 postoperatively.ConclusionsBased on prospective multicenter data over 1–2 years postoperatively, subtotal MTR for CRSwNP never led to ENS6Q scores ≥11, and patients experienced significant decreases in ENS6Q postoperatively. Subtotal MTR during ESS for CRSwNP was, therefore, unlikely to cause ENS even with long-term follow-up.Level of Evidence4 Laryngoscope, 135:59–65, 2025
Pubmed PDF Web\nSumeyye Sozduyar, \nErgun Ergun, \nPari Khalilova, \nGulnur Gollu, \nUfuk Ates, \nOzlem S. Can, \nTanil Kendirli, \nAydin Yagmurlu, \nMurat Cakmak, \nMeltem Kologlu\n
Publicatie 11-12-2024
In this study, it was compared the outcomes of percutaneous tracheostomy (PT) of infants and older children. The results showed that PT is a safe and feasible procedure even in infants. It also decreases the accidental early decannulation risk. Tracheostomy stricture is a more common problem in PT, especially in infants.ObjectivesPercutaneous tracheostomy is rarely performed in children, especially in infants. In the present study, we aimed to evaluate the complications and outcomes of PT via the Griggs technique according to the age and size of pediatric patients.MethodsThis study included 110 PICU patients who underwent PT using the Griggs technique between 2012 and 2020. The patients were divided into six groups according to their age, demographic data, primary disease, mean duration of intubation before PT, mean duration of PICU and hospitalization after PT, complications, and decannulation outcomes were compared between these groups.ResultsThe mean age and mean weight of the patients were 43.6 ± 58.9 months (1 month–207 months) and 14.6 ± 14.9 kg (2.6–65 kg), respectively. Mean intubation times before the procedures were 64.6 ± 40 days and 38.6 ± 37.9. Thirty-seven (33.6%) infants were under 6 months of age(Group 1). There were no intraoperative complications. Tracheostomy site stenosis was significantly greater in Group 1 than in the other age groups (p = 0.032). Granuloma formation and dermatitis incidence were similar in all age groups.ConclusionPT is a safe and feasible procedure even in small infants. The accidental decannulation risk is lower than standard tracheostomy. Interacting with rigid bronchoscopy guidance is essential to perform a safer procedure. The first tracheostomy change after PT in small infants under 6 months of age, the possibility of tracheostomy site (stoma) stenosis should be considered.Level of Evidence3 Laryngoscope, 135:416–422, 2025
Pubmed PDF Web\nRajeev Kumar, \nDheeraj Kondamudi, \nPrem Sagar, \nMaroof A. Khan, \nAanchal Kakkar, \nSmita Manchanda, \nAshu S. Bhalla, \nKapil Sikka, \nChirom A. Singh, \nRakesh Kumar, \nAlok Thakar\n
Publicatie 11-12-2024
BackgroundPre-vascular facial nodes (PV-FNs; perifacial lymph nodes) are supra-mandibular lymph nodes above the inferior border of the mandible. These are not part of routine neck dissection done for OCSCC. These lymph nodes can be sentinel station for metastatic lymph nodes from gingivobuccal complex cancers and are missed during routine neck dissection. It is imperative to include this sentinel station in routine neck dissection to prevent nodal recurrences.Materials and MethodsOne hundred thirty-seven patients with GBCC (T1–T4) were prospectively recruited between May 2020 and June 2022 with the intent to evaluate the incidence of PV-FN metastases and clinicopathological factors predicting them.ResultsPV-FN metastases were seen in 26 patients (18.9%; 26/137). The occult metastasis rate was 8.7% (12/137). On multivariate analysis, pathological T4 stage (pT4), LVE positivity, and intermediate-high BGS were statistically significant predictors of PV-FN metastases in our study.ConclusionsIncidence of PV-FN metastasis is high (18.9%) in GBCC, which can be potentially the first sentinel station in the lymphatic drainage pattern for this sub-site. Meticulous clearance of this nodal basin is of paramount importance during neck dissection to prevent nodal recurrences.Level of Evidence2 (CEBM-Level of Evidence-2.1) Laryngoscope, 135:148–152, 2025
Pubmed PDF Web\nDerek J. Lam, \nAndrea Hildebrand, \nThuan Nguyen, \nLourdes Quintanilla‐Dieck, \nGrace X. Tan, \nChris A. Hargunani, \nCarol J. Macarthur, \nHenry A. Milczuk\n
Publicatie 11-12-2024
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.ObjectivesPersistent 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.MethodsThis 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.ResultsPre- 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.ConclusionsPersistent 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, 135:377–384, 2025
Pubmed PDF Web\nYufei Pan, \nYuanyuan Lu, \nHuili Huang, \nChao Wang, \nXiao Han, \nHuiying Hu, \nKai Sun, \nJing Li, \nYonghui Zhang, \nKai Liu, \nZhenkun Yu\n
Publicatie 11-12-2024
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.ObjectivesTo 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.MethodsTwenty-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.ResultsIn 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.ConclusionIn 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, 135:257–262, 2025
Pubmed PDF Web\nYuanyuan Yang, \nFeitian Li, \nMengye Ma, \nChunfu Dai\n
Publicatie 11-12-2024
ObjectiveTo analyze the clinical features and surgical outcomes of patients with endolymphatic sac tumors (ELSTs).Study DesignSingle institution retrospective cohort study.MethodsThe 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.ResultsThe 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.ConclusionsMost 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, 135:339–344, 2025
Pubmed PDF Web\nBenjamin R. Johnson, \nMargaret T. Dillon, \nNicholas J. Thompson, \nMargaret E. Richter, \nAndrea B. Overton, \nMeredith A. Rooth, \nAmanda G. Davis, \nMatthew M. Dedmon, \nA. Morgan Selleck, \nKevin D. Brown\n
Publicatie 11-12-2024
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 AzBio sentence recognition in noise for the SoNcontra 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.MethodsEighteen 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 (SoNo), presented toward the affected ear (SoNci) or contralateral ear (SoNcontra). Perceived benefit was assessed with the Speech, Spatial, and Qualities of Hearing scale (SSQ) and the Tinnitus Handicap Inventory (THI).ResultsParticipants 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 (SoNcontra 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).ConclusionOlder 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 Evidence4 Laryngoscope, 135:352–360, 2025
Pubmed PDF Web\nYong‐Chao Chen, \nXin Wang, \nYi‐Shu Teng, \nShang Yan, \nDe‐Sheng Jia, \nHong‐Guang Pan\n
Publicatie 11-12-2024
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.PurposeBilateral 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.ResultsTwenty 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 Evidence3: retrospective case series Laryngoscope, 135:429–437, 2025
Pubmed PDF Web"\nAndrew S. Awadallah, \nAndrew J. Bowen, \nHawa M. Ali, \nThomas J. OByrne, \nAisha A. Aden, \nYousuf H. Khalil, \nEric S. Edell, \nMatthew J. Koster, \nSemirra L. Bayan, \nDale C. Ekbom\n"
Publicatie 11-12-2024
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.ObjectiveTo evaluate the impact of age on disease recurrence in idiopathic subglottic stenosis (iSGS) patients.MethodsThis 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.ResultsEighty-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).ConclusionThis 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, 135:198–205, 2025
Pubmed PDF Web\nJordan J. Varghese, \nMatthew A. Shew, \nAmit Walia, \nShannon M. Lefler, \nNedim Durakovic, \nCameron C. Wick, \nAmanda J. Ortmann, \nJacques A. Herzog, \nCraig A. Buchman\n
Publicatie 11-12-2024
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.ObjectiveTo validate electrocochleography (ECochG) between an auditory evoked potential (AEP) machine and an established cochlear implant (CI) manufacturer ECochG system.MethodsIntraoperative 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 kHz (~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.ResultsThirty 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 kHz) 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.ConclusionExtracochlear 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, 135:308–315, 2025
Pubmed PDF Web\nMartin Nue Møller, \nDebbie Berthelsen, \nMalene Svahn\n
Publicatie 11-12-2024
IntroductionBalloon 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.MethodsBalloon 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.ResultsTwo 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.ConclusionEustachian 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, 135:361–365, 2025
Pubmed PDF Web\nJames A. Curtis, \nCrystal Diaz, \nTheresa Lee, \nAnaïs Rameau\n
Publicatie 11-12-2024
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.MethodsManual 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.ResultsDifferences 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 kPa 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).ConclusionThe 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, 135:263–269, 2025
Pubmed PDF Web\nEllen L. Ferraro, \nNicholas Zura, \nBasem B. Abdelmalak, \nUrsula Galway, \nMichael S. Benninger, \nPaul C. Bryson\n
Publicatie 11-12-2024
IntroductionHigh-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.ResultsThe 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, 135:223–226, 2025
Pubmed PDF Web"\nNaomi Tesema, \nTaylor G. Lackey, \nMackenzie OConnor, \nPaul E. Kwak, \nAaron M. Johnson, \nMilan R. Amin\n"
Publicatie 11-12-2024
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.ObjectiveThis study aims to evaluate the clinical outcomes of patients receiving in-office vocal fold steroid injections (VFSI), highlighting relatively new measures around vocal pitch.MethodsPatients 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 McNemars tests.ResultsTwenty-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.ConclusionThis 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, 135:227–233, 2025
Pubmed PDF Web\nRishi Suresh, \nCheyenne Roohani, \nCynthia S. Wang, \nYann‐Fuu Kou, \nRomaine F. Johnson, \nStephen R. Chorney\n
Publicatie 11-12-2024
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.ObjectivesTo determine the incidence of subglottic stenosis (SGS) in children after tracheostomy and identify risk factors for development.Study DesignRetrospective cohort.MethodsAll 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.ConclusionsThe 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, 135:402–408, 2025
Pubmed PDF Web\nKarthikeyan M, \nVishudh Mohan, \nPurvi Purohit, \nVidhu Sharma, \nKapil Soni, \nBikram Choudhury, \nMithu Banerjee, \nPoonam Elhence, \nAmit Goyal\n
Publicatie 11-12-2024
This study is to associate the aggressiveness of cholesteatoma using Middle Ear Risk Index score and using miRNA-21 and IL-6 gene expression.BackgroundCholesteatoma, a destructive middle ear condition, poses challenges due to its variable clinical presentation and propensity for recurrence. Understanding its molecular underpinnings could enhance prognostication and guide therapeutic interventions. This study investigates the association between cholesteatoma aggressiveness, as assessed by the Middle Ear Risk Index (MERI), and the expression of miRNA-21 and IL-6 genes.MethodsA cross-sectional observational study involving 30 patients with cholesteatoma undergoing tympanomastoid exploration was conducted. MERI scores were calculated preoperatively, and cholesteatoma tissue was analyzed for miRNA-21 and IL-6 gene expression using RT-PCR. Statistical analysis was performed to correlate MERI scores with gene expression levels.ResultsThe majority (80%) of patients exhibited severe MERI scores, correlating with extensive middle ear pathology and necessitating canal wall-down (CWD) mastoidectomy. Higher miRNA-21 and IL-6 gene expression levels were observed in cholesteatoma tissues, indicating local aggressiveness and inflammatory activity. Significant moderate correlations were found between MERI scores and miRNA-21 (Pearson correlation = 0.579, p = 0.001) and IL-6 gene expression (Pearson correlation = 0.388, p = 0.034). Patients with severe MERI scores had elevated miRNA-21 and IL-6 levels, suggesting a more aggressive disease phenotype.ConclusionMERI scores demonstrated utility in predicting cholesteatoma aggressiveness, with higher scores correlating with elevated miRNA-21 and IL-6 expression. These findings suggest a potential role for MERI in guiding surgical decision-making and prognostication. Future research on targeted therapies based on molecular mechanisms holds promise for improving cholesteatoma management.Level of Evidence3 Laryngoscope, 135:366–372, 2025
Pubmed PDF Web\nNilam Patel, \nIsabel Held, \nAnna Trzcinska, \nJay Wasman, \nKumar N. Alagramam, \nNancy L. Oleinick, \nNicole Maronian, \nNelson S. Howard\n
Publicatie 11-12-2024
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.ObjectiveThe 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.MethodsThis 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.ResultsAll 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.ConclusionDirect 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, 135:270–276, 2025
Pubmed PDF Web\nImaal Ahmed, \nMichelle Yu, \nVitoria Chaves, \nRuiyang Xu, \nAndréane Lavallée, \nJennifer M. Warmingham, \nMorgan Firestein, \nMargaret H. Kyle, \nKaylee Fisher, \nEmma T. Merriman, \nCynthia Rodriguez, \nWestin Mace, \nCristina Fernandez, \nDani Dumitriu, \nAnil K. Lalwani\n
Publicatie 11-12-2024
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.ObjectiveGiven 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.MethodsData 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.ResultsIn 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).ConclusionThere 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 Evidence4 Laryngoscope, 135:385–392, 2025
Pubmed PDF Web\nDean Dudkiewicz, \nEyal Yosefof, \nThomas Shpitzer, \nAviram Mizrachi, \nMoshe Yehuda, \nHagit Shoffel‐Havakuk, \nGideon Bachar\n
Publicatie 11-12-2024
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.ObjectiveThe 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.MethodsRetrospective 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.ResultsThe 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.ConclusionsThe continuum spectrum of margin distance better predicts survival outcomes and locoregional control in OCSCC.Level of Evidence3 Laryngoscope, 135:161–167, 2025
Pubmed PDF Web\nJ.B. Eyring, \nWesley P. Allen, \nLeith O. Bayazid, \nBrandon M. Hemeyer, \nStephen Walker, \nQuinn T. Orb, \nJ. Fredrik Grimmer, \nJohn Rampton, \nJeremy D. Meier\n
Publicatie 11-12-2024
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.ObjectiveFetal 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.MethodsData 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.ResultsAmong 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.ConclusionWhile 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 Evidence3 Laryngoscope, 135:393–401, 2025
Pubmed PDF Web\nHans Van der Wall, \nLeticia Burton, \nMichelle Cooke, \nGregory L. Falk, \nDavid Tovmassian, \nJames J. Conway\n
Publicatie 11-12-2024
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.ObjectivesThere 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.MethodsFifty 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.ResultsThe 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).ConclusionThe 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 EvidenceAlthough 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, 135:73–79, 2025
Pubmed PDF Web\nChristine M. Clark, \nYeo Eun Kim, \nLucian Sulica\n
Publicatie 11-12-2024
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.BackgroundUnilateral 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.MethodsAdults 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.ResultsOne 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).ConclusionsBilateral 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 Evidence3 Laryngoscope, 135:234–238, 2025
Pubmed PDF Web\nJun‐Yeong Jeong, \nSamjhana Thapa, \nSeung‐Won Lee\n
Publicatie 11-12-2024
This article evaluated the preventive effects of steroid injections on vocal fold scarring at transcriptional, histological, and functional levels.ObjectivesTo assess the efficacy of intralesional steroid treatment in preventing vocal fold scarring following vocal fold surgery using a rabbit model.MethodsThe research involved 42 male New Zealand white rabbits. Fourteen rabbits underwent vocal fold scar surgery using a 532nm laser and served as controls (control group). The remaining rabbits were divided into two groups of 14: one group received vocal fold scar surgery followed by dexamethasone injection (Dexa group) and the other received the same surgery followed by triamcinolone injection (Triam group). Four weeks after surgery, histological examinations and high-speed video analyses of vocal fold vibration were conducted. The maximum amplitude of vibration was the primary measure for assessing vocal fold function. In addition, real-time polymerase chain reaction (PCR) studies were undertaken to analyze scar regeneration and remodeling.ResultsThe maximum amplitude differences were notably higher in the Dexa and Triam groups than in controls. Histologically, the collagen density (CD) ratios in both the Dexa and Triam groups were significantly reduced compared with controls. Real-time PCR analysis indicated marked elevations of Has-2 and Mmp-9 in the Dexa and Triam groups relative to controls.ConclusionsIntralesional steroid injections after vocal fold surgery are effective for reducing vocal fold scarring in a rabbit model.Level of EvidenceNA Laryngoscope, 135:176–182, 2025
Pubmed PDF Web\nShreya Mandloi, \nNeha Garg, \nBita Naimi, \nRiya Shah, \nPraneet Kaki, \nAngela Alnemri, \nAlexander Duffy, \nTingting Zhan, \nThomas M. Kaffenberger, \nMaurits S. Boon, \nColin T. Huntley\n
Publicatie 11-12-2024
BackgroundTransoral robotic surgery (TORS) lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) are effective surgical interventions for well-selected patients with obstructive sleep apnea (OSA) intolerant to continuous positive airway pressure (CPAP) therapy. Previous publications have demonstrated that HGNS patients have a lower postoperative apnea-hypopnea index (AHI) and length of hospital stay than TORS patients. No prior study has investigated the differences in costs between HGNS and TORS.ObjectivesThis study aims to compare surgery-related costs in patients undergoing HGNS versus TORS lingual tonsillectomy for OSA intolerant to CPAP.MethodsA retrospective study on OSA patients intolerant to CPAP that underwent HGNS or TORS from 2015 to 2022 at a tertiary care center. Cost was defined as the dollar amount associated with providing a specific service prior to the application of insurance.ResultsThis study included 395 patients (375 UAS and 20 TORS). Average total cost was significantly higher in the UAS group than the TORS group (UAS: $25,582.60; TORS: $5832.60; p < 0.001). Operating room costs were also significantly higher in the UAS group (UAS: $1978.20; TORS: $1490.90; p = 0.001). The TORS cohort averaged higher costs for pharmacy (UAS: $201.30; TORS: $416.60; p < 0.001) and anesthesia (UAS: $139.00; TORS: $307.60; p < 0.001).DiscussionThe total cost was significantly higher in the UAS group compared to the TORS group. When making management decisions, it is important to consider the cost of care provided as well as patient-centered outcomes to optimize the value of care.Level of EvidenceNA Laryngoscope, 135:457–462, 2025
Pubmed PDF Web\nAkash S. Halagur, \nKarthik Balakrishnan, \nNoel Ayoub\n
Publicatie 11-12-2024
This study explores bias in AI-simulated otolaryngology residency selection committees (RSC) by analyzing selection decisions for residency applicants differentiated only by race, gender, and sexual orientation using a publicly available large language model (LLM), Open AIs GPT-4. Results from simulated RSCs of diverse demographics reveal patterns of significant biases, with some selection preferences mirroring the RSC members own racial and gender identities, as well as other hierarchies of bias prevalent in society. The findings show that utilizing publicly available LLMs to aid in otolaryngology residency selection may introduce racial, gender, and sexual orientation bias, and the significant potential for bias should be appreciated and minimized to ensure an equitable and diverse field of future otolaryngologists.ObjectivesTo investigate potential demographic bias in artificial intelligence (AI)-based simulations of otolaryngology, residency selection committee (RSC) members tasked with selecting one applicant among candidates with varied racial, gender, and sexual orientations.MethodsThis study employed random sampling of simulated RSC member decisions using a novel Application Programming Interface (API) to virtually connect to OpenAIs Generative Pre-Trained Transformers (GPT-4 and GPT-4o). Simulated RSC members with diverse demographics were tasked with ranking to match 1 applicant among 10 with varied racial, gender, and sexual orientations. All applicants had identical qualifications; only demographics of the applicants and RSC members were varied for each simulation. Each RSC simulation ran 1000 times. Chi-square tests analyzed differences across categorical variables. GPT-4o simulations additionally requested a rationale for each decision.ResultsSimulated RSCs consistently showed racial, gender, and sexual orientation bias. Most applicant pairwise comparisons showed statistical significance (p < 0.05). White and Black RSCs exhibited greatest preference for applicants sharing their own demographic characteristics, favoring White and Black female applicants, respectively, over others (all pairwise p < 0.001). Asian male applicants consistently received lowest selection rates. Male RSCs favored White male and female applicants, while female RSCs preferred LGBTQIA+, White and Black female applicants (all p < 0.05). High socioeconomic status (SES) RSCs favored White female and LGBTQIA+ applicants, while low SES RSCs favored Black female and LGBTQIA+ applicants over others (all p < 0.001). Results from the newest iteration of the LLM, ChatGPT-4o, indicated evolved selection preferences favoring Black female and LGBTQIA+ applicants across all RSCs, with the rationale of prioritizing inclusivity given in >95% of such decisions.ConclusionUtilizing publicly available LLMs to aid in otolaryngology residency selection may introduce significant racial, gender, and sexual orientation bias. Potential for significant and evolving LLM bias should be appreciated and minimized to promote a diverse and representative field of future otolaryngologists in alignment with current workforce data.Level of EvidenceNA Laryngoscope, 135:87–93, 2025
Pubmed PDF Web\nAndrew Yousef, \nAriadne Nichol, \nDeborah Watson\n
Publicatie 11-12-2024
In this study, we demonstrate significant insights into the signaling behaviors of applicants and their influence on interview invitations. We found that 85% of interview offers came from programs that applicants signaled. With this, applicants were 5.4 times more likely to receive an interview from a program they signaled compared to programs they did not signal indicating a drastic novel emphasis on signaling.ObjectiveTo assess applicant opinions regarding program signaling and to understand the effect of 25 signals on interview outcomes during the 2023–2024 otolaryngology residency cycle.MethodsA 36-item anonymous online survey regarding signaling was sent to applicants who had applied to an otolaryngology residency program at a single institution. Participant demographics, performance in medical school, number of interviews received in relation to signals sent, and applicant perceptions regarding preference signaling were assessed.ResultsEighty-one applicants participated with a response rate of 30%. Students applied to a median of 64 programs. Approximately 84.4% of interview offers came from programs which the participants signaled. Participants were 5.4 times more likely to get an interview from a program they signaled over programs they did not signal (F = 31.73, p < 0.001). The most common factors that influenced which programs were chosen by candidates were: location (94.9%), departmental reputation (80.8%), and experience on a sub-internship rotation (69.2%). Overall, 73.0% of participants found signaling helpful and 82.0% agreed that signaling should continue.ConclusionUnderstanding the implications of a high-signaling application process in otolaryngology is crucial. Twenty-five signals led to 84% of interview offers coming from signaled programs and this was the most important variable associated with interview invitations. Location was the most prevalent factor when deciding where to signal. Signaling was well reviewed by most applicants.Level of EvidenceNA Laryngoscope, 135:80–86, 2025
Pubmed PDF Web\nRyan J. Davis, \nOluwatobiloba Ayo‐Ajibola, \nMatthew E. Lin, \nJoni K. Doherty\n
Publicatie 11-12-2024
Awareness of external auditory canal exostosis and its prevention has not been well characterized in California, the state with the most surfing participants in the United States. Our study sought to characterize this community of surfers external auditory canal exostoses knowledge, use of preventative earplugs, and barriers toward earplug use through an online survey. Overall, we discovered low reports of earplug use despite high awareness of external auditory canal exostoses and its preventability.ObjectivesCalifornia has the most surfers in the United States and a high prevalence of external auditory canal exostoses (EACEs) among them. We aimed to characterize their EACE knowledge, use of earplugs, and barriers toward earplug use.MethodsA RedCap survey was distributed to online surfing forums and surfers at California beaches. Descriptive statistics and regression analyses were used to characterize responses.ResultsOur cohort included 334 primarily male (n = 269, 81.52%), college-educated (n = 237, 71.17%) surfers who were on average 30.79 years old (SD = 11.07). Two hundred and ninety-seven (90.00%) heard of EACE and 317 (96.06%) believed earplugs prevent EACE. However, 214 (64.85%) had never used earplugs. Multivariable logistic regression found increased age (OR = 1.04, 95% CI = 1.00–1.08, p = 0.03), higher EACE knowledge quiz scores (OR = 1.47, 95% CI = 1.19–1.80, p < 0.001), and primarily surfing in Southern California (OR = 2.19, 95% CI = 1.15–4.16, p = 0.02) increased the likelihood of earplug use. Common reasons against earplug use included reduced hearing, discomfort, and social hindrance. Two hundred and eighty-seven (86.45%) would wear earplugs following more EACE knowledge. They preferred learning from surf community members, doctors, and surf events.ConclusionLow earplug use despite awareness of EACE preventability suggests a need for EACE education among California surfers and more accessible, user-friendly earplugs. Younger, less-skilled surfers who were more commonly unaware of EACE may represent a key intervention group. Education could be promoted through partnerships between health professionals and renowned surf organizations, as most participants indicated a willingness to use earplugs post-education.Level of EvidenceNA Laryngoscope, 135:286–292, 2025
Pubmed PDF Web\nWanyi Huang, \nBixue Huang, \nJincangjian Sun, \nQiyang Sun, \nYue Liang, \nHuiting Chen, \nXianren Wang, \nGuanxia Xiong\n
Publicatie 11-12-2024
ObjectivesThe relationship between the middle temporal (MTG) and occipital cortices in post-lingually deaf (PLD) individuals is unclear. This study aimed to investigate changes in the MTG and occipital cortices excitability and their effects on the occipital cortex in individuals with PLD after receiving a cochlear implant (CI).MethodsTwenty-six individuals with severe-to-profound binaural sensorineural PLD were assessed clinically. Nine individuals had received a unilateral cochlear implant over 6 months, while 17 had not. Brodmann area 19 (BA19, extra-striate occipital cortex) and MTG (auditory-related area of cortex) were selected as regions of interest. The excitability of the ROI was observed and compared in the surgery and no-surgery groups by functional near-infrared spectroscopy (fNIRS) in the resting state, and correlations between connectivity of the MTG and occipital cortex, and as well as the duration of time that had elapsed following CI surgery, were investigated.ResultsfNIRS revealed enhanced global cortical connectivity in the BA19 and MTG on the operative side (p < 0.05) and the connectivity between BA19 and the MTG also increased (p < 0.05). The connectivity between the MTG and BA19 was positively correlated with the duration of cochlear implantation, as was the case for BA18.ConclusionThere was evidence for remodeling of the cerebral cortex: increased excitability was observed in the MTG and BA19, and their connectivity was enhanced, indicating a synergistic effect. Moreover, the MTG may further stimulate the visual cortex by strengthening their connectivity after CI.Level of Evidence3 Laryngoscope, 135:331–338, 2025
Pubmed PDF Web\nRyan J. Davis, \nMatthew Lin, \nOluwatobiloba Ayo‐Ajibola, \nDiana D. Ahn, \nPayton A. Brown, \nJohn Parsons, \nTiffany F. Ho, \nJanet S. Choi\n
Publicatie 11-12-2024
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.ObjectivesThe 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.MethodsRedCap 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.ResultsCohort 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, 135:299–307, 2025
Pubmed PDF Web\nDylan Bertoni, \nSana Siddiqui, \nChihun Han, \nKathleen M. Tibbetts, \nJoseph Spiegel\n
Publicatie 11-12-2024
Background/ObjectivesHead and neck radiation therapy (HNRT) has traditionally been considered a contraindication to vocal fold medialization procedures. Although safety has been demonstrated, we hypothesize that actual management varies. This study evaluates practice patterns of otolaryngologists regarding vocal fold medialization in patients after HNRT.MethodsA 25-question survey evaluating respondents management of patients status post HNRT with vocal fold paresis/paralysis was distributed to 357 otolaryngologists. Practice patterns regarding injection laryngoplasty (IL), medialization thyroplasty (MT), and arytenoid adduction (AA) were queried.ResultsEight-two clinicians (23%) completed the survey. Ninety-one percent of respondents were laryngologists, 9% head and neck surgeons, 3% comprehensive otolaryngologists, and 3% “other.” Eleven (15%) had been in practice <5 years, 19 (25%) for 5–10 years, and 46 (61%) for >10 years. No respondents considered HNRT a contraindication to IL, and 11 (14%) reported complications from the procedure. Hyaluronic acid (58, 75%) was most commonly injected. Twenty percent considered HNRT a contraindication to MT, and 37% considered it a contraindication to AA. Gore-Tex was used most commonly (65%). Twenty-seven percent reported major complications after MT. All complications occurred in the >10-year practice group, and this group was more likely to delay surgery after HNRT (p = 0.022). Respondents with complications were more likely to perform MT in HNRT patients (p = 0.0191).ConclusionsOtolaryngologists generally do not consider HNRT to be a contraindication to IL, but some consider it a contraindication to MT/AA. Previous complications do not appear to deter surgeons from performing MT.Level of EvidenceNA (Survey Study) Laryngoscope, 135:183–190, 2025
Pubmed PDF Web\nPhillip Huyett, \nPhoebe K. Yu, \nDavid Kent, \nStephanie Stahl, \nShalini Manchanda, \nReena Mehra, \nJessica Rundo, \nKent Lee, \nLauren Makey, \nMax Lundeen, \nAsim Roy\n
Publicatie 11-12-2024
Hypoglossal nerve stimulation is an effective treatment for obstructive sleep apnea. The initial adjustment period is based on subjective improvement such as improvement in snoring and daytime sleepiness. Home sleep technologies stand the potential to offer objective assessment of sleep apnea as patients make adjustments to therapy at home and assess readiness for a home sleep apnea test or in-lab titration polysomnography.ObjectiveHypoglossal nerve stimulation (HGNS) is an implantable therapy for obstructive sleep apnea (OSA). Therapy efficacy is currently confirmed by a formal sleep study after empiric adjustment by the patient at home based on their subjective experience with the device. Home-based longitudinal apnea hypopnea index (AHI) measurements have the potential to refine HGNS therapeutic amplitude selection with objective data. Our objective was to compare AHI derived from routine sleep studies and two different home sleep devices in new HGNS recipients.MethodsProspectively enrolled patients receiving HGNS therapy were provided a Sleep Tracking Mat (Withings, Issy-les-Moulineaux, France) and NightOwl peripheral arterial tonometry (PAT) sensor (Ectosense, Leuven, Belgium) for longitudinal, home AHI monitoring from 1 to 6 months post-implant. Therapy efficacy was assessed at 3 and 6 months post-implant using in-lab polysomnography (PSG) or home sleep apnea test (HSAT). The sleep mat and PAT sensor AHI were compared against PSG and HSAT for accuracy of OSA severity identification.ResultsSixty patients were enrolled across 5 centers and followed for 6 months. The sleep mat had sensitivity and specificity for identifying AHI <15 of 61% and 82% and AHI <30 of 77% and 100%. The PAT device had sensitivity and specificity for identifying AHI <15 of 57% and 77% and AHI <30 of 81% and 80%.ConclusionsThe sleep mat and PAT sensor demonstrated high sensitivity and specificity for detection of mild and moderate OSA in patients with HGNS therapy and may enable longitudinal objective monitoring of HGNS efficacy in the home setting.Level of Evidence3 Laryngoscope, 135:469–477, 2025
Pubmed PDF Web\nLauran K. Evans, \nHaidee Chen, \nManwel Taki Labib, \nD. Alexander Cronkite, \nAlice C. Yu, \nMaya Ashendouek, \nDavid Elashoff, \nWanxing Chai‐Ho, \nDeborah J. Wong, \nMaie St. John\n
Publicatie 11-12-2024
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).ObjectivesAnaplastic 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).ConclusionsTargeted 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, 135:478–484, 2025
Pubmed PDF Web\nRobin Zhao, \nAnna S.G. Choi, \nAllison Koenecke, \nAnaïs Rameau\n
Publicatie 11-12-2024
Commercial automatic speech recognition (ASR) systems underperform for d/Deaf and hard-of-hearing (d/Dhh) individuals, especially those with “low” and “medium” speech intelligibility classification, prelingual onset of hearing loss, and sign language as primary communication mode. There is a need for ASR systems ethically trained on heterogeneous d/Dhh speech data.ObjectiveTo evaluate the performance of commercial automatic speech recognition (ASR) systems on d/Deaf and hard-of-hearing (d/Dhh) speech.MethodsA corpus containing 850 audio files of d/Dhh and normal hearing (NH) speech from the University of Memphis Speech Perception Assessment Laboratory was tested on four speech-to-text application program interfaces (APIs): Amazon Web Services, Microsoft Azure, Google Chirp, and OpenAI Whisper. We quantified the Word Error Rate (WER) of API transcriptions for 24 d/Dhh and nine NH participants and performed subgroup analysis by speech intelligibility classification (SIC), hearing loss (HL) onset, and primary communication mode.ResultsMean WER averaged across APIs was 10 times higher for the d/Dhh group (52.6%) than the NH group (5.0%). APIs performed significantly worse for “low” and “medium” SIC (85.9% and 46.6% WER, respectively) as compared to “high” SIC group (9.5% WER, comparable to NH group). APIs performed significantly worse for speakers with prelingual HL relative to postlingual HL (80.5% and 37.1% WER, respectively). APIs performed significantly worse for speakers primarily communicating with sign language (70.2% WER) relative to speakers with both oral and sign language communication (51.5%) or oral communication only (19.7%).ConclusionCommercial ASR systems underperform for d/Dhh individuals, especially those with “low” and “medium” SIC, prelingual onset of HL, and sign language as primary communication mode. This contrasts with Big Tech companies promises of accessibility, indicating the need for ASR systems ethically trained on heterogeneous d/Dhh speech data.Level of Evidence3 Laryngoscope, 135:191–197, 2025
Pubmed PDF Web\nOğuzhan Dikici, \nMehmet Emin Aslanci, \nBuse Ekim\n
Publicatie 11-12-2024
The results of the Video Head Impulse Test gain in myopia patients are higher than that in patients without refractive error. In addition, age may have an effect on gain values. It is important to consider this factor when evaluating the results of the Video Head Impulse Test in patients, and corrections should be made if necessary.ObjectiveThe objective of this study is to investigate the potential influence of refractive error on Video Head Impulse Test outcomes.Material and MethodsEighty-two patients were included in the study, and all patients underwent video head impulse testing. Patients were divided into four groups according to their refractive error: myopia, myopia-astigmatism, astigmatism, and emmetropia as control.ResultsPatients with myopia are younger than patients with astigmatism and controls; similarly, patients with myopia-astigmatism are younger than patients with astigmatism. The right and left lateral, anterior, and posterior gain values were statistically significantly lower in the control group compared with myopia and myopia-astigmatism patients (p < 0.05). There was a statistically significant relationship between the right and left lateral, anterior, and posterior gain values and the degree of myopia in the patients (p < 0.05).ConclusionThe results of the Video Head Impulse Test gain in myopia patients are higher than that in patients without refractive error. In addition, age may have an effect on gain values. It is important to consider this factor when evaluating the results of the Video Head Impulse Test in patients, and corrections should be made if necessary.Level of Evidence3 Laryngoscope, 135:345–351, 2025
Pubmed PDF Web\nSivakumar Chinnadurai, \nCassandra Meyer, \nBrianne Roby, \nAndrew Redmann, \nAbby Meyer, \nRobert Tibesar, \nLuke Jakubowski, \nTimothy A. Lander, \nMichael Finch, \nAsitha D.L. Jayawardena\n
Publicatie 11-12-2024
ObjectiveTympanostomy 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.ResultsThe 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 RelevanceTympanostomy 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, 135:423–428, 2025
Pubmed PDF Web\nJenny B. Xiao, \nJennifer M. Siu, \nEvan J. Propst, \nNikolaus E. Wolter\n
Publicatie 11-12-2024
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.ObjectivesTo 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).ConclusionMagnet, 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, 135:438–444, 2025
Pubmed PDF Web\nGary Gartling, \nLea Sayce, \nZachary Zimmerman, \nAlysha Slater, \nLizzie Hary, \nWenqing Yang, \nMichele Santacatterina, \nBernard Rousseau, \nRyan C. Branski\n
Publicatie 11-12-2024
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.IntroductionGlucocorticoids (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.MethodsMicroflap 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.ResultsAt 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.ConclusionAcutely, 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, 135:206–212, 2025
Pubmed PDF Web\nR. William Stout Jr, \nNina Gallo, \nSofia Torres‐Small, \nOkenwa Okose, \nChenhao Zhao, \nTristan Hayes, \nJohn Gleysteen, \nC. Burton Wood\n
Publicatie 11-12-2024
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.ObjectiveTo determine the effects of socioeconomic status (SES) on cutaneous melanoma of the head and neck.Data SourceSurveillance Epidemiology and End Results (SEER) Program.Review MethodsWe 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.ConclusionsWhen 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 Evidence3 Laryngoscope, 135:153–160, 2025
Pubmed PDF Web\nAkari Kimura, \nMohammed Imran Khan, \nMeena Easwaran, \nJoanne Soo, \nAmirbahador Golchin, \nElizabeth Erickson‐DiRenzo\n
Publicatie 11-12-2024
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.ObjectiveAnimal 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).MethodsMice 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.ResultsThe 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.ConclusionWe 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 EvidenceNA Laryngoscope, 135:213–222, 2025
Pubmed PDF Web\nDaniel D. Ghaderi, \nMatthew R. Aronson, \nAmrita Mehta, \nRyan M. Friedman, \nKendra S. McDaid, \nTerri Giordano, \nIan N. Jacobs, \nRiccardo Gottardi\n
Publicatie 11-12-2024
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.ObjectivePediatric 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.MethodsImmunomodulatory 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.ResultsIn 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.ConclusionsOverall, 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, 135:409–415, 2025
Pubmed PDF Web\nAlexander Treble, \nJennifer M. Siu, \nYasmine Madan, \nSuzanne Breton, \nJackie Chiang, \nBlake C. Papsin, \nEvan J. Propst, \nNikolaus E. Wolter\n
Publicatie 11-12-2024
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.ObjectivesNational 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.MethodsAn 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.ResultsThere 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.ConclusionAlthough 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.Level of Evidence5 Laryngoscope, 135:445–451, 2025
Pubmed PDF Web\nGrace M. Wandell, \nJaneth Garcia Swartwood, \nAshar Singh Brar, \nGregory N. Postma, \nPeter C. Belafsky\n
Publicatie 11-12-2024
The shape of esophageal dilators has not changed in 350 years. We developed a novel upper esophageal balloon dilation system for the specific shape of the upper esophageal sphincter (UES). This study compares and demonstrates the equivalent safety profile of UES dilation using the Infinity System to dilation with single and double conventional balloon dilators.ObjectiveThe shape of esophageal dilators has not changed in over 350 years. Clinical and animal research suggests that the upper esophageal sphincter (UES) is not round but approximates a kidney shape and that cylindrical dilators may be suboptimal. The Infinity UES Dilation System has been developed specifically for the anatomic configuration of the UES. This study evaluates the safety of the UES-specific Infinity Dilation System.MethodsAll patients undergoing dilation of the UES between January 1, 2022 and September 1, 2023 were included. Demographics, procedure indication, dilator type, minor adverse events, and major complications were abstracted. Minor adverse events, complications, and maximum dilation dimension (mm) were compared between groups.ResultsA total of 477 patients were included. Eight hundred and seventy-three total UES dilations were performed. The primary indications for UES dilation were cricopharyngeus muscle dysfunction (43%) and stenosis from radiation toxicity (40%). Twenty-three percent (202/873) of dilations were performed with an Infinity balloon, 31% (270/873) were performed using two conventional balloons placed side by side, and 46% (401/873) were performed with one singleton conventional balloon. The average maximum dilation dimension was 33 (±4.7) mm for Infinity balloons, 32 (±3.8) mm for two side-by-side balloons, and 18 (±3.4) mm for singleton balloons. There were three major complications with conventional balloons and none with Infinity balloons. There were no significant differences in minor adverse events between groups.ConclusionsA UES-specific esophageal dilator provides a greater maximum dilation dimension and appears to be at least as safe as dilation with a single cylindrical balloon designed to dilate the esophagus.Level of Evidence3 Laryngoscope, 135:66–72, 2025
Pubmed PDF Web\nKevin Wong, \nSwar Vimawala, \nMichael J. Ruckenstein\n
Publicatie 11-12-2024
\nAmrita Bhat, \nJolie L. Chang, \nMegan L. Durr\n
Publicatie 11-12-2024
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 Web\nRebecca J. Howell, \nAmna S. Mira, \nAndres Llico, \nVictoria S. McKenna\n
Publicatie 10-12-2024
Laryngeal high-speed videoendoscopy is an novel imaging technique used to visualize, sequence, and time fast anatomic movement during swallowing. This is a pilot study demonstrating tolerability and feasibility and using a custom-designed MATLAB GUI to represent the sequenced swallowing events.ObjectiveThis pilot study was designed to test the tolerability of a lower scope position and feasibility of custom-designed MATLAB graphical user interface (GUI) used to analyze playback review of laryngeal high-speed videoendoscopy (laryngeal HSV) during healthy volitional dry swallows. We hypothesized this method would conceptually provide time resolution for glottic closure events compared with standard (30 frames per second, fps), and enable a means to measure timing, sequence, and duration of laryngeal movements during swallowing not otherwise visualized.MethodsA total of 14 healthy adults (4 male, 22–80 years) participated. We performed laryngeal HSV at 500fps. Measurements included: (i) feasibility and tolerability of the procedure; (ii) identification of a swallowing segment of interest (SOI) for the peak of the swallow; and (iii) description of laryngeal swallowing movements using a GUI.ResultsFourteen subjects tolerated the procedure without discomfort and swallow images were able to be analyzed in 12. Using our GUI, mean SOI was 260 ms, yielding 130 frames for analysis (compared with seven in standard laryngoscopy). Vocal fold adduction, vocal fold medialization, and anterior–posterior arytenoid compression to the epiglottis prior to whiteout could be identified and sequenced.ConclusionParticipants tolerated a low position of the endoscope during dry volitional swallows. The output of our GUI demonstrated a novel technique for identifying, describing, and sequencing a swallowing SOI. Future studies should investigate laryngeal closure and arytenoid positioning with a bolus and in a range of ages, genders, and etiologies in both healthy and abnormal populations to better understand swallowing physiology.Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nShreya Mandloi, \nKathryn Nunes, \nElliott M. Sina, \nPeter A. Benedict, \nChase Kahn, \nAlexander Duffy, \nSamuel R. Shing, \nZachary D. Urdang, \nMarc Rosen, \nElina Toskala, \nMindy R. Rabinowitz, \nGurston G. Nyquist\n
Publicatie 10-12-2024
IntroductionAnticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin.MethodsThis study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day–6 months and 6 months–3 years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed.ResultsThe TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1 day–6 months compared to warfarin patients with DOAC patients (p < 0.0001). From 6 months–3 years after treatment initiation, LAAO patients experience reduced odds of epistaxis and epistaxis requiring nasal packing compared to warfarin patients (OR: 0.69 p = 0.0003; OR: 0.58 p = 0.0043). Institutionally, epistaxis resolved in 66% (8/12) LAAO patients with a history of epistaxis with an average follow-up of 1.5 years.DiscussionLAAO decreased the frequency of epistaxis and epistaxis requiring nasal packing in AF patients on warfarin after 6 months. Our institutional experience demonstrates long-term improvement in epistaxis after LAAO for DOAC and warfarin patients. Additional studies need to be performed to account for dual antiplatelet following LAAO on epistaxis risk.Level of EvidenceLevel 3 Laryngoscope, 2024
Pubmed PDF Web\nSante De Santis, \nStefania Galassi, \nJacopo Cambi\n
Publicatie 09-12-2024
The study compared the effectiveness of dupilumab, omalizumab, and mepolizumab in Italian patients with severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), showing significant improvements in quality of life and reduction in nasal polyp size across all groups. Dupilumab demonstrated the fastest response, with reductions seen as early as 4 weeks, while improvements in olfactory function and asthma control were observed in all groups.ObjectiveChronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a challenging condition often managed with biologic therapies. This study compares the clinical effects and response times of dupilumab, omalizumab, and mepolizumab in Italian patients with severe uncontrolled CRSwNP.MethodsThis bicentric, retrospective study included 33 patients treated at two Italian hospitals between April and December 2023. Inclusion criteria followed EPOS 2020 guidelines, focusing on adults with bilateral polyposis, history of endoscopic sinus surgery, and evidence of type 2 inflammation. Patients self-administered biologics according to AIFA protocols. Outcomes were assessed using SNOT-22 for quality of life, Nasal Polyp Score (NPS) for polyp size, and Sniffin’ Sticks-12 for olfactory function at baseline, 4 weeks, 3, 6, and 9 months.ResultsAll three treatment groups (dupilumab, omalizumab, mepolizumab) showed significant improvements in SNOT-22 scores from baseline to 9 months, with no significant differences between groups. Dupilumab showed the most rapid and sustained improvement in NPS, with significant reductions observed from 4 weeks onward. Both omalizumab and mepolizumab showed significant NPS reductions by 6 months. Olfactory function improved significantly in the dupilumab group, with a notable decrease in anosmic patients from 64.3% to 28.6% at 9 months. Asthma control, measured by Asthma Control Test (ACT) scores, improved across all groups.ConclusionDupilumab, omalizumab, and mepolizumab significantly improve quality of life and reduce nasal polyp size in CRSwNP patients, with dupilumab showing the fastest response. These findings support the effectiveness of biologics in real-world settings for managing severe CRSwNP.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nTakashi Mukaigawa, \nKoiku Asakura, \nAyaka Tsuzuki, \nAtsushi Urikura, \nTsukasa Yoshida, \nSeiya Goto, \nShinichi Okada, \nYohei Hiiragi, \nFuyuki Sato\n
Publicatie 09-12-2024
We investigated the efficacy of subtraction CT for assessing mandibular bone invasion in oral cancer, revealing its superior sensitivity and specificity compared with conventional imaging. Subtraction CT could serve as a valuable pretreatment diagnostic tool in head and neck cancer.ObjectivePretreatment evaluation of bone invasion in head and neck cancer is critical for treatment strategies. We investigated the usefulness of subtraction CT (SCT) in evaluating mandibular bone invasion in oral squamous cell carcinoma (OSCC).MethodsThis retrospective investigation included patients with OSCC who underwent surgery at the Shizuoka Cancer Center Hospital between 2018 and 2022. We evaluated tumor invasion of the mandibular bone by interpreting conventional computed tomography (CT), SCT, and magnetic resonance imaging (MRI) and comparing the findings with the pathological examination. Sensitivity and specificity were compared using the McNemar test, whereas Spearmans correlation and Bland–Altman methods were utilized to assess mandibular bone invasion depth.ResultsA total of 71 patients were enrolled. SCT showed significantly higher sensitivity than conventional CT for evaluating mandibular marrow invasion (97.2% vs. 80.6%, p = 0.031). In the evaluation of mandibular canal involvement, SCT showed significantly higher specificity than MRI (95.9% vs. 81.6%, p = 0.016). Furthermore, SCT demonstrated the highest correlation with pathological bone invasion depth (correlation coefficients: CT = 0.933, SCT = 0.950, MRI = 0.908; all p < 0.05).ConclusionThese results suggest that SCT is more effective than conventional imaging for diagnosing mandibular bone invasion and may be a useful modality for the pretreatment diagnosis of head and neck cancer.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nMohamed Aboueisha, \nZaroug Jaleel, \nHans C. Baertsch, \nCara Sauder, \nAlbert L. Merati, \nMichael M. Johns, \nNeel K. Bhatt\n
Publicatie 09-12-2024
Glottal Image Capture (GlottIC), a new mobile application, reliably quantifies vocal fold bowing in age-related vocal atrophy (ARVA) with strong intra-rater (r = 0.822) and inter-rater (ICC = 0.720) reliability. GlottICs bowing index also correlates well with manual calculations and visual-perceptual ratings, supporting its validity.BackgroundAge-related vocal atrophy (ARVA) causes vocal fold bowing, impacting communication and quality of life. The assessment of vocal fold bowing is largely subjective. Glottal Image Capture (GlottIC) is a new mobile application that helps quantify vocal fold bowing. We aim through this study to assess its reliability, compare it to manual calculation method, and compare differences between visual-perceptual bowing severity ratings.MethodsTen raters independently quantified Bowing Index (BI) using GlottIC from 10 videostroboscopic images among individuals with ARVA. There was 100% duplication of images to facilitate intra-rater reliability analyses using Pearsons correlation. Inter-rater reliability was quantified using Intraclass Correlation Coefficient (ICC) for experienced and novice raters. The correlation between manual calculations using ImageJ and GlottIC was analyzed.ResultsThe intra-rater reliability for total BI was strong (r = 0.822, p < 0.001). The inter-rater reliability for BI, calculated using ICC, was (ICC = 0.720; 95% CI: 0.579–0.852), indicating good consistency among the raters. Experts had higher ICC (ICC = 0.808; 95% CI: 0.678–0.906) compared to novice raters (ICC = 0.651; 95% CI: 0.468–0.816). There was a positive correlation between GlottIC and manual BI (r = 0.811, p < 0.001). As the BI increased, the bowing severity, based on visual-perceptual ratings, also increased (p < 0.001).ConclusionGlottIC is a reliable mobile application that can quantify vocal fold bowing in patients with ARVA with high intra- and inter-rater reliability. GlottIC BI measurments are highly correlated with manual BI and visual-perceptual ratings of bowing severity. Further improvements in reliability may be achieved with more robust rater training and automated technologies.Level of EvidenceLevel 3 Laryngoscope, 2024
Pubmed PDF Web\nJason D. Pou, \nMaya N. Matabele, \nKevin M. Robertson\n
Publicatie 06-12-2024
This retrospective study found that subcutaneous and topical TXA use during rhytidectomy decreased drain output and bruising without added complications. Subcutaneous TXA also decreased blood loss, operative time, and seroma formation compared with the control group.ObjectiveTranexamic acid is a potential rhytidectomy adjunct; however, its route of administration, benefits, and safety remain a topic of debate. The purpose of this study is to analyze the effects of topical and subcutaneous TXA during rhytidectomy.MethodsThis is a retrospective, 3-arm analysis of a single surgeons practice from Aug. 2019 to Nov. 2023. 175 consecutive patients underwent rhytidectomy; 55 did not receive TXA (8/2019–12/2020), 65 received intraoperative topical 25 mg/mL TXA (1/2021–7/2022), and 55 received subcutaneous 5 mg/mL TXA (7/2022–11/2023). Measured outcomes included drain output, bruising, operative time, estimated blood loss, and complications.ResultsSubcutaneous and topical TXA had similar drain outputs (11.32 mL vs. 12.98 mL, respectively) and bruising scores (20.93 vs. 22.12, respectively). These were significantly less than the control group (24.05 mL, p < 0.001 and 36.28, p < 0.001, respectively). The subcutaneous group operative time (196.13 min) was less than the topical and control groups (212.72 min, p = 0.01; 207.90 min, p = 0.037, respectively) in patients who underwent rhytidectomy with platysmaplasty. EBL and seroma formation in the subcutaneous TXA group were significantly less than the control (23.92 mL vs. 31.67 mL, p = 0.011; 3.60% vs. 18.18%, p = 0.03, respectively). Hematoma, epidermolysis, and infection rates were similar between all groups.ConclusionBoth topical and subcutaneous TXA use during rhytidectomy are associated with reduced postoperative drain output and bruising without an increased risk of complications. Subcutaneous TXA has the added associated benefit of decreasing operative time, EBL, and seroma formation.Level of EvidenceIII Laryngoscope, 2024
Pubmed PDF Web\nAriel Roitman, \nTadeas Lunga, \nAnumitha Venkatraman, \nKristopher M Schroeder, \nSusan L Thibeault, \nSeth H Dailey\n
Publicatie 06-12-2024
This study evaluates the fire risk of the novel TruBlue laser under controlled laboratory settings. Experimental tests reveal that the Medtronic™ ETT is highly safe, Rüsch® ETT has intermediate safety profile, while the MLT poses significant fire hazards. The study also identifies effective strategies to mitigate fire risks with ETTs and surgical pledgets.IntroductionThe risk of fire during laser microlaryngoscopy is well known. However, limited information is available about fire risk with the novel TruBlue laser. This study systematically evaluates its interactions with common surgical supplies, offering valuable insights into safety considerations for surgeons.Material and MethodsWe used experimental conditions to test the extent to which TruBlue laser energy produces smoke, perforation, or fire in Rüsch®, Medtronic™ and microlaryngeal endotracheal tubes and in surgical pledgets.ResultsOnly the Microlaryngeal Tube (MLT) caught fire. Notably, it happened only when the laser fiber shifted on the tubes surface. Smoke emerged solely from the laser fiber applied to the Medtronic™ shaft and only during continuous contact mode. Cuff perforation and smoke emanating from the shaft occurred in three-quarters of the Rüsch® trials. The pledgets radiopaque segment exhibited a greater combustibility than other segments (p < 0.01). In many of the pledget trials, faster smoke emission occurred with shorter laser-to-target distances (p < 0.05). Water-soaked pledgets displayed a reduced rate of smoke production (p < 0.01) and string division.ConclusionThe Medtronic™ tube assures remarkable safety with a nonignitable shaft and low cuff ignition. The MLT poses the highest ignition risk. Cuff perforation risk is mitigated by maintaining a 0.3-cm distance from the laser fiber tip. Pledget fire risk is mitigated by positioning the radiopaque part away from the laser beam and by soaking the pledget with water. Laser division of the pledgets string was common.Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nBrennan Olson, \nA. Yohan Alexander, \nKendall Tasche, \nLuciano C.P.C. Leonel, \nMaria Peris Celda, \nCarlos Pinheiro‐Neto\n
Publicatie 06-12-2024
Surgical access to tumors involving the infratemporal fossa (ITF) and adjacent regions can be challenging, and there is a continued need for novel approaches to complex tumors in this region. In this manuscript, we present a unique anatomical approach that allows contiguous exposure of the ITF and buccal space with mobilization of the lateral maxillary buttress. Laryngoscope, 2024
Pubmed PDF Web\nKavita Dedhia, \nMitchell Maltenfort, \nJenna Briddell, \nDavid Horn, \nCarol Li, \nPrasanth Pattisapu, \nDiego Preciado, \nCedric V. Pritchett, \nTodd Wine, \nChristopher B. Forrest\n
Publicatie 05-12-2024
In this study, the tympanostomy tube insertion (TTI) rate was 5.3%, which increased to approximately 20% in children with history of otitis media. Though multiple characteristics increase the risk of TTI, sensorineural hearing loss for TTI alone, and age 4–8 years at time of presentation in the TTI-A subset carried the highest risk.ObjectivesTo evaluate temporal trends and identify patient characteristics associated with otitis media (OM) surgery.MethodsA retrospective cohort study performed using electronic health record data from seven large pediatric medical networks from January 1, 2009, to December 31, 2022. Children <6 months old cohort entrance time and OM history were included and followed longitudinally.ResultsThe database included 1,448,390 children entering at age <6 months of which 5.3% underwent tympanostomy tube insertion (TTI). Inclusion criteria was met by 454,924 children. Age at first OM was 1.6 years (standard deviation SD: 1.1), with mean follow-up of 6.3 years (SD 3.7), and 249,818 (54.9%) were male. Among children with OM 64,950 (14.3%) underwent only TTI, and 13,188 (2.9%) had TTI with adenoidectomy (TTI-A). Over time, TTI only rates exhibited seasonal fluctuations with a drop in 2020, TTI-A rates were flat. The following patient characteristics greatly increased TTI: sensorineural hearing loss (adjusted hazard ratio, aHR 4.0, 95% confidence interval, CI 3.9–4.1), chronic adenoiditis (aHR 3.4 95% CI 3.0–3.5), and cleft palate (aHR 1.9 95% CI 1.8–2.0). Children 4–8 years old (aHR >11.7 95% CI 10.6–16.4), history of chronic adenoiditis (aHR 6.4 95% CI 5.4–7.7), or sleep disorders (aHR 4.9 95% CI 4.7–5.2) greatly increased TTI-A odds.ConclusionsOverall TTI rate was 5.3%, which increased to approximately 20% in children with OM. Aside from the COVID-19 pandemic, surgical rates have been stable. Though multiple characteristics increase the risk of TTI, sensorineural hearing loss for TTI only, and older age in the TTI-A subset carried the highest risk.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nAndrea Costantino, \nClaudio Sampieri, \nNam Suk Sim, \nArmando De Virgilio, \nSe‐Heon Kim\n
Publicatie 05-12-2024
Sparing adjuvant radiotherapy in selected HPV-positive oropharyngeal cancers treated with neoadjuvant chemotherapy and transoral robotic surgery appears to be feasible and may contribute to personalized treatment strategies, potentially minimizing treatment-related toxicity and obtaining a long-term disease control.ObjectiveTransoral robotic surgery (TORS) has shown promising results in treating human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), and there has been increasing interest in incorporating neoadjuvant chemotherapy (NCT) prior to TORS. This study aimed to assess the feasibility and safety of sparing adjuvant RT following NCT and TORS.MethodsA retrospective cohort study included consecutive patients with HPV-positive OPSCC who underwent NCT followed by TORS without adjuvant RT. Disease-free survival (DFS) was the primary outcome. Pattern of recurrence (local, regional, and distant), salvage treatment outcomes, and predictors of tumor recurrence were also assessed.ResultsA total of 84 patients were included in the analysis. No patients died during the study period. DFS rates (95% Confidence Interval, CI) at 1, 2, and 3 years were 92.8% (87.4–98.5), 87.0% (79.7–94.9), and 84.4% (76.0–93.8), respectively. Local, regional, and distant recurrence rates were 7.0%, 9.5%, and 3.6%, respectively. Salvage treatment achieved a 100% salvage rate. Predictors of tumor recurrence included the number of positive lymph nodes (hazard ratio: 2.66; 95% CI: 1.19–5.92) and clinical stage III at diagnosis (hazard ratio: 7.65; 95% CI: 1.97–29.7).ConclusionsRecommendation of adjuvant treatment based on pathologic adverse features appears to be associated with favorable outcomes in selected HPV-positive OPSCC cases treated with NCT and TORS. Future studies should focus on refining criteria for recommending adjuvant RT to further reduce recurrence rates and minimize treatment-related toxicity, contributing to personalized treatment strategies for HPV-related OPSCC.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nTong Wu, \nWenjie Miao, \nAyihen Qukuerhan, \nNilipaer Alimu, \nJuan Feng, \nCansi Wang, \nHua Zhang, \nHuimin Du, \nLin Chen\n
Publicatie 04-12-2024
This study systematically analyzes the global, regional, and national burden of nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on incidence, prevalence, mortality, and disability-adjusted life years (DALYs). It highlights gender, regional, age, and temporal trend disparities and projects the burden of NPC through 2046, emphasizing the need for targeted interventions in high-risk areas. Despite decreasing age-standardized incidence rates, NPC prevalence and absolute case numbers are increasing due to improved diagnostics and aging populations, particularly in East and Southeast Asia.BackgroundThis study analyzes nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs). It examines gender disparities, regional variations, age dynamics, and temporal trends to provide insights for health policy and resource allocation.MethodsWe used the Global Burden of Disease (GBD) approach to assess NPCs health burden, including incidence, prevalence, mortality, and DALYs. Trends from 1990 to 2021 were illustrated using estimated annual percent change (EAPC). Subgroup analysis revealed variations by gender, age, Socio-Demographic Index (SDI), GBD classification, and country. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models predicted future trends.ResultsIn 2021, there were 118,878 new NPC cases globally (1.38 per 100,000), with a prevalence of 525,219 cases (6.14 per 100,000), 75,359 deaths (0.87 per 100,000), and 249,019 DALYs (28.91 per 100,000). Males had higher rates across all metrics. Incidence peaked at ages 50–54, mortality at 70–74, and DALYs at 50–54. High SDI regions, especially East and Southeast Asia, showed higher burdens. Despite decreasing age-standardized incidence rates, absolute cases are rising, necessitating improved prevention and treatment strategies.ConclusionsNPC prevalence has increased due to better diagnosis and aging populations, despite decreasing age-adjusted incidence rates. Lower mortality rates indicate improved treatment. Males, especially in East and Southeast Asia, bear a higher NPC burden. These findings highlight the need for targeted interventions and tailored public health policies in high-risk regions.Level of EvidenceIII Laryngoscope, 2024
Pubmed PDF Web\nDo H. Kim, \nDavid W. Jang, \nSe H. Hwang\n
Publicatie 03-12-2024
The administration of botulinum toxin type A has demonstrated a capacity to alleviate nasal symptoms and enhance quality of life in individuals suffering from rhinitis. Its efficacy is particularly pronounced in patients with allergic rhinitis, with notable improvements in nasal congestion and rhinorrhea observed in the early phases of treatment. Nonetheless, the duration of the therapeutic benefit was found to be relatively limited.ObjectivesThis systemic review with meta-analysis evaluated the effect of intranasal BTX-A turbinate injection on chronic rhinitis-related symptoms.Data SourcesPubMed, SCOPUS, Embase, Web of Science, and Cochrane databases.Review MethodsWe reviewed studies retrieved from databases up to Aug 2024. The studies evaluating the degree of change of rhinitis-related symptom scores and quality of life before and after BTX-A injection were analyzed. Standard mean differences were used to calculate effect sizes.ResultsA total of 269 patients from 7 studies were analyzed. BTX-A injection showed a significant improvement in rhinitis-related symptoms (congestion: 2.5416, 95% CI 1.0927–3.9905, I2 = 94.4%, itching: 1.2553, 95% CI 0.6660–1.8446; I2 = 70.8%, rhinorrhea: 1.8451, 95% CI 1.0468–2.6435, I2 = 89.7%, and sneezing: 1.3580, 95% CI 0.5194–2.1967; I2 = 90.7%), total nasal symptom score (2.4020, 95% CI 1.4161–3.3879, I2 = 86.1%), and quality of life (1.5256, 95% CI 1.0760–1.9752; I2 = 0.0%) throughout the follow-up period (4 months). However, 3 months after injection, although symptom improvement remained, there was no statistical significance. Allergic rhinitis (AR) patients showed a significant improvement in rhinitis-related symptoms compared with nonallergic rhinitis (NAR) patients.ConclusionsNasal symptoms and quality of life scores related to rhinitis were decreased after BTX-A injection. In particular, this treatment showed better efficacy in AR and could be more beneficial for the symptoms of nasal congestion and rhinorrhea at the early periods of treatment. However, the effects lasted for a relatively short period of only 2–3 months. Laryngoscope, 2024
Pubmed PDF Web\nJin‐Young Min, \nKenneth H. Lee, \nJun Ho Lee\n
Publicatie 02-12-2024
\nShigeyuki Murono, \nTomotaka Kawase, \nHiroumi Matsuzaki, \nTomohiro Hasegawa, \nKazuya Kurakami, \nRumi Ueha, \nHiroaki Tadokoro, \nYoshikazu Kikuchi, \nYasushi Toh, \nAkihiro Shiotani, \nYukio Katori\n
Publicatie 29-11-2024
We conducted the first Japanese nationwide survey to determine the incidence, laryngeal distribution of lesions, preferred surgical management, and outcome of newly diagnosed adult-onset recurrent respiratory papillomatosis (RRP). A total of 186 patients with newly diagnosed adult-onset RRP from 78 institutions were identified during the present study period (2018–2019), suggesting an annual incidence of 0.20 per 100,000 population in Japan. This study is the largest ever, in terms of sample size, to investigate the laryngeal distribution of lesions as well as postoperative outcomes in newly diagnosed RRP patients.ObjectivesTo investigate the incidence, laryngeal distribution, management, and postoperative clinical course of patients with newly diagnosed adult-onset recurrent respiratory papillomatosis (RRP) in Japan.MethodsAn initial brief questionnaire was sent to 782 institutions, including all 101 core and 627 collaborating institutions providing board certification programs accredited by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery. A detailed questionnaire regarding patient age, sex, Derkays score, surgery, and postoperative clinical course was sent to 196 institutions caring for patients with either newly or previously diagnosed RRP.ResultsA total of 186 patients with newly diagnosed adult-onset RRP from 78 institutions were identified during the present study period (2018–2019), suggesting an annual incidence of 0.20 per 100,000 population in Japan. The true vocal folds were the most frequently affected subsites in the larynx, followed by the false vocal folds, anterior commissure, and laryngeal surface of the epiglottis. The use of cold instruments was the most preferred surgical approach, followed by the carbon dioxide laser and microdebrider. A significant difference in recurrence-free period after the initial surgery was observed between patients with lesions in a single region and those with lesions in multiple regions (p = 0.001).ConclusionHere, we estimated the annual incidence of adult-onset RRP for the first time in Japan. To the best of our knowledge, the present study is the largest to identify the laryngeal distribution of lesions, as well as postoperative outcomes after initial surgery in newly diagnosed adult-onset RRP patients.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nJackson R. Vuncannon, \nAlejandra Rodas, \nGeorges E. Daoud, \nRoberto M. Soriano, \nAzeem S. Kaka, \nC. Arturo Solares\n
Publicatie 29-11-2024
Endoscopic nasopharyngectomy in the context of recurrent nasopharyngeal carcinoma may require reconstruction with strongly vascularized flaps. This is fundamental to address the volumetric deficit and prevent complications such as carotid blowout syndrome. The submental island flap is well suited for this purpose. Laryngoscope, 2024
Pubmed PDF Web\nEdoardo Serafini, \nMargherita Basso, \nMassimo Lupi, \nDaniele Marchioni, \nFrancesco Mattioli\n
Publicatie 28-11-2024
Laryngeal manifestation of EGPA is rare and difficult to diagnose. The case treated at Policlinico of Modena turned out to be the first organic laryngeal manifestation in an adult patient.Eosinophilic granulomatosis with polyangiitis (EGPA), among various organs and systems, can affect the upper respiratory tract. The otolaryngologist must be able to suspect the pathology with the appearance of the first signs and recognize its late complications. Laryngeal involvement is rare and difficult to diagnose. A patient suffering from Churg-Strauss syndrome developed posterior glottic stenosis 5 years after diagnosis. A biopsy of the lesion confirmed the localized recurrence of EGPA. Rituximab therapy prevented further relapse after 12 months of follow-up. In the current literature, only two case reports, both pediatric, deal with laryngeal organic manifestation of the disease. Nonspecific findings, such as corditis or dysphonia, may be found in patients with EGPA in up to 25% of cases. Thus, even though primary laryngeal manifestation is rare, inflammation can be a common finding. The case herein reported appears to be the first organic Churg Strauss syndrome laryngeal manifestation in an adult patient. Laryngoscope, 2024
Pubmed PDF Web\nShayan Fakurnejad, \nAndrea M. Park, \nRahul Seth, \nP. Daniel Knott\n
Publicatie 27-11-2024
ObjectivesTo evaluate the impact of transfemale gender-affirming rhinoplasty on nasal appearance as evaluated by common facial analysis measures.MethodsRetrospective case series of patients undergoing gender-affirming nasal surgery at a single tertiary care center from March 2016 to July 2022. Pre- and postoperative photographs were analyzed, using iris width to normalize the measurements. Parametric tests were applied to identify differences in facial analytical measures.ResultsA total of 33 male to female transgender patients met the inclusion criteria for study entry. Reductive rhinoplasty techniques were frequently utilized. Osteotomies and dorsal reduction were performed in 90.9% and 72.7% of cases, respectively. Tip width decreased on average by 2.3 mm. There was a mean increase of 10.0° in nasolabial angle, and 5.5° increase in nasofrontal angle. Among the 51.5% of patients who underwent alar base reduction, there was a mean decrease of 2.3 mm in alar base width, and 3.1 mm decrease in nasal width. Alar base excision and nasal tip grafting were utilized in 51.5% and 63.6% cases respectively.ConclusionsTransfemale gender-affirming rhinoplasty techniques consistently and predictably altered facial analytical measures, and were effective in aligning nasal appearance with desired gender identity. Alar base excision and tip grafting were commonly employed techniques.Level of EvidenceLevel 4—Quantitative cohort study Laryngoscope, 2024
Pubmed PDF Web\nAriana L. Shaari, \nRebecca Ho, \nAman M. Patel, \nSean Haimowitz, \nJean Anderson Eloy, \nChristina H. Fang\n
Publicatie 27-11-2024
Ewing sarcoma (ES) is a rare aggressive malignancy that can present in the sinonasal region. To our knowledge, we report the first systematic review of sinonasal ES. Patients generally present with non-specific sinonasal symptoms, and surgery with adjuvant chemoradiation is the most common treatment modality.ObjectiveEwing sarcoma (ES) is a rare aggressive malignancy that can present in the sinonasal region. The objective of this study is to investigate the demographics, presentation, management, and outcomes of patients with sinonasal ES.Data SourcesPubMed, Web of Science, SCOPUS, CINAHL, and Cochrane Library.Review MethodsA scoping review of cases of sinonasal ES was performed. Inclusion criteria consisted of case reports, series, or retrospective reviews.Results785 total articles were retrieved. 72 articles met inclusion criteria and were included in the final review for a total of 93 cases. 48 (53%) patients were male. Mean age at diagnosis was 26.4 years old (range 1–89). Nasal obstruction (N = 55, 59%), epistaxis (N = 35, 38%), and impaired vision (N = 29, 29%) were the most common symptoms. On examination, 38 (41%) patients had a nasal cavity mass. Most tumors (N = 33, 35%) were located in the maxillary sinus. 44 (47%) were left sided and 4 (4%) were bilateral. The most utilized treatment modalities were surgical resection with adjuvant chemoradiotherapy (N = 27, 29%), chemoradiotherapy alone (N = 24, 26%), and surgical resection with adjuvant chemotherapy (N = 14, 15%). 56 patients had no evidence of disease (60%), 14 patients died with disease (15%), and 9 patients were alive with disease (10%) at the time of follow-up.ConclusionsTo our knowledge, we report the first scoping review of sinonasal ES. Patients generally present with non-specific sinonasal symptoms. Surgery with adjuvant chemoradiation is the most common treatment modality for these patients.Level of EvidenceNA Laryngoscope, 2024
Pubmed PDF Web\nPhoebe K. Yu, \nVictoria Wong, \nKaitlyn Cook, \nPhillip Huyett\n
Publicatie 27-11-2024
In a longitudinal prospective study of sleep measures in the immediate postoperative period, there were not significant changes in apnea-hypopnea index or hypoxemia after hypoglossal nerve stimulation. By comparion, there was a significant increase in the apnea-hypopnea index after expansion pharyngoplasty with a peak on post-operative night 2 without significant changes in the percentage of time with oxygen below 90%.ObjectivePatients with obstructive sleep apnea (OSA) are at an increased risk for perioperative cardiopulmonary complications. Our objective was to assess the postoperative effects of hypoglossal nerve stimulation implantation (HGNS) and expansion pharyngoplasty (EP) on longitudinal sleep apnea measures as a surrogate for respiratory complications.Study DesignProspective longitudinal cohort study of patients with OSA undergoing HGNS or EP.MethodsSleep studies were performed with the NightOwl Mini peripheral arterial tonometry (PAT) device. Changes in apnea-hypopnea index (AHI) and oximetry time below 90% (T90) were assessed between two baseline PAT studies prior to surgery and nightly PAT studies for the first postoperative nights (PON) 1–7, 10, and 14.ResultsThirty patients were enrolled (19 HGNS, 11 EP). The mean age was 52.6 years, 76.7% were male, and the mean clinical baseline AHI was 29.8/h. There were no significant changes in the AHI or T90 following HGNS implantation. Following EP, there was a statistically significant mean increase in AHI of +19.2/h on PON1, +24.9/h on PON2, and + 20/h on PON3 compared to baseline. T90 was also elevated after EP on PON1, 4, and 5. The mean increase in T90 was +7.4% (95% CI 2.9, 11.9) on PON1 compared to baseline.ConclusionsIn the immediate postoperative period, there were no significant changes in AHI or hypoxemia after HGNS, suggesting that there is no need for routine overnight observation after HGNS. There were significant increases in AHI and hypoxemia after EP suggesting that postoperative disposition should be considered on a case-by-case basis.Level of EvidenceIII Laryngoscope, 2024
Pubmed PDF Web\nPei‐Wen Wu, \nChi‐Che Huang, \nPo‐Hung Chang, \nTa‐Jen Lee, \nYu‐Hsi Fan, \nChien‐Chia Huang\n
Publicatie 27-11-2024
Blood eosinophil count (BEC) is the dominant clinical marker exhibiting the highest correlation with tissue type 2 inflammatory severity in patients with chronic rhinosinusitis and nasal polyps. Comorbid asthma, nonsmoking status, ethmoid/maxillary sinus ratio, and BEC were significant predictors of eosinophilic CRSwNP.ObjectiveSevere type 2 eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is challenging to treat and susceptible to recurrence post-surgery. This study aimed to evaluate the relationship between clinical markers and tissue type 2 inflammatory severity in patients with CRSwNP.MethodsAdult patients who underwent endoscopic sinus surgery for bilateral CRSwNP were prospectively enrolled. Tissue eosinophil count (TEC) was evaluated. Expression levels of type 2 cytokines, including IL-5 and IL-13, in nasal polyps were determined using real-time PCR. Correlations between clinical markers and tissue type 2 inflammation were also assessed.ResultsIn total, 150 participants were recruited. Ninety-five (63.3%) exhibited type 2 eosinophilic CRSwNP defined by TEC ≥10/high power field. Weak to moderate correlations were observed between clinical and tissue markers of type 2 inflammation. Among the clinical markers, blood eosinophil count (BEC) exhibited the highest correlation with tissue type 2 inflammatory severity, as determined by TEC, IL-5, and IL-13 expression levels in nasal polyps. Comorbid asthma, nonsmoking status, ethmoid/maxillary sinuses (E/M) ratio, and BEC were significant predictors of eosinophilic CRSwNP in the regression analysis.ConclusionsBEC, a dominant clinical marker, exhibits the highest correlation with tissue type 2 inflammatory severity, as determined by TEC, IL-5, and IL-13 in nasal polyps. Comorbid asthma, nonsmoking status, E/M ratio, and BEC were significant predictors of eosinophilic CRSwNP. This could help clinicians better evaluate the severity of type 2 inflammation in patients with CRSwNP and provide optimal therapeutic strategies.Level of Evidence4 Laryngoscope, 2024
Pubmed PDF Web\nLaura M. Mafla, \nRaymond J. So, \nIbrahim Abd‐Elazem, \nSamuel L. Collins, \nYee Chan‐Li, \nGabriela Lilly, \nIoan A. Lina, \nAlexander H. Gelbard, \nAlexander T. Hillel, \nKevin M. Motz\n
Publicatie 27-11-2024
This study investigates the potential of S100A8/A9 as a prognostic biomarker in Idiopathic Subglottic Stenosis (iSGS), a condition predominantly affecting women of northern European descent. Serum S100A8/A9 levels were significantly elevated in iSGS patients compared to controls, and a correlation was found between these levels and the time intervals between endoscopic dilations, suggesting its potential as a prognostic indicator. Further research with a larger cohort is warranted to validate these findings, which could enhance patient counseling and aid in the timely implementation of treatment strategies for iSGS.ObjectiveIdiopathic subglottic stenosis (iSGS) is a progressive fibrotic condition of the subglottis that presents in women of northern European descent. Endoscopic dilation is a common surgical approach to management of iSGS. The surgery-free interval, or the time between endoscopic dilation procedures is considered an indicator of disease severity. Variations in surgery-free intervals among iSGS patients underscore the necessity for prognostic biomarkers. The objective of this study was to explore serum levels of the damage-associated molecular pattern S100A8/A9 as a prognostic biomarker in iSGS.MethodsSerum from 20 iSGS patients and eight healthy controls was collected and S100A8/A9 levels were quantified using an ELISA. Patient data, including demographics and surgery-free intervals, were obtained from medical records. Serum S100A8/A9 levels were compared to surgery-free intervals. S100A8/A9 was also assessed using gene expression and immunofluorescence in iSGS specimens.ResultsS100A8/A9 was significantly elevated (p = 0.0413) in the serum of iSGS patients compared to controls (312.75 vs. 181.49 ng/mL). Linear regression analysis revealed a correlation (p = 0.009) between S100A8/A9 levels and endoscopic surgery-free interval. S100A8/A9 was significantly elevated (p = 0.0011) in patients with surgery-free intervals less than 1 year (455.2 ± 60.45 ng/mL; n = 8) compared to patients with intervals over 1 year (292.5.93 ± 162.4; n = 6).ConclusionS100A8/A9 is increased in the serum and tissue of patients with iSGS. In this cohort of iSGS patients, serum S100A8/A9 was associated with surgery-free intervals, potentially representing a prognostic biomarker. Further research within a larger cohort is needed to confirm these findings.Level of EvidenceLevel 3 Laryngoscope, 2024
Pubmed PDF Web\nHan Chen, \nLin Wang, \nJisheng Zhang, \nXudong Yan, \nLonggang Yu, \nYan Jiang\n
Publicatie 26-11-2024
This cross-sectional study of 16,717 participants from the Korean National Health and Nutrition Examination Survey found that frailty, as assessed by a modified frailty phenotype, was associated with an increased risk of chronic rhinosinusitis (CRS), with the greatest risk observed in middle-aged and older adults and those with lower education levels. The heightened risk of CRS with frailty may be attributed to increased levels of slowness and emotional exhaustion, suggesting that frailty prevention could be a strategy to manage CRS incidence.ObjectiveThis study aimed to investigate the connection between frailty and chronic rhinosinusitis (CRS) using a representative sample from the Korean population.MethodsThis cross-sectional study included 24,269 participants initially, with data sourced from the Korean National Health and Nutrition Examination Survey (KNHANES) database. Frailty was assessed using the modified frailty phenotype (FP) and frailty index (FI), with criteria tailored for the KNHANES dataset. CRS was identified based on the self-reported medical history of participants. Univariate and multivariate logistic regression analyses were employed to examine the correlation between CRS and frailty.ResultsThe prevalence of CRS among frail individuals was higher than that in the non-frail group. Frailty status (assessed by FP) (odds ratio OR = 1.484, 95% confidence interval CI: 1.217, 1.809) and frailty status (assessed by FI) (OR = 1.571, 95% CI: 1.107, 2,230) were associated with an elevated risk of CRS, particularly in individuals aged 40–60 years (OR = 1.826, 95% CI: 1.245, 2.680) and ≥61 years (OR = 1.549, 95% CI: 1.067, 2.249), as well as those with an education level below high school (OR = 1.717, 95% CI: 1.124, 2.624). The heightened risk of CRS associated with frailty may be attributed to increased levels of slowness (OR = 1.606, 95% CI: 1.255, 2.054) and emotional exhaustion (OR = 1.363, 95% CI: 1.158, 1.604).ConclusionThis study supported a link between frailty and CRS, potentially induced by slowness and emotional exhaustion, suggesting that effective interventions for preventing frailty should be developed to manage CRS incidence.Level of EvidenceLevel 3 Laryngoscope, 2024
Pubmed PDF Web"\nSweeya V. Raj, \nOlivia L. Prosak, \nKaitlin July OBrien, \nJason S. Park, \nShilin Zhao, \nChristopher T. Wootten\n"
Publicatie 23-11-2024
ObjectivesMicrolaryngoscopy and bronchoscopy (MLB) are essential tools for evaluating airway inflammation, but the reliability of endoscopic assessments for this purpose remains unclear. The aim of this study was to assess surgeons interrater reliability during endoscopic assessment of airway inflammation. The endoscopic factors used to determine overall airway inflammation were also assessed.MethodsWe conducted a cross-sectional study involving 24 pediatric patients who underwent MLB and arytenoid biopsy. Surgeons rated airway inflammation based on endoscopic images, and interrater reliability was assessed using Fleiss Kappa.ResultsFleisss Kappa demonstrated poor interrater reliability among all surgeons (0.111) and experienced surgeons (0.117). Surgeons varied in prioritizing visual features for assessing inflammation.ConclusionCurrent subjective assessments of airway inflammation during MLB exhibit poor interrater reliability, necessitating further research for improved diagnostic accuracy and informed treatment decisions in pediatric airway interventions.Level of EvidenceLevel 3 Laryngoscope, 2024
Pubmed PDF Web\nMichael W. Canfarotta, \nMargaret T. Dillon, \nA. Morgan Selleck, \nKevin D. Brown\n
Publicatie 22-11-2024
The current literature examining the effects of apical insertion depth and cochlear morphology on cochlear implant hearing preservation outcomes are conflicting. The present study found that larger scala tympani volumes were predictive of better hearing preservation outcomes, yet there was no effect of angular insertion depth. These findings suggest that intrinsic factors such as cochlear morphology may have a greater impact on low-frequency hearing preservation than apical positioning of a flexible lateral wall electrode array when using soft surgical techniques.ObjectivesTo examine the effects of scala tympani (ST) volume, cochlear duct length (CDL), and angular insertion depth (AID) on low-frequency hearing preservation for cochlear implant (CI) recipients of lateral wall electrode arrays.MethodsA retrospective review identified 45 adult CI recipients of 24-, 28-, or 31.5-mm lateral wall electrode arrays with preoperative unaided hearing thresholds ≤45 decibel hearing level (dB HL) at 250 Hz. All patients underwent preoperative and postoperative computed tomography to evaluate cochlear morphology and electrode array position. A linear mixed effects model evaluated effects of ST volume, CDL, AID, preoperative low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), age at surgery, and biological sex on the postoperative change in LFPTA at activation and 6 months post-activation.ResultsThere were significant main effects of ST volume (p = 0.044), age (p = 0.028), and biological sex (p = 0.003), indicating better low-frequency hearing preservation for CI recipients with larger ST volumes, younger age at surgery, and female biological sex. Although CDL positively correlated with ST volume (r = 0.74, p < 0.001), there was no significant main effect of CDL (p = 0.367). A broad range in AID of the most apical electrode contact was observed (301.4°–681.8°); however, there was no significant main effect of AID on low-frequency hearing preservation (p = 0.700).ConclusionsDuring the initial 6 months following implantation, intrinsic factors such as cochlear morphology may have a greater impact on low-frequency hearing preservation than apical positioning of a flexible lateral wall electrode array when using soft surgical techniques.Level of Evidence3 Laryngoscope, 2024
Pubmed PDF Web\nBoxiang Zhuang, \nHaiqiao Du, \nChenyu Chen, \nMenghua Li, \nShuoshuo Kang, \nQian Wang, \nShuwei Wang, \nWeiwei Guo, \nChang Lin, \nJianan Li, \nShiming Yang, \nRong Wang\n
Publicatie 22-11-2024
The presence and absence of SLC26A4 mutation, whether combined with Mondini malformation and patient age, are essential factors affecting the degree of hearing loss in the Chinese population.ObjectiveTo summarize the Solute Carrier Family 26 Member 4 (SLC26A4) mutations and clinical phenotypic characteristics of patients with Pendred syndrome/nonsyndromic enlarged vestibular aqueduct (PS/NSEVA).DesignA retrospective cohort study for the Chinese population was performed to analyze the hearing test results of 406 patients with PS/NSEVA who had a SLC26A4 mutation and the relationship between inner ear imaging and audiology.ResultsThere was a significant difference in the mean hearing threshold in patients with biallelic mutations (M2), monoallelic mutations (M1), and nonallelic mutations (M0) and between patients with isolated vestibular aqueduct enlargement (IEVA) and patients with IEVA combined with Mondini malformation. There was no significant difference between patients with different gene mutation types or different sexes, or between the width of the vestibular aqueduct (VA) and the mean hearing threshold. The degree of hearing loss was linearly correlated with age.ConclusionsWe propose that the presence and absence of SLC26A4 mutation, whether combined with Mondini malformation and patient age, are essential factors affecting the degree of hearing loss in the Chinese population. However, the number and type of mutations, degree of VA expansion, and sex of the patients did not affect the clinical audiological phenotype.Level of Evidence3 Laryngoscope, 2024
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