Yi Dong, Bing Zhou, Shunjiu Cui, Qian Huang, Yan Sun, Yunfu Liu, Xiaojin He, Huijun Han
Publication date 21-11-2024
This study reviewed the endoscopic and imaging characteristics and biopsy methods of nasal NKTL cases to explore effective methods for the early detection of suspected cases. The study also suggests that measuring the apparent diffusion coefficient (ADC) of lesions can help to guide the selection of appropriate biopsy sites and thereby improve the positive biopsy rates.
Objectives To develop methods for early detection of natural killer/T-cell lymphoma, nasal type (nasal NKTL) and to evaluate the use of apparent diffusion coefficient (ADC) measurements from diffusion-weighted imaging (DWI) for selecting biopsy sites to enhance the positive biopsy rate.
Methods The clinical data of 32 cases of nasal NKTL were retrospectively collected and analyzed. Cases were graded from 1 to 5 based on endoscopic and imaging findings. Biopsy methods included the superficial forceps method and deep incisional method. Data recorded included biopsy method, time to confirmed diagnosis, number of biopsies required, and ADC values of biopsy sites.
Results Both endoscopic and MRI lesion severity did not affect biopsy outcomes (p = 0.8248, 0.7571). The deep incisional biopsy method had a significantly higher probability of yielding positive pathological results compared to the superficial clamping method OR (95% CI) = 23.2143 (6.0448, 89.1513) (χ2 = 26.1089, p < 0.0001). The ADC value at the site with a positive biopsy result is significantly lower than at the site with a negative result (p = 0.0003). The diagnostic threshold for ADC value to predict a positive biopsy result was 0.603 × 10−3 mm2/s, with a Youden index of 0.43.
Conclusions Nasal NKTL has distinct characteristics distinguishing it from sinusitis and other tumors. Deep incision biopsy under general anesthesia is superior to the superficial method. The location of the positive sampling site can be guided by measuring the ADC value, and the optimal diagnostic threshold of this proposed method is 0.603 × 10−3 mm2/s.
Level of Evidence4 Laryngoscope, 2024
Gabriel Nahas, Yajun Chen, Apurva Ningundi, Samuel Tercyak, Diego Preciado
Publication date 21-11-2024
Objective(s)To investigate the role of microRNA-378 (miR-378) in the regulation of mucin gene expression and inflammatory response in human middle ear epithelial cells (HMEEC) during bacterial infection by non-typeable Haemophilus influenzae (NTHi).
Methods Human middle ear epithelial cells (HMEEC) were cultured and transfected with miR-378 or control miRNA. Post-transfection, cells were exposed to NTHi lysates. mRNA levels of MUC5B, MUC5AC, and IL-8 were quantified using RT-qPCR, and promoter activity was measured via luciferase assays. The effects of miR-378 on mucin and cytokine gene expression were analyzed.
Results Transfection with miR-378 significantly increased the expression of MUC5B (3.6 fold, p < 0.01), MUC5AC (19.1 fold, p < 0.01), and IL-8 (2.01 fold, p < 0.05) in HMEEC. NTHi exposure reduced MUC5B (1.385 fold, p < 0.05) and MUC5AC (1.61 fold, p < 0.05) gene expression in miR-378 transfected cells but significantly increased IL-8 levels (1.32 fold, p < 0.05). Luciferase assays showed that miR-378 upregulated the promoter activity of MUC5B (1.4 fold, p < 0.01) and MUC5AC (1.6 fold, p < 0.01) genes, indicating its role in transcriptional regulation.
ConclusionmiR-378 plays a crucial role in promoting mucin overproduction and an inflammatory response in the middle ear epithelium during OM. Targeting miR-378 could offer a novel therapeutic strategy for preventing the progression from AOM to COM.
Level of Evidencena Laryngoscope, 2024
Yury Rusetsky, Vladimir Averbukh, Zhanna Mokoyan, Nikolay Daykhes, Anna Elumeeva, Darya Volkova
Publication date 20-11-2024
There are two main philosophies for NSP—unilateral and bilateral closure. Two major tertiary centers, that follow different philosophies, allow us to compare the effectiveness of these approaches. The unilateral closure group (Group 1) used an anterior ethmoidal artery (AEA) flap to close the perforations in 47 patients. Group 2 consisted of 52 patients, who underwent bilateral closure of NSP. Subjective improvement, according to SNOT-25, was achieved in both groups, without significant intergroup differences. The effectiveness of bilateral closure was statistically higher in cases of “large” NSP.
Background There are two main approaches for nasal septal perforation (NSP) surgery—bilateral and unilateral repair. There are advantages and disadvantages to each of these techniques. At the same time, there is a lack of comparative studies on the effectiveness of these approaches. The study aims to compare the effectiveness of unilateral and bilateral closure of NSP.
MethodsA total of 99 patients with symptomatic NSP underwent surgery between 2021 and 2022 and were followed up at two large tertiary centers. The “unilateral closure” group (Group 1, N = 47) utilized an anterior ethmoidal artery (AEA) flap to close the perforations. Group 2 (N = 52) consisted of patients, who underwent bilateral closure of NSP.
Results Complete closure of the NSP was achieved in 39 of 47 (83%) patients in Group 1 and in 48 of 52 (92.3%) patients in Group 2. There was a trend toward a higher incidence of incomplete defect closure among Group 1 patients when analyzing the subgroups of large (>2 cm) NSP (RR = 2.75 95% CI: 0.96; 7.87, p = 0.072). There was a statistically significant decrease in SNOT-25 score after surgery in each of the study groups (p < 0.001) with no significant differences between groups (p = 0.51).
Conclusions The relative advantages of the thin flap are outweighed by the obtained data of higher efficacy of the bilateral technique in large NSP cases. Therefore, in cases of surgical repair of small and medium-sized NSP, the closure rates after single-layer and double-layer closure are comparable.
Level of EvidenceIII Laryngoscope, 2024
Isam Alobid, Natalia Arango Cabezas, Katherine C. Yuen‐Ato, Claire Hopkins, María Jesús Rojas‐Lechuga
Publication date 20-11-2024
Rhinotillexomania is a common habit that rarely leads to mutilating self-injury. Multidisciplinary approaches including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. This study aims to investigate the impact of rhinotillexomania and NSP on sinonasal symptoms and quality of life (QoL) compared with a healthy control group.
Background Nose picking is a common habit that rarely leads to mutilating self-injury. It is important to distinguish between rhinotillexomania (compulsive nose picking) as a disease and nose picking that results in or contributes to nasal septal perforation (NSP). The aim of this study is to investigate the impact of rhinotillexomania and NSP repair on sinonasal symptoms and quality of life (QoL).
Methodology/Principal Patients with symptomatic NSP due to rhinotillexomania and candidates for surgical repair were included. Sinonasal symptoms and QoL were measured using a visual analogue scale (VAS), Sinus CT scan, Barcelona Smell Test 24 (BAST-24), Sinonasal outcome test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), NOSE-Perf, and Medical Outcome Study Short Form (SF-36). Healthy volunteers without sinonasal disorders (n = 43) were also included.
ResultsA total of 37 patients with Rhinotillexomania (20 male 54.1%; mean age, 49.2 years SD 15.4) were recruited. Totally 32 patients (86.5%) had NSP with the posterior border anterior to the incisive canal. Follow-up data were registered for 29 patients with a mean follow-up duration of 22.1 months (standard deviation, SD 16.7). The overall success rate of NSP repair was 96.6%. Patients experienced significant improvement in sinonasal symptoms and QoL after surgery.
Conclusions Rhinotillexomania is a distinct entity from nose picking. Multidisciplinary approach including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. Placing nasal silicone sheets is recommended when the diagnosis of rhinotillexomania is confirmed. The greater palatine artery flap combined with inverted edges appears to be the most effective approach.
Level of Evidence Level 3 Laryngoscope, 2024
Omer Zarchi, Amir Amitai, Joseph Attias, Eyal Raveh, Tally Greenstein, Susan Alpert, Eyal Marcado
Publication date 20-11-2024
Electrical stimulation in proximity to a cochlear implant (CI) is contraindicated due to the potential risk of damaging the implant and thermal insult to the inner ear.
During surgical procedures that pose a risk to the nervous system, the use of transcranial electrical stimulation for neuromonitoring is crucial for assessing the integrity of the motor pathways and preventing neurological insults. This article depicts a case of a patient with CI undergoing two neuromonitored scoliosis correction surgeries, revealing a pending neurological insult, with preserved auditory function and normal functioning of the CI.
Electrical stimulation in proximity to a cochlear implant (CI) is contraindicated due to the potential risk of damaging the implant and thermal insult to the inner ear. Yet, during surgical procedures that pose a risk to the nervous system, the use of transcranial electrical stimulation for neuromonitoring is crucial for assessing the integrity of the motor pathways and preventing neurological insults. The current paper depicts a case of a patient with CI undergoing two consecutive surgeries for scoliosis correction, revealing a suspected pending neurological insult in the second operation. An audiological and electrical examination after each operation demonstrated preserved auditory function and normal functioning of the CI, respectively. The current case is consistent with previous reports reviewed in the paper, showing no CI failures nor hearing deterioration following transcranial electrical stimulation for neuromonitoring and electroconvulsive therapy. In light of this accumulating evidence, there is an urgent need for manufacturers and regulatory bodies to proactively undertake a comprehensive review of this declared contraindication. Subsequently, an updated data-driven risk analysis is essential to weigh the consequences of preventing the contraindicated tools and treatments, as well as their potential benefits to these patients. Laryngoscope, 2024
Amanda Atkins, Connor Koch, Sherin James, Akhilesh Wodeyar, Matti Sievert, Miguel Goncalves, Harishanker Jeyarajan, Jason M. Warram, Bharat A. Panuganti
Publication date 20-11-2024
Confocal laser endomicroscopy represents a promising intraoperative optical imaging modality to assess the mucosal footprint of laryngeal cancers prior to transoral laser microsurgery. We present two cases delineating its incremental advantages over white light and narrow band imaging endoscopy in the discrimination of subclinical, microscopic disease.
Confocal laser endomicroscopy (CLE) represents an emerging probe-based intraoperative optical imaging modality, contingent on differential fluoroscein uptake, equipped to improve intraoperative identification of subclinical mucosal disease. In the analysis herein, we describe improved sensitivity, compared to narrow band imaging and small-volume tissue biopsies, of CLE in the discrimination of occult disease based on cellular and subcellular morphology during endoscopic resection of early-staged larynx cancers. Laryngoscope, 2024
Brett M. Colbert, Molly Smeal, Zachary J. Cromar, Potyra Rosa, Susan H. Blanton, Byron L. Lam, Xue Z. Liu
Publication date 19-11-2024
Usher syndrome (USH) is a rare, autosomal-recessive genetic disorder and a leading cause of early onset deaf-blindness. Molecular testing is able to distinguish USH subtypes by causative gene. Molecular testing and diagnosis should be part of the routine care of USH individuals to facilitate earlier interventions and coordinated care between ophthalmology and audiology.
Introduction Usher syndrome (USH) is a rare, autosomal-recessive genetic disorder and a leading cause of early onset deaf-blindness. A clinical diagnosis is made by the presence of retinitis pigmentosa (RP) with sensorineural hearing loss (SNHL). Subtype (USH1, USH2, USH3) is determined by severity and age of onset. Molecular testing is able to further distinguish USH subtypes by causative gene. As gene therapy strategies continue to be explored for USH, it is important to know the underlying genetic cause and to coordinate care among an interdisciplinary team.
Methods We reviewed charts of 198 individuals presenting to the RP clinic at Bascom Palmer Eye Institute (BPEI) for suspected USH. Demographic information, USH clinical diagnosis, molecular testing, molecular diagnosis, and audiological data were collected.
Results Of the 198 patients reviewed, 190 (96%) met clinical criteria for USH and received a clinical diagnosis. There were 67 (35%) that had a genetic test with a pathogenic molecular diagnosis. The average ages at molecular diagnosis were USH1B, 20 years old; USH2A, 37 years old; USH2C, 50 years old. Of the 67 with a molecular diagnosis, 23 (34%) established ophthalmic care and 8 of these (11%) established audiological care.
Discussion/Conclusion Molecular testing and diagnosis should be part of the routine care of USH individuals to facilitate earlier interventions and coordinated care between ophthalmology and audiology.
Level of evidence4 Laryngoscope, 2024
Edward Christopher Dee, Stephanie Wang, Frances Dominique V. Ho, Roshal R. Patel, Kaitlyn Lapen, Yingzhi Wu, Fan Yang, Tej A. Patel, Erin Jay G. Feliciano, Sean M. McBride, Nancy Y. Lee
Publication date 16-11-2024
Although most patients with nasopharynx cancer (NPC) were Chinese, White, or Black, distant metastatic disease at presentation was most common among Hmong, Laotian, non-Hawaiian Pacific Islander, and Black patients, even having adjusted for social determinants of health. These findings underscore the limitations of evaluating diverse groups as a monolith, highlighting the value of disaggregated research. Efforts are needed to improve awareness of NPC among less canonically affected groups.
Introduction Although nasopharynx cancer (NPC) is rare in the United States, global epidemiology varies greatly. Therefore, understanding NPC disparities in the diverse US setting is critical.
Methods and Materials Data from the National Cancer Database (NCDB, 2004-2021) identified patients with NPC; NCDB allows disaggregation by Asian American (AA) subgroups. Multivariable ordinal logistic regression adjusting for demographic and socioeconomic factors defined adjusted odds ratios (aORs).
Results Of 15,862 patients, 11,173 (70.4%) were male (median age 59). Commonest groups included 10,034 (63.3%) White, 2,272 (14.3%) Black, 1,103 (7.0%) Chinese, 442 (2.8%) Filipino, and 338 (2.1%) Vietnamese patients. Prior to disaggregation, the proportion of stage IV disease at presentation was 43.2% among White (ref), 50.0% among Black (aOR 1.12, p = 0.012), 52.0% among Native American (aOR 1.18, p > 0.05), 41.9% among AA (aOR 0.97, p > 0.05), and 55.1% among Native Hawaiian and Other Pacific Islander patients (aOR 1.47, p = 0.021).
Upon disaggregation, the proportion of stage IV disease was the greatest (>50%) among Black (50.0%, aOR 1.12, p = 0.012), Laotian (61.5%, aOR 2.21, p = 0.001), Hmong (73.2%, aOR 2.92, p < 0.001), and Other Pacific Islander patients (60.9%, aOR 1.83, p = 0.004); 44.2% of Filipino patients also presented with stage IV disease (aOR 1.21, p = 0.033). Odds of presenting with advanced stage disease were lower among Chinese patients (35.7% stage IV, aOR 0.72, p < 0.001).
Conclusions Although most NPC patients were Chinese, White, or Black, stage IV disease at presentation was most common among Hmong, Laotian, non-Hawaiian Pacific Islander, and Black patients. Efforts are needed to improve awareness of NPC among less canonically affected groups.
Level of Evidence Level 4 Laryngoscope, 2024
Shreya Mandloi, Stacey Mardekian Gargano, Alexander N. Duffy, Peter A. Benedict, Samuel R. Shing, Chase Kahn, Paavali Hannikainen, Juan Pablo Pineda‐Reyes, David Bray, Elina M. Toskala, Mindy Rabinowitz, Marc Rosen, Christopher Farrell, James J. Evans, Gurston G. Nyquist
Publication date 14-11-2024
This study is one of the first to describe the presence of pigment incontinence in sinonasal mucosal melanoma. This is crucial to help guide management of the disease.
Background Regression is an immunological phenomenon described in cutaneous melanoma whereby tumor is replaced with tumor-infiltrating lymphocytes, granulation tissue, and mature fibroblasts often accompanied by pigment incontinence (accumulation of melanin in the upper dermis). Pigment incontinence results in grossly pigmented lesions that may be mistaken for viable tumor and has not been described in sinonasal mucosal melanoma (SNMM). This study investigates the presence of regression and pigment incontinence in patients with SNMM.
MethodsA retrospective chart review was conducted on SNMM patients from 2007 to 2023. Pathology slides from surgical resection were examined by two pathologists blinded to treatment information for the presence and extent of pigment-laden macrophages and other histopathologic features of regression.
Results Seventeen patients with SNMM were included in this study who underwent surgical resection. Three patients received neoadjuvant therapy followed by surgical resection. Regression was present in 94% of patients and pigment incontinence was present in 65% of patients and occurred in both neoadjuvant treated patients and treatment naïve patients. All three patients with neoadjuvant treatment had evidence of pigment incontinence.
Discussion This study highlights that SNMM often displays characteristics of regression. This study is one of the first to describe the presence of pigment incontinence in patients with SNMM. Pigment incontinence can be a part of the natural tumor life cycle and grossly pigmented lesions could easily be confused for melanoma especially after neoadjuvant therapy. Developing an understanding of regression and pigment incontinence within SNMM is important for diagnosis and clinical management.
Level of EvidenceIV Laryngoscope, 2024
Troy Wesson, Rachel A. Morrison, Lujuan Zhang, Sarah Brookes, Sam Kaefer, Patrick R. Finnegan, Haley Calcagno, Vincent J. Campiti, Sherry Voytik‐Harbin, Stacey Halum
Publication date 14-11-2024
The current study introduces the use of multi-layered mucosal-myochondral (MMC) collagen implants with or without cells to reconstruct hemilaryngeal defects in a porcine model. Findings demonstrate that MMC implants may be a feasible reconstructive option to restore hemilaryngectomy defects, overcoming a number of complications and challenges observed with conventional approaches.
Objective Partial laryngectomies result in voice, swallowing, and airway impairment for thousands of patients in the United States each year. Treatment options for dynamic restoration of laryngeal function are limited. Thus, there is a need for new reconstructive approaches. Here, we evaluated early (4 week) outcomes of multi-layered mucosal-myochondral (MMC) implants when used to restore laryngeal form and function after hemilaryngectomy in a porcine model.
Methods Six Yucatan minipigs underwent transmural hemilaryngectomies followed by reconstruction with customized MMC implants aiming to provide site-appropriate localization of regenerated laryngeal tissues, while supporting laryngeal function. All implants were fabricated from polymeric collagen, with a subset of muscle and cartilage implants containing motor endplate-expressing muscle progenitor cells or cartilage-like cells differentiated from adipose stem cells, respectively. Vocalization and laryngeal electromyography (L-EMG) measurements with nerve conduction studies were performed post-operatively and compared with baseline along with gross and histological analyses of the healing response.
Results All animals (n = 6) survived and maintained airway patency, safe swallowing, and phonation, without the use of tracheostomy and/or gastrostomy tubes. Histological evaluation indicated no adverse tissue reaction or implant degradation, showing progressive regenerative remodeling with mucosa reformation and ingrowth of new muscle and cartilage. Preliminary L-EMG suggested weak but detectable motor unit action potentials. Although vocalization duration, frequency, and intensity decreased post-operatively, all animals retained vocal capacity and parameter recovery was evident over the study duration.
Conclusion Engineered collagen polymeric implants in the presence or absence of autologous cell populations may serve as a feasible reconstructive option to restore dynamic function after hemilaryngectomy. Long-term follow-up is needed to further assess functional outcomes.
Level of EvidenceNA Laryngoscope, 2024
Domingos Hiroshi Tsuji, Adriana Hachiya, Rui Imamura, Luiz Ubirajara Sennes
Publication date 14-11-2024
This study assesses the long-term outcomes of endoscopic myoneurectomy (EMN) of the thyroarytenoid (TA) muscle for treating adductor spasmodic dysphonia (AdSD). Success rates increased with successive procedures, reaching 89.3% with three treatments. Vocal quality, evaluated using the Voice Handicap Index (VHI-30) and patient-reported outcomes, significantly improved posttreatment. In conclusion, although multiple procedures may be necessary, EMN offers significant benefits in restoring vocal function for AdSD patients.
Objective To evaluate the long-term results of endoscopic myoneurectomy (EMN) of the thyroarytenoid (TA) muscle for the treatment of adductor spasmodic dysphonia (AdSD), with an emphasis on vocal outcomes, adverse effects, and recurrence.
MethodsA total of 48 patients underwent up to three EMNs of the TA muscle and were followed for at least 18 months to evaluate the efficacy, based on patient and examiner assessments, and safety of the procedure(s). Vocal outcomes were evaluated through the use of the 30-item Voice Handicap Index (VHI-30) questionnaire and subjective (patient-reported) assessment.
Results In this group, 38 patients (79.2%) were considered successful. The median VHI-30 score at baseline was 97, decreasing to 26 after treatment, and the median subjective postprocedural improvement was 88.5%. The most common adverse effects were granulomas (in 18 cases), glottic insufficiency (in two), and dyspnea (in one).
Conclusions Although up to three procedures can be needed to achieve a high success rate, EMN of the TA muscle can provide excellent benefits in terms of vocal function with a low rate of complications.
Level of Evidence4 Laryngoscope, 2024
Christopher T. Wootten
Publication date 14-11-2024
Congenital cervical teratomas distort laryngotracheal anatomy due to compression of the airway or involvement in adjacent soft tissues. No prior report describes congenital absence of the hyoid secondary to massive congenital cervical teratoma. Because of the importance of the hyoid bone in supporting the anterolateral vault of the pharynx and the integrity of the supraglottic airway, novel hyoid reconstruction as well as tracheal onlay grafts were necessary to achieve sustained decannulation.
Herein is presented a case of a 3-year-old who was the product of a pregnancy complicated by fetal congenital cervical teratoma. The teratoma was resected day-of-life 6, and he underwent tracheotomy. Radiologic review of his cartilaginous cervical anatomy in utero, pre- and post-tumor excision indicated congenital absence of the hyoid. An initial double-staged laryngotracheal reconstruction improved the subglottic and tracheal airway, but the supraglottic and pharyngeal airway remained collapsed. Using a cadaveric cartilage, a hyoid was fashioned. After the pharynx and straps muscles were sewn to the hyoid construct, the supraglottic and supra-laryngeal airway improved. Subsequent laryngotracheal reconstruction, which included tracheal onlay grafts of cadaveric cartilage, achieved decannulation. Laryngoscope, 134:5207–5209, 2024
Yingying Li, Yue Shao, Xiumei Sun, Hai Huang, Xiaochen Leng, Yuliang Wang
Publication date 14-11-2024
We report a case of malignant transformation from the hyaline-vascular subtype of neck unicentric Castlemans disease(UCD) to follicular dendritic cell sarcoma. UCD is uncommon and the malignant transformation of UCD is extremely rare in the head and neck region. Regional lymph node resection including one or more adjacent regions is the preferred treatment choice. Appropriate treatment procedures for UCD and regular follow-up are essential for a good prognosis.
A patient with a large neck mass underwent appropriate imaging, routine blood tests, and serological evaluations. The medical history revealed the patient had undergone a lymphadenectomy in the same region 8 years ago, and the pathological diagnosis was the hyaline-vascular subtype of unicentric Castlemans disease (UCD). The incisional biopsy and subsequent histopathological and immunohistochemical examination revealed the diagnosis of follicular dendritic cell sarcoma, consistent with the malignant transformation of UCD. UCD is uncommon and the malignant transformation of UCD is extremely rare in the head and neck region. Regional lymph node resection of one or more adjacent regions is the preferred treatment choice. Appropriate treatment procedures for UCD and regular follow-up are essential for a good prognosis. Laryngoscope, 134:4985–4987, 2024
Kristen L. Janky, Jessie Patterson, Elizabeth A. Kelly
Publication date 14-11-2024
The purpose of this case report is to highlight both the feasibility and clinical utility of remote camera video head impulse testing (vHIT) in children <3 years. Five cases are described where remote camera vHIT was used to quantify ear specific semicircular function in children at risk for vestibular dysfunction who arebetween 6 and 31 months. Remote camera vHIT is feasible and provides ear specific information regarding semicircular canal function, which can be used to augment or validate the presence of vestibular dysfunction in children <3 years.
The purpose of this case report is to highlight both the feasibility and clinical utility of remote camera video head impulse testing (vHIT) in children <3 years. Five cases are described where remote camera vHIT was used to quantify ear specific semicircular function in children at risk for vestibular dysfunction. Remote camera vHIT is a helpful clinical tool for quantifying ear specific semicircular function in children between 6 and 31 months. Remote camera vHIT is feasible and provides ear specific information regarding semicircular canal function, which can be used to augment or validate the presence of vestibular dysfunction in children <3 years. Laryngoscope, 134:5201–5206, 2024
Anna Svejdova, Michal Homolac, Jana Krtickova, Jan Laco, Jan Mejzlik, Jana Dedkova, Jakub Drsata, Lukas Skoloudik, Petr Bradna, Viktor Chrobok
Publication date 14-11-2024
We present a rare case of bilateral isolated pseudogout involvement of the middle ear, an exceptionally rare manifestation of calcium pyrophosphate deposition disease with only two previous cases of unilateral involvement reported.
Pseudogout is characterized by the deposition of calcium pyrophosphate dihydrate crystals (CPPD), primarily affecting large joints. Extra-articular manifestations, particularly in the head and neck region, are exceedingly rare. We report a unique case of bilateral isolated pseudogout of the middle ear manifesting with progressive conductive hearing loss as the first and only symptom of pseudogout. Otoscopy and CT scan often yield a differential diagnosis that includes tumors or cholesteatoma, necessitating surgery with histopathological examination. The definitive diagnosis is confirmed upon identification of calcium pyrophosphate dihydrate crystals. In most cases, removal of the crystals results in resolution of conductive hearing loss. Laryngoscope, 134:5131–5134, 2024
Michaele Francesco Corbisiero, Nicole Wershoven, Matthew Clary, Brian Cervenka
Publication date 14-11-2024
This case report highlights the diagnosis and management of a patient with vocal cord paralysis resulting from a fishbone foreign body (FFB) in the esophagus. It underscores the challenges and clinical implications of delayed diagnosis and the necessity for a multidisciplinary surgical approach. It also emphasizes the importance of advanced imaging for detection and the careful surgical removal of FFBs to prevent severe complications.
Fish bone foreign bodies (FFBs) are relatively common but can present diagnostic challenges. Herein, we report a case of a 43-year-old female who initially presented to the Emergency Department with fever and throat discomfort after a choking incident, which led to a misdiagnosis of a viral infection after negative chest X-ray findings. Persistent symptoms, including new-onset vocal cord paralysis, prompted further investigation and an otolaryngology — head and neck surgery referral one month later. During the otolaryngology visit eight months after the initial incident, laryngoscopy revealed left true vocal cord paralysis and a subsequent CT scan revealed a 2.3 cm fishbone in the esophagus. Surgical removal involved flexible esophagoscopy and open neck exploration with careful dissection to avoid vascular injury. This case highlights the limitations of initial diagnostic methods, such as X-rays, and the necessity for heightened clinical vigilance and advanced imaging modalities like CT scans for persistent or evolving symptoms, particularly vocal cord paralysis. This case also supports multidisciplinary surgical management in cases of suspected esophageal FFBs involving the internal jugular vein and common carotid artery to prevent serious complications. Laryngoscope, 134:5062–5065, 2024
Sejad Ahmadzada, Kachorn Seresirikachorn, Lu Hui Png, Raewyn G. Campbell, Larry Kalish, Richard J. Harvey
Publication date 14-11-2024
The lateral recess of a well-pneumatized sphenoid sinus is challenging to access surgically. Traditional methods require the use of multiple angled endoscopes and curved instruments which may limit visualization. We describe a prelacrimal-transpterygoid/maxillary approach which offers direct access to this region with a 0° endoscope. Laryngoscope, 134:4918–4922, 2024
Pubmed PDF WebPranati Pillutla, Dinesh K. Chhetri
Publication date 14-11-2024
Adult airway stenosis is a common condition treated in the otolaryngology clinic. Patients with high-grade, long-segment stenosis often fail endoscopic management. We describe the successful use of a hybrid resection and laryngotracheoplasty procedure that maximizes airway luminal patency in adults with successful decannulation. Laryngoscope, 134:4893–4896, 2024
Pubmed PDF WebYasuko Ishibashi, Kenji Kondo, Yasushi Suzuki, Kimitaka Kaga
Publication date 14-11-2024
The etiology and pathogenesis of Cogans syndrome remain largely unknown. Here, we report a female case of atypical Cogans syndrome with temporal bone histopathology of acute disease period.
Cogans syndrome is a rare disorder first clinically defined in 1945, characterized by nonsyphilitic interstitial keratitis and progressive audiovestibular symptoms. Later, patients with audiovestibular dysfunction and various types of inflammatory eye disease were classified as having atypical Cogans syndrome. The etiology and pathogenesis of Cogans syndrome remain largely unknown. Here, we report a case of atypical Cogans syndrome with a histological assessment of the temporal bone during the acute disease period. Temporal bone histology was compared to age- and gender-matched normal control, and our findings revealed endolymphatic hydrops and degenerative changes in various parts of the inner ear. Laryngoscope, 134:5135–5138, 2024
Sarah E. Maurrasse, Vikash K. Modi
Publication date 14-11-2024
Producing high-quality surgical videos requires an understanding of cognitive theory and a working knowledge of film principles. In this editorial, we delve into pre-production, filming, and editing fundamentals that help create a professional product and highlight techniques to optimize knowledge acquisition through video content.
Pubmed PDF WebPublication date 14-11-2024
"Alec B. Chang, David ONeil Danis, Andrew R. Scott"
Publication date 14-11-2024
Amrita Bhat, Amritpal Singh, Megan L. Durr, Jolie L. Chang
Publication date 14-11-2024
We conducted a systematic review to assess the quality and measurement properties of seven identified patient-reported outcome measures (PROMs) assessing adult obstructive sleep apnea-related quality of life in sleep surgery. PROMs were evaluated for developmental methodology, structure, validity, and reliability using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. We found that content validity was doubtful or inadequate for all included PROMs, and further work is needed to update PROMs in terms of length, readability, validity, and physician/patient input in design.
Objective To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM.
Data Sources Pub Med, Web of Science, Embase, PsychINFO, and CINAHL.
Review MethodsA systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality.
ResultsA total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as “adequate” for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated “very good” analysis of internal consistency per COSMIN criteria, and six (86%) included data on test–retest reliability.
Conclusion Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 134:4838–4846, 2024
Troy Wesson, Victoria Rone, Mirian Ramirez, Shalini Manchanda, Stephanie Stahl, Yelena Chernyak, Noah Parker
Publication date 14-11-2024
We sought to systematically describe ways in which polysomnography and apnea-hypopnea-index are reported in prospective studies involving unilateral hypoglossal nerve stimulation. The reported sleep studies and corresponding apnea-hypopnea indices were highly variable across the studies. Because of the high degree of heterogeneity, future research would benefit from consistent use of a standardized apnea-hypopnea index to report outcomes related to hypoglossal nerve stimulation.
Objective Due to the controversy surrounding the appropriate outcomes in neurostimulation, we sought to systematically describe ways in which polysomnography and apnea-hypopnea index are reported in prospective studies involving unilateral hypoglossal nerve stimulation.
Data SourcesMEDLINE (Ovid), Embase (Ovid), Cochrane Library, and Scopus.
Review Methods Following the Preferred Reporting items of Systematic Reviews and Meta-analysis (PRISMA) Statement guidelines, a systematic two-reviewer system was used for study screening and quality assessment. Articles that met inclusion criteria were included. Quality was evaluated with either the Newcastle-Ottawa Quality Assessment Scale or the Covidence risk-of-bias tool.
Results Fifteen studies met the inclusion criteria, which included 14 prospective cohort studies and one randomized controlled trial. Titration polysomnography was the primary sleep study used to acquire data in five of the studies compared to only three studies employing exclusively non-titration polysomnography to report outcomes. Three studies compiled data from two or more sleep studies to report a single apnea-hypopnea index. Within the 15 studies, non-titration apnea-hypopnea index was the most reported type (five studies). Titration apnea-hypopnea index was used to report outcomes in one study. Five studies did not specify what type of apnea-hypopnea index was employed to report treatment effectiveness.
Conclusion The reported sleep studies and corresponding apnea-hypopnea indices were highly variable across the studies. Because of the high degree of heterogeneity, future research would benefit from consistent use of a standardized apnea-hypopnea index to report outcomes related to hypoglossal nerve stimulation.
Level of EvidenceNA Laryngoscope, 134:4873–4881, 2024
Jiongke Li, Xianpeng Xu, Xinxing Deng, Sha Li, Tao Guo, Hui Xie
Publication date 14-11-2024
Objectives The purpose of this study is to consolidate and condense the available evidence about the potential association between vestibular diseases and cognitive impairment.
Data Sources and MethodsA systematic search was conducted on four English databases (Pub Med, Embase, Web of Science, Cochrane Library) from the time of library construction to March 2024. The study incorporated various keywords such as “vestibular disorders,” “vertigo,” “dizziness,” “Menieres disease,” “benign paroxysmal positional vertigo,” “vestibular migraine,” “vestibular neuritis,” “labyrinthitis,” “bilateral vestibular disease,” as well as “cognitive function” and “cognitive dysfunction.” A qualitative review was conducted to look for and assess pertinent studies.
ResultsA total of 45 publications were incorporated, encompassing prevalent vestibular disorders, mostly targeting individuals in the middle-aged and older demographic. The findings indicate that individuals with vestibular disorders experience varying levels of cognitive impairment, which is evident in different aspects, with visuospatial cognitive deficits being more prominent. Furthermore, patients with chronic vestibular syndromes are more prone to cognitive dysfunction. Lastly, the hippocampus plays a crucial role in the intricate vestibular neural network.
Conclusion The findings of this comprehensive review indicate that vestibular disorders can result in impairments across various aspects of cognitive functioning, particularly in visuospatial cognition. The underlying mechanism may be associated with a decrease in the size of the hippocampus. Individuals suffering from chronic vestibular dysfunction exhibit a higher likelihood of experiencing cognitive deficits.
Level of EvidenceNA Laryngoscope, 134:4858–4872, 2024
Akash M. Bhat, Alejandro R. Marrero‐Gonzalez, Shaun A. Nguyen, Megan Scharner, Kirsten Meenan, Robert T. Sataloff
Publication date 14-11-2024
We sought to compare the efficacy of each type of photoangiolytic laser in the treatment of benign laryngeal lesions. We found that all photoangiolytic lasers are safe and effective in the treatment of benign laryngeal lesions. The 445-nm blue laser is a new and promising modality for laryngeal laser surgery, with similar safety and improved clinical outcomes compared to the traditional 585-nm pulsed dye laser and 532-nm KTP laser.
Objectives To compare the efficacy of the 445-nm blue laser to the 585-nm pulsed dye laser (PDL) and 532-nm potassium-titanyl-phosphate (KTP) laser in the treatment of benign laryngeal lesions.
Data Sources Cochrane Library, Pub Med, Scopus, and CINAHL.
Review Methods Following PRISMA guidelines, databases were searched from inception through January 29, 2024, for studies reporting the use of photoangiolytic lasers for treatment of benign laryngeal lesions, including the 585-nm PDL, 532-nm KTP laser, and 445-nm blue laser. Outcome measures included lesion resolution (%), mean differences (Δ) in Voice Handicap Index (VHI-10), and summed dysphonia grade, roughness, and breathiness (GRB) scale.
ResultsA total of 45 studies were included for meta-analysis, consisting of 348 patients treated with PDL, 550 patients with KTP laser, and 338 patients with blue laser. Treatment with blue laser resulted in the greatest lesion resolution (94.0%; 95% confidence interval CI: 90.2%–96.7%), followed by KTP laser (90.4%; 95% CI: 84.1%–95.2%), and PDL (86.9%; 95% CI: 62.9%–99.2%). VHI-10 improved significantly in patients following treatment with blue laser (Δ13.3; 95% CI: 10.7–16.0; p < 0.0001), KTP laser (Δ10.3; 95% CI: 7.4–13.3; p < 0.0001), and PDL (Δ7.4; 95% CI: 4.8–10.1; p < 0.0001). GRB improved significantly in patients following treatment with blue laser (Δ4.1; 95% CI: 2.9–5.2; p < 0.0001), KTP laser (Δ3.0; 95% CI: 2.0–4.0; p < 0.0001), and PDL (Δ2.5; 95% CI: 0.8–4.2; p = 0.005).
Conclusions Photoangiolytic lasers are effective in treating benign laryngeal lesions. Blue lasers are promising for laryngeal laser surgery. Laryngoscope, 134:4847–4857, 2024
Christine M. Liu, Jonathan B. Overdevest, Anna C. Zemke, Jess C. Mace, Adam J. Kimple, Amanda L. Stapleton, David A. Gudis, Timothy L. Smith, Jennifer L. Taylor‐Cousar, Daniel M. Beswick
Publication date 14-11-2024
Alberto Minzoni, Pietro Orlando, Giandomenico Maggiore
Publication date 14-11-2024
Andreas Machens, Henning Dralle
Publication date 14-11-2024
"Marie Duguet‐Armand, Jie Su, Brian OSullivan, John de Almeida, Ali Hosni, Ilan Weinreb, Bayardo Perez‐Ordonez, Stephen Smith, Ian Witterick, Christopher Yao, David Goldstein, Andrew Hope, Ezra Hahn, John Waldron, Jolie Ringash, Anna Spreafico, Eugene Yu, Shao Hui Huang"
Publication date 14-11-2024
Image-identified nodal features, despite modest sensitivity, have high specificity for pathologic findings. The prognostic value of adverse pathological nodal features is retained in radiologic assessment, and reduced OS is observed for imaging-identified N+, LN size >3 cm, >2 vs. ≤2 nodes, and iENE+.
Background and Purpose The aims of our study are to evaluate the diagnostic performance and prognostic value of radiological lymph node (LN) characteristics in pN+ oral cavity squamous carcinoma (OSCC).
Materials and MethodspN+ OSCC treated between 2012 and 2020 were included.
Preoperative imaging was reviewed by a single radiologist blinded to pathologic findings for the following nodal features: imaging-positive LN (iN+), laterality and total number, and image-identified extranodal extension (iENE). The sensitivity of iN+ for pN+ was calculated. The diagnostic performance of other nodal features was evaluated in the iN+ subgroup. The association of radiologic nodal features with overall survival (OS) was evaluated. Inter-rater kappa for radiologic nodal features was assessed in 100 randomly selected cases.
Results Of 406 pN+ OSCC, 288 were iN+. The sensitivity of iN+ for pN+ was 71% overall, and improved to 89% for pN+ LN >1.5 cm. Within iN+, sensitivity/specificity for LN size (>3 cm), total LN number (>4), and ENE were 0.44/0.95, 0.57/0.84, and 0.27/0.96, respectively. Sensitivity of iENE was higher in the subset, with major (>2 mm) versus minor (≤2 mm) pENE (43% vs. 13%, p = 0.001). Reduced OS was observed in iN+ versus iN– (p = 0.006), iENE+ versus iENE– (p = 0.004), LN size >3 versus ≤3 cm (p < 0.001), and higher LN number (p < 0.001). Inter-rater kappa for iN+, laterality, total LN number, and presence of iENE were 0.71, 0.57, 0.78, and 0.69, respectively.
Conclusion Our study shows that despite modest sensitivity of most radiological nodal features, the specificity of image-identified nodal features is high and their prognostic values are retained in pN+ OSCC.
Level of Evidence3 (retrospective review comparing cases and controls) Laryngoscope, 134:4947–4955, 2024
Jessie Marcet‐Gonzalez, Ruth K. Mizu, Jennifer N. Brown, Heena N. Prasla, Tien Pham, Julina Ongkasuwan, Elton Lambert, Tiffany Raynor, Joshua R. Bedwell
Publication date 14-11-2024
Objective The purpose of the study is to compare the incidence of early postoperative tracheotomy stoma wound complications in pediatric patients using a silver-impregnated barrier dressing (Mepilex Ag) versus a standard absorbent foam dressing (standard Mepilex).
Methods This is a prospective, non-blinded, randomized trial of pediatric patients undergoing tracheotomy at a tertiary care childrens hospital. Patients were randomized to receive Mepilex Ag versus standard Mepilex tracheostoma dressings following tracheotomy. All patients received standard postoperative wound care and daily stomal examination. Wound related complications, breakdown, granulation, and infection were recorded for the first 7 days after surgery. A non-inferiority study design was used to test the hypothesis that the Mepilex group had a non-inferior wound complication rate (within 10% margin) compared to the Mepilex Ag group.
Results Eighty-two patients were enrolled; 52 received Mepilex Ag, and 30 received standard Mepilex. There was no difference between the groups with respect to age, sex, race, surgical indication, or postoperative length of stay. Non-inferiority testing demonstrated that the Mepilex standard cohort had no more than 10% greater stomal wound complication rate than that of Mepilex Ag dressing group (p = 0.0108).
Conclusion Standard Mepilex was found to be non-inferior to Mepilex Ag in the prevention of tracheotomy stomal wound complications. Standard Mepilex may be used effectively in the postoperative period, potentially reducing costs to caregivers and the institution. Further work is needed to analyze additional factors that could contribute to poor postoperative stoma healing such as bacterial colonization.
Level of Evidence Randomized Controlled Trial, 2 Laryngoscope, 134:5160–5163, 2024
Rushi Patel, Aman M. Patel, Lucy Revercomb, Vivienne Qie, Christopher C. Tseng, Soly Baredes, Richard Chan Woo Park
Publication date 14-11-2024
Patients treated at high-volume facilities (HVFs) for salivary gland cancer experience worse survival if changing facility for postoperative radiation therapy (PORT). Our results suggest that patients treated surgically at HVFs should be counseled to continue their PORT at the same institution.
Objectives Changing location of postoperative radiotherapy (PORT) after treatment at a high-volume facility (HVF) is associated with worse survival in various head and neck cancers. Our study investigates this relationship in salivary gland cancer (SGC).
Methods The 2004–2016 National Cancer Database was queried for all cases of adult SGC treated with surgery and PORT with or without adjuvant chemotherapy. Patients with multiple cancer diagnoses, metastatic disease, or unknown PORT facility were excluded. Reporting facilities with >95th percentile annual case volume were classified as HVFs, the remainder were classified low-volume facilities (LVFs).
ResultsA total of 7885 patients met inclusion criteria, of which 418 (5.3%) were treated at an HVF. Patients treated at an HVF had higher rates clinical nodal positivity (18.2% vs. 14.0%, p < 0.001) and clinical T3/T4 (27.3% vs. 20.7%, p = 0.001) disease. Patients at HVFs changed facility for PORT at lower rates (18.9% vs. 24.5%, p = 0.009). Patients treated at an HVF had higher 5-year overall survival (5-OS) than those treated at an LVF (79.0% vs. 72.0%, p = 0.042). Patients treated at an HVF that changed PORT facility had worse 5-OS (60.8% vs. 83.2%, p < 0.001). Radiation facility change was an independent predictor of worse survival in patients treated at an HVF (HR: 8.99 3.15–25.67, p < 0.001) but not for patients treated at a LVF (HR: 1.11 0.98–1.25, p = 0.109).
Conclusions Patients treated at an HVF changing facility for PORT for SGC experience worse survival. Our data suggest patients treated surgically at an HVF should be counseled to continue their PORT at the same institution.
Level of Evidence3 Laryngoscope, 134:4935–4946, 2024
Emmanuel J. Jáuregui, Obinna Diala, Kyle O. Rove, Regina Hoefner‐Notz, Suhong Tong, Thanh Nguyen, Norman R. Friedman
Publication date 14-11-2024
Previous criteria for overnight monitoring after adenotonsillectomy may be too stringent. Our revised overnight monitoring criteria showed patients who successfully passed an asleep room air challenge were able to be candidate for same day surgery. We found our expanded criteria increased the number of same day surgery patients without an increase in the ED visit or readmission rate at 48 h as compared to prior to new criteria implementation.
Objectives Previous studies indicate children who pass an Asleep Room Air Challenge (AsRAC) do not have significant postoperative adverse respiratory events after adenotonsillectomy (T&A).
Subsequently, we revised our overnight monitoring (OM) criteria, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or nonsevere obesity (Class I) to be considered for same-day surgery (SDS) if they passed an AsRAC.
Our hypothesis is that our modified OM criteria would not increase the return visits or readmission rates for patients undergoing SDS within 48 h or 15 days of T&A.
MethodsA retrospective review of all children aged ≥3 and <21 years who underwent T&A at a tertiary childrens hospital and its satellite locations was performed from January 2017 to September 2022. Descriptive statistics and outcome measures were compared using a 3% margin noninferiority test before and after the new criteria implementation.
Results Before intervention, 3,266 (58%) T&As were performed as SDS.
Afterward, 74% of T&As were performed as SDS (p-value <0.05). There was no difference in the ED revisit rate for SDS within the 3% noninferiority margin. Following intervention, 29% more children with Class I obesity (62% vs. 33%) underwent SDS (p-value <0.001). Afterward, 19% more children with polysomnography underwent SDS (39% vs. 20%), p-value <0.001. After intervention, within 48 h of SDS, six (0.9%) children had revisits for bleeding and seven (1.2%) for vomiting. There were no perioperative respiratory events.
Conclusion Our revised monitoring criteria did not demonstrate an increase in ED visit or readmissions rates within 48 h or 15 days of T&A. Additionally, we found a 29% increase in Class I obese children undergoing SDS T&A.
Level of Evidence3 Laryngoscope, 134:5223–5230, 2024
Afash Haleem, Zachary Rosenthal, Daniel J. Lee
Publication date 14-11-2024
When contacted with an otologic emergency, urgent care centers struggle to appropriately refer to an emergency department. Medicaid patients significantly less insurance acceptance at urgent cares in states without Medicaid insurance. Self-pay patients can expect to pay on average $25 more for an appointment at an urgent care clinic in a state with Medicaid expansion.
Objectives To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance.
Methods One hundred twenty-five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one-week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self-pay price. Secondary outcomes included other measures of timely/accessible care. Chi-square/Mc Nemars tests and independent/paired sample t-tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis.
Results Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage-adjusted self-pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45–$48.54, p = 0.046). The rates of referral to an emergency department and self-pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both).
Conclusion Medicaid patients with otologic emergencies face reduced access to care at UCCs.
Level of EvidenceNA Laryngoscope, 134:5066–5072, 2024
Kathryn S. Marcus, Danielle R. Larrow, Kevin S. Gipson, Christopher J. Hartnick
Publication date 14-11-2024
A novel diagnostic and therapeutic titration algorithm for the Inspire hypoglossal nerve stimulator system, with particular attention paid to the sensor lead, was used to significantly reduce apnea-hypopnea index in three pediatric patients with Down syndrome and obstructive sleep apnea who failed to respond to the standard device titration that focused solely on stimulator lead adjustments.
Introduction Hypoglossal nerve stimulation (HGNS) is an effective therapy for carefully selected pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA), but optimization of device settings has been focused on stimulation settings. The potential benefits of sensing lead setting optimization have not been investigated. We describe a series of three cases of HGNS in children with DS where optimization of both the stimulation lead and sensing lead settings, as well as utilization of drug-induced sleep endoscopy (DISE), when indicated, was more effective than stimulation lead optimization alone.
Methods Using our novel titration algorithm, among the three identified pediatric patients with DS in whom HGNS initially failed to reduce the apnea-hypopnea index (AHI), two patients in whom sleep studies were characterized as hypopnea-dominant were assigned to advanced titration (optimization of stimulation settings and sensing lead settings). The third patient, with an obstructive apnea-dominant sleep study, was referred for interrogated DISE. Advanced titration included adjustment of both stimulation settings and sensing lead settings.
Results Application of the advanced titration algorithm, tailored to obstructive apnea- versus hypopnea-dominant sleep patterns, resulted in approximately 50% or greater reduction in AHI in all three patients. “Normal to mild OSA” AHI (AHI <5) was achieved in two patients.
ConclusionsA novel diagnostic and therapeutic titration algorithm for the Inspire HGNS system significantly reduced AHI in three pediatric patients with DS and OSA who had failed to respond to the standard device titration that focused solely on stimulation settings.
Level of Evidence4 Laryngoscope, 134:5164–5169, 2024
Mehmet Ekrem Zorlu, Canberk Kertmen, Abdulhalim Aysel, Fatih Yilmaz, Abdullah Dalgic, Togay Muderris
Publication date 14-11-2024
We aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates. We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group.
The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, and cheaper and cost-effective.
Objective This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates.
Methods We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer.
Results We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = −0.370).
Conclusion The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective.
Level of Evidence3 Laryngoscope, 134:4964–4970, 2024
Rahul Alapati, Bryan Renslo, Laura Jackson, Hanna Moradi, Jamie R. Oliver, Mohsena Chowdhury, Tejas Vyas, Antonio Bon Nieves, Amelia Lawrence, Sarah F. Wagoner, David Rouse, Christopher G. Larsen, Ganghui Wang, Andrés M. Bur
Publication date 14-11-2024
The study aims to develop machine learning (ML) and deep learning (DL) models using images from drug-induced sleep endoscopy to predict the success of hypoglossal nerve stimulator implantation for treating sleep apnea. The best-performing model was a deep learning model trained on velopharynx images, with significant accuracy and recall, outperforming those trained on the base of tongue or combined datasets. The research concludes that deep learning networks are promising for predicting the effectiveness of hypoglossal nerve stimulator therapy, and future work could improve model generalizability by using multi-institutional data.
Objectives To develop and validate machine learning (ML) and deep learning (DL) models using drug-induced sleep endoscopy (DISE) images to predict the therapeutic efficacy of hypoglossal nerve stimulator (HGNS) implantation.
Methods Patients who underwent DISE and subsequent HGNS implantation at a tertiary care referral center were included. Six DL models and five ML algorithms were trained on images from the base of tongue (BOT) and velopharynx (VP) from patients classified as responders or non-responders as defined by Shers criteria (50% reduction in apnea-hypopnea index (AHI) and AHI < 15 events/h). Precision, recall, F1 score, and overall accuracy were evaluated as measures of performance.
Results In total, 25,040 images from 127 patients were included, of which 16,515 (69.3%) were from responders and 8,262 (30.7%) from non-responders. Models trained on the VP dataset had greater overall accuracy when compared to BOT alone and combined VP and BOT image sets, suggesting that VP images contain discriminative features for identifying therapeutic efficacy. The VCG-16 DL model had the best overall performance on the VP image set with high training accuracy (0.833), F1 score (0.78), and recall (0.883). Among ML models, the logistic regression model had the greatest accuracy (0.685) and F1 score (0.813).
Conclusion Deep neural networks have potential to predict HGNS therapeutic efficacy using images from DISE, facilitating better patient selection for implantation. Development of multi-institutional data and image sets will allow for development of generalizable predictive models.
Level of EvidenceNA Laryngoscope, 134:5210–5216, 2024
Hana Vrzáková, Jesse Tapiala, Matti Iso‐Mustajärvi, Tomi Timonen, Aarno Dietz
Publication date 14-11-2024
To advance temporal bone drilling, psychomotor skills need to be trained along with technical prowess. We examined workload fluctuations using pupillary responses and reported on significant differences in key drilling phases. Our findings contribute to continuous monitoring in medical residency programs.
Objectives Training of temporal bone drilling requires more than mastering technical skills with the drill. Skills such as visual imagery, bimanual dexterity, and stress management need to be mastered along with precise knowledge of anatomy. In otorhinolaryngology, these psychomotor skills underlie performance in the drilling of the temporal bone for access to the inner ear in cochlear implant surgery. However, little is known about how psychomotor skills and workload management impact the practitioners continuous and overall performance.
Methods To understand how the practitioners workload and performance unfolds over time, we examine task-evoked pupillary responses (TEPR) of 22 medical students who performed transmastoid-posterior tympanotomy (TMPT) and removal of the bony overhang of the round window niche in a 3D-printed model of the temporal bone. We investigate how students TEPR metrics (Average Pupil Size APS, Index of Pupil Activity IPA, and Low/High Index of Pupillary Activity LHIPA) and time spent in drilling phases correspond to the performance in key drilling phases.
Results All TEPR measures revealed significant differences between key drilling phases that corresponded to the anticipated workload. Enlarging the facial recess lasted significantly longer than other phases. IPA captured significant increase of workload in thinning of the posterior canal wall, while APS revealed increased workload during the drilling of the bony overhang.
Conclusion Our findings contribute to the contemporary competency-based medical residency programs where objective and continuous monitoring of participants progress allows to track progress in expertise acquisition. Laryngoscope, 134:5087–5095, 2024
Rose Dimitroyannis, Stella Cho, Sharanya Thodupunoori, David Fenton, Rachel Nordgren, Christopher R. Roxbury, Andrea Shogan
Publication date 14-11-2024
AOM content on Tik Tok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content.
Introduction With the rise of social media, online platforms have become a common way to access healthcare information. This study examines the quality of pediatric acute otitis media (AOM) videos on Tik Tok, a popular short-form video social media platform.
MethodsA Tik Tok search was conducted between 8/18 and 8/19/2023 using pediatric AOM hashtags: #pediatric acute otitis media management, #kid ear infections remedy, #child ear infections treatment, and #kid ear infection. Data collected include number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional), and content categories. The Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-AV) and DISCERN questionnaire measured understandability, actionability, and quality of videos. Multivariable linear regression models were used (significance set at ≤0.05).
Results Of 166 videos, 38.6% (64) of uploaders were medical professionals, and 32.5% (54) were nonmedical influencers. Nonmedical influencer videos were viewed and shared significantly more than those by medical professionals (p < 0.05). Controlling for covariates, physicians were more likely to produce more beneficial and higher quality videos as compared with nonmedical influencers (β = 2.4 and 1.3, p < 0.01, respectively). However, physicians did not have significantly different ratings for understandability compared with nonmedical influencers (β = 0.45, p > 0.05).
DiscussionAOM content on Tik Tok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content.
Level of EvidenceNA Laryngoscope, 134:5184–5192, 2024
Johnathan Brown, Nicole McCoy, Jacqui Allen, Mekibib Altaye, Milan Amin, Semirra Bayan, Peter Belafsky, Brad DeSilva, Greg Dion, Dale Ekbom, Aaron Friedman, Mark Fritz, John Paul Giliberto, Elizabeth Guardiani, Christopher Johnson, Jan Kasperbauer, Brandon Kim, Brittany N. Krekeler, Maggie Kuhn, Paul Kwak, Yue Ma, Lyndsay L. Madden, Laura Matrka, Ross Mayerhoff, Cyrus Piraka, Clark A. Rosen, Meredith Tabangin, Shaun Wahab, Keith Wilson, Carter Wright, VyVy N. Young, Gregory Postma, Rebecca J. Howell
Publication date 14-11-2024
This study examined the demographic and clinical characteristics of patients who had minimal symptomatic improvement following surgical treatment for Zenker diverticulum. Patients with concomitant esophageal disorders were found to be more likely have less symptomatic improvement following surgery.
Objective To identify characteristics of patients who have poor improvement in symptoms following surgical management of Zenker Diverticulum (ZD).
Methods Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative who underwent surgical repair of ZD between August 2017 and January 2024. Patient demographics, esophagrams, and the 10-item Eating Assessment Tool (EAT-10) pre- and post-procedure were obtained from a REDCap database. t-tests, Wilcoxon rank sum tests, Chi-square or Fishers exact tests were used to compare the characteristics. Patients with <50% improvement in their EAT-10 scores were deemed surgical nonresponders (SNRs). Those with ≥50% improvement in their EAT-10 scores were deemed surgical responders (SRs).
ResultsA total of 184 patients were prospectively followed after undergoing either open or endoscopic surgical management. Twenty-two patients (12%) were deemed SNRs. Preoperative presence of a hiatal hernia was statistically significant characteristic between the SNRs (63.6%) and SRs (32.1%) (p = 0.004). Size of the ZD and history of previous ZD surgery was not a significant characteristic. The length of stay and complication rate were not statistically different between the groups.
Conclusion Coexistent esophageal pathology may lead to poor symptomatic improvement following ZD surgery. Preoperative workup of other esophageal disorders is recommended to detect likely SNRs. For SNRs, further esophageal workup may be necessary to evaluate for other esophageal causes related to poor symptomatic improvement following ZD surgery.
Level of Evidence3 Laryngoscope, 134:4897–4902, 2024
Sara Yang, Zoey Morton, Maddie Colcord, Ryan S. Jackson, Eric J. Moore, Jason Thuener, Arnaud F. Bewley, Andrew Coughlin, Samir S. Khariwala, Jeremy D. Richmon, Patrik Pipkorn, Ryan Winters, Oleg N. Militsakh, Chad A. Zender, James Wright, Mark K. Wax
Publication date 14-11-2024
This retrospective review discusses the role of a fibula free flap to reconstruct certain cervical spine defects and reports on the multi-institutional experience and postoperative outcomes.
Introduction Cervical spine defects result in spinal instability, putting the spinal cord and vertebral arteries at risk of damage and possibly devastating neurological injuries. The fibula free flap can span the spinal defects for stability. There is a paucity of literature on this technique.
Method Multi-institutional retrospective case series reviewing patients who underwent cervical spine reconstruction with a fibula free flap. Patient demographic information, comorbidities, characteristics of cervical spine defects, and free flap complications were collected.
ResultsA total of 1187 fibula free flaps across 10 different institutions were reviewed. Thirteen patients (1.09%) underwent cervical spine reconstruction with a fibula free flap. Average age was 52.3 years old with an age range of 12–79 years. There were six males (46.1%) and seven females (53.8%). The most common defect etiology was infection (n = 6, 46.1%). Most commonly involved cervical spine level of the defect was C5 (n = 10) followed by C6 (n = 9) and C4 (n = 8). The majority of reconstructed defects spanned three or more cervical levels, (n = 9, 69.2%). Facial artery was the most common arterial anastomosis (n = 8). Eight patients (61.5%) required a tracheostomy during their postoperative course. None of the patients had symptomatic or radiographic nonunion.
Conclusion This case series demonstrates that a vascularized fibula flap is a potential reconstructive option for cervical spine defects, especially in defects greater than three cervical levels, in the setting of infection, and previously radiated patients.
Level of Evidence4 Laryngoscope, 134:4923–4928, 2024
Nevra Keskin Yilmaz, Tomotaka Shimura, Artur Koerig Schuster, Sebahattin Cureoglu, Rafael da costa Monsanto
Publication date 14-11-2024
Despite otitis media and various disease processes being associated with endolymphatic hydrops, an exact explanation of the pathophysiology has yet to be reported. We studied a total of 15 chinchilla and 25 human temporal bones from our collection, which were categorized into acute otitis media, chronic otitis media (COM), and control groups, and a significant decrease in the mean area of the stria vascularis in the basal turn was identified in COM groups compared to controls of both species. The presented animal model exhibited parallel findings with human samples, suggesting its viability as a valuable model for future studies.
Objectives Despite otitis media and various disease processes being associated with endolymphatic hydrops (EH), an exact explanation of the pathophysiology has yet to be reported. This study aimed to investigate the changes in the cochlear lateral wall structures and their potential correlation with the presence and severity of cochlear EH in acute and chronic otitis media cases. The investigations were conducted in both chinchilla animal model and human temporal bone specimens.
Methods We studied a total of 15 chinchilla and 25 human temporal bones from our collection, which were categorized into acute otitis media, chronic otitis media (COM), and control groups. Through quantitative analysis, we measured the area of cochlear lateral wall structures and observed the presence and the degree of EH using light microscopy.
Results No significant changes were determined in the area of the spiral ligament (p > 0.05) across the species. However, a significant (p < 0.05) decrease in the mean area of the stria vascularis in the basal turn was identified in COM groups compared to controls of both species. Chinchilla model additionally exhibited pathology extending to the lower mid turn. A negative correlation was found between the mean strial area and the severity of EH in both the animal model and human samples.
ConclusionsCOM associated with significant changes in the stria vascularis that may lead to significant increase in the degree of EH. The presented animal model exhibited parallel findings with human samples, suggesting its viability as a valuable model for future studies.
Level of EvidenceNA Laryngoscope, 134:5103–5108, 2024
J. Dixon Johns, Peter H. Ahn, Abdul X. Rashid, Dylan R. Conroy, Paul F. Chisolm, H. Jeffrey Kim
Publication date 14-11-2024
There remains significant variability of reported facial nerve dysfunction rates following stereotactic radiosurgery for the management of vestibular schwannoma. The association between radiation exposure to the vulnerable segments of the facial nerve, including labyrinthine segment, and posttreatment facial nerve dysfunction remains poorly characterized in the literature. This study is the first, to our knowledge, that investigates detailed analysis of radiation doses to the relatively vulnerable labyrinthine segment of the facial nerve with regard to facial nerve dysfunction following Cyberknife® stereotactic radiosurgery.
Objective The incidence and risk factors for facial nerve dysfunction (FND) following Cyber Knife® therapy for vestibular schwannoma (VS) remain poorly understood. This study investigates whether differential radiation doses to vulnerable segments of the facial nerve may be associated with FND outcomes.
Methods Patients were identified who underwent Cyber Knife® radiosurgery for VS at a single institution. Basic demographics, tumor characteristics, and facial nerve function were collected. Total radiation doses to tumor, internal auditory canal (IAC), and labyrinthine segment of facial nerve (LSFN) were evaluated.
Results Six out of 64 patients experienced FND following Cyber Knife® treatment for VS (9.38%, 6/64). Patients with FND were compared to those without FND (control). Of the 64 patients, complete radiation records were obtained for 30 patients (6 FND vs. 24 control). There were no significant differences in demographic or tumor characteristics between control and FND cohorts. More severe FND (HB ≥ 4) had significantly larger tumors (3.74 vs. 1.27 cm3, p = 0.037) with directionally decreased time to FND (3.50 vs. 33.5 months, p = 0.106) than patients with HB < 4, respectively. There were directionally, nonsignificant differences between maximum radiation doses to the LSFN (2492.4 vs. 2557.0 c Gy, p = 0.121) and IAC (2877.3 vs. 2895.5 c Gy, p = 0.824) between the control and FND cohorts, respectively.
ConclusionsFND may represent an underrecognized sequelae of Cyber Knife® radiosurgery for VS that can occur many months following treatment. Further studies are needed to elucidate the effect of differential radiation exposure to the facial nerve with FND following treatment.
Level of Evidence3 (Retrospective Cohort Study) Laryngoscope, 134:5080–5086, 2024
Andrew R. Mangan, Kenzo M. Cotton, James Reed Gardner, Aryan Shay, Soroush Farsi, Noah B. Ross, Deanne King, Jumin Sunde, Emre Vural, Mauricio Alejandro Moreno
Publication date 14-11-2024
There has been no discussion of functional status and its role in delays to adjuvant therapy following free tissue transfer in the setting of head and neck cancer. Our study evaluates the relationship between functional status on delays to adjuvant therapy as well as evaluating other variables including demographics and socioeconomic status. Functional status should be used as a tool for head and neck surgeons to risk stratify their patients during treatment planning.
Objective Evaluate the effect of functional status and patient factors on delays in treatment with adjuvant therapy.
Methods Retrospective chart review (2020–2022) was conducted at a single tertiary referral center. Data were collected between January 2020 and October 2022, and 63 patients underwent free flap reconstructive surgery of the head and neck due to the presence of cancer and received adjuvant radiation therapy (RT). The main outcomes measured were Area Deprivation Index (ADI), Beale scores, distance to radiation center, functional status, patient demographics, gender, and length from surgery to initiation of RT.
Results Of the 63 patients who were reviewed, the average age was 65.5 years old and 63.8% were male. The average ADI state score was 5.6 and the national percentile of 77.1. The average Beale score was 3.7. The average distance traveled was 101.1 miles. Thirty-five patients were living independently, 16 were living in assisted living or received home care, and 15 were dependent or lived in a nursing home. Mann–Whitney U analysis revealed a significant association of increasing levels of dependence to delays in treatment compared to on-time treatment (p = 0.002). The odds of treatment delay were increased almost 10-fold for every additional increase in dependency level (OR = 9.87, 95% CI = 1.42–68.83).
Conclusions and Relevance Degree of dependent functional status correlates with delays in postoperative adjuvant RT in patients undergoing free tissue transfer for head and neck cancer. Preoperative risk stratification allows for physicians to address barriers to adjuvant therapy prior to delay.
Level of Evidence3 Laryngoscope, 134:4979–4984, 2024
A. Kadrie, C. Ward, M. Chanamolu, Joseph Berry, M.B. Gillespie
Publication date 14-11-2024
This study considered the utility and impact of obtaining computed tomography (CT) scans in patients with suspected peritonsillar abscess (PTA) by comparing outcomes between CT and non-CT usage. Using Tri NetX datasets, various outcomes of two cohorts: PTA without CT and PTA with CT were compared using a matched cohort analysis. The CT usage group had increased odds of receiving antibiotics, opiates and steroids as well as a higher likelihood of returning to the ED and developing a recurrent PTA.
Objectives Peritonsillar abscess (PTA) is a common deep space head and neck infection, which can be diagnosed with or without computed tomography (CT). CT poses a risk for false positives, leading to unnecessary abscess drainage attempts without benefit, whereas needle or open aspiration without imaging could potentially lead to missed abscess in need of treatment. This study considered the utility and impact of obtaining CT scans in patients with suspected PTA by comparing outcomes between CT and non-CT usage.
Methods Retrospective cohort analysis using Tri NetX datasets compared the outcomes of two cohorts: PTA without CT and PTA with CT. Measured outcomes included incision and drainage; quinsy adenotonsillectomy; recurrent PTA; airway emergency/obstruction; repeat emergency department (ED) visits; and need for antibiotics, opiates, or steroids. Odds ratios (OR) were calculated using a cohort analysis.
Results The CT usage group had increased odds of receiving antibiotics (OR 3.043, 2.043–4.531), opiates (OR 1.614, 1.138–1.289), and steroids (OR 1.373, 1.108–1.702), as well as a higher likelihood of returning to the ED (OR 5.900, 3.534–9.849) and developing a recurrent PTA (OR 1.943, 1.410–2.677). No significant differences were observed in the incidence of incision and drainage, quinsy adenotonsillectomy, or airway emergency/obstruction.
Conclusion Our study indicated that CT scans for PTA diagnosis were associated with increased prescription of antibiotics, opioids, steroids, return ED visits, and recurrent PTA. Future prospective trials are needed to determine if the use of CT scans indicates higher patient acuity that explains the potential negative outcomes.
Level of Evidence2 Laryngoscope, 134:4911–4917, 2024
Sang‐Yoon Han, Hee Won Seo, Seung Hwan Lee, Jae Ho Chung
Publication date 14-11-2024
Hearing loss is associated with reduced walking and a sedentary lifestyle. The use of hearing aids is associated with improved physical activity. Appropriate interventions, including hearing aids, should be provided to hearing loss patients.
Objectives Hearing loss causes numerous functional deficits. However, few studies have been conducted to assess the association between hearing loss and physical inactivity. This study aimed to evaluate the physical activity and sedentary behavior of hearing loss patients and their relation with the use of hearing aids.
Materials and Methods We extracted participants over 60 years of age with information on hearing status and physical activities from the eighth Korea National Health and Nutritional Examination Survey conducted from 2019 to 2020.
We classified them into four groups: a normal hearing group (≤25 dB), a mild hearing loss group (>25 dB and ≤40 dB), a moderate hearing loss group (>40 dB and ≤50 dB), and a non-serviceable hearing group (>50 dB). Additionally, we extracted hearing aid users with hearing levels exceeding 50 dB.
Results After adjusting other factors, the non-serviceable hearing group walked less frequently than the moderate (p = 0.004) and mild hearing loss group (p < 0.001) and walked less and sat more than the normal hearing group (walking frequency: p < 0.001; walking time: p = 0.020; and sitting time: p = 0.034). Also, the hearing aid users walked more frequently (p = 0.003) and for longer (p = 0.045) than the non-serviceable hearing group.
Conclusion Hearing loss is associated with reduced walking and a sedentary lifestyle. The use of hearing aids is associated with improved physical activity. Appropriate interventions, including hearing aids, should be provided to hearing loss patients.
Level of Evidence3 (individual cross-sectional study) Laryngoscope, 134:5109–5115, 2024
Sara Yang, Zoey Morton, Mackenzie Sautter, Gavin Young, Daniel Petrisor, Srinivasa R. Chandra, Mark K. Wax
Publication date 14-11-2024
Virtual surgical planning has optimized fibula free flap reconstruction for mandibular defects. The patient-specific plates created had been proven to be stable over long term with no plate fractures and minimal screw loosening. External plate exposure occurred in 10.8% of patients, highlighting the need to focus on the soft tissue envelope over the plate.
Objective Assess the long-term plate complications with patient-specific plates (PSPs) created with computer-aided design (CAD) and computer-aided manufacturing (CAM) for fibula free flap reconstructions for mandibular defects.
Methods Retrospective chart review from January 2010 to July 2022 of patients who underwent mandibular reconstruction with a fibula free flap and PSP. Primary outcome was plating-related complications, defined as plate exposure, fracture, loose screws, and plate removal.
ResultsA total of 221 patients underwent PSP fibula reconstruction. Average age was 59.8 + 14.3 years old with male to female ratio of 2:1. Squamous cell carcinoma of the mandible was the most common reason for resection, 47.5%, n = 105. Plate removal occurred in 11% of patients (n = 25) about 17.4 months after the initial surgery. Plates were removed due to exposure (76%, n = 19) or screw loosening (24%, n = 6). Malignancy was associated with an increased risk of plate complications when compared to benign tumor (odds ratio OR 9.04, confidence interval CI 1.36–3.85), osteonecrosis (OR 1.38, CI 0.59–3.48), and trauma (OR 1.26, CI 0.23–12.8). Postoperative radiation therapy (OR 2.27, CI 1.07–4.82, p = 0.026) and surgical site infection (OR 9.22, CI 4.11–21.88, p = 0.001) were associated with more plate complications.
ConclusionsCAD creates PSPs that remain stable in the majority of patients over the long term. Plate removal is less compared to non-PSP reconstruction. Consideration of the soft tissue envelope over the plate and management of perioperative infection at the time of surgery should be entertained.
Level of Evidence4 Laryngoscope, 134:4929–4934, 2024
Alex Hu, Nour Awad, Joonsue Lee, Rahul Patel, Ohad Cohen, Yael Bensoussan, Liran Oren, Aaron D. Friedman, Gregory R. Dion
Publication date 14-11-2024
Tracheal anastomosis closure technique comparisons are needed to determine optimal closure of the anastomosis to minimize anastomosis failure during post operative coughing. We compared interrupted and continuous tracheal anastomosis closure techniques across varying tensions during repetitive stimulated cough and found that pressure and length of tracheal stretch were significant, but no difference existed between anastomosis suture closure technique.
Background Anastomotic leak after tracheal resection may occur while coughing in the early postoperative period. We investigated the varying effects of suturing technique, stretch, and tension on anastomotic leaks during simulated coughs.
Methods End-to-end anastomoses were performed using continuous or interrupted sutures on excised porcine larynges. Tracheas were secured to a pressurized system simulating cough forces, submerged in a water bath, and stretched to 1, 2, and 3 cm above baseline. Peak pressure, incomplete cough generation, and observed leakages were recorded. Parameters were analyzed using Analysis of Variance (ANOVA), multiple linear regression, and logistic regression modeling.
Results Peak tension (B = −0.660, p < 0.001) and stretch lengths (B = −0.329, p = 0.006) were associated with variance in peak pressure (R2 = 0.77, F(3,294) = 8.182, p < 0.001). Incomplete coughs increased with higher peak tension (odds ratio OR = 15.627, p < 0.001) and stretching to 3 cm above baseline (OR = 4.335, p < 0.007). Similarly, leak occurrences, primarily from the posterior tracheal wall, increased with higher peak tension (OR = 1.787, p < 0.001) and stretching to 3 cm (OR = 2.613, p = 0.017). No significance was identified with suturing technique.
Conclusion Interrupted and continuous suture techniques do not differ in anastomotic strength during simulated coughs. Increased peak tracheal tension is associated with a weaker anastomosis, and tracheal stretch to 3 cm was associated with a weaker anastomosis. Our study supports the commonly held clinical belief that, to create a stronger anastomosis, tension should be minimized, and particular attention should be placed at the posterior tracheal wall during closure.
Level of EvidenceNA, Benchtop study Laryngoscope, 134:4998–5005, 2024
James C. Borders, Michelle S. Troche
Publication date 14-11-2024
Minimal detectable change represents the smallest amount of change in an outcome that is beyond measurement error or task variability. This study elucidated minimal detectable change for cough and lingual strength outcomes, providing thresholds that can be immediately implemented in both clinical practice and research.
Objective Minimal detectable change (MDC) represents the smallest amount of change required for an outcome to be considered real and not merely due to measurement error or task variability. This study aimed to examine MDC for cough and lingual strength outcomes among individuals with neurodegenerative disease.
Methods In a single session, individuals diagnosed with Parkinsons disease (PD), progressive supranuclear palsy (PSP), and cerebellar ataxia completed repeated measurements of voluntary sequential cough via spirometry (n = 143) and lingual isometric and swallowing pressure with the Iowa Oral Performance Instrument (n = 231). The MDC at the 95% confidence level was calculated with the following formula: MDC = 1.96 × √2 × SEM.
ResultsMDC for cough strength was 0.52 L/s (PD), 0.57 L/s (PSP), and 0.20 L/s (ataxia). On trials with the same number of coughs, MDC for cough strength was 0.18 L/s in PD and 0.24 L/s in ataxia. MDC for lingual isometric pressure was 5.44 k Pa (PD), 2.35 k Pa (PSP), and 3.41 k Pa (ataxia), whereas swallowing pressure was 5.60 k Pa (PD), 2.97 k Pa (PSP), and 7.34 k Pa (ataxia).
Conclusions These findings elucidate MDC for cough and lingual strength outcomes and expand our understanding of change that can be considered “real” and not merely due to task variability. MDC facilitates valid interpretations of changes following treatment, as well as power analyses to determine the smallest effect size of interest before data collection. To illustrate the application of MDC, we situate these findings in the context of hypothetical case studies and research studies.
Level of Evidence3 Laryngoscope, 134:5034–5040, 2024
Wenting Deng, Haoyang Wu, Yi Chen, Hao Xiong, Yongkang Ou
Publication date 14-11-2024
In early Menieres disease (MD), there is a higher ratio of saccule-to-utricle ratio inversion, indicating a potential diagnostic marker for the disease. Within the first 6 months of early MD, there is a greater likelihood of saccular hydrops. Endolymphatic hydrops in early MD may primarily originate from the saccule.
Objective To compare the saccule-to-utricle ratio in early- versus late-stage Menieres disease (MD) patients based on magnetic resonance imaging (MRI) images.
Methods In this retrospective study, we performed 3-dimensional real inversion recovery (3D-real IR) MRI 24 h after intratympanic gadolinium administration in unilateral MD patients at early-stage (n = 56) and late-stage (n = 70). Two radiologists independently graded endolymphatic hydrops (EH) and the saccule-to-utricle ratio inversion (SURI) was compared between the two groups. Furthermore, early-stage MD patients were further divided into two subgroups based on disease duration: ≤6 months (n = 20) and >6 months (n = 36) and the SURI was compared.
Results Among the 56 patients in the early-stage group, 26 cases (46.43%) exhibited an enlarged saccule that is larger than the utricle, showing SURI. In contrast, among the late-stage MD, only four cases (5.71%) showed SURI (p < 0.001). In the early-stage MD subgroup with a disease duration of ≤6 months, the proportion of SURI was 70% (14/20), which was higher than that in the subgroup with a disease duration of >6 months (33.33%, 12/36, p = 0.02).
ConclusionSURI may serve as an effective imaging marker for diagnosis of early-stage MD. Our finding suggests that endolymphatic hydrops in MD may primarily originate from the saccule.
Level of Evidence3 Laryngoscope, 134:5116–5121, 2024
Lyna Siafa, Farida El‐Malt, Catherine F. Roy, Karen M. Kost
Publication date 14-11-2024
This retrospective study represents one of the largest surgical series to date reporting on the efficacy and safety of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) in critically ill adults with obesity. It reports no difference in overall complication rates between patients without obesity and patients with obesity (7.3% vs. 10.5% respectively, p = 0.370).
Objective This study aimed to assess the safety and efficacy of endoscopic percutaneous dilatational tracheostomy (PDT) in obese and nonobese critically ill adults.
MethodsA retrospective study of all cases of PDT performed at two academic health centers between 2016 and 2023 was conducted. Primary outcomes included peri- and postoperative complications stratified by both timing and severity. body mass index (BMI) data were stratified according to the World Health Organization classification (class I obesity defined as BMI ≥ 30, class II obesity ≥35 and <40, class 3 obesity ≥40).
Results Totally 336 patients underwent a PDT, 279 of whom had available BMI data: 193 (69.2%) patients had a normal BMI, 56 (20.1%) had class I obesity, 15 (5.4%) class II obesity, and 15 (5.4%) class III obesity. The overall complication rates for the class I, II, and III obesity were 8.9%, 13.3%, and 13.3%, respectively. All procedures were successfully completed at the bedside (no conversions to an open approach), and there was no procedure-related mortality. The only accidental decannulation event was in a patient with class III obesity. There was no difference in overall complication rates between patients without obesity and patients with obesity (7.3% vs. 10.5%, respectively, p = 0.370).
Conclusion This study significantly expands the current literature and represents one of the largest studies to date reporting on PDT in patients with obesity.
Level of Evidence3 Laryngoscope, 134:5015–5020, 2024
Ari D. Schuman, Gianmarco A. Calderara, Aila Hanif, Sarah Hollas, Julina Ongkasuwan
Publication date 14-11-2024
Laryngeal reinnervation has become part of the standard of care for unilateral vocal fold paralysis in children. However, long-term outcomes are not well described. We show that voice improvements are durable over time at a median of 6.8 years of follow-up.
OBJECTIVEPediatric nonselective laryngeal reinnervation (NSLR) has gained popularity in recent years; however, long-term outcomes have not been reported.
METHODSPatients greater than 1 year post reinnervation were recruited. Families were asked to report Pediatric Voice-Related Quality of Life (PVRQOL) and provide an audio recording of connected speech. PVRQOL and voice measures were compared with preoperative and early postoperative outcomes (<12 months) using analysis of variance (ANOVA) for repeated measures and post hoc tests for linear trend.
RESULTSSixty-six patient families were contacted. Twelve patients responded with PVRQOL; six (50%) were female. Median age at surgery was 6.4 (range 1.9–15) and at follow-up 13.5 (range 10–18), with a median of 6.8 years (range 3–9.1) since surgery at follow-up. Mean preoperative PVRQOL was 68.1 (95% CI 52.3–84.0), early postoperative 86.5 (73.2–99.7), and long-term 90 (82.7–97.3). ANOVA showed no significant difference between values (p = 0.1228), but post hoc testing showed improving outcomes over time (p-for-trend 0.0304). PVRQOL was stable between early postoperative and long-term values (p = 0.3399).
Four voice samples were adequate for analysis. Mean preoperative cepstral peak prominence (CPP) was 5.2 (95% CI 3.4–7.0), early postoperative 8.5 (5.5–11.5), and long-term 6.8 (2.77–10.89, p = 0.3340, p-for-trend 0.2988) Low-to-high spectral ratio was 22.3 preoperatively (14.0–30.5), 23.0 early postoperative (17.4–28.7), and 28.8 long-term (17.4–40.2, p = 0.1174, p-for-trend 0.0364). Cepstral spectral index of dysphonia (CSID) was 83.0 preoperatively (44.1–121.8), 39.4 early postoperative (20.4–58.3), and 45.53 long-term (−0.05–91.1, p = 0.4457, p-for-trend 0.1464).
CONCLUSIONSYears after NSLR, PVRQOL, low-to-high spectral ratio, and CSID show no evidence of degradation over time.
Level of Evidence4 Laryngoscope, 134:5006–5009, 2024
Tingting Ji, Ting Long, Yuwei Liu, Jun Tai, Jie Zhang, Yanzhen Li, Xuexi Zhang, Zhiyong Liu, Qiaoyin Liu, Nian Sun, Shengcai Wang, Xin Ni
Publication date 14-11-2024
Congenital pyriform sinus fistula (CPSF) is a rare congenital cervical branchial malformation. However, there is no clinical study with a large sample size to follow up the exact efficacy and safety of carbon dioxide (CO2) laser cauterization in children with CPSF. Therefore, we collected and analyzed clinical data and follow-up information from 238 children with CPSF who underwent CO2 laser cauterization, and found that this treatment is an effective and safe treatment with a low recurrence rate and few complications and recommended as a viable therapeutic option for managing pediatric CPSF.
Objectives To investigate the efficacy and safety of carbon dioxide (CO2) laser cauterization in the treatment of pediatric congenital pyriform sinus fistula (CPSF), and to track and follow up the long-term outcome of the postoperative patients.
Methods This retrospective study was conducted at a single center, where clinical data and follow-up information of children with CPSF who underwent CO2 laser cauterization with the assistance of a suspension laryngoscope and microscope were collected and analyzed their clinical characteristics and prognosis. Subsequently, multiple logistic regression analysis was performed to identify potential predictors of the number of laser cauterization procedures.
ResultsA total of 238 children diagnosed with CPSF were recruited for this study, with 235 patients successfully achieving closure of the internal fistula through one or more CO2 laser cauterization procedures without recurrence. The median duration of follow-up was 6.46 (5.20, 7.64) years. Merely three patients (1.3%) developed recurrent cervical infection and eventually underwent open neck surgery. There were no instances of permanent perioperative complications throughout the follow-up. Additionally, our analysis revealed that the age at the first operation of CO2 laser cauterization was an independent risk factor associated with the number of operations.
Conclusions The CO2 laser cauterization for children with CPSF is an effective and safe treatment with a low recurrence rate and minimal complications during the follow-up period. Consequently, it is advisable to consider CO2 laser cauterization as a viable therapeutic option for managing pediatric CPSF.
Level of Evidence4 Laryngoscope, 134:5193–5200, 2024
Zaroug Jaleel, Mohamed A Aboueisha, Kelson Adcock, David J. Cvancara, Vicente Martinez, Greg Kinney, David J. Perkel, Neel K. Bhatt
Publication date 14-11-2024
Superior laryngeal nerve plays a key role in laryngeal sensation, with SLN deficits implicated in increased rates of dysphagia and aspiration in the elderly and patients with neurodegenerative disease. We present an in vivo rat model for quantitative sensory nerve action potential measurements of the SLN, thereby serving as a possible basis for future work on the effects of aging or neurodegenerative conditions on SLN function.
Objective Superior laryngeal nerve (SLN) function is critical to laryngeal sensation. Sensory dysfunction in the larynx, mediated through the internal branch of the superior laryngeal nerve (iSLN), is thought to occur with aging and neurodegenerative disease. However, objective analysis of iSLN neurophysiology is difficult due to its anatomic location and small diameter. This study measures sensory nerve action potentials (SNAP) from the iSLN in a rat model.
MethodsSNAP data were obtained from two adult rat strains (Sprague–Dawley, SD and Fischer 344 × Brown Norway F1 Hybrid rats, FBN). Evoked responses were obtained by stimulating the main trunk of the SLN and recording the response using a 160-μm cuff electrode placed around the iSLN. SNAP were averaged from 10 stimulations. Laryngeal adductor reflex (LAR) threshold measurements were obtained with stimulation of the iSLN and direct laryngoscopy. The sections of the iSLN were obtained for histologic analysis.
ResultsSLN-evoked responses were successfully obtained in 18 hemi-laryngeal preparations (SD n = 13 and FBN n = 5) with corresponding LAR threshold measurements. Mean(±SD) SNAP latency, total duration, amplitude, negative durations, and intensity were 2.28 ms (±0.56), 2.13 ms (±0.70), 879 μV (±535), and 0.69 mA (±0.25), respectively. SLN stimulation threshold to elicit an LAR was of 0.84 mA (±0.31).
Conclusion It is feasible to record evoked SLN responses in two adult rat strains. This work may lead to a tractable animal model for objective measurements of SLN neurophysiology with various disease states.
Level of EvidenceNA Laryngoscope, 134:5028–5033, 2024
Hyung‐Tae Kim, Sun‐Jung Kang, In‐Soo Cho, Da‐Bi Lee
Publication date 14-11-2024
Our study represents a significant advancement in the field of laryngology and transgender health care, providing robust data on the outcomes of a novel surgical technique developed to achieve a more natural-sounding feminine voice in transgender women. The retrospective analysis included 506 patients, revealing improved pitch elevation and patient satisfaction compared with previous methods.
Objectives To assess the efficacy and long-term durability of the enhanced technique of Type II Vocal Fold Shortening and Retrodisplacement of the Anterior Commissure (VFSRAC) for voice feminization compared with the preceding Type I method.
MethodsA retrospective analysis encompassed 506 patients drawn from a cohort of 1025 MtF transgender women who underwent VFSRAC between 2003 and 2021. The study period included cases from 2015 to 2021, during which the Type II update technique was implemented, involving a modification to the suture technique. Subjective and perceptual evaluations, aerodynamic and acoustic assessments, real-time pitch analysis, and videostroboscopic reviews were conducted pre- and postoperatively in the MtF transgender women cohort. Comparative statistical analyses were performed to discern differences between the earlier Type I method (2003–2014) and the more recent Type II method (2015–2021).
Results The preoperative mean speech fundamental frequency (sF0) for Type II VFSRAC was 134.5 Hz. Postoperatively, the mean sF0 increased to 196.7 Hz, 212.3 Hz, and 207.5 Hz at 3 months, 6 months, and beyond 1 year, respectively, exceeding outcomes observed with the Type I method. Postoperative subjective and objective assessments indicated an augmentation in voice femininity. Acoustic and aerodynamic indices were within the normal range, and the regularity of the vocal fold mucosal wave was preserved within normal parameters. These results suggest that patients achieved a natural phonation pattern after surgery.
Conclusions The application of our updated type II VFSRAC has demonstrated feasibility and consistently yielded favorable results for individuals desiring a naturally feminine voice.
Level of Evidence3 Laryngoscope, 134:5054–5061, 2024
"Chloe Santa Maria, Elizabeth A. Shuman, Benjamin Van Der Woerd, Clare Moffatt, Carlos X. Castellanos, William Z. Gao, Neel K. Bhatt, Yael E. Bensoussan, Jack Rodman, Kacie La Forest, Felicia Francois, Karla ODell, Dinesh K. Chhetri, Michael M. Johns III"
Publication date 14-11-2024
Fifteen patients with vocal fold scar and sulcus received a course of four serial 55 platelet-rich plasma (PRP) injections, without adverse effects. There were improvements in patient reported outcome measures post-PRP. CAPE-V scores also improved after PRP series, videostroboscopic appearance, however, showed variable results. PRP has been validated as a safe autologous option for treatment of vocal fold scar.
Objective Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function.
Methods In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated.
Results In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar.
There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases.
ConclusionsPRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs.
Level of Evidence3: Prospective cohort study, with blinded analysis Laryngoscope, 134:5021–5027, 2024
Stephanie Misono, Erin Y. Shen, Anna G. Sombrio, Scott Lunos, Jiapeng Xu, Jesse Hoffmeister, Ali Stockness, Lisa Butcher, Daniel Weinstein, Nathaniel T. Gaeckle, Raluca Gray, Jürgen Konczak
Publication date 14-11-2024
This study examined the feasibility and acceptability of laryngeal vibrotactile stimulation (VTS) in people with unexplained chronic cough. Laryngeal VTS use was feasible and acceptable and was associated with modest improvements in cough-related scales. Future studies will further examine laryngeal VTS use for chronic cough.
Objectives Unexplained chronic cough (UCC) is common and has significant impacts on quality of life. Ongoing cough can sensitize the larynx, increasing the urge to cough and perpetuating the cycle of chronic cough. Vibrotactile stimulation (VTS) of the larynx is a noninvasive stimulation technique that can modulate laryngeal somatosensory and motor activity. Study objectives were to assess feasibility and acceptability of VTS use by people with UCC. Secondarily, changes in cough-related quality of life measures were assessed.
Methods Adults with UCC recorded cough measures at baseline and after completing 2 weeks of daily VTS. Feasibility and acceptability were assessed through participant-reported device use and structured feedback. Cough-related quality of life measures were the Leicester Cough Questionnaire (LCQ) and the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ).
Results Nineteen adults participated, with mean age 67 years and cough duration 130 months. Notably, 93% of planned VTS sessions were logged, 94% of participants found the device comfortable to wear, 89% found it easy to operate and 79% would recommend it to others. Pre-post LCQ change achieved a minimal important difference (MID) (mean 1.3 SD 2.4, p = 0.015). NLHQ scores improved, but did not reach an MID.
Conclusions Laryngeal VTS use was feasible and acceptable for use by patients with UCC and was associated with a meaningful improvement in cough-related quality of life. Future studies will include VTS dose refinement and the inclusion of a comparison arm to further assess the potential for laryngeal VTS as a novel treatment modality for UCC.
Level of Evidence4 Laryngoscope, 134:5010–5014, 2024
Emilien Chebib, Guillaume Rougier, Antoine Dubray‐Vautrin, Joey Martin, Wahib Ghanem, Maria Lesnik, Baptiste Sabran, Alexandre Matet, Denis Malaise, Nathalie Cassoux, Rémi Dendale, Olivier Choussy, Nathalie Badois
Publication date 14-11-2024
This article summarizes our findings regarding lymph node evolution inside the parotid gland and submental and submanidbular nodes. We recommend to perform systematically an imaging setup and to perform an extensive neck dissection involving IA (submental areas) et IB (submandibular areas) areas when facing a lymph node evolution. Parotidectomy should be proposed only if pathological.
Objectives To describe a large cohort of eyelid and periorbital SCCs, to compare the location of the tumor and of the pathological lymph nodes, and to analyze the risk factors for lymph node involvement among tumor characteristics.
Methods All patients managed inside our institution for an eyelid and periorbital SCCs were included. Tumor characteristics, imaging setup, excision margins, lymph node evolution features, local, regional, and distant recurrences rates, and global survival were reported. The risk for lymph node involvement and location of pathological lymph nodes were analyzed through univariate and multivariate analyses.
Results Between January 2012 and August 2022, 115 patients were included, and 18 presented a lymph node evolution (15.7%), involving the parotid gland in 16 cases (88.9%), the submental and submandibular areas in seven cases (38%), and the jugular and carotid areas in four cases (22%). Tumor size above 20 mm, infiltration of the external canthus and periorbital structures, the presence of perineural invasion or vascular embolism, the depth of infiltration, and the presence of a local recurrence were significantly associated with the risk of lymph node evolution.
Conclusion Periorbital and eyelid SCCs present a true potential for lymph node evolution especially through the parotid gland. Extension setup including the parotid gland and neck should be mandatory, and lymph node dissection should be associated in case of parotidectomy for lymph node involvement.
Level of Evidence4 Laryngoscope, 134:4956–4963, 2024
Abdiasis Abdilahi, Seth Ramin, Cassandra Meyer, Sivakumar Chinnadurai, Noelle Morrell, Robert Tibesar, Brianne Roby
Publication date 14-11-2024
This study aimed to assess the effect of palatoplasty on growth velocity in undernourished and nourished orally fed children with cleft palate. Palatoplasty did not clinically improve growth velocity for undernourished children.
Objectives To assess the effect of palatoplasty on growth velocity in undernourished and nourished orally fed children with cleft palate.
MethodsA retrospective chart review was conducted using a data query with cleft-associated ICD-10 and ICD-9 codes to identify children who underwent cleft palate repair between 2006 and 2022 at a tertiary pediatric hospital. Data gathered included demographics, admission variables, weight gain, and weight percentile as per the WHO growth chart data. Inclusion was limited to patients with complete growth data and without parenteral feeding support. Nutritional status was defined as undernourished (≤3rd percentile) and nourished (>3rd percentile). Between and within-group comparisons were made using nonparametric tests.
ResultsA total of 192 patients met the study criteria. Among undernourished patients, the median pre- and postsurgical weekly weight gain was 0.09 kg and 0.05 kg (p = <0.0001), and the median growth percentiles were 0.67% and 1.1%, respectively (p = 0.03). Among nourished patients, the median pre- and postsurgical weekly weight gain was 0.12 kg and 0.07 kg (p = <0.0001), and the median growth percentiles were 25.4% and 29.5%, respectively (p = <0.0001). The postsurgical reduction in weight gain per week was similar across nutritional status (p = 0.43), however, the nourished group demonstrated a larger increase in median growth percentile (3.3% vs. 0.23%; p = 0.03).
Conclusion This study demonstrates that palatoplasty does not independently improve growth velocity in children who were able to maintain an oral preoperative diet. In the case of undernourished children, there was no clinically significant improvement in postoperative growth percentiles.
Level of Evidence3 Laryngoscope, 134:5145–5151, 2024
Tyler J. Gallagher, Malaika Jamal, Janet S. Choi
Publication date 14-11-2024
This study is a cross-sectional cohort study based on the 2017–2020 National Health and Nutrition Examination Survey examining the association between onset and etiology of hearing loss and psychosocial outcomes. On multivariable regression, this study found an association between early onset hearing loss and social avoidance and depression. This study suggests the need for further studies to assess the ability of hearing screening and intervention to alleviate the psychosocial impacts of early onset hearing loss suggested by the association in this study.
Objective Understand the differential association of onset and etiology of hearing loss with psychosocial outcomes among older adults.
Methods This is a cross-sectional cohort study based on 2017–2020 National Health and Nutrition Examination Survey. Adults aged ≥70 years who completed audiometric testing and questionnaires on onset and etiologies of hearing loss were included (n = 612). Outcomes included report of social avoidance and major depressive disorder (MDD, PHQ-9). Multivariable regression was utilized to examine differential associations of onset and etiology of hearing loss on psychosocial outcomes while adjusting for relevant factors.
Results In this nationally representative sample of US older adults with hearing loss, 20.8% 95%CI: 14.5–29.0% reported social avoidance due to hearing loss and 7.2% 95%CI: 4.3–11.8 reported symptoms suggestive of MDD. Multivariable regression demonstrated self-reported onset of hearing loss between ages 6–19 years (OR:2.49 95%CI: 1.52–4.10) and 20–59 years (OR:1.95 95%CI: 1.07–3.55) was associated with higher avoidance of social interaction than reported onset at ≥70 years. Those with onset between 20–59 years (OR:4.28 95%CI: 1.17–15.6) and 60–69 years (OR:5.68 95%CI: 1.85–17.5) were more likely to report symptoms consistent with MDD than those with onset at ≥70. Multivariable regression did not demonstrate increased risk of avoiding social interactions or MDD due to hearing loss from noise exposure, ear infection, or ear disease versus aging alone.
Conclusion There was an association between earlier hearing loss onset with social avoidance and MDD. This suggests a need for research to investigate the impact of earlier diagnosis and intervention for hearing loss on psychosocial outcomes.
Level of Evidence2b Laryngoscope, 134:5073–5079, 2024
Clare Moffatt, Pranati Pillutla, Payam Soltanzadeh, Dinesh K. Chhetri
Publication date 14-11-2024
Patients with myasthenia gravis may present de novo with primary otolaryngology complaints, including swallowing dysfunction. This study describes a range of unique presentations and rare diagnostic serologies which have not previously been fully described.
Introduction Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. MG patients may present de novo with primary otolaryngology complaints, including swallowing dysfunction. This study describes a range of unique presentations and rare diagnostic serologies, which have not previously been fully described.
MethodsA retrospective review was performed of all patients presenting with primary symptom of dysphagia and subsequently diagnosed with MG. Data collected included demographics, clinical presentation, swallow studies, serology, imaging, treatment, and response.
Results Five patients met the inclusion criteria. Four endorsed dysphagia as primary complaint and one endorsed dysphagia and dysphonia. All patients underwent in-office swallow evaluations that showed vallecular or pyriform sinus residue. Three patients completed modified barium swallow studies that showed pharyngeal weakness and epiglottic dysfunction in all, and upper esophageal sphincter dysfunction in two. One patient with additional symptom of dyspnea was admitted and found to be in myasthenic crisis. Upon serologic evaluation, three patients were positive for acetylcholine receptor (AChR) antibodies only, one for muscle-specific-kinase (MuSK) antibodies only, and one for low density lipoprotein receptor-related protein 4 (LRP4) antibodies only. All patients received neurology evaluation and were treated with steroids, pyridostigmine, plasma exchange, or rituximab. In three patients with over 1 year follow-up, symptoms were significantly improved or resolved.
ConclusionMG is an important differential diagnosis in patients with unexplained pharyngeal dysphagia. While workup can include AChR antibody screening, in seronegative patients with persistent symptoms, additional testing for MuSK and LRP4 may lead to diagnosis and effective treatment.
Level of Evidence4 Laryngoscope, 134:4903–4910, 2024
Samantha Goh, Jennifer M. Siu, Justine Philteos, Adrian L. James, Olivia Ostrow, Nicole K. McKinnon, Tobias Everett, Mark Levine, Hilary Whyte, Christopher Z. Lam, Evan J. Propst, Nikolaus E. Wolter
Publication date 14-11-2024
Esophageal button battery (BB) impaction can cause severe and life-threatening injuries and majority of presentations require transfer to tertiary institutions for removal. Delays in recognition and management prolong time to removal which puts patients at risk. This study reports the impact our institutional protocol had on the time to removal of BB in children. Our results demonstrated that rapid transfer and effective communication across hospitals and services are critical in the success of such protocols.
Objective Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.
Methods We developed a protocol for esophageal BB management Zakais Protocol (ZP). All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated.
Results Fifty-one patients (38 pre-ZP, 13 post-ZP) were included. Median age was 2.3 years (IQR 1.3–3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h 4.6 h (IQR 3.9–6.5) to 0.4 h (IQR 0.3–0.6), p < 0.001 and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x-ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%.
Conclusion Implementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications.
Level of Evidence3, Case-series Laryngoscope, 134:5170–5177, 2024
Samuel Bellavance, Michel Khoury, Isabelle Fournier, Jérôme Costisella, Annie Lapointe, Chantal Giguère, Marie‐Joëlle Doré‐Bergeron, Mathieu Bergeron
Publication date 14-11-2024
Objectives Tympanostomy tube insertion (TTI) under local anesthesia (LA) is gaining popularity but literature comparing long-term outcomes for children undergoing TTI under LA versus general anesthesia (GA) is limited. This study compares the long-term quality of life (QoL) between LA and GA in children undergoing TTI. Secondary objectives included long-term behavioral changes, parental satisfaction, tube durability, and postoperative complications.
Methods We prospectively followed children aged under 6 who underwent TTI, under LA or GA, 2 years prior. We assessed QoL using validated scales (OM6, PedsQL), analyzed behavioral changes and parental satisfaction through qualitative scales, and retrieved data on tube durability and non-immediate complications.
ResultsA total of 84 children (LA = 42; GA = 42) had complete data and a minimum of 1 year of follow-up. Demographic data were similar, except for younger patients in the LA group (1.4 vs. 1.9 years, p = 0.02). LA group exhibited increased fear of health care professionals following TTI (LA: Likert scale 2.1/5, GA: 1.5/5, p = 0.04). Tube retention rate was shorter in the LA group (at 15 months: GA:72%, LA:50%, p = 0.039). Two years post-TTI, there were no differences regarding QoL (OM-6 score; LA: 15.2/100, GA: 21.4/100, p = 0.18, and PedsQL score; LA: 84.3/100, GA: 83.8/100, p = 0.90), parental satisfaction with anesthesia (GA: 4.5/5, LA: 4.6/5, p = 0.56), and postoperative complications (GA: 3/42, LA: 7/42, p = 0.18).
ConclusionsTTI under LA in children is associated with an increased fear of health care professionals and shorter functionality of tympanostomy tubes as compared to GA. No difference was observed in long-term QoL, parental satisfaction, and complications rate.
Level of Evidence3 Laryngoscope, 134:5178–5183, 2024
Margo K. McKenna, Casey Rosen‐Carole, Michele Burtner, John L. Wilson, Suzie Greenman, Shalini Shah, Paul Allen
Publication date 14-11-2024
This article compares ankyloglossia in the neonatal intensive care unit (NICU) population to infants in the standard birth center (BC). In NICU infants, function scores after frenotomy were significantly improved compared to pre-frenotomy, potentially allowing earlier discharge to home. We propose a protocol for how to assess and treat infants in the NICU suspected of having symptomatic ankyloglossia.
Objective We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC).
Methods Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue-tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared.
Results Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre-frenotomy (p < 0.01).
Conclusion Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue-tie can be one critical intervention to move these patients closer to oral feeding and discharge to home.
Level of Evidence3 Laryngoscope, 134:5152–5159, 2024
Jordan Garcia, Lekha Yesantharao, Kevin D. Frick, Carole Fakhry, Wayne Koch, Wojtech Mydlarz, David W. Eisele, Christine G. Gourin
Publication date 14-11-2024
This study used the NIS to identify high-cost patients treated surgically for head and neck cancer. High-cost patients were associated with more than 4-fold higher costs of care, with greater comorbidity, higher complexity, mortality, and postoperative morbidity and were disproportionately cared for at teaching hospitals. Health system-level innovations are needed to improve quality and reduce costs in this population.
Objective Health care costs are disproportionately concentrated among a small number of patients. We sought to identify variables associated with high-cost patients and high hospital concentration of high-cost patients and to examine associations with short-term outcomes in head and neck cancer (HNCA) surgery.
Study Design The Nationwide Inpatient Sample was used to identify 170,577 patients who underwent HNCA surgery in 2001–2011. High-cost patients were defined as patients whose costs of care were in the top decile, and high-concentration hospitals were defined as those whose percentage of high-cost patients was in the top decile.
Methods Multivariable regression was used to evaluate associations between cost and patient and hospital variables, postoperative complications, and in-hospital mortality.
Results Costs associated with high-cost patients were 4.47-fold greater than the remaining 90% of patients. High-concentration hospitals treated 36% of all high-cost patients. High-cost patients were more likely to be non-white (OR = 2.08 1.45–2.97), have oral cavity cancer (OR = 1.21 1.05–1.39), advanced comorbidity (OR = 1.53 1.31–1.77), Medicaid (OR = 1.93 1.62–2.31) or self-pay payor status (OR = 1.72 1.38–2.14), income>50th percentile (OR = 1.25 1.05–1.51), undergo major procedures (OR = 3.52 3.07–4.05) and have non-routine discharge (OR = 7.50 6.01–9.35). High-concentration hospitals were more likely to be teaching hospitals (OR = 3.14 1.64–6.05) and less likely to be urban (OR = 0.20 0.04–0.93). After controlling for all other variables, high-cost patients were associated with an increased odds of mortality (OR = 8.00 5.89–10.85) and postoperative complications (OR = 5.88 5.18–6.68). High-concentration hospitals were associated with an increased odds of postoperative complications (OR = 1.31 1.08–1.61) but were not associated with increased mortality (OR = 0.98 0.67–1.44).
Conclusions High-cost HNCA surgical patients are associated with increased postoperative morbidity and mortality, and are disproportionately concentrated at teaching hospitals.
Level of Evidence4 Laryngoscope, 134:4971–4978, 2024
Antonio A. Bon‐Nieves, Lazaro R. Peraza, Zinnarky K. Ortiz‐Correa, Daniel L. Price, Carlos D. Pinheiro‐Neto
Publication date 14-11-2024
In this article, we aim to introduce a new method for treating palatal defects caused by resection of a mass using the ccNSF. This was in conjunction of assessing the average NSF area and compared it to the average palate area. This is a retrospective cohort study looking at 108 head CT scans of non-apparent head and neck pathology or trauma. Our primary outcome is to compare the area of the composite chondromucosal nasoseptal flap with the area of the hard palate.
Objective The use of composite chondromucosal nasal septal flaps (ccNSF) has been demonstrated to be effective in cadaveric studies for the anterior skull base and the orbit. However, their application in the clinical setting remains unexplored. Our study aims to introduce a new method for treating palatal defects using ccNSF. Additionally, we studied the average NSF area and compared it to the average palate area.
Methods We collected 108 CT scans from the medical records of patients without head and neck pathologies from a tertiary medical institution. We quantified the quadrangular (septal) cartilage and palate areas. Furthermore, we included a clinical case in which we used the ccNSF for the palatal defect reconstruction. This was to compare the mean area between the palate and the septal cartilage.
Results The ccNSF covered the palatal defect without any significant complications for the first 9 months of follow-up. A total of 102 CT scans met the inclusion criteria and were measured. We found that the mean quadrangular cartilage had a length of 2.50 (±0.52) cm, a width of 2.28 (±0.51) cm, and an area of 5.43 (±1.68) cm2. The mean palate length was 2.73 (±0.44) cm, with a width of 3.13 (±0.34) cm, and area of 7.87 (±1.43) cm2.
Conclusions The ccNSF proved successful in palatal defect reconstruction, resulting in positive outcomes and no major complications until the 9-month follow-up. The ccNSF is a useful flap that avoids the use of free flap transfer and its associated morbidities.
Level of Evidence4 Laryngoscope, 134:4882–4887, 2024
Al‐Rahim Habib, Graeme Crossland, Raymond Sacks, Narinder Singh, Hemi Patel
Publication date 14-11-2024
Since 2011, a tele-otology service in Northern Territory, Australia has conducted 13,726 ear exams on 3,950 Aboriginal and Torres Strait Islander individuals from 93 communities, averaging 759 reviews per year. Approximately 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss.
The results of this review confirm that the service has made substantial progress in addressing ear disease in this critically underserved population, but key areas requiring further attention have been identified. This tele-otology service may serve as a reference for future telehealth services in rural and remote settings to optimize service delivery for ear health and hearing assessments for First Nations people.
Objective To evaluate a referral-based, tele-otology service in rural and remote areas of the Northern Territory, Australia.
MethodsA retrospective observational cohort study was performed of a tele-otology service in 93 Aboriginal and Torres Strait Islander communities (2011 to 2019). Assessments included face-to-face examinations performed by Clinical Nurse Consultants and audiologists, and asynchronous reviews performed by otolaryngologists. Multivariable logistic regression was performed to determine the likelihood of ear disease, adjusted for age and gender. Intra- and inter-rater agreement was assessed between otolaryngologists.
ResultsA total of 3,950 patients were reviewed (6,838 encounters, 13,726 ear assessments). The median age of patients was 9.8 years (interquartile range: 7.2 years). Overall, 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss. Substantial intra- and inter-rater agreement in diagnosis was found between otolaryngologists (κ = 0.71 and κ = 0.78, respectively). The most common ear conditions identified were chronic otitis media (COM, 28.1%) and otitis media with effusion (OME, 16.5%). Topical or oral antibiotics were initiated in 14.1% of all encounters, most often for acute otitis media or COM. Surgery was recommended in 27.7% of all encounters, most often myringoplasty, adenoidectomy, and myringotomy with insertion of tympanostomy tubes.
Conclusion Tele-otology is a critical component of an integrated approach to evaluating ear disease in Indigenous people living in rural and remote areas. The high prevalence of OME, COM, and surgical recommendations highlights the need for community engagement, regular follow-up, and early interventions to prevent long-term hearing loss.
Level of EvidenceNA Laryngoscope, 134:5096–5102, 2024
Christian M. Meerwein, Kachorn Seresirikachorn, Blake Lindsay, Peta‐Lee Sacks, Larry Kalish, Raewyn G. Campbell, Ray R. Sacks, Richard J. Harvey
Publication date 14-11-2024
This study aims to assess the developmental attributes of sphenoid sinuses affected by fungal balls and describe a surgical approach which reestablishes gravity-dependent drainage to compensate for any mucociliary dysfunction. We found that the smaller or nondominant sphenoid sinus is more affected by sphenoid sinus fungal ball. Surgical reshaping of the sphenoid to prevent mucostasis is favorable in managing the smaller affected sinus cavity.
Objectives The aim was to assess the developmental attributes of sphenoid sinuses affected by fungal balls and describe a surgical approach which reestablishes gravity-dependent drainage to compensate for any mucociliary dysfunction.
MethodsA within-patient case–control analysis was performed on sphenoid sinus dimensions from patients with sphenoid sinus fungal ball (SSFB). Radiological dimensions were assessed to determine the dominant or larger sinus by volume and width. Pneumatization in the sagittal and lateral extent was assessed. The influence of sinus size and pneumatization variants within a patient was analyzed. Patency and the presence of mucostasis from radical reshaping of the sinus cavity were documented at least 3 months after surgery. Complications (bleeding, cerebrospinal fluid leak, and cranial nerve palsy) were recorded.
Results Twenty-three patients (59 ± 19 years, 86% female, 46 sphenoid sinuses) were assessed. Fungal ball was more common in the smaller (non-dominant) sinus, by width (78% vs. 22%, p < 0.01) and by proportion of total sphenoid volume (0.39 ± 0.16 vs. 0.61 ± 0.16, p < 0.01). Pneumatization variants did not influence the development of SSFB within a patient. All patients had patency and the absence of mucostasis or persistent inflammation at last follow-up. No complications were reported.
Conclusion The smaller or nondominant sphenoid sinus is more affected by SSFB. Surgical reshaping of the sphenoid to prevent mucostasis is favorable in managing the smaller affected sinus cavity.
Level of Evidence4 Laryngoscope, 134:4888–4892, 2024
Anisha R. Noble, Robert J. Fleck, Matthew T. Maksimoski, Kevin McElfresh, Yann‐Fuu Kou, Meredith E. Tabangin, Alessandro de Alarcón
Publication date 14-11-2024
This is a study highlighting the benefit of dynamic voice computed tomography in the diagnosis and management of pediatric posterior glottic diastasis. Dynamic CT can measure the size of a posterior glottic gap and determine the amount of cricoid to be removed during endoscopic cricoid reduction. All patients demonstrated improvement in dysphonia postoperatively. Results seek to optimize management of pediatric posterior glottic diastasis and present a safe and effective amount of cricoid to remove during surgery.
Objectives Posterior glottic diastasis (PGD) is an underappreciated etiology of dysphonia in patients with prior airway reconstruction or prolonged intubation. In endoscopic posterior cricoid reduction (ePCR), cricoid is removed to minimize the posterior glottic gap. Dynamic voice computed tomography (DVCT) permits visualization of the posterior glottis, estimating the amount of cricoid to be removed. Posterior glottic gaps in patients undergoing ePCR were compared to non-dysphonic patients to describe pediatric PGD and establish surgical parameters for ePCR.
MethodsDVCTs performed in non-dysphonic patients and dysphonic patients undergoing ePCR from 2014 to 2023 were reviewed. EPCR operative reports were queried. Pre- and postoperative Pediatric Voice Handicap Index (pVHI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and aerodynamic measures were reviewed.
Results Seventeen pediatric patients who underwent ePCR and 19 non-dysphonic patients were included. Posterior glottic gaps were significantly larger in the dysphonic group (median 2.
4 mm IQR: 2.0, 2.8 vs. 1.
3 mm IQR: 1.1, 1.7, p < 0.001). Mean width of the cricoid removed was 1.6 mm (SD 0.4 mm). Mean (SD) pre- and postoperative pVHI scores were 55.5 (19.9) and 34.6 (16.0; p < 0.001). Mean (SD) pre- and postoperative CAPE-V scores were 52.7 (15.4) and 36.5 (20.4; p < 0.001), respectively.
Conclusions Children in this cohort tolerated an average 1.3 mm posterior glottic gap without dysphonia. Dysphonic patients with PGD had a median 2.4 mm gap and underwent cricoid reduction by 1.6 mm. All ePCR patients demonstrated improvement in dysphonia. Results seek to optimize the management of pediatric PGD and present a safe and effective amount of cricoid to remove during ePCR.
Level of Evidence4 Laryngoscope, 134:5139–5144, 2024
Elizabeth O. Shay, Rachel A. Morrison, Lujuan Zhang, Samuel L. Kaefer, Troy Wesson, Abigail Cox, Sherry L. Voytik‐Harbin, Stacey Halum
Publication date 14-11-2024
Curative injectable therapies are needed for the treatment of vocal fold paralysis. Herein, we describe the use of an in situ polymerizing (scaffold-forming) collagen with and without muscle-derived motor-endplate expressing cells for injection into the vocal fold of a porcine model of unilateral vocal fold paralysis. Our results demonstrate that this novel approach is well-tolerated, promotes medialization, and provides a microenvironment for recurrent laryngeal nerve innervation.
Objective Vocal fold paralysis impairs quality of life, and no curative injectable therapy exists. We evaluated injection of a novel in situ polymerizing (scaffold-forming) collagen in the presence and absence of muscle-derived motor-endplate expressing cells (MEEs) to promote medialization and recurrent laryngeal nerve (RLN) regeneration in a porcine model of unilateral vocal fold paralysis.
Methods Twelve Yucatan minipigs underwent right RLN transection. Autologous muscle progenitor cells were isolated from muscle biopsies, differentiated, and induced to MEEs. Three weeks after RLN injury, animals received injections of collagen, collagen containing MEEs, or saline into the paralyzed right vocal fold. Stimulated laryngeal electromyography and acoustic vocalization were used for function assessments. Larynges were harvested and underwent histologic, gene expression, and further quantitative analyses.
Results Injections were well-tolerated, with the collagen scaffold showing immunotolerance and collagen-encapsulated MEEs remaining viable. Collagen-treated paralyzed vocal folds showed increased laryngeal adductor muscle volumes relative to that of the uninjured side, with those receiving MEEs and collagen showing the highest volumes. Muscles injected with MEEs and collagen demonstrated increased expression of select neurotrophic (BDNF and NTN1), motor-endplate (DOK7, CHRNA1, and MUSK), and myogenic (MYOG and MYOD) related genes relative to saline controls.
Conclusion In a porcine model of unilateral vocal fold paralysis, injection of in situ polymerizing collagen in the absence and presence of MEEs enhanced laryngeal adductor muscle volume, modulated expression of neurotrophic and myogenic factors, and avoided adverse material-mediated immune responses. Further study is needed to determine long-term functional outcomes with this novel therapeutic approach.
Level of EvidenceNA Laryngoscope, 134:4988–4997, 2024
Juan Pablo Dueñas, Nathalia Buitrago‐Gómez, José Hugo Arias‐Botero, Gregory Randolph, Marika Russell, Amr Abdelhamid Ahmed, Roberto Valcavi, Carlos Simón Duque, Ralph P. Tufano
Publication date 14-11-2024
Electrical parameters, particularly the mean procedural impedance, are associated with the success of RFA as measured by the VRP. The importance of this lies in the fact that several of these variables can be altered by the physician conducting the procedure (power, impedance and impedance peaks), offering the possibility of enhancing ablation efficacy and discovering improved techniques.
Objective Radiofrequency ablation (RFA) uses the heat generated by a high-frequency alternating electric current, and according to Ohms and Joules law, the delivered current is inversely proportional to the circuit impedance. The primary objective of this study was to investigate whether tissue impedance during radiofrequency ablation (RFA) for benign thyroid nodules is related to the degree of volume reduction.
Methods This observational study included consecutive patients treated with RFA for benign thyroid nodules from February 2020 to August 2023. Technical effectiveness was defined as a volume reduction percentage (VRP) >75% at 6 months after the treatment. Multivariate logistic regression analyses were performed to identify the potential role of clinical factors and changes in tissue impedance on technique effectiveness.
Results Totally 72 patients were included with 73 benign thyroid nodules. Maximal impedance peaks reached <18 times, and mean procedural impedance ≤300 Ω were significantly associated with a volume decrease of >75% at bivariate analysis. These cutoff points were exploratory, as no existing literature suggests these variables are related to the degree of volume reduction. After adjusting for age, volume, and composition, significant associations were found for mean electrical impedance in the multivariate analysis (OR = 4.86 confidence interval CI 1.29–18.26, p = 0.019). The energy adjusted by volume (delivered energy) was not associated with a VRP >75% (p = 0.7746).
Conclusions This study suggests that a mean procedural impedance </= 300 Ω is related to the effectiveness of RFA as measured by VRP. Additional prospective and randomized studies are needed to compare electrical parameters with VRP.
Level of Evidence3 Laryngoscope, 134:5231–5238, 2024
Simon R. Best, Jonathan M. Bock, Nicole B. Fowler, Eric H. Raabe, Adam M. Klein, Theodore W. Laetsch, Kim McClellan, Rico N.P.M. Rinkel, Nabil F. Saba, Douglas R. Sidell, James B. Tansey, David E. Tunkel, Geoffrey D. Young, Karen B. Zur
Publication date 14-11-2024
This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP.
Objective To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real-world clinical experience.
MethodsA bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method-based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy.
Results Seventy-nine statements were identified across nine critical domains, and 45 reached consensus clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision-making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3).
Conclusion This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP.
Level of Evidence5 Laryngoscope, 134:5041–5046, 2024
Ulrik Steen Nielsen, Eva R. Rasmussen, Marie R. Rosenørn, Andreas P Schjellerup Jørkov, Preben Homøe
Publication date 14-11-2024
Incidence and demography of recurrent respiratory papillomatosis in Denmark from 1994 to 2021 were analyzed using SNOMED codes and a national data bank to extract every incidence in the period, proving to be a valuable way to extract data showing high recurrence rates in children under the age of 3 and decreasing incidence in the study period.
Objectives The aim of this study is to describe the incidence and demographics of laryngeal papillomatosis (LP) in Denmark, including sex and age distribution, recurrence rates, and HPV subtypes, using a new method of register identification.
Methods The data were extracted from the Danish Pathology Data Bank using SNOMED codes instead of the usual method using ICD codes from the Danish National Health Register. The derived pathology records were manually verified by three medical doctors. The study period was 1994–2021. Patients were categorized according to age as either juvenile-onset RRP (JoRRP) if <18 years or adult-onset RRP (AoRRP) if 18 years or older.
Results We identified 1819 RRP patients (JoRRP: 56; AoRRP:1763). The overall incidence per 100,000 inhabitants were 0.17 for JoRRP and 1.45 for AoRRP. The vast majority (72%) of the patients were male, but there was no significant difference in age at onset of RRP or recurrence rates between the sexes. Children below 3 years of age had the highest recurrence probability. Extracting data using SNOMED codes resulted in a positive predictive value of 99% regarding total number of biopsies and 98% regarding individuals. The incidence decreased throughout the study period.
Conclusion Comparable incidence and recurrence rates of RRP were found between Denmark and Norway. In this study, the Danish Pathology Register was found to be a highly valuable method for identifying LP patients. The effect of the nationwide HPV vaccination program can be evaluated using this method as the vaccinated cohort is starting to grow older and reproduce.
Level of Evidence Retrospective registry-based national cohort study, 3 Laryngoscope, 134:5047–5053, 2024
Mihai A. Bentan, Emaan Dawood, David Moffatt, Maria V. Suurna, Ryan Nord
Publication date 14-11-2024
Objective Hypoglossal nerve stimulation (HNS) can be an effective treatment for moderate to severe obstructive sleep apnea (OSA) in positive airway pressure (PAP) intolerant patients. To better understand patient experiences with HNS therapy, we explored reported events from HNS-related Facebook groups and the Manufacturer and User Facility Device Experience (MAUDE) database.
MethodsA retrospective analysis of HNS-related Facebook posts from three groups pertaining to HNS therapy, from October 1, 2022 to October 1, 2023, was performed. Posts were analyzed for patient-reported adverse events. Concurrently, the MAUDE database was reviewed for HNS-related events during the same timeframe.
Results From 737 Facebook posts, 132 (17.55%) adverse events were identified. Adverse events included pain (34.85%), stimulation discomfort (14.39%), lip weakness (6.82%) and issues related to lead tethering or tight leads around the neck (3.79%). Analysis of the MAUDE database found 428 adverse events, including pain (24.07%), lip weakness (0.44%), and lead tethering (1.64%).
Conclusion Facebook group members reported higher rates of lip weakness and lead tethering than recorded in the MAUDE database. These findings illustrate how diverse data sources, such as social media, can enhance our understanding of patient experiences and identify gaps in patient education with HNS therapy.
Level of EvidenceNA Laryngoscope, 134:5217–5222, 2024
Akash S. Halagur, Uchechukwu C. Megwalu
Publication date 14-11-2024
Objectives To determine whether limited English proficiency (LEP) is associated with likelihood of prior audiogram and hearing aid use among US adults with hearing loss.
Methods This cross-sectional study of four merged National Health and Nutrition Examination Survey (NHANES) cycles included 12,636 adults with subjective (self-reported) or objective (audiometric) hearing loss. Subjects were classified as LEP if they completed the NHANES survey in a language other than English, or with the help of an interpreter. Likelihood of audiogram among participants with subjective and objective hearing loss, and likelihood of hearing aid use among participants with objective hearing loss were assessed using unadjusted and adjusted logistic regression.
Results Individuals with LEP were less likely to have undergone audiogram among subjects with subjective (odds ratio OR 0.72, 95% confidence interval CI 0.67–0.77), and objective (OR 0.70, 95% CI 0.65–0.74) hearing loss. The association persisted for those with subjective hearing loss (OR 0.79, 95% CI 0.72–0.86), and objective hearing loss (OR 0.81, 95% CI 0.73–0.89) after adjusting for relevant covariates. Individuals with LEP were less likely to use hearing aids (OR 0.88, 95% CI 0.84–0.93). This association disappeared (OR 0.99, 95% CI 0.95–1.04) after adjustment.
ConclusionLEP is associated with lower utilization of hearing healthcare services. This may be due to the complex interplay of socioeconomic and language disparities, which may act as barriers to hearing healthcare utilization. Individuals with LEP should be prioritized when designing interventions to improve accessibility to hearing healthcare.
Level of Evidence3 Laryngoscope, 134:5122–5130, 2024
Ethan J. Han, Krishna K. Bommakanti, Maie A. St. John
Publication date 14-11-2024
Medullary thyroid carcinoma (MTC) comprises less than 5% of thyroid cancers but is responsible for over 10% of deaths related to thyroid cancer. Regional lymph node metastasis is common and associated with mortality, thus total thyroidectomy with central compartment lymph node dissection is the standard surgical treatment for MTC. In this best practice submission, we aim to review the existing literature and determine whether calcitonin levels can serve as a reliable method for risk-stratifying MTC without overt lymph node involvement.
Pubmed PDF WebPublication date 14-11-2024
David E. Melon, Harold C. Pillsbury III,, Willard C. Harrill
Publication date 14-11-2024
The study is a cross-sectional observational study of allergen-specific immunotherapy (AIT) adherence and premature cessation in a single Otolaryngology practice over 5 years. Only a small percentage of patients completed the minimum recommended duration of AIT, and that most patients discontinued therapy in the first year for various reasons, often unknown. The study developed an Otolaryngic Allergy Patient Journey Map (OAPJM) to identify potential predictors of nonadherence and outlines a framework for harnessing enhanced intelligence to improve patient outcomes and reduce health care costs.
Objectives Allergen-specific immunotherapy (AIT) is an effective treatment for allergic disease but requires long treatment duration and premature cessation is of significant concern. Drivers of premature cessation remain poorly understood and no predictive models currently exist. We hypothesized that a novel patient journey map and de novo real-time patient electronic health status instruments (eHSIs) could effectively capture patient perceived cost, commitment, and treatment benefit to identify individual patients at risk for premature AIT cessation.
Study Type Cross-Sectional Observational Study.
MethodsA single Otolaryngology allergy immunotherapy (AIT) program was studied over 5 years. Instances of premature cessation were classified. An Otolaryngic Allergy Patient Journey Map was developed to identify and target automated, real-time, patient-reported, electronic health status instrument responses.
Results Data capture was robust, with 61,406 data points collected and an eHSI survey completion rate of 81.3%. However, based on correlation analysis and logistic regression alone, real-time eHSI responses were not predictive of individual patient premature AIT cessation.
A total of 597 AIT patients discontinued treatment prematurely: 64.4% stopping within the first year. Specifically, 74.0%–76.3% of subcutaneous AIT patients and 88.5%–100% of sublingual AIT patients did not complete the minimum recommended treatment duration of 3 years.
Conclusion Patient journey mapping can aid in the design of longitudinal care models and patient engagement strategies. Yet, eHSI patient responses of perception of AIT cost, benefit, and convenience did not correlate with the likelihood of premature treatment cessation. Our imperfect clinical intuition may not account for the dynamic drivers of premature AIT discontinuation. Future development of predictive tools feed by large patient-centric data sets may be incorporated into routine practice resulting in delivery of a more streamlined and personalized approach with reduced premature AIT cessation, improved outcomes, and reduced health care expenditures.
Level of EvidenceNA Laryngoscope, 134:S1–S14, 2024
Jennifer M. Siu, Shaunak Amin, Evan J. Propst, Nikolaus E. Wolter, Jeremy Prager, Michelle Wyatt, Claire Lawlor, Douglas Sidell, Deepak Mehta, Reema Padia, Nicholas Smith, Christopher Hartnick, Catherine K. Hart, Xing Wang, Kaalan Johnson
Publication date 13-11-2024
Multi-institutional validation of the Interarytenoid Assessment Protocol demonstrates strong inter- and intra-rater reliability for assessment of IAMH. Standardization of anatomical evaluations may improve our ability to perform more reliable outcomes studies of pediatric pharyngeal dysphagia in the future.
Background Current assessment techniques for determining whether a patient has normal interarytenoid anatomy, a deep interarytenoid notch, or a minor laryngeal cleft are highly variable. However, differentiating between these three entities is important, given it may distinguish whether a patient should be considered for surgical intervention. The Interarytenoid Assessment Protocol (IAAP) was developed to provide standardization of interarytenoid anatomy evaluations. We aimed to assess the reliability of the IAAP for assessment of interaytenoid mucosal height (IAMH) through a multi-institutional validation study.
Methods Reliability of the IAAP was assessed by 10 pediatric otolaryngologists all from different academic centers. 30 de-identified endoscopic videos of interarytenoid assessments were rated at two separate time points, 2 months apart. Intra-class correlation (ICC) coefficients with two-way models were used to evaluate inter- and intra-rater reliability.
Results Thirty endoscopic videos were collected for patients with a median (IQR) age of 4.9 years (59 months; range: 1 month to 20 years). On the first video assessment, inter-rater reliability was 0.74 (95% CI 0.63–0.84), and on the second video assessment, inter-rater reliability was 0.75 (95% CI 0.63–0.85) indicating strong inter-rater reliability. Overall intra-rater test–retest reliability was 0.75 (95% CI 0.69–0.79) indicating strong agreement. In almost half, 14 (46.6%) raters chose IAAP classification levels within 1 level of each other.
Conclusions Multi-institutional validation of the IAAP demonstrates strong inter- and intra-rater reliability for assessment of IAMH when evaluated through pictorial analysis. Standardization of anatomical evaluations may improve our ability to perform more reliable outcomes studies of pediatric pharyngeal dysphagia in the future.
Level of EvidenceNA Laryngoscope, 2024
Troy Wesson, Satyajit Ambike, Radha Patel, Charles Yates, Rick Nelson, Alexander Francis, Sarah Burgin
Publication date 13-11-2024
Insertional speed of cochlear implant electrode arrays (EA) during surgery is correlated with force. Low insertional speed, and therefore force, may allow for preservation of intracochlear structures leading to improved outcomes. Given the importance of low insertional speeds, we investigate the feasibility of using inertial sensors for kinematic analysis during EA insertion to augment otolaryngology-head and neck surgery training.
Objective Insertional speed of cochlear implant electrode arrays (EA) during surgery is correlated with force. Low insertional speed, and therefore force, may allow for preservation of intracochlear structures leading to improved outcomes. Given the importance of low insertional speeds, we investigate the feasibility of using inertial sensors for kinematic analysis during EA insertion to augment otolaryngology-head and neck surgery training.
Methods Practicing otolaryngology surgeons were recruited and inertial measurement units (IMU; Metamotions+, MBIENTLAB Inc, San Jose, CA) consisting of accelerometers were used to measure hand speed during EA (Cochlear™Nucleus®CI522 cochlear implant with Slim Straight electrode, Cochlear Limited, Sydney, Australia) insertion into a cadaveric cochlea. A mixed regression model was utilized to determine differences in speed across trials within a surgeon.
ResultsA total of nine trials were performed by three surgeons. The highest mean ± SD speed obtained was 8.4 ± 1.7 mm/s, and the highest speed was 22.5 mm/s. Mean speed was not significantly different across trials within surgeons (p > 0.05).
DiscussionIMUs are relatively inexpensive and relatively easy to use sensors that provide information on variables that may be of interest for otolaryngology resident training. The use of IMUs as part of advanced temporal training for cochlear electrode insertion can provide insight into hand speed, thereby allowing residents to train with specific regard to this variable. Future randomized-controlled trials can be carried out to determine whether IMUs are conducive to lower insertional speeds.
Level of EvidenceNA Laryngoscope, 2024
Stefanie N.H. Reijers, Jantien L. Vroegop, Pauline W. Jansen, Bernd Kremer, Marc P. van der Schroeff
Publication date 13-11-2024
Our longitudinal findings suggest that children with slight to mild hearing impairments participate in lower levels of education and tend to exhibit more behavioral problems compared with those with normal hearing. Despite the fact that the observed associations are small in magnitude, our study emphasizes that children with elevated hearing thresholds may face difficulties in daily functioning and may require additional support. It may be worth considering the possibility of hearing loss in children who experience difficulties with attention, socialization, or academic performance.
Objective To examine the impact of slight to mild hearing loss in children by studying its association with academic performance and behavioral problems.
Methods This study was embedded within a prospective birth cohort in Rotterdam, the Netherlands. Participants underwent audiometric and behavioral evaluations between ages 9–11 (April 2012–October 2015) and 13–15 (May 2017–September 2019). At 13–15, a multiple linear regression was conducted to explore the relationship between hearing acuity and both academic and behavioral outcomes. A cross-lagged analysis using data from ages 9 to 11 investigated bidirectional associations between hearing loss and behavioral problems.
Results The cross-sectional part of the study involved 4688 participants at the age of 13–15 years. The relative risk for children with slight to mild hearing loss of being placed in a lower educational level compared with the highest level was 1.52 (95% confidence interval (CI) 1.14, 2.02). Among boys, elevated high-frequency pure-tone average (HPTA) was associated with a higher total problem score (per 1 dB HPTA: β = 0.01; 95% CI 0.00, 0.02). For girls, elevated low-frequency pure-tone average (LPTA) was associated with a higher attention problem score (per 1 dB LPTA: β = 0.02; 95% CI 0.01, 0.02). Cross-lagged effects showed that participants with increased pure-tone averages in low frequencies at 9–11 years had more social problems at ages 13–15 years (Z-score difference: 0.01; 95% CI 0.01, 0.02).
Conclusion Elevated hearing thresholds in slight to mild hearing loss were linked to poorer academic performance and increased behavioral problems.
Level of Evidence2 (prospective cohort study) Laryngoscope, 2024
Rema Shah, Sidharth Tyagi, Dheeman Futela, Ajay Malhotra, Benjamin L. Judson
Publication date 12-11-2024
Academic otolaryngology faculty salaries are inequitable across gender and race and measures are needed to address this to improve diversity and equity.
Objectives The aim of this study was to assess recent trends in financial compensation in the field of academic otolaryngology, and distribution based on rank, sex, race/ethnicity, and geographical regions in academic medical centers.
Methods The AAMC Faculty Salary Survey was used, which collects information for full-time faculty at US academic centers. Financial compensation data for otolaryngology faculty with MD or equivalent degree were collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geographical region.
Results The AAMC Faculty Salary Survey data for 2023 included responses for 1641 faculty members from academic otolaryngology departments. Median faculty compensation increased on an average 0.58%–2.81% per year from 2017 to 2023, with the greatest increase at the senior ranks and smaller increases at the Instructor rank. Male faculty members were consistently compensated more than women at all ranks throughout the study period, and the salary gap increased at the higher academic ranks. Black/African American faculty had a lower median compensation compared to White faculty at all ranks. Faculty members in the northeast region had the highest median compensation at all ranks.
Conclusion This study summarizes the trends of otolaryngology faculty compensation and shows persistent salary inequities at academic medical centers in the United States.
Level of EvidenceN/A Laryngoscope, 2024
Cha Dong Yeo, Haeng‐Jin Lee, Jong Seung Kim, Eun Jung Lee
Publication date 12-11-2024
Long-term follow-up revealed that the prevalence of Menieres disease was 1.44 times higher in the atopic dermatitis group compared to the control group. Moreover, older age, female sex, allergic rhinitis, allergic contact dermatitis, and allergic conjunctivitis were identified as factors that increase the risk of developing Menieres disease.
Objectives Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by relapsing and remitting episodes. Although AD is well-known for its association with other allergic conditions, its relationship with Menieres disease has not been thoroughly investigated. This study aimed to explore the potential correlation between AD and Menieres disease.
Methods This study utilized data from the National Health Insurance Service-National Sample Cohort, a nationwide population-based database. The AD group was selected from a cohort of 1 million individuals randomly extracted from database. A non-AD group was obtained through Propensity Score Matching.
Results The AD group comprised 84,579 individuals, with an equal number of individuals in the non-AD (control) group. The overall hazard ratio (HR) for Menieres disease in the AD group was 1.44 (95% confidence interval (CI): 1.31–1.6). Subgroup analysis showed an adjusted HR of 0.42 (95% CI: 0.38–0.48) for Menieres disease in males, 4.99 (95% CI: 4.45–5.62) in the middle-aged group (40–59 years), and 8.21 (95% CI: 7.21–9.35) in the older age group (≥60 years). Additionally, the adjusted HRs for developing Menieres disease were higher in patients with comorbidities, including allergic rhinitis (1.18 95% CI, 1.07–1.32), allergic contact dermatitis (1.32 95% CI, 1.19–1.48), and allergic conjunctivitis (1.54 95% CI, 1.32–1.82).
Conclusion Long-term follow-up revealed that the prevalence of Menieres disease was 1.44 times higher in the AD group compared to the control group. Moreover, older age, female sex, allergic rhinitis, allergic contact dermatitis, and allergic conjunctivitis were identified as factors that increase the risk of developing Menieres disease.
Level of Evidence3 Laryngoscope, 2024
Patrick J. Gaffney, Kunal R. Shetty, Sancak Yuksel, Vivian F. Kaul
Publication date 12-11-2024
Oxidative stress is important to the current understanding of aminoglycoside-induced ototoxicity. This review finds that multiple pharmacotherapies targeting oxidative stress are effective in reducing ototoxicity secondary to aminoglycosides.
ObjectiveA feared complication of aminoglycoside treatment is ototoxicity, which is theorized to be attributed to the production of aminoglycoside-induced reactive oxygen species. Previous studies using animal models have suggested that numerous therapies targeting reducing oxidative stress may prevent ototoxicity from aminoglycosides. However, few clinical studies have been conducted on these antioxidants. This systematic review and meta-analysis examines the effectiveness of antioxidant therapies in the treatment of aminoglycoside-induced ototoxicity.
Data Sources Pub Med, Embase, Web of Science, and Clinical Trials.gov.
Review MethodA literature search was conducted in August 2024. This review sought randomized controlled trials to be conducted on humans to examining otologic outcomes in aminoglycoside-induced ototoxicity following administration of medications intended to reduce oxidative stress.
ResultsA systematic review yielded 2037 results, of which seven studies met inclusion criteria. N-acetylcysteine (NAC) was investigated in four studies, aspirin in two studies, and vitamin E in one study. Six studies examined the benefit of antioxidant treatments for up to 8 weeks after administration while one study tested subjects hearing after 1 year. In pooled analysis, two studies assessing NAC showed the greatest reduction in ototoxicity (RR 0.112, 95% CI, 0.032–0.395; p = 0.0007; I2 = 18%), followed by two studies examining aspirin (RR 0.229, 95% CI, 0.080–0.650; p = 0.0057; I2 = 0%). One study performed with vitamin E did not find a reduction in ototoxicity compared to the placebo (RR 0.841, 95% CI, 0.153–4.617; p = 0.8416).
Conclusions Multiple studies have shown that NAC and aspirin are effective in reducing ototoxicity from treatment with aminoglycosides. However, there is a lack of high-quality evidence. Additional studies should examine whether aspirin and N-acetylcysteine provide long-term benefit, and which of the other promising antioxidants translate from animal models.
Level of EvidenceN/A Laryngoscope, 2024
Kathryn L. Nunes, Victor Jegede, Derek S. Mann, Pablo Llerena, Richard Wu, Leonard Estephan, Ayan Kumar, Sana Siddiqui, Raphael Banoub, Scott W. Keith, Madalina Tuluc, Arielle G. Thal, Richard Goldman, Leila J. Mady, David M. Cognetti, Adam J. Luginbuhl, Michael C. Topf, Joseph M. Curry
Publication date 12-11-2024
Virtual Reality (VR) has the potential to improve clinical outcomes; however, there is a lack of randomized controlled trials evaluating VR or meaningful metrics. This randomized controlled pilot study analyzes the impact of a Virtual Reality Case Enhancement Protocol (VRCEP) compared to standard preoperative surgical planning. The VRCEP was a feasible addition to surgeon workflow and was associated with decreased margin events, including the novel margin event score.
Objective Application of virtual reality (VR) for surgical planning may improve clinical outcomes for head and neck cancer (HNC) resection. There is a lack of randomized trials and meaningful metrics to assess such technological applications. Our objective was to evaluate the feasibility of a VR protocol for oncologic surgical planning and assess the impact on surgical outcomes.
MethodsA randomized controlled trial utilizing a VR Case Enhancement Protocol (VRCEP) versus standard of care (SOC) surgical planning was conducted. The primary endpoint was feasibility, defined as >80% successful VRCEPs. Metrics included surgeon task-load burden (TLB) using the NASA Task-Load Index and “margin events,” defined as "the need for defect-driven margins, positive frozen margins, and/or positive final margins." Margin events were used to calculate a margin event score (MES) per case and margin event rate (MER) per cohort.
Results Thirty-four patients were included in the final analysis (17 VRCEP, 17 SOC) with 94.4% of eligible VRCEP cases completed (17/18). Surgeon TLB was unchanged with VRCEP. Cases undergoing VRCEP were associated with a lower mean MES (0.27 vs. 0.94, p = 0.014) and MER (11.6% vs. 35.6%, p = 0.0041). VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032). Although not statistically significant, positive frozen and final margin rates were lower in VRCEP.
Conclusion Completion of the VRCEP was feasible with no significant increase in surgeon TLB appreciated. VRCEP yielded fewer MEs. Further investigation into the benefit of VR in HNC resection is warranted. Margin events may represent useful metrics for assessing novel surgical technologies.
Level of Evidence2 Laryngoscope, 2024
Jeffrey C. Mecham, Hannah Gibbs, Trenton House, Patrick Scheffler
Publication date 09-11-2024
Objectives To assess the impact of body mass index (BMI) on hypoglossal nerve stimulator (HNS) implantation outcomes in pediatric patients with Down syndrome (DS). We compare outcomes of HNS implantation when comparing children based on overweight or obese status.
Methods Retrospective cohort study of patients at a single tertiary pediatric hospital who underwent HNS implantation between 2022 and 2024. Patients with DS under 21 years of age at time of implantation were included. One child with Wolf-Hirschhorn syndrome was also included. The main outcome measured was reduction in apnea-hypopnea index (AHI).
Results Twenty patients were implanted with HNS during the study period. Eleven patients were implanted with a BMI considered overweight and 8 patients with a BMI considered obese. No significant correlation was found between BMI percentile and AHI reduction (r = 0.06, p = 0.8). No significant differences were found between obese and non-obese groups for preoperative AHI, postoperative AHI, or AHI reduction. Both groups responded favorably to HNS therapy with AHI reduction of 83.8% in obese patients and 81.9% in non-obese patients.
Conclusion We demonstrate no difference in postoperative AHI outcomes when comparing patients with obesity defined as BMI >95th percentile compared to those without.
Level of Evidence3 Laryngoscope, 2024
Susmita Chennareddy, Kalena H. Liu, Maria A. Mavrommatis, Derek D. Kao, Aparna Govindan, Zachary G. Schwam, Maura K. Cosetti
Publication date 09-11-2024
Indications for CI are expanding as research demonstrates benefit in populations previously thought inappropriate. This systematic review and meta-analysis demonstrates global postoperative improvement in speech and auditory outcomes in children with bilateral SNHL and CND after CI.
Objective Cochlear nerve deficiency (CND) is commonly implicated in moderate-to-profound pediatric sensorineural hearing loss (SNHL). Although cochlear implantation (CI) was previously contraindicated in CND patients, recent studies have demonstrated the potential for auditory response to CI in a subset of CND patients, though clinical outcomes remain variable. This study aims to evaluate pre- and postoperative speech and auditory outcomes of CI in pediatric patients with bilateral SNHL and radiographically confirmed CND.
Data Sources Embase and Ovid MEDLINE.
Review MethodsA systematic review was conducted to identify studies reporting pre- and postoperative outcomes of children with CND confirmed by magnetic resonance imaging who underwent CI. A random-effects model was used to account for within- and between-study variance in speech and auditory outcomes.
Results After abstract screening of 818 distinct articles, 16 studies were selected for final inclusion, consisting of 248 patients with cochlear nerve hypoplasia or aplasia who underwent CI. Various speech perception and language development tests were investigated across studies (Speech Intelligibility Rating, Speech Perception Category, Speech Awareness Thresholds, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, Categories of Auditory Performance, and Auditory Level). Pooled outcomes demonstrated improvement in speech perception after CI in pediatric patients with CND (SMD 2.18, 95% CI 1.68–2.69).
Conclusion Indications for CI are expanding as research demonstrates benefit in populations previously thought inappropriate. Our study demonstrates global postoperative improvement in speech and auditory outcomes in children with bilateral SNHL and CND after CI.
Level of EvidenceNA Laryngoscope, 2024
Fatemeh Ramazani, J. Douglas Bosch, Derrick R. Randall
Publication date 09-11-2024
Introduction Intralesional corticosteroid injection for management of subglottic stenosis (SGS) is thought to improve patients surgery free interval (SFI). The objective of this study was to determine the difference in SFI between idiopathic SGS (iSGS) patients treated with endoscopic dilation alone, dilation with a single intraoperative intralesional corticosteroid injection, or dilation with intraoperative steroid injection followed by serial in-office serial intralesional steroid injection (SILSI) procedures.
Methods Retrospective review of patients with iSGS from 1/1/2012 to 12/1/2023. The SFI was calculated as the time between surgical interventions and independent samples median test was used to compare the difference in SFIs between treatment groups.
Results This study identified 305 procedures, involving 104 patients. Fifty-five procedures involved endoscopic dilation alone (median SFI = 658, IQR: 595 days), 102 involved one injection of steroids intraoperatively (median SFI = 395, IQR: 296 days), 27 involved endoscopic dilation (ED) followed by a single postoperative ILSI (median SFI = 533, IQR: 351), and 15 involved postoperative SILSI (median SFI = 585, IQR: 338 days). Comparing SFI between groups found mean SFI was significantly longer among patients managed with only ED compared with a single intraoperative steroid injection (p = 0.001). Patients who were initially managed with ED and an intraoperative steroid injection has a statistically significant decrease in SFI (p = 0.032) when transitioned to management with ED and intraoperative steroid injection followed by a single ILSI postoperatively.
Conclusion Patients who received a single intraoperative steroid injection experienced shorter SFI when compared with those managed with dilation alone. SILSI did not result in a significant increase of SFI within this population.
Level of Evidence3 Laryngoscope, 2024
David T. Kent, Holly A. Budnick, Katherine K. Green, Phillip Huyett, Amy E. Schell, Maria V. Suurna
Publication date 08-11-2024
Hypoglossal nerve stimulation (HNS) is a surgical treatment for obstructive sleep apnea that activates in a phasic manner. The most widely available HNS device has respiratory entrainment programming settings that are not widely utilized. We present an algorithm for office-based respiratory sensing adjustments to optimize HNS respiratory entrainment.
Hypoglossal nerve stimulation (HNS) is a surgical treatment for obstructive sleep apnea that activates in a phasic manner. The most widely available HNS device has respiratory entrainment programming settings that are not widely utilized. We present an algorithm for office-based respiratory sensing adjustments to optimize HNS respiratory entrainment. Laryngoscope, 2024
VyVy N. Young, Danielle M. Gillard, Brandon Truong, James J. Lappin, Claire E. Perrin, Steven D. Stockton Jr, Clark A. Rosen, Yue Ma
Publication date 08-11-2024
Objective An increasing number of laryngeal and esophageal procedures are being performed as “awake” procedures (non-general anesthesia), with some under local anesthesia, including in clinic. While high tolerance and safety profiles have been reported for various laryngeal procedures, few studies directly assess tolerability of awake dilation procedures of the upper esophagus (UE) and laryngotracheal airway (LTA).
Study Design Prospective, open-label.
Methods Prospectively collected patient and physician surveys from a tertiary laryngology center recorded patient tolerance, safety, and perceptions of awake UE and LTA balloon dilation.
Results Fifty-six awake procedures were performed on 41 patients, including 46 UE and 20 LTA dilations. All procedures were successfully completed. Overall pain was mild (3.5 ± 2.4/10, ranging 0 = no pain to10 = worst pain) and the dilation itself was reportedly the most painful portion (4.1 ± 2.9/10). Patient satisfaction with the procedure was high (7.0 ± 2.2/10, ranging 0 = worst to 10 = best experience). Most patients would undergo the procedure again (73.6%) and would recommend the procedure to others (89.3%). Patient-reported tolerance was similar immediately postoperatively and at follow-up. LTA and UE dilation patients reported similar levels of tolerance.
Conclusions Awake upper esophageal balloon dilation is a safe, well-tolerated procedure with high completion and patient satisfaction rates. Similarly, early experience with awake laryngotracheal airway balloon dilation suggests comparable favorability, although careful consideration of patient selection and procedural implementation is strongly recommended to optimize and protect patient safety.
Level of Evidence3 Laryngoscope, 2024
Kelti M. Munroe, Leigh J. Sowerby, Christopher J. Chin
Publication date 07-11-2024
Topical tranexamic acid is used to treat epistaxis. We reviewed the evidence for this practice, and found based on the current literature, it may be a useful adjunct in managing epistaxis.
Pubmed PDF WebTatiana Ferraro, Colin Villarin, Christian Jung, Sanjena Venkatesh, Tiffany Peng‐Hwa
Publication date 07-11-2024
A systematic review of outcomes in adult otolaryngology across primary language or varying levels of English proficiency. Patients with LEP are adversely impacted across various otolaryngology subspecialties and underrepresented in the literature. These results underscore the necessity of improved research practices and future directions to improve health equity in this vulnerable population.
Objective Limited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP-related disparities in adult otolaryngology.
Data Sources Web of Science, Pub Med, and Scopus.
MethodsA systematic review of US-based, peer-reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.
Results An initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full-text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% – 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient-reported LEP status reported significant findings more often than those using electronic health record-derived data (p < 0.01). Under the Kilbourne framework, all studies were “detecting” (N = 21, 67.7%) and “understanding” (N = 10, 32.3%) disparities. In outcomes-focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.
Conclusion Patients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.
Level of EvidenceNA Laryngoscope, 2024
Víctor de Cos, Kendyl Naugle, Omer Baker, Elida Kocharian, Omid Moshtaghi, Peter R. Dixon, Akihiro Matsuoka, Jeffrey P. Harris
Publication date 07-11-2024
We aim to use the Area Deprivation Index to investigate the correlations between neighborhood socioeconomic disadvantage, SARS-CoV-2 vaccination rates, infection severity, and subsequent audiovestibular symptoms. Patients experiencing greater neighborhood socioeconomic disadvantage were found to have lower SARS-CoV-2 vaccine booster rates, higher rates of postinfection hospitalization, and increased rates of certain otologic and neurotologic symptoms following infection.
Objectives We aim to use the Area Deprivation Index (ADI) to investigate the correlations between neighborhood socioeconomic disadvantage (NSD), SARS-CoV-2 vaccination rates, infection severity, and subsequent audiovestibular symptoms.
Methods In this retrospective cohort study, surveys were administered to participants ≥18 years of age who received a SARS-CoV-2 vaccination and/or tested positive for SARS-CoV-2 infection between January 2020 and September 2022. ADI scores were calculated for each patient to quantify NSD. Statistical analyses were performed to compare demographic and clinical characteristics between ADI quintiles.
Results Of 2415 participants, the majority were female (62.8%) and White (87%), with a mean age of 60.8 years. Individuals in ADI Quintile 5 were less likely to receive second booster doses than those in Quintile 1 (58% vs. 71%, p < 0.0001). Among those infected with SARS-CoV-2, those in ADI Quintile 5 were 2.5 times more likely to be hospitalized (relative risk = 2.46, 95% confidence interval 1.03, 5.88) than those in Quintile 1. Symptoms more likely to be experienced by participants in ADI Quintile 5 than those in Quintile 1 immediately following SARS-CoV-2 infection included headaches (28% vs. 21%, p = 0.02), aural fullness (14% vs. 6%, p < 0.0001), change of hearing (8% vs. 4%, p = 0.01), dizziness (15% vs. 8%, p < 0.01), and otalgia (8% vs. 4%, p < 0.01).
Conclusions Individuals experiencing greater NSD were found to have lower SARS-CoV-2 vaccine booster rates, higher rates of postinfection hospitalization, and increased rates of certain otologic and neurotologic symptoms following infection.
Level of EvidenceIII Laryngoscope, 2024
Jia‐Lu He, Xue‐Er Zhou, Chang Cao, He‐Yi Tang, Bao‐Lin Jia, Yong‐Tao Dong, Yan Sun, Gui‐Quan Zhu
Publication date 06-11-2024
In the present study, we presented the detailed procedure and experience of endoscope-assisted transoral procedure of accessory parotid gland (APG) tumor resection. The surgical steps and tips were described and summarized clearly in our video. Laryngoscope, 2024
Pubmed PDF WebQuynh‐Lam Tran, Pauline P. Huynh, Bryan Le, Nancy Jiang
Publication date 06-11-2024
This article compares the understandability, actionability, quality, and readability of ChatGPT-generated patient information to that of patient material gathered from the ENTHealth.org website for six select laryngology topics. Patient information acquired from ChatGPT was more difficult to read compared to that from the American Academy of Otolaryngology-Head and Neck Surgery website.
Objective To evaluate and compare the readability and quality of patient information generated by Chat-Generative Pre-Trained Transformer-3.5 (ChatGPT) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using validated instruments including Flesch–Kincaid Grade Level (FKGL), Flesch Reading Ease, DISCERN, and Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P).
MethodsENTHealth.org and ChatGPT-3.5 were queried for patient information on laryngology topics. ChatGPT-3.5 was queried twice for a given topic to evaluate for reliability. This generated three de-identified text documents for each topic: one from AAO-HNS and two from ChatGPT (ChatGPT Output 1, ChatGPT Output 2). Grade level and reading ease were compared between the three sources using a one-way analysis of variance and Tukeys post hoc test. Independent t-tests were used to compare DISCERN and PEMAT understandability and actionability scores between AAO-HNS and ChatGPT Output 1.
Results Material generated from ChatGPT Output 1 and ChatGPT Output 2 were at least two reading grade levels higher than that of material from AAO-HNS (p < 0.001). Regarding reading ease, ChatGPT Output 1 and ChatGPT Output 2 documents had significantly lower mean scores compared to AAO-HNS (p < 0.001). Moreover, ChatGPT Output 1 material on vocal cord paralysis had a lower PEMAT-P understandability compared to that of AAO-HNS material (p > 0.05).
Conclusion Patient information on the ENTHealth.org website for select laryngology topics was, on average, of a lower grade level and higher reading ease compared to that produced by ChatGPT, but interestingly with largely no difference in the quality of information provided.
Level of EvidenceNA Laryngoscope, 2024
Benjamin Damazo, Nainika Nanda, Seth Dailey
Publication date 06-11-2024
We demonstrate submucosal thyroarytenoid myectomy with arytenoidectomy as a novel technique to improve glottic airway patency. This improves outcomes compared with current available techniques by preserving laryngeal mucosal lining and harnessing lateral retraction of glottic tissue to reduce revisions for granulation tissue and laryngeal scar. Additionally, this allows for long-term preservation of voice and swallow outcomes.
Objective Surgery for bilateral vocal fold immobility (BVFI) aims to establish a patent airway while maintaining voice and swallow function, a unique dilemma. Current techniques display unfavorable healing vectors, and exposed endolaryngeal tissue results in substantial airway granulation requiring postoperative care. We present a novel technique to improve glottic airway patency by preserving laryngeal mucosal lining and harnessing lateral retraction of glottic tissue to reduce revisions for granulation tissue and laryngeal scar.
Methods Case-series analysis was performed on eight BVFI patients who underwent submucosal thyroarytenoid myectomy with arytenoidectomy for treatment from 2011 to 2021. Patient medical comorbidities and BVFI etiology were reviewed. Decannulation rates, revision procedures, requirement of emergency services, and pre- and postoperative status were assessed by laryngology and speech-language pathology using the following metrics: VHI, DI, Modified Medical Research Council (MMRC), GRBAS, jitter percentage, shimmer percentage, pitch range, maximum phonation time, and dysphonia severity index, and diet type. Pre- and postoperative distal-chip flexible laryngoscopy with stroboscopy was performed. Outcome measures were assessed using paired Students t-test of pre- and postoperative categorical variables.
Results Successful decannulation was achieved in all (four of eight) patients with previous tracheostomy. All patients reported improved respiratory symptoms without tracheotomy. There was no difference in long-term voice outcomes. All patients tolerated a mechanical soft or regular diet, without new or worsened dysphagia.
Conclusion Submucosal thyroarytenoid myomectomy with arytenoidectomy represents an effective BVFI treatment, through utilizing natural vectors of scarring, preservation of endolaryngeal mucosa, and preservation of the superficial lamina propria and the vocal ligament.
Level of Evidence4 Laryngoscope, 2024
Dylan G. Vance, David Z. Allen, Amy B. Leming, Madisyn Cox, Sonya E. Fogg, Sameer H. Siddiqui, Hallie R. Wilson, Andrew G. Tritter
Publication date 06-11-2024
Type 1 Thyroplasty (TT1) is a well-established procedure used for medializing an immobile vocal fold. Silastic and Gore-Tex are the two most common materials used to accomplish this, but comparative data on their relative efficacy are scarce. In this meta-analysis, we compare the two most common reported metrics, maximum phonation time and voice handicap index between Silastic and Gore-Tex implants. We found that both implants are statistically significant with improvements, and there is no difference between the two.
Objective Type 1 Thyroplasty is a well-established procedure used for medializing an immobile vocal fold. Silastic and Gore-Tex are the two most common materials used to accomplish this, but comparative data on their relative efficacy are scarce. We sought to compare outcomes between Silastic and Gore-Tex implants via systematic review and meta-analysis for unilateral vocal fold immobility.
Methods We collected available data from Pub Med, Embase, and Web of Science on demographics, maximum phonation time (MPT), voice handicap index (VHI-10/30) score, and any other relevant metrics encountered before comparatively evaluating differences in outcomes.
Results The search yielded 1,534 records with 55 manuscripts ultimately included. There were 41 unique studies that utilized Silastic for a total of 1038 patients. There were 13 unique studies that utilized Gore-Tex for a total of 245 patients. The pooled mean increase in MPT for Silastic patients was 7.8 s (+1.3 SMD) compared with 5.7 s for Gore-Tex (+1.6 SMD). There was significant publication bias present in both analyses. The pooled mean change in VHI-30 with Silastic was −45.4 (62.2%, −2.09 SMD) compared with −51.6 (73.5%, −1.1 SMD) with Gore-Tex. The pooled mean change in VHI-10 with Silastic was −15.6 (54%, −0.46 SMD) compared with −11.6 (43%, −0.86 SMD) with Gore-Tex. There was no significant publication bias present in VHI outcomes.
Conclusions Silicone and Gore-Tex implants provide adequate and comparable results in TT1. The data supporting this conclusion are limited by follow-up, diversity in outcomes, limited data availability, and publication bias. Future research should be dedicated to comparing implants in a well-randomized environment. Laryngoscope, 2024
Uche C. Ezeh, Naomi Tesema, Sukaina Hasnie, Tom Ben‐Dov, Sara C. Gallant, Megan M. Gaffey, Francine Blei, Max M. April
Publication date 06-11-2024
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) flow chart showing our search strategy and number of included and excluded studies.
Objective Infantile subglottic hemangioma (SGH) poses a risk of airway compromise if untreated. Traditionally, operative endoscopy (OH) diagnoses SGH, but since the discovery of beta-blockers efficacy in treating infantile hemangiomas (IHs) in 2008, and advances in endoscopic technology, nonoperative methods have emerged. This review identifies endoscopic practices for diagnosing and monitoring infantile SGH during the oral beta-blocker treatment era.
Data SourcesA comprehensive literature search in October 2022 and August 2023 covered Pub Med, Embase, Cochrane Library, SCOPUS, and Web of Science.
Review Methods The search was limited to English-language studies published since 2008, considering this when propranolol was demonstrated as an effective treatment option for IH. The articles were screened for relevance based on predefined inclusion and exclusion criteria.
Results After inclusion and exclusion criteria, sixty final studies were identified, describing 240 cases of infantile SGH. Most children were diagnosed using OE alone (73.3%; n = 176/240), 23.3% (n = 56/240) using office-based laryngoscopy procedures (OBPs) followed by OE, 3.3% using OBP alone (n = 8/240). There were no reported diagnostic endoscopy-related complications. Twenty-nine studies described using endoscopy plus diagnostic imaging to either confirm an SGH lesion, characterize the extent of disease spread, or rule out other causes of presenting symptoms. The proportion of infants diagnosed with OE alone decreased from 2008 to 2023.
Conclusion Operative endoscopy remains the SGH diagnostic standard, but OBP adoption is increasing. Further research is needed to determine the optimal SGH diagnosis and management approach.
Level of EvidenceNA Laryngoscope, 2024
Amy E. Ensing, Henok Getahun, Rebecca Z. Lin, Amy L. Zhang, Emma K. Landes, Judith E. C. Lieu
Publication date 06-11-2024
Using a cross-sectional survey of pediatric otolaryngology patients aged 2–18 years old, we sought to investigate the relationship between pediatric obstructive sleep apnea (OSA) severity and quality of life (QOL). Children with sleep disordered breathing (SDB) or OSA had lower QOL than those without SDB; however, no consistent differences in QOL were found between children with varying OSA severities. Therefore, disease burden in pediatric patients with mild OSA and SDB should not be underestimated.
Objectives To investigate the relationship between pediatric obstructive sleep apnea (OSA) severity and quality of life (QOL).
Study Design This study was a cross-sectional survey.
Methods Patients aged 2–18 years being evaluated for OSA were recruited from a pediatric otolaryngology clinic and sleep center. Participants completed the Obstructive Sleep Apnea Questionnaire (OSA-18) and the PedsQL™ Multidimensional Fatigue Score (MFS).
Results Responses of 18 control participants without OSA, 26 participants with clinically resolved OSA, 19 with non-obstructive sleep disordered breathing (SDB), 29 with mild OSA, 21 with moderate OSA, and 27 with severe OSA were analyzed. OSA-18 scores for controls were lower (indicating higher QOL) than patients with SDB (mean difference MD = −31.1; 95% CI −42.7 to −19.5), mild OSA (MD = −30.4; 95% CI −40.1 to −20.7), moderate OSA (MD = −23.6; 95% CI −34.5 to −12.7), or severe OSA (MD = −40.1; 95% CI −50.0 to −30.2). Participants with resolved OSA also had lower OSA-18 scores than participants in the SDB and OSA groups. Few differences were observed between the SDB, mild OSA, moderate OSA, and severe OSA groups on either the OSA-18 or PedsQL MFS, and these did not demonstrate a clear pattern. Linear regression of apnea hypopnea index (AHI) and OSA-18 or PedsQL MFS scores revealed weak relationships (R2 < 0.1).
Conclusion Using both an OSA-specific measure and generic fatigue measure, no consistent differences in QOL scores were found between children with varying OSA severities. Therefore, disease burden in pediatric patients with mild OSA and SDB should not be underestimated.
Level of Evidence Level 3 Laryngoscope, 2024
Ian D. Bowers, Yue Ma, Tyler W. Crosby, Clark A. Rosen, Steven D. Stockton Jr., Sarah L. Schneider, VyVy N. Young
Publication date 06-11-2024
Objectives After modified Wendler glottoplasty (mWG), close follow-up with laryngologist and speech-language pathologist (SLP) is thought to be essential to achieve best outcomes. This study presents a case series of patients undergoing mWG at a single institution to identify factors associated with trends in post-operative follow-up.
Methods Retrospective review of trans women patients who underwent mWG between March 2018 and July 2023 was performed. Demographic data, pre-operative care, and post-operative course were reviewed. Lost to follow-up (LTFU) was defined as a failure to return to the office or schedule a follow-up appointment as recommended, for ≥2 months after last visit. Logistic regressions were utilized to identify possible factors associated with being LTFU.
Results Eight (50%) of 16 patients met LTFU criteria. Patients were considered not LTFU if they completed care (n = 3, 19%) or were still undergoing care (n = 5, 31%). Patients with chronic diseases were less likely to become LTFU (p = 0.03). Those lost to follow-up had more no-show visits (p = 0.04). Total number of gender-affirming surgeries, distance from hospital, socioeconomic status of residential zip code, race/ethnicity, other psychological history, and patient-reported outcome measure scores did not affect LTFU rates.
Conclusion Fifty percent of patients were LTFU after modified Wendler glottoplasty. Even one no-show visit increased risk of being LTFU, whereas the presence of chronic diseases was protective against this. This study illustrates that increased efforts are needed following mWG to better understand the factors associated with being LTFU and to facilitate patients ability to complete post-operative care successfully.
Level of Evidence4 Laryngoscope, 2024
Sawita Kanavitoon, Yann‐Fuu Kou, Michael J. Rutter
Publication date 06-11-2024
Congenital tracheal stenosis (CTS) is a rare life-threatening condition. Comorbidities such as various cardiac defects, prematurity, and genetic disorders would complicate the treatment options. Early surgical treatment with a cardiopulmonary bypass machine provides favorable outcomes in large, experienced centers.
Objectives To investigate demographic data and airway management techniques for patients with congenital tracheal stenosis (CTS) during the preoperative, intraoperative, and postoperative periods.
Study DesignA retrospective chart review.
Methods This study was a retrospective case series at a single tertiary care pediatric medical center. It encompassed all children diagnosed with CTS who underwent slide tracheoplasty from January 2001 through December 2018. Exclusion criteria were acquired stenosis, tracheomalacia, patients without a confirmed diagnosis of CTS, and those with missing data. Patient demographics and details of airway management were collected and analyzed.
ResultsA total of 148 patients met the inclusion criteria. The most common etiology of CTS was congenital tracheal rings (90.5%). The median age at surgery was 9 months (interquartile range IQR 3.3–35.4), and the median stenosis length was 4.0 cm (IQR 3.5–5.4). The most frequent comorbidities were genetic diseases, prematurity, and preoperative intubation. The most common related cardiac comorbidities were pulmonary artery sling, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot. Most of the patients with CTS exhibited 50% to 80% stenosis. Most of the patients underwent thoracic approach slide tracheoplasty. Airway management was primarily accomplished using an oral or nasal endotracheal tube preoperatively, cardiopulmonary bypass during surgical repair, and an oral or nasal endotracheal tube during closure and the postoperative period.
Conclusions Slide tracheoplasty is an effective treatment for congenital tracheal stenosis. Coordinated airway management between the anesthesia and surgical teams is crucial. Appropriate planning yields the best patient outcomes.
Level of Evidence4 Laryngoscope, 2024
Jia‐Lu He, Xue‐Er Zhou, Chang Cao, Su Chen, Fan Yang, Yong‐Tao Dong, Yan Sun, Gui‐Quan Zhu
Publication date 06-11-2024
We presented the surgical procedures of full endoscopic total parotidectomy followed by the sternocleidomastoid muscle flap transplantation via a short postauricular hairline incision, and reported patient outcomes to evaluate the feasibility and efficacy of this novel approach. Laryngoscope, 2024
Pubmed PDF WebHinpetch Daungsupawong, Viroj Wiwanitkit
Publication date 05-11-2024
Dor Hadida Barzilai, Shai Tejman‐Yarden, Abraham Goldfarb, Ophir Ilan
Publication date 05-11-2024
"R. Brynn Jones‐Rastelli, Claire Crossman, Dmanda Price, Frederick Stal, Sonja Molfenter"
Publication date 04-11-2024
The objectives of this study were: (1) To determine whether perception of pharyngeal residue severity differs by view plane on videofluoroscopy. (2) To explore whether the Bolus Clearance Ratio (BCR) can be reliably applied in the anterior–posterior (AP) plane. (3) To investigate the relationship between perception of residue severity and BCR measures across view planes. Perceptions of pharyngeal residue severity differ between lateral and AP planes, with inconsistent directionality. The BCR shows good to excellent reliability across planes and correlates strongly with perception of residue severity.
Objectives(1) To determine whether perception of pharyngeal residue severity differs by view plane on videofluoroscopy. (2) To explore whether the Bolus Clearance Ratio (BCR) can be reliably applied in the anterior–posterior (AP) plane. (3) To investigate the relationship between perception of residue severity and BCR measures across view planes.
Methods Images of the same bolus condition in lateral and AP were rated using a simple 5-point ordinal descriptive scale (none, trace, mild, moderate, severe) by 225 speech-language pathologists via electronic survey. BCR measures were obtained for the same set of images from four trained raters. Wilcoxon signed-rank tests and cumulative mixed modeling were used to compare ratings by plane. BCR reliability was calculated using intraclass correlation coefficients. Perceptual ratings were compared with BCR measures using Spearman correlations.
Result(1) Perception of residue severity was not consistent across plane in 9/10 image pairs (p < 0.05), with a significant fixed effect of plane on severity rating (β = 0.41; z = 7.27; p < 0.001). The directionality of differences varied by case. (2) Inter-rater reliability for BCR measures was good across lateral (intraclass correlation coefficient ICC = 0.82) and AP (ICC = 0.87) planes, with superior intra-rater reliability in AP (lateral ICC = 0.85; AP ICC = 0.98). (3) There was a strong positive correlation between perceptual ratings and BCR measures in both planes.
Conclusions Perception of pharyngeal residue severity differs between lateral and AP planes with inconsistent directionality raising important questions about the clinical implications of single plane studies. The BCR shows good-excellent reliability and strong correlation with perception across planes, offering a promising method for cross-plane quantification.
Level of Evidence Level III, diagnostic study with a gold standard Laryngoscope, 2024
Seung Cheol Han, Junhyung Bae, Jin‐A Park, Ji Ye Lee, Raden A. Anatriera Sumarsono, Chae‐Seo Rhee, Ye Ji Shim, Doo Hee Han
Publication date 04-11-2024
The extent of the maxillary sinus fungus ball increases over time, with the time interval being the only significant factor influencing changes in its extent. Other factors, including age, gender, comorbidities, and dental treatment history, do not show a significant association with these changes.
Objectives The frequency of paranasal sinus fungus balls, a common form of rhinosinusitis, has increased. Although treatment and causative factors have been well investigated, the evolving nature of the fungal balls remains unelucidated. This study aimed to investigate and analyze the changing patterns of fungus balls.
Methods This retrospective study analyzed data from 35 participants selected from a pool of 41,497 patients who underwent brain magnetic resonance imaging (MRI) at a large health care center. The extent of the fungus balls was evaluated by grading them from 1 to 4 based on the MR images. The changing process of the fungus ball was analyzed based on demographics, interval between the MRI scans, comorbidities, and specific dental interventions.
Results The fungus ball grades showed significant progression over time. In the analysis of 29 sinuses with initially low-grade (grades 0, 1, and 2) fungus balls, 15 sinuses showed a grade change <2 (no/minimal change group), whereas 14 sinuses showed grade changes of ≥2 (substantial change group). Intergroup comparison showed that only the interval between the initial and final MRI scans differed significantly (p = 0.008). However, factors, such as age, sex, comorbidities, and history of dental procedures, did not differ significantly between the two groups.
Conclusion This study shows the extent of change in fungus balls, primarily over time. These results offer critical insights into the natural course and progression of the maxillary sinus fungus ball.
Level of Evidence4 Laryngoscope, 2024
Elliot Morse, Alexandra Li, Sara Albert, Lexa Harpel, Anaïs Rameau
Publication date 04-11-2024
Kosuke Miyamura, Daiki Nakashima, Tsuguhisa Nakayama, Kota Wada, Robson Capasso, Shintaro Chiba
Publication date 04-11-2024
We measured anterior, superior, and posterior nasal septal deviation angles, comparing obstructive sleep apnea (OSA) and non-OSA groups. OSA patients appear to exhibit more pronounced anterior nasal septal deviations. Comprehensive OSA patient septoplasty requires selecting proper techniques based on careful deviation evaluations, including open approaches to address substantial anterior deviations.
Objectives Nasal septal deviation can cause nasal breathing issues, contribute to obstructive sleep apnea (OSA) development, and often hinders successful CPAP therapy. We hypothesized that although prevalent in the general population, nasal septal deviations differ structurally between OSA and non-OSA patients. This study evaluated nasal septal deviation morphology in OSA versus non-OSA patients using computed tomography (CT).
Methods We consecutively enrolled 128 adult patients undergoing septoplasty for nasal obstruction between April and September 2019. Seven with trauma/surgery history were excluded. Polysomnography was performed preoperatively for those with significant sleep complaints. Using identical preoperative sinus CTs routines, we measured anterior, superior, and posterior deviation angles, comparing OSA and non-OSA groups.
Results We studied 121 septoplasty patients (37 females, 84 males, mean age 45.73 ± 1.29 years), with 34 OSA and 87 non-OSA. Anterior deviation angle was significantly greater in OSA (mean 9.1 ± 0.7°) versus non-OSA (mean 6.5 ± 0.5°) groups (p = 0.001). However, no significant superior or posterior deviation differences existed between groups (p = 0.266 and 0.231, respectively). Multiple logistic regression showed anterior deviation as the only significant independent OSA predictive factor.
Conclusion Among the nasal septal deviations, only the anterior deviation was associated with the presence of OSA. Thus, the selection of a surgical technique for anterior deviation is an important consideration in patients with OSA.
Level of Evidence3 Laryngoscope, 2024
Prestina Smith‐Davidson, Khaled Altartoor, M.M. Kabongo, Henry Claussen, Robert A. Arthur, H.R. Johnston, John M. DelGaudio, Sarah K. Wise, C.A. Solares, Emily M. Barrow, Kelly R. Magliocca, Michael Koval, Joshua M. Levy
Publication date 02-11-2024
This work represents the first report of dysregulated prostaglandin receptor synthesis in allergic fungal rhinosinusitis (AFRS). In an unbiased analysis of all genes expressed in AFRS versus healthy sinonasal epithelium at air–liquid interface, PTGER2 was the second most significantly upregulated gene. This finding was replicated by quantitative RT-PCR and immunoblot in patient samples not included in bulk RNA-seq analysis.
Objectives Allergic fungal rhinosinusitis (AFRS) is an eosinophilic subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP). This study aimed to investigate the transcriptome of AFRS nasal polyp epithelium.
Methods Sinonasal epithelial cells were harvested from healthy nasal mucosa and polyp tissue collected from participants undergoing elective sinonasal surgery. Primary epithelial cells were subsequently grown in air/liquid interface and subjected to RNA-seq analysis, RT-qPCR, immunoblotting, and immunostaining.
ResultsA total of 19 genes were differentially expressed between healthy and AFRS sample epithelium. The second top candidate gene, ranked by adjusted p-value, was prostaglandin E receptor 2 (PTGER2). The upregulation of PTGER2 was confirmed by RT-qPCR and immunoblot. The presence of the EP2 receptor, encoded by the PTGER2 gene, was confirmed by immunocytochemistry.
ConclusionPTGER2 is a potential novel therapeutic target for AFRS. EP2 dysregulation is associated with aspirin-exacerbated respiratory disease, potentially giving insight into common mechanisms of disease in severe CRSwNP.
Level of EvidenceNA Laryngoscope, 2024
Petar Stanković, Michael Bette, Robert Mandić, Stephan Hoch, Boris A. Stuck, Thomas Wilhelm
Publication date 31-10-2024
We performed an animal study on 16 Wistar rats (32 nerves) to report safe distances to facial nerve for bipolar cautery. Continuous intraoperative neuromonitoring was used to quantify the degree of nerve damage. Cautery up to 30 W can be safely used as close as 3 mm from the facial nerve.
Objective Currently no data exist on what distance from facial nerve (FN) it is safe to perform bipolar cautery (BC) in parotid surgery, although frequently performed.
Methods The degree of damage was measured using continuous intraoperative neuromonitoring (cIONM, NIM™ 3, Medtronic) in 16 Wistar rats. Amplitude drop of at least 50% (A50) or a loss of signal (LOS) in the cIONM was defined as harmful; BC was performed in power range 20–60 W.
ResultsBC ≤30 W did not cause LOS (0/14 nerves). When applying 35 W, A50 occurred at 4 mm from FN and LOS was noted in 1 of 5 nerves. BC at a power of 40 to 60 W demonstrated LOS in all nerves (12/12) at a 5 mm distance.
ConclusionBC up to 30 W can be safely applied up to 3 mm distance from FN. 40 to 60 W should be avoided and used only at a distance of over 6 mm from FN.
Level of evidenceNA/animal study. Laryngoscope, 2024
William A. Strober, Kwasi Enin, Dorina Kallogjeri, Jay F. Piccirillo, Helga Komen, Matthew L. Rohlfing
Publication date 31-10-2024
Objectives Microlaryngeal surgeries require unique considerations for airway management to facilitate patient safety and adequate surgical exposure. Small-diameter endotracheal tubes (ETTs) are widely used but have raised concerns regarding patient safety, including questions about the potential for barotrauma, effective ventilation, and adequate oxygenation. We hypothesize that small ETTs will prove to be safe in a variety of cases.
Methods We conducted a case series analyzing the safety of 5.0 ETTs in microlaryngeal surgeries at Washington University School of Medicine from November 2020 to November 2023. Outcome measures included intraoperative desaturations (SpO2 < 90% for >2 min), high peak inspiratory pressures (PIPs) (>40 cm H2O), and prolonged extubation times (>15 min). Univariate regression models were used to analyze associations of sociodemographic and clinical variables with these outcome measures.
Results This study included 76 small-ETT microlaryngeal surgeries. There were 5 instances of desaturations, no reported incidents of barotrauma, and no cases in which intraoperative tube exchange was required due to issues with oxygenation or ventilation. Median PIP was 38 cm H2O, with a range of 17–78 cm H2O. 46% of patients had a PIP above 40 cm H2O. There were prolonged extubation times in 14% of procedures. No association was shown between sociodemographic and clinical variables with risk of desaturations, high PIPs, or prolonged extubation times.
Conclusion Our study suggests that 5.0 ETTs are safe for microlaryngeal surgery in a variety of patients. Otolaryngologists and anesthesiologists should consider this information when choosing between the multiple available options for airway management during microlaryngeal surgery.
Level of Evidence Level 4 Laryngoscope, 2024
Karim Asi, Dylan G. Vance, Andrew G. Tritter
Publication date 30-10-2024
The superior laryngeal nerve (SLN) block is a long-established anesthetic procedure that has more recently gained popularity for its applications in Otolaryngology and particularly in Laryngology. The SLN block may be utilized for a variety of upper aerodigestive tract-related indications, with randomized control trial data supporting its more traditional indication of pre- and post-procedural anesthesia for interventions like endotracheal intubation, endolaryngeal surgery, and thyroidectomy. Our study highlights the inconsistencies in SLN blocks and raises awareness to further optimize protocols for this continually growing practice.
Objective Superior laryngeal nerve (SLN) injection is performed for a variety of upper aerodigestive tract-related indications. Existing literature examines the efficacy of SLN injection for specific indications. However, there is a paucity of insight into overall practice patterns and a lack of standardization, particularly with regards to medication and dosing, treatment time frame, and circumstances. The goal of this study is to elucidate the practice patterns of SLN injection and allow for broader understanding of its utilization.
Data Sources/Methods This is a descriptive study of results from an electronic survey disseminated via email to US-based and international otolaryngologists and laryngologists.
Results80 responses were collected. 53.8% responders endorsed utilizing SLN injection in their practice, including 39/43 laryngologists (90.7%). Responders perform SLN injection for an array of indications, using a variety of anesthetic and steroid combinations and dosages. The most used steroid is triamcinolone (81.4%). The most used anesthetic is lidocaine (53.5%). 43% of respondents endorse willingness to perform bilateral injections simultaneously. Follow-up after initial injection is highly inconsistent, as are time intervals between injections and number of injections performed. With regards to side effects and complications discussed prior to the procedure, 95% counseled patients on pain/discomfort while roughly half of responders discussed bleeding/hematoma, aspiration risk, vasovagal response, and/or globus sensation, respectively.
Conclusions This is the first known study investigating the practice patterns of SLN injection. The substantial variability of responses reflects a lack of standardization of this procedure despite its widespread use. Further study is needed to optimize protocols.
Level of Evidence Levels 5 and 6 Laryngoscope, 2024
Van der Wall Hans
Publication date 30-10-2024
Jerome R. Lechien, Jennifer Aoun, Giannicola Iannella, Antonino Maniaci, Luigi A. Vaira
Publication date 30-10-2024
Ozkan Onal, Merih Onal
Publication date 30-10-2024
Rachel E. Weitzman, Karena Zhao, Matthew S. Sclafani, Yashes Srinivasan, Eli Stein, Arron Cole, Anthony P. Sclafani
Publication date 29-10-2024
Three venous thromboembolism risk assessment models—Caprini, Pannucci-NSQIP, and COBRA—were evaluated in 869 otolaryngology surgical patients. We were able to show that there is a moderately strong correlation between all three scores, although this correlation was weakened or lost in the inpatient population. Simpler RAMS such as COBRA and Pannucci-NSQIP may be used instead of Caprini RAM in the majority of otolaryngology surgical patients, which would streamline and potentially automate portions of the preoperative risk assessment workflow.
Objectives Venous thromboembolic events (VTEs) are a leading cause of postoperative morbidity, prolonged hospital stay, and increased cost. Recommendations for mechano- and chemoprophylaxis are currently based on the 2005 Caprini score, a screening tool developed to identify patients at risk for VTE. The Caprini risk assessment model (RAM) was designed for surgical impatients and has been tested in a number of surgical fields, including otolaryngology. However, the vast majority of otolaryngology cases are performed as ambulatory surgery. Simpler RAMs include the COBRA scoring system and Pannucci-NSQIP. Here, we evaluate risk stratification of otolaryngology surgical patients and correlate the findings of these three RAMs.
Study Design Retrospective chart review.
MethodsA retrospective chart review of 869 patients undergoing surgery by Weill Cornell faculty otolaryngologists between June and December 2022 was performed. Patient demographics, VTE risk factors, admission status, surgical subservice, and postoperative events were collected, and RAM scores were calculated for each patient. Wilcoxon and Kruskal–Wallis rank-sum tests were utilized to assess differences in VTE risk scores based on type of procedure and admission status, and Spearmans correlation was utilized to assess agreement between the three different scoring systems. Multivariate linear regressions were utilized to assess variables that impacted the Caprini, COBRA, and NSQIP RAMs.
Results In total, two patients developed postoperative venous thromboembolism. Furthermore, there is a strong positive correlation between Caprini and COBRA RAMs (even when broken down by admission status, although it weakens in the inpatient population). There is a moderate positive correlation between Caprini and Pannucci-NSQIP in the full cohort, but that correlation is lost in the inpatient population.
Conclusions Otolaryngology surgical patients are at low risk of postoperative VTE. Caprini, Pannucci-NSQIP, and COBRA RAMs correlate well in determining ambulatory patients at risk for postoperative VTE and shorter, simpler RAMS such as COBRA and Pannucci-NSQIP can be used instead of Caprini RAM.
Level of Evidence3 Laryngoscope, 2024
James A. Stewart, Harrison Reeves, Nicholas Rivers, Bharat Panuganti
Publication date 28-10-2024
This case report highlights a rare and atypical presentation of Burkholderia cepacia complex (BCC) infection manifesting as a laryngeal abscess in an immunocompetent patient, initially mistaken for a malignancy. It underscores the importance of considering infectious etiologies even when clinical and radiographic findings strongly suggest malignancy.
The Burkholderia cepacia complex (BCC) is a rare pathogen typically causing respiratory illnesses in immunocompromised individuals. We present a novel case of BCC manifesting as a laryngeal abscess, mimicking a laryngeal malignancy in an immunocompetent patient. A 74-year-old male presented to the emergency department with acute respiratory failure and was emergently intubated, revealing abnormal supraglottic tissue. ENT consultation post-extubation and flexible laryngoscopy suggested malignancy in the right supraglottis. A subsequent CT neck showed an expansive paraglottic mass, again consistent with an advanced malignancy. During direct laryngoscopy with biopsy, purulence was encountered, and cultures were obtained. Biopsy results showed benign mucosa with inflammation, and cultures identified BCC. The patient received 7 days of Levofloxacin and Ampicillin-Sulbactam before culture results. Follow-up 2 weeks later showed near-complete symptom resolution, normal supraglottic mucosa on flexible laryngoscopy, and interval CT neck showed resolution of the “mass.” This case involves an unusual presentation of an acute paraglottic BCC infection initially mistaken for a laryngeal mass. BCC is typically a threat to individuals with cystic fibrosis (CF) or other immunocompromised states due to its intrinsic antibiotic resistance. However, BCC is rarely implicated in paraglottic infections or abscess formation. This is the first reported case of a laryngeal BCC infection mimicking a laryngeal mass. It underscores the importance of maintaining an open differential diagnosis until pathologic confirmation, even when imaging and clinical examination suggest malignancy. Laryngoscope, 2024
Reut Book, Anna Lazutkin, Aviad Book, Ron Eliashar
Publication date 28-10-2024
The study investigated the impact of an acute stress event on SNOT-22 scores. Contrary to the initial assumption, the results showed that the scores were not adversely affected by the stress event.
Objective To assess the impact of a major crisis, such as the October 7, 2023, terror attack, on SNOT-22 scores, especially the extra-rhinologic subdomains.
Methods This retrospective cohort study was conducted at the Rhinology Clinic in a Tertiary University Hospital. Patients who visit our Rhinology Clinic routinely complete the SNOT-22, a widely employed questionnaire designed for evaluating health-related quality of life in individuals with rhinologic conditions.
Patients were divided into two groups: 5 weeks before the October 7 terror attack and 5 weeks after. Primary outcomes for analyses included the Sedaghat Subdomain model of the SNOT-22. Descriptive analysis and Welchs t-test were used to compare SNOT-22 subdomain scores between groups.
ResultsA total of 159 patients completed the SNOT-22 questionnaire, with 60 before and 99 after October 7, 2023. A general decrease in average scores was observed across all subdomains, with a significant decrease in the Nasal subdomain (p = 0.0388). Subgroup analysis showed an increase in the Ear/Facial subdomain in Arabic and the Sleep and Function subdomains in English, though not statistically significant. In sex-based sub-analysis, female patients showed a significant decrease in the Emotions subdomain.
Conclusion Our study was unable to establish a direct link between the terror attack and specific SNOT-22 subdomains. However, the observed trends suggest that SNOT-22 may display variability or unreliability when used during periods of high stress.
Level of EvidenceIII Laryngoscope, 2024
Witsanu Jullamusi, Narin Ratanaprasert, Warut Pongsapich, Navarat Kasemsuk
Publication date 26-10-2024
This systematic review and meta-analysis considered 13 studies with 1504 participants. Preoperative calcium and vitamin D supplementation in patients who underwent total thyroidectomy results in reduction of postoperative symptomatic hypocalcemia.
Objectives The objective of this systematic review and meta-analysis was to assess the role of preoperative calcium and vitamin D supplementation in patients who underwent total thyroidectomy.
Data Sources The search for randomized controlled trials was performed in the OVID Medline and Embase databases.
Review Methods The last search was made on September 16, 2024. Three independent reviewers evaluated full-text articles from relevant reports based on eligibility criteria. The quality of the included studies was assessed by two reviewers according to the ROB 2 tool.
Results This systematic review and meta-analysis considered 13 studies with 1504 participants. There were positive results in treatment outcomes including the mean postoperative calcium level (MD, 0.30 mg/dL: 95% CI, 0.15 to 0.44); the 48 h of postoperative hypocalcemia (OR, 0.41; 95% CI, 0.27 to 0.62); the postoperative symptomatic hypocalcemia (OR, 0.38; 95% CI, 0.24 to 0.62); the IV calcium supplementation (OR, 0.32; 95% CI, 0.18 to 0.58); and length of hospital stays (MD, −0.29; 95% CI, −0.51 to −0.07) as compared to the control group. Readmission rates showed no significant differences between the groups (OR, 0.15; 95% CI, 0.01 to 3.08).
Conclusions Preoperative calcium and vitamin D supplementation in patients who underwent total thyroidectomy results in reduction of postoperative symptomatic hypocalcemia. The finding is critical because it offers a feasible and effective solution that could improve patient care while potentially reducing the burden of numerous blood tests during the postoperative period.
Registration This systematic review protocol was registered with PROSPERO (registration number CRD42021278859).
Level of Evidence Level 1 Laryngoscope, 2024
Jie Lily Huang, Hesham Khalid, Krizzia Angelaine Biaco Alvaran, Shiying Hey, Natalie Watson, Yakubu Karagama
Publication date 26-10-2024
Setting up a laryngology in-office procedure clinic within the NHS confers patient, organizational, and economic benefits. Waiting lists in the United Kingdom are currently of a political and public health concern. This article details a novel and resilient approach in addressing the growing backlog of patients awaiting laryngology care.
Objectives Laryngology disease burden is growing while theater capacity is falling. Over half a million patients are waiting for ENT care in England alone (1). The demand for laryngology services has continued to grow significantly, particularly post-COVID (2). Meanwhile, the number and efficiency of ENT theater lists are reduced (3).
To tackle the growing backlog, NHS England has emphasized the need for innovative strategies by separating elective from emergency services and by increasing the resilience of elective delivery (4). The establishment of an office-based laryngology procedure clinic is a potential solution.
Methods We offer a narrative review and audit of our experience in founding an in-office laryngology procedure service within a tertiary NHS center with the aim of streamlining this setup process for other interested ENT units.
Results We outline an in-depth exploration of the personnel, equipment, and processes necessary to establish an in-office procedure clinic.
Our experience showed that the procedure clinic functions well when implemented within the framework of existing ENT elective and emergency services.
Although there is initial investment required in terms of money, effort, and time, our outcomes show that the clinical and economic benefits of the clinic outweigh the costs, also allowing for patients to access investigations and treatments reliably and efficiently.
Conclusion Setting up a laryngology in-office procedure clinic within the NHS confers patient, organizational, and economic benefits. It provides a novel and resilient approach in addressing the growing backlog of patients awaiting laryngology care and should be popularized in the current health care environment.
Level of Evidence Level 4 Laryngoscope, 2024
Julio A. de Leon, David J. Cvancara, Abbey L. Carlson, Alice Cheng, Zain H. Rizvi, J.P. Giliberto, Cara Sauder, Neel K. Bhatt
Publication date 26-10-2024
Age-related vocal atrophy (ARVA) significantly impacts quality of life (QOL). This study assessed health utility in ARVA patients using standard gamble, time trade-off, and visual analog scale. Results highlight ARVAs severe impact on QOL, comparable to monocular blindness, emphasizing the need for further research and therapeutic development.
Objective Age-related vocal atrophy (ARVA) negatively impacts voice and quality of life (QOL). This study aims to determine utility-based QOL in ARVA patients, correlate findings with traditional patient-reported outcome measures (PROMs), and generate utility-based inferences.
Methods Forty ARVA patients were prospectively recruited from a tertiary care center. Health utility was measured using standard gamble, time trade-off, and visual analog scale, assessing participants current health states relative to defined comparison states (blindness/death). Traditional PROMs (Voice Handicap Index-10 VHI-10 and Voice-Related Quality of Life Scale V-RQOL) were also collected. Descriptive and paired statistics were performed to determine health utility, and Pearson correlation assessed the association between PROMs and health utilities.
Results Mean health utility in ARVA was 0.84 ± 0.22, 0.88 ± 0.17, and 0.62 ± 0.25 using standard gamble, time trade-off, and visual analog scale, respectively. There were positive correlations between V-RQOL and time trade-off (r = 0.66; p < 0.0001) as well as with standard gamble (r = 0.47; p = 0.002). Participants with ARVA reported no difference in health utility impact between their voice impairment and monocular blindness (Mean dif 10.9; 95% CI –1.6, 23.5; p = 0.101). Patients with ARVA were willing to part with an average 4.6 ± 6.1 years of life to restore normal voice.
ConclusionsARVA patients view their voice impairment as a significant health decrement, comparable to monocular blindness. These findings underscore the substantial impact of ARVA on QOL and highlight the need for continued research and new therapies.
Level of Evidence4 Laryngoscope, 2024
Benjamin M. Laitman, Rachel Kominsky, Jill Gregory, Peak Woo
Publication date 23-10-2024
Expansion laryngoplasty is a new, combined procedure which can treat both glottic and subglottic stenosis simulataneously. This is a small case series showing how to perform this surgery as well as outcomes from a 15-year period. Laryngoscope, 2024
Pubmed PDF WebTing‐Chia Young, Wen‐Hsiu Wang, Chia‐Huei Chu, Hung‐Ching Lin, Pey‐Yu Chen
Publication date 23-10-2024
Autoimmune inner ear disease (AIED) is characterized by rapid progressive, bilateral asymmetric sensorineural hearing loss (SNHL) and fluctuating hearing levels. Concomitant autoimmune systemic diseases are not uncommon, with rare instances manifesting as a paraneoplastic syndrome. We describe a case of AIED secondary to paraneoplastic syndrome of diffuse large B cell lymphoma (DLBCL).
Autoimmune inner ear disease (AIED) is an uncommon cause of fluctuating sensorineural hearing loss (SNHL), which is diagnosed by exclusion and required a high index of suspicion. Secondary AIED, which accompanies other autoimmune diseases, occurs in up to 30% of AIED cases. Secondary AIED is a rare manifestation of paraneoplastic syndrome, and the causal malignancy may be occult initially. Detecting and treating associated diseases, along with the use of immunosuppressants, are the mainstay for the management of AIED.
Herein, we presented a woman with bilateral fluctuating and progressive SNHL, partially responding to steroid or immunosuppressant treatment. Her hearing eventually stabilized after completing the treatment for diffuse large B cell lymphoma, which was diagnosed 6 months after the onset of hearing loss. This case serves as a reminder to physicians to be aware of AIED in cases of fluctuating SNHL and the possibility of associated malignancy alongside autoimmune disturbance. Laryngoscope, 2024
Kenya Kobayashi, Yuki Saito, Shimpei Miyamoto, Satoru Miyawaki, Yusuke Ito, Koji Yamamura, Kenji Kondo
Publication date 23-10-2024
The positional stability of the inner canthus is mainly provided by the anterior limb of the medial palpable ligament (MPL). Proper repair of the anterior limb of the MPL is extremely important to prevent postoperative canthus malposition. This video presents proven techniques and technical tips for MPL management in medial maxillectomy via a lateral rhinotomy. Laryngoscope, 2024
Pubmed PDF WebNeil K. Osafo, Jonathan M. Bock, Joel H. Blumin, Jazzmyne A. Adams, David Friedland, Jake Luo
Publication date 23-10-2024
We sought to determine the correlation between social determinants of health (SDOH) and reflux care patterns at our tertiary academic facility. We found that SDOH correlates with the patterns of reflux evaluation and management at our tertiary care center.
Objectives To assess the correlation of social determinants of health (SDOH) with the general care patterns related to gastroesophageal reflux disease and laryngopharyngeal reflux. Determine correlation of SDOH on utilization rates for medication, reflux testing and surgical intervention for patients diagnosed with reflux. Describe overall care patterns for gastroesophageal reflux disease care at a tertiary academic facility.
Study Design Retrospective chart review.
Methods Patient demographics (age, sex, race, ethnicity, and insurance status) were extracted for adults diagnosed with reflux between 2009 and 2019. Odds ratios (ORs) for the associations between sociodemographic factors and reflux treatment pathways were determined by chi-square analyses.
ResultsA total of 143,786 patients were evaluated during the study period with a diagnosis code of reflux. A subgroup of 40,754 patients had objective reflux testing including Bravo, dual pH-impedance, manometry, esophagogastroduodenoscopy (EGD) and esophagram, but no significant difference in utilization rates was found. A total of 239 patients who failed medical management underwent fundoplication. White (OR 2.43, 95% confidence interval CI 1.56–3.70) and female (OR 1.37, 95% CI 1.05–1.79) patients were more likely to undergo fundoplication than Black (OR 0.42, 95% CI 0.25–0.70) and male (OR 0.72, 95% CI 0.55–0.95) patients. Patients with private insurance (OR 1.58, 95% CI 1.23–2.04) were more likely to undergo fundoplication than those with public insurance (OR 0.65, 95% CI 0.50–0.84). Male patients were less likely to undergo fundoplication (OR 0.69, 95% CI 0.49–0.98) among patients evaluated for reflux with EGD.
ConclusionsSDOH correlate with patterns of reflux evaluation and management at our tertiary care center.
Level of EvidenceIV Laryngoscope, 2024
Aristides Sismanis, Daniel Coelho
Publication date 23-10-2024
Objectives To determine the yield of a comprehensive diagnostic algorithm for patients with pulsatile tinnitus (PT) and to review the common etiologies and present clinical pears for their diagnosis.
Methods Retrospective chart review of patients with PT from 2013 to 2023. Charts were reviewed for demographic data (age, sex, BMI), side of PT (or bilateral), specialty clinic of initial evaluation, coexistent symptoms in addition to PT, and final diagnosis (or non-diagnosis). Clinical, audiometric, laboratory, and radiographic data were collected. Putative chart diagnoses were reviewed by the authors and deemed likely or unlikely to be the source of the patients PT. Those with “unlikely” were grouped in the “idiopathic” cohort. The diagnostic algorithm is presented in detail.
Results Two hundred and 90 patients were included for analysis. The overall diagnostic yield was 90.7% for all patients and 95.6% for those patients who completed the recommended workup – a substantial improvement over published rates. Twenty-nine etiologies were identified with the most common etiology was idiopathic intracranial hypertension (IIH). Twenty-one diagnoses comprised no more than 5% of patients. Seventy-three patients (25.2%) had more than one pathology as a potential source for their PT.
ConclusionsPT can present a diagnostic challenge to the clinician. The findings of this study, however, reveal that proper evaluation based on obtaining a thorough history, performing a physical examination, coupled with properly directed imaging studies and blood testing can accomplish a high diagnostic yield of at least one potential etiology.
Level of Evidence4 Laryngoscope, 2024
Shir Keren, Itai Hazan, Omer J. Ungar, Chilaf Peled, Yoav Gimmon, Ismael Abu Freh, Benyamin Kaminer, Daniel M. Kaplan, Oren Ziv
Publication date 22-10-2024
In this prospective cohort study, we found a significant association between sleep deprivation and the decrease in the VOR gain examined in the lateral semicircular canal, suggesting that the vestibular function might be influenced by sleep deprivation.
Objective To investigate the association between sleep deprivation and vestibular dysfunction by Video Head Impulse Test (vHIT).
Methods This prospective clinical trial explores the impact of acute sleep deprivation on the vestibular-ocular reflex (VOR) in medical residents. The study involved healthy physicians from diverse medical disciplines. Participants underwent vHIT assessments before and after a 26-h shift. The examinations focused solely on the right lateral semicircular canal. Participants further completed a demographics and fatigue questionnaire, including the Fatigue Severity Scale (FSS) questionnaire and a Visual Analog Fatigue Score (VAFS).
Results The study involved 30 medical residents. Participants experienced a statistically significant decrease in VOR gain in the right horizontal semicircular canal during a 26-h shift (p < 0.01). While the FSS and VAFS questionnaires showed no significant difference before and after the shift, the analysis of ∆VOR gain indicated a statistically significant increase associated with decreased sleep time during the shift (p = 0.018, 95% Confidence Interval 0.08, 0.68). The most substantial increase in ∆VOR occurred between 22–26 h of sleep deprivation. No significant differences were observed in ∆VOR between genders, ages, disciplines, department shifts versus emergency room shifts, or years of residency.
ConclusionvHIT can be used as an objective, reliable screening tool for severe sleep deprivation among physicians. The decrease in the VOR gain may indicate that vestibular function is influenced by sleep deprivation. The clinical significance of these findings is still questioned, more studies may help to assess this effect.
Level of Evidence3 Laryngoscope, 2024